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Abstracts from the 17th National Congress of the Italian Society of Cardiovascular Prevention (SIPREC), Naples, 21–23 March 2019

Abstracts

1 01. RV SPECKLE TRACKING ANALYSIS IN RENAL TRANSPLANT RECIPIENTS AFTER 12 MONTHS OF UNSUPERVISED EXERCISE TRAINING

1.1 Laura Stefani, Beatrice Leone, Elena Zappelli, Pietro Amedeo Modesti, Giorgio Galanti

1.1.1 Sports Medicine Center, University of Florence, Florence, Italy

Introduction: RV function is strongly associated with clinical outcomes in the population at high cardiovascular risk. The RV chamber has been largely studied especially in the cardiopulmonary disease as predictive aspect for a reduced exercise capacity. More recently particularly deformation parameters as Speckle tracking echocardiography (STE) is applied as imaging technique for an accurate evaluation. Renal Transplant Recipient (RTR) is the new category involved in the physical activity program despite the high CV risk.

Aim: To assess the global RV function in the RTR regularly submitted to physical activity (PA) at moderate intensity for 1 year.

Methods: A group of 50 RTR, aged 50 ± 5, was trained for 1 year following a mixed exercise program 30 subjects with a high quality of image and trained for at least 3 times a week, were followed by echocardiographic exam every 6 months. They were investigated by 2D RV standard parameters and strain analysis by X-Strain software with the measurement of the Free Wall (FW) of the RV at T0, T6, and T12 months.

Results: RTR had at initial phase, low values of RVFW strain with respect of the normal range and vs to the HC; The RVFW strain was found significantly (P < 0.01) increased at the end of the exercise program, restoring the normal range. The RV diastolic function maintained normal with a significant (p < 0.05) and progressive adjustment of the E/A ratio in RTR only. No significant variations in controls.

Conclusions: One year of moderate intensity of unsupervised physical exercise improves the RV chamber performance. The investigation of both of the systolic and diastolic parameters and by the strain analysis can contribute to a correct follow-up in RTR patients. This approach could be proposed especially in the absence of clinically evident symptoms and during physical exercise program. More data will be necessary in future to support this hypothesis.

2 02. A RETROSPECTIVE ANALYSIS OF VPBS IN TRAINED BICUSPID AORTIC VALVE ATHLETES

2.1 Laura Stefani, Matteo Donadei, Lorenzo Casatori, Giorgio Galanti

2.1.1 Sports Medicine Center, University of Florence, Florence, Italy; FMSI–Italian Sports Medicine Federation, Italy

Introduction: Bicuspid aortic valve (BAV) represents a common congenital cardiac disease (1–2%) normally compatible with sports activity. In case of competitive sports, the eligibility can be otherwise limited by presence of symptoms, aortic valve dysfunction or arrhythmias.

Aim: To verify, in a large cohort of BAV athletes, the prevalence of VPBs found in the maximal exercise test (ET) at the first sports medicine clinical evaluation.

Methods: A sample of 356 BAV athletes, regularly followed at Sports Medicine Center of the University of Florence, since 10 years, was retrospectively evaluated for arrhythmic events found at the first sports medicine check-up. The athletes (321 M and 35 F) were in the range of 8–50 years old (medium 24.00 ± 14.14) and practiced sports at high cardiovascular impact (predominantly soccer, basketball and track and field). Inclusion criteria were to undergo to a 2D echocardiography and ET conducted at 85% of their maximal effort. Ventricular arrhythmic events (VPBs) were reported if they were ≥ 3 at rest and/or during the test. Exclusion criteria were age > 50 years and the presence of any other cardiac or systemic structural diseases. They were matched with a control group of 400 athletes (age 19.70 ± 9.7) without BAV and similarly trained.

Results: Only 25 (7.02%) showed VPBs at the ET. The total amount was 403 single VPBs and 4 monomorphic couple; a polymorphic pattern was present in only 3 athletes and only 5 have induced-exercise VPBs at peak. None of them showed acute events or had major arrhythmias. The difference of the VPBs prevalence in BAV athletes vs control subjects (VPBs 6.25%) was not significant (p > 0.05).

Conclusions: Prevalence of VPBs is low in BAV athletes and it seems to be not different from athletes without BAV. In case of sports eligibility, the BAV should not be considered as a cause of risk of major arrhythmic events. More data in this field could optimize the cost/effective ratio for the eventual ECG Holter indications.

3 03. ADHERENCE TO THE MEDITERRANEAN DIET AMONG SOLID ORGAN TRANSPLANT RECIPIENTS UNDER PRESCRIPTION FOR PHYSICAL EXERCISE: ANALYSIS OF CLINICAL CASES

3.1 Orlando Nardone1, Francesco Sofi2, Giorgio Galanti1, Laura Stefani1

3.1.1 1Sports Medicine Center, 2Department of Experimental and Clinical Medicine, University of Florence Florence, Italy; 2Department of Experimental and Clinical Medicine, Unit of Clinical Nutrition, University of Florence, Florence, Italy

Introduction: Aerobic and resistance exercises have been promoted recently to improve quality of life in transplant patients and to reduce cardiovascular risk factors. Today most transplant survivorship rehabilitation programs consists of unsupervised exercise programs. Therefore, the Mediterranean diet has long been associated with lower incidence of cardiovascular disease.

Aim: To investigate the effect of dietitian involvement and unsupervised individualized physical activity in a multidisciplinary lifestyle intervention.

Methods: This is an open, randomized, controlled, parallel clinical trial. Twenty patients with renal transplant recipients and liver transplant recipients were recruited at the Department of Sports and Exercise of the Careggi University Hospital, Florence. The patients were divided in two group: 10 renal transplant recipients and 10 liver transplants. They were enrolled for 3 months of unsupervised exercise prescription programs and dietetic advice. A complete evaluation was performed in terms of body composition, physical performance, myocardial conditions and adherence to the Mediterranean diet using a specific diet score.

Results: Significant improvements were observed: BMI − 0.15 (from 23.45 to 23.30), weight − 0.35 (from 69.50 to 69.150), waist circumference − 0.7 (from 92.40), FFM + 2.07 (from 52.210 to 54.280), FM − 0.89 (from 15.44 to 14.55), Hand grip dx + 3.3 (from 33.2 to 37.2), Hand grip sx + 1 (from 36.3 to 37.3). Adherence to the Mediterranean diet, determined with ADM score, was increased by 1 point (from 31.6 to 32.6); determined with MEDI-LITE score by 0.2 (from 11.5 to 11.7).

Conclusion: Individually prescribed home-based exercise programs were cost effective, safe and resulted in modest improvements in body composition and total body water distribution with little to no adverse effect on cardiac function. Dietary advice can contribute to healthier eating habits and a trend for weight loss. These improvements, in conjunction with multidisciplinary care and pharmacological treatment can lead to improvements in cardiovascular risk factors.

4 04. MALIGNANT VENTRICULAR ARRHYTHMIAS ENSUING FROM DRUG-INDUCED QTC PROLONGATION. A RETROSPECTIVE STUDY

4.1 Renato De Vecchis1, Carmelina Ariano1, Adelaide Fusco2

4.1.1 1Preventive Cardiology and Rehabilitation Unit, Dsb 29 “S. Gennaro Dei Poveri Hospital”, Napoli, Italy; 2Institute Of Cardiology, University Of Campania“Luigi Vanvitelli“, Monaldi Hospital, Napoli, Italy

Introduction: Several drug classes (antiarrhythmics, antimicrobials, antidepressants, phenothiazines, opiates, prokinetics of digestive tract, etc.) have been related to ventricular hyperkinetic arrhythmias such as torsade de pointes (TdP). TdPs are usually heralded by an abnormal prolongation of heart rate-corrected QT interval on the electrocardiogram, so-called drug -induced long heart rate-corrected QT (diLQTc).

Aim: We don’t know to what extent the drug induced QTc prolongation is able to predict malignant arrhythmias. Thus, we have retrospectively examined the clinical history of patients with diLQTc.

Methods: The case-record, concerning the period January 2008–December 2017, was collected from two hospitals. diLQTc was defined as drug-induced heart rate-corrected QT of ≥ 450 ms or ≥ 470 ms, respectively in male or female patients. The primary purpose was to verify whether in diLQTc patients the length of this electrocardiographic segment was associated with the risk of symptoms or events (TdP, ventricular fibrillation).

Results: 73 validated cases of diLQTc were gathered. Among them, the QTc duration was not able to predict the occurrence of symptoms or events (odds ratio: 0.998; 95% CI 0.984–1.013; p = 0.8821). Likewise, a diQTc lasting longer than 500 ms compared to diQTc comprised between 450 and 500 ms was not associated with an increased risk of arrhythmic events.

Conclusions: In our diLQTc patients, QTc duration did not predict occurrence of symptoms, or arrhythmic events. Thus, other determinants should be postulated to clarify why sometimes diQTc prolongation propitiates ventricular malignant arrhythmias whereas in other cases this arrhythmogenic effect is lacking.

5 05. SERUM MAGNESIUM LEVELS AND PREVIOUS IMA ASSOCIATION IN A HOSPITALIZED TYPE 2 DIABETIC POPULATION

5.1 Adriano Gatti1, Flora Gatti2

5.1.1 1Department of Metabolic Disease, ASL Napoli 1 Centro, Naples, Italy; 2Department of Human Studies, University of Naples Federico II, Naples, Italy

Aim: To clarify the association between serum magnesium levels and CV risk in a hospitalized type 2 diabetic population (T2D).

Methods: Retrospective observational cohort study on 735 type 2 diabetics examined twice, within an average interval of 5.71 ± 2.45 years. In all patients, the presence of a documented previous acute myocardial event has been highlighted or excluded.

Results: Patients with previous IMA had lower levels of serum magnesium (OR = 4.73; IC = 2.529–8.851; p < 0.001).

Conclusions: Hypomagnesemia is significantly associated with the previous cardiovascular event. We can therefore state that, however determined, the presence of low levels of magnesium in the diabetic patient coincides with the presence of a previous CV event and therefore with a higher CV risk. These results were observed at the first observation and then confirmed at the second admission.

6 06. HYPERURICEMIA AND ISCHEMIC HEART DISEASE: CAUSE AND EFFECT OR SIMPLE COEXISTENCE

6.1 Adriano Gatti1, Flora Gatti2

6.1.1 1Department of Metabolic Disease, ASL Napoli 1 Centro, Naples, Italy; 2Department of Human Studies, University of Naples Federico II, Naples, Italy

Aim: To verify the association between hyperuricemia and ischemic heart disease in a population of type 2 diabetics, hypothesizing that greater cardiovascular morbidity and mortality may be triggered by increased values of uricemia, which reduce NO and increase endothelial dysfunction.

Methods: Retrospectively, we reviewed the medical records of type 2 diabetic patients hospitalized in the last 10 years in our Department of Metabolism Diseases. The population were subjected to anamnestic collection, paying attention to previous documented ischemic events.

Results: The results highlight how, given the same age, the same years of diabetic disease and the same parameters of glico-metabolic compensation at the time of admission, the presence of hyperuricemia was associated with the cardiovascular risk (OR = 1.76; IC: 1.408–2.196, p < 0.0001). Khosla et al. have already shown how chronic hyperuricemia interferes with nitric oxide (NO) metabolism, resulting in endothelial dysfunction, and it reduces endothelial-mediated vasodilation.

Conclusions: According to the EULAR recommendations, it is appropriate to reach the uricemia target (< 6 mg/dl). This result is associated with beneficial effects on the control of cardiovascular risk factors and on the development of cardiac, vascular and renal damage. In our observation, we believe that the target value should be revised downwards in diabetic subjects, by intervening early on the verification of values of 5.6 mg/dl of uric acid value that in our population has been the cut-off due to the simultaneous presence of ischemic heart disease.

7 07. FORMAL AND INFORMAL CARE AFTER STROKE: A MULTICENTRIC LONGITUDINAL STUDY

7.1 Gianluca Pucciarelli1, Silvio Simeone2, Davide Ausili3, Paola Rebora4, Maeregu Woldeyes Arisido5, Rosaria Alvaro6, Ercole Vellone7

7.1.1 1RN, MSN, PhD, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; 2RN, MSN, PhD, Department of Cardiology, Policlinico Federico II, Naples, Italy; 3RN, MSN, PhD, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; 4PhD, Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery; University of Milano-Bicocca, Milan, Italy; 5PhD, Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery; University of Milano-Bicocca, Milan, Italy; 6MSN, FESC, Professor, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; 7PhD, RN, FESC Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

Introduction: Although several studies have been conducted on stroke survivors during the post-rehabilitation discharge period, very few studies have focused on the formal and informal care received by stroke survivors during the first year after home discharge.

Aims: To describe the type and the amount of formal and informal care received by stroke survivors during the first year after home discharge and to identify the baseline predictors.

Methods: A 12-months longitudinal study was adopted. The linear mixed effects model was also used to identify the baseline predictors of formal and informal caregiving needs.

Results: A sample of 415 stroke survivors was enrolled. Survivors were 70.6 years old and predominantly male at 52.7%. Regarding formal care, physiotherapy and speech therapy decreased significantly over time, but nursing care and occupational therapy remained stable. Regards paid informal care, stroke survivors received a mean of 17 h of paid informal care per week and these hours did not significantly decrease after one year from discharge. Higher numbers of paid informal caregiving hours per week were predicted by older age, higher education levels, lower BI scores and living without unpaid informal caregivers. Indeed, higher numbers of unpaid informal care hours per week were predicted by lower BI scores and living with unpaid informal caregivers.

Conclusions: Especially during the first few months after rehabilitation hospital discharge, survivors need further care, both nursing and physiotherapy, because they are often discharged before achieving independent functioning.

8 08. THE LIVED EXPERIENCES OF WOMEN ABOUT SEXUAL HEALTH AFTER ACUTE MYOCARDIAL INFARCTION

8.1 Silvio Simeone1, Assunta Guillari2, Gianluca Pucciarelli1, Filomena Stile3, Gianpaolo Gargiulo4, Nicola Serra5, Maria RosariaEsposito6, Teresa Rea2

8.1.1 1PhD, Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; 2PhD, RN, Department of Public Health, University Federico II of Naples, Naples, Italy; 3Midwife, Presidio Ospedaliero Valle d’Itria-Martina Franca, Taranto, Italy; 4MNS, RN, Department of Public Health, University Federico II of Naples, Naples, Italy; 5Dr, Department of Public Health, University Federico II of Naples, Naples, Italy; 6PhD, MNS, RN, Istituto Nazionale Tumori Fondazione “G. Pascale” Naples, Naples, Italy

Introduction: The quality of life of subjects who survived to acute myocardial infarction (AMI) is evaluated through the perception of their sexual life too. Contrary to recommendation write in international guidelines, this aspect is often overlooked, in fact patients who had suffered a AMI and their healthcare professionals do not appear to give proper attention to this aspect. After a heart attack resume to a normal sexual activity reduces anxiety, stress, depression and can improve quality of life. The doubts and fears that arise in patients after a myocardial infarction prevent proper recovery of sexual activity; often, these fears are unfounded and quickly disappear, but their presence puts the patient and partner’s relationship and also their quality of life at risk.

Aim: The aim of the study was to understand the experience of the sexual health of Italian women one year after acute myocardial infarction.

Methods: Phenomenology by Cohen.

Results: “Fear of recurrence of infarction”, “stress” and “the need to receive spontaneous information” are the main themes emerged from our analysis of interviews.

Conclusions: Sexuality for myocardial infarction’s survivors is an important aspect of one’s health and quality of life. Understanding the lived experience about it in the health of women must stimulate careful consideration in all health workers and encourage rehabilitation programs that do not neglect this aspect.

9 09. RECLASSIFICATION OF HYPERTENSION BY THE NEW AMERICAN ACADEMY OF PEDIATRICS GUIDELINES IDENTIFIES OBESE YOUTH AT HIGHER CARDIOVASCULAR RISK COMPARED TO THE EUROPEAN SOCIETY OF HYPERTENSION CRITERIA

9.1 Procolo Di Bonito, MD1, Lucia Pacifico, MD2, Claudio Chiesa, MD3, Cecilia Invitti, MD4, Claudio Maffeis, MD5, Maria Rosaria Licenziati, MD6, Melania Manco, MD7, Emanuele Miraglia del Giudice, MD8, Marco Giorgio Baroni, MD9, Giuliana Valerio, MD10, for the CARITALY Study group

9.1.1 1Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples; 2Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy; 3Institute of Translational Pharmacology, National Research Council, Rome; 4IRCCS Istituto Auxologico Italiano, Department of Medical Sciences & Rehabilitation, Milan; 5Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona; 6Department of Pediatrics, AORN Santobono-Pausilipon, Naples; 7IRCCS Bambino Gesù Children’s Hospital, Rome; 8Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples; 9Department of Experimental Medicine, Sapienza University of Rome, Rome; 10Department of Movement and Wellbeing Sciences, University of Naples Parthenope, Naples, Italy

Introduction: The main reference systems for diagnosis of hypertension (HTN) in children are the guidelines of American Academy of Pediatrics (AAP) 2017 and the European Society for Hypertension (ESH) 2016. The two systems differ in the lowered cut-offs proposed by the AAP with respect to ESH.

Aim: To evaluate whether reclassification of HTN by the AAP criteria would identify overweight/obese (OW/OB) youth at higher cardiometabolic risk compared to the ESH criteria.

Methods: A sample of 4029 OW/OB youth (6–18 years) defined non hypertensive by ESH (ESH) has been evaluated. Echocardiographic data were available in 382 youth.

Results: Using the AAP criteria, 627/4029 (16%) youth were reclassified as hypertensive (ESH/AAP+). They showed older age, higher BMI, waist-to-height ratio (WhtR), HOMA-IR, BP (p < 0.0001), and LVM index (g/h2.16) (P < 0.05) as compared to ESH. The young people ESH-/AAP+ showed higher prevalence of visceral adiposity (WhtR ≥ 0.65), insulin-resistance (HOMA-IR ≥ 97.5th percentile in normal weight) and LV hypertrophy (LVH) (LVMi ≥ 45 g/h2.16) as compared to ESH. The odds ratio (95% CI) adjusted for confounders, was 1.47 (1.17–1.85) (p = 0.001) for high WhtR, 1.22 (1.02–1.48) (p = 0.037) for insulin-resistance and 2.21 (1.07–4.55) (p = 0.032) for LVH in ESH/AAP+ youth vs ESH, respectively.

Conclusions: In young people with OW/OB who were classified as ESH-, the reclassification by AAP identified a significant number of youth at high cardiovascular risk, who would have been lost in the screening. Our data support the need of revision of the ESH criteria and suggest the adoption of the AAP guidelines also in the European countries.

YOUNG INVESTIGATORS

10 01. CONCORDANCE BETWEEN THE WCRF RECOMMENDATIONS AND REDUCED GLOBAL CARDIOVASCULAR RISK IN A COHORT OF SURVIVED BREAST CANCER PATIENTS

10.1 Laura Stefani, Simone Magro, Orlando Nardone, Maria Alberta Palano, Pietro Amedeo Modesti, Giorgio Galanti

10.1.1 Sports Medicine Center, University of Florence, Florence, Italy

Introduction: Body weight control through proper diet management following World Cancer Research Fund recommendations (WCRF) and physical activity play a role in reducing neoplastic risk and improving quality of life.

Aim: To evaluate the concordance between the WCRF recommendations, updated to 2017, and the improvement of anthropometric and physical parameters in a cohort of patients with previous stable breast neoplasia, without signs of co-morbidity and in complete remission of neoplastic disease, in Italy.

Methods: This is an open, randomized, controlled, parallel clinical trial. Twenty-one patients with previous breast cancer were recruited at the Department of Sports Medicine and Exercise of the Careggi University Hospital, Florence. The patients were divided into two groups (GN1 and GN2). They were submitted to two evaluations in a week: in the first a complete evaluation was performed in terms of body composition, physical performance, myocardial conditions and adherence to the Mediterranean diet. In the end, a weekly food diary was delivered to understand patient habits. In the second visit, after the completion of the completed diary, an in-depth analysis on nutrition was carried out. Lifestyle and nutrition were corrected for GN1 using WCRF recommendations; instead, general and standardized food councils have been delivered to GN2. The follow-up was two months for patients of both groups, in which all anthropometric, physical and dietary measures were repeated.

Results: Significant improvements were observed in GN1 for the following anthropometric parameters: BMI − 0.4 (from 28.6 to 28.2; 95% CI), weight − 1.0 kg (from 72.7 to 71.7; 95% CI), waist circumference − 1.7 cm (from 93.5 to 91.8; 95% CI) and hip circumference − 1.3 cm (from 104.9 to 103.6; 99% CI). Adherence to the Mediterranean diet, determined with the MEDI-LITE score, was increased by 1 point (from 14 to 15; 99% CI). Finally, significant improvements were identified for the amount of weekly physical activity, equal to 35 min (from 173 to 208; 99% CI) and for strength of the lower body, determined with the Chair Test, equal to 2 repetitions (from 17 to 19; 95% CI).

Conclusions: The study suggests that the following WCRF recommendations could significantly improve most of the anthropometric and physical parameters among female breast cancer survivors. It can be widely proposed in populations.

11 02. RATE CONTROL STRATEGY BUT NOT TRANSCATHETER ABLATION IMPROVES CLINICAL OUTCOMES IN PATIENTS WITH A HISTORY OF ATRIAL FIBRILLATION OVER A MEDIAN FOLLOW-UP OF 20 MONTHS: RESULTS FROM A RETROSPECTIVE COHORT STUDY

11.1 Adelaide Fusco1, Renato De Vecchis2, Carmelina Ariano2

11.1.1 1Institute of Cardiology, University Of Campania “Luigi Vanvitelli”, Monaldi Hospital, Napoli, Italy; 2Preventive Cardiology And Rehabilitation Unit, Dsb 29 “S. Gennaro Dei Poveri Hospital”, Napoli, Italy

Introduction: In the rhythm control strategy, secondary prevention of atrial fibrillation (AF) is carried out with Vaughan–Williams class IA, IC and III drugs. Instead, in the rate control strategy patients are allowed to remain in AF, provided that they are treated with drugs having depressive action on the AV node conduction.

Methods: A cohort retrospective study was designed to compare three groups of AF patients, treated either with transcatheter ablation (Abl), or rate control or rhythm control strategies. A composite of death, disabling stroke, severe bleeding and cardiac arrest was the primary endpoint.

Results: 175 AF patients were considered over a 20-month follow-up (interquartile range = 14–24 months). An increased risk of the primary endpoint was associated with the rhythm control strategy (hazard ratio [HR]: 3.3159; 95% CI 1.5415–7.1329; p = 0.0023) and with AF recurrences during the follow-up (HR: 1.0448; 95% CI 1.0020–1.0895; p = 0.0410). Conversely, a significantly decreased risk of the primary endpoint was associated with the rate control strategy (HR: 0.0711; 95% CI 0.0135–0.3738; p = 0.0019). Abl was not a significant predictor of the primary endpoint.

Conclusions: Abl does not provide a significant improvement of the composite of death, disabling stroke, severe bleeding and cardiac arrest unlike rate control strategy.

12 03. EFFECTS OF DRONEDARONE ON ALL-CAUSE MORTALITY AND ON CARDIOVASCULAR EVENTS IN PATIENTS TREATED FOR ATRIAL FIBRILLATION. A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

12.1 Adelaide Fusco1, Renato De Vecchis2, Carmelina Ariano2

12.1.1 1Institute Of Cardiology, University Of Campania “Luigi Vanvitelli”, Monaldi Hospital, Napoli, Italy; 2Preventive Cardiology and Rehabilitation Unit, Dsb 29 “S. Gennaro Dei Poveri Hospital”, Napoli, Italy

Introduction: After original entry of dronedarone on the market (2009), some safety concerns have led to limit the dronedarone use to paroxysmal or persistent atrial fibrillation, and to exclude it from therapy or prevention of ventricular tachyarrhythmias.

Aim: To explore some efficacy and safety endpoints concerning dronedarone, by analyzing the evidence derived from quantitative evaluation (meta-analysis) of literature data.

Methods: We comprised in the meta-analysis exclusively randomized controlled trials (RCTs) that reported relevant clinical outcomes with dronedarone. Primary efficacy outcomes were all-cause mortality, major acute cardiovascular events and worsening heart failure. Secondary outcomes of interest were ventricular tachyarrhythmias, stroke and systemic embolism.

Results: Seven studies were recruited on the whole. Dronedarone use was not associated with any significant advantage as regards all-cause mortality (p = 0.31) and major cardiovascular events p = 0.28), as well as regarding the endpoint” worsening heart failure” p = 0.20). Notably, when data from ATHENA study were excluded, dronedarone use was associated with increased all-cause mortality (post exclusion pooled odds ratio = 1.77; p = 0.0089), increased risk of major cardiovascular events (post exclusion pooled odds ratio = 2.16; p = 0.0014) and increased risk of worsening heart failure (post exclusion pooled odds ratio = 1.618; p = 0.006).

Conclusions: Dronedarone did not confer any significant protection against all-cause mortality, major cardiovascular events or worsening heart failure. Moreover, with the sensitivity analyses, exclusion of one study (ATHENA trial) made dronedarone a predictor of worse mortality, of increased cardiovascular morbidity and increased risk of worsening heart failure.

13 04. MELATONIN FOR HYPERTENSIVES WITH NON-DIPPER PROFILE DETECTED BY MEANS OF CONTINUOUS BLOOD PRESSURE MONITORING: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

13.1 Adelaide Fusco1, Carmelina Ariano2, Renato De Vecchis2

13.1.1 1Institute Of Cardiology, University Of Campania“Luigi Vanvitelli“, Monaldi Hospital, Napoli, Italy; 2Preventive Cardiology and Rehabilitation Unit, Dsb 29“S. Gennaro Dei Poveri Hospital”, Napoli, Italy

Introduction: Melatonin is believed to be able to counteract the lack of fall in blood pressure during nighttime sleep.

Aim: To conduct a meta-analysis assessing the effects on nocturnal arterial pressure exerted by melatonin.

Methods: We considered only randomized controlled trials including the use of a continuous blood pressure monitoring system able to detect systolic and diastolic blood pressure during nighttime sleep in patients treated with melatonin and in controls.

Results: Seven studies with 221 participants were pooled in the meta-analysis. Melatonin use was a predictor of significant decrease in nocturnal systolic blood pressure [SBP] (difference in means [MD] = − 5.74 mmHg; 95% CI − 6.07 to − 5.41 mmHg; p < 0.00001). This change was generated by the very steep decrease in nocturnal SBP detected in patients treated with controlled-release(CR) melatonin (MD = − 8.42 mmHg; 95% CI − 8.82 to − 8.02 mmHg; p < 0.00001), whereas the mean change in nocturnal SBP, found in patients taking fast -release (FR)melatonin, was nonsignificant. Even in the case of diastolic blood pressure, the overall antihypertensive effect originated from the pressure reduction caused by CR melatonin (MD = − 3.06 mmHg; 95% CI − 3.99 to − 2.12 mmHg; p < 0.00001), whereas the pressure changes attained by the FR melatonin users compared to placebo were nonsignificant. No major adverse events occurred.

Conclusions: Evening administration of CR melatonin has been shown to induce a significant pressure decrease over the nocturnal sleep. The controlled release melatonin preparations, differently from those with fast release, could find a place in the antihypertensive armamentarium.

14 05. A RETROSPECTIVE ANALYSIS OF VENTRICULAR PREMATURE BEATS IN TRAINED BICUSPID AORTIC VALVE ATHLETES

14.1 Matteo Donadei, Lorenzo Casatori, Laura Stefani, Giorgio Galanti, Pietro Amedeo Modesti

14.1.1 Sports Medicine Center, University of Florence, Italy and FMSI–Italian Sports Medicine Federation, Italy

Introduction: Bicuspid aortic valve (BAV) represents a common congenital cardiac disease. In competitive sports, eligibility can be limited by presence of symptoms, aortic valve dysfunction or arrhythmias.

Aim: To verify the prevalence of VPBs in BAV at maximal exercise test (ET) at first sports medicine clinical evaluation.

Methods: A sample of 356 BAV athletes, followed for 10 years, was retrospectively evaluated for arrhythmic events found at first sports medicine check-up. The athletes (321 M and 35 F, age 24.00 ± 14.14) practiced sports at high cardiovascular impact. Inclusion criteria were to undergo a echocardiography and ET at 85% of their maximal effort. Ventricular premature beats (VPBs) were reported if ≥ 3 at rest and/or during the test. Exclusion criteria were age > 50 years, presence of significant aortic stenosis (transvalvular flow > 3.0 m/s) and any other disease. They were matched with a control group of 400 athletes (age 19.70 ± 9.7).

Results: Only 25 (7.02%) showed VPBs at the ET. The total amount was 403 single VPBs and 4 monomorphic couple; a polymorphic pattern was present in only 3 athletes and only 5 have induced-exercise VPBs at peak. None of them showed acute events or major arrhythmias. The difference of the VPBs prevalence in BAV athletes vs control (6.25%) was not significant.

Conclusions: Prevalence of VPBs in BAV athletes without stenosis is low and seems to be similar to athletes without BAV. In case of sports eligibility BAV should not be considered as a cause of risk of major arrhythmic events.

15 06. LIFESTYLE EVALUATION IN PATIENTS OVER 65 RECOVERED IN A HOSPITAL GERIATRIC DEPARTMENT, PROTECTED DISCHARGE

15.1 Mario Virgilio Papa1, Bievel Radulescu Raluca2 Virgilia Federica Papa3, Stefano De Simone4, Rosa Capriello5

15.1.1 1University Of Medicine Luigi Vanvitelli Naples, Italy; 2University Of Medicine Carol Davila Bucharest, Bucharest, Romania; 3Doctor Psichologist, Naples, Italy; 4Doctor Psichologist Psichotherapy Asl Napoli2, Naples, Italy; 5Doctor Dietetian, Aorn S. Anna E San Sebastiano, Caserta, Italy

Introduction: According to national ISTAT database, over 65 are about 13,672,000, equal to 22.6% of the current population, and are destined to grow (34% by 2050), but have changed a lot compared to their peers of only twenty years ago.

Aim: To propose new lifestyles considering their age and pathologies in order to avoid obesity and sarcopenia.

Methods: It has been proceeded at the time of the admission to an evaluation of the nutritional state with the detection of parameters which body index, dynamometry, test of the path. It was performed after a food survey with the recall of 24 h and a survey on food frequencies. With the help of a psychologist it has been intervened on the smoking habit (7% patients). A specific nutritional path integrated by physical activity is provided to the patients according to individual possibilities calculated together with the techniques of motor rehabilitation.

Results: Of the about 50 enrolled patients, 42 returned constantly every three weeks in the maintaining of the commitment. Approximately 12 patients have replaced the daily walk with pilates or soft exercise classes, 5 patients have opted for ballroom dancing, 3 do yoga. All patients kept the dietary regime assigned to them.

Conclusions: Lifestyle change is possible even in older age especially if adequate specific support is given.

16 07. AORTIC STIFFNESS IS INCREASED IN NORMOTENSIVE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

16.1 Ettore Mancia1, Giuseppe Mule’1, Massimiliano Morreale1, Annalisa Savoja1, Angelo Ferrante2, Claudia Cusimano1, Santina Cottone1

16.1.1 1Unit of Nephrology and Hypertension; ESH Excellence Center; PROMISE; University of Palermo, Palermo, Italy; 2Unit of Rheumatology, DIBIMIS; University of Palermo, Palermo, Italy

Introduction: Patients with systemic lupus erythematosus (SLE) have an increased risk of developing cardiovascular (CV) events. A marker of early vascular aging (EVA) is aortic pulse wave velocity (aPWV) which is a measure of arterial stiffness.

Aim: To evaluate aPWV and the prevalence of EVA in a group of normotensive patients with SLE and to compare these values with those obtained in age- and gender-matched control subjects.

Method: Aortic PWV was measured by a validated oscillometric device (Arteriograph). EVA was identified when the age-adjusted z-score of aPWV exceeded + 1.96 (EVA1). The aPWV z-score was calculated using the ratio “Observed PWV–Predicted PWV/SD Predicted’’ and we obtained the predicted PWV values through regression equation. We adopted another definition of EVA (EVA2) wherein we included individuals with PWV values above the 90th percentile of aPWV distribution.

Results: We enrolled 57 patients with SLE, aged 37.6 ± 11 years (9% men) and 29 healthy controls, aged 37.6 ± 9 years (10% men). Aortic PWV, aPWV z score, prevalence of EVA1 (12.3 vs 0%; p = 0.049) and EVA2 (19.3 vs 0%; p = 0.011) were significantly higher in SLE patients than in controls (Figure 1). The associations of aPWV and of aPWV z score with SLE were confirmed in multivariate models built in the overall study population, after adjustment for age, sex, BMI and mean blood pressure (both p < 0.001).

Conclusions: The impaired aortic distensibility we observed in patients with SLE may help to explain their increased CV risk.

17 08. SERUM URIC ACID IS INCREASED IN NORMOTENSIVE OBESE CHILDREN WITH A PARENTAL HYSTORY OF HYPERTENSION

17.1 Ettore Mancia1, Giuseppe Mulè1, Valentina Cacciatore1, Claudia Cusimano2, Rosanna Roppolo2, Francesca Cardella2, Santina Cottone1

17.1.1 1Unit of Nephrology and Hypertension; ESH Excellence Center; PROMISE; University of Palermo, Palermo, Italy; 2Paediatric Diabetes Unit, Children’s Hospital “G. Di Cristina”, Palermo, Italy

Introduction: Increased uric acid levels are associated with new-onset hypertension in children. Nevertheless, controversy remains concerning a direct causative role of serum uric acid (SUA) in the pathogenesis of essential hypertension (EH).

Aim: To determine if normotensive obese children and adolescent offspring of adults with EH show SUA levels different than those of paediatric subjects in whom there is no family history of EH.

Methods: Fifty-nine obese normotensive children and adolescents, aged between 8 and 17 years, attending for metabolic assessment the Paediatric Diabetes Unit, Children’s Hospital “G. Di Cristina”, and for cardiovascular evaluation the ESH Hypertension excellence center of the University of Palermo, underwent routine blood chemistry and oral glucose tolerance test with glucose and insulin determinations. All subjects had BP determinations below the 90th percentile and had no previous history of elevated BP.

Results: There were 14 subjects whose parents were both normotensive (FH−), and the remaining 45 subjects whose one or both parents were hypertensive (FH+). FH+ did not differ regarding age, sex distribution, BP values, body mass index, waist circumference, serum glucose levels when compared to FH−. Among the metabolic parameters assessed, only SUA was significantly higher in FH+ than in FH− (p = 0.007). This difference held after adjusting for age, gender and BMI (p = 0.01) (Figure 2).

Conclusions: Our results, showing higher values of SUA in normotensive obese children and adolescents with parental history of EH, seem to support the hypothesis that increased SUA may precede and determine the development of hypertension.

18 09. CLINICAL SIGNIFICANCE OF GENDER DIFFERENCES IN OLDER PEOPLE WITH METABOLIC SYNDROME

18.1 Yasmine Grassi, Marco Bertolotti, Chiara Mussi

18.1.1 Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia and University Hospital of Modena, Modena, Italy

Introduction: Metabolic syndrome (MetS) is a cluster of risk factors that, if associated, increase the risk to develop cardiovascular (CV) disease and diabetes. In older subjects the impact of MetS and the role of gender are relevant but poorly understood.

Aim: To analyse gender differences in geriatric patients with MetS, and to assess whether these differences could affect the standard treatment options, often controversial in the elderly.

Methods: 1382 outpatients attending our Cardiogeriatric Clinic were studied. MetS was defined in accordance with the “Harmonized definition” (2009). We applied a “multidimensional geriatric assessment” including: pharmacological and medical history, clinical examination, blood tests, anthropometric parameters and the main geriatric syndromes, focusing on depression.

Results: MetS prevalence was 27.8% (27.3% in males, 28.2% in females), with a higher prevalence, over age 85, in women compared with men. Female sex is an independent risk factor for MetS (OR 2.56; p = 0.001). The most common component was high blood sugar (32.4%) in males, and elevated waist circumference (46.9%) in females. 93.2% of the sample with MetS has hypertension. Males with MetS have a higher CV risk (39.3%) compared to women (25.3%), however no differences were observed between treatment with CV drugs between genders.

Conclusions: Main differences between genders concern women > 85, the prevalence of CV disease, which is higher in men, and dizziness (higher in women). Remarkably, the prevalence of depression is deeply associated with MetS in women. Increasing awareness in physicians about CV prevention in postmenopausal women was also observed.

19 10. PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN A LARGE MONOCENTRIC COHORT OF BREAST CANCER PATIENTS

19.1 Giacomo Tini1,, Matteo Sarocchi1, Davide Sirello1, Matteo Toma1, Angelo Buscaglia1, Francesco Scanavino1, Sara Oneto1, Danilo Baccino1, Stefano Giovinazzo1, Eleonora Arboscello2, Claudio Brunelli1, Paolo Spallarossa1

19.1.1 1Clinic of Cardiovascular Diseases, IRCCS San Martino Policlinic Hospital, University of Genova, Genova, Italy; 2Department of Emergency, IRCCS San Martino Policlinic Hospital Genova, Italy

Introduction: Breast cancer (BC) and cardiovascular diseases (CVD) are the leading causes of mortality and morbidity in women. Cardiovascular risk factors (CVRF) predispose to both CVD and cardiotoxicity from anticancer treatments.

Aim: To define prevalence of CVRF in a large BC cohort of women systematically evaluated at our Cardio-Oncology outpatient clinic.

Methods: All BC patients evaluated before starting chemotherapy and/or radiotherapy, from January 2016 to December 2017, were retrospectively enrolled.

Results: 278 BC women were included. Mean age was 63 ± 12 years: 137 were > 65 years (49%) (Table 1). A-hundred-twenty-six patients were scheduled for treatment with anthracyclines (45%) and 57 with trastuzumab (21%). We found a substantial prevalence of CVRF in our population, with 40% of patients having ≥ 2 CVRF. Thirty-two-percent of patients were smokers, 39% were dyslipidemic and 40% had hypertension. Sixty-five of the 107 dyslipidemic women (60%) were not on therapy with statins. Among the 112 women affected by hypertension, 20 (18%) had blood pressure values not on target and required adjustment of therapy. Thirteen patients received a new diagnosis of hypertension (13/166: 8%). CVRF were significantly more common in older women (CVRF ≥ 2: 29% in younger vs. 51% in elderly, p < 0.001), as well as hypertension, diabetes and dyslipidaemia alone. At a multivariate analysis, age > 65 years, but not CVRF ≥ 2, was inversely associated with prescription of anthracyclines before the cardio-oncologic consultation (Table 2).

Conclusions: CVRF are significantly prevalent in BC women, with a sub-optimal control. Their presence, however, seems not to influence the oncologist’s choice of chemotherapies before the cardio-oncologic evaluation.

20 11. INVERSE RELATIONSHIPS BETWEEN CHOROIDAL THICKNESS AND RENAL RESISTANCE INDEX IN HYPERTENSIVE PATIENTS

20.1 Giulio Geraci1, Giuseppe Mulè1, Francesco D’Ignoto1, Tiziana La Blasca1, Dario Cacciatore1, Nicola Sinatra1, Santina Cottone1, Maria Vadalà2

20.1.1 1Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre–University of Palermo, Palermo, Italy; 2Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy

Introduction: Alterations of the renal microcirculation have been documented in animal models of hypertensive renal damage. Traditionally, the retina has been considered the easiest accessible window to study the systemic microcirculation, even though the choroid is the most important vascular layer of the eye. The introduction in the past few years of advanced optical coherence tomography (OCT) techniques has greatly increased our understanding of the choroid. Although the renal resistive index (RRI) was initially considered to reflect intrarenal vascular pathological processes, this index is actually regarded as the result of complex interaction between renal and systemic vascular wall properties and hemodynamic factors, and it is endowed with prognostic implications.

Aim: To analyse the relationships between choroidal thickness (CT) and RRI in a group of hypertensive patients.

Methods: We enrolled 66 nondiabetic essential hypertensives (67% men; mean age: 52 ± 12 years), consecutively attending our Hypertension Centre.

Results: The glomerular filtration rate (GFR) estimated by the CKD-EPI equation was 78 ± 2 ml/min/1.73 m2, and the RRI 0.64 ± 0.07. Splitting the study population into 2 groups on the basis of the 75th percentile of the distribution of RRI, we found lower choroidal thickness in the group with greater values of RRI (all p < 0.001; Figure 3). We observed also significant inverse correlations between CT and RRI, that held even after adjustment for GFR, age and gender (Table 3).

Conclusions: Our findings confirm the close relationships between changes in the ocular microcirculation and renal dysfunction and suggest that intrarenal hemodynamic alterations are involved in these relationships.

21 12.CARDIOVASCULAR RISK STRATIFICATION THROUGH THE EVALUATION OF COMMON CAROTID STIFFNESS BY SPECKLE-TRACKING ULTRASONOGRAPHY

21.1 Rosa Curcio1, Natasa Mojovic1, Massimo R. Mannarino1, Salvatore Innocente1, Matteo Pirro1, Vanessa BianconiD1

21.1.1 1Unit of Internal Medicine, University of Perugia, Perugia, Italy

Introduction: Carotid speckle-tracking ultrasonography is emerging as a non-invasive and feasible method for evaluating the multi-directional mechanics of carotid arteries. The association between carotid stiffness and cardiovascular (CV) risk has not been fully elucidated.

Aim: We investigated the association between left common carotid (lcc) elastic modulus (lccEM) and pulse wave velocity (lccPWV) and two conventional surrogate markers of CV risk, i.e. lcc intima-media thickness (lccIMT) and aortic PWV (aPWV). Also, we explored the association between lccEM and lccPWV and the 10-year risk of fatal CV events.

Methods: Seventy-eight dyslipidemic patients were enrolled among those who referred to our tertiary care center for the management of lipid disorders. The 10-year risk of fatal CV events was estimated according to the European Atherosclerosis Society (EAS) recommendations. Carotid speckle-tracking ultrasonography was used to assess lccEM and lccPWV, while lccIMT was automatically calculated through a grey-scale analysis of the ultrasound images. The SphygmoCor Vx system was used to assess aPWV.

Results: Seventeen (22%), 24 (31%), 21 (27%) and 16 (20%) patients were in the low, moderate, high ad very high risk categories, respectively. LccEM correlated with aPWV (rho = 0.58, p < 0.001) and lccIMT (rho = 0.25, p = 0.025), while lccPWV correlated with aPWV (rho = 0.35, p = 0.002) but not with lccIMT. In a binary logistic regression model including age, lccEM, lccPWV, lccIMT and aPWV as independent variables, age (OR = 1.098, CI 1.017–1.185; p = 0.017) and lccPWV (OR = 1.717, CI 1.053–2.801; p = 0.030) were independent predictors of high/very high CV risk.

Conclusions: Carotid speckle-tracking ultrasonography might provide additive information for the CV risk stratification in dyslipidemic patients.

22 13. A SYSTEMATIC REVIEW AND META-ANALYSIS OF INTERVENTIONAL STUDIES ON THE ANTI-INFLAMMATORY EFFECTS OF STATINS ON ARTERIAL WALL

22.1 Vanessa Bianconi1, Massimo R. Mannarino1, Amirhossein Sahebkar 2, Matteo Pirro1

22.1.1 1Unit of Internal Medicine, University of Perugia, Perugia, Italy; 2 School of Pharmacy, Mashhad University of Medical Sciences, Iran

Introduction: A number of interventional studies have explored the anti-inflammatory effects of statin therapy on arterial wall inflammation through a 18F-fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (18F-FDG PET/CT)-based evaluation of different arterial territories. Overall, these trials have produced inconsistent results.

Aim: We evaluated by a systematic review and meta-analysis of interventional studies the effects of statin therapy on arterial wall inflammation.

Methods: Trials with at least one statin treatment arm and reporting target-to-background ratio (TBR), an indicator of blood-corrected 18F-FDG uptake by the arterial wall, as the target variable of the statin anti-inflammatory activity were searched in PubMed-Medline, SCOPUS, ISI Web of Knowledge, and Google Scholar databases. Evaluation of biases, a random-effects model with generic inverse variance weighting, and a sensitivity analysis were performed for qualitative and quantitative data assessment and synthesis. Subgroup and meta-regression analyses were also performed.

Results: Meta-analysis of 7 eligible studies, comprising 10 treatment arms with 287 subjects showed a significant reduction of TBR following statin treatment [Weighted Mean Difference (WMD): − 0.104, p = 0.002). This result was consistent both in high-intensity (WMD: − 0.132, p = 0.019) and low-to-moderate intensity statin studies (WMD: − 0.069, p = 0.037). Statin dose/duration, plasma cholesterol, C-reactive protein level changes, and baseline TBR did not affect the TBR treatment response to statins.

Conclusions: Statins reduce arterial wall inflammation, as assessed by 18F-FDG PET/CT imaging. Larger clinical trials should clarify whether statin-mediated cholesterol-lowering or other pleiotropic mechanisms may explain this effect.

23 14. PARATHYROID HORMONE LEVELS PREDICT CAROTID PLAQUE ECHOGENICITY IN POSTEMENOPAUSAL WOMEN

23.1 Elena Cosentini1, Massimo Raffaele Mannarino1, Rosa Curcio1, Anna Maria Scarponi1, Matteo Pirro1, Vanessa Bianconi1

23.1.1 1Unit of Internal Medicine, University of Perugia, Perugia, Italy

Introduction: Increased ultrasound echogenicity of carotid atherosclerotic plaques may reflect the amount of intralesional calcium deposition. Parathyroid hormone (PTH), which has a crucial role in calcium homeostasis, has been shown to promote both bone resorption and vascular calcification (the so-called “calcification paradox”).

Aim: We investigated the association between serum PTH levels, femoral bone mineral density (BMD) and echogenicity of carotid atherosclerotic plaques in postmenopausal women.

Methods: We enrolled 63 postmenopausal women with asymptomatic carotid atherosclerotic plaques. Traditional cardiovascular risk factors were evaluated. Serum PTH levels were measured. The ultrasound grey-scale median (GSM) analysis was performed to estimate carotid plaque echogenicity. Femoral BMD was assessed through dual-energy X-ray absorptiometry (DXA).

Results: Max and mean GSM values of carotid atherosclerotic plaques were significantly higher in osteoporotic women (45.6 ± 13.4 and 53.6 ± 19.9) compared to those with osteopenia (30.7 ± 11.6 and 31.6 ± 12.6) or normal femoral BMD (36.8 ± 11.7 and 39.1 ± 12.1). An inverse association was observed between femoral neck BMD and mean GSM values (rho = − 0.26, p = 0.039), whereas a positive association was observed between serum PTH levels and max and mean GSM values (rho = 0.57, p < 0.001 and rho = 0.59, p < 0.001, respectively). Femoral neck BMD and serum PTH levels predicted mean GSM values independently from body mass index and age (β = − 0.24, p = 0.05 and β = 0.39, p = 0.002, respectively).

Conclusion: Serum PTH levels and femoral neck BMD predict the echogenicity of atherosclerotic plaques in postmenopausal women. Increased serum PTH levels may represent the pathophysiological link between postmenopausal osteoporosis and carotid atherosclerotic plaque calcification.

24 15. RIGHT VENTRICULAR SPECKLE TRACKING ANALYSIS IN RENAL TRANSPLANT RECIPIENTS AFTER 12 MONTHS OF UNSUPERVISED EXERCISE TRAINING

24.1 Beatrice Leone, Elena Zappelli, Pietro Amedeo Modesti, Giorgio Galanti, Laura Stefani

24.1.1 Sports Medicine Center–University of Florence, Florence, Italy

Introduction: Right Ventricular (RV) function is strongly associated with clinical outcomes in population at high cardiovascular risk. More recently, particularly deformation parameters as Speckle tracking echocardiography is applied as imaging technique for an accurate evaluation. Renal Transplant Recipient (RTR) is the new category involved in the physical activity program despite the high CV risk.

Aim: The study aims to assess the global RV function in the RTR regularly submitted to physical activity (PA).

Methods: a group of 50 patients, 30 asymptomatic RTR and 20 Healthy Control (HC), aged 50 ± 5, was trained for 1 year following a mixed exercise program for at least 3 times a week.
They were followed by echocardiographic exam every 6 months, investigated by 2D RV standard parameters and strain analysis by X-Strain software measuring the Free Wall (FW) of the RV at T0, T6 and T12 months.

Results: RTR had initially low values of RVFW strain compared to the normal range and the HC (Table 4). The RVFW strain was found significantly (p < 0.01) increased at the end of the exercise program, restoring the normal range. The RV diastolic function shows a significant (p < 0.05) and progressive adjustment of the E/A ratio in RTR only. No significant variations in controls.

Conclusions: One year of moderate intensity of unsupervised physical exercise improves the RV chamber performance. The investigation of both the systolic and diastolic parameters and by the strain analysis can contribute to a correct follow-up in RTR. More data will be necessary to support this hypothesis.

25 16. EFFECTS OF LIRAGLUTIDE VS EMPAGLIFLOZIN TREATMENT ON CIRCULATING MICROVESICLES IN TYPE 2 DIABETIC PATIENTS

25.1 Sara Coluzzi, Maria Pompea Antonia Baldassarre, Fabrizio Febo MD, Pamela Di Tomo, Tech, Paola Lanuti, Giuseppina Bologna, Eva Ercolino, Gloria Formoso, Agostino Consoli

25.1.1 Aging Research Center and Translational Medicine CeSI-MeT, “G. d’Annunzio” University, Chieti-Pescara, Chieti, Italy

Introduction: Endothelium derived microvesicles (MVs) are circulating cellular markers of endothelial dysfunction, the first step of vascular disease. By evaluating MVs, one might gain insight mechanisms underlying the proven cardiovascular (CV) protective effects of glucagon-like peptide 1 (GLP-1) receptor agonists and gliflozins.

Aim: To observe in vivo the effects of liraglutide or empagliflozin, as compared to gliclazide, on circulating MVs levels, a direct indicator of vascular damage, in type 2 diabetic patients.

Methods: Thirty-eight type 2 diabetic subjects, HbA1c > 7% with no CV complications, were randomized to liraglutide (12), empagliflozin (13), or gliclazide (13) as add on to metformin therapy. MVs count was obtained by flow cytometry performed before and after a 12 week-treatment period. Levels of MVs derived from endothelium, platelets and leukocytes were evaluated in freshly drawn whole blood, using a single platform count.

Results: Levels of total, endothelial and platelet MVs were significantly reduced only after treatment with liraglutide (p < 0.05). No relationship between MVs change and improvement in HbA1c levels was observed.

Conclusions: Liraglutide treatment significantly reduce circulating levels of specific biomarkers of endothelial dysfunction. In contrast, empagliflozin, does not seem to have any effect on these markers and therefore on the vascular protection, supporting the hypothesis of two different mechanisms of action: a vascular direct effect determined by liraglutide and a predominantly hemodynamic action in the case of empagliflozin.

26 17. RELATIONSHIPS BETWEEN PLASMA ALDOSTERONE LEVELS AND LEFT VENTRICULAR MASS AND GEOMETRY IN ESSENTIAL HYPERTENSIVE PATIENTS: DOES SEX MATTER?

26.1 Marta Giambrone, Giuseppe Mulè, Alessandra Sorce, Alida Tunno, Katia Montalbano, Nicola Sinatra, Valentina Cacciatore, Leonardo Calandra, Santina Cottone, Emilio Nardi

26.1.1 Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre–University of Palermo, Palermo, Italy

Introduction: Experimental evidence suggested that aldosterone can cause myocardial hypertrophy and fibrosis. However, previous studies on the association between plasma aldosterone concentration (PAC) and left ventricular (LV) mass (LVM) and geometry, in subjects without primary aldosteronism yielded conflicting results.

Aim: To evaluate the relationships of PAC with LV mass and geometry in patients with essential hypertension (EH), and to assess the influence of gender on these relationships.

Methods: We enrolled 478 subjects (men: 63%; mean age 44 ± 12 years) with untreated EH. The measurements included 24-h blood pressures, plasma renin activity (PRA) and PAC, obtained by radioimmunoassay and an echocardiogram. For its skewed distribution PAC was log transformed and expressed as median value and interquartile range.

Results: PAC was significantly lower in subjects with normal LVM indexed for body surface area (BSA), as compared to those with concentric remodeling to the patients with eccentric LV hypertrophy (LVH), and to the subjects with concentric LVH (Figure 4). Significant correlations of Log (PAC) with LVM, either indexed for BSA (r = 0.20; p < 0.0001), or for height^2.7 (r = 0.21; p < 0.0001) and with relative wall thickness (RWT) (r = 0.18; p < 0.0001) were found. These correlations were similar in men and in women and remained statistically significant in multiple regression analyses, even after adjustment for potential confounding factors (all p < 0.01).

Conclusions: Our results seem to suggest that in essential hypertensive patients circulating aldosterone levels are independently associated with concentric LV geometry, without gender related differences.

27 18. GOOD-DAY: EFFICACY OF GAMIFICATION OF AN EDUCATIONAL TRAINING TO MEDITERRANEAN DIET ON WEIGHT AND METABOLIC CONTROL IN PAEDIATRIC OBESITY. PRELIMINARY DATA AT 6 MONTHS

27.1 Valentina Mancioppi1, Arianna Solito1, Roberta Ricotti1, Deborah Carrera2, Francesca Archero1, Valentina Landoni1, Rossana Errichiello1, Elisa Bona3, Maria Cavaletto3, Simonetta Bellone1, Flavia Prodam4,5

27.1.1 1Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; 2SCDO of Clinical Nutrition and Dietetics, Maggiore della Carità Hospital, Novara, Italy; 3Department of Science and Innovation Technological, University of Piemonte Orientale, Novara, Italy; 4Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; 5Interdisciplinary Research Center of Autoimmune Diseases, University of Piemonte Orientale, Novara, Italy

Introduction: The progression of co-morbidities in paediatric obesity can be delayed or prevented with proper life-style changes.

Aim: To assess the efficacy on weight loss and cardiometabolic risk factors of a Mediterranean diet (MD) educational training and gamification (The Mediterranean Game of Goose, MGG), and the microbiota shaping with MD adherence and food composition.

Methods: Pilot open-label randomized controlled trial. 60 obese subjects (10–18 years) will be enrolled and randomly allocated to routine care or MD training + gamification by using the MGG. Clinical, biochemical and stool evaluations will be performed every 3 and 6 months respectively, including an OGTT at baseline and after 12 months, as well as an abdominal US; then, subjects will be clinically evaluated after 24 months. A complete nutritional evaluation (24-h recall, KIDMED and CEHQ-FFQ questionnaire, Mediterranean Adequacy Index, Dietary Inflammatory Index) and physical activity evaluation (IPAQ-Adolescents questionnaire) will be always collected.

Preliminary results: 57 patients have been enrolled. 24 subjects drop-out. At V0, the age was 12.9 ± 2.00 years, the 50.9% was female and the 31.6% was pre-pubertal. 22 patients completed the V3 visit (after 6 months). Four patients completed the study. All subjects had a low-average adherence to MD at baseline. At V3, BMI z-score, systolic and diastolic blood pressure and fasting glycaemia were significantly decreased without differences between the two groups. Total and LDL-cholesterol decreased in MGG group, while significantly increased in control group.

Conclusions: Gamification could be an overcoming strategy to improve self-awareness and skills on better nutritional choices on long-term.

28 19. A SYSTEMATIC REVIEW OF THE EFFECTS OF SKIPPING BREAKFAST ON WEIGHT AND CARDIOMETABOLIC RISK FACTORS IN CHILDREN AND ADOLESCENTS

28.1 Arianna Solito1, Valentina Mancioppi1, Alice Monzani1, Roberta Ricotti1, Marina Caputo2, Francesca Archero1, Flavia Prodam1,2,3, Simonetta Bellone1,3

28.1.1 1 SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; 2 Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; 3Interdisciplinary Research Center of Autoimmune Diseases, University of Piemonte Orientale, Novara, Italy

Introduction: The incidence of skipping breakfast in pediatric subjects is rising, and a relationship with overweight (OW) and obesity (OB) has been shown. Associations with cardiovascular outcomes in adults have been reported.

Aim: The purpose of this systematic review was to summarize the effects of skipping breakfast on body weight and metabolic outcomes in the paediatric worldwide population.

Methods: We searched relevant databases (2008–2018) and identified 56 articles, of which 39 were suitable to be included, basing on inclusion criteria (observational; defined breakfast skipping; weight and/or metabolic outcomes).

Results: Overall, 286,804 children and adolescents living in 33 countries were included. The definitions of OW/OB, skipping breakfast and the nutrient assessment were highly heterogeneous. Confounding factors were reported infrequently. The prevalence of skipping breakfast ranged 10–30%, with an increasing trend in adolescents, mainly in girls. Skipping breakfast was associated with OW/OB in the 94.7% of the subjects. The lack of association was shown mainly in infants. Moreover, 16,130 subjects were investigated for cardiometabolic outcomes. Skipping breakfast was associated with a worse lipid profile, blood pressure levels, insulin-resistance, and metabolic syndrome. Breakfast skippers had poor dietary habits.

Conclusions: This review supports breakfast in the promotion of healthy dietary habits in paediatric individuals, for both the risk of OW/OB and metabolic diseases. We encourage studies using standardized and generalizable indicators. Data on confounders, time of fasting, chronotypes, nutrition quality are needed.

29 20. UNATTENDED AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT AND CARDIAC TARGET ORGAN DAMAGE: A PILOT STUDY

29.1 Simone Donadio, Grazia Canciello, Maria Angela Losi, Raffaele Izzo, Federica De Pisapia, Maria Immacolata Arnone, Giuliano De Stefano, Giovanni Albano, Costantino Mancusi

29.1.1 Hypertension Research Center FEDERICO II University of Naples, Naples, Italy

Introduction: ESC-2018 guidelines identify the inaccuracy of manual ambulatory blood pressure (AOBP), emphasizing the Unattended Automatic Office Blood Pressure(UAOBP) importance in obtaining more reliable measurements. However, a 5-15 mmHg difference between AOBP and UAOBP is mentioned. This interval value underlines uncertainty in evaluating both methods due to extremely heterogeneous clinical studies on this topic.

Aim: Assessing if the pressure difference between UAOBP and AOBP adopted in American and European guidelines is reproducible and evaluating the correlation of UAOBP with markers of hypertension mediated target organ damage in hypertensive patients.

Methods: UAOBP and AOBP were taken on a 48-outpatients cohort in Italy. Pressure difference between the two methods and their correlation with general anthropometric and cardiac parameters were analysed. The correlation of the two methods with echocardiographic organ damage indices was studied.

Results: Systolic-UAOBP values were lower than systolic-AOBP ones (135 ± 7 mmHg vs 139 ± 21 mmHg). Differences between values measured using the two methods were ΔSBP = 4±10 mmHg and ΔDBP = 3 ± 9 mmHg for systolic-BP and diastolic-BP respectively. ΔDBP was significantly directly correlated with female sex (r = 0.347, p = 0.016) and also lower in men compared to women (0.11 ± 8.9 vs 6.07 ± 7.42, p = 0.016). The difference between UAOBP and AOBP was 8 mmHg for systolic values, so that an unattended systolic-BP of 140 mmHg corresponded to an attended systolic blood pressure of 148 mmHg. Finally unattended systolic-BP was better correlated with left-ventricular mass indexed/h2.7 (r = 0.381, p = 0.008) than attended systolic-BP (r = 0.286, p = 0.049).

Conclusions: UAOBP provides values significantly lower than AOBP ones and it can better identify cardiac damage. The difference in BP-values between the two methods is much lower than which obtained in most clinical studies.

30 21. THE EFFECTS OF SACUBITRIL/VALSARTAN ON CARDIOVASCULAR HEMODYNAMICS RETRIVED BY SPHIGMOCORE IN PATIENTS AFFECTED BY HEART FAILURE WITH REDUCED EJECTION FRACTION: PRELIMINARY DATA ANALYSIS

30.1 Allegra Battistoni, MD1, Francesca Miceli, MD1, Vivianne Presta, MD1, Barbara Citoni, MD1, Sebastiano Sciarretta, MD PhD2, Nadia Attalla El Halabieh, MD1, Sara Cangianiello, MD1, Giuliano Tocci, PhD, MD1, Massimo Volpe, MD, FAHA, FESC1,2

30.1.1 1Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli (IS), Italy

Introduction. Recent introduction of sacubitril/valsartan has markedly improved pharmacological treatment of heart failure with reduced ejection fraction (HFrEF). Little is known about the effects of sacubitril/valsartan on cardiovascular haemodynamic parameters.

Aim: To investigate the effects of sacubitril/valsartan on cardiac performance and vascular function in patients affected by HFrEF.

Methods: We consecutively enrolled HFrEF patients attending to our HF unit and who were still symptomatic despite optimal medical therapy (NYHA class II or III) and without contraindications to sacubitril/valsartan-based therapy. All patients underwent clinical evaluation, routine lab tests, and office blood pressure (BP) measurement before starting sacubitril/valsartan therapy and three months after the titration to the maximal tolerated dose. Also, vascular indexes, including pulse wave velocity (PWV), central blood pressure and vascular age, were measured with Mobil-O-Graph.

Results: In this preliminary analysis, 5 consecutive patients (F 20%; mean age 66 years; mean left ventricular ejection fraction 27.6%) were enrolled. At start, mean brachial systolic (SBP) and diastolic (DBP) BP were 120/66 mmHg. After three months of treatment, there was a significant reduction in both SBP (91 mmHg; p = 0,035) and DPB (56.8 mmHg; p = 0.002). Mean central SBP and DBP were 106.6/67.7 mmHg at start and significantly decreased after 3 months (80.8 mmHg, p 0.009 and DBP 56.6 mmHg p = 0.001, respectively) (Figure 5). Mean resting heart rate did not differ during follow-up. Stroke volume, peripheral resistances, cardiac output and cardiac index did not significantly differ between two time points, whereas PWV decreased from 9.82 to 8.86 m/s (p = 0.002). Vascular age decreased from 67.8 to 61.6 years (p = 0.008) (Figure 6).

Conclusions: Our preliminary data indicate that sacubutril/valsartan, when added to optimal medical therapy, in patients affected by HFrEF may have favourable effects on vascular function. The decrease in BP is more evident for brachial one than central one. Accordingly, there is also a decrease of PWV whereas cardiac functional indexes do not change significantly. This evidence seems to indicate a beneficial effect on vessels, which is consistent with the reduction in vascular age.

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© Italian Society of Hypertension 2019

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