Abstracts from the 27th Asian Pacific Society of Cardiology Congress by Radcliffe Cardiology

Abstracts from the 27th Asian Pacific Society of Cardiology Congress 13–15 July 2023 Singapore

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ABSTRACTS

27th Asian Pacific Society of Cardiology Congress

Abstracts from 27th Asian Pacific Society of Cardiology Congress

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):1–68. DOI: https://doi.org/10.15420/japsc.2023.2.s1 Open Access: This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.

Young Investigator Awards

Sheng Jie Lu,1,2 Jasper Chua,1,2 Su Yin Chaw,3 Ann-Marie Chacko3 and Derek Hausenloy1,2,4,5

YIA-001 Effects of Dapagliflozin on hsCRP and Left Ventricular Global Longitudinal Strain in Patients with Acute Myocardial Infarction

1. NHRIS, National Heart Centre Singapore; 2. Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School; 3. Cancer and Stem Cell Biology Programme, Duke-NUS Medical School; 4. Yong Loo Lin School of Medicine, National University Singapore; 5. The Hatter Cardiovascular Institute, University College London

Santi P Ramdhani,1 Habibie Arifianto2 and Niniek Purwaningtyas3 1. Regional Public Hospital of Bima; 2. Department of Cardiology and Vascular Medicine, Sebelas Maret University Public Hospital; 3. Department of Cardiology and Vascular Medicine, Dr Moewardi Hospital

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-002. Correspondence: Sheng Jie Lu, gmslyu@nus.edu.sg

Background: Microvascular obstruction (MVO) is a key determinant of heart failure following myocardial infarction. In this study, for the first time, fibre optic confocal laser endomicroscopy (CLM) was applied to real-time imaging of the microvascular obstruction (MVO) in the beating murine heart subjected to acute ischaemia/reperfusion injury (IRI), providing a pre-clinical platform for testing therapeutics on MVO.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-001. Correspondence: Santi Ramdhani, santipramdhani@gmail.com

Background: Acute myocardial infarction (AMI) has two prognostic parameters; hsCRP indicates the degree of inflammation, and global longitudinal strain (GLS) reflects cardiac function and ventricular remodelling. SGLT-2 inhibitors such as dapagliflozin have been shown to reduce cardiac inflammation and minimise infarct size. This study aimed to determine the effects of dapagliflozin 10 mg once daily for seven days as additional therapy to hsCRP and left ventricular GLS in patients with AMI.

Methods: A murine myocardial IRI model (45-min regional ischaemia with temporary ligation of left coronary artery [LCA] and 30-min reperfusion) was applied. 150 µl dextran-FITC (150 kDa) was injected retro-orbitally, then CLM imaging with a flexible mini-probe (ProFlex S-1500, Cellvizio) was applied to the epicardial surface at 30 min postischaemia and 30 min post-reperfusion, respectively. A nitric oxide donor nanoparticle (NONP) was IV administrated 5 min prior to reperfusion to prevent MVO.

Methods: This was an experimental randomised control trial study, preand post-method, double-blind, held from February to April 2021 on 30 patients with AMI at the Dr Moewardi General Hospital and UNS Hospital, Central Java, Indonesia. Patients were randomly divided into two groups: the treatment group received an additional therapy of dapagliflozin 10 mg once daily for seven days, and the control group received a placebo. hsCRP and GLS levels were measured before and at seven days of hospitalisation.

Conclusion: Dapagliflozin as an additional therapy significantly reduces hsCRP and improves GLS in patients with AMI.

Results: Visualisation of the macro- and microvasculature was confirmed at various positions of the beating heart. Next, acute myocardial ischaemia was induced, and reduced microvasculature blood flow below the LCA ligature was observed as evidenced by reduced or even the absence of FITC. Importantly, the microvasculature in non-ischaemic myocardium was unaffected. Further, at 30 min postreperfusion, partially recovered microvasculature with significant FITC was visualised, but most areas showed less or no reflow due to MVO and damaged microvasculature as evidenced by leakage of FITC signal outside. Interestingly, with NONP treatment, the microvascular network was restored at 30 min post-reperfusion. In addition, FITC signal was even greater below the LCA ligation, suggesting increased blood flow and cardiac tissue penetration due to the vasodilatory effect of NO.

YIA-002 Real-time Imaging of Microvasculature Injury and Vasculoprotective Effects of Nitric Oxide During Acute Myocardial Ischaemia/Reperfusion Injury

Conclusion: This study demonstrated coronary microvasculature changes in the beating heart subjected to IRI, indicating the development of MVO. Importantly, the study uncovered the effective prevention of MVO with NONP following IRI in mice.

Results: Dapagliflozin 10 mg once daily for seven days as an additional therapy was statistically significant in reducing hsCRP (p=0.001; from 47.07 ± 50.91 to 21.45 ± 33.13) and improving left ventricular GLS (p=0.001; from −7.59 ± 3.33 to −12.60 ± 3.99). If the two groups were compared, the delta hsCRP reduction in the treatment group was also statistically significant (p=0.001), as was the delta GLS (p=0.001).

Abstracts from 27th Asian Pacific Society of Cardiology Congress YIA-004 Comparison of Risk Stratification Scores for Pulmonary Arterial Hypertension Patients in a Multi-ethnic Asian Population

Background: Epicardial adipose tissue (EAT) is associated with the pathogenesis of arrhythmogenic cardiomyopathy (ACM); whether it contributes to the disease phenotype is poorly understood. The aim of this study was to systematically investigate the lipidome of EAT in patients with ACM and its relationship with the immune environment in myocardium.

Hao Wen Jiang,1 Jonathan Yap,1,2 Jin Shing Hon,1 Adila Ismail,1 Chee Lan Lim,1 Sumathy Perumal,1 Wen Ruan,1 Duu Wen Sewa,3 Ghee Chee Phua,3 Sue-Ann Ng,3 Cassandra Hong,3 Andrea Low,3 Soo Teik Lim1,2 and Ju Le Tan1,2

Methods: Lipidomics analyses of EAT from 24 patients with ACM and 10 healthy donors were conducted using liquid chromatography tandem mass spectrometry. 3T3-L1 cells were used to explore the effect of saturated fatty acid on the adipokine expression from adipocytes. Singlecell RNA sequencing was used to compare immune environment in myocardium of ACM patients and healthy donors. Cell migration assay, immunofluorescence, western blot was used to examine the influence of adipocytokines on macrophage activation.

1. National Heart Centre Singapore; 2. Duke-NUS Medical School; 3. Singapore General Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-004. Correspondence: Hao Wen Jiang, hjiang011@e.ntu.edu.sg

Background: Guidelines recommend risk stratification of pulmonary arterial hypertension (PAH) patients to guide management. There are currently several risk stratification scores. These scores have largely been validated in various pulmonary hypertension registries in the West. The aim of this study was to investigate the performance of these different risk scores in PAH patients from a multi-ethnic Asian population.

Results: The expression level of beige fat markers (TBX1 and TMEM26) and brown fat marker TNFRSF9 was higher in the EAT of ACM patients compared to healthy donors. Lipid profiling of EAT revealed significant increase of saturated triglyceride in patients with ACM compared with healthy donors, especially in the EAT of right ventricle. The addition of saturated fatty acid in culture medium significantly increased the expression level of adipokines of differentiated 3T3-L1 cells. Single-cell RNA sequencing revealed obvious accumulation of proinflammatory macrophages in the myocardium of right ventricle of ACM patients compared to healthy donors. The macrophages showed high expression level of proinflammatory markers like IL1β, CCL3, CXCL2, CXCL3, and CXCL8. The adipokines secreted by saturated fatty acid-cultured 3T3-L1 cells could promote the expression of proinflammatory markers (IL1β, CCL3, CXCL8) in macrophages.

Methods: A retrospective review was performed of all PAH patients from January 2014 to June 2021 from a single tertiary cardiac centre. Inclusion criteria were the availability of at least WHO functional class II or III, 6-minute walk distance or NT-proBNP. Mortality outcomes were obtained from national registries. All patients were followed up to 30 June 2022. Using the 2022 ESC/ERS, REVEAL Lite 2.0 and COMPERA 2.0 risk scores, patients were classified into different risk strata. The C-statistic was calculated to determine the discrimination power of each model.

Conclusion: The increased saturated triglyceride in EAT from patients with ACM might induce adipokine secretion, which further promotes macrophage activation and proinflammatory cytokine secretion in myocardium.

Results: A total of 165 patients (mean age 56.2 ± 17.6 years; 125 women; 100 Chinese, 35 Malay, 21 Indian; 72 idiopathic, 52 connective tissue disease, 35 congenital heart disease, 6 others) were included. All scores showed significant difference in mortality outcomes between the different risk strata (p<0.01), with the highest risk group showing the highest mortality. With the 2022 ESC/ER and REVEAL Lite 2.0 scores, 1-year mortality rates for low-, intermediate-, and high-risk groups were 4.8% versus 3.8%, 7.1% versus 1.9% and 60% versus 14% respectively. With the COMPERA 2.0 score, 1-year mortality rates for low-, intermediate-low-, intermediate-high-, and high-risk groups were 2.7%, 1.9%, 13%, and 19% respectively. The 2022 ESC/ERS, REVEAL Lite 2.0 and COMPERA 2.0 risk scores had a C-statistic of 0.64, 0.67 and 0.72, respectively for predicting 1-year mortality.

YIA-006 Evaluating the Relation Between Left Atrioventricular Coupling Index and Heart Failure in Asian Patients with Hypertrophic Cardiomyopathy

Tony Li,1 Novi Yanti Sari,1 Selvie Yeo,2 Chi Hang Lee,1 Edward Lee,1 Tiong Cheng Yeo,1 James Yip,1 Kian Keong Poh,1 William Kong,1 Weiqin Lin,1 Ching Hui Sia1 and Raymond Wong1 1. National University Heart Center, Singapore; 2. Yong Loo Lin School of Medicine, National University of Singapore

Conclusion: Risk stratification is a useful tool in prognosticating Asian PAH patients and may play an important role in guiding therapeutic management.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-006. Correspondence: Tony Li, tonyli92@gmail.com

YIA-005 Saturated Triglyceride in the Epicardial Adipose Tissue Promotes Macrophage Activation in Arrhythmogenic Cardiomyopathy

Background: Left atrioventricular coupling index (LACI) is a novel index for assessing left atrial function and LA-LV uncoupling. This study aimed to investigate whether LACI was associated with heart failure (HF) hospitalisation in Asian patients with HCM.

Song Ren Shu, Hao Cui, Mengxia Fu, Xiao Chen and Jiangping Song

Methods: This was a retrospective study involving 291 patients diagnosed with HCM between 2010 and 2017. LACI was defined as the ratio of left atrial (LA) end-diastolic-volume divided by left ventricular (LV) enddiastolic-volume. We tested a previously defined cut-off for LACI (≥40%) against outcomes of HF hospitalisation and event-free survival from a composite of adverse events, including all-cause mortality, VT/VF events,

National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-005. Correspondence: Song Ren Shu, shusongren@126.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress YIA-008 Catheter Ablation of Ventricular Arrhythmia in Patients with an Implantable CardioverterDefibrillator: Systematic Review and Meta-analysis

appropriate device therapy if an ICD was implanted, stroke and HF hospitalisation. Results: The patients had a mean age of 59.0 ± 16.7 years and had a male preponderance (71.2%). The cumulative event-free survival over follow-up of 3.9 ± 2.7 years was 52.3% for patients with LA-LV uncoupling versus 74.5% for patients without (p<0.001). Multivariable Cox regression analyses was performed separately for each LA parameter, adjusting for age, sex, LV ejection fraction, LV maximal wall thickness >30mm, LV outflow tract (LVOT) gradient >30mmHg, more-thanmoderate mitral regurgitation and atrial fibrillation. Analyses showed an independent association between HF hospitalisation and LACI (HR 1.883; 95% CI [1.202–2.950], p=0.006), LA-minimum-volumeindexed (HR 1.032; 95% CI [1.018–1.047], p<0.001) as well as LAmaximum-volume-indexed (HR 1.005; 95% CI [1.000–1.020], p=0.037). Inclusion of LACI in the model provided a larger improvement in the risk stratification for HF hospitalisation, compared to conventional LA parameters.

Khi Yung Fong,1 Yiong Huak Chan,1 Yue Wang,2 Colin Yeo,2 Eric Lim3 and Vern Hsen Tan2

1. Yong Loo Lin School of Medicine, National University of Singapore; 2. Department of Cardiology, Changi General Hospital; 3. National Heart Centre Singapore Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-008. Correspondence: Colin Yeo, drcolinyeo@gmail.com

Background: Implantable cardioverter-defibrillator (ICD) shocks are associated with higher mortality and reduced quality of life. This study aimed to investigate the effectiveness of catheter ablation (CA) of ventricular tachycardia in patients with an ICD. Methods: An electronic literature search was conducted to retrieve randomised controlled trials comparing CA versus control. The primary outcomes were recurrence of ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation [VT/VF]) and mortality. Kaplan–Meier curves for these outcomes were digitised to obtain individual patient data, which was pooled in a one-stage meta-analysis to determine HRs and 95% CIs. Secondary outcomes included cardiac hospitalisation, electrical storm, syncope, appropriate ICD therapy, appropriate ICD shocks, and inappropriate shocks. For these, study-level HRs or RRs were obtained and pooled under random-effects meta-analyses. Subgroup analysis was performed for trials investigating prophylactic CA (before or during ICD implantation).

Conclusion: In Asian patients with HCM, LACI was independently associated with HF hospitalisation and a composite of adverse outcomes.

YIA-007 Shared Genetic Pathways Contribute to Risk of All-cause Heart Failure and Cardiomyopathies Hiroki Yoshida,1 Kaoru Ito,2 Kazuo Miyazawa2 and Ryo Kurosawa2

1. The University of Tokyo Hospital; 2. Institute of Physical and Chemical Research Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-007. Correspondence: Hiroki Yoshida, goodfield2605@gmail.com

Results: Nine studies and 1,103 patients were retrieved. CA significantly reduced VT/VF recurrence compared to control (shared-frailty HR=0.63; 95% CI [0.49–0.81]; p<0.001) but not mortality (shared-frailty HR=0.84; 95% CI [0.57–1.23]; p=0.361). CA was associated with significantly lower rates of cardiac hospitalisation, electrical storm, appropriate ICD therapies and shocks, but not syncope or inappropriate shocks. Subgroup analysis found similar results for prophylactic CA, except that no significant difference was observed for cardiac hospitalisations.

Background: Several genetic analyses related to heart failure (HF) have been conducted recently. However, fewer causative genes have been identified than in the other cardiovascular diseases. This is because HF is a very heterogeneous disease. Interestingly, some analyses revealed that even healthy individuals have some mutations, such as protein-truncating variants in the TTN gene. Besides, some with such a mutation develop HF under the condition of alcohol abuse or pregnancy. This leads to the idea that a shared pathway may exist as the genetic basis for these heterogeneous HF. To identify it, we conducted a comprehensive genetic analysis.

Conclusion: CA is associated with reduced ventricular arrhythmia recurrence, appropriate ICD shocks and cardiac hospitalisation and may be effective in preventing future morbidity. Future trials are needed to support the continued benefit of these promising results, and to investigate the optimal timing of ablation.

Methods: Deep sequencing of 112 genes related to cardiac function and structure was performed on 11,614 HF patients from BioBank Japan. Next, we conducted a case-control study with 4,813 HF-free individuals from BioBank Japan.

YIA-009 Association of Left Atrial Spontaneous Echo Contrast Detected on Transoesophageal Echocardiogram and Thromboembolism Outcomes

Results: After quality control, 13,640 variants were detected, 63.1% of which were missense and 4.1% were putative loss of function variants. The case-control study revealed that nine genes were significantly associated with all-cause HF. Of these, TTN and FLNC were associated with HF. In addition, the study clarified the comprehensive distribution of cardiac function-related mutations in HF patients.

Bicong Li,1 Tony Li,1 Benjamin YQ Tan,2 Leonard LL Yeo,2 Tiong Cheng Yeo,1 Kian Keong Poh,1 Swee Chong Seow,1 William KF Kong,1 Raymond CC Wong1 and Ching Hui Sia1 1. Department of Cardiology, National University Heart Centre; 2. Division of Neurology, Department of Medicine, National University Hospital

Conclusion: This is the first report of a large-scale genetic analysis of allcause HF related to cardiomyopathies in Japanese. As a result, nine genes were identified as associated with HF, suggesting that these genes could be therapeutic targets.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-009. Correspondence: Bicong Li, lydiali0505@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Objective: To study thromboembolic outcomes associated with spontaneous echo contrast identified on transoesophageal echocardiography (TEE) in our centre.

over 6 weeks. Patients in the CBCR arm received 12 group-based face-toface exercise sessions with educational materials over 4 weeks. Cardiac rehabilitation (CR) utilisation (uptake, adherence, and completion) and 6-minute walk test (6MWT) were evaluated at the 6-week timepoint. Data were analysed using IBM Statistical Package for Social Sciences version 28.0. Ethical approval was obtained from the National Health Group Domain Specific Review Board (No. 2020/00006).

Methods: A total of 172 patients with spontaneous echo contrast (SEC) were identified on consecutive TEE studies performed between January 2014 and September 2022. 64 (37.2%) patients were undergoing TEE as preprocedural screening for radiofrequency ablation or direct-currentcardioversion for atrial fibrillation. We compared long-term stroke risk between the group with SEC alone and the group with SEC and LA thrombus. Peri-procedural stroke risk within 24 hours of the procedure was analysed for patients with SEC who underwent RFA or DCCV. Next, the cohort was split into three subgroups: SEC and LA thrombus, SEC with AF, and SEC without AF, and the rates of ischaemic stroke over follow-up were compared.

Results: Thirty patients were randomised to either the I-CREST intervention arm (n=16) or the CBCR control arm (n=14). Both groups demonstrated significant improvements in 6MWT results from baseline to 6 weeks (I-CREST 462.8 ± 87.7 m to 544.8 ± 74.6 m, p<0.001; CBCR 462.4 ± 71.3 m to 510 ± 69.4 m, p=0.008). In terms of CR utilisation (I-CREST versus CBCR): uptake was 93.8% (15/16) versus 100% (14/14); adherence was 93.3% (14/15) versus 78.6% (11/14); completion was 81.3% (13/16) versus 42.9% (6/14). CR completion was significantly different between groups (p=0.029). No significant between-group differences were observed for 6MWT and CR uptake and adherence.

Results: The cohort was mostly male (61.6%) with a mean age of 64 ± 12. 49 years; patients were also found to have LA thrombus. All except one patient with SEC proceeded with their planned procedure. Despite being appropriately anticoagulated, 2 of 39 patients (5.1%) undergoing RFA developed a periprocedural stroke. None of the 10 patients undergoing DCCV developed a periprocedural stroke. Over a follow-up of 2.98 ± 2.60 years, 5 (4.1%) patients with SEC had a stroke compared to 6 (12.2%) with LA thrombus. Patients with LA thrombus had the highest stroke risk (p=0.028). Patients with SEC but without AF and thus not on anticoagulation had a higher stroke risk than appropriately anticoagulated patients with AF (p=0.047).

Conclusion: These preliminary results suggest that the I-CREST system has the potential to be an equally effective alternative to CBCR for CHD management.

YIA-011 Clinical Characteristics and Outcomes of Asian Patients with Differing Haemoglobin Levels Undergoing Transcatheter Valve Implantation Yu-Hang, Rodney Soh, Wei-Sheng, Nicholas Chew,1 Yi-Shan, Joy Ong,1 Jimmy Hon,2 Ting Ting Low,1 Edgar Tay,1 James Yip,1 Yinghao Lim1 and Ivandito Kuntjoro1

Conclusion: Findings of SEC on TEE were associated with periprocedural stroke for AF ablation despite appropriate oral anticoagulation. Patients with SEC but not AF had an elevated stroke risk compared to anticoagulated patients with SEC and AF. Long-term stroke risk was highest in patients with LA thrombus despite oral anticoagulation.

1. Department of Cardiology, National University Heart Centre; 2. Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre

YIA-010 An Integrated-Cardiac Rehabilitation Employing Smartphone Technology: Preliminary Results of a Single-blinded Randomised Controlled Trial

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-011. Correspondence: Rodney Soh, rodney.soh@mohh.com.sg

Background: The effect of differing levels of haemoglobin (Hb) on outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) remains controversial. This study explored the characteristics and impact of haemoglobin (Hb) levels on Asian patients undergoing TAVI.

Hadassah Joann Ramachandran,1 Alvin Chuen Wei Seah,1 Tee Joo Yeo,2 Qamaruzaman Syed Gani,3 Serene Peiying Lim,3 Shuet Ming Lai2 and Wenru Wang1

1. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore; 2. National University Heart Centre Singapore, National University Hospital; 3. Rehabilitation Department, National University Hospital, National University Health System, Singapore

Methods: This was a retrospective cohort study of patients who underwent TAVI from 1 November 2010 to 31 June 2021 at a tertiary centre. Patients were split into three groups: normal Hb level (≥12g/dl), intermediate Hb level (10–11.9g/dl) and severe Hb level (<10g/dl). Demographics, risk factors in relation to endpoints of all-cause mortality, acute kidney injury and bleeding outcomes were analysed.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-010. Correspondence: Hadassah Joann Ramachandran, hadassah.joann. ramachandran@u.nus.edu

Results: 254 patients were included and followed up for 20 ± 20 months. Patients with anaemia were more likely to have chronic kidney disease and peripheral arterial disease compared to patients without. Compared to the normal Hb level group, patients with severe Hb level and intermediate Hb level had increased all-cause mortality [adjusted HR (aHR) 5.10; 95% CI [1.77–14.74]; p=0.003 and aHR 4.68; 95% CI [1.73– 12.65]; p=0.002, respectively]. Compared to normal Hb level group, patients with severe Hb level had increased risk of acute kidney injury post procedure [OR 3.92; 95% CI [1.29–11.87]; p=0.016]. There was no significant risk of major bleeding post TAVI between different stages of anaemia.

Objective: To evaluate the effectiveness of an Integrated-Cardiac Rehabilitation Employing Smartphone Technology (I-CREST) system as an alternative to centre-based cardiac rehabilitation (CBCR) in patients with coronary heart disease (CHD). Methods: Patients in the I-CREST arm received a novel home-based I-CREST system: bespoke I-CREST smartphone application and a wearable heart rate monitoring device and were remotely supervised through the I-CREST web portal and weekly telephone calls with a research nurse

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Oral Presentations

Conclusion: Patients with severe anaemia undergoing TAVI had increased comorbidity burden compared to those without. Despite adjustments for comorbidities, these patients had higher all-cause mortality and acute kidney injury but no increased risk of major bleeding after TAVI.

OP-001 SIRENA: A Novel Risk Score for Stratification in Pulmonary Embolism

Dmitry Duplyakov,1 Natalia Cherenanova,1,2 Irina Mullova,1,2 Alexey Erlikh,3,4 Tatiana Pavlova,1,2 Olga Barbarash,5 Evgeniya Schmidt5 and Svetlana Berns6

YIA-012 Validation of Point-of-care Handheld Echocardiography to Assess Diastolic Function in Primary Care Diabetic Patients

1. Samara State Medical University; 2. Samara Regional Cardiology Dispensary; 3. Pirogov Russian National Research Medical University; 4. City Clinical Hospital №29 named after N.E. Bauman; 5. Kuzbass Cardiology Centre; 6. National Medical Research Center for Therapy and Preventive Medicine

Diana Hui Ping Foo,1 Rose Hui Chin Jong,1 Yenny Yen Yen Yeo,1 Mohammad Nor Azlan Sulaiman,1 Macnicholson Igo,1 John Jui PIng Yeo,1 Chanchal Chandramouli,2,3 Wouter Ouwerkerk,3,4 YeeQuant Chung,5 Maila Mustapha,6 Carolyn Su Ping Lam2,3 and Alan Yean Yip Fong1,7

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-001. Correspondence: Dmitry Duplyakov, duplyakov@yahoo.com

1. Clinical Research Centre, Sarawak General Hospital; 2. Duke-NUS Medical School; 3. National Heart Centre Singapore; 4. Department of Dermatology, Amsterdam UMC; 5. Us2.ai; 6. Klinik Kesihatan Jalan Masjid; 7. Sarawak Heart Centre

Objective: To create a new prognostic score for in-hospital mortality risk assessment of patients with PE. Methods: Researcher-driven Independent Russian Registry of Acute Pulmonary Embolism (SIRENA) with enrolment period April 2018 to April 2019, and 20 hospitals from 15 cities of Russia.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):YIA-012. Correspondence: Diana Hui Ping Foo, dianafoo.crc@gmail.com

Objective: To examine the feasibility of a novel AI-enhanced point-of-care handheld echocardiography to assess diastolic function among subjects with diabetes in primary care.

Results: Six hundred and nine patients were enrolled into the SIRENA register (F 50.7%, average age 63.0 ± 14.5 years). Independent predictors for in-hospital mortality risk were LVEF <40%, immobilisation over the last 12 months, creatinine clearance <50 ml/min, syncope, and cyanosis on admission. Each of these factors with a value of 1 point has become a component of the new SIRENA predictive score. With SIRENA score values of 0, 1, 2 and 3 or more points, in-hospital mortality was 3.1%, 7.0%, 16.7% and 40.0%, respectively. Mortality with values <2 points was 5.0%, and with a value of ≥2 points was 24.3% (RR 4.87; 95% CI [2.97–7.98]; p<0.001). Prognostic sensitivity was 62.7% and specificity was 78.5%. The value of the area under the ROC curve for the SIRENA was 0.76 (95% CI [0.69– 0.83]), while for sPESI index was 0.73 (95% CI [0.66–0.80)]. Patients with high risk for both sPESI and SIRENA had mortality of 27.1%, which was significantly higher compared to 13.9% for patients with high risk only for sPESI (RR 1.94; 95% CI [1.36–2.82]; p<0,001), but did not differ significantly from SIRENA: 24.3% (RR 1.11; 95% CI [0.75–1.65]; p=0,78).

Methods: Patients with diabetes (n=70, age ≥40 years) and preserved left ventricular ejection fraction on echocardiography, were prospectively enrolled from primary care. Each patient had echocardiography examinations performed by trained sonographers using both the novel AI-guided handheld echocardiography with AI-automated diastolic function analysis (AI-echo), and conventional cart-based echo with manual diastolic function analysis (CB-echo). The presence versus absence of diastolic dysfunction defined as septal e’ <7cm/s or lateral e’ <10cm/s or left atrial volume index >34ml/m² or E/e’ >14 or tricuspid regurgitation peak velocity >280cm/s or mitral valve E/A ≥2 was compared between AI-echo and CB-echo (as ground truth). Results: AI-echo showed sensitivity of 83.02%, specificity of 76.47%, and diagnostic accuracy of 81.43% in detecting diastolic dysfunction compared to CB-echo procedure. In four patients, AI-echo detected diastolic dysfunction while CB-echo identified absence of diastolic dysfunction (false positives), two patients had lateral e’ measuring close to 10cm/s cut-off comparing AI-echo to CB-echo; two had varying lateral e’ due to suboptimal tissue Doppler signals. In seven patients, AI-echo identified absence of diastolic dysfunction while CB-echo detected diastolic dysfunction (false negatives); similarly, three patients had lateral e’ close to 10cm/s cut-off comparing both procedures; three had varying septal e’ or lateral e’ due to suboptimal tissue Doppler signals. Only one patient with atrial fibrillation had significant differences in left atrial volume index comparing AI-echo to CB-echo procedures. Median time needed to acquire echo images for one AI-echo examination was 4 minutes and 9 seconds.

Conclusion: SIRENA prognostic score has a high accuracy in prediction of in-hospital mortality of patients with PE.

OP-002 Characteristics and Outcome of Out-of-hospital Cardiac Arrest in a Hilly Area in Japan Valeryia Zmushka,1 Goro Tajima,2 Keita Iyama,2 Koichi Hayakawa,2 Yurika Kawazoe,2 Shuntaro Sato2 and Osamu Tasaki1,2

1. Nagasaki University; 2. Nagasaki University Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-002. Correspondence: Valeryia Zmushka, valeryzmushko@gmail.com

Objective: To analyse the characteristics of out-of-hospital cardiac arrest (OHCA) in a hilly area in Japan and investigate prognostic indicators.

Conclusion: AI-enhanced point-of-care handheld echocardiography showed very good diagnostic accuracy in detecting diastolic dysfunction. This finally allows for echocardiography screening at primary care for early detection of diastolic dysfunction in diabetes.

Methods: A retrospective population-based study of the Utstein registry in the Nagasaki medical region (NR) over 10 years (2011 to 2020), which

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Abstracts from 27th Asian Pacific Society of Cardiology Congress included data of 4,203 OHCA patients who were directly transferred from the field and on whom resuscitation was attempted. The main outcome measure was cerebral performance categories (CPC): favourable 1–2. Areas that are not easily accessible for emergency medical service (EMS) due to hilly slopes were named ‘slope areas’ (SA); areas where EMS can park an ambulance close to patients were named ‘accessible areas’ (AA).

1.13; p=0.010), (HR 1.07; 95% CI [1.01–1.14]; p=0.027). Receiver curve operating analysis identified RVFWS of −19.1% and −12.6% in predicting the composite endpoints and HF hospitalisation with an AUC of 0.758 and 0.710, respectively. Conclusion: Both RVFWS and RV4CLS were independently associated with heart failure admission as well as a composite of adverse outcomes in Asian patients with CA.

Results: Although call-to-hospital-arrival time (CHA) in NR was about 1 minute longer than the average in Japan, the outcomes were similar. CHA in SA was longer than in AA: 38.2 versus 36.0 minutes (p<0.001). The average one-month survival with CPC 1–2 was 2.13 times higher in AA (p<0,001). In multivariate logistic regression, prehospital return of spontaneous circulation, initial ECG rhythm, use of automatic cardiopulmonary resuscitation devices (a-CPR) and automated external defibrillators (AED) by bystanders, age group, existence of witness, CHA, gender, and year were associated with neurological outcomes; use of a-CPR devices was associated with poor prognosis. The occurrence in SA was not detected as a prognostic indicator.

OP-004 ND-13: A Small DJ-1-Derived Peptide Mediating Big Events for Acute Cardioprotection Aishwarya Prakash,1,5 Fan Yu,1,2 Shuo Cong,1,2 Siavash Beikoghli Kalkhoran,3 Gustavo E Crespo-Avilan,1,5 Sze Jie Loo,1,5 Dani Offen,4 Chrishan Ramachandra,1,5 Sauri Hernandez-Resendiz1,5 and Derek J Hausenloy1,2,5

1. Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School, Singapore; 2. Yong Loo Lin School of Medicine, National University Singapore, Singapore; 3. The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK; 4. Department of Human Genetics and Biochemistry, Sackler School of Medicine, Felsenstein Medical Research Center, Tel Aviv University, Israel; 5. National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore

Conclusion: Occurrence in SA was not associated with poor prognosis in multivariate analysis. In SA, EMS used a-CPR more often and CHA was longer, which might reflect a poorer prognosis in SA.

OP-003 Prognostic Value of Right Ventricular Strain in Asian Patients with Cardiac Amyloidosis

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-004. Correspondence: Aishwarya Prakash, aishwarya.prakash@u.duke.nus.edu

Novi Yanti Sari, TYW Li, TC Yeo, JWL Yip, KK Poh, WKF Kong, PLF Ng, Ping Chai, YC Lim, WQ Lin, CH Sia and RCC Wong

Background: Reduction in mitochondrial oxidative phosphorylation (OXPHOS) and dysregulation of fission/fusion processes are key events that determine mitochondrial homeostasis and cardiomyocytes (CMs) survival in acute myocardial ischaemia-reperfusion injury (IRI). This study aims to elucidate whether the administration of ND-13, a small peptide based on DJ-1, preserves mitochondrial homeostasis by optimising mitochondrial respiration capacity and modulating the fusion/fission process.

National University Heart Centre Singapore Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-003. Correspondence: Novi Yanti Sari, novitham.md@gmail.com

Background: Recent advances in echocardiography have facilitated the diagnosis and prognostication of cardiac amyloidosis (CA), with left ventricular dysfunction identified by strain imaging being a significant predictor of worse outcomes. However, the role of right ventricular (RV) imaging in assessing prognosis in Asian patients with CA is not well understood. The objective of this study is to investigate whether RV strain can contribute to risk stratification in Asian patients with CA.

Methods: In vitro, ex vivo, and in vivo murine models of IRI were used to elucidate the cardioprotective effect of ND-13. Infarct size, cardiac function, mitochondrial function, oxidative stress, survival signalling pathways and DJ-1 protein levels were assessed.

Methods: This study includes 80 patients diagnosed with CA at a single tertiary centre between 2005 and 2021. CA was diagnosed using a combination of invasive and non-invasive modalities. All routine echocardiographic data were collected. RV strain imaging, including RV 4-chamber longitudinal strain (RV4CLS) and RV free wall strain (RVFWLS), were analysed against endpoints of heart failure (HF) admission, all-cause mortality, and a composite outcome of HF admission and mortality. The RV parameters were analysed separately to avoid collinearity.

Results: In this study, it was demonstrated that ND-13 protects cardiomyocytes against IRI by modulating OXPHOS at the onset of reperfusion. Robust cell protection was reproduced in the in vitro, ex vivo, and in vivo models of IRI, highlighting the efficacy and efficiency of this small peptide in reducing cell death acutely. Basal, maximal, and spare respiratory capacity was significantly increased in CMs treated with ND13, indicating an optimised functioning of the electron transport chain (ETC) complexes, oxygen consumption, and glucose oxidation. It is speculated that ND-13 either directly binds to the ETC complexes to maximise their functionality and/or promotes pyruvate dehydrogenase activity to drive OXPHOS, which ultimately implicates fission/fusion process regulation.

Results: Patients had a mean age of 66±13 years and were predominantly male (63.7%). Light-chain amyloidosis (AL) was the most prevalent at 52.5%. On univariate analysis, RVFWS and RV4CLS demonstrated a significant association with HF admission and tested outcomes, while conventional RV parameters did not. On Cox regression analysis adjusting for amyloid subtype, atrial fibrillation, and LVEF; both RVFWS and RV4CLS remained significantly associated with HF hospitalisations ([HR 1.12, 95% CI 1.01–1.24, p=0.049), (HR 1.16; 95% CI [1.01–1.33]; p=0.036)] and a composite outcome of HF admission and mortality [(HR 1.07; 95% CI 1.02–

Conclusion: These results pointed to ND-13 as a ‘two-hit’ strategy of acute cardioprotection, linking metabolism and mitochondrial fusion/ fission processes. ND-13 protects cardiomyocytes by optimising the mitochondrial respiratory capacity, which might balance the energy demand in reperfused CMs, restoring energy production.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress OP-005 A Novel Speckle-tracking Echocardiography Parameter Considering Left Ventricular Afterload in a Model of Septic Cardiomyopathy

National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-006. Correspondence: Song Ren Shu, shusongren@126.com

Kei Sato,1 Karin Wildi,1,2,3,4 Jonathan Chan,5,6 Chiara Palmieri,7 Nchafatso Obonyo,1,2,8,9 Silver Heinsar,1,2 Keibun Liu,1,2 Samantha Livingstone,1,2 Noriko Sato,1 Carmen Ainola,1,2 Gabriella Abbate,1 Mahé Bouquet,1,2 Emily Wilson,1,2 Margaret Passmore,1,2 Kieran Hyslop,1,2 David Platts,1,5 Jacky Suen,1,2 Gianluigi Li Bassi1,2 and John Fraser1,2

Background: To improve understanding of the pathogenesis of functional tricuspid regurgitation (TR), this study characterised the cellular composition of the tricuspid valve leaflet and identified the molecular alterations of each cell type in valves with functional TR.

1. Critical Care Research Group/The Prince Charles Hospital; 2. Faculty of Medicine, University of Queensland; 3. Department of Intensive Care Medicine, University Hospital Basel; 4. Faculty of Medicine, University of Basel; 5. Cardiology Department, The Prince Charles Hospital; 6. Griffith University, School of Medicine; 7. University of Queensland, School of Veterinary Science; 8. DeAL/KEMRI-Wellcome Trust Research Programme; 9. Wellcome Trust Centre for Global Health Research, Imperial College London

Methods: Single-cell RNA sequencing of tricuspid valve leaflets from 10 patients was performed, including five patients with moderate-tosevere functional TR and five non-diseased controls. Using marker genes identified from single-cell transcriptomes, the spatial distributions of valvular cell states were characterised using multiplexed fluorescence. Joint comparative analyses were used to systematically profile the patterns of aberrant gene expression in functional TR specimens. In silico analyses were performed to document dysregulated cell-to-cell interactions, and predictions were validated with immunostaining. In vitro studies were conducted using primary valvular interstitial cells (VICs) isolated from patients undergoing heart transplantation.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-005. Correspondence: Kei Sato, m02045ks@gmail.com

Background: Conventional echocardiographic parameters often fail to detect septic cardiomyopathy (SCM) due to the decreased left ventricular (LV) afterload and subsequent hyper LV contraction. Left ventricular stroke work index (LVSWI) and afterload-related cardiac performance (ACP) consider LV afterload and could be more sensitive values in SCM; however, the invasive nature or complicated procedure prevents clinical applications. This exploratory study aimed to investigate first, whether the speckle-tracking echocardiography (STE) parameter, pressure-strain product (PSP), can non-invasively predict catheterbased LVSWI, ACP, and serum lactate in a SCM-like model, and second, if PSP can distinguish the subphenotypes of acute respiratory distress syndrome (ARDS), that is, sepsis-like (S) versus non-sepsis-like (NS) groups.

Results: The transcriptional profiles of 84,102 cells were assessed and six major cell clusters were identified, along with 25 cell subtypes, in TR and NC specimens. VICs were the largest population, followed by myeloid cells, lymphocytes, valvular endothelial cells, myoVICs, and mast cells. It was found that VICs and lymphoid cells exhibited more heterogeneity in TR patients. Further analyses demonstrated that VICs exhibited higher transcriptional activity toward matrifibrocyte-like cells and myofibroblastlike cell differentiation, myeloid cells activated immune response and lymphoid cells promoted fibrosis. Enhancement of COMP–CD47 interaction in TR specimens was discovered. In vitro studies, the blockade of COMP-CD47 attenuated the activation and pro-fibrotic remodelling of VICs indicated by decreased cellular migration and decreased expression of fibrotic markers.

Methods: Sixteen adult sheep with ARDS were randomly assigned to either S group (n=8), or NS group (n=8). Pulmonary artery catheter-based LVSWI, ACP and serum lactate were simultaneously measured with transthoracic echocardiography. Two PSP indices were calculated by multiplying the mean arterial blood pressure and either global circumferential strain (GCS) PSPcirc or radial strain (GRS) PSPrad.

Conclusion: This single-cell atlas highlights the transcriptomic heterogeneity underlying the cell functions and interactions in human tricuspid valves and defines molecular and cellular perturbations in functional TR. Targeting the COMP-CD47 interaction might be therapeutic for functional TR by relieving fibrotic remodelling.

Results: Pressure-strain product showed a significant correlation with LVSWI (PSPcirc r2=0.66; p<0.001) and ACP (PSPcirc, r2=0.82; p<0.001) in the S group. Although PSP could not distinguish between ARDS subphenotypes, PSP better predicted LVSWI (PSPcirc, area under the curve [AUC] 0.86), ACP (PSPcirc AUC 0.88) and serum lactate (PSPrad AUC 0.75) than LV ejection fraction, GCS and GRS.

OP-007 SPP1+ Macrophage is a Cellular Target for Alleviating Fibrotic Remodelling of Coronary Perivascular Adipose Tissue Song Ren Shu, Mengxia Fu, Xiao Chen, Ruojin Zhao, Xiaohu Wang and Jiangping Song

Conclusion: A novel STE parameter, PSP based on GCS and GRS, has a potential to non-invasively predict catheter-based LVSWI, ACP and serum lactate in SCM-like condition.

National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-007. Correspondence: Song Ren Shu, shusongren@126.com

OP-006 Single-cell RNA Sequencing Identifies COMP-CD47 Interaction as a Target for Functional Tricuspid Regurgitation

Background: Perivascular adipose tissue (PVAT) is vital for vascular homeostasis and PVAT dysfunction is associated with increased atherosclerotic plaque burden. This study explored the mechanisms underlining coronary PVAT dysfunction in coronary atherosclerosis.

Song Ren Shu, Mengxia Fu, Ruojin Zhao, Xiaohu Wang, Xiao Chen and Jiangping Song

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Methods: Single-cell RNA sequencing was performed of the stromal vascular fraction of coronary PVAT from three groups of heart transplant recipients, including three patients with advanced atherosclerosis, three patients with early atherosclerosis, and four non-atherosclerosis control subjects. Bioinformatics was used to annotate the cellular populations, depict the cellular developmental trajectories and interactions, and explore the differences among three groups of coronary PVAT at the cellular and molecular level. Pathological staining, quantitative realtime polymerase chain reaction, and in vitro studies were performed to validate the key findings.

both cell area and nuclear area. ROS production and caspase-3 expression were increased in the high glucose group. RhoA, ROCK1 and phosphorylation of DRP1(Ser616) were also enhanced. Treatment with fasudil, siRhoA, or siROCK could ameliorate oxidative stress and apoptosis, as well as reduce phosphorylation of DRP1(Ser616).

Results: 10 cell types were identified among 70,447 cells from human coronary PVAT. Several cellular subpopulations, including naive CD4+ T-cells, SPP1+ macrophages, and profibrotic preadipocytes, were accumulated in coronary PVAT surrounding atherosclerotic coronary arteries compared to non-atherosclerosis coronary arteries. The fibrosis percentage was increased in coronary PVAT surrounding atherosclerotic coronary arteries and was positively associated with the burden of coronary artery stenosis. Cellular interaction analysis suggested SPP1 secreted by SPP1+ macrophages interacted with CD44/integrin on fibroadipogenic progenitor cells. In vitro studies showed blockade of CD44 or integrin prevented profibrotic and promigratory activation of fibroadipogenic progenitor cells.

OP-009 A Multicenter Prospective Interventional Trial of Bone Marrow-derived Mononuclear Cell Implantation for Patients with Thromboangiitis Obliterans

Conclusion: RhoA/ROCK1/Drp1 signalling pathway promotes mitochondrial fission in DCM, leading to increased oxidative stress and apoptosis. Drp1(Ser616) may be the regulatory phosphorylation site in diabetic heart.

Takaaki Ozawa,1 Kenji Yanishi,1 Ayumu Fujioka,1 Arito Yukawa,1 Kojiro Imai,2 Isao Yokota,3 Kei Fujikawa,4 Ayumu Yamada,5 Akari Naito,5 Hirofumi Kawamata,1 Yukihito Higashi,6 Tomoaki Ishigami,7 Ken-ichiro Sasaki,8 Syuhei Tara,9 Koichiro Kuwahara,10 Satoshi Teramukai4 and Satoaki Matoba1 1. Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine; 2. Department for Medical Innovation and Translational Medical Science, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; 3. Department of Biostatistics, Graduate School of Medicine, Hokkaido University; 4. Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; 5. The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine; 6. Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University; 7. Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine; 8. Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine; 9. Department of Cardiovascular Medicine, Nippon Medical School of Medicine; 10. Department of Cardiovascular Medicine, Shinshu University School of Medicine

Conclusion: SPP1+ macrophages accumulated in coronary PVAT surrounding atherosclerotic coronary arteries and promoted the profibrotic activation of fibro-adipogenic progenitor cells via SPP1-CD44/ integrin interaction.

OP-008 RhoA/ROCK/Drp1-mediated Mitochondrial Fission to Cardiac Remodelling in Diabetic Cardiomyopathy Dong Juan Wang, Jinyan Zhong and HengDong Li Li Ningbo No.2 Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-008. Correspondence: Dong Juan Wang, wangdongj2007@126.com

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-009. Correspondence: Takaaki Ozawa, oz-tk108@koto.kpu-m.ac.jp

Background: Diabetic cardiomyopathy (DCM) is a clinical condition of cardiac dysfunction, independent of hypertension, coronary artery disease and cardiac valvulopathy. Accumulating evidence has demonstrated that mitochondrial dynamics play a key role in DCM, which is one of the major components in triggering myocardial changes.

Background: Thromboangiitis obliterans (TAO) can develop critical limbthreatening ischaemia (CLTI). Despite conventional treatments, such as smoking cessation or revascularisation, young patients require limb amputation. Therapeutic angiogenesis using bone marrow-derived mononuclear cells (BM-MNC) implantation has demonstrated long-term efficacy and safety in CLTI patients, particularly those with TAO. To put BM-MNC implantation into clinical practice, further evidence is required. This study aimed to determine the efficacy of BM-MNC implantation in a first prospective trial for CLTI patients with TAO.

Methods: There is no effective treatment to prevent cardiac remodelling in DCM at present. Phosphorylation was one of the major post-translational modifications for Drp1, which regulated mitochondrial fission. This study investigated whether RhoA/ROCK1/Drp1 signal pathway mediates mitochondrial fission and is linked to myocardial fibrosis and cardiac remodelling in DCM.

Methods: This multicentre, prospective, interventional trial was performed under an advanced medical care programme. Patients with no-option CLTI caused by TAO with skin perfusion pressure (SPP) <30 mmHg were enrolled into the study. BM-MNCs implantation was performed within 28 days. Patients were refractory or could not adapt to conventional standard treatments, such as drug therapy, endovascular treatment (EVT) or bypass surgery. The follow-up period was 180 days and the primary endpoint was an improvement in the mean SPP value in the affected target limb 180 days after implantation.

Results: DCM rats were induced by a high-fat diet combined with STZ injection. Experimental DCM exhibited increased interstitial collagen deposition, mitochondrial injury, oxidative stress and apoptosis, which were significantly ameliorated by fasudil treatment. Expression of RhoA, ROCK1 and phosphorylation of DRP1(Ser616) were enhanced in DCM, which were decreased after fasudil treatment. There was a significant prolongation in CTD90 in DCM. Moreover, myocardial cells were cultured in normal or high glucose medium. Exposure to high glucose increased

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Results: One patient dropped out of the follow-up and a total of 21 patients enrolled from October 2017 to September 2021 were finally analysed. The mean age was 47.6 years (male, 90.5%; Fontaine classification IV, 57.1%). The mean SPP value significantly improved on day 180 (p<0.001). This effect was sustained at the long-term period of 180 days. In addition, the secondary endpoints (numerical rating scale scores and transcutaneous oxygen pressure values) significantly improved on day 180. No serious adverse events related to BM-MNC implantation occurred. The three-year major amputation-free and overall survival probabilities were 95.5% and 89.5%, respectively. The clinical outcomes of BM-MNC implantation were comparable to those of EVT or bypass surgery based on previous reports.

Conclusion: There is high prevalence of OSA in an Asian population with hypertension and high cardiovascular risk. Age and BMI are independent predictors of OSA.

OP-011 Clinical Frailty and Vascular Endothelial Growth Factor C in Heart Failure: The PREHOSP-CHF Study

Moritake Iguchi,1 Hiromichi Wada,1 Tsuyoshi Shinozaki,2 Masahiro Suzuki,3 Yoichi Ajiro,4 Morihiro Matsuda,5 Akihiro Koike,6 Tomomi Koizumi,7 Masatoshi Shimizu,8 Yujiro Ono,9 Takashi Takenaka,10 Satoru Sakagami,11 Yukiko Morita,12 Kazuteru Fujimoto,13 Kazuya Yonezawa,14 Kazuro Yoshida,15 Akiyo Ninomiya,16 Toshihiro Nakamura,17 Junichi Funada,18 Yutaka Kajikawa,19 Yoshifumi Oishi,20 Toru Kato,21 Kazuhiko Kotani,22 Mitsuru Abe,1 Masaharu Akao1 and Koji Hasegawa1

Conclusion: BM-MNCs implantation may become a safe and effective treatment selection for CLTI patients with TAO.

OP-010 Prevalence and Predictors of Obstructive Sleep Apnoea in Chinese Patients with Hypertension and High Cardiovascular Risk

1. Kyoto Medical Center; 2. Sendai Medical Center; 3. Saitama Hospital; 4. Yokohama Medical Center, 5. Kure Medical Center; 6. Fukuokahigashi Medical Center; 7. Mito Medical Center; 8. Kobe Medical Center; 9. Higashihiroshima Medical Center; 10. Hokkaido Medical Center; 11. Kanazawa Medical Center; 12. Sagamihara Hospital; 13. Kumamoto Medical Center; 14. Hakodate Hospital; 15. Nagasaki Hospital; 16. Nagasakikawadana Medical Center; 17. Kyushu Medical Center; 18. Ehime Medical Center; 19. Fukuyama Medical Center; 20. Higashitokushima Medical Center; 21. Tochigi Medical Center; 22. Jichi Medical University

Yi Hui Ou,1 Juliana Colpani,1 Siew Pang Chan,1 Weiqiang Loke,1 Crystal Cheong,4 William Kong,2 Calvin Chin,3 Pipin Kojodjojo,2 Philip Wong,5 Peter Cistulli6 and Chi Hang Lee2 1. National University of Singapore; 2. National University Heart Centre Singapore; 3. National Heart Center Singapore; 4. National University Hospital; 5. Raffles Hospital; 6. Royal North Shore Hospital

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-011. Correspondence: Moritake Iguchi, moritake.igu@gmail.com

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-010. Correspondence: Yi Hui Ou, mdcyhui@nus.edu.sg

Background: Frailty is a critical problem in heart failure (HF). Vascular endothelial dysfunction is involved in the pathogenesis of HF and is considered to be the cause of frailty. This study investigated the association of vascular endothelial growth factor (VEGF) families with frailty in HF.

Background: Hypertension is a major cardiovascular risk factor and optimal blood pressure (BP) control is important. Obstructive sleep apnoea (OSA) is highly prevalent, and it is the most common secondary cause for hypertension. OSA therapy using continuous positive airway pressure (CPAP) has been shown to reduce BP. However, CPAP is poorly accepted and tolerated. Mandibular advancement device (MAD) is an alternative treatment for OSA. The CRESCENT trial was designed to determine the relative efficacy of MAD versus CPAP on BP control in Chinese patients with OSA, hypertension and high cardiovascular risk.

Methods: This was a multicentre prospective cohort study to determine the predictive value of VEGF families for prognosis among patients with HF. A total of 1,024 patients (mean age, 75.5 years; 58.7% male) were included in the analyses. Serum levels of VEGF, VEGF-C and VEGF-D were measured. Frailty was assessed by Canadian Study of Health and Aging Clinical Frailty Scale (CFS).

Methods: Chinese patients with OSA and hypertension with high cardiovascular risk were recruited to undergo an in-laboratory polysomnography (PSG). Patients with OSA (apnoea-hypopnoea index ≥15 events/hour) were randomised into the CPAP or MAD group at a 1:1 ratio. The primary endpoint was the difference in mean BP between 6 months and baseline. The secondary endpoints included other BP parameters, heart rate, biomarkers, cardiac magnetic resonance, and quality of life questionnaires.

Results: A total of 256 (25.1%) patients had frailty (CFS ≥5) at baseline. Frail patients were older, more likely female, and had higher levels of NTproBNP, high sensitivity troponin I, and high sensitivity C-reactive protein. During the two-year follow-up, frail patients showed significantly higher incidence of all-cause death (HR 4.12; 95% CI [3.14–5.42]). Regarding VEGF families, frail patients had significantly lower levels of VEGF-C, and higher levels of VEGF-D. Multiple regression analysis revealed that VEGF-C was inversely correlated and VEGF-D was positively correlated with CFS. After adjusting for clinical confounders, low VEGF-C level was independently associated with all-cause death in frail patients (HR 0.74; 95% CI [0.58–0.94] for 1-SD increase).

Results: The CRESCENT trial commenced recruitment in October 2019. Among the 3,479 patients assessed, 321 patients were eligible and consented to participate. A total of 306 patients had validated PSG results, of which 220 patients had OSA, giving an OSA prevalence of 71.9%. Compared with the non-OSA group, the OSA group were more likely to be male, have significantly higher BMI, neck circumference and waist-hip ratio. There was no significant difference in the cardiovascular risk factors, other concomitant conditions, number of antihypertensives and types of medications between the OSA and non-OSA group. Using logistic regression, only age (p=0.006) and BMI (p=0.003) were shown to independently predict OSA.

Conclusion: In HF patients, a low VEGF-C value was associated with frailty and was an independent risk for all-cause death in frail patients.

OP-012 A Neonatal Rat Model of Pulmonary Vein Stenosis De Bao Li,1 Lisheng Qiu,1 Haifa Hong,3 Hao Chen,1 Peibin Zhao,2 Yingying Xiao,3 Hao Zhang,2,4 Qi Sun1 and Lincai Ye1,4,5

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Clinical observation indicates that exercise capacity, an important determinant of survival in patients with congenital heart disease (CHD), is most decreased in children with reduced pulmonary blood flow (RPF). However, the underlying mechanism remains unclear. Human RPF lung samples were obtained from children with tetralogy of Fallot as well as piglet and rat RPF lung samples from animals with pulmonary artery banding surgery. Impaired alveolarisation and vascularisation, the main characteristics of pulmonary dysplasia, were observed in the lungs of RPF infants, piglets, and rats. RPF caused smaller lungs, cyanosis, and body weight loss in neonatal rats and reduced the number of alveolar type 2 cells. RNA-seq demonstrated that RPF induced the downregulation of metabolism and migration, a key biological process of late alveolar development, and the upregulation of immune response, which was confirmed by flow cytometry and cytokine detection. In addition, the immunosuppressant cyclosporine A rescued pulmonary dysplasia and increased the expression of the Wnt signalling pathway, which is the driver of postnatal lung development. It was concluded that RPF results in pulmonary dysplasia, which may account for the reduced exercise capacity of CHD patients with RPF. The underlying mechanism is associated with immune response activation, and immunosuppressants have a therapeutic effect in CHD-associated pulmonary dysplasia.

1. Department of Thoracic and Cardiovascular Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; 2. Children’s Heart Center, Institute of Cardiovascular Development and Translational Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China; 3. Department of Thoracic and Cardiovascular Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; 4. Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 5. Institute of Pediatric Translational Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-012. Correspondence: De Bao Li, lidebao@sjtu.edu.cn

Background: Pulmonary vein stenosis (PVS), one of the most challenging clinical problems in congenital heart disease, leads to secondary pulmonary arterial hypertension (PAH) and right ventricular (RV) hypertrophy. Due to the lack of a rodent model, the mechanisms underlying PVS, and its associated secondary effects are largely unknown, and treatments are minimally successful. This study created a neonatal rat PVS model with the aim of increasing understanding of the mechanisms and possible treatments for PVS.

OP-014 Understanding the Cardiology Training Landscape in Asia-Pacific

Methods: PVS was created at postnatal day 1 (P1) by banding pulmonary veins that receive blood from the right anterior and mid lobes. The condition was confirmed using echocardiography, computed tomography (CT), gross anatomic examination, haematoxylin and eosin (H&E) staining, and immunofluorescence. Lung and RV remodelling under the condition of PVS were evaluated using H&E staining and immunofluorescence.

Fathima Aaysha Cader,1 Wishnu Aditya Widodo,2 Mohammed Al-Omary,3 Lucky Cuenza,4 Derek Lee Pok Him,5 Misato Chimura,6 Raja Ezman Raja Shariff,7 Purich Surunchupakorn,8 Wei-Ting Chang,9 Faisal Habib,10 Bernard Wong,11 Amit Omprakash Singh,12 Vorn Malis,13 DongHyuk Cho,14 Juwairia Alali,15 Gary Gan,16 Arun Maskey,17 U I Hewarathna,18 Phan Tuan Dat,19 Zill-e Huma,20 Francis Lim,21 Negar Saleh,22 Satoshi Honda,23 Ganchimeg Ulziisaikhan,24 Tan Chen Ting,25 Samshol Sukahri,26 Do Van Chien,27 Akmal H Arshad,28 Jack Tan29 and Jonathan Yap29

Results: At P21, echocardiography revealed a change in wave form and a decrease in pulmonary artery acceleration time (indicators of PAH) at the transpulmonary valve site in the PVS group. CT at P21 showed a decrease in pulmonary vein diameter in the PVS group. At P30 in the PVS group, gross anatomic examination showed pulmonary congestion, H&E staining showed wall thickening and lumen narrowing in the upstream pulmonary veins, and immunofluorescence showed an increase in the smooth muscle layers in the upstream pulmonary veins. In addition, at P30 in the PVS group, lung remodelling was evidenced by hyperaemia, thickening of pulmonary small vessel walls and smooth muscle layers, and reduction of the number of alveoli. RV remodelling was evidenced by an increase in RV free-wall thickness.

1. Ibrahim Cardiac Hospital & Research Institute; 2. Jakarta Heart Center; 3. The Maitland and John Hunter Hospitals; 4. Philippine Heart Center; 5. Queen Elizabeth Hospital; 6. Osaka University Graduate School of Medicine; 7. UiTM Sungai Buloh; 8. Central Chest Institute of Thailand; 9. Chi-Mei Medical Center; 10. Adam Malik General Hospital Medan; 11. North Shore Hospital; 12. King Edward Memorial Hospital, Mumbai; 13. Calmette Hospital; 14. Korea University College of Medicine; 15. Rashid Hospital, Dubai Academic Health Corporation; 16. Blacktown Hospital; 17. Shahid Gangalal National Heart Centre, Kathmandu; 18. Teaching Hospital Ratnapura; 19. Hanoi Medical University Vietnam National Heart Institute; 20. National Institute of Cardiovascular Diseases, Karachi; 21. RIPAS Hospital; 22. Mt Sinai Hospital; 23. National Cerebral and Cardiovascular Center; 24. National Cardiovascular Center of the Third State Central Hospital in Mongolia; 25. Sarawak Heart Centre, Malaysia; 26. University Malaya Medical centre; 27. Central military hospital, Hanoi; 28. Gleneagles Kuala Lumpur; 29. National Heart Centre

Conclusion: A neonatal rat model of PVS was successfully established, showing secondary lung and RV remodelling. This model may serve as a useful platform for understanding the mechanisms and treatments for PVS.

OP-013 Congenital Heart Disease: Associated Pulmonary Dysplasia and its Underlying Mechanisms

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-014. Correspondence: Fathima Aaysha Cader, aaysha.cader@gmail.com

Lin Cai Ye and Debao Li

Shanghai Children’s Medical Center

Background: Diversity in cardiology training and credentialing pathways in the Asia-Pacific exist. The aim was to map these variations and report similarities and disparities among the regions.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-013. Correspondence: Lin Cai Ye, YLC717@163.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Methods: The Asian Pacific Society of Cardiology (APSC) represents 22 cardiology societies in the region. A 42-item online questionnaire was distributed to a credentialed cardiologist serving as a representative from each of the APSC member regions, allowing obtainment of region-specific data.

and metabolic health in AMI patients using data from a multi-ethnic national AMI registry. Methods: A total of 73,382 AMI patients from the national Singapore Myocardial Infarction Registry (SMIR) were included. These patients were classified into four groups based on the presence or absence of metabolic diseases, diabetes mellitus, hyperlipidaemia, and hypertension, and obesity: metabolically-healthy-normal-weight (MHN); metabolicallyhealthy-obese (MHO); metabolically-unhealthy-normal-weight (MUN); and metabolically-unhealthy-obese (MUO).

Results: Responses were derived from a total of 22 APSC member regions. All regions required specialist qualification to practice cardiology: 50% have a single training pathway, while 22.7% and 27.3% have two or three pathways, respectively. 50% countries awarded an MD at training completion, while 36.5% awarded fellowship not culminating in a degree. 90.9% regions had structured cardiology training curricula with assigned supervisor and regular assessments. 19 of 22 regions required mandatory training in internal medicine prior to cardiology, which was 3 years, 2 years and 1 year in 10, 6 and 2 of the regions, respectively Overall training duration towards becoming a cardiologist varied (range 3–10 years), 31.8% was 5 years, with 18.2% each being 6 and 7 years. The majority of programmes had mandatory clinical cardiology (81.8%), interventional cardiology (81.8%), pacing/ electrophysiology (68.2%) and imaging (68.2%) training. Although the majority trained physicians in coronary angiography, PCI, pericardiocentesis, temporary pacing, trans-thoracic and transoesophageal echo, over two-thirds of regions had no training in coronary CT and CMR. 68.2% required mandatory research for board certification. 77.3% had an exit exam at completion of training (local in 86.4% cases). The European Examination in Core Cardiology was offered in 63.6% of regions. Board certification was mandatory for general cardiology practice in 72.7% regions. Separate subspeciality fellowships were mandatory in 75% of regions.

Results: MHO patients had reduced unadjusted risk of all-cause inhospital, 30-day, 1-year, 2-year, and 5-year mortality following the initial MI event. However, after adjusting for potential confounders, the protective effect from MHO on post-AMI mortality was lost. Furthermore, there was no reduced risk of recurrent MI or stroke within 1-year from onset of AMI by the MHO status. However, the risk of 1-year mortality was higher in female and Malay AMI patients with MHO compared to MHN even after adjusting for confounders. Conclusion: In AMI patients with or without metabolic diseases, the presence of obesity did not affect mortality. The exception to this finding were female and Malay MHO who had worse long-term AMI mortality outcomes when compared to MHN suggesting that the presence of obesity in female and Malay patients may confer worsened outcomes.

OP-016 Diabetes Mellitus is Associated with Coronary Plaque Volume from Coronary Computed Tomography Angiography

Conclusion: Significant regional variations in cardiology training and credentialing pathways exist, presenting opportunities to harmonise and improve training metrics regionally.

OP-015 Body Mass Index, Metabolic Health Status and Prognosis in Myocardial Infarction Patients: National Registry-based Study

1. National Heart Centre Singapore; 2. Duke-NUS Medical School; 3. Department of Diagnostic Imaging, National University Hospital; 4. Yong Loo Lin School of Medicine, National University of Singapore; 5. Tan Tock Seng Hospital; 6. Department of Cardiology, National University Heart Centre; 7. Department of Surgery, National University Hospital; 8. National University Health System; 9. Bioinformatics Institute, Agency for Science, Technology and Research; 10. Institute for Infocomm Research, Agency for Science, Technology and Research

Junsuk Ko,1 Ching-Hui Sia,2 Huili Zheng,3 Andrew Fu-Wah Ho,4 David Foo,6 Ling-Li Foo,3 Patrick Zhan-Yun Lim,7 Boon Wah Liew,8 Ping Chai,2 Tiong-Cheng Yeo,2 James WL Yip,2 Terrance Chua,5 Mark Yan-Yee Chan,2 Jack Wei Chieh Tan,5 Heerajnarain Bulluck9 and Derek J Hausenloy2 1. Duke-NUS Medical School; 2. Department of Cardiology, National University Heart Centre Singapore, Singapore; 3. Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore; 4. SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore; 5. Department of Cardiology, National Heart Centre Singapore, Singapore; 6. Tan Tock Seng Hospital, Singapore, Singapore; 7. Khoo Teck Puat Hospital, Singapore, Singapore; 8. Changi General Hospital, Singapore; 9. Leeds Teaching Hospital NHS Trust, Leeds, UK

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-016. Correspondence: Shuang Leng, leng.shuang@nhcs.com.sg

Background: To investigate the relationship between diabetes mellitus (DM) and coronary plaque detected on coronary computed tomography angiography (CCTA) in patients with coronary artery disease. Methods: This is a multicentre study which performs CT scans in 5,000 patients (APOLLO study NCT05509010). In the current stage of the study, a subset of 276 patients (60 ± 10 years; 79 female; 75% Chinese, 18% Indian/Malay, 7% other) underwent semiautomated CCTA analysis, which involved segmenting the lumen and arterial wall and quantifying the plaque characteristics. Plaque composition was classified as necrotic core, fibro-fatty, fibrous, and calcified, using the following Hounsfield unit strata: −30 to 30, 31 to 130, 131 to 350, and more than 350, respectively.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-015. Correspondence: Junsuk Ko, junsuk_ko@alumni.brown.edu

Background: Obesity is an important risk factor for acute myocardial infarction (AMI), but the interplay between metabolic health and obesity on AMI mortality has been controversial. In this study, the aim was to elucidate the risk of short- and long-term all-cause mortality by obesity

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Results: Of the 276 patients, 62 (22%) were diagnosed with DM. Patients with DM had significantly higher total plaque volume (median [IQR] 1,004 [448–1,487] versus 615 [229–1,125] mm³, p=0.001), fibrous plaque volume (348 [178–598] versus 230 [91–426] mm³, p=0.005), and calcified plaque volume (209 [87, 505] versus 104 [19, 294] mm³, p<0.0001) compared with patients without DM. After adjusting for age, gender, hypertension, hyperlipidaemia, and obesity, DM was identified as a significant risk factor for increased plaque volume in a multivariable analysis. Patients with DM had a mean total plaque volume that was 210 mm³ higher than patients without DM (estimate 210, 95% CI [35–386]; p=0.019), after controlling for the same confounders.

Conclusion: Obesity and hypertension were significantly associated with increased EAT volume, highlighting the importance of managing obesity and hypertension to reduce cardiovascular risk.

Conclusion: DM is significantly associated with higher plaque volume, which may increase the risk of atherosclerosis complications.

Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University, Japan

OP-018 Effect of Smoking Initiation Age in Young Adulthood on Nicotine Dependency

Swati Mittal, Maki Komiyama, Yuka Ozaki, Hajime Yamakage, Noriko Satoh-Asahara, Hiromichi Wada, Akihiro Yasoda, Masafumi Funamoto, Yasufumi Katanasaka, Yoichi Sunagawa, Tatsuya Morimoto, Yuko Takahashi, Takeo Nakayama and Koji Hasegawa

OP-017 Association Between Epicardial Adipose Tissue Volume and Cardiac Risk Factors in Coronary Artery Disease Patients

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-018. Correspondence: Swati Mittal, drsm78@gmail.com

Background: Despite the extensive reporting of adverse effects of smoking on cardiovascular health, many smokers find smoking cessation difficult because of nicotine dependency. Smoking initiation in early adolescence leads to such difficulties; but few studies have examined the effects of smoking initiation at 20 years or older. This study examined the effect of age at smoking initiation on smoking cessation rate, nicotine dependency, cardiovascular risk factors and psychological status with a cut-off point of 20 years, the legal age of smoking in Japan.

Shuang Leng,1,2 Nur Amirah Syahindah Raffiee,1 Lynette Teo,3,4 Min Sen Yew,5 Mark Yan-Yee Chan,4,6 Kee Yuan Ngiam,4,7,8 Yan Ting Loong,1 Liza Suk Ha Ho,1 Hwee Kuan Lee,9 Weimin Huang,10 Roger Vaughan,2 Terrance Chua,1,2 Swee Yaw Tan,1,2 Lohendran Baskaran1,2 and Liang Zhong1,2 1. National Heart Centre Singapore; 2. Duke-NUS Medical School; 3. Department of Diagnostic Imaging, National University Hospital; 4. Yong Loo Lin School of Medicine, National University of Singapore; 5. Tan Tock Seng Hospital; 6. Department of Cardiology, National University Heart Centre; 7. Department of Surgery, National University Hospital; 8. National University Health System; 9. Bioinformatics Institute, Agency for Science, Technology and Research; 10. Institute for Infocomm Research, Agency for Science, Technology and Research

Methods: The study included 1,382 smokers at a smoking cessation at an outpatient clinic. Clinical indicators, including smoking initiation age were assessed by adjusting for age at hospital visit and sex. This study was approved by the ethics committee of National Hospital Organization of Kyoto Medical Centre.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-017. Correspondence: Shuang Leng, leng.shuang@nhcs.com.sg

Results: The group with smoking initiation age <20 years reported a higher number of cigarettes/day (p=0.002), respiratory carbon monoxide levels (p<0.001), self-rating depression scale score (p=0.014), Fagerström test of nicotine dependence (FTND) score (p<0.001), and lower successful smoking cessation rate (OR 0.711; 95% CI [0.552–0.917] than the group with initiation age ≥20 years. The group with smoking initiation age at 20 or 21 years reported a higher FTND score (p<0.001) and lower diastolic blood pressure (p<0.05) than the group with the initiation age of ≥22 years.

Background: This study aimed to investigate the association between epicardial adipose tissue (EAT) volume and cardiac risk factors in a large, multicentre cohort of patients with coronary artery disease (CAD). Methods: The study included 879 patients with CAD (58 ± 11 years; 294 women; 72% Chinese, 20% Indian/Malay, 8% other) (APOLLO study NCT05509010). EAT volume and coronary artery calcification (CAC) score were measured using non-contrast computed tomography. Among these patients, 52% had hypertension, 19% had diabetes, 69% had hyperlipidaemia, and 31% had obesity. Patients were categorised into five groups based on the presence and number of cardiac risk factors, which included hypertension, diabetes, hyperlipidaemia, and obesity.

Conclusion: Further increasing the legal age for purchasing tobacco to 22 years or older is likely to lead to an additional reduction in nicotine dependence and possible decrease in cardiovascular morbidity.

OP-019 Direct Oral Anticoagulants versus Warfarin in Low-risk Atrial Fibrillation: Systematic Review and Meta-analysis

Results: EAT volume was positively correlated with age (r=0.261, p<0.0001), BMI (r=0.378, p<0.0001), and CAC score (r=0.151, p<0.0001). A significant positive association was observed between EAT volume and number of cardiac risk factors. Multivariable analysis adjusted for age and gender showed that the presence of obesity and hypertension were independently associated with EAT volume. After controlling for the same confounders, the mean EAT volume for patients with obesity was 35 mm³ higher than for patients without obesity (estimate 35, 95% CI [28, 42], p<0.0001). Similarly, patients with hypertension had a mean EAT volume that was 6.7 mm³ higher than that of patients without hypertension (estimate 6.7, 95% CI [0.2, 13.1], p=0.043).

Khi Yung Fong,1 Yiong Huak Chan,1 Colin Yeo,2 Gregory Lip3 and Vern Hsen Tan2

1. Yong Loo Lin School of Medicine, National University of Singapore; 2. Department of Cardiology, Changi General Hospital; 3. Liverpool Centre for Cardiovascular Science, University of Liverpool Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-019. Correspondence: Colin Yeo, drcolinyeo@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Background: Pivotal trials comparing direct oral anticoagulants (DOAC) against warfarin in patients with atrial fibrillation (AF) have predominantly involved patients with high stroke risk. This study aimed to evaluate the efficacy and safety of DOAC versus warfarin in patients with low stroke risk.

amplitude significantly reduced from supine (-4.31 ± 4.62 mV) to prone (1.28 ± 1.56, p<0.001). New Q-waves were noted in prone. ST-segment/T wave, and arrhythmia detection were unchanged. Prone position was less reliable in detecting anterior MI and LVH. Conclusion: The interpreting physician should be aware of the significant increase in heart rate with prone position and consequent decrease in PR-/QT-intervals. Furthermore, there is significant change in axis due to the anatomic shift in the heart’s position when lying prone. However, prone ECG maintains its utility in detecting ST-segment/T wave abnormalities and is reliable in distinguishing sinus from non-sinus rhythms. It therefore remains a valuable non-invasive screening tool in patients requiring prone ventilation.

Methods: An online literature search was conducted to retrieve studies comparing clinical outcomes between patients treated with DOAC versus warfarin for AF, reporting outcomes for patients at low or minimal risk of stroke (CHA2DS2-VASc scores 0–2 or CHADS2 scores 0 –1). The primary outcome was the occurrence of stroke or systemic embolism. Secondary outcomes included major bleeding, intracranial haemorrhage (ICH) and all-cause mortality. HRs for all outcomes were pooled in random-effects meta-analyses. A network meta-analysis (NMA) of individual DOACs versus warfarin was also conducted.

OP-022 Deep Learning for Enhancement of Echocardiographic Prediction of Left Ventricular Ejection Fraction: The DEEP-EF Study

Results: Eleven studies (132,980 patients) were included. DOAC was associated with a significantly lower risk of stroke or systemic embolism (HR 0.85; 95% CI [0.75-0.96]; p=0.008, I2=0%), major bleeding, ICH, and mortality compared to warfarin. This benefit persisted even when study arms which had CHA2DS2-VASc scores of 2 were excluded. When restricted to three studies investigating only patients with a single non-sex-related stroke risk factor, significant benefit was seen only for the outcome of major bleeding. In the NMA, only dabigatran was superior to warfarin for all four outcomes.

Jose Donato Magno,1,2 Frank Tally Cabuco,3 Rani Ailyna Domingo,2 Nathaniel Orillaza1,2 and Prospero Naval3

1. University of the Philippines College of Medicine; 2. University of the Philippines-Philippine General Hospital; 3. Department of Computer Science, University of the Philippines Diliman Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-022. Correspondence: Jose Donato Magno, jamagno1@up.edu.ph

Conclusion: DOACs should be the standard of care in low-risk AF patients who require anticoagulation. Dabigatran appears to have the best balance of stroke prevention and reduction in major bleeding.

Background: Echocardiographically determined ejection fraction (EF) remains one of the most valuable and practical metrics to estimate left ventricular (LV) systolic function. Standard methods for EF assessment, however, can be time-consuming, operator-dependent, and error-prone. Moreover, semantic segmentation of 2D echocardiography often deals with low-quality, low-contrast images, especially in challenging and limited resource settings. The objective was to create a deep learning framework for LV segmentation and EF estimation using two cardiac views that match or even outperform current single-view state-of-the-art models.

OP-021 Impact of Prone Position on 12-Lead Electrocardiogram Interpretation: A Comparison of Supine and Prone Electrocardiogram Joseph Lawrence Ponciano, Ramon Miguel Rivera and Luigi Pierre Segundo The Medical City Philippines

Methods: Using two echocardiographic views, we developed a novel end-to-end deep learning framework with two architectures to estimate EF: analysis segmentation and action-recognition. The models were then trained using the Cardiac Acquisitions for Multistructure Ultrasound Segmentation (CAMUS) data set, composed of 1,000 fully annotated echocardiography videos. This open access data set provided ground truth masks of various LV regions to allow measurement of geometric and clinical performance metrics (dice score, mean surface distance, and runtime performance, mean absolute error) for the model.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-021. Correspondence: Joseph Lawrence Ponciano, joloponciano@gmail.com

Background: Proning, as a lung recruitment strategy in the management of ARDS, has increased utility due to worldwide burden of COVID-19. Recent data suggests that patients in prone position have greater risk of cardiac complications on top of established myocardial injury brought about by SARS-COV-2 infection. This makes screening for early detection of such problems invaluable. Objective: Establish correlation between standard and prone-position ECG provides an easy and quick non-invasive screening tool in managing these patients.

Results: The segmentation model, channel-separated and dilated denseUnet (CDDenseUnet), was able to predict segmented frames, outperforming current state-of-the-art (SOTA) architectures in terms of dice score, mean surface distance, and run-time performance, reaching scores of 95.2%, 1.2 mm, and 0.02 seconds, respectively. Meanwhile, our prediction model, Two-Channel R(2+1)d, could analyse segmented LV regions in apical 2-chamber (A2C) and apical 4-chamber (A4C) views, producing better results than traditional EF estimation with a mean absolute error of 3.8%.

Methods: Cross-sectional study of 42 adult patients aged 18 years or older. ECGs were performed in standard and prone positions. Results: Mean heart rate was higher in prone (75.69 ± 13.21 bpm) compared with supine (73.55 ± 13.63 bpm, p=0.025). PR interval, QRS duration and QTc were reduced in prone position. QRS axis deviated leftward in prone (21.50 ± 41.96) versus supine (27.12 ± 39.36, p=0.005) and the P-wave axis shifted to the left in prone (35.18 ± 25.45). Septal QRS

Conclusion: The new model marries the advantages of current SOTA techniques with traditional yet widely accepted methods of EF estimation

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Abstracts from 27th Asian Pacific Society of Cardiology Congress OP-024 The Favourable Effect of Transcatheter Aortic Valve Implantation on Healthcare Costs in Frail Patients

using two cardiac views. When benchmarked against existing methods, the CDDenseUnet model outperformed most methods in the majority of metrics without sacrificing speed of calculation. Such a new model can improve clinical decision-making through timely and accurate estimation of LV systolic function.

Minju Han,1 Jeehoon Kang,1 So-Jeong You,2 JinKyung Jeon,2 Sol Kwon,2 Jung-Kyu Han,1 Han-Mo Yang,1 Kyung Woo Park,1 Bon-Kwon Koo1 and Hyo-Soo Kim1

OP-023 Association Between High Clinical Risk and Platelet Reactivity and Clinical Outcomes in Coronary Artery Disease

1. Seoul National University Hospital; 2. Medtronic Korea Ltd Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-024. Correspondence: Minju Han, hanminju.im.hi@gmail.com

Sung Joon Park,1 Jeehoon Kang,1 Doyeon Hwang,1 Jung-Kyu Han,1 Han-Mo Yang,1 Kyung Woo Park,1 Jung-Won Suh,2 Young-Hoon Jeong,3 Bon-Kwon Koo1 and Hyo-Soo Kim1

Background: Frailty is a risk factor for disability and mortality following cardiac procedures, causing increased vulnerability to stressors. This study aimed to evaluate the impact of frailty, as measured by the Hospital Frailty Risk Score (HFRS), on post-procedural mortality and resource use in transcatheter aortic valve implantation (TAVI) patients.

1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital; 2. Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital; 3. CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine

Methods: A retrospective study was conducted using National Health Insurance Service (NHIS) database identifying TAVI patients between 2015 and 2019. Patients were classified into low, intermediate, and high frailty groups based on HFRS, calculated with ICD-10 codes up to two years before the procedure. Medical costs, number of admissions and length of hospital stay were compared pre- and post-TAVI. Survival analysis and log-rank test were performed to assess all-cause mortality, cardiovascular mortality, atrial fibrillation (AF), and stroke.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-023. Correspondence: Sung Joon Park, ulysseshk0921@gmail.com

Objective: To evaluate the additive value of platelet reactivity on clinical risk factors in predicting adverse clinical outcomes after PCI in a large east Asian population.

Results: 2,085 patients were included in the analysis (mean age 79.7 ± 5.6 years; 47.1% male). The high frailty group had the oldest patients, highest proportion of women, and most comorbidities. Postprocedural medical costs decreased significantly in highly frail patients (8,668 ± 12,527 to 7,127 ± 12,405 KRW, p<0.001). Number of admissions decreased in the intermediate and high frailty groups (0.95 ± 1.45 to 0.93 ± 1.97 in intermediate and 1.78 ± 2.18 to 1.25 ± 2.34 in high, p<0.001), while postTAVI length of hospital stays decreased in all groups (33.56 ± 35.69 to 30.49 ± 37.36 in low, 55.95 ± 44.72 to 44.95 ± 49.47 in intermediate, and 84.69 ± 58.66 to 60 ± 64.6 in high, p<0.001). All-cause and cardiovascular deaths occurred more in the intermediate and high frailty groups (p<0.0001 for all-cause, p=0.076 for cardiovascular death), while AF and stroke incidences were similar among groups.

Methods: In a prospective, multicentre registry from 32 centres in Korea 13,160 patients who received PCI between 2003 and 2018 were included. Clinical risk factors were evaluated based on the TIMI (thrombolysis in myocardial infarction) risk score for secondary prevention (TRS2P) and platelet reactivity was measured by the platelet reactivity unit (PRU) using the VerifyNow assay. The primary outcome was a composite of all-cause death, myocardial infarction (MI) and ischaemic stroke at 5-year follow-up. Secondary outcomes were the individual components of primary outcome and major bleeding during the follow-up period. Results: Among the total population, the PRU value was available in 11,714 (89.0%) patients. Mean values of the PRU and TRS2P were 217.8 ± 78.7 and 1.56 ± 1.12, respectively. During the 5-year follow-up period, the primary outcome occurred in 695 (5.9%) patients. By the ROC analysis, PRU had additive value on TRS2P for predicting the primary outcome (AUC 0.665 versus 0.654, p<0.001, for TRS2P and TRS2P+PRU, respectively). The entire population was classified into four groups using 252 for PRU, which determined the high PRU (HPR [PRU ≥252]) and low PRU group (LPR [PRU<252]), and 3 points for TRS2P, which established the high TRS2P (HTR [≥3/9 TRS2P]) and low TRS2P group (LTR [0–2/9 TRS2P]). The 5-year KM estimates of the primary outcome in the four groups were 3.2% (135/4256) versus 4.9% (98/1987) versus 7.1% (246/3457) versus 10.7% (216/2014), in LTR/LPR, LTR/HPR, HTR/LPR and HTR/HPR, respectively.

Conclusion: TAVI effectively lowered medical costs in highly frail patients after the procedure, and reduced number of admissions and length of hospital stay in all patients. All-cause death and cardiovascular death occurred more in patients with intermediate and high frailty, while incidences of AF and stroke were not different among groups.

OP-025 Feasibility and Safety of Distal Radial Artery Access with Chronic Kidney Disease: From KODRA Registry Sang Yeub Lee

Chung-ang University Gwangmyeong Hospital

Conclusion: In the secondary prevention setting after PCI, TRS2P and PRU were independent predictors of adverse clinical outcomes at 5-year follow-up. TRS2P and PRU demonstrated a synergistic risk stratification, implying the additive value of platelet reactivity over clinical risk factors in risk assessment.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-025. Correspondence: Sang Yeub Lee, louisahj@gmail.com

Background: There is no data regarding patients with chronic kidney disease (CKD) in distal transradial access (DRA). This study aimed to

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Abstracts from 27th Asian Pacific Society of Cardiology Congress investigate the feasibility and safety of DRA in patients with CKD from a prospective multicentre observational registry.

[1.2–4.2]; p=0.04), multivessel disease (OR 2.48; 95% CI [2.3–2,.7]; p<0.0001), chronic total occlusion (OR 1.91; 95% CI [1.65–2.2]; p<0.0001), ACC/AHA type B2/C lesion (OR 1.6; 95% CI [1.4–1.7]; p<0.0001) and left main lesion (OR 1.88; 95% CI [1.5–2.4]; p<0.0001).

Methods: A total of 5,000 patients in the Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach (KODRA) were analysed. CKD was defined as less than eGFR 60 ml/min per 1.73 m2. Patients were divided into less and greater than eGFR 60 ml/min per 1.73 m2.

Conclusion: Diabetes, hypertension, previous PCI, previous CABG, low EF, multivessel disease, CTO, ACC/AHA type B2/C lesion, and left main lesion are predictors of in-stent restenosis.

Results: There were 909 patients with CKD and 4,091 patients with normal kidney function. Mean age was 73.56 ± 10.544 years with CKD and 64.89 ± 1,11.588 years without CKD. The rates of female patient, history of hypertension, diabetes, peripheral arterial disease, previous coronary intervention, previous cerebrovascular disease, atrial fibrillation, and current smoker were significantly higher in the CKD group. There was no significant difference of puncture success rate between the groups (94.5% in CKD versus 94.4% in non-CKD). Puncture time was not significantly different (98.15 ± 126.829 versus 99.99 ± 118.887 sec, p=0.686). Contrast volume was significantly lower in the CKD group than in the non-CKD group (117.89 ± 77.35 versus 125.41 ± 89.07 ml, p=0.019). The rate of distal radial artery occlusion was also similar between patients with or without CKD (0.8 versus 0.7%, p=0.651). The rates of hand swelling and hand dysfunction were also extremely low in both groups. The rate of access site complication in DRA was significantly higher in the CKD groups (8.1%) than in non-CKD groups (4.9%, p<0.0001) and DRA-related bleeding rate was also significantly higher in CKD (5.0%) than in non-CKD (3.1%, p=0.009) patients.

OP-027 Chronic Kidney Disease and Outcomes of Transcatheter Aortic Valve Implantation in Asian Patients with Different Surgical Risk Categories Rodney Soh Yu-Hang, 1 Nicholas Chew Wei-Sheng,1 ,1 Kenneth Ngoh,1 Joy Ong Yi-Shan,1 Jimmy Hon,2 Ting-Ting Low,1 Edgar Tay,1 James Yip,1 Yinghao Lim1 and Ivandito Kuntjoro1 1. Department of Cardiology, National University Heart Centre; 2. Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-027. Correspondence: Rodney Soh, rodney.soh@mohh.com.sg

Background: The effect of chronic kidney disease (CKD) on patients undergoing transcatheter aortic valve implantation (TAVI) with different surgical risks is unclear. This study explored the impact of CKD on Asian patients with different surgical risks undergoing TAVI.

Conclusion: This analysis from a large prospective registry showed favourable feasibility of DRA in patients with CKD. Bleeding complications were reported more frequently in CKD patients. Most bleeding issues were limited to the access site and were not clinically significant.

Methods: This retrospective cohort study included patients who underwent TAVI from November 2010 to June 2021 at a tertiary centre. Patients were split into two groups: no/mild CKD (estimated eGFR ≥30mL/ min per 1.73 m2) and moderate/severe CKD (eGFR <30mL/min per 1.73 m2). Demographics, risk factors in relation to endpoints of all-cause mortality, rehospitalisation and bleeding outcomes were analysed with subgroup analysis of low surgical risk (Society of Thoracic Surgeons [STS] risk score <4) and intermediate/high surgical risk (STS ≥4).

OP-026 Predictors of In-stent Restenosis after Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis Leo Deddy Pradipta, Adwin Alamsyaputra, Inne Pratiwi Farissa and Ilham Uddin

Results: Two hundred and fifty-four patients were included and followed for 20 ± 20 months. Patients with moderate/severe CKD were likely female with higher comorbidity burden. Compared to no/mild CKD patients, moderate/severe CKD patients had increased all-cause mortality (aHR 3.26; 95% CI [1.39–7.62]; p=0.006). Moderate/severe CKD patients with high surgical risk had increased all-cause mortality (aHR 9.63; 95% CI [2.30–40.28]; p=0.002] while there was no impact of CKD on all-cause mortality for patients with low surgical risk. CKD had no impact on rehospitalisation or major bleeding events post TAVI.

Dr. Kariadi General Hospital Semarang Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):OP-026. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Objective: The objective of this meta-analysis was to determine predictors of in-stent restenosis (ISR) after coronary stenting. Methods: Multiple databases including PubMed, Scopus and ScienceDirect were searched for relevant studies published in English from 2012 to 2023. Full-text articles of studies were used to compare the various risk factors of ISR after DES stenting. Review Manager 5.4 was used to estimate the effects of those risk factors among eligible articles. The quality of research methods was evaluated using the NewcastleOttawa Scale.

Conclusion: Moderate/severe CKD patients undergoing TAVI had higher comorbidity burden. Despite adjustments for comorbidities, these patients had higher all-cause mortality in patients with moderate to high surgical risk but not in patients with low surgical risk but no increased risk of rehospitalisation or major bleeding post TAVI.

Moderated Posters

Results: There was total of 9 studies with 19,853 participants, comprising 5,040 patients with ISR and 14,813 patients without ISR. Results of analysis showed increased risk of restenosis in patients with diabetes (OR 1.39; 95% CI [1.24–1.5]; p<0.0001), hypertension (OR 1.13; 95% CI [1.05–1.21]; p=0.0006), previous PCI (OR 1.8; 95% CI [1.22–2.66]; p=0.003), previous CABG (OR 1.36; 95% CI [1.22–1.53]; p<0.0001), low EF (OR 2.2; 95% CI

MP-001 Profiles, Treatment Patterns and 1-Year Outcomes of Patients with Heart Failure in Thailand Rungroj Krittayaphong,1 Thanita Boonyapiphat,2 Teerapat Yingchoncharoen,3 Noppawan Charoenyos,4

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Background: Diabetes is closely related to heart failure (HF); the two conditions form a vicious circle by directly and indirectly affecting each other. Despite this, there has been no clear evidence that aggressive diabetes interventions improve HF. The first SGLT2 inhibitor large-scale clinical trial, EMPA-REG OUTCOME, published in 2015 showed that empagliflozin reduced cardiovascular mortality and hospitalisation for HF. Although some mechanisms are currently proposed for cardioprotective effects of SGLT2 inhibitors, most advocated mechanisms are based on limited data requiring further validation.

Wattana Wongtheptien,5 Sarinya Puwanant,6 Runyawan Chotenimitkhun,7 Ply Chichareon,8 Arintaya Phrommintikul,9 Chalongchai Thundee,10 Srisakul Chirakarnjanakorn1 and Rapeephon Kunjara-Na-Ayudhya11 1. Faculty of Medicine Siriraj Hospital, Mahidol University; 2. Lampang Hospital; 3. Faculty of Medicine Ramathibodi Hospital, Mahidol University; 4. Chaophraya Yommarat Hospital; 5. Chiangrai Prachanukroh Hospital; 6. Faculty of Medicine, Chulalongkorn University; 7. Police General Hospital; 8. Faculty of Medicine, Prince of Songkla University; 9. Faculty of Medicine, Chiang Mai University; 10. Surin Hospital; 11. Vichaiyut Hospital and Medical Center

Methods: To gain mechanistic insight into how SGLT2 inhibitors improve the prognosis of HF, this study examined the effect of SGLT2 inhibitor empagliflozin in a mouse model of HF induced by transverse aortic constriction, TAC. Empagliflozin was administered once a day for two weeks after TAC surgery and echocardiography was performed to evaluate cardiac function.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-001. Correspondence: Rungroj Krittayaphong, rungroj.kri@mahidol.ac.th

Background: Heart Failure (HF) is one of the most common cardiac problems in Asian populations. Understanding characteristics, treatment and clinical outcomes of HF patients may lead to better management.

Results: Empagliflozin treatment preserved cardiac function and suppressed left ventricular hypertrophy compared to control mice. Consistently, the mRNA expression level of HF markers, and the fibrosis area in histological analysis were suppressed in the empagliflozinadministered group. Moreover, flow cytometric analysis of immune cells in the heart revealed that the number of bone marrow-derived macrophages was significantly reduced by empagliflozin administration, leading to suppression of macrophage-evoked inflammatory responses.

Methods: In the Thai Heart Failure Registry (THFR), we prospectively enrolled patients diagnosed with HF from 37 hospitals in Thailand. Inclusion criteria were patients with hospitalisation due to HF in the past 5 years or diagnosis of HF with reduced ejection fraction (HFrEF). Main outcomes were the composite of all-cause death or HF. Baseline clinical data, investigations and medications were collected. Rate and dose of guideline-directed medical treatment (GDMT) were recorded.

Conclusion: Results suggest that SGLT2 inhibitors may reduce inflammatory responses following pressure overload by affecting bone marrow-derived immune cells, thereby suppressing the exacerbation of HF.

Results: There was a total of 2,000 patients. The average age was 59.1 ± 14.5 years; 68.9% were male. 91.7%, 4.6% and 3.7% were HFrEF, HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction (HFmrEF), respectively. 35.4%, 47.8%, 33.0%, and 42.8% had history of coronary artery disease (CAD), hypertension, diabetes, and dyslipidaemia, respectively. Average left ventricular ejection fraction (LVEF) was 33.0 ± 13.9%. 38.5%, 28.8%, 16.9%, 92.9%, 64.2% and 5.6% received angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), angiotensin receptor neprilysin inhibitors (ARNI), β-blockers (BB), mineralocorticoid receptor antagonist (MRA), and sodiumglucose cotransporter-2 inhibitors (SGLT2i), respectively. 83.7% received ACEI or ARB or ARNI. Among patients with HFrEF who received GDMT, 26.0%, 17.4%, 10.2% and 39.4% received medication dose less than 50% of target dose for ACEI, ARB, ARNI and BB, respectively. The incidence rates of composite outcomes of all patients with HFrEF, HFpEF and HFmrEF were 12.09 (10.50–13.85), 13.89 (7.18–24.26) and 12.86 (5.88– 24.41), respectively. The incidence rates of death and HF were 6.78 (5.67– 8.05) and 6.68 (5.57–7.94) per 100 person-years, respectively.

MP-003 Influencing Factors Associated with Large Epicardial Fat Volume Change During Cardiac Cycle Tae Eun Kim and Eun Ju Chun

Seoul National University Bundang Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-003. Correspondence: Tae Eun Kim, 20309@snubh.org

Objective: To find out what clinical factors influence epicardial fat volume (EFV), which is known to be well correlated with coronary artery disease (CAD). Methods: In 230 patients who underwent CCTA, EFV was measured using dedicated software at every 10% incremental interval phase in the R-R interval by two experienced observers. The difference of EFV (ΔEFV = maximal EFV − minimum EFV) and difference ratio of EFV (Δ%EFV = ΔEFV / mean EFV) were calculated in all patients. Δ%EFV was classified into three grades (group 1, <10%; group 2, 10–20%; group 3, >20%) and clinical factors were compared among these three groups.

Conclusion: Despite a high rate of GDMT use in THFR, the rate of death and HF event remains high. These results reflect an unmet need in HF management.

MP-002 Empagliflozin Protects Against Heart Failure Through Inhibition of Inflammatory Responses Mediated by Bone Marrow-derived Macrophages

Results: Mean EFV was 119.6 ± 49.7 cm3 and ΔEFV was 15.6 ± 8.4 cm3. According to Δ%EFV grades, group 1 (n=71, 31%), group 2 (n=119, 51.3%) and group 3 (n=42, 18.1%) were classified. Using one-way ANOVA analysis, age was positively linear correlated with Δ%EFV grades, while mean EFV and basal metabolic index (BMI) was reversely correlated with Δ%EFV grades (all p<0.05). In clinical factors, the prevalence of diabetes and hypertension was significantly higher in groups 2 and 3 compared to group 1 (all p<0.05). However, there were no significant differences in

Keita Horitani, Yoshiko Karatsu, Kensaku Wada and Ichiro Shiojima

Internal Medicine II, Kansai Medical University Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-002. Correspondence: Keita Horitani, horitani.keita@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress prevalence of sex, current smoker, dyslipidaemia, atrial fibrillation and hsCRP among the three groups (all p>0.05).

Methods: Human heart specimens collected from ventral septal defect (VSD) children were classified based on age (3M or 1Y) and analysed by immunostaining, extracellular matrix (ECM) solution preparation, and RNA-sequencing. The ECM was used for cell culture and proteomic analyses. The proteins identified in the proteomic analysis were further verified by testing their ability to promote CM proliferation.

Conclusion: EFV is changed during the cardiac cycle, and Δ%EFV is particularly prominent in the elderly, patients with diabetes, hypertension, or lower BMI. Therefore, EFV quantification is recommended at the same phase during cardiac cycle, particularly in patients with these conditions.

Results: The transcriptomic analysis of human hearts revealed 344 differentially expressed genes (DEGs) between 3M and 1Y hearts. Gene ontology (GO) analysis of the DEGs demonstrated that they were mainly enriched in hormone, oxidation/metabolism, and ECM. 3M-ECM but not 1Y-ECM promoted the proliferation of human induced pluripotent stem cell-derived CMs (HiPSC-CMs). Proteomics analysis of the ECM revealed 167 differentially expressed proteins (DEPs) between 3M and 1Y-ECM. The GO analysis of the DEPs demonstrated that they were mainly enriched in oxidation/metabolism. Among the DEPs, calcium ion-binding protein agrin and mitochondrial pyruvate carrier BRP44 have been reported to promote CM proliferation. This study demonstrated that agrin alone but not BRP44 or insulin alone promoted HiPSC-CM proliferation and that the combination of agrin, BRP44 and insulin (ABI) enhanced the effect of agrin, highlighting the synergy of hormones and anti-oxidation/metabolism in human CM proliferation.

MP-004 Usefulness of Lung Ultrasound in Acute Decompensated Heart Failure Patients Requiring Non-invasive Positive Pressure Ventilation Tatsuya Kokawa and Shinobu Hosokawa Tokushima Red Cross Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-004. Correspondence: Tatsuya Kokawa, tat.k.522@gmail.com

Background: Non-invasive positive pressure ventilation (NPPV) is an effective treatment for acute decompensated heart failure (ADHF). However, it can be challenging to determine when to wean patients off the ventilator.

Conclusion: A map of human CM-proliferation transition was elucidated, illustrating the synergy of hormone and anti-oxidation/metabolism in human CM proliferation.

Methods: Data was retrospectively analysed from 20 ADHF patients (mean age 83.5 years, male 45%) who required NPPV and were transported to Tokushima Red Cross Hospital by ambulance from December 2022 to March 2023. NPPV was discontinued by physician judgement (mean duration 1.75 days). We recorded the total number of B-lines (0–3 per region, 8 regions) and positive regions (3 B-lines in a region) within 24 hours before or 6 hours after discontinuing NPPV and evaluated their relevance to cardiovascular events. Cardiovascular events were defined as reattachment of NPPV or in-hospital HF death.

MP-006 The Association of Non-alcoholic Fatty Liver Disease and Venous Thromboembolic Disease in Healthy Adults

Sung Sik Oh,1 Namkyun Kim,2 Min Su Jung,2 Youngjoon Kwon,2 Jong Sung Park,2 Hong Nyun Kim2 and Se Yong Jang2 1. Presbyterian Medical Center; 2. Kyungpook National University Hospital

Results: When dividing into a B-line minority group (≤15, 10 cases, 50%) and a majority group (≥16, 10 cases, 50%), the event occurrence rate was significantly higher in the majority group (0/10 versus 5/10, p=0.0118). When dividing into a B-line negative group (≤4 regions, 12 cases, 60%) and a positive group (≥5 regions, 8 cases, 40%), the event occurrence rate was significantly higher in the positive group (0/12 versus 5/8, p=0.0021). ROC analysis suggested that the total number of B-lines (AUC 0.953, p<0.0001) and the number of positive B-line regions (AUC 0.947, p<0.0001) were both potentially effective predictors for the event occurrence rate.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-006. Correspondence: Sung Sik Oh, hazelnut5@naver.com

Background: Non-alcoholic fatty liver disease (NAFLD) is becoming a major burden in public healthcare, and several studies have reported that NAFLD is a prothrombotic state. This study investigated the relationship between NAFLD and the incidence of venous thromboembolism (VTE) in a Korean population.

Conclusion: Evaluating B-lines in ADHF patients requiring NPPV may be an effective means of predicting the risk of mechanical ventilation reattachment or HF death.

Methods: This study evaluated 472,212 healthy individuals without comorbidities who underwent national health check-ups in the Republic of Korea from 2009 to 2014. NAFLD was defined by a surrogate marker, fatty liver index (FLI). FLI was calculated with four variables (triglycerides [TG], body mass index [BMI], gamma-glutamyltransferase [GGT], and waist circumference [WC]) as follows: FLI = (e0.953 × loge(TG) + 0.139 × BMI + 0.718 × loge(GGT) + 0.053 × WC − 15.745)/(1 + e0.953 × loge(TG) + 0.139 × BMI + 0.718 × loge(GGT) + 0.053 × WC − 15.745) × 100. The association between FLI and VTE was analysed using multivariate Cox proportional hazards regression models.

MP-005 A Map of Human Cardiomyocyte Proliferation Transition Ying Ying Xiao

Children’s Hospital of Shanghai, Shanghai Jiaotong University Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-005. Correspondence: Ying Ying Xiao, bebetter1997@163.com

Results: During a median follow-up of 7.1 years, new-onset VTE occurred in 4,499 patients (1.0%). Patients were categorised into quartile groups according to FLI (first quartile [Q1], 0–5.759; second quartile [Q2], 5.759– 15.391; third quartile [Q3], 15.391–37.199; and fourth quartile [Q4], >37.199). With increasing FLI values, the incidence of VTE also demonstrates a

Objective: To reveal a map of the human cardiomyocyte (CM) proliferation transition, providing an opportunity to narrow the translational gap between human and rodent cardiac regeneration.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress tendency to increase. (Q1, 598 [0.5%]; Q2, 1,033 [0.9%]; Q3, 1,443 [1.2%]; Q4, 1,425 [1.2%]). In the age and gender-adjusted multivariate model, the HR (95% CI) was 1.94 (1.77–2.14) for the highest group of FLI compared with that of the lowest. When the model was further adjusted for clinical variables with p<0.01 in the univariate analyses, the HR (95% CI) was 1.47 (1.33–1.62) for Q4 compared with Q1.

1. NUS Yong Loo Lin School of Medicine; 2. National University Hospital, Department of Cardiology Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-008. Correspondence: Joel Kai-Xiang Lau, joellau2000@gmail.com

Background: Diabetes mellitus (DM) is a well-established risk factor for coronary artery disease (CAD), and the prevalence of DM is increasing. However, its impact on stress echocardiography (SE) outcomes remains unclear. This study aims to investigate the differences between DM and non-DM patients in the evaluation and outcomes of SE.

Conclusion: FLI was related to the risk of VTE, which was confirmed after adjusting for various other risk factors for VTE, including age, gender, smoking status, blood pressure, and glucose and lipoprotein levels.

MP-007 Influence of Blood Pressure and Left Ventricular Mass on Subclinical Coronary Atherosclerosis

Methods: This was a retrospective cohort study of 2,329 patients who underwent SE between January 2014 and December 2018. SE results and outcomes were collected using electronic medical records.

Enver De Wei Loh,1 Weiting Huang,2 Rehena Sultana,3 Siew Ching Kong,2 Swee Yaw Tan,2 Calvin Woon-Loong Chin,2 Jiunn Liang Jonathan Yap2 and Khung Keong Yeo2

Results: The mean follow-up period was 5.8 ± 1.3 years. Patients with DM who underwent SE were younger (DM 53.5 ± 14.2 years versus nonDM 61.1 ± 10.5 years) and had more comorbidities, including hypertension, hyperlipidaemia, previous myocardial infarction, ischaemic heart disease, prior percutaneous coronary intervention, history of coronary artery bypass grafting and previous stroke/transient ischaemic attack. The most common indications for SE were to assess symptoms for suspected CAD (53.4%), assess prior abnormal tests, such as electrocardiogram or myocardial perfusion imaging (25.7%) and assess the status of pre-existing CAD (5.4%). On SE, more DM patients were positive for ischaemia (DM 13.4% versus non-DM 7.3%, p<0.001). Using Cox proportional hazards regression analysis, DM status (HR 2.609; 95% CI [1.944–3.502], p<0.001) was an independent predictor of major adverse cardiac events, after adjusting for age, sex, smoking status, positive ischaemia stress echocardiography results and medication changes.

1. Lee Kong Chian School of Medicine, Nanyang Technological University; 2. Department of Cardiology, National Heart Centre Singapore; 3. Centre for Quantitative Medicine, Duke-NUS Medical School Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-007. Correspondence: Enver De Wei Loh, enverldw@gmail.com

Background: This study explored the relationship of blood pressure (BP) and left ventricular (LV) mass to the presence of subclinical coronary atherosclerosis in a population without known cardiovascular disease. Methods: This was a cross-sectional study of the SingHEART cohort at baseline. Individuals were grouped as follows: no hypertension and normal LV mass index (LVMI); no hypertension and high LVMI; hypertension and normal LVMI; hypertension and high LVMI. Logistic regression models were used to assess the interaction effect of hypertension and LVMI on the presence of coronary artery calcium (CAC+). Youden’s index was used to determine optimal BP thresholds to stratify risk of coronary atherosclerosis.

Conclusion: DM patients undergoing SE had worse outcomes and higher mortality than non-DM patients.

Results: A total of 745 subjects were included, of whom 215 had coronary atherosclerosis. BP was a strong predictor of LVMI and CAC phenotypes (p<0.001). Compared with individuals with no hypertension and normal LVMI, those with no hypertension and high LVMI had no increased risk of CAC+ (RR 0.83; 95% CI [0.47–1.47]). However, risk was significantly increased in patients with hypertension and normal LVMI (RR 1.47; 95% CI [1.13–1.91]), or hypertension and high LVMI (RR 1.72; 95% CI [1.26–2.36]). Presence of coronary atherosclerosis was more likely with ambulatory BP above the 24hour, daytime and night-time thresholds of 119/80, 121/82, 113/69 mmHg for men and 120/76, 123/79, 108/65 mmHg for women, respectively.

MP-009 A Multicentre Study of Clinical Predictors of Positive Pyrophosphate Scintigraphy to Diagnose ATTR Amyloidosis

Conclusion: BP was associated with risk of subclinical coronary atherosclerosis, and LV mass significantly modified the interaction between hypertension and CAC. Further causative studies are needed to establish the relationships among blood pressure, LV remodelling and coronary atherosclerosis.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-009. Correspondence: Manami Shingu, manami.shingu124@gmail.com

Manami Shingu,1 Wataru Fujimoto,2 Ryousuke Murai,3 Takashi Kuragaichi,4 Yuya Matsue5 and Tetsuari Onishi6 1. Hyogo Prefectural Tamba Medical Center; 2. Hyogo Prefectural Awaji Medical Center; 3. Kobe City Medical Center Central City Hospital; 4. Hyogo Prefectural Amagasaki Medical Center; 5. Juntendo University Hospital; 6. Hyogo Prefectural Harima-Himeji Medical Center

Background: The prevalence of ATTR amyloidosis is increasing with improvement of diagnostic techniques and increasing awareness of the disease worldwide. 99mTc-pyrophosphate (99mTc-PYP) scintigraphy has high diagnostic performance for ATTR cardiac amyloidosis. This study aims to validate the characteristics of patients with positive 99mTc-PYP scintigraphy in a multicentre setting to provide more accurate case selection criteria.

MP-008 Impact of Diabetes Mellitus Status on Clinical Characteristics and Outcomes of Patients Undergoing Stress Echocardiography Joel Kai-Xiang Lau,1 Hui Xian Claire Seah,1 Tony YW Li,2 Tiong Cheng Yeo,2 Kian Keong Poh,2 Raymond CC Wong,2 Ching Hui Sia2 and William KF Kong2

Methods: All patients who received 99mTc-PYP scintigraphy with suspected ATTR cardiac amyloidosis in participating institutions in Japan

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Abstracts from 27th Asian Pacific Society of Cardiology Congress between 1 January 2018 and 31 July 2022 were enrolled in the study. Patient data were extracted from the hospital’s electronical database. A positive 99mTc-PYP was defined as a visual grade 2 or 3 in the image after 3 hours.

Conclusion: Starting cardiac rehabilitation as early as possible after stabilisation of the patient following the onset of cardiovascular disease is beneficial. This is particularly important for patients with ACS. In addition, it may be worth considering the active use of cardiac rehabilitation when there is no continuous improvement in cardiac function despite the implementation of guideline-directed medical therapy (GDMT).

Results: One hundred and thirty-six patients were included in the analysis. 62 patients were 99mTc-PYP positive. We adopted four factors; troponin I/T ≥0.06 ng/mL, the existence of peripheral entrapment neuropathy (carpal tunnel syndrome or scoliosis), conduction disturbance (QRS complex ≥120 ms, first-degree or higher degree atrioventricular block, patients with pacemaker implantation) and left ventricular hypertrophy (ventricular septal wall thickness or posterior wall thickness ≥12 mm) to create a scoring system based on the logistic regression. One point was assigned for each and the points were added up to evaluate positivity of 99mTc-PYP scintigraphy. Positive rate in the zero-point group was only 7%, in contrast to 89% in the four-point group. The AUC of the index was 0.793 (95% CI [0.72–0.87]).

MP-011 Ivabradine Treatment for a Rat Model with Duchenne Muscular Dystrophy

Koichi Kimura,1 Ryota Tochinai,1 Takeru Saika,1 Hiroyuki Morita,1 Koki Nakanishi,1 Yoshiharu Tsuru,2 Shin-ichi Sekizawa,1 Keitaro Yamanouchi1 and Masayoshi Kuwahara1 1. The University of Tokyo; 2. Primetech Corporation Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-011. Correspondence: Koichi Kimura, esk63970-conf@yahoo.co.jp

Conclusion: The combination of clinical information can provide accurate pre-test probability for 99mTc-PYP scintigraphy. It will help clinicians make an early diagnosis of ATTR amyloidosis.

Background: Duchenne muscular dystrophy (DMD) is a progressive inherited myopathy that results from a dystrophin gene mutation on the X chromosome. All young DMD patients suffer from inevitable skeletal muscle weakness and life-threatening cardiomyopathy. Most DMD patients show sinus tachycardia with hypotension due to their autonomic nervous system disorder.

MP-010 Effects of Cardiac Rehabilitation: Change in CPET and Echocardiography Following Improvements in Cardiorespiratory Capacity

Objective: To clarify whether ivabradine, which can directly suppress sinus node pacemaker without lowering blood pressure, ameliorates DMD cardiomyopathy.

ByengJu Son, Jong-il Park, Jong-sun Park, Dong-gu Shin, Jang-won Son, Ung Kim, Jongho Nam, Kang-un Choi and Yu-jung Jung

Methods: The study used a DMD rat model with completely deficient dystrophin generated by CRISPR/Cas9 gene-edit method. Animals were divided into two groups and treated with 10 mg/kg per day ivabradine or vehicle for 3 months using an implanted transgastric microinfusion pump system.

Yeungnam University Medical Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-010. Correspondence: ByengJu Son, sharnhoste@naver.com

Background: The objective of this study was to investigate the effects of cardiac rehabilitation on cardiovascular and respiratory function by evaluating changes in CPET and echocardiography results following improvements in cardiorespiratory capacity.

Results: A significant heart rate decline was observed in ivabradinetreated DMD rats. Echocardiography showed significant ameliorations in LV systolic function variables (M-mode LVFS and Simpson’s LVEF), LV diastolic function variable (averaged E/Ea from septal and lateral TDI), and RV function variables (RVFAC and RV free-wall Sa by TDI) compared with the vehicle-treated DMD rats (p<0.05 in all variables listed above). Histopathological study showed a trend toward decreased myocardial fibrosis in ivabradine-treated rats, although the difference did not reach statistical significance.

Methods: This study was conducted retrospectively by collecting medical history CPET, and echocardiography data of patients who underwent cardiac rehabilitation from June 2020 to March 2023 (total 27; ACS 14, CCS 7, idiopathic DCMP 5, HCM 1). Results: In the group with increased NT-proBNP levels, baseline VO2 max/ kg was lower compared to the group with normal NT-proBNP levels. Both groups showed rapid improvement up to 6 months after cardiac rehabilitation, followed by a slower recovery phase from 6 months to 1 year.

Conclusion: Ivabradine ameliorated cardiac dysfunction and fibrosis in DMD rats, suggesting that ivabradine can be another treatment option for DMD patients with sinus tachycardia.

MP-012 Myosin Inhibition Using Mavacamten Facilitates Relaxation of the Myofibrils from Rhe HFpEF Heart

While there was a difference in the absolute value of baseline VO2 max/kg between the group who underwent PCI for ACS and the group who underwent PCI for CCS, both groups showed similar achievement rates of predicted VO2 max. However, the group that underwent PCI for ACS showed superior improvement compared to the group that underwent PCI for CCS during the initial 6 months of cardiac rehabilitation. Similarly, the degree of improvement decreased after 6 months in both groups. There was no correlation between the cardiorespiratory capacity measured by CPET and changes in systolic and diastolic function observed on echocardiography.

Ying-Hsi Lin,1 En Ping Yap,1 Shuo Cong, Chrishan Julian Alles Ramachandra,2 Nicole Gui Zhen Tee2 and Derek Hausenloy1 1. Duke-NUS Medical School; 2. National Heart Centre Singapore; 3. University College London Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-012. Correspondence: Ying-Hsi Lin, ying-hsi.lin@duke-nus.edu.sg

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Background: Mavacamten, a small molecule inhibitor of myosin ATPase, has been developed as a treatment for hypertrophic cardiomyopathy (HCM), and is currently being tested in HFpEF patients. This study aimed to investigate whether mavacamten directly modulates sarcomere mechanical properties to improve myocardial relaxation in a two-hit mouse HFpEF model.

ATP5a1 in cEVs mainly derived from cardiomyocytes in healthy heart tissue. In addition, it was demonstrated that adipose-derived stem cell (ADSC)-derived EVs with ATP5a1 overexpression showed a much better therapeutic effect on MI/R injury compared to control ADSC-derived EVs. Conclusion: These findings highlight the protective role of EVs derived from healthy tissues in cardiac injury and the potential strategy to modulate ATP5a1 as an important therapeutic target for the therapy of M/ IR-induced myocardial damage.

Methods: Adult C57Bl/6 mice were fed with a standard diet or high-fat diet (HFD) + L-NAME to induce HFpEF (n=10 mice/group). Mouse myofibrils (n=3 per animals) were obtained and the contractile function of the sarcomere with or without the presence of mavacamten were investigated using a myofibril mechanical system. Effects of mavacamten at the cellular level were determined in healthy control human iPSC cardiomyocytes.

MP-014 The Role of Arterial Stiffness in Takotsubo Cardiomyopathy with Intracranial Blood Injection in Rabbits

Results: Mechanical analysis showed myofibrils isolated from HFpEF mice have impaired relaxation when activated at sub-maximal [Ca2+], significantly higher stiffness and elevated Ca2+ sensitivity, compared with control animals. Ex vivo treatment of mavacamten alleviates relaxation impairment and completely normalised Ca2+ sensitivity and stiffness of the myofibrils from HFpEF animals. In vitro treatment of mavacamten shortened the relaxation time of healthy human iPSC cardiomyocytes, suggesting that the effects of mavacamten at the myofibril level could be translated to the cellular level.

Mao Takahahshi

Department of Cardiology, Sakura Hospital, Medical Center, Toho University, Chiba, Japan Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-014. Correspondence: Mao Takahahshi, takahashi-04@sakura.med.toho-u.ac.jp

Background: Takotsubo cardiomyopathy (TCM) is reported to occur after subarachnoid haemorrhage, and the involvement of a critical activity of catecholamines has been mentioned, but the details of its onset have not been fully clarified. Recently, proper arterial stiffness was measured with cardio-ankle vascular index. The aim of this study was to clarify the role of arterial stiffness in onset of TCM using rabbits under infusion of noradrenaline and injection of blood into brain ventricle.

Conclusion: Myosin ATPase inhibition using mavacamten could normalise relaxation and stiffness abnormalities of the myofibrils in HFpEF. These findings position mavacamten as a potential therapeutic intervention for improving diastolic function in patients with HFpEF.

MP-013 Cardiac-derived Extracellular Vesicles Improve Mitochondrial Function to Protect Against Heart Ischaemia/Reperfusion Injury by Delivering ATP5a1

Methods: Rabbits were divided into three groups: infusion of noradrenaline (group A), infusion of noradrenaline + injection of saline into the brain ventricle (group B) and infusion of noradrenaline + injection of blood in the brain ventricle (group C). Aortic arterial stiffness beta (Aβ) and femoral arterial stiffness beta (Fβ) were defined according to definition of the cardio-ankle vascular index. Blood pressure (BP), Aβ, Fβ and femoral vessel resistance (FVR) were measured. Left ventricular movement were monitored with echocardiography.

Xuan Liu, Shanshan Shi, Xuedi Geng, Enhao Wang and Xiaohui Zhou Tongji University School of Medicine

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-013. Correspondence: Xuan Liu, asscenliu@163.com

Results: BP increased uniformly in all three groups. Fβ in groups A, B and C increased from 3.6 ± 3.2, 3.6 ± 3.6 and 3.9 ± 4.2, to 15 ± 2, 17.9 ± 2.4, and 34.8 ± 9.1 due to the ICP enhancements in addition to noradrenaline administration, respectively. Fβ in groups B and C was significantly larger than in group A. On echocardiography, a much higher akinesic area of the apex was observed in group C compared with groups A and B. Cardiac movements similar to TCM were observed slightly in group B and clearly in group C.

Background: Extracellular vesicles (EVs) derived from ischaemiareperfusion heart aggravate cardiac injury. The purpose of this study was to investigate whether EVs from healthy heart tissue (cardiac EVs, cEVs) can mitigate myocardial ischaemia-reperfusion (MI/R) injury and the underlying mechanisms. Methods: cEVs were isolated from healthy heart tissue using gradient centrifugation and injected intramyocardially after releasing the coronary ligation. Mice were subjected to MI/R 72 hours after injection.

Conclusion: Noradrenaline administration infusion and blood injection into the brain ventricle induced TCM with accompanying enhanced femoral arterial stiffness. These results suggest that elevated arterial stiffness might be involved in the formation of TCM in addition to a critical activity of catecholamines and an increase in intracranial pressure with blood injection.

Results: Intramyocardial administration of cEVs significantly improved the cardiac function in murine MI/R models. cEVs treatment inhibited ferroptosis and maintained mitochondrial homeostasis in cardiomyocytes subjected to ischaemia-reperfusion. RNA-seq analysis and in vitro experiments revealed that cEVs can transfer functional ATP5a1 into cardiomyocytes, suppress mitochondria ROS production, alleviate mitochondrial damage, and inhibit cardiomyocytes ferroptosis. While knockdown of ATP5a1 abolished the protective roles of cEVs in cardiomyocytes post hypoxia-reoxygenation (H/R). Furthermore, cardiomyocytes secreted EVs account for the vast majority of cEVs, and

MP-015 Recurrent Transient Ischaemic-trained Macrophages Exacerbate Cardiac Inflammation During Myocardial Injury Jinyun Zhu

Second Affiliated Hospital, College of Medicine, Zhejiang University

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Abstracts from 27th Asian Pacific Society of Cardiology Congress seniors aged 80 years or older were included. Pooled outcomes of allcause, cardiac and in-hospital death, subsequent stroke/transient ischaemic attack (TIA), subsequent myocardial infarction (MI), subsequent congestive cardiac failure (CCF), subsequent coronary angiogram and overall major adverse cardiac events (MACE) in both elective and emergency PCI groups were analysed.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-015. Correspondence: Jinyun Zhu, jinyun311@163.com

Background: Recurrent myocardial ischaemia is common in patients with coronary artery disease, which predicts adverse outcome and high mortality. Macrophages are critical early initiators of innate immunity following ischaemia. This study evaluates whether repeated ischaemia can lead to ‘trained immunity’ in macrophages and myeloid progenitors, which would contribute to inflammation in the heart.

Results: Eight studies representing 8,399 patients were identified. Compared to emergency PCI, elective PCI has a lower risk of in-hospital death (OR 0.13; 95% CI [0.05–0.33]) and MACE (OR 0.25; 95% CI [0.10– 0.66]). There was no significant difference in the risk of stroke/TIA (OR 0.45; 95% CI [0.16–1.24]). Overall, the pooled outcomes of elective PCI described a <1% risk of cardiac death, in-hospital death, and subsequent stroke/TIA; a 4–6% risk of all-cause death, subsequent CCF, subsequent MI, and MACE; 8% risk of 1-year mortality, and a 15% risk of repeated coronary angiogram. In comparison, emergency PCI had a higher risk at 8.73% of in-hospital death and 10.77% of MACE.

Methods: Recurrent transient myocardial ischaemia was induced by ligating LAD for five minutes followed by opening and resting one week until next ischaemia stimuli. Mice were divided into trained one time (TI1), two times (TI2) and sham groups. Immune cell and inflammation were evaluated by flow cytometry. Cardiac macrophages and bone marrow granulocyte macrophage progenitors (GMPs) were isolated by FACS. RNASeq performed in trained GMPs (T2 versus T1 versus T0). Monocytes from C57Bl6 mice were isolated and divided in trained (hypoxia 2% O2) and sham (21% O2) groups followed resting in normoxia for 3 days.

Conclusion: The mortality risk of elective PCI in seniors aged 80 years and older remains low compared to emergency PCI. Closer follow-up within 1 year of PCI should be considered.

Results: Recurrent ischaemia enhanced inflammation and aggravated cardiac dysfunction in trained mice compared to sham. Mice with recurrent ischaemia showed a trend toward more cardiac CCR2+ macrophages, blood Ly6Chigh monocytes, and bone marrow (lineage-ckit+sca1+progenitor) LSK and GMPs. Consistently, recurrent ischaemia induces metabolic rewiring in cardiac macrophages. In vitro assay, hypoxia training results in increased production of proinflammatory cytokines, such as IL-6, TNF-α, and IL-1β, compared with normoxia. RNA-seq revealed differentially expressed genes involved in cholesterol metabolism in the trained groups.

MP-017 A Nomogram to Predict Patient Mortality after Linear Ventriculoplasty for Left Ventricular Aneurysm

Xieraili Tiemuerniyazi, Ziang Yang and Wei Feng Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-017. Correspondence: Xieraili Tiemuerniyazi, tiemuernyz@mail2.sysu.edu.cn

Conclusion: Repeated ischaemia-induced trained immunity acts in the bone marrow and enhances myelopoiesis, which exacerbate myocardial inflammation after cardiac injury.

Objective: To develop a risk prediction model for mortality in patients with ischaemic anterior wall left ventricular aneurysm (LVA) undergoing linear ventriculoplasty (LVP).

MP-016 Outcomes of Elective and Emergency Percutaneous Coronary Intervention in Seniors: A Systematic Review and Meta-analysis

Methods: A total of 741 patients with an ischaemic anterior wall LVA who underwent LVP between January 1999 and March 2021 at Fuwai Hospital were retrospectively enrolled, and 22 clinical features were assessed. The entire cohort was randomly grouped into training and validation cohorts in a ratio of 8:2. Backward stepwise elimination approach and the least absolute shrinkage and selection operator (LASSO) regression were used for feature selection. A nomogram was developed based on a multivariable Cox regression model. The performance of the model was evaluated using discrimination and calibration. Decision curve analysis was performed to test clinical usefulness.

Norman H Lin,1 Jamie SY Ho,1 Andie Hartanto Djohan,1 Vanda Ho,2 Yao Neng Teo,3 Yao Hao Teo,1 Nicholas L Syn,3 Yin Nwe Aye,4 Jackie Chiu,1 Rodney YH Soh,1 Ping Chai,1,3 Tiong-Cheng Yeo,1,3 Hui-Wen Sim,1 HuayCheem Tan,1,3 Mark Y Chan1,3 and Ching-Hui Sia1,3

1. Department of Cardiology, National University Heart Centre Singapore; 2. Division of Geriatric Medicine, University Medicine Cluster, National University Health System; 3. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; 4. The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust

Results: The mean age of patients was 58.6 ± 9.6 years, and 15.8% were female. The mean ejection fraction was 42.8 ± 8.5%. Coronary artery bypass grafting was performed in 93.4% of the patients. During a median follow-up of 60 months, 105 patients died. Eight features were selected. Multivariable Cox regression model revealed that age, female sex, EF and concomitant mitral valve surgery were independent predictors of long-term mortality, while diabetes showed marginal significance. The model achieved good calibration and discriminative ability as indicated by the concordance index (training 0.71; validation 0.77). Decision curve analysis showed that the model had good clinical usefulness.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-016. Correspondence: Norman Huangyu Lin, normanhylin@gmail.com

Background: Ischaemic heart disease is a leading cause of death, especially in seniors aged 80 years and above. The authors performed a systematic review and meta-analysis of the outcomes of elective versus emergency percutaneous coronary intervention (PCI) in this group. Methods: Searches of four databases (PubMed, Embase, Scopus and Central) were conducted on 15 February 2021. Original studies on PCI in

JOURNAL OF ASIAN PACIFIC SOCIETY OF CARDIOLOGY www.JAPSCjournal.com

Abstracts from 27th Asian Pacific Society of Cardiology Congress Conclusion: The nomogram developed in this study can be useful for risk prediction after LVP in patients with an ischaemic anterior-wall LVA.

characteristics were analysed. Least absolute shrinkage and selection operator regression were used for feature selection, and multivariable Cox regression was applied to develop a nomogram for risk prediction. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, nonfoetal myocardial infarction, repeat revascularisation and stroke.

MP-018 Efficacy and Safety of Transankle Intervention in Endovascular Therapy

Naotoshi Wada, Tetsuya Nomura, Keisuke Shoji, Natsuya Keira and Tetsuya Tatsumi

Results: A total of 570 patients with 601 CE targets, including left anterior descending (41.4%), right coronary artery (43.9%), left circumflex artery (6.8%) and diagonal branches/intermedius ramidus (8.0%) were enrolled. The mean age was 61.0 ± 8.9 years and 77.7% were male. Four features were identified as the predictors of MACCE: age ≥65 years (HR 2.12; 95% CI [1.38–3.25]; p<0.001), left main disease (HR 2.56; 95% CI [1.46–4.49]; p=0.001), mitral regurgitation (≥mild, HR 1.91; 95% CI [1.01–3.65]; p=0.049) and left anterior descending endarterectomy (HR 1.69; 95% CI [1.09– 2.62], p=0.018), and a nomogram for the 1- and 3-year MACCE prediction was developed. The model showed relatively good discrimination (C-index 0.68), calibration and clinical usefulness.

Kyoto Chubu Medical Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-018. Correspondence: Naotoshi Wada, wada-n@koto.kpu-m.ac.jp

Background: The authors have been practising transankle intervention (TAI) to reduce radiation exposure to operators and provide minimally invasive treatment to patients. TAI is a technique in which a guiding sheath is inserted through the dorsal artery or posterior tibial artery (PTA) to achieve balloon angioplasty or stenting in lower extremity artery disease (LEAD). The efficacy and safety of TAI have not been determined.

Conclusion: The nomogram provides estimation of 1- and 3-year MACCErisk after CABG+CE.

Methods: A retrospective single-centre study was conducted on 20 patients who underwent endovascular therapy with TAI from September 2021 to January 2023.

MP-020 Spironolactone versus Eplerenone in Patients with Resistant Hypertension: A Systematic Review and Indirect Meta-analysis

Results: 70% were men. Hypertension was present in 75% of patients, diabetes in 65% and acute ischaemia in 5%. Aorto-iliac lesion was present in 25% and femoropopliteal lesion in 85%. 30% of lesions included occlusion. The dorsal approach was used in 85% of cases and PTA in 15%. Infrapopliteal intervention was required before treatment of the target lesion in 30% of cases. A drug-coated balloon (DCB) was used in 70%, interwoven nitinol stent (IWS) in 10%, and bare nitinol stent (BNS) in 25%. Procedure success was achieved in 100%. There were no puncture site complications and no acute occlusion of the approach vessel (average observation period 157 days).

Hanselim Lim1 and Wuri Noviar Hamdani2

1. St. Vincentius Hospital; 2. Abdoel Wahab Sjahranie General Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-020. Correspondence: Hanselim Lim, hanselim_lim@hotmail.com

Objective: To compare the effectiveness between spironolactone and eplerenone in lowering blood pressure (BP) in resistant hypertension (RH) patients.

Conclusion: TAI appears to be a useful method of achieving treatment while minimising complications.

Methods: Randomised controlled trials (RCTs) comparing eplerenone or spironolactone with placebo in RH patients were included. The primary outcome was the systolic and diastolic BP mean difference (MD). Secondary outcome was serum potassium level MD. Pairwise metaanalysis was first conducted with mean BP and mean potassium level difference. The pooled estimates were then analysed to attain the adjusted indirect comparisons.

MP-019 Risk Prediction after Coronary Artery Bypass Grafting Combined with Coronary Endarterectomy

Ziang Yang, Xieraili Tiemuerniyazi and Wei Feng Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College

Results: Six RCTs involving 665 patients were included in the systematic review. The pooled MD of systolic and diastolic BP between eplerenone and placebo showed a decrease of −6.38 (p=0.0007) and −4.45 (p<0.0001), respectively. The pooled MD of systolic and diastolic BP between spironolactone and placebo showed a decrease of −4.82 (p=0.01) and −2.31 (p=0.006), respectively. The pooled MD of serum potassium levels between eplerenone and placebo, as well as spironolactone and placebo, was 0.16 (p=0.39) and −0.08 (p=0.59), respectively. Indirect comparison meta-analyses of the MD in systolic and diastolic BP (systolic MD 1.66; 95% CI [−3.46–6.78]; p=0.5250 and diastolic MD 2.14; 95% CI [−0.63–4.91]; p=0.1293) as well as mean serum potassium levels (MD 0.24; 95% CI [−0.23–0.71]; p=0.313) between spironolactone and eplerenone showed no significant difference.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):MP-019. Correspondence: Ziang Yang, yzang47@163.com

Background: Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) is used for complete revascularisation of diffusely coronary arteries disease. Studies report increased risk after this procedure, such as operative mortality and postoperative myocardial infarction. Risk prediction in these patients is essential. Methods: Patients undergoing coronary artery bypass grafting combined with coronary endarterectomy (CABG+CE) between September 2008 and July 2022 at our centre were recruited retrospectively. Thirty-two

Conclusion: Spironolactone and eplerenone showed an equal decrease in systolic and diastolic BP and serum potassium level in patients with RH.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Poster Presentations

Methods: A total of 40 patients with confirmed severe COVID-19 hospitalised to the ICU at Sanglah General Hospital Bali, between June and September 2021, were enrolled in the study. RV function and laboratory examinations were performed within 24 hours of patients being admitted to the ICU.

PP-001 10-Year Experience in the Management of STEMI in Patients over 90 Years

Dmitry Duplyakov,1 Polina Duplyakova,1,2 Tatiana Pavlova,1,2 Alia Tukhbatova,1 Elena Adonina1 and Temur Kislukhin1

Results: The proportion of RVD as defined by TAPSE and RV S’ were 12.5% and 16%, respectively. Myocardial injury defined by increased troponin I level was observed in 57.5% patients. Increased troponin I level moderately correlated to decrease TAPSE (r=-0.54, p=0.000). A cut-off point troponin I of 264 pg/dL had sensitivity, specificity and negative predictive value of 80%, 88.5% and 96.87%, respectively, in predicting RVD in severe COVID-19 (AUC=0.971; 95% CI [0.919–1]; p=0.001). A significant shorter median survival was observed in the group with decreased RV function but not in the increased troponin group. RV dysfunction, male sex and obesity were associated with poorer prognosis in severe COVID-19 patients

1. Samara State Medical University; 2. Samara Regional Cardiology Dispensary Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-001. Correspondence: Dmitry Duplyakov, duplyakov@yahoo.com

Objectives: To study hospital outcomes in patients over 90 years of age with ST-elevation myocardial infarction (STEMI) according to chosen approaches. Methods: From January 2012 to December 2021, 127 patients over 90 years of age with STEMI were hospitalised at the Samara Regional Clinical Cardiology Dispensary. Invasive management was initially chosen for 32 patients (25%) referred for angiography, 24 of which underwent PCI. The invasive group (IG) consisted of 24 patients who underwent PCI (mean age 91.1 [90–99] years; F66.7%). The conservative group (CG) included the remaining 103 patients (mean age 91.7 [90–100] years; F66.9%).

Conclusion: RV dysfunction and myocardial injury were common in patients with severe COVID-19. RV dysfunction but not myocardial injury attributed to the increased of mortality risk suggesting that mechanisms other than myocardial injury were responsible for mortality-related RV dysfunction

PP-003 Predictors of In-hospital Mortality in Patients with ST Segment Elevation Myocardial Infarction

Results: In-hospital mortality was 41.7% (43 patients) in the CG group and 20.8% (5 patients) in the IG group (p=0.193). Pulmonary oedema developed in 20 (19.4%) patients from the CG group, and in 2 (8.3%) patients from the IG group (0.37 [0.08–1.74]; p=0.196). Cardiogenic shock occurred in 31 (24.4%) patients with STEMI from the CG group, and in 4 (16.7%) patients from the IG group (0.56 [0.18–1.79]; p=0.327). Mechanical complications developed in 10 (9.7%) patients in the CG group, and in 2 (8.3%) patients in the IG group (p=0.597). The combined endpoint (CV death, PE and CS) was achieved in 56 (54.4%) patients in the CG group and in 9 (37.5%) patients in the IG group (0.50 [0.20–1.26]; p=0.137).

Leo Deddy Pradipta, Niko Wangi Yuandika, Alfredo Alfredo, Jefry Pinondang Sianipar, Aida Yulia Amany and Safir Sungkar RSUP Dr. Kariadi Semarang Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-003. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Objective: To identify risk factors for in-hospital mortality due to STEMI at Dr. Kariadi Hospital, Semarang.

Conclusion: There are no advantages of invasive strategy in patients with STEMI over 90 years of age.

Methods: This was a retrospective study that included all STEMI patients with onset less than 12 hours between January 2022 and February 2023. Multivariate analysis was performed using logistic regression with the backward method to assess predictors of mortality.

PP-002 Right Ventricular Dysfunction and Myocardial Injury in Severe COVID-19 and its Association with In-hospital Mortality

Results: The study involved 162 patients with a mortality rate of 17.9%. Multivariate analysis showed that several factors could increase the risk of mortality, such as diabetes (aOR 2.7; 95% CI [1.8–8.3]), cardiac arrest on admission (aOR 12.04; 95% CI [8.6–16.9]), heart rate <60 BPM or >100 BPM (aOR 1.7; 95% CI [1.2–6.6] and aOR 1.6; 95% CI [1.2–2.4], respectively), Killip class IV (aOR 3.6; 95% CI [1.3–6.5]), creatinine >2.0 mg/dl (aOR 1.8; 95% CI [1.5–6.4]), ventilator usage (aOR 4.1; 95% CI [2.7– 7.3]) and anterior extensive STEMI (aOR 4.8; 95% CI [1.5–7.3]). Factors that could reduce the mortality risk were angiotensin blocker (aOR 0.28; 95% CI [0.07–0.61]), statin (aOR 0.7; 95% CI [0.31–0.88]), mineralocorticoid receptor antagonist (MRA) (aOR 0.35; 95% CI [0.11–0.67]], and primary percutaneous coronary intervention (PPCI) (aOR 0.16; 95% CI [0.03– 0.55]).

Gusti Ayu Riska Pertiwi,1 Ida Bagus Rangga Wibhuti,2 Ni Made Ayu Wulan Sari,2 Luh Oliva Saraswati Suastika2 and Marilaeta Cindryani3

1. Cardiology Residence at Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Udayana, Prof Ngoerah General Hospital; 2. Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Udayana, Prof Ngoerah General Hospital; 3. Department of Anesthesiology, Faculty of Medicine Universitas Udayana, Prof Ngoerah General Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-002. Correspondence: Gusti Ayu Riska Pertiwi, pertiwiayuriska@gmail.com

Conclusion: Clinical presentation of cardiac arrest has the highest risk of death; the sequence is anterior extensive STEMI, ventilator usage, Killip class IV, DM, creatinine >2.0 mg/dl and HR <60 BPM or >100 BPM.

Objectives: To evaluate the proportion of right ventricular (RV) dysfunction and myocardial injury, and the impact of RVD and myocardial injury on outcomes in severe COVID-19.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-004 Comparison of Inotrope Score as a Predictor of Mortality in Patients with Cardiogenic Shock

Results: There were seven studies with a total of 732 participants, comprising 369 patients who received continuous furosemide administration and 363 patients who received intermittent furosemide administration. The analysis results showed no significant differences in all-cause mortality (OR 0.84; 95% CI [0.42–1.7]; p=0.63), total length of stay (MD −0.27; 95% CI [−3.54, 3.0]; p=0.87), reduction of body weight (MD −0.48; 95% CI [−1.34, 0.38]; p=0.28), total urine output (MD −0.43; 95% CI [−0.92, 0.06]; p=0.08), hyponatraemia (MD 0.54; 95% CI [−0.57, 1.65); p=0.34), hypokalaemia (MD −0.05; 95% CI [−0.21, 0.11]; p=0.54) or increase of creatinine (MD −0.00; 95% CI [−0.15, 0.14]; p=0.96) between the two groups.

Leo Deddy Pradipta, Adwin Alamsyaputra, Inne Pratiwi Farissa and Safir Sungkar Dr Kariadi General Hospital Semarang

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-004. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Objective: To compare total inotrope exposure score(TIES) and vasoactive inotropic score (VIS) in predicting mortality in patients with cardiogenic shock.

Conclusion: There were no differences between the two furosemide administration methods regarding mortality, length of stay, reduction of body weight, urine output, incidence of hyponatraemia-hypokalaemia and raised creatinine serum.

Methods: This was a-single centre, retrospective study of 40 patients with cardiogenic shock between November 2021 and October 2022. VIS was calculated using the total of highest dose of inotropes and vasopressors administered in the first and subsequent 24 hours (VISmax24 and VISmax48). VIS was dichotomised into ‘high’ if VISmax24 >20; VISmax48 >15 and into ‘low’ if VISmax24 <20; VISmax48 <15. TIES was calculated by adding time factor for each individual vasoactive and inotrope drugs. TIES >23.5 was associated with poor outcome. The data was analysed using IBM SPSS Statistics 26.

PP-006 Effect of Systolic Blood Pressure Variability Following Intravenous Thrombolysis in Acute Ischaemic Stroke: A Meta-analysis Leo Deddy Pradipta, Dessy Natalia, Yovita Andhitara, Udin Bahrudin and Mochamad Ali Sobirin Dr. Kariadi General Hospital Semarang

Results: Of the 40 patients, 16 (40%) died in CVCU. VISmax24 >20 was found in 8 patients (20%), VISmax48 >15 in 4 (10%), and TIES >23.5 in 16 (40%). Diagnostic score test for predicting mortality: VISmax24 obtained 43.75% sensitivity, 95.83% specificity, positive predictive value (PPV) 87.5%, negative predictive value (NPV) 71.88% and 75% accuracy; VISmax48 obtained 12.5% sensitivity, 91.67% specificity, PPV 50%, NPV 57.89% and 60% accuracy; and TIES obtained 87.5% sensitivity, 91.67% specificity, PPV 87.5%, NPV 91.67% and 90% accuracy. Area under receiver operating characteristic (AUROC) in VISmax24, VISmax48, and TIES was 0.727, 0.484, and 0.897, respectively.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-006. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Objective: The purpose of this systematic review and meta-analysis was to ascertain how systolic blood pressure variability (SBPV indices), successive variance of SBPV (SPBVsv), following intravenous thrombolysis (IVT) affected the outcome in acute ischaemic stroke (AIS). Methods: PubMed, Scopus, ScienceDirect and ProQuest were searched for articles published before October 2022. Pooled multivariate OR and 95% CI were obtained using Jeffrey’s Amazing Statistics Program (JASP). Outcomes included favourable functional result using modified Rankin Scale (mRS) score <2 within 90 days and intracranial haemorrhage event within 36 hours after IVT. Newcastle Ottawa Scale (NOS) was used to rate the reliability of the studies.

Conclusion: TIES is a better score for predicting mortality in patients with cardiogenic shock and warrants prospective validation in larger numbers of patients across institutions.

PP-005 Comparison of Different Furosemide Regimens as Acute Decompensated Heart Failure Treatment: An Updated Meta-analysis

Results: Initial search revealed 2,089 studies, of which 8 included 3,1791 patients with AIS who underwent IVT and met the inclusion criteria. Increased of SBPVsv following IVT was substantially related with a poorer functional result in AIS (OR 2.72; 95% CI [1.38–5.36]; I2 = 93.8%; p=0.004) and increased risk of ICH (OR 1.46; 95% CI [1.01–2.12], I2 = 73.6%; p=0.043).

Leo Deddy Pradipta, Adwin Alamsyaputra, Inne Pratiwi Farissa and Safir Sungkar Dr Kariadi General Hospital Semarang

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-005. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Conclusion: SBPV has a negative relationship with 90-day outcome in AIS patients who receive IVT, while the risk of ICH within 36 hours after IVT is increased.

Objective: To compare the efficacy of continuous versus bolus furosemide in treating patients with ADHF.

PP-007 Systemic Immune-Inflammation Index as Predictor of High Thrombus Burden in ST-elevation Myocardial Infarction

Methods: PubMed, ScienceDirect and Scopus were searched for studies that examined the efficacy of continuous versus intermittent administration of furosemide in acute decompensated heart failure patients between 2017 and March 2023. The primary endpoints included all-cause mortality, total length of stay, 48-h reduction of body weight, 48-h total urine output, 48-h sodium-potassium level change, and increase of 48-h creatinine serum.

Wenny Widyastuti, Eka Fithra Elfi, Masrul Syafri and Muhammad Syukri

Department of Cardiology and Vascular Medicine, Universitas Andalas/ Dr. M. Djamil Hospital, Padang, Indonesia

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Abstracts from 27th Asian Pacific Society of Cardiology Congress the 6-h group (p=0.040); and between the 6-h and 4-h group (p=0.047). Correlation test showed that there was moderate correlation (r=0.398) and significant difference (p=0.029) between treatment groups with TGF-β expression. Results of linear regression test showed that the particulate matters treatment group affected 17.5% of the increase in TGF-β expression.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-007. Correspondence: Wenny Widyastuti, w.wenny.31@gmail.com

Objective: To evaluate the association of systemic immune-inflammation index (SII) and high thrombus burden (HTB) in STEMI patients, and determine the cut-off point of SII for predicting HTB.

Conclusion: There was a moderate correlation between particulate matters exposure and TGF-β expression. There was no significant difference between particulate matters exposure and vascular wall thickness.

Methods: This was a retrospective study of STEMI patients with onset less than 12 hours at the Cardiac Center RSUP Dr. M. Djamil Padang, Indonesia from January to September 2022. Data were taken from patient medical records. SII value was calculated (platelet × neutrophil ÷ lymphocyte) before coronary angiography was performed. The classification of thrombus burden was analysed and confirmed by the interventionist who performed the coronary intervention. Non-parametric bivariate test with Mann-Whitney was used to analyse the association of SII and thrombus burden, then continued with diagnostic analysis to determine the cut-off point of SII with the receiver operating curve (ROC) procedure.

PP-009 Prevalence of Obstructive Sleep Apnoea in Singapore Taxi Drivers and its Association with Blood Pressure Control Yik Hin Chan,1 Yi Hui Ou,1,2 Junping Liu,1 Astar Thant1 and Chi Hang Lee1,2

1. National University Hospital Singapore; 2. Yong Loo Lin School of Medicine, National University of Singapore

Results: There was a total of 141 patients in this study with 117 (82.9%) in the HTB group. The overall characteristics of patients between the low thrombus burden (LTB) group and the HTB group were homogenous, with significant differences only in some laboratory data. The SII value in the HTB group was higher than in the LTB group (1,495.57 [518.00–8,137.53] versus 814.96 [291.56–3,482.29]; p<0.001). The cut-off point for SII was 952.41 with a sensitivity of 85.5% and specificity of 66.7% for predicting HTB in STEMI patients (AUC 77%).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-009. Correspondence: Yik Hin Chan, chanjustin093@gmail.com

Background: The number of elderly taxi drivers in Singapore is rising. Enduring long driving hours, drivers become exhausted and sometimes doze off, making them prone to traffic accidents. Obstructive sleep apnoea (OSA) is a leading cause of excessive daytime sleepiness and hypertension, but is underappreciated in the community. This study investigated the prevalence of OSA in local taxi drivers and its association with blood pressure (BP) control.

Conclusion: A high SII value can be used as a predictor of HTB in STEMI patients, especially in developing countries, to help prepare patients before PPCI.

Methods: Taxi drivers over 60 years of age were recruited for overnight polysomnography. Participants completed an Epworth Sleepiness Scale (ESS) questionnaire. OSA is defined when the apnoea-hypopnoea Index (AHI) ≥15 events p/h, or AHI is 5≤15 events p/h if the patient’s ESS score is ≥10 (daytime sleepiness). Participants with OSA underwent 24-h ambulatory BP monitoring (ABPM).

PP-008 Effect of Particulate Matters on TGF-β Expression and Vascular Wall Thickness of Rattus Norvegicus Rats Eryn Aisyah,1 Muhammad Aminuddin,1 Budi Pikir1 and Ketut Sudiana2

Results: As of March 2023, 32 taxi drivers participated in the study: 28 men and 4 women. Overall, 43.8% (n=14) of the participants were overweight (BMI 25.0–29.9), while 32.3% (n=10) were obese (BMI ≥30.0). 65.6% (n=21) of the participants had hypertension. Of the 30 participants who completed the baseline study, 23.3% (n=7) experienced daytime sleepiness. OSA was diagnosed in 73.3% (n=22) of the participants. The mean 24-h systolic and diastolic BP were 126 and 80 mmHg, respectively. In addition, 31.8% (n=7) of the OSA participants had suboptimally controlled BP, indicated by 24-h mean systolic BP ≥130 mmHg.

1. Department of Cardiology and Vascular Medicine, Faculty of Medicine Airlangga University; 2. Department of Anatomical Pathology, Faculty of Medicine Airlangga University Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-008. Correspondence: Eryn Aisyah, file.eryn.aisyah@gmail.com

Objective: To determine the correlation and effect of particulate matters exposure as the elements of air pollution on differentiation of vascular heart tissue through examination of TGF-β expression with immunohistochemistry method and examination of vascular wall thickness with histopathological method.

Conclusion: OSA is prevalent in elderly taxi drivers, with 75.0% (n=24) of the study participants being overweight or obese. Approximately onethird of the OSA participants had sub-optimally controlled BP.

Methods: This is was experimental laboratories research (in vivo study) by conducting particulate matters exposure to rat using the post-test only control group design. A total of 30 mice were divided into three groups: control; 4-h particulate matters exposure; and 6-h particulate matters exposure. The particulate matters dose of 133 mg m3/h was given for 14 days.

PP-010 Comparison of Reperfusion Time of STEMI Between Pre-pandemic and COVID-19 Pandemic in a PCI-capable Hospital Matilde Melanie Cheng-co The Medical City

Results: There were significant differences between groups in different TGF-β expression (p=0.018). From the Pairwise test results, there was a significant difference between TGF-β expression in the control group and

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-010. Correspondence: Matilde Melanie Cheng-co, mmchengmd@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Background: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has placed a heavy strain on the healthcare system. Many health personnel were infected and many institutions placed a moratorium on elective cardiac catheterisation procedures to preserve resources and avoid exposure.

CX3CR1, without differences 30 days after the end of treatment. In addition, there were higher expressions of CCR2 and CCR5 proteins in the group with diabetes at the initial visit for classical, intermediate and nonclassical monocytes, with no differences for CX3CR1, without differences 30 days after the end of treatment. Concerning each group separately, there were reductions in the expression of CCR2 as well as CCR5 in classical, intermediate, and non-classical monocytes, and reduction of CX3CR1 in classical monocytes 30 days after the end of treatment in the group with diabetes, without differences in the group without diabetes.

Objectives: The study aimed to compare reperfusion time among STEMI patients during the COVID-19 pandemic compared to the pre-pandemic period, and to further determine incidence of hospital outcomes, including in-hospital mortality. This was a single-centre, analytical, observational, retrospective cohort.

Conclusion: These findings suggest that the expression of the biomarkers of cardiovascular disease CCR2 and CCR5, in patients with periodontitis associated with diabetes, is favourably modulated after the end of the non-surgical periodontal treatment.

Methods: The study included 149 STEMI patients who underwent primary PCI and were enrolled to the Acute Myocardial Infarction Program of The Medical City from February 2018 to February 2022. Patients were and divided into pre-pandemic (n=73) and COVID-19 pandemic (n=76) groups.

PP-012 High-absorption Curcumin Reduces Serum Atherosclerotic Low-density Lipoprotein Levels in Patients with Mild Chronic Obstructive Pulmonary disease

Results: There was no significant difference in the door-to-wire time between the pre-pandemic and COVID-19 pandemic (p=0.38) groups. Linear regression analysis showed that increased door-to-wire time was associated with longer ICU stay during the pre-pandemic period, whereas during the COVID-19 pandemic, door-to-wire time did not significantly predict length of hospital stay (p=0.317) and length of ICU stay (p=0.347).

Masafumi Funamoto,1 Yoichi Sunagawa,2 Yasufumi Katanasaka,2 Hajime Yamakage,1 Noriko Satoh-Asahara,1 Maki Komiyama,1 Hiromichi Wada,1 Koji Hasegawa1 and Tatsuya Morimoto2

Conclusion: There was no significant difference in the door-to-wire time between pre-pandemic and covid-19 pandemic groups. Recommendations to decrease door-to-wire time include adequate staffing, increased awareness of timely AMI management, and strengthening of the STEMI network through hub-and-spoke programmes.

1. Clinical Research Institute, National Hospital Organization Kyoto Medical Center; 2. Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-012. Correspondence: Masafumi Funamoto, funamoto@tokushima-u.ac.jp

PP-011 Expression of Biomarkers of Cardiovascular Disease in Individuals with Diabetes Associated with Periodontitis

Background: There is growing evidence that chronic obstructive pulmonary disease (COPD) is associated with inflammation and that such inflammation in COPD is not only confined to the lungs but also involves systemic circulation and can impact blood vessels. Therefore, COPD is now recognised as a risk factor of atherosclerotic vascular disease as well as a detrimental factor of heart failure. Curcumin is a natural product possessing antioxidant and anti-inflammatory activities. The present study examined the effects of high-absorption curcumin on inflammatory markers in patients with mild COPD.

Carolina França,1 Danielle Germano,1 Yeon Kim,2 Jônatas do Amaral,3 Marina Shio,1 Luiz Nali,1 André Bachi1 and Débora Pallos2

1. Post Graduate Program in Health Sciences, Santo Amaro University; 2. Post Graduate Program in Odontology, Santo Amaro University; 3. ENT Research Lab, Department of Otorhinolaryngology –Head and Neck Surgery, Federal University of Sao Paulo

Methods: This was a randomised, double-blind, parallel-group study. Patients with stages I–II COPD according to the GOLD guideline were randomly assigned to receive 90 mg high-absorption curcumin agent or placebo twice a day for 24 weeks. Changes in blood inflammatory parameters were evaluated.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-011. Correspondence: Carolina França, carolufscar24@gmail.com

Objectives: To evaluate the effects of non-surgical periodontal treatment in the expression of monocyte chemokine receptors (considered biomarkers of cardiovascular disease), in the presence or absence of diabetes.

Results: There were no differences between the curcumin and placebo groups in baseline characteristics including age, male to female ratio, or BMI in 39 evaluable patients. The percent changes in blood pressure and HbA1c and LDL-cholesterol, triglyceride, or HDL-cholesterol levels after administration for 24 weeks was similar for the two groups. However, the percent change in the level of α1-antitrypsin-low-density lipoprotein (ATLDL) complex, an oxidatively modified LDL that accelerates atherosclerosis, was significantly (p=0.020) lower in the curcumin group than in the placebo group.

Methods: The study included patients (n=45) diagnosed with advanced periodontitis, associated (n=25) or not (n=20) with diabetes (both recognised as risk factors for cardiovascular disease). Peripheral mononuclear blood cells were submitted for evaluation of expression of CCR2, CCR5 and CX3CR1 receptors by realtime PCR and flow cytometry, at the initial visit and 30 days after the end of non-surgical periodontal treatment.

Conclusion: High-absorption curcumin reduces levels of atherosclerotic AT-LDL, which may lead to the prevention of future cardiovascular events in mild COPD patients.

Results: There were higher expressions of CCR2 and CCR5 receptors at the initial visit in the group with diabetes, with no differences for

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-013 Clinical Trial for High-absorption Curcumin Targeting p300-Histonetransferase Activity in Patients with Hypertensive Heart Disease

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-014. Correspondence: Kohsaku Goto, goto-kohsaku@g.ecc.u-tokyo.ac.jp

Objectives: To unveil tricuspid regurgitant (TR) fraction associated with systemic right ventricle (sRV) dysfunction in adult congenital heart diseases using a recent novel method of cardiac magnetic resonance (CMR).

Masafumi Funamoto,1 Yoichi Sunagawa,2 Yasufumi Katanasaka,2 Maki Komiyama,1 Masaharu Akao,1 Akihiro Yasoda,1 Hajime Yamakage,1 Noriko Satoh-Asahara,1 Hiromichi Wada,1 Yasumasa Ikeda,3 Tatsuya Morimoto2 and Koji Hasegawa1

Background: Treatment strategies for sRV patients remain poorly established due to a lack of precise assessment modality for complex cardiac anomaly. New promising techniques of volumetric and blood flow analysis in CMR allow quantitative evaluation of haemodynamics in these patients.

1. Clinical Research Institute, National Hospital Organization Kyoto Medical Center; 2. Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka; 3. Department of Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School

Methods: A retrospective, case-control study of all adult sRV patients who underwent CMR examinations at least twice between 2012 and 2022 was conducted. The primary endpoint was a decline of sRV ejection fraction (sRVEF). In CMR analysis, the phase-contrast flow at each anatomical area was recorded correctly and regurgitant fraction was calculated accurately.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-013. Correspondence: Masafumi Funamoto, funamoto@tokushima-u.ac.jp

Background: Hypertension is a strong risk factor of heart failure (HF) with preserved ejection fraction. Curcumin is a natural compound possessing p300-specific histone acetyltransferase inhibitory activity and prevents the development and worsening of HF in animal models. This doubleblind, placebo-controlled, randomised study examined the efficacy of high-absorption curcumin in patients with hypertension history.

Results: Overall, 19 patients were recruited for analysis. Over an average follow-up period of 70.5 months, TR was an independent prognostic factor for sRVEF deterioration (OR 14.6; p=0.0041) in a multivariate logistic regression analysis. Receiver operating characteristics curve showed that the cut-off value of 21.5% in TR fraction demonstrated excellent diagnostic performance for predicting the primary outcome (AUC 0.91, sensitivity 80%, specificity 100%).

Methods: Patients with a history of hypertension but stable blood pressure <140/90 mmHg and left ventricular ejection fraction ≥60% were assigned to either a curcumin or placebo group, and orally took 180 mg/ day of high-absorption curcumin or placebo for 24 weeks.

Conclusion: Precise assessment by CMR unveiled that even mild-tomoderate severity (21.5%) in TR fraction could cause a deterioration in sRVEF. These findings suggest that intervention for TR should be considered earlier than in the current guideline.

Results: There were no differences between the curcumin (n=73) and placebo (n=69) groups in baseline patient characteristics. The percentage change in plasma BNP levels was significantly lower in the curcumin group than in the placebo group. Patients were stratified according to their age at baseline. In patients <65 years of age, percentage BNP changes were significantly lower in the curcumin than in the placebo group (MD −81.8; 95% CI [−139.3, −24.3]). However, in patients ≥65 years of age, percentage BNP changes were similar between the curcumin and placebo groups. There was a significant interaction (p=0.011) in the curcumin/placebo effect between patients <65 and those ≥65 years of age.

PP-015 Exposure to Aircraft Noise Worsens Cardiovascular Complications in Diabetes

Dominika Mihaliková,1 Miroslava Kvandová,1 Maria Teresa Bayo Jimenez,1 Sanela Rajlic,2 Lea Strohm,1 Henning Ubbens,1 Andreas Daiber,1,3 Claudius Witzler,4 Wolfram Ruf,4 Matthias Oelze,1 Philipp Wild,3,5 Paul Stamm,1 Swenja Kröller-Schön,1 Thomas Münzel1,3 and Thomas Jansen1

Conclusion: High-absorption curcumin significantly inhibited the increase of plasma BNP levels in patients <65 years of age with a history of hypertension. This study is the first piece of evidence for establishing a strategy to prevent the development of HF and control blood pressure.

1. Center for Cardiology, Cardiology I – Laboratory of Molecular Cardiology, University Medical Center of the Johannes Gutenberg University; 2. Department of Cardiothoracic and Vascular Surgery, University Medical Center of the Johannes Gutenberg University; 3. German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main; 4. Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University; 5. Center for Cardiology, Preventive Cardiology and Medical Prevention, University Medical Center of the Johannes Gutenberg University

PP-014 Evaluation of Tricuspid Regurgitant Fraction in Cardiac Magnetic Resonance for Patients with Systemic Right Ventricle

Kohsaku Goto,1 Katsura Soma,1 Hiroyuki Tokiwa,1 Masahiko Umei,1 Akihito Saito,1 Taro Kariya,2 Toshiyuki Kojima,1 Katsuhito Fujiu,3 Ryo Inuzuka,4 Yasutaka Hirata5 and Atsushi Yao6

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-015. Correspondence: Dominika Mihaliková, dmihalik@uni-mainz.de

1. Department of Cardiovascular Medicine, The University of Tokyo Hospital; 2. Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital; 3. Department of Advanced Cardiology, The University of Tokyo Hospital; 4. Department of Pediatrics, The University of Tokyo Hospital; 5. Department of Cardiac and Thoracic Surgery, The University of Tokyo Hospital, 6. Division for Health Service Promotion, The University of Tokyo

Background: Diabetes is a metabolic disease characterised by high blood glucose levels leading to severe cardiovascular and neurological complications. Traffic noise has been recognised as an important environmental stressor. We showed that noise exposure induces oxidative stress-mediated cardiovascular damage through NOX activation and uncoupling of eNOS. Although epidemiological data indicates that noise

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Abstracts from 27th Asian Pacific Society of Cardiology Congress raises the incidence of metabolic diseases, until now their interaction has not been fully elucidated. This study investigated the effects of aircraft noise exposure on cardiovascular complications in diabetes.

Conclusion: Poor sleep was pervasive in this study of 100 homogenously distributed ACS patients confined during a pandemic surge. Clinical history of stroke and poor sleep efficiency were significantly associated with prolonged hospital stay. Although no significant differences were found between the groups, a trend in the presence of more pre-existing comorbidities, most complications developed, (all) deaths occurred and longer hospital stays among poor sleepers was observed.

Methods: C57BL/6 mice were treated with streptozotocin to induce type I diabetes and treated with S961 or fed a high-fat diet to induce type II diabetes. To investigate the effects of noise, the animals were exposed to aircraft noise for the last four days of treatment. Afterwards, animal tissues were harvested and analysed.

PP-017 Regression of Infarct Scars in COMETAMI (Concomitant Milrinone and Esmolol Treatment in Acute Myocardial Infarction)

Results: Noise interferes with glucose metabolism, worsens diabetesinduced hypertension and impairs endothelial function of vessels. Endothelial dysfunction was coupled with increased levels of ADMA and elevated superoxide formation. This was associated with higher levels of 3-NT-positive proteins. Furthermore, an additive effect of noise on increase of mitochondrial ROS along with impaired mitochondrial function was observed. Finally, an increment in inflammation markers in noiseexposed animals was observed.

Joy Ong,1 Poay Huan Loh,1 Siew Pang Chan,1 Cher Yi Wong,1 Vion Tan,1 Huay Cheem Tan,1 Lynette Teo,2 Ming-He Huang3 and Kian Keong Poh1

1. National University Heart Centre Singapore; 2. National University Hospital Singapore; 3. Gulf Coast Heart Clinic Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-017. Correspondence: Joy Ong, joyong.93@gmail.com

Conclusion: This study investigated the effect of aircraft noise on cardiovascular complications in diabetes. Data indicated that exposure to noise may have additive effects on endothelial dysfunction, oxidative stress, mitochondrial dysfunction and inflammation, notably in patients at greater cardiovascular risk, with pre-existing cardio-metabolic diseases.

Background: Reperfusion ischaemic injury during percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may result in poorer outcome. This study investigated the use of adjunctive cardioprotective therapy for PCI in a first of its kind proof-ofconcept clinical study, based on positive pre-clinical data in animal models.

PP-016 Sleep Quality Among Acute Coronary Syndrome Patients During a Pandemic Surge in the Philippines

Methods: This was a single-blinded trial in which 22 patients were randomised into two arms: an active group receiving an infusion combination therapy of phosphodiesterase-3 inhibitor milrinone + β1blocker esmolol, and a placebo group receiving saline infusion during PCI. Serum biomarkers of troponin, CK-MB and CK collected at 0, 4, 12, 24, 36, 48 and 72-hour time points; and echocardiographic parameters and MRI findings of delayed enhancement collected at 5 days and 6 months; were independently analysed.

Renato Ong, Abigail Zaraspe and Saturnino Javier Makati Medical Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-016. Correspondence: Renato Ong, r.ongjrmd@gmail.com

Background: Poor sleep is a public health concern and has been associated with cardiovascular disease.

Results: Echocardiographically, LA volume was lower (43.1 versus 55.1 ml [p=0.037]), and mitral E/A was lower in the placebo (0.7 versus 1.3 [p=0.044]) compared to the active group. The area under curve analyses demonstrated that the troponin I, CK-MB, and CK curves were not statistically significant between groups. MRI infarct size analyses showed significant improvement of infarct size in placebo compared to active, with a higher >50% reduction in infarct size at 6 months compared to 5 days (p<0.01).

Methods: This study evaluated sleep quality among acute coronary syndrome (ACS) patients during a pandemic surge at Makati Medical Center using the Pittsburgh Sleep Quality Index questionnaire. Results: Eighty-one (81%) patients were poor sleepers and 19 (19%) were good sleepers. The mean age was 62 years, with more male than female patients. The majority were never smokers. The three most common preexisting comorbid conditions were hypertension (77%), dyslipidaemia (64%) and diabetes (41%). There were significantly more good sleepers who had very good sleep quality and greater 85% sleep efficiency than poor sleepers (p<0.001 and p=0.036, respectively). In contrast, there were significantly more poor sleepers who took longer time to fall asleep, had shorter sleep duration, and reported more daytime dysfunction (all p<0.001). Multivariate analysis showed that habitual sleep efficiency was significantly associated with prolonged hospital stay (adjusted OR 0.439; 95% CI [0.272–0.708]; p<0.001). The most common cardiac complication was cardiogenic shock (4%). Five (5%) patients died while 95 (95%) were discharged (21 [22%] patients had prolonged hospital stay). Among the ACS patients with poor sleep, those who had pre-existing stroke were significantly 25 times more likely to have prolonged hospital stay compared to those who do not have stroke (adjusted OR, 24.763 [95% CI, 2.320–264.336]; p=0.008).

Conclusion: Patients who received placebo treatment had higher improvement of infarct size and volume by MRI compared to those with adjuvant milrinone and esmolol combination infusion to reduce ischaemiareperfusion injury. Further work is needed to assess the results of scar regression.

PP-018 The Belun Sleep Platform to Diagnose Obstructive Sleep Apnoea in Patients with Hypertension and High Cardiovascular Risk

Yi Hui Ou,1 Joy Ong,2 As Tar Thant,1 Chieh Yang Koo,2 Lydia Leung,4 Siew Pang Chan,1 Serene Wong2 and Chi Hang Lee2 1. National University of Singapore; 2. National University Heart Centre Singapore; 3. Belun Technology Company Ltd; 4. Alexandra Hospital

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Results: Of 60 patients, 56.7% were male and 43.3% were female. There were no statistically significant differences in mean age, BMI and history of diabetes between the control and hypertensive groups (58 versus 54 years, p=0.300; 24.5 versus 22.5, p=0.061; 1.9% versus 1.8%, p=0.398, respectively). Echocardiographic examination showed LA diameter and LA volume index were higher in the hypertensive group (31.47 versus 28.43 mm, p=0.090; 24.04 ml/m2 versus 18.03 ml/m2, p=0.100, respectively). No diastolic dysfunction was found in either group. Comparison between PALS in the hypertensive and control groups showed significantly statistical result (25.05% versus 46.36%, p=0.001) with lower value in the hypertensive group.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-018. Correspondence: Yi Hui Ou, mdcyhui@nus.edu.sg

Background: Current hypertension guidelines recommend that at-risk individuals be screened for obstructive sleep apnoea (OSA). The Belun Ring is a wearable OSA diagnostic device worn on the palmar side of the proximal phalanx of the index finger. Methods: The study recruited 129 participants with hypertension and high cardiovascular risk for a simultaneous polysomnography and Belun Ring monitoring for one night. The apnoea–hypopnoea index (AHI) derived was compared between polysomnography (PSG) and Belun Ring using various statistical methods.

Conclusion: Patients with arterial hypertension have decreased PALS reflecting abnormality of reservoir LA function even in the absence of echocardiographic signs of LV diastolic dysfunction. PALS may be a promising tool for the early diastolic LV impairment in hypertension.

Results: Of the 127 participants who completed the study, 88% were male, mean age was 60 ± 8 years, mean BMI was 27 ± 4 kg/m2, and 21% of the participants scored >10 in Epworth sleepiness scale. The AHI derived from PSG was 26.6 ± 24.5 events/h and that derived from the Belun Ring was 25.2 ± 18.2 events/h (intraclass correlation coefficient 0.882; 95% CI [0.837–0.916]). A Bland-Altman plot showed the difference between the Belun Ring and PSG AHIs to be −1.3 ± 10.4 events/h. Area under the receiver operating characteristic for the Belun Ring AHI was 0.961 (95% CI [0.932–0.990], p<0.001). When the Belun Ring AHI of ≥15 events/h was used to diagnose OSA, the sensitivity, specificity, positive predictive value and negative predictive value were 95.7%, 77.6%, 85.3% and 93.8%, respectively. The overall accuracy was 87.4%. Cohen’s kappa agreement was 0.74 ± 0.09 (p<0.001). Similar results were obtained when the oxygen desaturation index was used to diagnose OSA.

PP-021 The Role of Inflammatory Signalling Pathways Involving the CD40L-CD40-TRAF Cascade in Diabetes and Hypertension

Lea Sophie Strohm,1 Steffen Daub,1 Matthias Oelze,1 Marin Kuntic,1 Henning Ubbens,1 Imo E. Hoefer,2 Alex von Kriegsheim,3 Hartmut Kleinert,4 Christian Weber,5 Dorothee Atzler,5 Philipp Wild,6 Thomas Münzel,1 Christoph Knosalla,7 Esther Lutgens5 and Andreas Daiber1 1. Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University; 2. Laboratory for Experimental Cardiology, UMC Utrecht; 3. Institute of Genetics and Cancer, University of Edinburgh; 4. Department of Pharmacology, University Medical Center of the Johannes Gutenberg University; 5. Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians Universität; 6. Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University; 7. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin

Conclusion: A high prevalence of OSA was detected in patients with hypertension and high cardiovascular risk. The Belun Ring is a reliable device for diagnosing OSA, similar to polysomnography.

PP-020 Early Detection of Left Atrial Strain Abnormalities by Speckle Tracking in Hypertension Shindu Phalguna,1 Alles Firmansyah1 and Mefri Yanni2

1. Resident Cardiology Department of Cardiology and Vascular Medicine, Universitas Andalas; 2. Staff Cardiology Department of Cardiology and Vascular Medicine, Universitas Andalas

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-021. Correspondence: Lea Sophie Strohm, lstrohm@uni-mainz.de

Background: This study tested the hypothesis that the inhibition of CD40L-CD40-TRAF signalling in mouse models of hypertension and diabetes has cardio- and vasoprotective effects. The study aimed to characterise the CD40L-CD40-TRAF cascade and major markers of inflammation in vascular bypass material and sera from artery disease patients (CAD).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-020. Correspondence: Shindu Phalguna, shinduphalguna123@gmail.com

Background: Arterial hypertension is associated with morphological and functional left atrial (LA) abnormalities. An increase in LA size in patients with hypertension may suggest early sign of LV diastolic impairment leading to heart failure. Peak atrial longitudinal strain (PALS) is a new echocardiographic method reflecting LA reservoir function. This method is particularly useful when changes are subtle and not easily determined by traditional parameters, as it is in arterial hypertension. Objective: To evaluate PALS using 2D strain in patients, with and without hypertension as an indicator for early diastolic LV impairment.

Methods: TRAF6 inhibitor and angiotensin-II application in C57/BL6J and db/db mice were performed subcutaneously through osmotic minipumps. Mouse cardiac and aortic tissue were used for FACS analysis, isometric tension studies, DHE staining, IHC staining, Western blotting and mRNA expression analysis. Bypass material and serum from CAD patients with diabetes and/or hypertension were used to perform NGS, Olink proteomic analysis and mRNA expression analysis.

Methods: 60 patients with normal ejection fraction (30 control patients versus 30 hypertensive patients) underwent echocardiography examination. PALS was measured using speckle tracking 2D echocardiography. Mean PALS between the groups were analysed statistically.

Results: Mouse models showed that TRAF6 inhibition benefits endothelial function by suppressing inflammatory pathways and reducing vascular oxidative stress. Initial Olink analysis shows an increase in markers of atherothrombosis and endothelial cell activation in the plasma of CAD patients. In addition, specific gene clusters in aortic tissue that correlate

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Abstracts from 27th Asian Pacific Society of Cardiology Congress with the comorbidities of CAD patients through NGS were identified. Key markers like NOX2, CD40L, CD68, and 3NT are stepwise increased with each additional comorbidity in the plasma of CAD patients.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-023. Correspondence: Shohei Yokota, yokota.shohei@ncvc.go.jp

Background: Percutaneous left ventricular assist device (pVAD) supports haemodynamics and unloads the left ventricle (LV) in the acute phase of cardiogenic shock. Although pVAD supports only the LV, in some cases, the establishment of acute Fontan circulation during ventricular fibrillation (VF) has been observed. This study investigated the haemodynamic mechanisms of pVAD support during VF, with a focus on pulmonary vascular resistance (PVR).

Conclusion: CD40L-CD40-TRAF signalling plays a major role in the development of endothelial dysfunction. TRAF6 inhibition is linked to cardiovascular protection and could be a promising therapeutic target for cardiovascular diseases. In CAD patients with hypertension and/or diabetes, similar markers of inflammation were increased to the murine models.

PP-022 Efficacy and Safety of Partial Oral Antibiotic Treatment in Vietnamese Patients with Infective Endocarditis

Methods: Under general anaesthesia, pVAD (Impella CP) was inserted via the left carotid artery in four goats (48.9 ± 8.6 kg) and VF was induced using direct current. Left atrial pressure (LAP), aortic pressure (AP), and pulmonary artery flow (PAF) and pressure (PAP) were simultaneously recorded. Pulmonary vascular resistance (PVR) was calculated as (PAPLAP)/PAF. The impact of pVAD support level on haemodynamics during VF and the increment of PVR due to pulmonary artery micro-embolisation under pVAD support condition were examined.

Duy Tran Cong,1,2,3 Cuong Tran Dai,1,2 Toan Dang Quang,1,2 Duy Nguyen Truong1,2 and Sy Hoang Van1,2 1. Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City; 2. Department of Cardiology, Cho Ray Hospital; 3. Cardiovascular Center, University Medical Center Ho Chi Minh City

Results: During VF, the pVAD could maintain AP (VF; 31.4 ± 7.1 and VF + high support; 31.4 ± 7.1 mmHg versus 66.9 ± 14.5 mmHg; p<0.05) and decreased LAP (26.7 ± 5.7 versus 9.0 ± 2.8 mmHg; p<0.05) support level dependently, indicating the establishment of acute Fontan circulation observed in the clinic. High PVR decreased pVAD generated PAF from 1.2 ± 0.5 to 0.5 ± 0.2 (l/min). Increases of PVR decreased LVP and rendered the pVAD support condition to LV suction.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-022. Correspondence: Duy Cong Tran, dr.trancongduy@ump.edu.vn

Background: Patients with infective endocarditis (IE) are treated with intravenous antibiotic agents for 4–6 weeks according to current guidelines. The efficacy and safety of partial oral antibiotics in Vietnamese patients with stable IE are unknown. This study evaluated the efficacy and safety of partial oral antibiotic treatment in patients with IE.

Conclusion: pVAD could strongly support haemodynamics during VF. PVR is a major determinant to maintain stable pVAD operation during VF.

PP-024 NPM1 Impairs Post-infarction Cardiac Repair by Repressing Oxidative Phosphorylation Remodelling of Reparative Macrophages

Methods: This was a preliminary open-label, single-arm clinical trial on IE patients (≥18 years old) admitted to the Department of Cardiology, Cho Ray Hospital between June 2019 and August 2022. Patients who had IE caused by Streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative Staphylococci and were in a stable condition were switched to oral antibiotic treatment after being administered intravenous antibiotics for at least 14 days. The primary outcome was a composite of all-cause mortality, unplanned cardiac surgery, embolic events and recurrent IE until 6 months after antibiotic treatment was completed.

Sheng Zhang,2 Xuewen Duan,2 Xingguang Liu3 and Zhen Zhen Zhan1

1. Shanghai Institute of Transplantation, Renji Hospital, Shanghai Jiao Tong University School; 2. Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine; 3. Department of Pathogen Biology, Naval Medical University, Shanghai

Results: Twenty IE patients were enrolled in the study; 80% male, mean age 44.6 ± 13.5 years. The identified pathogens were Streptococcus (85%) and Staphylococcus (15%). The most frequent position of vegetation was the mitral valve (75%). The mean time of changing to oral antibiotic treatment was 16 (15.0–21.5) days from the initiation of antibiotics. The primary outcome did not occur in any patient after switching to oral antibiotics.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-024. Correspondence: Zhen Zhen Zhan, zhanzz2022@sjtu.edu.cn

Objective: To investigate the role and mechanisms of macrophage NPM1 in cardiac repair after acute myocardial infarction (MI).

Conclusion: In Vietnamese patients who had IE caused by Streptococcus or Staphylococcus and were in a stable condition, switching to oral antibiotic treatment was highly effective and safe.

Methods: Peripheral blood mononuclear cells (PBMCs) were collected from healthy individuals and patients with MI to analyse NPM1 expression and its correlation with prognostic indicators of MI. A mouse strain with macrophage-specific knockout of NPM1 was developed to observe the effect of NPM1 deficiency. Metabolomic profiling was used to analyse the influence of NPM1 deletion on metabolic patterns. Transcriptomic sequencing combined with CUT&Tag was used to analyse the epigenetic mechanisms by which NPM1 regulates macrophage metabolic remodelling.

PP-023 The Percutaneous Left Ventricular Assist Device for Stable Haemodynamic Support During Ventricular Fibrillation Shohei Yokota, Hiroki Matsushita, Hidetaka Morita, Masashi Fukumitsu, Yuuki Yoshida, Kei Sato, Toru Kawada, Kazunori Uemura and Keita Saku

Results: NPM1 expression in PBMCs of patients with MI was upregulated compared to healthy individuals and was positively correlated with

National Cerebral and Cardiovascular Center

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Abstracts from 27th Asian Pacific Society of Cardiology Congress prognostic indicators. Macrophage-specific NPM1 deletion significantly reduced cardiac fibrosis, promoted angiogenesis, improved cardiac function, and inhibited ventricular remodelling in MI mice. NPM1 deletion promotes the reparative phenotype and function by enhancing mitochondrial oxidative phosphorylation and inhibiting glycolysis pathways. Mechanistically, NPM1 directly binds to the promoter of TSC1, and epigenetically inhibits the TSC1 transcriptional expression, inhibiting the activation of mTOR cascades, ultimately leading to macrophage metabolic reprogramming. Both antisense oligonucleotides and inhibitory compounds targeting NPM1 exhibited remarkable protective effects on heart repair after MI.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-026. Correspondence: M Hanumantha Reddy, dr.hanumanthreddy@gmail.com

Objective: To evaluate the effect of balloon pulmonary angioplasty (BPA) in patients with distal chronic thromboembolic pulmonary hypertension (CTEPH) by New York Heart Association (NYHA) functional class and 6-minute walk distance (6MWD), and study the decrease in pulmonary artery pressure and improvement in right atrial and right ventricular function by echocardiography. Methods: The study group consisted of CTEPH patients presenting from January 2017 to April 2018. who were considered inoperable by the CTEPH team and underwent BPA. CTEPH patients with proximal thrombi at lobar and segmental level were excluded. This was an observational retrospective and prospective follow-up study. Detailed case records and investigations were collected. At 8 weeks from last BPA session, patients were assessed clinically, then 6MWD, blood investigations and echocardiography were performed.

Conclusion: Findings from this study indicate that NPM1 participates in the metabolic reprogramming and phenotypic transition of macrophages after MI through epigenetic mechanisms, impeding the repair of cardiac injury and the recovery of cardiac function.

PP-025 Correlation Between Tiffeneau-Pinelli Index and Mean Pulmonary Arterial Pressure in Atrial Septal Defect Patient

Results: The mean age at presentation was 39.81 + 12 years. Of 11 patients, five were men and six were women. Mean duration of symptoms was 40.5 months. Total number of BPA sessions performed was 30. The minimum number of BPA sessions undergone was one, the maximum number of BPA sessions undergone by one patient was five, and 45% of patients underwent two BPA sessions. The total number of segmental arteries dilated was 104. Number of segmental vessels dilated each session was 3.46. There was statistically significant improvement in NYHA class and 6MWD after BPA. 6MWD increased from 299 to 421 m (p<0.001). This improvement in functional capacity was strongly associated with improvement in RV function (TAPSE from 15.3 to 18.9 mm) and reduction in PASP (from 92 to 60mm Hg).

Leo Deddy Pradipta, Adwin Alamsyaputra, Inne Pratiwi Farissa and Ilham Uddin Dr. Kariadi General Hospital Semarang

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-025. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Objective: To analyse the correlation between Tiffeneau-Pinelli index and mean pulmonary arterial pressure (mPAP). Methods: This was a-single centre, retrospective study of adult patients with atrial septal defect who underwent closure surgery between January and December 2022. Forced expiratory volume in the 1st second (FEV1) and forced vital capacity (FVC) calculation was performed using spirometry, several weeks before operation. All procedures were performed according to 2019 ATS/ERS standardisation of spirometry. FEV1/FVC ratio was divided into severe (ratio <50%) and not severe (ratio >50%). Right heart catheterisation (RHC) indices, including mPAP, flow ratio, and pulmonary arterial resistance index (PARI), were recorded.

Conclusion: In patients who underwent BPA, there was statistically significant improvement in 6MWD. These changes corresponded to treatment-induced reduction in pulmonary artery pressure and lend support to the use of BPA in patients with distal CTEPH. ECHO and 6MWD can be used to evaluate BPA efficacy and monitor disease progression.

PP-027 Predictors of Length of Stay in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention: A Historical Cohort Study

Results: A total of 32 patients (34 + 14 years, 33% male) were enrolled in the study. Of 32 patients, 18 patients had mPAP<40 mmHg and 14 had mPAP >40 mmHg. Patients with higher mPAP had significantly lower FEV1 and FVC (p=0.03 and p=0.02, respectively). FEV1/FVC ratio was lower in patients with higher mPAP as well, which means that patients with higher mPAP tend to have severe restrictive lung defect. There is a statistically strong correlation between Tiffeneau-Pinelli Index and mPAP (r=0.489 and p=0.002, respectively).

Hidayatul Alia Ahmad, SY Ang, YJ Loo, WCJ Tan and AO Sahlen National Heart Centre Singapore Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-027. Correspondence: Hidayatul Alia Ahmad, hidayatul24@gmail.com

Conclusion: Tiffeneau-Pinelli index has strong correlation with mPAP in patients with atrial septal defect. Low Tiffeneau-Pinelli index is associated with higher mean pulmonary arterial pressure and vice versa.

PP-026 Balloon Pulmonary Angioplasty in Patients with Distal CTEPH: First Single-Centre Experience in India

Background: The efficacy of primary percutaneous coronary intervention (PPCI) in restoring blood flow to the myocardium has been well documented. Studies have shown the feasibility of acute myocardial infarction (AMI) patients being discharged within three days after PPCI. However, eligible patients remain hospitalised beyond 72 hours. The purpose of this study was to identify demographic and clinical variables associated with length of stay (LOS) beyond 72 hours and unplanned readmission within 30 days of discharge.

Narayana Hrudayalaya Hospital

Methods: 240 records of patients with AMI who had undergone PPCI from January 2016 to December 2016 were examined. The demographic

M Hanumantha Reddy, Bagirath Raghuraman and George Cherian

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Abstracts from 27th Asian Pacific Society of Cardiology Congress and clinical variables of LOS and unplanned readmission were determined using survival analysis. Spearman’s Rho was used for univariate analysis while linear and logistics regression were used for multivariate analysis. Data were analysed, and p≤0.05 was considered statistically significant. Ethical approval was obtained for the study.

Conclusion: In this Asia T2D cohort with no known CRCs and limited echo screening, one-fourth had subclinical structural heart disease emphasising the need for regular echo screening in individuals with risk markers such as older age, T2D, hypertension, higher CV risk and albuminuria.

Results: The mean LOS was 107.36 (STD ± 88.12) and unplanned readmission was found in 13.4% (n=32) of the population. Age (p=0.033), pulse rate (p=0.003), haemoglobin (p=0.006), creatinine (p=0.02) and LVEF (p=0.001) were statistically significant in LOS beyond 72 hours. In an unplanned readmission, age (p=0.004), sex (p=0.002), hypertension (p=0.02), ESRF (0.007), and presenting haemoglobin (p<0.0001) were significant risk factors and previous CABG (p=0.027) and arrhythmias (p=0.003) were independent factors.

PP-029 Coffee Consumption among STEMI Patients Treated with Primary Percutaneous Coronary Intervention

Maria Elfiana, Teuku Muhammad Haykal Putra, Amelia Shadrina and Wishnu Aditya Widodo Jakarta Heart Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-029. Correspondence: Maria Elfiana, maria.elfiana96@gmail.com

Conclusion: Older patients with diabetes and abnormal rhythm, haemoglobin and creatinine levels were more likely to be hospitalised beyond 72 hours. Post procedure ejection fraction also affects the clinical decision for discharge. Previous CABG and arrhythmias during the index hospitalisation increases patient risk of an unplanned readmission by 8.5% and 3.8%, respectively.

Background: Daily routine coffee consumption has significantly increased in all parts of the general population. The association of coffee drinking and myocardial infarction continues to be controversial. Moreover, current evidence of coffee consumption and its contribution to ST-elevation myocardial infarct (STEMI) has not yet been explored. We studied the association of coffee consumption and other cardiovascular risk factors in STEMI patients treated with primary percutaneous coronary intervention (PPCI).

PP-028 Burden and Correlates of Abnormal Echocardiogram in Type 2 Diabetes: Take Care of Me (TCoM) Asia Cohort

Methods: A cross-sectional analysis of 97 STEMI patients treated with PPCI in Jakarta Heart Center was performed. Data were collected between October 2022 and February 2023. All patients were interviewed during hospitalisation about their daily routine coffee consumption. Other cardiovascular risk factors and clinical profile were also included in allying the overall conclusions.

Suresh Damodaran, Maria February R Cruz and Sudhakar Subramaniam Sri Ramakrishna Hospital

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-028. Correspondence: Suresh Damodaran, sureshendocrine@gmail.com

Background: Cardiac disease is often clinically silent in type 2 diabetes (T2D) leading to missed opportunities for prevention of cardio-renal complications (CRCs). TCoM subset of the ongoing iCaReMe, global, cloud-based registry (NCT03549754) evaluated the prevalence, types, and correlates of abnormal echocardiogram (echo) in patients with T2D.

Results: This study involved 78 men (80.4%) and 19 women (19.6%) diagnosed with STEMI with a mean age of 55 ± 10 years. Among them, 65 patients (67%) drank coffee daily. Major prevalence of coffee drinking was found in male (92.3%) patients. Significant association was identified in smoking and diabetes with regular coffee consumption (p=0.04 and p=0.016). It appeared no contribution of coffee drinking with clinical outcome and severity of disease as observed from similar proportion of left ventricle (LV) dysfunction and vessels involved from both groups. None of any other investigated factors were significantly different.

Methods: This multinational, observational registry provides real-world data on patient characteristics, disease management, and outcomes in T2D, chronic kidney disease, heart failure and hypertension. Individuals (≥18 years) with T2D without known CRCs at baseline were enrolled from routine clinical practice in Asia (India, Malaysia and Philippines) between December 2020 and December 2021. Correlation and regression analyses were performed.

Conclusion: Daily routine coffee consumption is associated with smoking and diabetes as a cardiovascular risk factor among STEMI patients.

PP-030 Epidemiology of Hypertension and Challenges in Managing Hypertension in the Asia-Pacific: A Scoping Review

Results: In 4,951 recruited individuals (mean ± SD: age 54.9 ± 11.99 years, BMI 26.7 ± 5.12 kg/m2; 51.3% women), 58.4% were overweight/obese, 41.1% had hypertension, 57.6% had T2D duration >5 years, 59.2% had uncontrolled glycaemia (HbA1c >7%), 36.6% had high/very high cardiovascular (CV) risk according to 2019 ESC guidelines and 28% had A2/A3 albuminuria. Among 328 (6.6%) individuals with available echo data, 82 (25%) had at least one abnormality. In multivariate analysis (OR 95% CI), age (1.08, 1.05–1.11, p<0.0001), hypertension (1.73, 1.04–2.86, p<0.05) and CV risk (1.02, 0.24–4.39, p<0.0001) were associated with abnormal echo. Significant associations (p<0.05) were found between left ventricular hypertrophy and hypertension (v=0.16), and between left atrial enlargement and A2/A3 albuminuria (v=0.25).

Hao Wen Jiang,1,3 Raja-Ezman Raja Shariff,2 Jonathan Yap,1,20 Shyn Yi Tan,3 Lucky Cuenza,4 Bambang Dwiputra,5 WeiTing Chang,7 Misato Chimura,8 Ganchimeg Ulziisaikhan,9 Derek Pok Him Lee,10 Vorn V Malis,11 Uditha Hewarathna,12 KangUn Choi,13 Dong-Hyuk Cho,14 Fathima-Aaysha Cader,15 Gary Gan,16 Akmal Arshad,17 Purich Surunchupakorn,18 Quang Nguyen,19 Tazeen-Hasan Jafar,20 Paul Pronyk,20 Badai Tiksnadi,21 Kenny Sin1,20 and Jack Tan1,20

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Abstracts from 27th Asian Pacific Society of Cardiology Congress 1. National Heart Centre Singapore; 2. UiTM Sungai Buloh; 3. Lee Kong Chian School of Medicine; 4. Philippine Heart Center; 5. Harapan Kita National Cardiovascular Center Jakarta; 6. Adam Malik General Hospital Medan; 7. Chi-Mei Medical Center; 8. Osaka University Graduate School of Medicine; 9. National Cardiovascular Center of the Third State Central Hospital; 10. Queen Elizabeth Hospital; 11. Calmette Hospital; 12. Teaching Hospital Ratnapura; 13. Yeungnam University Hospital; 14. Korea University Anam Hospital; 15. Ibrahim Cardiac Hospital & Research Institute; 16. Blacktown Hospital; 17. Gleneagles Kuala Lumpur; 18. Central Chest Institute of Thailand; 19. Bach Mai Hospital; 20. Duke-NUS Medical School; 21. Universitas Padjadjaran

Background: The benefits of omega-3 fatty acid are controversial. This study investigated long-term clinical efficacy of omega-3 fatty acid use on cardiovascular outcomes and mortality in patients with type 2 diabetes.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-030. Correspondence: Hao Wen Jiang, hjiang011@e.ntu.edu.sg

Results: The primary endpoint was similar in omega-3 fatty acid users compared to non-users, 17.1 versus 17.8 per 1,000 person years (HR 0.898; 95% CI [0.69–1.17]; p=0.4231) after adjustment. In individual outcomes, all-cause death (9.0 versus 14.7 per 1,000 person years [HR 0.511; 95% CI (0.357–0.732); p=0.0003]) was significantly lower in the omega-3 fatty acid group. Cardiac death (2.5 versus 3.4 per 1,000 person years [HR 0.565; 95% CI (0.286–1.116); p=0.1001]), MI, PCI and stroke rates were not different between the two groups. As the duration of omega-3 fatty acid use stratified by quartiles (Q1–4) increased, the risk of primary event at Q4 was significantly low with (HR 0.306; 95% CI [0.176– 0.533]; p<0.0001).

Methods: A population-based cohort study was performed using Korean National Health Insurance data from 2009 to 2014. Among 63,727 participants with diabetes aged 40–79, 2,393 users of omega-3 fatty acid were compared with 2,393 non-users with 1:1 propensity matching. Primary endpoint was composite of myocardial infarction (MI), stroke, percutaneous coronary revascularisation and cardiac death for median 3.2 years.

Background: There remains great heterogeneity in availability of data and approaches in managing hypertension within Asia-Pacific. We aimed to perform a review to better understand the current epidemiology and challenges faced in tackling hypertension regionally. Methods: A comprehensive search across five electronic databases was performed from September 2012 to September 2022. Additional grey literature was also obtained and analysed. Data were qualitatively synthesised and discussed under five major domains: (a) epidemiology, (b) care provision, hospitalisation and financial implications, (c) medications, (d) existing measures and (e) challenges at various tiers.

Conclusion: Use of omega-3 fatty acid was associated with reduced total mortality but not with lower cardiovascular events in type 2 diabetes patients in a large real-world population.

Results: Sixteen countries participated in the review. Data on regional prevalence between 2014 and 2022 were mainly derived from government-level national surveys and ranged between 10.6% and 48.3%. Urbanisation, gender, ageing population, socioeconomic status, and ethnicity were significant factors influencing local prevalence. Furthermore, rates of undiagnosed, untreated and uncontrolled hypertension, where available, were alarming within the region with various factors from domains (b) to (e) contributing to this. Data on care provision and hospitalisation linked to hypertension, or hypertensionrelated complications, were generally sparse. Data on financial implications were also variable, focusing more on direct cost (e.g. hospitalisation and prescription) and less on indirect cost (e.g. loss of productivity). Despite national hypertension societies and guidelines, there is little agreement in the use of anti-hypertensives between countries. Various measures and policies exist in each country (e.g. salt reduction campaigns) to help combat hypertension. Nevertheless, challenges abound; some are systemic (e.g. lack of manpower and facilities) while others appear more granular and culturally influenced (e.g. local diets and traditional beliefs).

PP-032 Association of Lipid Variability with Risk of Coronary Heart Disease in Lowrisk, Statin-naïve Individuals Jeonggyu Kang and Byung Jin Kim Kangbuk Samsung Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-032. Correspondence: Jeonggyu Kang, kamgjk@gmail.com

Background: The association between lipid variability and coronary heart disease (CHD) in low-risk, statin-naïve individuals is poorly studied. This research investigated the associations of lipid variability with subclinical coronary atherosclerosis and CHD development in this population. Methods: A cross-sectional study enrolled 46,002 participants from a health screening program. A separate retrospective cohort study followed 91,738 participants for CHD events over a median period of 7.2 years. All participants were statin-naïve and lipid measurements were conducted at least four times before assessing coronary artery calcium (CAC) scores and identifying CHD events. Tobit regression and Cox proportional hazards models were employed for analysis.

Conclusion: With the increasing prevalence of hypertension, a concerted effort on several fronts is needed to tackle this public health threat. Stakeholders from different countries may benefit from the experiences of others and subsequently develop tailored solutions locally.

Results: Among lipid profiles and variability indices, the variability independent of the mean (VIM) of low-density lipoprotein cholesterol (LDL-C) showed a positive association with increased CAC score (1.29; 95% CI [1.06–1.58]) in the highest quintile compared to the lowest. In the cohort study, 625 CHD cases were developed with an overall incidence rate of 97.8 per 100,000 person years. The VIM of LDL-C was also associated with an elevated risk of CHD development (HR 3.28; 95% CI [2.60–4.14]). These associations persisted even in groups with low estimated atherosclerotic cardiovascular (ASCVD) risk.

PP-031 Omega-3 Fatty Acid Use and Cardiovascular Events in Patients with Diabetes Sang-Ho Jo

Hallym University Sacred Heart Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-031. Correspondence: Sang-Ho Jo, sophi5neo@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Conclusion: This study demonstrated significant associations of lipid variability with CAC scores and CHD development risk in statin-naïve and low-ASCVD-risk populations. Further research on early intervention strategies is warranted to reduce CHD development, even for those not typically targeted for lipid-lowering agents.

cardiometabolic risk factors. This study investigated the effects of dapagliflozin on cardiometabolic risk factors. Methods: This was a randomised, single-blind, placebo-controlled, parallel study. Age, sex, and BMI were matched between groups. All patients were recommended not to change diet and exercise pattern until the study ended. Thirty-five patients with type 2 diabetes in each group were given placebo or dapagliflozin 10 mg, respectively, daily for 2 months.

PP-033 Pattern of Rheumatic Heart Disease in Western Nepal: An Echocardiographic Study, Single-centre Experience

Background: Rheumatic heart disease (RHD) is a chronic debilitating consequence of acute rheumatic fever. Echocardiography is a simple tool to diagnose the valvular lesion. This study aimed to identify the pattern of valvular involvement.

Results: When compared with placebo, dapagliflozin significantly decreased triglyceride and triglyceride/HDL cholesterol ratio (both p<0.05 by unpaired t-test). When compared with placebo, dapagliflozin significantly improved flow-mediated dilation and reduced high-sensitivity CRP (both p<0.05 by unpaired t-test). When compared with placebo, dapagliflozin significantly reduced insulin, glucose and HbA1c (p<0.05, p<0.001 and p<0.01, respectively, by unpaired t-test), and improved insulin sensitivity (p<0.01 by unpaired t-test). Finally, when compared with placebo, dapagliflozin significantly reduced visceral fat (p<0.05 by unpaired t-test).

Methods: This was a retrospective transthoracic echocardiographic analysis of patients presenting with RHD over a two-year period from July 2020 to July 2022.

Conclusion: Dapagliflozin controls cardiometabolic risk factors in patients with type 2 diabetes. These effects are one of main mechanisms in preventing cardiovascular outcome by SGLT2 inhibitors.

Results: Five hundred and sixty-three echocardiograms with a diagnosis of RHD were recorded. The mean age of patients was 33.59 ± 12 years. The most common age group was 21–40 years (56.66%). There was female preponderance over male (77.4% versus 22.6%) patients. Isolated MR was most common among isolated lesion (64.44%). Multivalvular lesion was more common than isolated lesions (76.03% versus 23.97%). Isolated mitral stenosis (MS) and isolated mitral regurgitation (MR) was more common in female patients (82.1% and 758%, respectively). Isolated aortic regurgitation (AR) was more common in male patients (55%). Multivalvular Involvement was in the order of MS+MR>AR+MR>M S+AR>AS+AR>MS+AS>AS+MR. Mean mitral valve area was 0.2 ± 0.39 cm2. Among MS, 65 (19.69%) had mild, 145 (43.93%) had moderate and 120 (36.36%) had severe lesion, common in female patients and age group 21–40 years. Mild, moderate and severe MR were more common in female patients, while severe AR was found only in male patients. Overall, 271 (48.13%) had pulmonary hypertension and was more common in severe MS.

PP-038 Atherogenic Biomarkers and Gingival Bleeding Among Smokers

Conclusion: Valvular heart disease is common with the most common lesion being RHD in developing countries like ours. This study shows that RHD is more common in female and middle-aged patients. Multivalvular lesion are more common than isolated lesions.

Methods: This cross-sectional study comprising 60 smokers (mean age 59.9 ± 13.7 years) was conducted at an outpatient smoking cessation clinic at Kyoto Medical Centre. The smokers were divided into two groups based on the presence or absence of gingival bleeding, which was assessed by probing. Additionally, the clinical characteristics and blood parameters of the patients were measured. Ethics approval for the study was obtained from the Ethical Review Committee at the National Hospital Organization Kyoto Medical Centre (Fushimi-Ku, Kyoto, Japan).

Bishal KC, Sachin Dhungel, Samir Gautam and Mazhar Khan Gautam Buddha Community Heart Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-033. Correspondence: Bishal KC, bishalk@gmail.com

Swati Mittal, Maki Komiyama, Yuka Ozaki, Hajime Yamakage, Noriko Satoh-Asahara, Akihiro Yasoda, Hiromichi Wada, Masafumi Funamoto, Kana Shimizu, Yasufumi Katanasaka, Yoichi Sunagawa, Tatsuya Morimoto, Yuko Takahashi, Takeo Nakayama and Koji Hasegawa Kyoto University Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-038. Correspondence: Swati Mittal, drsm78@gmail.com

Background: Smoking is an important risk factor of gingivitis and has detrimental effects on both oral health and the cardiovascular system. This study aimed to evaluate the association between cardiovascular biomarkers and gingival bleeding among smokers.

PP-035 Cardiometabolic Effects of Dapagliflozin in Patients with Type 2 Diabetes Kwang Kon Koh

K-heart Clinic & Lab

Results: Significantly higher (p=0.03) levels of α1-antitrypsin low-density lipoprotein complex (AT-LDL), an oxidised LDL complex that promotes atherosclerosis, were observed among smokers with no gingival bleeding on probing when compared to that among smokers with gingival bleeding. The pocket depths in smokers without gingival bleeding were significantly (p=0.04) lower than those among smokers with gingival bleeding.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-035. Correspondence: Kwang Kon Koh, kwangkon.koh@gmail.com

Background: Large-scale cardiovascular outcome trials with sodium glucose cotransporter-2 (SGLT2) inhibitors have shown significant results in preventing cardiovascular outcome. The main mechanisms may control

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Conclusion: The absence of gingival bleeding among smokers was associated with higher levels of AT-LDL. These findings could indicate reduced blood flow due to atherosclerosis among smokers with no gingival bleeding.

Background: Speckle-tracking echocardiography is a reliable tool for the assessment of left atrial (LA) function. Our previous systematic review and meta-analysis from 2,542 healthy subjects focused on mean normal LA strain values only. Many more recent studies have been published since the previous meta-analysis, which warrants a re-evaluation of the mean. More importantly, however, the lower limits of normal (LLN) is potentially more clinically relevant for the identification of pathological values of LA strain.

PP-039 Knowledge and Attitudes Among Physicians and Nurses Toward Cardiopulmonary Resuscitation: Questionnaire Development

Methods: Following PRISMA guidelines, a systematic review was conducted by searching PubMed, Embase and Scopus databases for studies of global LA function if they involved >30 healthy patients without cardiac disease or risk factors. Normal range for reservoir strain (RS), conduit strain (CD) and contractile strain (CS), along with a weighted mean of the lower confidence interval of normal, were calculated using a random effects model.

Amraphel Nicolas, Anna Francesca Mulles, Rogelio Jr Velasco, Maria Cecilia Punzalan, Marc Denver Tiongson, Cecilia Jimeno, Felix Eduardo Punzalan and Richard Henry Tiongco Philippine General Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-039. Correspondence: Amraphel Nicolas, king.uplb@gmail.com

Results: Fifty-five studies (8,205 healthy patients) satisfied inclusion criteria. Meta-analysis revealed a normal value for RS of 41.7% (95% CI; 39.5–44.0) from 45 articles, for CD with 24.7% (20.9–28.4) from 24 articles, and CS with 16.6% (14.7 – 18.6) from 31 articles. Weighted average of the LLN for RS was 22.7 ± 8.2%, CD with 8.8 ± 4.4% and CS with 6.6 ± 4.3%.

Background: Cardiopulmonary resuscitation is a life-saving action that is crucial for survival following a sudden cardiac death. Identifying knowledge and attitude of providers is important to improve resuscitation and patient outcomes.

Conclusion: The normal LA strain values have been updated by pooling >3 times larger data. The weighted average of the LLN of LA strains may represent a better clinical cut-off to distinguish normal from abnormal. Further studies with clinical correlation are warranted.

Objective: The study aimed to develop a validated and reliable questionnaire for the assessment of knowledge and attitudes of physicians and nurses towards cardiopulmonary resuscitation.

PP-041 Comparison of Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy in Patient with Hypertension

Methods: The questionnaire was developed in a Philippine tertiary government hospital from 2020 to 2021. Literature review and blueprint development guided the creation of the initial questionnaire. An expert panel and sample of the population were consulted for face and content validation using cognitive debriefing form and content validity index. Test and retest method was performed from 17 September to 23 November 2021 with analysis using intraclass correlation coefficient and Cronbach’s alpha to assess reliability. Item analysis was done using difficulty and discriminative index. The minimum passing level was assessed by cardiovascular experts.

Leo Deddy Pradipta, Niko Wangi Yuandika, Aida Yulia Amany, Alfredo Alfredo, Jefry Pinondang Sianipar and Safir Sungkar Dr. Kariadi General Hospital Semarang Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-041. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Results: The questionnaire consisting of a 25-item knowledge domain and a 25-item attitude domain was developed. Content validity index was 1.0 for all questions after thorough revision. Test-retest method among 105 participants revealed intraclass correlation coefficient of 0.77 (95% CI [0.66–0.84]), indicating good reliability and Cronbach’s alpha of 0.8139, indicating good internal consistency. Overall, the questions based on difficulty index were determined as easy and were interpreted as having excellent discrimination power. The minimum passing level for both BLS only and BLS + ACLS is 90%.

Objective: To analyse three electrocardiographic criteria for LVH compared with transthoracic echocardiography (TTE) finding. Methods: This was a single-centre, retrospective study, that included 55 consecutive patients with hypertension who had visited the cardiology clinic. EKG and TTE were performed. The Peguero-Lo Presti criteria was calculated by adding deepest S amplitude in any precordial lead to the S amplitude in V4 (SD + SV4). Patients with valvular abnormalities, myocardial infarction, LV dysfunction, pericardial disease, bundle branch blocks, atrial fibrillation, flutter, or pulmonary disease were excluded from this study.

Conclusion: The 50-item questionnaire on knowledge and attitude among physicians and nurses towards cardiopulmonary resuscitation was deemed valid, reliable and easy, based on difficulty index, and carried excellent discrimination power.

Results: Thirty-one hypertensive patients (56%) had LVH by TTE. Of the 55 patients, 18 had LVH based on Peguero-Lo Presti criteria with a sensitivity of 58.06%. Cornell voltage criteria was positive in 8 of 55 patients with a sensitivity of 25.81% and Sokolow-Lyon criteria was positive in 6 of 55, with a sensitivity of 19.35%. Peguero-Lo Presti EKG criteria had a higher sensitivity (58.06%) and specificity (91.67%) in the diagnosis of LVH than traditional criteria.

PP-040 Assessing the Lower Limit of Normal for Left Atrial Strain in Healthy Subjects

Deva Nirthanakumaran,1 Koya Ozawa,2 Prajith Jeyaprakash,1,2 Faraz Pathan1,2 and Kazuaki Negishi1,2

Conclusion: Peguero-Lo Presti criteria for diagnosing LVH is more sensitive and specific than Sokolow-Lyon and Cornell voltage criteria. It may be that the latter component of the QRS complex, which corresponds to the S wave, better represents voltage variations in patients with LVH.

1. Nepean Hospital; 2. University of Sydney Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-040. Correspondence: Deva Nirthanakumaran, deva.nirthanakumaran@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-042 Effectiveness of Lower Range of Highintensity Statin Therapy in Lowering LDL-C Among STEMI Patients

potential military candidates. Strict selection criteria often involve evaluating ECG patterns that are considered normal variants and may result in the elimination of candidates who are fit for service. Objective: To assess the rate of abnormal findings in pre-participation ECG among enlisted troops.

Dipanker Prajapati, Birat Krishna Timalsena and Chandra Mani Adhikari Shahid Gangalal National Heart Centre

Methods: The retrospective cohort study evaluated pre-participation ECG. All ECGs were performed at the Ridwan Meuraksa Army Hospital. The initial screening involved a 12-lead resting ECG and a regular treadmill test during peak exercise, with 100% target heart rate and passing the 10 METS fitness class. ECG readings according to NATO recommendations were compared with guidelines from the Indonesian army. Abnormal ECG results were categorised into normal variants, those requiring further investigation, and disqualified officer school applicants.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-042. Correspondence: Dipanker Prajapati, dipankerprajapati@gmail.com

Background: Lipid-lowering is an important intervention to reduce cardiovascular morbidity and mortality after ST-elevation myocardial infarction (STEMI). There is a myth that a lower range of high-intensity statin is sufficient in an Asian population due to lower body mass and increased side-effects of statin. This study was conducted to assess the proportion of patients achieving guideline-directed therapeutic lowdensity lipoprotein cholesterol (LDL-C) targets while on lower-range highintensity statin treatment among STEMI patients.

Results: The study included 304 participants who underwent preselection examinations. Fourteen elite and eight non-elite soldiers had bundle branch block characteristic. Ten ECGs (3.2%) showed asymptomatic a delta wave pattern, and 163 troops soldiers (62.2%) had early repolarisation pattern (ERP) compared to 199 staff soldiers (37.8%). These results differ from the preassigned ECGs, which recorded no cases of ERP. Echocardiography and Holter monitoring were performed in participants with abnormal findings. Eighteen cases of bradycardia were found in the troops and staff group, which requires further consideration. Further analysis using χ2 analysis indicate no statistical difference between preparticipant ECG conclusion.

Methods: This was an observational cohort study conducted at Shahid Gangalal National Heart Centre, a tertiary cardiac centre in Kathmandu, Nepal, from November 2021 to July 2022 among admitted patients with a diagnosis of acute STEMI who were prescribed a lower range of highintensity statin therapy (atorvastatin 40 mg and rosuvastatin 20 mg). Baseline clinical characteristics along with lipid parameters were collected during admission and lipid parameters were reassessed three months after the treatment. The data were evaluated and appropriate statistical tests were performed.

Conclusion: ECG screening is crucial to distinguish between normal ECG variants and significant ECG abnormalities that may disqualify potential candidates.

Results: A total of 240 patients were included in the study. After three months of therapy, target LDL-C level <1.4 mmol/l was noted only in 16.3% of patients and target LDL-C reduction by ≥50% from baseline only in 7.1%. Just 3.3% of the study population achieved a target of both LDL-C goals of <1.4 mmol/l and ≥50% reduction of LDL-C from baseline. However, 40.8% of the study participants met the 2012 ESC STEMI guideline LDL-C target achievement of <1.8 mmol/l.

PP-044 Echocardiographic Parameters on the Prediction of Mortality in Patients with Chronic Kidney Disease Undergoing Haemodialysis Samantha Katrina Reyes Bulacan Medical Center

Conclusion: The overall proportion of patients attaining recommended LDL-C levels after recent STEMI was low among those prescribed with a lower range of high-intensity statin, reflecting the need for rigorous follow-up including monitoring of lipid levels and intensification of statin dose and type as recommended by international guidelines.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-044. Correspondence: Samantha Katrina Reyes, sksreyes0917@gmail.com

Background: Earlier detection of patients at high risk of cardiovascular complications could help physicians adapt therapy and follow-up accordingly, potentially delaying the occurrence of adverse cardiac events or the initiation of renal replacement therapy. The objective of this study was to determine the prognostic value of echocardiographic parameters in chronic kidney disease (CKD) in haemodialysis patients, using echocardiographic data to describe cardiovascular status and occurrence of all-cause and cardiovascular mortality.

PP-043 Is Variant of Electrocardiography Pattern Relevant for Exclusion Criteria for Newly Recruited Soldiers? Ardhestiro Putro,1 Bambang Budi Siswanto,2 Bayushi Eka Putra3 and Wika Wiwik1

1. Indonesian Heart Association; 2. Harapan Kita National Cardiac Centre; 3. Berkah Pandeglang General Hospital

Methods: A prospective, single-centre, analytical study was conducted in the Bulacan Medical Centre haemodialysis unit. Of 140 enrolled patients, only 53 were included in the study. Basic demographic information was obtained, along with the aetiology of CKD. Patients were prospectively followed up for 6 months, with a combination of all-cause and cardiovascular mortality as primary outcome measures.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-043. Correspondence: Ardhestiro Putro, dr.ardhestiro@gmail.com

Background: Recruits for the military undergo rigorous physical examination. To minimise the risk of cardiovascular issues, given their exposure to intense physical exertion during combat and exercise, the use of electrocardiography (ECG) is common in the examination of

Results: The study included 53 haemodialysis patients with CKD. Ten patients died from cardiovascular events or any other cause during the

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Abstracts from 27th Asian Pacific Society of Cardiology Congress 6-month study period. There were no reported significant findings for cardiovascular risk factors, comorbidities and echocardiographic parameters as predictors of mortality in CKD patients.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-046. Correspondence: Amelia Shadrina, ameliashadrina@ymail.com

Background: Coronary artery disease (CAD) involves the emergence of various risk factors. An increased proportion of younger patients with STelevation myocardial infarct (STEMI) has been observed in multiple epidemiological studies. The characteristic of cardiovascular risk factors profile between different age groups might be different. Lack of notable current evidence regarding cardiovascular risk factors hinder the comprehensive treatment of patients.

Conclusion: High cardiovascular mortality/morbidity and all-cause mortality are correlated with abnormal left ventricular geometry and functions in this patient group. Echocardiographic evaluation is probably effective for identifying patients at an earlier stage who could most benefit from optimised cardiac management. This study suggests that the current data does not support the model wherein patterns in echo parameters are used to predict mortality in patients with CKD undergoing haemodialysis.

Methods: This was cross-sectional study of 97 STEMI patients treated with primary percutaneous coronary intervention (PCI) in Jakarta Heart Centre between October 2022 and February 2023. Cardiovascular risk factors and patient clinical data were obtained from medical records and interviews during hospitalisation. Subjects were divided into two age groups for statistical analysis (≤45 years and >45 years).

PP-045 Comparison of Different Atherosclerotic Cardiovascular Disease Risk Assessment Tools in a Bangladeshi Population Sharadindu Shekhar Roy

National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh

Results: Seventy-eight men (80.4%) and 19 women (19.6%) diagnosed with STEMI with a mean age of 55 ± 10 years were identified. Younger STEMI patients presented with a significantly higher proportion of smokers (80% versus 50%; p=0.029). The proportion of obesity in younger STEMI patients was significantly higher (73.3% versus 43.3%; p=0.049). None of the other investigated factors were significantly different between the two age groups.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-045. Correspondence: Sharadindu Shekhar Roy, roy.sharadindu2009@gmail.com

Background: The accuracy of various 10-year atherosclerotic cardiovascular disease risk assessment tools in a Bangladeshi population may not be the same as in other populations. The aim of this study was to compare the various risk assessment tools to calculate 10-year atherosclerotic cardiovascular disease risk in a Bangladeshi population.

Conclusion: Younger STEMI patients had significantly different risk factors compared to older patients in terms of obesity and smoking habit.

PP-047 Awareness of Metabolic Syndrome in the General Population: Results from a Nationwide Survey

Methods: Patients admitted with first myocardial infarction at the National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, from October 2016 to September 2019 were included. This was a cross-sectional study with a total of 610 patients. Atherosclerotic cardiovascular disease risk was calculated using Framingham coronary heart disease risk score (FRSCHD), Framingham risk score-cardiovascular disease (FRS-CVD), American College of Cardiology/American Heart Association (ACC/AHA)-ASCVD risk score and QRISK-2 model, assuming that patients had presented one day before the cardiac event for risk assessment.

Mi-Seung Shin,1 Kyung-Jin Kim,2 KyungHee Kim3 and KwangKon Koh4

1. Gachon University Gil Medical Center; 2. Ewha Womans University Medical Center; 3. Incheon Sejong Hospital; 4. K-Heart Clinic and Lab Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-047. Correspondence: Mi-Seung Shin, msshin@gilhospital.com

Results: FRS-CVD risk score performed the best as it could identify the largest number of patients (60.7%) at high atherosclerotic cardiovascular disease risk, while ASCVD risk score performed the worst (only 31.3% patients were identified for high ASCVD risk). QRISK-2 model and FRSCHD tools performed intermediately (45.7% and 41.3% patients, respectively, were identified for high risk). The cut-off for high ASCVD risk definition was considered 20%.

Objective: To provide the basic data necessary for setting targets for the prevention of metabolic syndrome (MS) in the general population and the promotion of education regarding the same. Methods: Using a self-written input method, a nationwide online survey was conducted between January and February 2023 in a representative sample of Korean people. Information was sought regarding the awareness of MS, knowledge of the cause and prevention of MS, and the appropriate response to MS. Awareness and perception of MS in the general Korean population was evaluated.

Conclusion: FRS-CVD atherosclerotic cardiovascular disease appears to be the most useful ASCVD risk assessment tool in a Bangladeshi population. This difference may be due to the estimation of risk for several additional outcomes using the FRS-CVD assessment tool compared with others.

Results: One thousand people (mean age 45.67 years, male 50.9%) participated in the study. Approximately 71% of participants were aware of MS, and 78.8% of participants had heard of MS. Awareness of MS showed a positive correlation with age, household income, disease history and family history. 56.6% of participants thought MS was a disease. Most participants responded that reduced calorie intake and exercise are needed for the management of MS (84.7% and 89.9%, respectively). 53.8% of participants exercised regularly to prevent MS. 41.4% of participants thought they were not properly informed about MS.

PP-046 Cardiovascular Risk Factor Profile Among Younger STEMI Patients Treated with Primary Percutaneous Coronary Intervention Amelia Shadrina, Teuku Muhammad Haykal Putra, Maria Elfiana and Wishnu A. Widodo

Department of Cardiology and Vascular Medicine, Jakarta Heart Centre

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Abstracts from 27th Asian Pacific Society of Cardiology Congress 53.8% of participants thought they did not know what to do for a healthy lifestyle.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-049. Correspondence: Si Ling Soh, dr.sohsiling@ijn.com.my

Conclusion: Most participants showed good awareness, but still very much wanted to be provided with information about MS. Special attention must be paid to educating the public about MS.

Background: Aortic stenosis (AS) is a common cause of surgical aortic valve replacements (SAVR). There are different haemodynamic profiles with different outcomes.

PP-048 Use of Non-HDL Cholesterol as a Treatment Target in a Multi-ethnic Population

Objectives: To analyse frequencies and outcome for different AS variants and determine overall in-hospital and 1-year mortality. Methods: All AS patients (either isolated or with aortic regurgitation) undergoing SAVR from 2015 to 2021 were analysed from preoperative transthoracic, intraoperative transoesophageal echo and electronic medical records.

Wann Jia Loh,1,2 Samuel Soh,3 Hnin Tun Mon,4, Pei Ting Tan,5 Chin Shern Lau6 and Tar Choon Aw6,7

1. Department of Endocrinology, Changi General Hospital; 2. Duke-NUS Medical School; 3. SingHealth Cardiology; 4. Health Services Research Unit, Changi General Hospital; 5. Clinical Trial and Research Unit, Changi General Hospital; 6. Department of Laboratory Medicine, Changi General Hospital; 7. Department of Medicine, National University of Singapore

Results: 974 patients with AS underwent SAVR. The most common significant AS variant is high gradient severe AS (HGS-AS, 49.9%) followed by normal flow low gradient severe AS (NFLG-AS, 10.0%), paradoxical low flow low gradient severe AS (PLFLG-AS, 6.4%), classical low flow low gradient severe AS (CLFLG-AS, 6.1%) and reverse area gradient mismatch (RAG-AS, 2.7%). The highest in-hospital mortality was CLFLG-AS at 13.6% followed by PLFLG-AS at 11.3%, NFLG-AS at 8.2%, HGS-AS at 6.0%, and the lowest was RAG-AS at 3.8%. Total one-year mortality (including in-hospital) was also the worst for CLFLG-AS at 27.1% followed by PLFLG-AS at 22.9%, NFLG-AS at 16.1%, HGS-AS at 12.8% and the lowest was RAG-AS at 10.5%. Overall in-hospital mortality was 6.9% and total one-year mortality was 12.8%. Pre-operative ejection fraction has no relationship with outcomes but lower stroke volume index and lower flow rate both have significant association with higher in-hospital mortality (p<0.001 for both).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-048. Correspondence: Samuel Soh, soh.heng.samuel@gmail.com

Background: Although international guidelines recommend the use of non-high-density lipoprotein cholesterol (non-HDL-C) in addition to lowdensity lipoprotein cholesterol (LDL-C) as treatment targets in cardiovascular event prevention, the target non-HDL-C is not routinely used in our country. The aim was to evaluate the potential usefulness of adopting guideline-recommended non-HDL-C levels as a treatment target. Methods: A retrospective study of all patients with lipid panel blood tests measured in a single centre over two years was conducted. The lipid panel consisted of direct LDL-C, total cholesterol, HDL-C and triglyceride.

Conclusion: The outcomes for different AS variants are the same as prior published studies except for NFLG-AS which has worse outcome than HGS-AS. RAG-AS has the best outcome.

Results: 21,605 consecutive patients with lipid profiles were analysed in the hospital laboratory. The median age was 61 years. 64.0% of patients were male, 52.6% with ischaemic heart disease and 68.1% with atherosclerotic cardiovascular disease (ASCVD). Among all patients with LDL-C <1.8 mmol/l, 95.7% had a corresponding non-HDL-C <2.6 mmol/l from the same lipid panel. In contrast, among patients with non-HDL-C <2.6 mmol/l, only 43.8% had corresponding LDL-C <1.8 mmol/l. In patients with ASCVD (n=14, 704), 23.7% had LDL<1.8 mmol/l, whereas 48.8% had non-HDL <2.6 mmol/l. 96.0% of patients with ASCVD who achieved LDL-C goal <1.8 mmol/l achieved non-HDL-C goal <2.6 mmol/l using the same lipid profile. When comparing patients with triglyceride <1.7 mmol/l with ≥1.7 mmol/L, the mean remnant cholesterol concentration was higher in all three major ethnicities (p<0.001) when triglyceride level was ≥1.7 mmol/l.

PP-050 A Systematic Review of Screening Tools for Social Determinants of Health in Cardiovascular Disease Takahiro Suzuki,1 Atsushi Mizuno,1 Haruyo Yasui,2 Satsuki Noma,3 Takashi Omori,4 Jeffrey Rewley,5 Takeo Nakayama,6 Naoki Kondo7 and Yayoi Tetsuou Tukada3

1. Department of Cardiovascular Medicine, St Luke’s International Hospital; 2. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine; 3. Department of Cardiovascular Medicine, Nippon Medical School; 4. Department of Cardiovascular Medicine, Fukuoka Heartnet Hospital; 5. Center for Health Equity Research and Promotion, Crescenz VA Medical Center Philadelphia; 6. Department of Health Informatics, Kyoto University School of Public Health; 7. Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University

Conclusion: Compared with LDL-C, the corresponding guidelinerecommended non-HDL-C goal was significantly easier to achieve, suggesting that is unlikely to be clinically useful in our patient population except possibly for patients with hypertriglyceridaemia. Further studies are needed to establish the appropriate non-HDL-C goal paired with LDL-C goal for different cardiovascular risk groups in an Asian population.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-050. Correspondence: Takahiro Suzuki, takasu.623@gmail.com

PP-049 Haemodynamics and Outcomes in Aortic Stenosis Patients Undergoing Surgical Aortic Valve Replacement Between 2015 and 2021

Background: Social determinants of health (SDOH) affect people’s health. The importance of SDOH needs to be recognised to prevent the development of cardiovascular disease (CVD). The aim was to conduct a systematic review of tools to assess SDOH regarding CVD and comprehensively evaluate how these tools could be applied to evaluate SDOH in cardiovascular fields.

Si Ling Soh, Shaiful Azmi Yahaya, Tey Yee Sin and Aslannif Roslan Institut Jantung Negara

JOURNAL OF ASIAN PACIFIC SOCIETY OF CARDIOLOGY www.JAPSCjournal.com

Abstracts from 27th Asian Pacific Society of Cardiology Congress Methods: A systematic literature search of the PubMed database was conducted on 19 May 2022. Inclusion criteria were assessed SDOH screening tools in patients with CVD, and evaluated SDOH tools using CVD as an outcome measure.

Conclusion: Graft patency after CABG+CE might be lower, especially in patients who receive non-LAD-CE.

PP-052 Effectiveness of Phase II Cardiac Rehabilitation in Reducing Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Grafting

Results: Eight hundred and seventy-seven articles were reviewed and 42 articles focusing on screening tools for SDOH regarding CVD were identified. In these articles, 33 unique tools for SDOH were found, with 18 targeting multiple domains and 15 for a single domain. Of the 42 articles, 27 (64.3%) targeted populations with CVD and 11 (26.2%) evaluated CVD as an outcome in populations without CVD. Four studies (9.5%) compared SDOH differences between CVD and non-CVD populations. The most common cardiovascular conditions were ischaemic heart disease, heart failure and stroke. Among the 18 multiple-domain tools, only five (27.8%) assessed all five main SDOH domains simultaneously.

Benjamin Jose Quito and Anthony Earl Uy Chong Hua Hospital

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-052. Correspondence: Benjamin Jose Quito, benjaminquitomd@gmail.com

Background: Cardiac rehabilitation is underutilised as a secondary prevention strategy after coronary artery bypass grafting (CABG). This study aims to evaluate the effectiveness of phase II cardiac rehabilitation in reducing outcomes in post-CABG patients.

Conclusion: The review revealed recent interests in SDOH in the cardiovascular field and there were some useful screening and assessment tools that can evaluate main five domains of SDOH. Future studies are needed to clarify the importance of the intervention about SDOH screening on outcome.

Methods: This is a retrospective cohort study. Patients who underwent isolated CABG under the Z-benefit programme between January 2016 and December 2017 from a Philippine cardiac referral centre were randomised, and the first 151 patients contacted were included in the study. Chart review and telephone follow-up were done. The 3-year outcomes evaluated were all-cause mortality, cardiac mortality, cardiac rehospitalisation and heart failure (HF) symptoms.

PP-051 Graft Patency after Coronary Artery Bypass Grafting Combined with Coronary Endarterectomy Xieraili Tiemuerniyazi, Ziang Yang, Yangwu Song, Wei Zhao, Fei Xu and Wei Feng

Results: Thirty-four patients (22.5%) participated in phase II cardiac rehabilitation (CRG) with no recorded events. In the group with no participation in phase II cardiac rehabilitation (NCRG), three deaths with one cardiac mortality, three cardiac rehospitalisations, one repeat coronary angiogram, and seven patients with increasing HF symptoms were reported. Although the zero event-rate in the CRG is noteworthy, there was no statistically significant difference between the outcomes of both groups.

Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-051. Correspondence: Xieraili Tiemuerniyazi, tiemuernyz@mail2.sysu.edu.cn

Objective: To evaluate the graft patency after coronary artery bypass grafting (CABG) combined with coronary endarterectomy (CE).

Conclusion: The 3-year event-rate in patients undergoing CABG under the Z-benefit programme is very low and is limited to patients with no participation in phase II cardiac rehabilitation. Low surgical risk patients may not derive much benefit from phase II cardiac rehabilitation, but the zero event-rate after 3 years in those participating in phase II cardiac rehabilitation may likely have clinical relevance for both the patients and the clinicians in their decision to pursue phase II cardiac rehabilitation.

Methods: Patients who underwent CABG+CE between July 2010 and June 2022 with available follow-up coronary angiographic results were retrospectively recruited into the study. All patients underwent CE on at least one of the coronary targets. The CE-targeted graft patency (defined as <50% stenosis) was summarised. Multivariable logistic regression was performed to adjust the potential confounders.

PP-053 The Impact of Outpatient Cardiac Rehabilitation on 6-minute Walk Distance in Adults after Congenital Heart Disease Surgery

Results: A total of 158 patients (age 59.4 ± 9.3 years, 38 [24.1%] female) were enrolled, and 551 grafts were anastomosed. CE was performed (total 164) on the left anterior descending artery (LAD, 59 [35.9%]), right coronary artery (80 [48.8%]), left circumflex artery (16 [9.8%]) and diagonal branches (9 [5.5%]). Postoperative myocardial infarction was observed in 7 (4.4%) of the patients. During a median follow-up of 12.1 [3.4, 20.0] months, 2 patients died, while stenosis or occlusion was observed in 48 (29.2%) of the CE-targeted grafts. The CE-targeted graft patency rate was much higher among the LAD-CE patients than the non-LAD-CE patients (81.4% [48/59] versus 64.8% [68/105], p=0.025), but lower than nonendarterectomised LAD (81.4% [48/59] versus 92.9% [92/99]; p=0.027). The patency of CE-targeted grafts in non-LAD-CE patients were also lower than non-endarterectomised arteries (64.8% [68/105] versus 87.2% [251/288]; p<0.001). After adjusting for age, gender, BMI and antithrombotic therapy in the multivariable logistic regression, non-LAD-CE was still associated with lower graft patency (OR 0.38; 95% CI [0.17–0.83]; p=0.016).

Aa Ayu Dwi Adelia Yasmin,1 Basuni Radi,2 Ade Meidian Ambari2 and Bambang Dwiputra2

1. Prof. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali; 2. National Cardiovascular Center Harapan Kita, University of Indonesia Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-053. Correspondence: Aa Ayu Dwi Adelia Yasmin, gungdwiadelia@gmail.com

Objective: To determine the impact of outpatient cardiac rehabilitation (CR) programme with adaptations during pandemic on 6-minute walk distance (6MWD) in adult patients who underwent congenital heart surgery. Methods: This was a cohort retrospective study which analysed data from medical records of adult patients who underwent CR programme after

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Abstracts from 27th Asian Pacific Society of Cardiology Congress congenital heart surgery from March 2020 to December 2021. The changes of 6MWD before and after 12 sessions of outpatient CR programme are discussed.

Conclusion: A large proportion of patients reported breathing, pain and circulation symptoms related to long COVID-19. Further studies are needed to explore this association.

Results: During the COVID-19 pandemic from March 2020 until December 2021, 946 patients completed the CR programme in this single centre, and 135 (14.27%) were adults post congenital heart surgery who were enrolled in this study. The subjects were 35.07 ± 12.76 years of age and most were female (61.48%). The most common surgical procedure was ASD closure (61.48%). The 6MWD improved significantly from 326.41 ± 78.38 to 387.70 ± 61.41 m; p<0.001. After being classified by age, sex, presence of PH, concomitant surgeries, estimated glomerular filtration rate (eGFR), haemoglobin level, ejection fraction (EF), and tricuspid annular plane systolic excursion (TAPSE), there was no significant difference on 6MWD increase among study subjects.

PP-055 Association of Fibrinogen with Cardiovascular Outcomes in Patients with Concurrent Psoriasis and Coronary Artery Disease Lin Zhao, Yan Zeng and Xianliang Zhou

Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-055. Correspondence: Lin Zhao, zhaolin@fuwai.com

Background: It is unclear if fibrinogen is a risk factor for adverse events in psoriatic patients with established coronary artery disease (CAD). The association between fibrinogen levels and cardiovascular adverse events in these patients was investigated.

Conclusion: Cardiac rehabilitation programmes with adaptations due to the COVID-19 pandemic may improve exercise capacity in adult patients after congenital heart surgery as indicated by increase in 6MWD with minimal side-effects, regardless of demographic features, surgical procedures, and comorbidities. The result of this study supports the continuous implementation of a comprehensive cardiac rehabilitation programme in this population, even with several adaptations in the pandemic era.

Methods: A retrospective cohort study of consecutive psoriatic patients with CAD between January 2017 and May 2022 in our hospital was conducted. Clinical records were collected, and comparisons were made between groups. Kaplan–Meier survival analysis was used to evaluate the association between variables.

PP-054 A Pilot Study of the Prevalence of Long COVID Symptoms among Patients with Cardiovascular Conditions

Results: Of the 267 participants, 84 had elevated levels of fibrinogen. The proportion of hypertension was higher in patients with elevated fibrinogen, while the proportions of diabetes and chronic kidney disease were not different between the two groups. After the mean follow-up of 35.41 months, major adverse cardiovascular events (MACE) and rehospitalisation due to heart failure (HF) were more prone to occur in the elevated fibrinogen group (log-rank p=0.033 and 0.049, respectively). In the subgroup analysis, elevated fibrinogen was associated with MACE in patients age <60 years (log-rank p=0.045) and in patients with diabetes (log-rank p=0.043); elevated fibrinogen was associated with rehospitalisation due to HF in men (log-rank p=0.028), patients without hypertension (log-rank p=0.024) and patients without chronic kidney disease (log-rank p=0.044).

Choi Ying Yun,1 Pei-En Chau,2 Shi-Han Ang,2 Nicholas Fang,2 Chai Ping,1 Tiong-Cheng Yeo,1 KF William Kong,1 Kian-Keong Poh,1 CC Raymond Wong,1 ZL Ryan Leow,1 YW Tony Li,1 CY Edward Lee,1 ST Aloysius Leow1 and Ching Hui Sia1 1. National University Heart Centre Singapore; 2. National University Singapore Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-054. Correspondence: Choi Ying Yun, cadencey96@gmail.com

Background: Long COVID is a syndrome describing patients with persistent or new symptoms after a COVID-19 infection. Long COVID is not well characterised in cardiac patients. The aim of this study was to find out the prevalence, severity and associations of long COVID symptoms among cardiac patients.

Conclusion: In psoriatic patients with CAD, elevated fibrinogen was associated with clinical adverse events in patients with specific clinical characteristics.

PP-133 Evolocumab Use in Asia-Pacific: Observed LDL-C Reduction, Physician Goals and Patient Perceptions: HALES Observational Study

Methods: This cross-sectional study was carried out on 206 cardiac patients in the outpatient department at National University Hospital. All patients had a COVID-19 diagnosis four or more weeks prior to the survey. Information was collected on the patients’ cardiovascular comorbidities. An interviewer-administered questionnaire consisting of the Symptom Burden Questionnaire-Long COVID (SBQ-LC) and other questionnaires covering anxiety, depression and quality of life, were performed.

Hung-Fat Tse,1 Huang-Yu Chang,2,3 David Colquhoun,4,5,6 Jung-Sun Kim,7 Kian Keong Poh,8,9 Karam Kostner,10 Pisit Hutayanon,11 Meejin Cho,12 Jeff Lange,12 Kamlanathan Kodiappan13 and Saikiran Leekha12

1. Department of Surgery, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong; 2. Division of Cardiology, Heart Centre, Cheng Hsin General Hospital; 3. Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University; 4. School of Medicine, University of Queensland; 5. Wesley Medical Centre, Wesley Hospital; 6. Greenslopes Private Hospital; 7. Severance Cardiovascular Hospital, Yonsei University College of Medicine; 8. Yong Loo Lin School of Medicine, National University of Singapore; 9. Department of Cardiology, National University Heart Centre, National University

Results: The mean age of participants was 62.9 ± 13 years and 65 (31.6%) were female. Of 206 patients, 95 (46.1%), 62 (30.1%) and 75 (36.4%) reported breathing, pain and circulation symptoms, respectively. Patients who had abnormal breathing and pain scores were more likely to be younger. Patients with abnormal breathing and circulation scores were more likely to be female. A large majority of patients who reported symptoms in breathing, pain and circulation had mild to moderate anxiety on the Generalised Anxiety Disorder-7 questionnaire.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Results: The mean LDL-C level was significantly higher in the PR group than in the non-PR group (139.5 ± 44.3 versus 115.5 ± 2.3 mmol/l, p=0.015). A receiver operating characteristic analysis showed that the best cut-off value of LDL-C to detect PR was 7.2 mmol/l (sensitivity 71.8%, specificity 77.5%, AUC 0.706). LDL-C level was independently associated with the presence of PR (OR 1.012; 95% CI [1.001–1.025]; p=0.042).

Health System; 10. Department of Cardiology, Mater Hospital, University of Queensland; 11. Cardiology Unit, Department of Medicine, Faculty of Medicine, Thammasat University; 12. Amgen Asia Holding Ltd; 13. Amgen Biopharmaceuticals Malaysia Sdn Bhd Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-133. Correspondence: Hung-Fat Tse, hftse@hku.hk

Conclusion: A high LDL-C level was associated with the presence of PR among statin-naïve patients with ACS. These results suggest that LDL-C level is useful in identifying ACS patients with PR.

Background: Real-world data are needed to understand the effectiveness of new therapeutic options for LDL-C reduction within the context of AsiaPacific clinical practice.

PP-057 Automatic Sizing for Left Atrial Appendage Occlusion Using Deep Learning: Comparison of Manual Sizing

Methods: HALES comprised (a) a chart review of evolocumab-treated patients to obtain LDL-C measures at baseline and at follow-up (until the earliest date of evolocumab discontinuation, lost to follow-up, death, or date of data collection) and (b) a physician survey and one-time data collection of clinical characteristics of patients initiating evolocumab or initiating/continuing the non PCSK9 inhibitor lipid-lowering therapy. Patients could enrol in (a) or (b), but not both. The study was conducted at Hong Kong, Thailand, South Korea, Singapore, Taiwan and Australia, and was approved by local ethical committees. In the chart review, the index date was of first evolocumab dose taken after local market approval.

Heechang Chae, Joon Min Lee and Tae Hyun Nam Seoul National University Bundang Hospital

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-057. Correspondence: Heechang Chae, 20381@snubh.org

Background: Although CT sizing is known to be the most accurate method of sizing left atrial appendage orifice (LAAO) closure, it is a timeconsuming task and requires a learning curve. This study investigated whether the use of automatic sizing for LAAO by CT-based deep learning allows accurate device sizing.

Results: The chart review included 724 patients who initiated evolocumab from the date of regulatory approval to 2021. The clinical characteristics of this mostly (74%) Asian population included 20% with familial hypercholesteraemia, 32% with diabetes, 40% with prior myocardial infarction and 68% with prior revascularisation. From a median baseline LDL-C of 3.3 mmol/l, these patients had a median percent change in LDL-C of −62.5% at LDL-C measurements occurring between one and six months of evolocumab use.

Methods: Orifice detection from the medial axis of the appendage searching for the maximum increase in axis-distance with respect to the surface. 50 atrial fibrillation (AF) and 50 non-AF patients were enrolled. Manual sizing of LAAO by two observers (10 years [expert] and 4 years [non-expert]) were compared to those derived by auto-sizing. Additionally, task time between manual sizing and auto-sizing was compared.

Conclusion: The observed LDL-C reduction (−62.5%) following initiation of evolocumab and practice patterns for lipid management within the Asia-Pacific population are consistent with evidence from clinical trials and global clinical practice.

Results: Mean diameter of LAAO by expert and non-expert manual sizing was 26.0 ± 4.6 mm and 24.0 ± 4.3 mm, respectively (Pearson’s correlation coefficient [PCC]=0.82). The auto-sizing diameter was 25.8 ± 4.6 mm, which is good correlated with both expert sizing (PCC=0.79) and nonexpert sizing (PCC 0.77). However, auto-sizing is more agreed with expert manual sizing in AF patients (PCC 0.81) than agreement with non-expert sizing (PCC 0.69). The mean manual time by experts and non-experts were 102 ± 3 0 sec and 114 ± 48 sec, respectively, which were significantly higher than auto-sizing (10 ± 2 sec, p<0.001). In 14 patients who underwent LAAO closure, the difference of real procedural device size and autosizing was 1.60 ± 1.69 mm, which is similar to expert sizing (1.39 ± 0.98 mm), but lower than non-expert sizing (2.14 ± 2.51 mm, p<0.05).

PP-056 High Low-density Lipoprotein Cholesterol Levels are Associated with Plaque Rupture Among Acute Coronary Syndrome Patients Kiyoshi Asakura, Yoshiyasu Minami, Takako Nagata, Masahiro Katamine and Junya Ako Kitasato University School of Medicine Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-056. Correspondence: Kiyoshi Asakura, kiyomail12@gmail.com

Conclusion: Auto-sizing by CT-based deep learning is timesaving compared to manual sizing, and is more correlated with expert sizing, especially in AF patients.

Background: The impact of high low-density lipoprotein cholesterol (LDL-C) level on the presence of plaque rupture (PR) among patients with acute coronary syndrome (ACS) remains to be elucidated. The purpose of this study was to clarify the association between LDL-C levels and the presence of PR.

PP-058 4D Stress-Echo Strain Parameters in Evaluation of Left Ventricular Remodelling in Coronary Artery Disease Patients

Methods: A total of 79 statin-naïve patients with ACS who underwent optical coherence tomography imaging of culprit lesions were included in the study. Patients were classified into either the PR group (n=39) or the non-PR group (n=40). Clinical characteristics including LDL-C levels were compared between the two groups.

Nikolai Nelasov, Ekaterina Kreneva, Maxim Morgunov, Olga Eroshenko, Andrey Palenyy, Eliso Gurtskaya, Anna Nechaeva, Irina Golovro, Maria Ovrulova and Juri Mekertuichan Rostov State Medical University

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Abstracts from 27th Asian Pacific Society of Cardiology Congress and having bilateral opacities on chest radiograph were found to be significant predictors of poor outcomes. TTE findings were not associated with poor outcomes.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-058. Correspondence: Nikolai Nelasov, nelassov@rambler.ru

Background: Some publications demonstrate that assessment of left ventricular (LV) strain in patients with coronary artery disease (CAD) can help identify remodelling processes in the heart. This study aimed to analyse if speckle tracking global and segmental longitudinal LV strain (GLS & SLS), LV rotation (R) and twisting (T) parameters obtained during 4D stress-echo with vasodilator infusion can be utilised as LV remodelling predictors.

Conclusion: Among admitted adult COVID-19 patients who underwent TTE, there was a low prevalence of abnormal LV and RV systolic function, and low prevalence of abnormal RV dimension. The authors support the ASE recommendations to perform TTE only if it can provide clinical benefit to minimise unnecessary exposure to healthcare workers and minimise healthcare costs.

PP-060 Comparing Non-surgical Weight Loss with Surgical Weight Loss on Strain Parameters and Left Ventricle Pressures

Methods: Forty-seven patients (mean age 59.0 years; CI [56.9–61.3]); male 44) with CAD (32 without previous myocardial infarction and 15 after myocardial infarction) underwent 4D stress-echo with adenosine triphosphate and automated function imaging analysis of GLS, SLS, R and T. The presence of remodelling was identified by LV end systolic volume (LVESV). Correlation coefficients (r) between strain parameters registered during stress-echo submaximal myocardial hyperaemia phase and LVESV were analysed.

Vinay Panday,1 Ching Hui Sia,1 Sik Yin Tan,1 William Kong1,2 and Kian-Keong Poh1,2

1. National University Health System; 2. Yong Loo Lin School of Medicine Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-060. Correspondence: Vinay Panday, vinaypanday36@gmail.com

Results: GLS showed good correlation with LVESV (r=0.652). Correlations between SLS and LVESV varied from moderate to strong (r=0.456 to r=0.810). R also demonstrated moderate and high correlations with LVESV (r=0.400 to r=0.723). When analysing T parameter, correlations with LVESV were weaker (r=0.365 to r=0.507).

Background: Several studies have demonstrated that surgical weight loss (SWL) improves left ventricle (LV) filling pressures and speckle tracking-derived strain parameters. It is unknown if moderately obese Asian patients with non-surgical weight loss (NSWL) would have similar improvements. This study evaluated changes in LV filling pressures and speckle tracking-derived strain parameters in patients undergoing NSWL and SWL.

Conclusion: Strain parameters GLS, SLS and R obtained during 4D stressecho with adenosine triphosphate can be used for predicting LV remodelling in patients with CAD.

PP-059 Prevalence of Abnormal Echocardiogram Among Adult Patients with COVID-19 Admitted at a Tertiary Hospital

Methods: Seventy-eight participants were recruited for the stud. Sixty-six participants were included in the NSWL cohort. Patients underwent a 16week lifestyle programme consisting of exercise and dietary intervention. Twelve participants underwent gastric bypass and were included in the SWL cohort. Transthoracic echocardiography with speckle tracking was performed at baseline for both cohorts, after lifestyle intervention in the NSWL cohort and 24 weeks after surgery in the SWL cohort.

Mark Anthony Pablico, Jezreel Taquiso, Anne Marie Kathryn Ingente-Pineda, Felix Eduardo Punzalan and Lucky Cuenza Manilamed Medical Center Manila

Results: Mean age and gender of the NSWL and SWL cohort were similarly matched. Participants in the NSWL cohort achieved lower BMI reduction than those in the SWL cohort. Compared to the SWL cohort, the NSWL cohort had lower improvements in LV filling pressures (LV septal E’: 0.0547 ± 2.08 versus 2 ± 1.90 cm/s, p<0.01; LV lateral E’: 0.858 ± 2.28 versus 2.08 ± 1.44 cm/s, p=0.04). Participants in the NSWL cohort had lower improvements in speckle tracking-derived strain parameters of the LV (−1.13 ± 3.39 versus −3.84 ± 2.90, p=0.011) and left atrium (1.35 ± 13.96 versus 10.02 ± 13.44, p=0.0386).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-059. Correspondence: Mark Anthony Pablico, docmpablico@gmail.com

Objective: To characterise transthoracic echocardiogram (TTE) findings among admitted adult COVID-19 patients in terms of left and right ventricular dimensions and systolic function. Secondary objectives were to describe the clinical profile and hospital outcomes, and to determine association of outcomes with the collected variables. Methods: This was a retrospective observational cohort study among admitted COVID-19 patients who underwent TTE from April 2020 to December 2021. Simple logistic regression was used to explore variables associated with mortality.

Conclusion: Compared to SWL, NSWL did not confer similar improvements in LV filling pressures and speckle tracking-derived strain parameters.

PP-061 Prognostic Role of TAPSE and PASP Ratio in Patient with Severe Mitral Regurgitation

Results: A total of 197 patients were analysed. Left ventricular (LV) systolic function was abnormal in 17.77% and right ventricular (RV) systolic function was abnormal in 3.05%. Abnormal RV dimension was seen on 4.57% and 50.25% presented with abnormal LV geometry, of which 61.61% had concentric LV remodelling. Wall motion abnormalities were found in 16.75% presenting as hypokinesia in most cases. More than one-quarter of the patients died, but the majority improved. On multiple logistic regression analysis, only age, being admitted in the intensive care unit,

Leo Deddy Pradipta, Devina Gabriella Nugroho, Wildan Mubarok and Susi Herminingsih Dr. Kariadi General Hospital Semarang

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-061. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Objective: This study aimed to assess the ability of TAPSE/PASP ratio as a non-invasive measure of RV-to-PA coupling in predicting AF in patients with severe mitral regurgitation.

p=0.939, r=−0.014). LA ESVI and E/E’ exhibited a significant correlation (p=0.007, r=0.479; p=0.016, r=0.443). Strain imaging, including GLS and LA strains, demonstrated excellent reproducibility within and between observers. The intraobserver and interobserver reproducibility of LASr, LAScd, and LASc were also excellent, except for moderate reproducibility of LASc.

Methods: This was a single-centre, retrospective study analysis, encompassing 44 patients with severe mitral regurgitation diagnosed using transthoracic echocardiography. At the time of admission, an echocardiographic examination of the systolic and diastolic function of the left ventricle was performed. To evaluate the functions of the RV, calculations of TAPSE, PASP, and ratio of TAPSE to PASP were performed. In 2021, Velasco et al. showed that TAPSE/PASP ratio <0.35 was associated with poor prognosis. Data were studied to determine the ability of TAPSE/ PASP ratio to predict atrial fibrillation (AF) in patients with severe mitral regurgitation.

Conclusion: There was no significant correlation between GLS, LA strain, and T2* cardiac MRI. Further research with a larger cohort is necessary to establish the reliability of these methods for diagnosing cardiac iron overload in thalassaemia patients. This study provides valuable insights into the real-world context of transfusiondependent thalassaemia patients in Thailand, who have a lower prevalence of subclinical cardiac siderosis and are receiving deferiprone, which positively affects cardiac overload due to payment coverage.

Results: The study included 44 patients with severe mitral regurgitation. Mean age was 51.55 + 15.46 years and 32 (72.7%) were male. TAPSE/PASP ratio probably had better prognostic AF predictor than either TAPSE or PASP separately. TAPSE/PASP ratio <0.35 was associated with increased risk of AF (83%) and statistically had positive correlation with the incidence of AF (r=0.422, p=0.002).

PP-063 Bicuspid Aortic Valve Patient Undergoing Surgical Aortic Valve Replacement: Anatomy, Echocardiography, Strains and Outcomes Si Ling Soh, Aslannif Roslan and Shaiful Azmi Yahaya

Conclusion: TAPSE/PASP ratio appears to be poor prognostic predictor in patients with severe mitral regurgitation. It is associated with an increased risk of AF in such patients.

Institut Jantung Negara Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-063. Correspondence: Si Ling Soh, dr.sohsiling@ijn.com.my

PP-062 A Correlation Between Echocardiographic Left Ventricular Global Longitudinal Strain and T2* Cardiac MRI

Objective: To analyse anatomy, echocardiogram, strain analysis and outcome of bicuspid aortic valve patients undergoing surgical aortic valve replacement (SAVR).

Narongrit Rasarak, Kriengsak Funilkul, Korrakot Pornchaichanakit, Torpong Claimon, Dusit Jit-ueakul and Kritsana Tipcome

Methods: All patients with BAV who underwent SAVR at Institut Jantung Negara from 2015 to 2021 had their transthoracic and intraoperative transoesophageal echocardiogram analysed. Speckle strain tracking was performed retrospectively. In-hospital and 1-year mortality was acquired from medical records and the National Registration Department.

Vajira Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-062. Correspondence: Narongrit Rasarak, n.rasarak@gmail.com

Objective: To assess the association among left ventricular strain (GLS), LA strains, other echocardiographic observations, and T2* cardiac MRI in asymptomatic thalassaemia patients.

Results: Four hundred and forty-eight (33.3%) patients with BAV of 1,346 underwent SAVR. The mean age of patients was 56.1 ± 13.1 years. The most common type was Sievers 1 (right-left), 65.4%, followed by Sievers 1 (right-non), 19.2%; Sievers 0, 10%; and Sievers 1 (left-non), 5.4%. For AS haemodynamics, the most common was high-gradient severe AS (63%), normal-flow low gradient severe AS (6.2%), low flow low gradient severe AS (4.8%), reverse area gradient mismatch (4.6%) and paradoxical low flow low gradient severe AS (4.0%). There was significant relationship between lower GLS (−10.13% versus −13.38%, p=0.004), lower LArS (12.56% versus 23.57%, p<0.001) and lower RVFWs (−14.81% versus −19.75%, p=0.004) with in-hospital mortality. There was significant relationship for lower stroke volume index (p=0.004), lower flow rate (p<0.001), smaller aortic valve area (p=0.024) and higher tricuspid regurgitation velocity (p=0.04) with in-hospital mortality. Interestingly, there was no association of ejection fraction, peak velocity, mean pressure gradient, dimensionless index and acceleration time with inhospital mortality.

Methods: Cardiovascular complications are a major cause of morbidity and mortality in transfusion-dependent thalassaemia. While T2* cardiac MRI is the preferred diagnostic tool for detecting cardiac siderosis, it is not always accessible to asymptomatic patients in real-world practice. Thirty thalassaemic patients receiving regular blood transfusions underwent both cardiac MRI and echocardiography evaluations on the same day. The echocardiography assessed multiple parameters including GLS, LA strains (LA strain; LA reservoir strain [LASr], LA conduit strain [LAScd], LA contraction strain [LASc]), LV ejection fraction, and tissue Doppler parameters, while the consistency of strain imaging was evaluated for intraobserver and interobserver variations. The study also analysed the correlations between echocardiographic findings, patient characteristics, laboratory values, and T2* cardiac MRI results.

Conclusion: A significant number of SAVR patients have bicuspid aortic valve with the most common type being Sievers 1 (right-left fusion). Lower strain values, stroke volume index and flow rate are strongly associated with in-hospital mortality.

Results: The study found no significant correlation between GLS and T2* cardiac MRI (p=0.917, r=−0.200), or between LA strain and T2* cardiac MRI (LASr p=0.529, r=−0.120; LAScd p=0.536, r=−0.120; LASc

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-064 3D Holographic Virtual Reality Imaging Analysis of Aortic Valve Leaflet Reconstruction Technique

versus any anticoagulants for VTE prevention. Primary endpoint was composite of VTE events. Secondary endpoints were mortality, bleeding events, and wound complications.

Tokyo D Tower Hospital

Results: Eleven RCTs with 17,963 patients were included in the analysis. Patients receiving aspirin as VTE prophylaxis had no significant difference in terms of reducing VTE events (RR 1.03; 95% CI [0.71–1.48]; p=0.88), mortality (RR 1.01; 95% CI [0.68–1.49]; p=0.97), bleeding events (RR 0.97; 95% CI [0.80–1.05]; p=0.38), and wound complications (RR 0.76; 95% CI [0.50–1.16]; p=0.21), compared to anticoagulation after orthopaedic trauma or surgery.

Takeo Tedoriya

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-064. Correspondence: Takeo Tedoriya, t.tedoriya@gmail.com

Background: Aortic valve leaflet reconstruction using three same-sized autologous pericardium leaflets (ATLAS) was performed in strictly selected patients. The outcomes of ATLAS were evaluated using 3D holographic VR imaging.

Conclusion: Aspirin is as clinically effective as anticoagulation in preventing VTE events and mortality after orthopaedic trauma or surgery. Aspirin is also equally safe as any anticoagulants in terms of reducing bleeding events and wound complications from the index event or procedure.

Methods: The basic technique was: (1) three same-sized leaflets were tailored to original templates referred by STJ diameter; (2) the new commissures and nadirs were confirmed based on 3D-VR image; (3) leaflets were sutured on the cusp-suture line; and (4) commissure coaptation stitches were placed to prevent from minor leakage. Enrolled patients underwent ECG-triggered cardiac CT. Thin-sliced axial images were obtained during mid-to-end diastole. Subtracted volume rendering CT data were converted to the workstation to obtain 3D-VR image for assessment of pre- and postoperative valve structure. Periodic echocardiography was performed postoperatively to evaluate function of reconstructed aortic valve leaflets.

PP-066 Clinical Outcomes of Hospitalised Adult Cancer Patients with Venous Thromboembolism Prophylaxis in a Tertiary Hospital Andre Karl Faculin and Patricio Palmes

West Visayas State University Medical Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-066. Correspondence: Andre Karl Faculin, andrekarlfaculin@gmail.com

Results: From 2015, ATLAS was performed in 42 patients (AS 14, AR 28). In 17 patients, additional annular adjustment procedures were performed. One patient died after two months due to sepsis of preoperative active IE. One redo AVR was done due to perforation of leaflet. 3D-VR image revealed three well-balanced leaflets configuration after ATLAS. Echocardiographic evaluation revealed no AR more than mild, and mean AVPG was 8.6 mmHg after the surgery, and 8.8 mmHg in six years.

Background: Malignancy serves as a risk factor for venous thromboembolism (VTE), a major cause of in-hospital morbidity and mortality. The study aimed to determine the clinical outcomes of hospitalised adult cancer patients with VTE prophylaxis; specifically, clinicodemographic profile, prophylaxis type and duration, clinical outcomes, associated factors and predictors.

Conclusion: ATLAS can provide anatomical physiologic correction of the aortic valve. 3D-VR analysis was useful for preoperative information of the aortic root to accomplish ATLAS, as well as to evaluate reconstructed aortic valve. The short- and mid-term outcomes after ATLAS were acceptable with excellent haemodynamic conditions with well-balanced three leaflets.

Methods: This was a retrospective analytical research study of adult cancer patients admitted in a tertiary university hospital from January 2018 to December 2020. Descriptive and analytical statistical tools were utilised with significance set at p<0.05. This paper was approved by the ethics review committee.

PP-065 Clinical Effectiveness of Aspirin Versus Anticoagulation for Venous Thromboembolism Prevention Following Orthopaedic Trauma and Surgery

Results: The majority of the 360 cancer patients were elderly, non-smoker women with hypertension, diabetes and asthma. Most had gastrointestinal, gynaecological/urological and breast cancers; stage IV cancers with liver, lung and/or bone metastasis; and prior surgery or chemotherapy. Mechanical prophylaxis outnumbered pharmacological prophylaxis. The longer the length of hospital stay, the greater the likelihood of patients to receive thromboprophylaxis (p<0.001). Complications such as bleeding, pulmonary embolism and deep venous thrombosis occurred whether they received VTE prophylaxis or not but were statistically significant (p=0.003). More patients without VTE prophylaxis died but in-hospital mortality was not significantly different between the two cohorts (p=0.230). Predictors of prolonged hospital stay for patients with VTE prophylaxis were service type accommodation, higher VTE risk score and haematological cancers while gynaecological/urological cancers were predictors of shorter hospital stay.

Daryl Dakay and Elaine Gallardo Chong Hua Hospital

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-065. Correspondence: Daryl Dakay, drdakay061889@gmail.com

Objective: To compare the clinical effectiveness and safety between aspirin and anticoagulation in preventing venous thromboembolism (VTE) following an orthopaedic trauma or surgery. Methods: Only randomised controlled trials (RCT) comparing aspirin and any anticoagulants as VTE prophylaxis following an orthopaedic trauma or surgery were selected for review. PubMed, Embase, and Cochrane databases were searched for RCTs reporting clinical outcomes of aspirin

Conclusion: Cancer patients with VTE prophylaxis stayed longer and developed complications during admission but in-hospital mortality was not statistically different from those without VTE prophylaxis.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-067 Comparison of Endovenous Laser Ablation and Mechanochemical Ablation in Varicose Vein Treatment: A Meta-Analysis

Methods: This was a single-centre, retrospective, observational study that included no-option CLTI patients (n=100) who underwent BM-MNCs implantation from 2010 to 2019. All patients were surveyed for long-term outcomes.

Leo Deddy Pradipta, Adwin Alamsyaputra, Inne Pratiwi Farissa and Novi Anggriyani

Results: Excluded from the study were 3 patients implanted in only upper limbs, 9 patients with over twice implantation, 20 patients with non-ASO; and 3 patients in which it was difficult to survey outcomes. Finally, 65 patients (72 limbs) were analysed. The median follow-up duration was 29.5 months. The average age was 68 years (male 65%, Rutherford classification V or VI 76%, diabetes 55%, haemodialysis 37%). In all patients, the 1-year, 5-year, and 10-year major amputation-free rate was 84%, 71%, and 66%, respectively. The 1-year, 5-year, and 10-year amputation-free survival (AFS) rate was 70%, 38%, and 24%, respectively. Multivariate logistic regression analysis showed that no run-off vessels below the knee was an independent predictor associated with any amputation-free rate (p<0.05). In addition, haemodialysis, high controlling nutritional status (CONUT) score and high C-reactive protein before BMMNCs implantation were independent predictors associated with AFS rate (all p<0.05). Severe frailty (clinical frailty scale ≥8) tended to be associated with AFS rate (p=0.09).

Dr. Kariadi General Hospital Semarang Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-067. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Background: This study aimed to compare EVLA and MOCA to achieve anatomic success as the primary outcome and adverse events as secondary outcome. Methods: Multiple databases including PubMed, Scopus and ScienceDirect were searched for relevant studies in English from 2012 to 2022. Full-text articles of studies were used to compare the outcomes between EVLA and MOCA for limb varicose vein treatment. The primary outcome was complete occlusion one year after procedure, while secondary outcome was periprocedural pain beyond one week after procedure. Review Manager 5.4 was used to estimate the effects of the results among eligible articles. The quality of research methods was evaluated using Modified Jadad Scale.

Conclusion: BM-MNCs implantation is a feasible and safe therapy for nooption CLTI patients with ASO. In patients with non-haemodialysis or low clinical frailty scale, greater efficacy may be expected.

Results: Initial screening yielded 554 studies; four randomised controlled trials involving 347 limb varicosity patients met the stud inclusion criteria. Complete occlusion of the target vein at one year was significantly greater in the EVLA group compared to the MOCA group (OR 0.23; 95% CI [0.1– 0.53; p=0007) and periprocedural pain was not significantly different in both groups (SMD 0.06; 95% CI [0.15–0.27]; p=0.59).

PP-069 Diagnostic Potential of MicroRNA-1, 21 and 29 as Early Biomarkers of Myocardial Fibrosis in HFpEF Makhyan Jibril Al Farabi, Muhammad Gani Arifitrianto, Rahima Ratna Juwita, Okky Wahyu Firmansyah, Andrianto Andrianto and I Gde Rurus Suryawan

Conclusion: EVLA is more effective compared with MOCA as treatment in limb varicose vein. There is no difference in periprocedural pain between the two groups.

Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Airlangga, Soetomo Academic and General Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-069. Correspondence: Makhyan Jibril Al Farabi, makhyan.jibril@gmail.com

PP-068 Outcomes and Predictors after Bone Marrowderived Mononuclear Cells Implantation for Critical Limb-threatening Ischaemia with Arteriosclerosis Obliterans

Background: There is a need for a minimally invasive diagnostic tool with less radiation for the development of early myocardial fibrosis and targeted treatment for HFpEF. This study aimed to investigate the diagnostic potential of circulating microRNAs (miRNAs) for detecting early myocardial fibrosis development in heart failure with preserved ejection fraction patients (HFpEF).

Jun Yoshimura, Kenji Yanishi, Hirofumi Kawamata, Takaaki Ozawa, Daiki Goto, Yusuke Hori, Ayumu Fujioka, Arito Yukawa and Satoaki Matoba Kyoto Prefectural University of Medicine

Methods: This observational study used a case-control research design. Peripheral blood samples were isolated from 25 HFpEF patients and 25 normal patients, and measured for complete laboratory testing, NTproBNP levels using ELISA, and microRNA-1, 21 and 29 levels using RTPCR. All patients also underwent echocardiography and GLS to measure the myocardial fibrosis progression. Data were analysed using SPSS 25.0.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-068. Correspondence: Jun Yoshimura, j.y.gdmjw395@gmail.com

Background: Several clinical studies have reported the safety and efficacy of therapeutic angiogenesis using autologous bone marrow-derived mononuclear cells (BM-MNCs) implantation for patients with no-option critical limb-threatening ischaemia (CLTI). However, clinical outcomes in CLTI patients with arteriosclerosis obliterans (ASO) are worse than in those with thromboangiitis-obliterans or collagen disease-associated vasculitis. Clinical predictors affecting long-term outcomes after BM-MNCs implantation have not been found in no-option CLTI patients with ASO.

Results: HFpEF patients had significantly higher GLS compared to normal patients (−13 ± 2.4% versus −19 ± 3.2%; p<0.05), suggesting HFpEF patients tend to have myocardial fibrosis. HFpEF patients also had significantly higher microRNA-1 and microRNA-21 compared to normal patients (p<0.05), but lower microRNA-1 (p<0.05). There is a positive correlation between microRNA-1 and microRNA-21 with GLS finding (r=0.753, p<0.05; and r=0.675, p<0.05) and an inverse correlation between microRNA-29 with GLS finding (r=−0.653, p<0.05). Using a GLS

Objectives: To find several predictors affecting the efficacy of BM-MNCs implantation.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress cut-off of −15% for myocardial fibrosis, microRNA-1, microRNA-21 and microRNA-29 can predict myocardial fibrosis based on GLS with a specificity of 78% and sensitivity of 75%.

1. National Cardiovascular Center Harapan Kita; 2. Faculty of Medicine, Krida Wacana Christian University Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-071. Correspondence: Ruth Grace Aurora, dr.ruth.grace.aurora@gmail.com

Conclusion: Increasing microRNA-1 and microRNA-21 followed by decreasing microRNA-29 in HFpEF patients suggest their roles in early myocardial fibrosis. Detection of those biomarkers can be beneficial for early myocardial fibrosis diagnosis, early aggressive HFpEF treatment and targeted miRNA silencing therapy to prevent the worsening of HFpEF.

Background: During the COVID-19 pandemic, reduction in heart failure (HF) hospitalisations have been widely reported. Furthermore, patients with HF, in particular those with reduced ejection fraction (HFrEF) are at high risk of unfavourable courses of COVID-19. This study aimed to elucidate changes in HFrEF hospitalisation before, during, and after the COVID-19 pandemic in Indonesia.

PP-070 Heart Failure Patients in a Thai Real-world Clinical Cohort

Methods: A single-centre retrospective cohort study was performed on 7,517 HFrEF patients who were hospitalised between 2017 and 2021 at the National Cardiovascular Center Harapan Kita (NCCHK). Data were extracted from medical record reviews.

Porntep Amornritvanich, Cholatid Ratanatharathorn, Panu Looareesuwan, Teerapat Yingchoncharoen and Ammarin Thakkinstian Ramathibodi Hospital

Results: Median age of patients was 57 (18–99) years. The prevalence of HF admission before the COVID-19 pandemic period increased up to 2,172 admissions, then decreased by 27.5% during the pandemic. Early after the pandemic, the prevalence stayed the same. This study showed longer LOS (>7 days) and was significantly higher after the pandemic compared to before and during the pandemic (47.4% versus 34.6% and 40.4%, p<001), respectively. During the pandemic period, hospitalised HF patients comprised 10–14% of total bed occupation. Recurrent hospitalisations decreased insignificantly (p=0.074) during the pandemic, even though some patients were hospitalised more than four times in a year. The mortality rate of HF patients increased significantly during the pandemic compared to before the pandemic period (6% versus 3.1%, p<0.001).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-070. Correspondence: Porntep Amornritvanich, eartty.ipad@gmail.com

Background: This study aimed to create a heart failure (HF) cohort profile and estimate transition probabilities. Methods: The study used data from Ramathibodi Hospital in Bangkok, Thailand from 2010 to 2020, to analyse a cohort of adult patients diagnosed with HF using the ICD-10 coding system who had GDMT and/or echocardiographic results for LVEF. Patients on two or more GDMT medications or specific medications for HF were classified as HF patients and grouped based on LVEF. The study focused on mortality, hospitalisation and changes in HF classification with or without specific medications and Kaplan–Meier estimates were used to calculate transition probabilities.

Conclusion: During the pandemic, not only the prevalence of HF, but also the length of stay and readmission of HF patients were impacted, perhaps due to the hesitance of patients to receive routine medical care. Thus, the mortality rate of HF patients increased significantly during pandemic.

Results: This information relates to a study of HF patients conducted between 2010 and 2020, which included 13,426 patients diagnosed with HF by the ICD-10 coding system as of December 2022. The study identified a target population consisting of patients on specific medications, including ARNI and vericiguat, as well as those receiving three of the four medications recommended by the European Society of Cardiology. By retrieving echocardiographic data and matching it with patients who were coded as HF on ICD-10, the target population was expanded. Patients were categorised into different types of HF based on their EF, with a final cohort of 19,256 patients, including 1,635 with HFrEF, 1,443 with HFmrEF, and 16,178 with HFpEF.

PP-072 Clinical Characteristics and Outcomes of Patients with Heart Failure with Preserved Ejection Fraction in Taiwan Cze Ci Chan, Fu-Chih Hsiao and Pao-Hsien Chu

Department of Cardiology, Linkou Medical Center, Chang Gung Memorial Hospital

Conclusion: This well-characterised HF cohort is based on 10-year clinical practice data. Further research will investigate the treatment effect of each medicine, which could then be used to predict outcomes for an individual patient. These cohorts may also be used for emulating RCTs on different treatment strategies and exploring real-world outcomes. Economic evaluation will further guide treatment management and planning strategies in a Thai population.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-072. Correspondence: Cze Ci Chan, czecichan@gmail.com

Background: Data regarding the distribution of left ventricular ejection fraction (LVEF) among patients with de novo heart failure (HF) and the outcomes of patients with HF with preserved ejection fraction (HFpEF) in Taiwan are limited.

PP-071 National Trends in Heart Failure Hospitalisation in Indonesia: Before, During and After COVID-19 Pandemic

Methods: Patients with de novo HF were identified from the Chang Gung Research Database from 2016 to 2020. Outcomes investigated included all-cause death, cardiovascular death, all-cause hospitalisation and HF hospitalisation. Outcomes between patients with HFpEF and HF with reduced ejection fraction (HFrEF) were compared after propensity score matching.

Ruth Grace Aurora,1 Susetyo Atmojo,1 Betcy,2 Rarsari Surarso,1 Mira Fauziah,1 Dian Yaniarti Hasanah,1 Hary Sakti Muliawan1 and Bambang Budi Siswanto1

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Results: A total of 7,736 patients with de novo HF were identified. Among them, 4,393 (56.79%) patients had HFpEF and 1,977 (25.56%) patients had HFrEF. Compared with the HFrEF group, patients with HFpEF were older (71.5 versus 64.2 years, STD=0.49), and more likely to be female (48.85% versus 31.11%, STD=0.3683). Comorbidities were more prevalent in patients with HFpEF. After a median follow-up of 2.11 years, the incidence of allcause death and hospitalisation were comparable between the two groups. Patients with HFpEF had a lower risk of cardiovascular death (HR 0.82; 95% CI [0.68–1.0]) and HF hospitalisation (HR 0.6, 95% CI [0.53–0.68]).

PP-074 Cognitive Decline Increasing the Risk of Frailty for Patients with Heart Failure: An Observational Study

Conclusion: Patients with HFpEF were older, more likely to be female, and had a higher burden of comorbidities. Compared with patients with HFrEF, patients with HFpEF had a comparable incidence of all-cause death and hospitalisation after propensity score matching. However, the risk of cardiovascular death and HF hospitalisation were higher among patients with HFrEF.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-074. Correspondence: Yu-Chiuan Tong, yuchiuan0305@gmail.com

Pi-Ling Chou,1,2,3 RN Yi-Hui Ho1 and Yu-Chiuan Tong1 1. School of Nursing, College of Nursing, Kaohsiung Medical University; 2. Department of Nursing, Kaohsiung Medical University Hospital; 3. Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University

Background: Cognitive frailty (CF) has become the primary cause of poor prognosis in heart failure (HF) patients. There is a lack of understanding of cognitive frailty among patients with HF and the relationship between cognitive decline and physical frailty.

PP-073 Integrating Home Telemonitoring to Heart Failure Ancillary Clinic: A Promising Experience

Methods: A prospective, cross-sectional study design was adopted to recruit 110 patients with HF from the cardiology ward of a medical centre in Taiwan. Data were collected between 1 January and 31 August 2021. Study instruments included the Montreal Cognitive Assessment scale Taiwan version (MoCA-T) and Frailty Phenotype Criteria (FPC). Data were analysed using the χ2 test, independent t-test, and logistic regression analysis in SPSS 22.0.

Jonathan Christopher,1 Leonardo Paskah Suciadi,2 Anisa Firdaus,3 Selin Wilsy Meltiana Nanlohy,3 Alexanderina Thesubia Pooroe,3 Titus Kurnia Hariadi2 and Antono Sutandar2 1. Heart Failure Clinic, Siloam Hospitals Kebon Jeruk; 2. Siloam Heart Institute/ Siloam Hospitals Kebon Jeruk; 3. Heart Failure Clinic, Siloam Hospitals Kebon Jeruk

Results: Fifty-nine per cent of the patients with HF exhibited cognitive decline. The prevalence of CF in patients with HF ranged from 30%. Cognitive function was a significant predictor of frailty (OR 0.88; 95% CI [0.79–0.98]; p=0.02). More patients with frailty had cognitive decline than those with pre-frailty or non-frailty.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-073. Correspondence: Jonathan Christopher, joc.suhardy@gmail.com

Background: A telemonitoring service integrated to the Heart Failure Ancillary Clinic (HFAC) was developed. The team consisted of a HFdedicated medical officer, nurses, nutritionists and pharmacists, and rendered virtual follow-up visits periodically, aimed to deliver comprehensive education to the patients and their caregivers to improve adherence and self-care, as well as clinical monitoring.

Conclusion: The results of the study revealed a high prevalence of cognitive decline and contributed high risk of frailty in patients with HF. Clinical professionals should enhance their assessment of cognitive function and frailty to identify patients with a high risk of CF in advance. Further intervention is required to improve functional status in these patients and prevent poor prognosis.

Methods: Patients with newly diagnosed HF and/or recent admissions were referred from Cardiology Clinics. Data of demography, risk stratifications, LVEF, NYHA functional class, comorbidities and medication list were collected into electronic medical records. After initial education at the HFAC, the team arranged virtual visits by WhatsApp message, or voice or video call. Rehospitalisation and all-cause death were reported or traced.

PP-075 Real-world Characteristics, Mortality and Treatment Patterns of Guideline-directed Medical Therapy in Incident Sacubitril/Valsartan Users in Taiwan Shih-Tsung Huang,1 Hsi-Yu Lai,2 Hui-Min Chuang,2 WenJone Chen,3,4,5 Wan-Tseng Hsu6 and Fei-Yuan Hsiao2,6,7

Results: A total of 122 patients were enrolled prospectively from April 2021 to February 2023. The median age of patients was 66 years, and 36% were female. Based on LVEF classification, 68% of patients were HFrEF and 22% HFpEF. Most patients had NYHA II (57%) or III (23%). Moreover, 53 patients (43%) were categorised for having high-risk profiles. In the HFrEF group, the percentage of patients who received angiotensin receptor/neprilysin inhibitor (ARNI), angiotensin receptor blocker (ARB) or angiotensin converting enzyme inhibitor (ACEI), β-blocker, spironolactone, and sodium-glucose cotransporter-2 Inhibitor (SGLT2I) was 43%, 47%, 75%, 72%, and 55%, respectively. Rehospitalisation occurred in 11% patients and all-cause mortality was 13%.

1. Center For Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University; 2. Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; 3. Department of Emergency Medicine, College of Medicine, National Taiwan University; 4. Department of Emergency Medicine, National Taiwan University Hospital; 5. Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine; 6. School of Pharmacy, College of Medicine, National Taiwan University; 7. Department of Pharmacy, National Taiwan University Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-075. Correspondence: Wen-Jone Chen, wjchen1955@ntu.edu.tw

Conclusion: Implementing telemonitoring to HFAC might potentiate HF patient profiling and management. Interactive communication between healthcare providers and patients is paramount to successful implementation.

Background: In recent clinical guidelines, sacubitril/valsartan has become the frontline therapy for heart failure (HF). However, data on incident

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Abstracts from 27th Asian Pacific Society of Cardiology Congress sacubitril/valsartan users is limited, especially in Asian populations. This study aimed to explore patient characteristics, mortality and treatment patterns of guideline-directed medical therapy (GDMT) in incident sacubitril/valsartan users.

was estimated. A subgroup analysis was conducted among patients with incident AMI between 2014 and 2017, and their mortality rates and treatment patterns at 3-year follow-up were investigated. For all analyses, estimates for STEMI and NSTEMI were examined respectively.

Methods: Patients who newly received sacubitril/valsartan as regular users between 2017 and 2019 were identified from Taiwan’s National Health Insurance Research Database (NHIRD). Characteristics, treatment patterns and mortality rates were investigated in all eligible patients.

Results: The age-standardised incidence of AMI slightly decreased from 47.6 per 100,000 people in 2014 to 44.7 per 100,000 people in 2020. The incidence of STEMI remained unchanged during the study period (from 14.3 in 2014 to 14.7 in 2020), while the incidence of NSTEMI decreased slightly (from 33.3 in 2014 to 31.0 in 2020). Among patients with incident AMI admission, the mortality rate at index hospitalisation was 11.7% higher in NSTEMI patients (13.1%) than in STEMI patients (8.3%). At index AMI admission, 40.4% of patients received all guideline-recommended secondary prevention drugs, including antiplatelets, β-blockers, ACEI/ARB and statins. The proportion of uses of these drugs, particularly ACEI/ARB and statins, were lower in NSTEMI than STEMI.

Results: Among 23,398 patients (mean age 64.7 ± 15.0 years, 72.3% male), 65.8% had HF, 16.9% had myocardial infarction, and 27.1% had been admitted within 14 days before being prescribed sacubitril/ valsartan. Regarding previous GDMT utilisation, 95.9% of patients had been prescribed any GDMT, including 10.8% ACEI/ARB single users, 15.6% β-blocker single users and 65.3% ACEI/ARB + β-blocker combined users. The 30-day, 90-day, 180-day, and 1-year all-cause mortality rates were 0.9%, 3.5%, 6.5%, and 11.5%, respectively. Although the use of sacubitril/valsartan significantly decreased from 91.6% in the first quarter to 79.6% in the fourth quarter, the median daily dose increased from 100 to 200 mg/day after one-year follow-up. Similar decline trends were found in the use of any GDMT, β-blocker, mineralocorticoid receptor antagonist and diuretics, while the use of ACEI/ARB increased as time progressed.

Conclusion: This study reports distinct epidemiology treatment patterns and mortality among STEMI and NSTEMI patients in Taiwan.

PP-077 What Are the Gaps Preventing Physicians from Prescribing Guideline-directed Medical Therapy? Pei-Fang Chung, Chi-Cheng Huang, Bing-Hsiean Tseng, Jung-Cheng Hsu and Yen-Wen Wu

Conclusion: This study provided real-world data regarding patient characteristics, mortality and treatment patterns in incident sacubitril/ valsartan users. The decline in use of sacubitril/valsartan accompanied by an increase in mean daily dose merits further investigation.

Division of Cardiology, Cardiovascular Medical Center, Far-eastern Memorial Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-077. Correspondence: Pei-Fang Chung, vancomycin500@gmail.com

PP-076 Nationwide Trends in Incidence, Mortality and Treatment Patterns in Hospitalised Acute Myocardial Infarction Patients in Taiwan

Background: Despite its proven benefits, there are gaps in the real-world administration of guideline-directed medical therapy (GDMT) in HFrEF patients. This study aimed to analyse the reasons prohibiting physicians from prescribing GDMT to provide direction for enhancing future adherence.

Hui-Min Chuang,1 Shih Tsung Huang,2 Wen-Jone Chen,3,4,5 Wan Tseng Hsu6 and Fei Yuan Hsiao1,5,6

1. Graduate Institute Of Clinical Pharmacy, College Of Medicine, National Taiwan University; 2. Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University; 3. Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; 4. Department of Emergency Medicine, National Taiwan University Hospital; 5. Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine; 6. School of Pharmacy, College of Medicine, National Taiwan University; 7. Department of Pharmacy, National Taiwan University Hospital

Methods: All patients hospitalised for newly diagnosed HFrEF were enrolled. Physicians were asked to provide a reason if patients were not using specific GDMT. Prescription patterns were reported according to the date of hospitalisation (2018Q1–2019Q4). Results: From 2018Q1 to 2019Q4, a total of 343 HFrEF patients were discharged. The proportion of patients who received all three pillars of GDMT at discharge remained 60–80%. Beta-blockers were used in >80% of patients in every quarter, so the main factor limiting patients from threepillar GDMT was the lower prescription rate of ACEIs/ARBs and MRAs, which varied from 70% to 90%. The main concerns were renal impairment (71.2%) and hypotension (24.2%) for ACEIs/ARBs; however, 68.1% of patients designated as renal impairment had eGFR >15 ml/kg per min, of which ACEIs/ARBs should be considered. For MRAs, elevated serum creatinine >2.0 mg/dl (70.4%) was the major reason, but 27.8% of patients were not given MRA because they were considered stable according to previous guidelines.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-076. Correspondence: Wen-Jone Chen, wjchen1955@ntu.edu.tw

Background: Contemporary data on the nationwide epidemiology of acute myocardial infarction (AMI), particularly stratifying by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), is extremely limited. This study aims to investigate the nationwide trend in incidence, disease characteristics, treatment patterns and mortality among patients with AMI.

Conclusion: The study revealed that about one-third of HFrEF patients were not receiving optimal GDMT, in most cases due to renal impairment. Efforts should be made to address these concerns, such as the pharmacist’s clinic to review and encourage the addition of GDMT at outpatient setting, to enhance overall adherence.

Methods: A nationwide cohort study was conducted using Taiwan’s National Health Insurance Research Database from 2014 to 2020. Patients admitted for incident AMI were included in the study, and annual incidence

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-078 Cardiac Amyloidosis as a Secondary Phenomenon to Inflammatory Bowel Disease

Results: The main reason for the development of CHF was coronary artery disease (64.5%). Left ventricle ejection fraction <40% was registered in 229 (38.7%) patients. Hydrothorax was observed in 45.7% and ascites in 11.3%. Low systolic blood pressure was observed in more than 25% of patients; inotropic support in the hospital was required by 14.2%, and outpatient in 9.1%. Oxygen support at outpatient was carried out in 4.2% of patients. There were 12 (1.9%) patients on the waiting list for heart transplantation. There were 11 patients with cardiac resynchronisation therapy (CRT) and 8 patients with implantable cardioverter defibrillator (ICD), while 58 (9.8%) patients had indications for implantation of CRT/ICD. At 90 days from date of inclusion in the register, 59 (10.0%) patients had died. According to the binary logistic regression of left bundle branch block, the presence of hydrothorax, need for oxygen support at outpatient, and history of heart surgery were associated with the high risk of a fatal outcome.

Daryl Dakay,1 Marie Louisse Oppus2 and Jun Maximo Lasco1 1. Chong Hua Hospital, Cebu; 2. Chong Hua Hospital, Mandaue Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-078. Correspondence: Daryl Dakay, drdakay061889@gmail.com

Background: Secondary amyloidosis is the accumulation of abnormal amyloid protein fragments in reaction to a persistent inflammatory state. This case report demonstrates an atypical secondary amyloidosis elicited by inflammatory bowel disease (IBD). Presented here is the case of an elderly man with cardiac amyloidosis as a secondary phenomenon to IBD complicating its course. Complications: A 69-year-old male sought medical attention for palpitation and chest discomfort. He further reported worsening of exertional dyspnoea with intermittent abdominal pain and diarrhoea. He was previously diagnosed with IBD and was being maintained on mesalazine. Arrhythmia was immediately recognised on initial evaluation and was given appropriate intervention. Cardiac biomarkers were elevated suggesting acute coronary syndrome with concomitant heart failure. An invasive strategy was pursued requiring stenting of right coronary artery (RCA) stenosis. However, echocardiography revealed findings not commensurate with the angiographic report. Thus, further imaging study was done to permit evaluation for any structural heart disease. Cardiac magnetic resonance (CMR) demonstrated increased left ventricular wall thickness and atrial size with diffuse late gadolinium enhancement (LGE), suggesting cardiac amyloidosis. He eventually went into cardiac decompensation provoked by overt gastrointestinal bleeding.

Conclusion: Patients with progressive forms of CHF need adequate medicine therapy and dynamic supervision with the introduction of palliative care.

PP-080 Left Ventricular Mass Index as a Prognostic Factor in Patients with ATTR-Type Cardiac Amyloidosis

Miho Fujita,1 Shigeki Kobayashi,2 Maho Ishikawa,1 Yusuke Nakashima,1 Yoshihide Nakamura,2 Hironori Ishiguchi,1 Tatsuhiro Fujimura1 and Takayuki Okamura1 1. Yamaguchi University Graduate School of Medicine; 2. Yamaguchi University School of Medicine Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-080. Correspondence: Miho Fujita, komachi.l1555@gmail.com

Results: Autopsy revealed amyloid deposition in the liver, kidney and heart. Immunohistochemistry also showed positive result for amyloid A protein.

Objective: To evaluate prognostic factors in patients with ATTR-type cardiac amyloidosis.

Conclusion: Cardiac amyloidosis is a rare but significant complication in IBD, particularly ulcerative colitis (UC). Monitoring for manifestations suggesting cardiac involvement must be incorporated in the approach for IBD patients.

Methods: We performed a prospective observational cohort study for patients with ATTR type cardiac amyloidosis diagnosed according to the Japanese Circulation Society Guideline. Patients were followed up for more than 6 months in our hospital. The primary endpoint was a composite of the cardiovascular death and the first hospitalisation due to worsening heart failure (HF). BNP, troponin T(TnT), other biomarkers, and indices of cardiac function and renal function were measured on admission.

PP-079 Short Registry of Progressive Forms of Chronic Heart Failure

Dmitry Duplyakov,1 Olesya Rubanenko,1 Inna Skripnik,2 Kseniya Matyukhina2 and Anatolii Rubanenko2

Results: Thirty-three consecutive patients with ATTR type cardiac amyloidosis were enrolled and followed up for a median period of 12 months. Median patient baseline characteristics were 78 years of age, LVEF 44% and BNP 258.8 pg/ml, respectively. Tafamidis was prescribed in 27 patients (82%). During the follow-up period, 8 of 33 patients had cardiovascular events [HF death (n=4) and HF hospitalisation (n=4)]. In comparison with parameters (biomarkers, cardiac function, and renal function) between patients with and without cardiovascular events, left ventricular mass index (LVMI), IVC diameter and complicated rate of pleural effusion were significantly higher in the event group than in nonevent group. Cox proportional hazards analysis showed that LVMI was an independent predictor of prognosis.

1. Samara State Medical University; 2. Samara Regional Cardiology Dispensary Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-079. Correspondence: Dmitry Duplyakov, duplyakov@yahoo.com

Objective: To consider the clinical characteristics of patients with chronic heart failure (CHF) NYHA III—IV. Methods: A short registry of progressive forms of CHF NYHA III–IV was conducted from 60 institutions for 1 month (16 May 2022 to 15 June 2022). Five hundred and ninety-one patients were included (median age 71.0 [64.0–80.0] years, 339 [57.4%] male), most of whom (278 [47%]) were 60–75 years old.

Conclusion: Results suggest that LVMI is prognostically important in advanced cardiac amyloidosis with relatively low LV ejection fraction.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-081 The Benefit of Earlier Use of Sacubitril/Valsartan in Patients with Newly Diagnosed Heart Failure

controlled trial using exercise intervention to improve the fatigue symptoms of HF patients. Results: This study included 459 patients. Four studies were in aerobic exercises, and two were in inspiratory muscle training. Four aerobic exercise studies, after sensitivity analysis and removing literature with high heterogeneity, the remaining three studies showed homogeneity (I2=0%; p=0.46), resulting in improvement of fatigue (MD −0.51; 95% CI [−0.89, −0.12]; p=0.001). Two inspiratory muscle training studies showed moderate homogeneity (I2=54%; p=.14), that significantly improved fatigue (MD −11.36; 95% CI [−15.30, −7.41], p<.00001). In addition, four studies measured quality of life, and the results of three studies were analysed for meta-analysis. There was moderate heterogeneity (I2=56%, p=0.10) among the studies (MD −0.04, 95% CI [−0.45, 0.37]; p=.83), and the effect was not significant.

Fu-chih Hsiao

Chang Gung Memorial Hospital, Linkou Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-081. Correspondence: Fu-chih Hsiao, maniclone@gmail.com

Background: Whether or not earlier initiation of sacubitril/valsartan in patients with de novo heart failure and reduced ejection fraction (HFrEF) results in improved clinical outcomes and left ventricular reverse remodelling remains to be elucidated. Methods: Patients with newly diagnosed HFrEF and who had prescriptions for sacubitril/valsartan after diagnosis were identified from Chang Gung Research Database from 2016 to 2020. Early users were those who initiated sacubitril/valsartan within 6 months after diagnosis; late users were those who initiated after 6 months. Outcomes between early and late users were compared after propensity score weighting, including the cumulative number of heart failure hospitalisation (HFH), emergent visits, and the composite of both. Change in left ventricular ejection fraction (LVEF) was also investigated.

Conclusion: It is recommended that HF patients maintain regular exercise of at least 120 minutes per week, or three times a week, 30 minutes each time. In addition, performing 30 minutes of inspiratory muscle training with 40% MIP every day can significantly improve fatigue. However, although exercise remarkably improves fatigue symptoms, it does not greatly improve quality of life.

PP-083 Growth Differentiation Factor 15 and Prognosis Across Body Mass Index Category in Heart Failure

Results: From 2016 to 2020, a total of 410 patients with newly diagnosed HFrEF and who had prescriptions for sacubitril/valsartan were identified. Among them, 188 patients were early users, and 222 patients were late users. The two groups had comparable demographics and comorbidities after weighting. Before weighting, the risk of total emergent visits (HR 0.73; 95% CI [0.61–0.86]) and the composite of total HFH and emergent visits (HR 0.86; 95% CI [0.77–0.97]) were lower among early users after a median follow-up of 2.53 years. After weighting, early users had a lower risk of total emergent visits (HR 0.84; 95% CI [0.71–0.99]). LVEF increased significantly in both groups; however, the changes were significantly more pronounced in the early users (28.7–45.3% in early users; 28.9–40.2% in late users, p<0.0001).

1. Kyoto Medical Center; 2. Sendai Medical Center; 3. Saitama Hospital; 4. Yokohama Medical Center; 5. Kure Medical Center; 6. Fukuokahigashi Medical Center; 7. Mito Medical Center; 8. Kobe Medical Center; 9. Higashihiroshima Medical Center; 10. Hokkaido Medical Center; 11. Kanazawa Medical Center; 12. Sagamihara Hospital; 13. Kumamoto Medical Center; 14. Hakodate Hospital; 15. Nagasaki Hospital; 16. Nagasakikawadana Medical Center; 17. Kyushu Medical Center; 18. Ehime Medical Center; 19. Fukuyama Medical Center; 20. Higashitokushima Medical Center; 21. Tochigi Medical Center; 22. Jichi Medical University

Conclusion: After the diagnosis of HFrEF, initiation of sacubitril/valsartan within 6 months was associated with a lower risk of total emergent visits, compared to initiation after 6 months. The improvement in LVEF was also more pronounced in early users.

PP-082 Effectiveness of Exercise Training on Fatigue and Quality of Life for Patients with Heart Failure

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-083. Correspondence: Moritake Iguchi, moritake.igu@gmail.com

Ping Hsiung1 and Pi-Ling Chou2

1. Zuoying Branch of Kaohsiung Armed Forces General Hospital; 2. Kaohsiung Medical University

Background: Growth differentiation factor-15 (GDF-15), a stressresponsive member of the TGF-β cytokine superfamily, is an independent prognostic predictor in heart failure (HF). GDF-15 has been also reported to be associated with cardiac cachexia and malnutrition. However, the association of GDF-15 and prognosis in patients with HF according to BMI is unclear.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-082. Correspondence: Ping Hsiung, vtori923@gmail.com

Background: Fatigue often reduces the health-related quality of life in patients with heart failure (HF). However, no systematic review and metaanalysis has investigated the effect of exercise interventions to improve fatigue in HF patients.

Methods: A total of 1,024 patients (mean age 75.5 years, 58.7% male) were included in the analyses. Serum levels of GDF-15, as well as NTproBNP, high sensitivity troponin I (hs-cTnI), and high sensitivity C-reactive protein (hs-CRP), were measured. Patients were divided into three groups based on the tertile of BMI low (≤19.9), middle (>19.9 to ≤23.4) and high (>23.4).

Methods: The systematic review followed the PRISMA Statement. The database included PubMed, Cochrane Library, Embase, CINAHL and Web of Science databases. The included article type was a randomised

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Results: NT-proBNP levels were higher in the low group, but hs-cTnI and hs-CRP were comparable between the three subgroups. GDF-15 levels were significantly lower in the high groups (low 2,271 pg/ml; middle 2,264 pg/ml; high 1,888 pg/ml). During the 2-year follow-up, all-cause death and major adverse cardiovascular events (MACE: cardiovascular death and HF hospitalisation) occurred in 111 and 130 patients in the low group, 66 and 132 in the middle group, and 34 and 88 in the high group. In multivariate analysis, higher GDF-15 was significantly associated with the incidence of all-cause death and MACE in the middle and high groups, but not in the low group.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-085. Correspondence: Hwei Sung Ling, hweisung@gmail.com

Background: Clinical correlates and prognostic significance of plasma GDF15 in heart failure (HF) with improved ejection fraction (EF), compared with NT-proBNP and global longitudinal strain (GLS) were studied. Methods: Patients who fulfilled HF improved EF criteria were identified from the GDF-15 prospective observational study previously conducted in a tertiary HF clinic from 2019 to 2021. Composite adverse outcomes, including death, HF hospitalisation, worsening HF unscheduled visits and LVEF deterioration were retrospectively analysed.

Conclusion: Among HF, higher GDF-15 was significantly associated with all-cause death and MACE, especially in the middle and high BMI groups.

Results: Eighty-one percent of the cohort were male with mean age of 52 years. A high rate of comorbidities was observed (hypertension 71%; diabetes 45.3%; AF 17.3%). The majority of the patients (87%) were in NYHA (I). Nine percent of patients had composite adverse outcomes during subsequent follow-up. The proportion with adverse outcomes increased to 28% when LVEF deterioration was included. The mean NTproBNP, GDF-15, GLS were 357 pg/ml, 1,572 pg/ml, and −12.1%, respectively. Significant correlations were observed between GDF15 with NT-proBNP (r=0.414) and NT-proBNP with GLS (r=−0.351). Higher NT-proBNP and GDF15 levels were associated with poorer MAGGIC prognostic scores (r=0.549, 0.41 respectively). NT-proBNP was also related to severe diastolic echo parameters. Hypertension and diabetes were strongly associated with higher elevated GDF15 levels. The mean value of NTproBNP and GLS were significantly associated with adverse clinical outcomes (157 versus 612, p=0.006; 12 versus 9, p=0.031, respectively). Higher mean GDF-15 showed a trend towards worse subsequent prognosis (1,736 versus 2,828, p=0.094).

PP-084 Heart Failure Rehabilitation Reduced Readmissions by Half and Improved Quality of Life Daman Kaur, Keith Dyson, Eileen Hall and Jill Lowrey Health New Zealand Hawkes Bay Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-084. Correspondence: Daman Kaur, daman.kaur@hbdhb.govt.nz

Background: Heart failure (HF) patients often have limited exercise capacity due to dyspnoea and fatigue. Despite the availability of effective treatment, HF is associated with poor quality of life (QoL), high morbidity and mortality. Maori are twice as likely to die; and four times more likely to be hospitalised for HF. HF hospitalisations are an estimated 2% of New Zealand’s health system costs. Supervised exercise programmes are recommended for HF patients. However, establishing and maintaining these programmes are challenging due to fiscal, facility and staffing constraints. To mitigate these barriers, a trial was commenced that integrated HF patients into the already established pulmonary rehabilitation programme. The programme was modified to meet HF rehabilitation guidelines.

Conclusion: The prognostic role of NT-proBNP, GLS and GDF-15 were demonstrated in this HFimpEF cohort. A larger study is needed to validate this pilot effort.

PP-086 Early Cardiac Rehabilitation for Elderly Patients Hospitalised for Heart Failure: A Meta-analysis and Systematic Review

Methods: Patients were referred into the programme by either a cardiologist, cardiac nurse practitioner or HF nurse specialist. Between 2019 and 2021 a total of 200 patients were enrolled in an 8-week rehabilitation programme. Outcomes were evaluated by analysing hospital readmission rates and through validated QoL tools. 25 patients were randomly selected for interviews, to gain an understanding of the enablers and barriers to rehabilitation.

Enerose Magno,1 Cristine Santelices,1,2 Noemi Pestano1,3 Maria Shinili Solano1 and Asimah Mangondaya1 1. Manila Doctors Hospital; 2. Manila Medical Center; 3. Philippine General Hospital

Results: HF patients who attended the programme were almost 50% less likely to be readmitted; had reduced breathlessness and improved fitness. Self-management skills and health literacy were also improved.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-086. Correspondence: Enerose Magno, magnoenerosemd@gmail.com

PP-085 Multimodal Assessment of Heart Failure Improved EF (HFimpEF) Cohort Using GDF15, NT-proBNP and GLS

Background: Following acute decompensated heart failure (ADHF), elderly patients continue to have marked impairments in physical function, including deficits in strength, balance, mobility and endurance, which usually persist, and baseline function is never recovered. Safe and effective interventions to improve physical function for this type of population remain unclear. This study aims to determine the efficacy of early cardiac rehabilitation in improving functional capacity, 6-minute walk distance, rehospitalisation, and mortality among elderly patients hospitalised for ADHF.

1. Sarawak Heart Centre; 2. Unimas Malaysia Sarawak

Methods: Randomised controlled trials with outcomes on functional capacity measured by Short Physical Performance Battery (SPPB), 6-minute walk distance, rehospitalisation and mortality were searched for in PubMed/MEDLINE and Google Scholar.

Conclusion: HF rehabilitation has proven to be a low-cost, high-value intervention, but is generally underused.

Hwei Sung Ling,1,2 Yee Ling Cham,1 Bui Khiong Chung,1 Alan Yean Yip Fong,1 Han Bing Chow,1,2 En Ze Chan,1,2 How Kiat Khor,1 Francis Shu,1 Chen Ting Tan,1 Lai Kuan Leong,1 Keng Tat Koh,1 Yen Yee Oon,1 Asri Said1,2 and Tiong Kiam Ong1

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-088 Outcome Evaluation of Pharmacistled Medication Reconciliation Clinic at Post-discharge Heart Failure Clinic

Results: A pooled analysis of studies on early cardiac rehabilitation showed a significant difference in the improvement of functional capacity in elderly patients with ADHF (RR 0.29; 95% CI [0.21–0.41]), as measured by SPPB with an intervention effect size of +1.5 units (CI 95% [1.46–1.55]), which is three times as large as the minimal clinically significant difference reported. The intervention group could walk 33 m more than those on standard care with substantial improvement in 6-minute walk distance (RR 32.7; CI 95% [30.83–34.57]). However, there were no significant differences noted in all-cause rehospitalisation (RR 0.68; CI 95% [0.39– 1.19]) and mortality rates (RR 1.32; CI 95% [0.71–2.44]).

Chin Yin Ong, Peik Ching Low, Ai Lee Tan and Sing Teang Kong Department of Pharmacy, National University Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-088. Correspondence: Chin Yin Ong, ongchinyin98@hotmail.com

Objective: This study aimed to evaluate the outcomes of medication therapy reconciliation clinic (MTRC) in heart failure (HF) patients during the outpatient HF-discharge clinic visit after recent HF-related hospital admission.

Conclusion: Among elderly patients hospitalised for ADHF, early cardiac rehabilitation resulted in significant improvement in functional capacity and 6-minute walk than usual care; however, no benefits were noted on rehospitalisation and mortality rates.

Methods: This 5-month pilot study was performed at a restructured teaching hospital in Singapore (September 2022 to February 2023). Patients who rejected this service or were under other intermediate and long-term care services were excluded. During MTRC, the pharmacist provided individualised counselling and education (disease, medication, self-care). The main outcomes were drug-related problem (DRP) and resolution, total medication supply at home, and 30-day HF-related readmission and mortality post-MTRC review.

PP-087 Clinical Profile of Moderate to Massive Pericardial Effusion at a Tertiary Hospital in Cebu, Philippines Doucel Oliver and Neil Wayne Salces Chong Hua Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-087. Correspondence: Doucel Oliver, douceloliver@gmail.com

Results: Of 197 patients scheduled for outpatient HF-discharge clinic, 52 (26.4%) were reviewed by MTRC before doctor consultation. Twenty-eight DRP were identified. Wrong administration (either dose or frequency) was the top DRP (39.3%), followed by non-compliance (28.6%), duplication (14.3%), no indication (10.7%), expired drug (3.6%), and untreated indication (3.6%). All detected DRP were resolved. Physical medication reconciliation was conducted in 42 (80.7%) patients. Total medication supply at home for a subset of patients (n=23) who brought all their supplies amounted to S$9,366.86. Median cost saved was S$262.30, IQR S$135.74–525.60 (average S$407.24 per patient), attributed to medication reconciliation. Thirty days after MTRC, only one patient (2%) had HF-related readmission due to fluid indiscretion.

Objective: To describe the clinical characteristics and outcomes of patients with pericardial effusion, demographic and clinical profiles, diagnostic modalities, treatment procedure and outcomes. Methods: Cross-sectional, descriptive study of moderate and massive pericardial effusion. Data was collected from chart review from January 2011 to December 2021 at Chong Hua Hospital. Results: Among the 157 admitted patients, 58% were male and the majority were in the sixth decade of life. Hypertension (38.2%) and diabetes (20.4%) were the most common comorbidities. Dyspnoea (68%) was the initial presenting symptom in most patients, along with tachycardia (44%) as the most common sign. Beck’s triad and pulses paradoxus were infrequent, along with classic ECG findings of low voltage complexes and electrical alternans. Aetiologies of pericardial effusion were not identified in 71 patients (45%). More common than malignant causes were non-malignant causes, such as tuberculosis (37%) and SLE (19%). Other non-infectious causes, such as iatrogenic post-open-heart surgeries, aortic dissection, and coronary artery perforation were identified. One hundred patients underwent drainage with either pericardiocentesis, creation of pleuropericardial window and pericardiostomy. Postoperative complications (3%) were supraventricular tachycardia (1%) and pneumothorax (2%). The fatality rate was 17.8% and the average hospital stay was 12 days.

Conclusion: DRP is common in HF patients. Data from this study conforms with findings from other studies. It reinforces that medication reconciliation by pharmacists detects and resolves DRPs, and prevents unnecessary medication collection and wastage, without an increase in adverse clinical outcome.

PP-089 Prevalence and Mortality of Patients with Cardiorenal Syndrome: A Systematic Review and Meta-analysis Si Wei David Fan and Leong Tung Ong University Of Malaya

Conclusion: This study showed that most patients with pericardial effusion were male in the sixth decade of life, and female aged 60–69 years, on cross-tabulation of age and gender. Dyspnoea and tachycardia were the most frequent symptom and sign, respectively. Massive pericardial effusion with tamponade physiology was the predominant echocardiographic finding. Cardiac tamponade was also seen in those with moderate pericardial effusion. Most of the aetiological diagnoses were undetermined, followed by non-malignant causes, predominantly tuberculosis. Lung cancer was the most common cause of malignant pericardial effusion. The majority underwent pericardiostomy. Case fatality rate was 17.8% and the average hospital stay was 12 days.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-089. Correspondence: Leong Tung Ong, leotungong@gmail.com

Background: Cardiorenal syndrome (CRS) is characterised by acute or chronic dysfunction of the heart or kidneys resulting in acute or chronic dysfunction in the other organ. These two organs, which are interrelated physiologically, may often affect each other under pathological states. This study aimed to investigate the prevalence and mortality rate of CRS in patients with heart failure (HF) or acute coronary syndrome and acute kidney injury.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-091 Prevalence and Clinical Significance of Late Gadolinium Enhancement in Children and Adolescents with Hypertrophic Cardiomyopathy

Methods: A systematic literature search was conducted on PubMed, Embase and Web of Science up until 31 December 2022. Statistical analysis was conducted using Cochrane Review Manager 5.4. Pooled prevalence and the overall mortality rate were calculated using the random effect models and generic inverse variance method.

Leong Tung Ong and Si Wei David Fan University of Malaya

Results: Seventeen studies which fulfilled the inclusion criteria were included in the meta-analysis. The overall prevalence of CRS in patients with HF or acute coronary syndrome was 32% (95% CI [0.23–0.41]; p<0.00001; I2=95%). The overall prevalence of CRS in patients with acute kidney injury was 15% (95% CI [0.02–0.29]; p<0.00001; I2=97%). The overall mortality rate of cardiorenal syndrome was 28% (95% CI [0.18– 0.35]; p<0.00001; I2=95%).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-091. Correspondence: Leong Tung Ong, leotungong@gmail.com

Background: Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death among paediatric populations. Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging is a promising tool for the assessment of hypertrophic cardiomyopathy in adults, but limited data are available in paediatric populations. This research aimed to investigate the prevalence and clinical significance of LGE in paediatric patients with hypertrophic cardiomyopathy.

Conclusion: The prevalence of CRS in patients with HF or acute coronary syndrome (32%) is higher compared to the prevalence of CRS in patients with acute kidney injury (15%). Additionally, CRS had high overall mortality rate, which requires prompt diagnosis and treatment.

Methods: A systematic literature search was conducted in PubMed, EMBASE and Web of Science up until 31 December 2022. Statistical analysis was conducted using Cochrane Review Manager 5.4. Pooled prevalence was calculated using the random effect models and generic inverse variance method. Effect sizes were expressed as the standardised mean difference (SMD) and 95% CI.

PP-090 Prevalence and Risk Factors of Heart Failure in Hyperthyroidism Patients: A Systematic Review and Meta-analysis Si Wei David Fan and Leong Tung Ong

Results: Fifteen studies were included in this meta-analysis involving 750 patients. The overall prevalence of LGE in paediatric hypertrophic cardiomyopathy was 48% (95% CI [0.39–0.57]). The extent of focal replacement fibrosis presented as percentage of left ventricular mass was 3.27 (95% CI [2.28–4.25]). The left ventricular ejection fraction of LGE positive hypertrophic cardiopathy was lower than the LGE negative hypertrophic cardiopathy with SMD 0.53 (95% CI [−3.68, 2.62]). The left ventricular mass index of LGE positive hypertrophic cardiopathy was higher than the LGE negative hypertrophic cardiomyopathy with a SMD of 0.91 (95% CI [0.42–1.41]). The prevalence of adverse events in patients with LGE positive was 20% (95% CI [0.14–0.25]).

University Of Malaya Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-090. Correspondence: Leong Tung Ong, leotungong@gmail.com

Background: Hyperthyroidism has a significant impact on the cardiovascular system, causing thyrotoxic cardiomyopathy, which is characterised by atrial fibrillation (AF), left ventricular hypertrophy and diastolic dysfunction, and may lead to heart failure (HF). There is limited data available on the incidence, clinical characteristics and risk factors for HF associated with hyperthyroidism. This study aimed to investigate the prevalence and associated risk factors for HF in patients with hyperthyroidism.

Conclusion: LGE is highly prevalent in paediatric hypertrophic cardiomyopathy and may be a useful predictor for adverse events.

Methods: A systematic literature search was conducted of PubMed, Embase and Web of Science up until 31 December 2022. Pooled prevalence was calculated using the generic inverse variance method in Cochrane Review Manager 5.4. Risk factors were calculated using the meta-regression model with log odds ratio transformation in R programming.

PP-092 Assessment of Efficacy and Safety of Omecamtiv-Mecarbil Treatment for Patients with Heart Failure: A Meta-analysis Stephanie Palacios and Patricio Palmes

West Visayas State University Medical Center

Results: Twelve studies which involved 22,824 patients were included in the meta-analysis. The overall prevalence of HF in patients with hyperthyroidism was 12% (95% CI [0.09–0.15]). Further analysis of prevalence of HF in patients who underwent treatment with medication, surgery and radioiodine ablation were 9% (95% CI [0.05–0.14]), 29% (95% CI [−0.13–0.70]) and 11% (95% CI [0.04–0.17]), respectively. The risk factors of HF in hyperthyroidism include hypertension (OR 3.71), history of coronary artery disease (OR 2.16), history of stroke or transient ischaemic attack (OR 3.75), goitre (OR 1.89), AF (OR 16.95), chronic kidney disease (OR 5.73) and anaemia (OR 4.12).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-092. Correspondence: Stephanie Palacios, palacios.stepha@gmail.com

Objective: This study assessed the efficacy (heart-failure free outcome) and safety (cardiovascular death outcome) of omecamtiv-mecarbil for patients with moderate to severe heart failure (HF). Methods: Articles were searched for and identified from various databases, comparing omecamtiv-mecarbil (25, 37.5 or 50 mg twice daily) with placebo. Randomised controlled trials published in English in the past 5 years were included in the final meta-analysis. The efficacy and safety of omecamtiv-mecarbil and were compared with placebo, and the results were expressed using OR with 95% CI.

Conclusion: HF occurs in 12% of patients with hyperthyroidism, with the most common risk factors being AF, followed by chronic kidney disease and anaemia.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Results: A total of three studies were included from 186 articles (no. patients, n=18,696) searched, screened, reviewed, and appraised. In terms of efficacy, pooled random effect estimates showed a significant OR 1.1 (95% CI [1.05–1.19]; p<0.001). Use of omecamtiv-mecarbil is significantly 12% higher in reducing the occurrence of HF compared with the placebo. In terms of safety, pooled random effect estimates showed OR 1.00 (95% CI [0.93– 1.07]; p-value: 0.93). Our results showed that use of omecamtiv-mecarbil is as safe as the placebo in reducing cardiovascular death. It can also be seen that there were moderate and low heterogeneities among the included studies in terms of efficacy (I2 = 44%) and safety (I2 = 0%), respectively.

PP-094 Quality of Life in Heart Failure with Reduced Ejection Fraction Patients: Obesity Paradox as Debate

Conclusion: Among patients with moderate to severe HF, those who received omecamtiv-mecarbil had a lower incidence of a heart-failure event and showed the same safety outcome compared with placebo.

Objective: To analyse the phenomenon of obesity paradox on the quality of life (QoL) of heart failure with reduced ejection fraction (HFrEF) patients.

Yogi Rachmawan,1 Witri Pratiwi1 and Helda2

1. Faculty of Medicine Universitas Swadaya Gunung Jati Indonesia; 2. Faculty of Public Health Universitas Indonesia Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-094. Correspondence: Yogi Rachmawan, yogikage@gmail.com

Methods: A cross-sectional study was conducted at the heart failure (HF) clinic of Hasna Medika Palimanan Cardiovascular Hospital, Cirebon, Indonesia. Samples were HFrEF patients who had received medication for at least 6 months and were recruited by accidental sampling. Inclusion criteria were HF patients with ejection fraction <40%. HF patients with motoric impairments were excluded. Data were collected through medical record, physical examination, and Kansas City Cardiomyopathy Questionnaire (KCCQ-12). The association between variables and quality of life (QoL) were analysed using Spearman’s rank test (p<0.05).

PP-093 The Comparison of Lipid Profile Between Patients with and without Acute Renal Dysfunction in HF Gede Bagus Gita Pranata Putra,1 Wayan Wita,2 Made Bakta,3 Wayan Sudarsa4 and Bambang Budi Siswanto5

1. Cardiology and Vascular Medicine Department Sajiwani General Hospital-Faculty of Medicine Warmadewa University; 2. Cardiology and Vascular Medicine Department Prof IGNG Ngoerah Hospital-Faculty of Medicine Udayana University; 3. Internal Medicine Department Prof IGNG Ngoerah Hospital-Faculty of Medicine Udayana University; 4. Surgery Department Prof IGNG Ngoerah Hospital-Faculty of Medicine Udayana University; 5. Cardiology and Vascular Medicine Department National Cardiac Centre Harapan Kita Hospital-Faculty of Medicine Indonesia University

Results: One hundred and fifty-four patients participated in the study (68.8% male, 31.2% female). Most patients (64.9%) were 45–64 years of age and 5.2% were <45 years of age. 40.3% were obese, 9.7% were underweight and 65.6% had central obesity. Based on KCCQ-12, 3.2% and 31.2% of the sample had poor and fair QoL, respectively. Age (p=0.035; r=−0,17), BMI (p=0.041; r=0.165) and rehospitalisation (p<0.001; r=−0.42) had a significant relationship with QoL in HFrEF patients.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-093. Correspondence: Gede Bagus Gita Pranata Putra, rgitazpranataputra@gmail.com

Conclusion: Obese HFrEF patients have better QoL than underweight patients; this is a phenomenon of the obesity paradox. However, the mechanism is still being debated. HFrEF patients should receive good nutritional management in addition to optimal pharmacotherapy.

Background: The correlation between renal dysfunction and heart failure (HF) has been known extensively as ‘cardiorenal syndrome’. Renal dysfunction is not only a cause of morbidity but also a risk factor for mortality in HF patients. Prevention is essential for improving the prognosis of HF patients. The lipid profiles of patients with acute renal dysfunction were compared to those without acute renal dysfunction with HF.

PP-095 Correlation Between Serum Chloride and N-terminal Pro-B-type Natriuretic Peptide Level in Acute Decompensated Heart Failure

Methods: This was a cross-sectional observational study from January 2020 to December 2021. Participants were 70 HF patients who underwent treatment in the emergency department and/or intensive cardiovascular care unit.

Riski Hanika Syafar,1 Masrul Syafri,2 Citra Kiki Krevani2 and Yose Ramda Ilhami2

1. Faculty of Medicine, Universitas Andalas; 2. Department of Cardiology and Vascular Medicine, Universitas Andalas, Dr M Djamil Hospital

Results: Acute renal dysfunction patients had a statistically significant (p<0.05) increase in dyslipidaemia compared to non-renal dysfunction patients, particularly with high LDL levels. The association between statin therapy and low incidence of acute renal failure in patients with HF was statistically significant (p<0.05) according to additional findings from the study.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-095. Correspondence: Riski Hanika Syafar, riski_hanika@yahoo.com

Background: Globally, acute decompensated heart failure (ADHF) has become a high burden due to its morbidity and mortality. The recommended laboratory test to assess prognosis of ADHF is N-terminal pro-B-type natriuretic peptide (NT-proBNP), but it is limited and expensive, especially in Indonesia. The other laboratory test is serum chloride. Some studies have revealed an association between lower serum chloride with higher NT-proBNP and poorer prognosis. The aim of this study was to analyse correlation between serum chloride and NT-proBNP in ADHF.

Conclusion: Dyslipidaemia (particularly high LDL-C level) is associated with acute renal failure events in individuals with HF setting. Patients who receive statin therapy are associated with lower incidence of acute renal failure in the setting of HF condition. This demonstrates that uncontrolled LDL-C level might contribute to the propensity of renal dysfunction, so as dyslipidaemia therapy can be recommended for a patient with HF, focusing on LDL-C levels that reduce the risk of acute renal failure in patients who have HF.

Methods: This was a cross-sectional study conducted at M. Djamil Hospital from August 2022 to November 2023. ADHF patients hospitalised

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Abstracts from 27th Asian Pacific Society of Cardiology Congress in the cardiac centre with LVEF <50%, who agreed to participate in the study, were included. Patients were excluded if they were >75 years of age; had non-cardiogenic shock, atrial fibrillation, tachycardia ≥120 bpm, stroke, eGFR <30 ml/min per 1.73m2, sepsis and BMI ≥40 kg/m2. All patients underwent a laboratory test for serum chloride and NT-proBNP level on admission. The correlation of serum chloride and NT-proBNP level was assessed using the Spearman’s correlation test.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-097. Correspondence: Wataru Takahashi, takahashi.wataru.fu@mail.hosp.go.jp

To clarify the cardiovascular prognostic difference between heart failure with mid-range ejection fraction (HFmrEF) and heart failure with recovered ejection fraction (HFrecEF), we retrospectively analysed 336 patients with non-ischaemic HF (213 male, prevalence of atrial fibrillation (AF) 46%, average age 68.0 ± 13.3 years and follow-up duration 68.6 ± 51.0 months) consisting of 165 HFmrEF (Group M: left ventricular ejection fraction [LVEF] 40–49% at first visit, average LVEF 45.2 ± 3.9%) and 171 HFrecEF (Group R: LVEF <40% at first visit [average LVEF 32.0 ± 6.6%] and improved EF ≥40% after treatment). Comparison was made between the two groups. There were no significant differences in prevalence of AF and LVEF after treatment (Group M: 49.9 ± 11.4; Group R: 51.5 ± 8.1%) between the two groups. Rate of taking high-dose β-blocker (≥10mg carvedilol) was higher in Group R (65% versus 42%; p=0.001). Kaplan–Meier analysis showed that all-cause death (p=0.004) and avoidance rate of hospitalisation by cardiovascular events (p<0.001) were significantly better in Group R than in Group M. Multivariate analysis showed that <10% improvement of LVEF with treatment (HR 2.32; 95% CI [1.49–3.61]; p<0.001) and AF (HR 1.93; 95% CI [1.34–2.81]; p=0.005) are independent risk factors for cardiovascular hospitalisation; however, no significant factors associated with cardiovascular death were identified in both groups. Cardiovascular prognosis may be significantly better in patients with HFrecEF than in those with HFmrEF on the non-ischaemic aetiology.

Results: There were 30 ADHF patients (25 men and 5 women), with a median age of 60.5 (20–74) years. Median serum chloride and NTproBNP levels were 103 (84–110) mmol/l and 5,765.5 (922–25,000) pg/ ml, respectively. Based on Spearman’s correlation test, serum chloride had a moderate negative correlation with NT-proBNP (r=−0.456, p=0.011). Conclusion: There was a moderate negative correlation between serum chloride and NT-proBNP level in ADHF.

PP-096 Quality of Care Among Admitted Acute Heart Failure Patients at the Emergency Room of the Philippine General Hospital (UP-PGH) Bai Sitti Ameerah Asleah Tago, Zane Oliver Nelson, Marie Kirk Patrich Maramara, Lauren Kay Evangelista and Felix Eduardo Felix Eduardo Philippine General Hospital

PP-098 Heart Failure Adherence to Science Implementation in Asia: Driving Adoption of GDMT in Five Countries

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-096. Correspondence: Bai Sitti Ameerah Asleah Tago, ashleytago@yahoo.com

Background: The global incidence and prevalence rates of heart failure (HF) are approaching epidemic proportions, as evidenced by the increase in the number of HF hospitalisations, HF deaths, and spiralling costs associated with the care of HF patients according to the available literature. This study aimed to provide real world data on guideline adherence to address this gap in healthcare delivery, with the aim of improving patient care at the emergency room level.

Carolyn Lam,1 Larry Allen,2 Nguyen Vinh Pham,3 Rungroj Krittayaphong,4 Yen-Wen Wu5 and Jasper Tromp6 1. National Heart Centre Singapore; 2. University of Colorado; 3. Tam Anh General Hospital; 4. Siriraj Hospital, Mahidol University; 5. Far Eastern Memorial Hospital; 6. The NUS Saw Swee Hock School of Public Health Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-098. Correspondence: Amy Tam, amy.tam@heart.org

Results: A total of 104 patients were included in the study. The mean age of patients was 53 years, the majority were male (54.8%) and had New York Heart Association functional class III (64.4%). 45% percent were hypertensive. The most common precipitating factors were infection (43.26%), medication non-compliance (30.77%), and dietary indiscretion (28.84%). The most common diagnostics were 12-lead ECG (91.34%), chest X-ray (75.96%) and echocardiography (74.03%). The most common medications were furosemide (100%), enoxaparin (89.89%), nitrates (30.77%), aspirin (25.96%) and clopidogrel (20.19%). 13.46% of the patients died.

Background: Large gaps in the implementation of guideline-directed heart failure (HF) therapies in Asia are associated with worse patient outcomes. Quality improvement programs have been demonstrated to improve adherence to guideline-directed therapies; however, a comprehensive multinational HF quality improvement programme is lacking across Asia. Methods: The HF Adhere to Science Implementation in Asia (A.S.I.A.) programme aimed to accelerate initiation and adoption of the evidencebased, guideline-directed medical therapies through a sustainable and scalable quality improvement model for hospitals across five Asian countries (Taiwan, Thailand, Vietnam, Indonesia and Malaysia). An Implementation Science Framework was applied, including model sharing, capacity building, patient journey and data collection to identify gaps in current key performance indicators (KPI) and interventions to improve adoption. Tools were developed for continuous quality improvement through data collection, analysis, and feedback to drive rapid cycle improvement in both in- and outpatient settings. Hospital performance was assessed by proportion of eligible patients in whom KPIs were achieved at discharge.

Conclusion: Overall quality of care was good. Results of this study could serve as the basis for quality-of-care improvement initiatives, as well as emphasise the significance of clinical practice guidelines to increase the likelihood of desired health outcomes.

PP-097 Prognostic Difference Between Heart Failure with Mid-range Ejection Fraction and that with Recovered Ejection Fraction Wataru Takahashi

National Hospital Organization Shinshu-ueda Medical Center

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Results: The HF A.S.I.A. programme successfully launched in 2021 with the establishment of an expert panel, finalisation of KPIs, identification of clinical champions and on-boarding of sites. Based on data from 10 hospitals in 2022, the performance improved over time, reaching >90% for majority of KPIs.

Objective: To determine the risk of HFpEF among stable chronic obstructive pulmonary disease (COPD) patients using the H2PEF score. Methods: The echocardiographic and clinical profiles of COPD patients from January 2018 to March 2020 were evaluated using the H2PEF score using four clinical and two echocardiographic variables categorised into low, intermediate, and high likelihood of HFpEF. A retrospective analysis of demographics and clinical characteristics were determined. Continuous values were expressed as mean SD. Frequencies of clinical variables were compared between three groups using a χ2 analysis. SPSS 20 software was used in the analysis. Statistical significance was defined as p<0.05.

Conclusion: Hospitals participating in HF A.S.I.A. programme demonstrated improvements for all KPIs with sustained performance for 12 consecutive months. Results show the incremental value of systematic, continuous quality improvement initiatives over time, to address gaps in implementation of HF therapies in Asia.

PP-099 The Relationship Among Confidence, Health Literacy and Self-care Behaviours in Patients with Heart Failure

Results: A total of 1,919 patients underwent spirometry and only 114 (5.94%) met the inclusion criteria. The majority had a score of 2–5 (intermediate) which comprises 72 (64.9%) and only 32 (28.1%) scored <2 (low) and 8 (7%) scored ≥6 (high).

Yu-Chiuan Tong1 and Pi-Ling Chou2

1. Kaohsiung Medical University; 2. Kaohsiung Medical University

Conclusion: There is an intermediate likelihood for HFpEF among stable COPD patients. Further testing is needed to establish the diagnosis of HFpEF among this population.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-099. Correspondence: Yu-Chiuan Tong, yuchiuan0305@gmail.com

PP-101 The Impact of Cardio-renal Anaemia Syndrome on the Prognosis of Patients with Chronic Heart Failure

Objective: To determine the mediating or moderating effects of confidence on health literacy and self-care behaviours in patients with heart failure (HF). Methods: A prospective, descriptive, cross-sectional study on HF patients (n=106) at a southern medical centre hospital in Taiwan. A one-time data collection was performed from 22 July 2022 to 23 November 2022. Research tools included the Heart Failure-Specific Health Literacy Scale (HF-SHLS), the confidence subscale of the Revised Dutch Heart Failure Knowledge Scale (R-DHFKS), and the European Heart Failure Self-care Behaviour Scale (EHFScB-9).

Sae Ujiro, Wataru Fujimoto, Makoto Takemoto, Koji Kuroda, Soichiro Yamashita, Junichi Imanishi, Masamichi Iwasaki, Takanori Todoroki and Masanori Okuda Awaji Medical Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-101. Correspondence: Sae Ujiro, sae.ujiro@gmail.com

Results: The mean age was 59.11 (SD 12.42) years; 64.2% were men and 62.3% were NYHA class II. Among the HF patients, 24% had low health literacy, 24% had insufficient confidence and 29% had poor self-care behaviours. Health literacy significantly positively correlated with confidence (r=0.46, p<0.001) and self-care behaviour (r=0.45, p<0.001). Confidence significantly positively correlated with self-care behaviour (r=0.38, p<0.001). Confidence was a mediator between health literacy and self-care behaviour (path reduced from β=0.45 to 0.34, p<0.001).

Objective: To investigate the impact of cardio-renal anaemia syndrome on the prognosis of patients with chronic heart failure (HF). Methods: We conducted a prospective observational study of chronic HF in Awaji Island, Japan using the KUNIUMI registry chronic cohort. We included 1,646 patients registered between March 2019 and March 2021 and examined the impact of cardio-renal anaemia syndrome on composite events in one year, defined as all-cause death and hospitalisation due to HF. Cardiac failure was defined as stage C/D HF, renal failure as eGFR <60mL/min per 1.73m², and anaemia as Hb <13 mg/dl for male patients and Hb <12 mg/dl for female patients.

Conclusion: The degree of confidence in knowledge significantly mediates health literacy and self-care behaviour. The results suggest that while strengthening the self-care behaviours of patients with HF, clinical staff need to educate the knowledge and skills of patients with HF to improve their disease-related health literacy. In addition, cognitive behavioural therapy and other methods can also increase patients’ confidence.

Results: We identified 410 patients (24.9%) with cardio-renal anaemia syndrome and 236 events. The proportion of patients with cardio-renal anaemia syndrome was higher among older patients (17.8% for <65, 28.8% for 64–84, and 51.8% for >85 years of age). Cox proportional hazard regression analysis showed that patients with cardio-renal anaemia syndrome had a significantly higher incidence of all-cause death or HF hospitalisation compared to non-cardiac failure patients (HR 6.93 [95% CI, 4.89–9.82]; p<0.001).

PP-100 Estimating the Risk for Developing HFpEF Among Clinically Stable COPD Patients Using H2PEF Score

Conclusion: Findings from this study suggest that the incidence of cardiorenal anaemia syndrome increases with age and that its co-occurrence with chronic HF is associated with a worse prognosis. Early identification and management of cardio-renal anaemia syndrome may be crucial in improving outcomes for patients with chronic HF.

Francis Emmanuel Tulod and Celine Aquino Chong Hua Hospital

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-100. Correspondence: Francis Emmanuel Tulod, francistulodmd@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-102 Clinical Features and Outcomes of Takotsubo Syndrome Compared to Acute Myocardial Infarction

investigate the outcomes of a cohort of Asian patients with HCM with regards to AF. Methods: We evaluated the prevalence and outcomes of AF in 295 consecutive patients who were diagnosed with HCM at a tertiary cardiology centre from 2010 to 2017.

Kantasit Wisanuvej and Krissada Meemook Ramathibodi Hospital, Mahidol University

Results: The prevalence of AF in the cohort was 17.3%. AF patients were more commonly female (29.8% versus 12.3%, p<0.001), and older (64.5 ± 15.8 versus 57.5 ± 16.8, p=0.008) with concomitant ischaemic heart disease (39.2% versus 27.8%, p=0.045). HCM AF patients presented with palpitations (47.1% versus 13.5%, p<0.001) and dyspnoea (25.5% versus 9.8%, p=0.002). On echocardiography, there was no significant difference in left ventricular (LV) dimensions or ejection fraction. However, more patients with AF had enlarged left atrium and elevated left ventricular filling pressure (defined by a septal E/e’ ≥11 in patients with AF versus an average LV E/e’ >14 in patients without AF) (47.5% versus 78.4%, p<0.001). Only 58.8% of HCM patients with AF were on oral anticoagulation. This did not translate to a significantly elevated rate of ischaemic stroke. HCM AF patients tended develop progressive heart failure (HF) requiring admission (21.6% versus 9.4%, p=0.014).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-102. Correspondence: Kantasit Wisanuvej, kantasit55@hotmail.com

Background: Limited information is available on the characteristics and outcomes of Takotsubo cardiomyopathy in Thailand. The aim of this study is to establish an understanding of Takotsubo cardiomyopathy and to compare clinical outcomes with acute myocardial infarction. Methods: Patients diagnosed with takotsubo cardiomyopathy from the Ramathibodi cardiac catheterisation laboratory registry between 2011 and 2023 were enrolled in the study. Clinical features and outcomes were analysed, and complications and mortality rates were compared with ageand sex-matched patients with acute coronary syndrome in a 2:1 ratio. Results: A total of 198 patients were included in the study, of whom 66 had Takotsubo cardiomyopathy. Most patients with Takotsubo cardiomyopathy were female (86.4%) and had a mean age of 71.8 years. Emotional triggers were identified in 9 (13.6%) patients, while physical triggers were identified in 45 (68.2%) patients. The most common physical triggers were infection (27.3%), followed by neurological disorders and surgery. The mean left ventricular ejection fraction in patients with Takotsubo cardiomyopathy was 43.1 ± 11.1%. Severe complications, including ventricular arrhythmia, shock, and heart failure, were detected in 36 (54.5%) patients with Takotsubo cardiomyopathy and 70 (53.0%) patients with acute coronary syndrome. In-hospital mortality rates were 4.6% for Takotsubo cardiomyopathy and 1.5% for acute coronary syndrome. One-year mortality rates were 9.1% and 3.0% for takotsubo cardiomyopathy and acute coronary syndrome, respectively. However, the differences in both in-hospital mortality and one-year mortality between the two groups were not statistically significant (Poisson regression, p=0.31 for in-hospital mortality and Cox proportional hazard, p=0.60 for one-year mortality).

Conclusion: HCM patients with AF were more commonly female and older, and more likely to develop HF requiring admission. The rates of oral anticoagulation in HCM patients with AF was suboptimal and this should be explored further to optimise future care.

PP-104 Association of Hyperuricaemia with Rehospitalisation Due to Heart Failure in Patients with Psoriasis and Coronary Artery Disease Lin Zhao, Yan Zeng and Xianliang Zhou

Background: Hyperuricaemia has been identified as a risk factor of cardiovascular diseases. However, the association of hyperuricaemia with rehospitalisation due to heart failure (HF) in psoriatic patients with coronary artery disease (CAD) remains unclear.

Conclusion: Takotsubo cardiomyopathy is often detected in elderly female patients and is more frequently triggered by physical causes. It is not a benign condition, as the mortality rate is considerable and comparable to that of acute coronary syndrome.

Methods: We conducted a retrospective cohort study of consecutive psoriatic patients with CAD between January 2017 and May 2022 in our hospital. Clinical records were collected and comparisons were made between patients with and without hyperuricaemia. Kaplan–Meier survival analysis was used to evaluate the association between variables.

PP-103 Atrial Fibrillation in an Asian Cohort of Patients with Hypertrophic Cardiomyopathy

Selvie Yeo,1 Tony YW Li,2 Novi Yanti Sari,2 Chi-Hang Lee,2 Edward CY Lee,2 Tiong-Cheng Yeo,2 James WL Yip,2 Kian-Keong Poh,2 William KF Kong,2 Yoke Ching Lim,2 Weiqin Lin,2 Ching-Hui Sia2 and Raymond CC Wong2

Results: Of the 307 participants, 83 had hyperuricaemia. The proportion of chronic kidney disease was higher in patients with hyperuricaemia (p<0.001), while the proportion of diabetes was lower in patients with hyperuricaemia (p=0.025). Levels of triglycerides and homocysteine were higher in patients with hyperuricaemia (p=0.002 and 0.028, respectively). After a mean follow-up period of 35.32 months, rehospitalisation due to HF was more prone to occur in the hyperuricaemia group (7.5% versus 1.9%, p=0.047). In the subgroup analysis, hyperuricaemia was associated with rehospitalisation, especially in patients aged <60 years (log-rank p=0.019), patients without diabetes (log-rank p=0.025) and patients without hypertension (log-rank p=0.045).

1. Yong Loo Lin School of Medicine, National University of Singapore; 2. Department of Cardiology, National University Heart Centre, Singapore Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-103. Correspondence: Selvie Yeo, selvieyeo7@gmail.com

Background: Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with poorer outcomes. The aim of this study was to

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Conclusion: In psoriatic patients with CAD, hyperuricaemia can independently predict rehospitalisation due to HF, especially in patients aged <60 years and those without diabetes or hypertension.

databases. Quality assessment was done using National Institutes of Health (NIH) Quality Assessment and meta-analysis results were expressed as OR with 95% CI.

PP-105 Clinical Efficacy of Catheter Ablation versus Medical Rate Control of Atrial Fibrillation Across Heart Failure Phenotypes

Results: A total of five studies were included of 1,575 articles searched, screened, reviewed and appraised. Apixaban, edoxaban and rivaroxaban were the NOACs used in the included randomised clinical trials. In terms of efficacy (n=70,118), the chance of a stroke- or systemic embolism-free event was not significantly different (p=0.29) between NOACs- and warfarin-treated patients (OR 1.05; 95% CI; 0.96–1.16). In terms of safety (n=59,630), the use of NOACs had a significant 31% reduced likelihood of adverse events (OR 0.69; 95% CI; 0.47– 1.01; p<0.00001) compared to warfarin. There were also high heterogeneities observed among the included studies (efficacy I2=82%; safety I2=96%).

Daryl Dakay, Alex Junia and Neil Wayne Salces Chong Hua Hospital

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-105. Correspondence: Daryl Dakay, drdakay061889@gmail.com

Objective: To compare the clinical efficacy between catheter ablation and medical rate control among patients with atrial fibrillation (AF) and heart failure (HF).

Conclusion: Use of apixaban, edoxaban and rivaroxaban for AVHD/AF patients is as effective as warfarin in preventing stroke/systemic embolism. However, use of these NOACs is safer compared to warfarin in terms of preventing major bleeding events.

Methods: Only randomised controlled trials (RCT) comparing catheter ablation and medical rate control in patients with AF and HF were selected for review. PubMed, Embase and Cochrane databases were searched for RCTs reporting clinical outcomes of catheter ablation versus medical rate control for AF in HF patients with >6 months follow-up. The primary endpoint was change in left ventricular ejection fraction (LVEF). Secondary endpoints were 6-minute walk test (6MWT) distance, quality of life (QoL), BNP levels and number of adverse events.

PP-107 Clinical Performance Measures and Quality of Life of Patients with Atrial Fibrillation in Bhutan: CARE-AF Study

Tshering Pem,1 Mahesh Gurung,2,3 Phurpa2 and Dorji Tashi3 1. Samtse General Hospital; 2. Khesar Gyalpo University of Medical Sciences; 3. Jigme Dorji Wangchuk National Referral Hospital

Results: Five RCTs with 615 patients were included in the analysis. Patients in the catheter ablation group had greater improvement in LVEF (WMD 7.38; 95% CI; p<0.001), longer 6-min walk distance (WMD 17.41; CI 95%; p<0.0001), lower Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (WMD −6.21; CI 95%; p<0.00001), and lower BNP levels (WMD −113.1 ng/l; CI 95%; p<0.00001), compared with medical rate control. However, the catheter ablation group had higher rates of adverse events, mostly from procedural complications (RR 2.2; CI 95%; p=0.005).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-107. Correspondence: Tshering Pem, tsheringpem035@gmail.com

Background: The American College of Cardiology/American Heart Association (ACC/AHA) released a performance measure (PM) tool to measure the quality of care provided in atrial fibrillation (AF) management. Real-life application of the tool and the implications of adherence to these metrics on the quality of life (QoL) of AF patients, especially in a developing country like Bhutan, is unknown.

Conclusion: Catheter ablation is superior to medical rate control in terms of LVEF improvement, increase in functional status, reduction in biomarker, and better QoL among patients with AF and HF.

Methods: A cross-sectional study was conducted that enrolled nonvalvular AF patients aged >18 years at a tertiary care centre in Bhutan from 1 December 2018 to 1 January 2020. AF patients in the adherent group had to achieve all ACC/AHA PM components (CHA2DS2-VASc stroke risk documentation, anticoagulation prescribed for high-risk patients and subsequent prothrombin time monitoring). The QoL of AF patients was assessed by AF effect on QoL (AFEQT) score.

PP-106 Efficacy and Safety of Novel Anticoagulants versus Warfarin in Atrial Fibrillation Patients: A Meta-analysis Stephanie Palacios and Patricio Palmes

Results: Of 88 participants included, 56 (63.6%) were in the nonadherent group. The suboptimal adherence to PM was in terms of CHA2DS2-VASc score documentation (56.8%) and anticoagulation prescription (61.36%). The mean AFEQT score was better in the adherent group but was statistically non-significant (61.9 ± 16.8 versus 57.1 ± 15.9; p=0.7).

West Visayas State University Medical Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-106. Correspondence: Stephanie Palacios, palacios.stepha@gmail.com

Objective: To compare the primary efficacy (free of stroke or systemic embolism events) and safety (major bleeding) of novel anticoagulants (NOACs) compared to warfarin in patients with atrial fibrillation (AF) due to acquired valvular heart disease (AVHD).

Conclusion: This is the first study conducted in Bhutan to assess the quality of care and QoL of AF patients that identified opportunities for improvement in AF management and revealed a trend of better QoL in the adherent group. The finding calls for prompt action to identify and address the challenges of implementing standard guideline-directed AF care in Bhutan.

Methods: Studies published in English in the past 10 years comparing the efficacy and safety of NOACs versus warfarin in patients with AF and AVHD were searched for and identified from PubMed, EMBASE and Scopus

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-108 High Burden versus Low Burden Idiopathic Premature Ventricular Contraction with Major Adverse Cardiovascular Events

Objective: To analyse whether T wave area dispersion (TW-AD) will predict sudden cardiac death in acute anterior ST segment elevation myocardial infarction (STEMI). Methods: A case-control study was conducted in patients with acute anterior STEMI at Dr. Kariadi General Hospital Semarang from January 2020 until August 2022. The study comprised patients with acute anterior STEMI who survived and patients who died during hospitalisation. TW-Ad was measured by standard 12-lead ECG taken within 10 minutes of admission in the emergency department. TW-Ad was measured between J point and end of T wave. TW-Ad was calculated as the average of normalised T wave areas in V4, V5, and V6 leads using the formula proposed by Kenttä et al. in 2018. Data were descriptively analysed using IBM SPSS Statistics 26.

Shindu Phalguna,1 Alles Firmansyah,1 Tommy Daindes2 and Hauda El Rasyid2

1. Resident Cardiology Andalas University; 2. Electrophysiologist of Cardiology and Vascular Department Andalas University Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-108. Correspondence: Shindu Phalguna, shinduphalguna123@gmail.com

Background: Recent studies have suggested that premature ventricular contraction (PVC) leads to heart enlargement and even reversible cardiomyopathy. PVC burden ratio is defined as the number PVCs divided by total heart rate. Burden greater than 24% lead, 79% and 78% sensitivity and specificity, respectively for cardiomyopathy. PVC is defined as high burden if RVOT origin >10% and LVOT origin >20% increases risk of left ventricular ejection fraction reduction and major adverse cardiovascular events (MACE).

Results: Of the 40 patients included in the study, 20 survived 20 died during hospitalisation. In patients who survived, TW-AD ranged from 0.58 to 0.95 with a mean of 0.81. In patients who died, TWAD ranged from −0.83 to 0.67 with mean of −0.32. Lower values of TW-AD (<0), were found in acute STEMI anterior patients who died during hospitalisation. Patients who survived had TW-AD >0.

Objectives: To compare high- versus low-burden PVC with MACE in M. Djamil Hospital over a 1-year follow-up period.

Conclusion: Low TW-AD, calculated from standard 12-lead ECG, could be an important value in predicting the risk of in-hospital mortality in patients with acute STEMI anterior.

Methods: 100 patients (50% high- and 50% low-burden PVC) were identified using Holter BTL 12 leads. Patients underwent echocardiography to eliminate structural heart disease. Patients were followed up for 6 months to identify MACE (defined as admission for heart failure, ischaemic/infarct cardiovascular, cardiac death, or malignant arrythmia). Distribution data was examined using ShapiroWilk test. Mean MACE between patients with high-burden and lowburden PVC were compared (analysed with SPSS 25) and examined using t-pair test.

PP-110 A Case of Multiple Embolic Infarctions by Atrio-oesophageal Fistula After Percutaneous Transcatheter Ablation

Hyo Suk Nam, Yu Jin Koo, Jae Wook Jung and Young Dae Kim Department of Neurology, Yonsei University College of Medicine Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-110. Correspondence: Hyo Suk Nam, hsnam@yuhs.ac

Results: The total sample comprised 48% male and 52% female patients in the high-burden group, and 46% male and 53% female patients in the low-burden PVC group. Mean age was 41.50 ± 11.59 years versus 32.62 ± 9.35 (CI 95%), p=0.025, respectively. Both groups had the same result in origin of PVC (RVOT 78%, LVOT 12%, LV Apex 10%, p=0,01). Comparison of MACE in the high- versus lowburden PVC group revealed no significant differences (8% versus 6%, p=0,500).

Background: The authors report a case of multiple septic embolic infarctions after atrio-oesophageal fistula following radiofrequency ablation. Complication: A 58-year-old man was admitted with left-side weakness. Three weeks earlier, he had catheter radiofrequency ablation to treat chronic atrial fibrillation. Neurological examination revealed that he had left-side grade 1 weakness in the upper extremity and grade 2 weakness in the lower. MRI revealed multiple infarctions in the bilateral cerebral and cerebellar hemispheres with haemorrhagic transformations in the infarcted lesions. On day two of hospitalisation, he was found to have decreased cognitive capacity, and had two generalised tonic-clonic seizures. The patient had a 40.1°C fever with leucocytosis. Blood cultures were positive for streptococcus viridans.

Conclusion: High burden PVC occur increasingly in older aged patients. There is no relationship between sex, location of origin and MACE between high- versus low-burden PVC. However, the existence of idiopathic PVC, both high- and low-burden, mostly comes from RVOT. Increasing age has potential to become high burden PVC that leads to MACE.

PP-109 T Wave Area Dispersion in Acute Anterior ST Segment Elevation Myocardial Infarction: Does it Matter?

Results: Transoesophageal echocardiography revealed atriooesophageal fistula with a newly developed echogenic irregular mass attached on the posterior left atrium, which was suspected to be a vegetation. The patient received antibiotics and left atrial and oesophageal wall repair. Two months later, the patient still had decreased cognitive capacity, with decreased pain response on the left side.

Leo Deddy Pradipta, Adwin Alamsyaputra, Inne Pratiwi Farissa, Aruman Yudanto and Pipin Ardhianto Dr. Kariadi General Hospital Semarang

Conclusion: When patients have neurological deficits and fever after cardiac intervention, the possibility of infective endocarditis from atriooesophageal fistula should be considered.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-109. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-134 Knowledge and Associated Factors Among Patients with Atrial Fibrillation: A Cross-Sectional Study in China

Background: There is a worldwide shortage of trained sonographers and long waiting times for expert echocardiogram. There is a pressing need for task shifting to increase the accessibility of patients to echocardiograms. The objective of this study was to determine the learning curve of a novice without prior sonography training using an artificial intelligence (AI)enhanced point-of-care (POC) device to acquire images for left ventricular ejection fraction (LVEF) assessment.

Chen Xi Jiang,1 Xiao Xia Liu,1 Liang Yuan,2 Hai Tao Yuan,3 Huimin Zhu,4 Nian Li,5 Jian Xu,6 De Yong Long,1 Ming Long Chen2 and Chang Sheng Ma1 1. Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University; 2. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University; 3. Department of Cardiology, Shandong Provincial Hospital, Jinan, China; 4. Department of Cardiology, Ningbo First Hospital; 5. Department of Cardiology, China Resource and WISCO General Hospital; 6. Department of Cardiology, An Hui Provincial Hospital

Methods: A novice with no prior echo experience underwent a two-week training programme to acquire echo images using a handheld echo device with AI realtime image guidance, analysis and LVEF reporting (AI novice pathway). Symptomatic patients with suspected HF (n=100) were prospectively recruited. All patients also had standard cart-based echoes by trained sonographers interpreted by qualified cardiologists (reference standard).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-134. Correspondence: Chen Xi Jiang, jiangcxcn@126.com

Results: The novice acquired interpretable images in 96 patients. The mean time required for the novice to perform a POC echo was 12 minutes and 51 seconds. The learning rate was 60.2% for the first 20 patients, 30.4% for patients 20 to 40, and plateaued at 3.5% for patients 40 to 60. The correlation between the reference standard LVEF and AI-novice pathway LVEF was 0.713. The median absolute deviation of the AI-novice pathway LVEF from the reference standard LVEF was 2.30%, with a median relative percentage deviation of −3.99%. The root mean square error was 8.31, with a mean absolute error (MAE) of 1.86.

Objectives: To assess the knowledge level of atrial fibrillation (AF) among Chinese patients with AF and determine its association with sociodemographic characteristics and treatment practices. Methods: A nationwide cross-sectional survey was conducted among adult AF patients in China between May and August 2022. Knowledge level of AF was measured with a validated scale (8 items, score ranging from 0 [worst] to 8 [best]) regarding hazards, symptoms and management. Univariate and multivariate logistic regression analyses were performed to identify the relevant factors.

Conclusion: AI-enhanced echocardiogram image acquisition by novices is a feasible option to help increase accessibility of LVEF assessments.

Results: In total, 2,002 patients with AF from 55 centres across 17 provinces in China completed the questionnaire. The mean knowledge score for disease was 3.14 (<4 was considered poor knowledge level). The following variables were associated with good knowledge: university/ college education or above, disposable annual income ≥¥80,000, AF duration, complication with obstructive sleep apnoea syndrome, and history of ablation. The proportion of patients who had heard of catheter ablation (41.36%) was much lower than those who heard of oral anticoagulants (85.96%) and rhythm/rate control drugs (81.37%). Age, disposable annual income >¥16,000, rural medical insurance, complication with coronary heart disease and heart failure, good AF knowledge, limited heavy physical activity and involvement in treatment decisions were significantly associated with awareness of catheter ablation.

PP-112 Same-day Discharge Following Percutaneous Coronary Intervention: Prevalence, Trends, Interhospital Variation and Costs in Queensland, Australia

Conclusion: AF knowledge was found to be insufficient, especially in newly diagnosed patients. The awareness of new treatment options was affected by patients’ level of knowledge and involvement in treatment decisions. Both disease education and treatment communication should be improved to help patients have better treatment choices.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-112. Correspondence: Yingyan Chen, ychen@usc.edu.au

Yingyan Chen,1 Andrea Marshall,2,3 Laetitia Hattingh,2 Laurie Howes,2 Rohan Jayasinghe,2,3 Rohan Poulter,4 Yash Singbal,5,6 Gregory Starmer,7 ChiungJung (Jo) Wu,1 Raibhan Yadav8 and Ian Smith9

1. University of the Sunshine Coast; 2. Gold Coast University Hospital; 3. Griffith University; 4. Sunshine Coast University Hospital; 5. Princess Alexandra Hospital; 6. University of Queensland; 7. Cairns Hospital; 8. The Townsville Hospital; 9. Queensland Health

Objectives: Despite the demonstrated safety of same-day discharge (SDD) following elective percutaneous coronary intervention (PCI), rates vary worldwide (0–83%). This study aimed to identify SDD prevalence, trends, interhospital variation, and cost-effectiveness across public hospitals.

PP-111 Learning Curve of Novice in Artificial Intelligenceenhanced Point-of-Care Echocardiogram

Methods: Using descriptive and inferential statistics, data were analysed from the Queensland Cardiac Outcome Registry and National Hospital Cost Data Collection for patients who underwent elective PCI between 2013 and 2019 in six Queensland public hospitals in Australia (A to F). Patients were either discharged the same day or stayed overnight (ONS).

Weiting Huang,1 Tracy Koh,1 Jasper Tromp,2 Feiqiong Huang,3 Yoran Hummel,3 Chanchal Chandramouli,1 Carolyn Su Ping Lam1 and See Hooi Ewe1

1. National Heart Centre Singapore; 2. Saw Swee Hock School of Public Health, National University Singapore; 3. Us2.ai, Singapore

Results: The overall SDD prevalence was 6.5% (286/4,387), with the rate increasing from <1% in 2013 to >9% in 2019. Prevalence varied at the individual hospital level. Two hospitals did not perform SDD during the

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-111. Correspondence: Weiting Huang, huang.weiting@singhealth.com.sg

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Abstracts from 27th Asian Pacific Society of Cardiology Congress study period. The remaining hospitals demonstrated variability in SDD prevalence, with the highest being 28% (range 4–28%). Compared to ONS, SDD conferred cost savings with an average of AUD$3,695 less per patient, although this was influenced by the extent to which each hospital used SDD. The hospital with the highest prevalence of SDD demonstrated that the cost of SDD was nearly half of that for ONS.

1. Liverpool Hospital; 2. University of New South Wales; 3. Western Sydney University Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-114. Correspondence: Viet Dang, viet.dang@health.nsw.gov.au

Background: Temporary transvenous pacing (TP) is required for bradyarrhythmia/heart block in the context of ST-elevation myocardial infarction (STEMI) despite primary percutaneous coronary intervention (PPCI). This practice is associated with complications such as ventricular perforation and wire migration/dislodgement/non-capture. The objective of this study was to review the incidence, angiographic characteristics, management and complications of TP in STEMI over three years in the local health district.

Conclusion: Only a small proportion of patients undergoing PCI are discharged the same day. Broader implementation of SDD could contribute to considerable cost savings for public hospitals in Australia. The development and implementation of an evidence-based standardised SDD programme may facilitate the widespread adoption of this model of care, which is essential in the era of sparse hospital resources.

PP-113 Comprehensive Home-based Atrial Fibrillation Monitoring with Mobile Health Devices: A New Nursing Challenge Pilot Program

Methods: Six hundred and sixty-two STEMI-primary-PCI database cases between 2020 and 2022 yielded 27 patients requiring TP during their index procedure. Coronary angiogram and case notes were reviewed by two cardiologists.

Thitima Pornma, Parat Krongchuen and Kanintorn Soontorndhada

Results: Twenty-seven STEMI-PPCI patients required TP; 8 (30%) in 2020, 8 (30%) in 2021 and 11 (40%) in 2022. Inferior STEMI was the most common culprit vessel; dominant RCA (24/28 lesions [86%]), followed by 1 (3%) each of left main, LAD, LCx, SVG-RCA (1 had both LAD and RCA culprits). The median age of patients was 70 years, and 21/27 (78%) were male. TP indications were 3°AV block (24/27 [89%]), ‘slow’ atrial fibrillation (2/27 [7%]) and sinus bradycardia (1/27 [4%]). Access was via the femoral vein in 24/27 (89%) and internal jugular in 3 (11%). Balloon-tipped wires were used in 3/27 (11%). Median dwell time was 28 h (IQR ± 88 h) with the longest being 376 h. Three patients (11%) required permanent pacemakers, 3 (11%) required repositioning for TP wire migration/ dislodgement, and 3 right ventricular perforations (11%) resulted in mortality with an average dwell time of 143 hours (6 days). Total inhospital mortality was 10/27 (37%), related to cardiogenic shock, multiorgan failure and tamponade.

Bangkok Christian Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-113. Correspondence: Thitima Pornma, pornmatima@gmail.com

Objectives: Atrial fibrillation (AF) can cause several burdens, including disabilities from thromboembolic stroke or heart failure hospitalisation. However, early diagnosis and long-term care is still an issue in developing countries. This programme intends to implement home-based AF monitoring systems with new generation mobile health devices to help detect paroxysmal AF and evaluate arrhythmic burden in this patient group. Methods: Eight pioneer patients with cardiac history suspicious of cardiac arrhythmia were enrolled in the study. Patient heart rate was monitored using a novel mobile health device, including smartwatch, ambulatory oximetry device and skin patch one-lead cardiac monitoring system. The recorded report was reviewed at a follow-up session by a cardiologist. Patients who received arrhythmic alerts from devices could contact nursing staff earlier and subsequently discuss the alert with their physician at an OPD visit via the hospital telemedicine system.

Conclusion: STEMI patients needing TP are commonly dominant RCA (inferior) and rarely require permanent pacing in the PPCI era. Longdwelling TP wires increases perforation risk and mortality hazard. Regular clinical review to reduce TP dwell times and updated protocolised management plans should improve safety.

Results: Three patients were detected with arrhythmic signals by their devices. All three patients subsequently underwent 48-hour ambulatory Holter monitoring. One patient had premature ventricular complexes. Two other patients had paroxysmal AF. All patients diagnosed with AF were considered to initiate anticoagulant therapy together with rate control medications and were consulted for definite therapy with electrophysiologic study and radiofrequency ablation.

PP-115 Incidence, Predictors and Outcomes of Permanent Pacemaker Implantation after TAVR for Severe Aortic Stenosis Samantha Delgado, Fabio Enrique Posas, Ferdinand Alzate and Precious Emary Samonte St Luke’s Medical Center - Global City

Conclusion: Home-based AF mobile cardiac monitoring devices are novel tools that can assist early detection in paroxysmal AF patients and can be important equipment for medical assessment in patients who aim for rate control strategy.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-115. Correspondence: Samantha Delgado, samsdmd@gmail.com

Objectives: To determine the incidence, predictors and outcomes of permanent pacemaker implantation (PPI) performed within 30-days posttranscatheter aortic valve replacement (TAVR).

PP-114 Temporary Trans-venous Pacing in STelevation Myocardial Infarction in Southwestern Sydney, Australia 2020–2022

Methods: Employing a retrospective cohort design, the medical records of adult patients with severe aortic stenosis who had undergone TAVR from 2012 to 2021 at our centre were reviewed. Clinical, procedural and

Viet Dang,1 Katie Nguyen,1 Ashley Towney,1 Rohan Rajaratnam,1,2,3 Hany Dimitri,1,2,3 Dominic Leung1,2,3 and Sidney Lo1,2,3

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Abstracts from 27th Asian Pacific Society of Cardiology Congress outcome data were recorded and analysed using Cox proportional hazards regression and Kaplan–Meier survival curves.

Conclusion: Patients with functional MR were older, had more comorbidities and had significantly higher rates of HF admission and mortality.

Results: Of 170 records, 36 patients (21.18%) underwent PPI within 30 days post-TAVR. The 30-day incidence of PPI was 8.68 per 1,000 patients at risk (95% CI [6.08–12.01]). The hazard of PPI was significantly higher among patients with diabetes (cHR 2.73; p=0.009), right bundle branch block (cHR 4.93, p=0.001), atrial flutter (cHR 5.04, p=0.029), intermediate STS risk category (cHR 2.57, p=0.024), and mechanically expandable valve (cHR 2.38, p=0.040). The ventricular pacing dependency rate of >90% at 30 days and at 1 year was 57.14% and 50.00%, respectively. Although patients with PPI had higher hazards of mortality at 30 days (cHR=2.41, p=0.251) and 1 year (cHR=1.17, p=0.743), as well as lower survival (χ2=3.64, p=0.057) compared to patients without PPI, none were statistically significant.

PP-117 Quantitative Coronary Angiography versus Optical Coherence Tomography in Assessing Intermediate Left Main Coronary Artery Lesions: A Comparative Study Sneha Garg, Pramod Pareek and Rakesh Mahla

Department of Cardiology, JLN Medical College, Ajmer Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-117. Correspondence: Sneha Garg, drsnehagarg1406@gmail.com

Objectives: This study aimed to compare visually non-significant left main (LM) coronary artery lesions using quantitative coronary angiography (QCA) and optical coherence tomography (OCT) for assessing a better modality in countries where OCT is not widely available.

Conclusion: One-fifth of patients required PPI within 30 days after TAVR with a self-expanding or mechanically expandable valve. Positive predictors of PPI included diabetes, intermediate STS risk category, preexisting right bundle branch block or atrial flutter, and mechanically expandable valve. At least half of the patients with pacemaker interrogation data on follow-up were pacemaker-dependent at 30 days and at 1 year. However, PPI had no significant impact on 30-day and 1-year all-cause mortality and cardiovascular mortality, as well as survival.

Methods: A comparative study was conducted at a tertiary care centre in northwest India from January 2022 to January 2023. Thirty-five patients with visually non-significant LM lesions underwent OCT and QCA analysis, from which 27 adequate results were statistically analysed. Inclusion criteria were age >18 years, visually non-significant LM lesions (defined by stenosis <50%) and history of acute coronary syndrome. Exclusion criteria were history of PCI or CABG, known LM disease.

PP-116 Are There Outcome Differences in Different Aetiologies of Severe Mitral Valve Regurgitation?

Results: The mean age of patients was 60.9 ± 8.2 years, and 18 were male. Fifty-nine percent presented with acute MI, 33% with USA and 7% with NSTEMI. Minimum lumen diameter by QCA was 3.02 ± 0.77 mm and by OCT was 3.22 ± 0.65 mm. Reference diameter calculated by QCA was 4.04 ± 0.61 mm and by OCT was 4.34 ± 0.66 mm. Minimum lumen diameter of QCA was weakly correlated to that of OCT (r=0.25, p=0.12). Reference lumen diameter of QCA had good correlation with that of OCT (r=0.59, p=0.001). The average area of stenosis in QCA and in OCT was 25.7 ± 11.3% and 37.1 ± 21.1%, respectively, with statistically significant difference between the two (p<0.05) and QCA underestimating the stenosis. 29.6% of patients had significant LM stenosis and were advised of intervention accordingly. OCT lesion characterisation showed white mural thrombus in 7%, fibrocalcific plaque in 33%, fibrous plaque in 33% and fibroatheroma and mixture lesions in the rest.

Nicholas Gao,1 Vinay Bahadur Panday,2 Beth Shi Yu Lim,1 Jessele Shian Yi Lai,1 Ching-Hui Sia,1,2 William Kok Fai Kong1,2 and Kian-Keong Poh1,2

1. National University of Singapore, Yong Loo Lin School of Medicine; 2. Department of Cardiology, National University Heart Centre Singapore Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-116. Correspondence: Nicholas Gao, e0500916@u.nus.edu

Objectives: Mitral valve regurgitation (MR) is the most common valvular disorder. The causes of MR are broadly divided into flail, degenerative and functional causes. However, it is unclear if different aetiologies of MR portend a worse outcome of heart failure (HF) admissions and mortality. This study aimed to assess the outcomes of patients with different aetiology of MR.

Conclusion: Area stenosis is significantly underestimated by QCA compared to OCT, resulting in missing significant LM lesions. There is a good correlation and agreement between QCA and OCT for measurement of reference diameters. However, MLD is underestimated by QCA. OCT is a better modality for assessing LM artery lesion severity and thus, guiding intervention.

Methods: Consecutive patients with severe MR diagnosed on index echo examinations from 1 January 2014 to 31 December 2021 were retrospectively analysed. Patients with other valvular lesions of moderate severity or greater, or prior valvular interventions, were excluded from the study. Clinical outcomes were ascertained by review of medical records. The primary outcome was a composite of HF hospitalisations and allcause mortality.

PP-118 Effectiveness of Guideline-endorsed Low-density Lipoprotein Cholesterol Reduction Rates in Patients with Prior Percutaneous Coronary Intervention

Results: Patients were followed up for a mean of 5.1 ± 1.8 years. Patients with functional MR were significantly older and had more ischaemic heart disease. Patients with flail MR had the largest regurgitation volume (flail MR 95.6 ± 52.2 ml; degenerative MR 79.2 ± 37.7 ml; functional MR 58.2 ± 33.8 ml, p<0.01) while functional MR had significantly lower ejection fraction (flail MR 61.8 ± 8.3%; degenerative MR 59.9 ± 10.3%; functional MR 29.5 ± 11.3%, p<0.01). Patients with functional MR had significantly higher rates of composite outcomes (functional MR 68.8%; degenerative MR 23.9%, flail MR 22.3%, p<0.01).

Yu Jung Jung,1 Dong-Gu Sin,1 Jong-Sun Park,1 Woong Kim,1 Jang-Won Son,1 Jong-Ho Nam,1 Kang-Un Choi,1 Byung-Ju Son,1 Jong-Il Park,1 Jihyun Song,2 Younghee Bea,2 Youhyun Joe,2 Jinho Lee,2 Chanhee Park2 and Heeryung Kong2 1. Yeungnam University Medical Center; 2. College of Medicine, Yeungnam University

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Abstracts from 27th Asian Pacific Society of Cardiology Congress than 5 times pre-PCI in pre-PCI abnormal hs-TnT/TnI level. Patients were divided into PMI (n=29) and non-PMI (n=56) groups. Post-PCI angio-IMR was significantly high in the PMI group compared with the non-PMI group (47.7 ± 20.1 versus 31.3 ± 13.2, p=0.0002). In both univariate and multivariate logistic regression analyses, post-PCI angio-IMR was associated with PMI. Patients with post-PCI angio-IMR ≥35 showed significantly developed PMI frequently (53.5% versus 14.2%, p<0.0001).

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-118. Correspondence: Yu Jung Jung, skyone13@naver.com

Background: Low-density lipoprotein cholesterol (LDL-C) should be treated by guideline-directed management >50% reduction of initial LDL-C and <3.1 mmol/l (55mg/dl)LDL-C level with prior percutaneous coronary intervention (PCI). However, there is no direct comparative evidence on target reduction rate and target LDL-C level. This study investigated the clinical influence of >50% reduction from baseline LDL-C in patients with prior PCI.

Conclusion: High post-PCI angio-IMR are strongly correlated with PMI. Post-PCI angio-IMR may be a predictor of PMI as well as of invasive IMR.

Methods: A total of 3,109 patients with prior PCI were retrospectively enrolled from 2014 January to 2020 December at Yeungnam University Medical Center. The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, non-fatal myocardial infarction and stroke. The secondary endpoints were individual components of the primary endpoint.

PP-120 Factors Associated with Stent Thrombosis Following Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

Results: Among all patients, the achievement rate of target LDL-C <3.9 mmol/l (70 mg/dl) was 59.4%, while the achievement rate of target LDL-C <3.1 mmol/l (55 mg/dl) and >50% reduction from baseline was 15.1%. There was no significant difference between the LDL <3.1 mmol/ group and the LDL ≥3.1 mmol/l group at risk for MACE (HR 0.90; 95% CI [0.74–1.09]; p=0.293). However, the group that achieved >50% reduction of LDL-C from baseline LDL-C level showed a significant reduction in the occurrence of MACE, regardless of whether target LDL-C level <3.1 mmol/l (HR 0.70; 95% CI [0.49–1.20]; p=0.048) or ≥3.1 mmol/l (HR 0.51; 95% CI [0.39–0.66]; p<0.001), compared to the group with <50% reduction of LDL-C.

RSUP Dr. Kariadi Semarang

Leo Deddy Pradipta, Adwin Alamsyaputra, Inne Pratiwi Farissa and Susi Herminingsih

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-120. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Objectives: To examine each component that could predict the occurrence of stent thrombosis in patients who successfully underwent PPCI. Methods: Several databases, including PubMed, Scopus and ScienceDirect, were queried for relevant studies published before March 2023. Eleven published studies were evaluated further for characteristics that could increase the likelihood of stent thrombosis following PPCI procedure. RevMan 5.4 was used to build and display a summary of the included research using a random or fixed effect model. Using the Newcastle-Ottawa Scale, the quality of research methodologies was determined.

Conclusion: Whether the target-LDL-C level was <3.1 mmol/l or not, >50% reduction from the baseline LDL-C reduced the incidence of MACE.

PP-119 Relationship Between Angiographyderived IMR at Post Procedure and Periprocedural Myocardial Injury

Results: From a total of 11 published studies, we drew the conclusion that an increasing risk of stent thrombosis was related to advanced age (OR 1.95; 95% CI [1.2–2.93]; p<0.0001), diabetic (OR 1.2; 95% CI [1.0–1.72]), chronic kidney disease (OR 2.11; 95% CI [1.45–3.07]; p<0.0001), previous PCI (OR 2.57; 95% CI (1.29–5.12); p=0.007), and Killip class >1 on presentation (OR 1.88; 95% CI [1.2–3.5]; p=0.04).

Tetsuya Matsuyama, Takayuki Okamura, Tatsuhiro Fujimura, Yousuke Miyazaki, Yuki Nakata, Tetsuro Oda, Mamoru Mochizuki, Hitoshi Uchinoumi, Takeshi Suetomi, Yoshihide Nakamura and Maho Ishikawa Yamaguchi University Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-119. Correspondence: Tetsuya Matsuyama, tm19880209@gmail.com

Conclusion: Advanced age, history of diabetes, history of chronic kidney disease, previous PCI, and Killip class >1 on presentation were associated with increased risk of stent thrombosis in patients who underwent PPCI.

Background: Periprocedural myocardial injury (PMI) is a common complication following percutaneous coronary intervention (PCI). High post-PCI index of microcirculatory resistance (IMR) has been reported to be a predictor of PMI. Angiography-derived IMR (angio-IMR) is a pressurewire-free index to assess coronary microvascular function.

PP-121 The Determinants of Slow/No-reflow Phenomenon After Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

Objectives: This study was designed to reveal the correlation of angioIMR and PMI.

RSUP Dr. Kariadi Semarang

Leo Deddy Pradipta, Adwin Alamsyaputra, Inne Pratiwi Farissa, Udin Bahrudin and Yan Herry

Methods: In consecutive elective PCI in which the diagnosis of PMI was possible, 85 patients in which post-PCI angio-IMR was calculable were enrolled. Angio-IMR was calculated using computational flow and pressure simulation. PMI was defined as an elevation of hs-TnT/TnI greater than 5 times the 99th-percentile upper reference limit in patients with pre-PCI normal hs-TnT/TnI level, and post-PCI hs-TnT/TnI elevation greater

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-121. Correspondence: Leo Deddy Pradipta, dancingdeagle@gmail.com

Objectives: This meta-analysis aimed to find the possibility of predisposition for slow/no-reflow, which could be related to both local and systemic factors.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Methods: Multiple databases, including PubMed, Scopus and ScienceDirect were searched for relevant studies published from 2010 to 2023. Seventeen screened published studies were assessed further for variables that could increase or reduce risk of slow/no-reflow phenomenon after intervention in patients with ACS. RevMan 5.4 software was used to compile and show the summary of included studies through a random or fixed-effect model. The quality of research methods was evaluated using the Newcastle Ottawa Scale tool.

procedural aspect of postdilatation procedures. This encompassed the frequency and maximum pressure of postdilatation. Conclusion: Suboptimal coronary flow occurred in 25% of STEMI patients treated with primary PCI. Postdilatation procedure is not associated with suboptimal coronary flow during primary PCI.

PP-123 Characteristics of Low Clinical Likelihood Chronic Coronary Syndrome Patients with Significant Coronary Lesion

Results: In the 17 studies, with a total of 14,001 patients, increasing risks of slow/no-reflow were associated with advanced age, hypertension, family history of coronary artery disease, cerebrovascular disease, left anterior descending artery as culprit, direct stenting, low ejection fraction (EF) on admission, high creatinine level, initial TIMI flow <3, Killip class >1 at presentation, longer stent implantation, and thrombus grade >3. Balloon predilatation, thrombus aspiration, and GPIIb-IIIA usage could reduce the risk. Initial TIMI flow <3, longer stent implantation, and low EF on admission had the greatest impact on slow/no-reflow phenomenon (OR 3.7; 95% CI [2.32–5.88]; p<0.0001, OR 3.35; 95% CI [1.5–7.35]; p=0.01 and OR 3.3; 95% CI [1.2–5.0], p<0.0001, respectively).

Sarah Qonitah, Ahmad Pandu Pratama and Indah Puspita Mohammad Hoesin Hospital Palembang Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-123. Correspondence: Sarah Qonitah, sarahqonitah@gmail.com

Background: Chronic coronary syndrome (CCS) is a pathological process characterised by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. Significant coronary artery disease (CAD) is defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30–70% stenosis with fractional flow reserve ≤0.8. This study aimed to identify the characteristics of low clinical likelihood CCS patients with significant coronary lesion based on pretest probability (PTP) score, demographic characteristics, risk factors, and laboratory and echocardiography findings.

Conclusion: Initial TIMI flow <3, longer stent implantation and low EF on admission are the strongest predictors of slow/no-reflow risk factors.

PP-122 Postdilatation After Stent Deployment is Not Associated with Suboptimal Coronary Flow During Primary Percutaneous Coronary Intervention

Methods: This was a retrospective cohort study. The medical records of 60 low clinical likelihood CCS patients with positive inducible ischaemia area from dobutamine stress echocardiography and significant CAD lesion from coronary angiography were reviewed.

Teuku Muhammad Haykal Putra, Amelia Shadrina, Maria Elfiana, Wahyu Aditya Soedarsono and Wishnu Aditya Widodo Jakarta Heart Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-122. Correspondence: Teuku Muhammad Haykal Putra, tm_haykal@yahoo.com

Results: The incidence of significant CAD in the study population was 56.1%. There was a significant relationship between age >65 years with the incidence of significant LAD lesion (23.3%, p=0.017); significant LCx lesion (20%, p=0.040). There was a significant relationship between PTP score ≥16% with significant LAD lesion (55.0%, p=0.001); significant LCx lesion (45.0%, p=0.020); and significant RCA lesion (40.0%, p=0.023).

Background: Suboptimal coronary flow (TIMI flow <3) is frequently seen after primary percutaneous coronary intervention (PCI). Conflicting evidence is widely available arguing whether adjunctive balloon dilatation (postdilatation) after stent implantation during primary PCI might contribute to this circumstance. While it is believed to be beneficial for stent optimisation, its use in acute coronary syndrome may lead to thrombus and plaque debris embolisation.

Conclusion: Patients >65 years of age have a higher incidence of significant LAD and LCx lesions. Patients with pre-test probability score ≥16% have a higher incidence of significant lesions across coronary branches, predominantly in the LAD.

Objectives: To investigate whether technical aspects of primary PCI involving postdilatation after stent deployment are associated with suboptimal coronary flow.

PP-124 Angiographic Profile of a Cohort of Women with Acute Coronary Syndrome: Single-centre Experience

Methods: This was a retrospective observational study of 76 ST-elevation myocardial infarction (STEMI) patients treated with primary PCI between October 2022 and February 2023 at the Jakarta Heart Center. Clinical data and coronary angiography images were obtained from medical records. Patients without stent implantation were excluded.

Miriyalini Sundararajah, Ajith Kularatne, Priyantha Kannangara, Chaminda Kularatne, Asiri Gunasekara, Gayan Abeysinghe, Dulaanga Rathnayake and Ruwanthi Jayasinghe National Hospital Kandy

Results: The study involved 63 men (82.9%) and 13 women (17.1%) with mean age of 54.6 ± 10 years. Suboptimal coronary flow after primary PCI was observed in 19 patients (25%). Patients with suboptimal coronary flow were likely to be male (100% versus 77.2%, p=0.03), presented with worse Killip class (36.8% versus 14.0%, p=0.031), and developed worse LV function (LV ejection fraction 49.8 ± 8.3% versus 57.7 ± 8.0%, p=0.001). There was no significant difference between both groups in terms of any

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-124. Correspondence: Miriyalini Sundararajah, yalinisundararajah@gmail.com

Objectives: To determine the angiographic patterns of women who presented with acute ST- elevation myocardial infarction (STEMI) to National Hospital Kandy.

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Methods: A retrospective cross-sectional study was conducted among a cohort of women who were clinically diagnosed with STEMI at National Hospital Kandy, Sri Lanka, from 1 January 2020 to 1 January 2022.

2.01; 95% CI [1.17–3.45]). Using a cut-off value of 0.30, catheter-based AT/ ET had a sensitivity of 80% and specificity of 92% for diagnosing severe AS (AUC 0.94; 95% CI [0.90–0.97]), with consistent results from subgroup LGAS (AUC 0.94, 95% CI [0.93–0.99]).

Results: A total of 122 female patients were recruited with a mean age (SD) of 61.18 (9.09) years. Coronary angiogram revealed single vessel disease, double vessel disease and triple vessel disease in 46 (37.7%), 45 (36.9%) and 31 (25.4%) patients, respectively. Eighty-three (68.0%) had no left main coronary artery (LMCA) disease. Degree of LMCA disease among the study population was mild (n=31, 25.4%), moderate (n=4, 3.3%) and severe (n=4, 3.3%). Patients with LMCA disease (39=32%) were older (64.41 ± 7.36 years) than patients without LMCA (59.67 ± 9.46 years) (p=0.007). The right coronary, left anterior descending and left circumflex arteries were identified as the culprit vessels in 50 (41.0%), 49 (40.2%) and 14 (11.5%) patients, respectively. One hundred and nine (89.3%) patients underwent primary percutaneous coronary intervention and stenting. There were three hospital deaths within 48 hours.

Conclusion: This study supports the use of catheter-based AT/ET >0.30 as a complementary diagnostic tool for severe aortic stenosis across the spectrum of low-gradient AS. Further studies are needed to validate these findings in larger, multicentred studies with more diverse patient populations.

PP-126 Characteristics of P2Y12 Platelet Function Test in Patients Undergoing Coronary Intervention Jonathan Christopher,1 Leonardo Paskah Suciadi,2 Titus Kurnia Hariadi2 and Antono Sutandar2

1. Siloam Hospitals Kebon Jeruk; 2. Siloam Heart Institute/Siloam Hospitals Kebon Jeruk

Conclusion: Most of the women with STEMI in the study population did not have LMCA involvement and the most common culprit artery was the right coronary. In-hospital deaths did not have LMCA involvement. Mortality was low because most patients presented with stable inferior STEMI, early admission and proper hospital care in a developing country.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-126. Correspondence: Jonathan Christopher, joc.suhardy@gmail.com

Objectives: Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 receptor inhibitor has been the standard treatment for patients undergoing percutaneous coronary intervention (PCI). Clopidogrel is the most popular thienopyridine used for this purpose. However, there are increasing concerns about its resistance due to P2Y12 gene polymorphism. Platelet function testing (PFT) could be an interesting solution to evaluate the efficacy of platelet inhibition by this agent.

PP-125 Identifying Missing Tools in Aortic Systolic Upstroke Parameter for Valvular Aortic Stenosis Diagnosis

Wittawin Wangpermpoon, Thinnakrit Sasiprapha, Tawai Ngernsritrakul and Mann Chandamivol

Methods: A retrospective review was conducted of adult patients who underwent PCI between January 2021 and March 2023 at Siloam Hospitals Kebon Jeruk, Jakarta. Initially, these patients were on clopidogrel as the preferred antiplatelet. PFT was obtained from the blood test and measured using VerifyNow preprocedurally. Patient data was collected through electronic medical record. The primary endpoint was to determine P2Y12 resistance to antiplatelet therapy according to P2Y12 reaction unit (PRU) and P2Y12 inhibition percentage.

Ramathibodi Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-125. Correspondence: Wittawin Wangpermpoon, wpp.wittawin@gmail.com

Background: Echocardiography is a widely accepted method for diagnosing severe aortic stenosis (AS), but it has certain limitations. Alternative methods, such as the direct catheter-based crossing of the valves, carry a risk of stroke. Delayed aortic upstroke parameters might predict the severity of aortic stenosis.

Results: Data of 269 patients were collected. Patients had a median age of 61 years and 59 patients were women (21.9%). Seventy-one patients (26.4%) were identified with PRU >208. One hundred and fifty-one patients (56.1%) were identified as resistant to P2Y12 inhibitor (<20% P2Y12 inhibition). As a consequence of this finding, a decision was made to switch clopidogrel to ticagrelor. Follow-up for the clinical outcomes and MACE are ongoing.

Objectives: This study aimed to investigate the diagnostic utility of measuring catheter-based aortic acceleration time with ejection (AT/ET) for the diagnosis of severe aortic stenosis, including low-gradient (LG) AS. Methods: The study included 139 patients who underwent cardiac catheterisation at Ramathibodi Hospital, including patients with varying degrees of AS. Patients with LGAS were classified by an algorithm according to ESC guideline. All patients received echocardiographic assessments and direct haemodynamic measurements of AT/ET. The association between AT/ET and AS severity and other conventional utilities was analysed using logistic regression and ROC analysis.

Conclusion: More than half of the patients unexpectedly had P2Y12 resistance. Thus, evaluation of PFT could be beneficial for patients undergoing coronary intervention to optimise antithrombotic strategy.

PP-127 Ezetimibe 5 versus 10 mg Combined with Statin Therapy in Dyslipidaemia: Randomised Controlled Trial (EZ-5)

Results: Of the 139 patients, 73 had severe AS (52.5%), and 20 had low gradient (27.3%). The mean AT/ET was 0.33 in the severe AS group and 0.28, 0.24 in moderate, and mild–no AS patients, respectively. AT/ET was significantly correlated with conventional echocardiographic and haemodynamic parameters. AT/ET is the strongest predictor of severe aortic stenosis using the multivariable test with relevant variables (OR

Jessada Kanchanasinitth and Nakarin Sansanayudh Phramongkutklao Hospital Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-127. Correspondence: Jessada Kanchanasinitth, fluke_a@hotmail.com

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Abstracts from 27th Asian Pacific Society of Cardiology Congress Objectives: Ezetimibe is a known cholesterol absorption inhibitor that treats dyslipidaemia by reducing LDL-C. Observational retrospective data suggests that ezetimibe 5 mg and 10 mg have a comparable effect on LDL-C reduction. The objective was to evaluate efficacy of 5 mg and 10 mg doses of ezetimibe combined with HMG-CoA reductase (statin) on LDL-C reduction among dyslipidaemia patients.

statin prescription increased from 45.4% at hospital admission to 87.1% at discharge and remained similarly high at 82% at 6, 12 and 24 months. Other LLT were concomitantly prescribed to 19.2% of patients at discharge and increased to 43.9% at 24 months. Ezetimibe was the most common second-line LLT prescribed (39.9%, n=187), followed by inclisiran (n=5) and anti-PCSK9 monoclonal antibodies (n=4). However, the LDL-C goal ≤1.8 mmol/l was achieved in only 44% of patients at 6 and 12 months, and in 46.3% at 24 months. When LDC-goal ≤1.4 mmol/l was adopted, only 21–22% of patients achieved goal at 6, 12 and 24 months. The highest percentage of patients achieving LDL-C ≤1.4 mmol/l was at 6 months (22%).

Methods: This was a randomised, open-labelled study of dyslipidaemia patients who failed to meet LDL-C target at the Phramongkutklao Hospital, Thailand from May 2021 to January 2022. One hundred and eight patients were randomised equally in two groups: 5 mg versus 10 mg daily. The primary endpoint was the percentage change in LDL-C values between the two groups. Secondary endpoints included percent LDL-C target achievement and the percentage change of HDL-C, TG, TC, CK, hsCRP, ALT and AST.

Conclusion: LDL-C goals were not achieved in more than half of the study cohort despite high prescription rates of high-intensity statin. Second- and third-line LLT are under-prescribed. More effort should be made to improve LDL-C control in this high-risk cohort of patients.

Results: After 8 weeks of treatment, both groups had significantly reduced LDL-C (p<0.001). LDL-C was lowered in the ezetimibe the 5 mg group by 1.5 ± 1.3 mmol/l whereas the 10 mg group reduced LDL by 1.2 ± 1.3 mmol/l (p=0.35). The difference in serum LDL-C percentage change between groups was 2.3 (95% CI [−6.2, 10.9]; p=0.59). The serum percentage change of TC, TG, HDL-C, AST, ALT, CPK, and hsCRP was not significant. The percentage of patients who met their LDL-C target in the 5 mg and 10 mg groups was not substantially different (28% and 38.9% [p=0.16], respectively). When stratified by LDL-C level, 88% and 84.3% of LDL-C <5.6 mmol/l (p=0.59), 44% and 51% of LDL-C <3.9 mmol/l (p=0.48) and 18% and 27.5% of LDL-C <3.1 mmol/l (p=0.26).

PP-129 The Cardioprotective Effects of SGLT2 Inhibitors in Type 2 Diabetes with Coronary Artery Disease in Malaysia

Wan Ahmad Syazani Mohamed,1 Khairul Nisa’ Ishak,1 Hasniza Zaman Huri,2 Azrul Fahmi Jaharudin,3 Ahmad Syadi Mahmood Zuhdi,3 Samshol Sukahri3 and Amira Hajirah Abdul Jamil2 1. Nutrition Unit, Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research (IMR); 2. Faculty of Pharmacy, University Malaya; 3. Department of Cardiology, Faculty of Medicine, University Malaya

Conclusion: Combination therapy of ezetimibe 5 mg with statins was comparable to 10 mg with statins, with equivalent efficacy on LDL-C reduction. Patients who achieved the LDL-C target were not significantly different between groups. Ezetimibe 5 mg, when combined with a statin is an alternative treatment in dyslipidaemia patients with similar efficacy to 10 mg ezetimibe.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-129. Correspondence: Wan Ahmad Syazani Mohamed, syazanimohamed@gmail.com

Background: Sodium-glucose contrasporter-2 (SGLT-2) inhibitor is an antidiabetic medication that promotes glycosuria. It is also known to indirectly reduce cardiovascular complications according to several studies. The cardioprotective effects of SGLT-2 inhibitor in patients with type 2 diabetes (T2DM) with coronary artery disease (CAD) in Malaysia have yet to be explored. This study aimed to compare the cardiac functions in T2DM patients with CAD following the initiation of SGLT-2 inhibitors to determine cardiovascular outcome.

PP-128 Evaluation of Lipid-lowering Therapies Among Patients with Ischaemic Heart Disease Admitted to Hospital

Ying Hui Mak,1 Fionn Chua,2 Audrey Lam,1 Lily Mae Dacay,3 Zhong Hui Lee,1 Vern Hsen Tan,4 Colin Yeo4 and Wann Jia Loh3,5 1. Department of Pharmacy, Changi General Hospital; 2. Dietetics Department, Changi General Hospital; 3. Department of Endocrinology, Changi General Hospital; 4. Department of Cardiology, Changi General Hospital; 5. Duke-NUS Medical School

Methods: A quasi-experimental cohort study was conducted by recruiting 360 patients in a single centre (180 T2DM patients initiated with SGLT-2 inhibitors and 180 T2DM patients not initiated with SGLT-2 inhibitors) during a 6-month period. Ejection fraction (EF), left ventricular end diastolic volume (LVEDV) and left ventricular mass index (LVMI) were measured using echocardiography.

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-128. Correspondence: Wann-Jia Loh, loh.wann.jia@singhealth.com.sg

Background: Combination therapy with ezetimibe and/or PCSK9 inhibitors should be considered in patients with IHD with suboptimal LDL-C. The objective was to assess the prescription pattern of lipid lowering therapies (LLT) in IHD patients and their LDL-C goal attainment rates.

Results: Eighteen patients (12 patients with SGLT-2 inhibitor, 6 patients without SGLT-2 inhibitor) successfully completed the study. SGLT-2 inhibitor showed an increment of EF (48.3 ± 4.13% to 54.8 ± 4.12%, p=0.01), though the reduction of LVEDV (152.6 ± 18.73 ml to 131.9 ± 16.78 ml) and LVMI (242.5 ± 31.76 g to 195.8 ± 36.37 g) were not statistically significant.

Methods: 555 patients with IHD who were admitted to hospital were recruited. LLT prescriptions and corresponding LDL-C levels at baseline and at 6, 12 and 24 months were assessed.

Conclusion: SGLT-2 inhibitors have a valuable effect on EF for T2DM patients with CAD independent of LVEDV and LVMI, suggesting benefits in combating cardiovascular complications, especially heart failure.

Results: Study participants were mostly men (82.3%); 48.5% were of Chinese ethnicity and 47% were newly diagnosed with IHD. High-intensity

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Abstracts from 27th Asian Pacific Society of Cardiology Congress PP-130 The Efficacy of Allopurinol in Cardiovascular Disease: A Systematic Review and Metaanalysis of Randomised Controlled Trials

Results: Most of the cyclists (63%) had left ventricular hypertrophy (LVH) with most of them having eccentric LVH. As many as 20% of cyclists experienced an increase in diastolic LV diameter. The average global longitudinal strain (GLS) of cyclists who experienced left ventricle (LV) dilatation was −14 while the average GLS of cyclists without LV dilatation was −16; this indicates a possibility of subclinical LV dysfunction in cyclists who experience LV dilatation. As many as nine (30%) cyclists experienced grade I diastolic dysfunction. Several mild valve abnormalities were found in the cyclists, namely in the form of mitral regurgitation, aortic regurgitation and tricuspid regurgitation.

Yuyang Ye, Guangzhi Liao and Yong Peng West China Hospital, Sichuan University

Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-130. Correspondence: Yuyang Ye, yeyuyangcd@163.com

Background: The effects of allopurinol in secondary prophylaxis among patients with cardiovascular disease are not well defined. The latest evidence is summarised in this study.

Conclusion: Eccentric LVH is the most common cardiac remodelling found in cyclists by echocardiographic examination. GLS examination is necessary to detect subclinical LV dysfunction, especially in patients who are known to have LV dilatation.

Methods: The literature was searched for randomised controlled trials (RCTs) of allopurinol in patients with cardiovascular disease published up to 11 February 2023. The primary outcome was cardiovascular death.

PP-132 Systematic Review of Clinical Profile of Athletes with Hypertrophic Cardiomyopathy with Good Ejection Fraction

Results: The results of 21 RCTs from 22,806 patients were combined. Compared to placebo/usual care, allopurinol treatment was not associated with a significant reduction in cardiovascular death (RR 0.60; 95% CI [0.33–1.11]) or all-cause death (RR 0.90; 95% CI [0.72–1.12]). However, evidence from earlier trials and studies with small sample sizes indicated that allopurinol might confer a transient effect in decreasing cardiovascular death (RR 0.34; 95% CI [0.15–0.76]) across patients undergoing CABG or with acute coronary syndrome. In comparisons between allopurinol and febuxostat, there was no difference in cardiovascular death (RR 0.92; 95% CI [0.69–1.24]) or all-cause death (RR 1.02; 95% CI [0.75–1.38]).

Stephanie Palacios and Patricio Palmes

West Visayas State University Medical Center Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-132. Correspondence: Stephanie Palacios, palacios.stepha@gmail.com

Objective: To describe the clinical profile of athletes with hypertrophic cardiomyopathy (HCM) who had good ejection fraction (EF) in echocardiography.

Conclusion: Administration of allopurinol did not result in remarkable improvement in death or adverse cardiovascular outcomes compared with placebo/usual care in patients with cardiovascular disease. Given the limitations of the original studies, the potential benefits observed in the early period among patients undergoing CABG or with ACS who were receiving allopurinol therapy require further confirmation by future RCTs. Comparison between allopurinol and febuxostat revealed no superior benefits of the former in reducing the risk of adverse cardiovascular events.

Methods: A systematic review was conducted by searching the databases for peer-reviewed articles published in the past 10 years. Observational studies published in English were screened. Two reviewers independently conducted the searches, extracted the data and assessed the quality of each study. Assessment was done using Johanna Briggs Institute’s Critical Appraisal Tool checklists. Results: Three case-control studies yielding 265 search results were included from Bosnia and Herzegovina, Germany and Qatar. Participants (n=152) from all studies were mostly male, active in sports, and aged 18– 68 years. Echocardiographic measurements were performed for all participants in the included studies. EF range among the participants was 50–60%. The intraventricular septum thickness in diastole (IVSd), thickness of the rear wall of the left ventricle (LVPWd) and diameter of the left ventricle during systole (LVSD) were significantly different between athletes compared to non-athletes with HCM. The global longitudinal strain (GLS) was reduced in non-athletes with HCM compared with athletes with HCM. The longitudinal and circumferential LV deformation during exercise was significantly lower in athletes with aortic stenosis compared with athletes with HCM.

PP-131 Analysis of Heart Remodelling Parameters Based on Echocardiography in Cyclists in Mataram City Yanna Indrayana, Yusra Pintaningrum, Basuki Rahmat, Romi Ermawan and Anak Agung Sagung Mas Meiswaryasti Putra Medical Faculty, Mataram University, Indonesia Citation: Journal of Asian Pacific Society of Cardiology 2023;2(Suppl 1):PP-131. Correspondence: Yanna Indrayana, yannaindrayana@unram.ac.id

Objectives: Regular exercise induces changes in myocardial structure and function. These changes are known as cardiac remodelling. Cycling is one of the most popular types of sports. No previous study in Indonesia has analysed cardiac remodelling parameters based on echocardiography in a cyclist population.

Conclusion: IVSd, LVPWd, LVSD, GL and longitudinal and circumferential LV deformation assessment of athletes with HCM differ significantly from non-athletes with HCM. These identified differences in echocardiography measurements may provide clear differentiation of pathological from physiological HCM in athletes, allowing them to continue doing unrestrictive activities.

Methods: This was a descriptive study regarding cardiac remodelling parameters based on echocardiographic examination of cyclists in the city of Mataram.

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