Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 120

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 118 AFRICA
Background/hypothesis: SCD in children and adolescents occurs
with unclear frequency and is devastating. There are many aetiolo-
gies of SCD in children/adolescents. We hypothesise that survival
is achievable with a multi-disciplinary/multi-centre primary and
secondary prevention approach emphasising awareness/education as
well as advocacy for secondary prevention approaches (lay-public
cardiopulmonary resuscitation (CPR), education, automated exter-
nal defibrillation (AED) use and placement of school CPR-AED
programmes.
Material and methods: Project ADAM (PA) was initiated in the
state of Wisconsin at Children’s Hospital of Wisconsin in November
1999. PA is a primary and secondary prevention programme.
Warning sign education, teaching importance of comprehensive
pre-participation exam, advocacy for individual school emergency-
preparedness plans and school CPR-AED programmes are all part of
PA. Since inception, affiliate PA programmes have been established
in other states: Georgia, Pennsylvania, Florida, Illinois, Alabama,
Washington, Tennessee, Texas and Michigan.
Results: PA has saved 60 lives since November of 1999. Of the
total, 24 lives of children/adolescents and 36 lives of adults have
been saved: Wisconsin (total 23, children/adolescents 10, adults 13);
Georgia (total 29, children/adolescents 11, adults 18); Pennsylvania
(total 4, children/adolescents 2, adults 2); Texas (total 2, children/
adolescents 1, adults 1).
Conclusions: PA has saved the lives of both children/adolescents
and adults. Education/awareness and implementation of CPR-AED
programmes across the country aimed at children and adolescents
will have the potential to save many mores lives, adults included.
505: METABOLIC SYNDROME-RELATED CHARACTERIS-
TICS ARE ASSOCIATED WITH AN INCREASED CAROTID-
FEMORAL PULSEWAVE VELOCITY IN CHILDREN
Kate McCloskey 1,3,4, Cong Sun1, Angela Pezic1, Jenny Cochrane2,
Ruth Morley1,3, Peter Vuillermin1,4,5, David Burgner1, 3, Terry Dwyer1,2,
Anne-Louise Ponsonby 1,2,3
1Murdoch Children’s Research Institute, Royal Children’s Hospital,
Victoria, Australia
2Menzies Research Institute, University of Tasmania
3Department of Paediatrics, University of Melbourne, Australia
4Deakin University, Melbourne, Australia
5Child Health Research Unit, Barwon Health, Geelong, Australia
Background/hypothesis: The origins of cardiovascular disease are
in childhood, with changes to vessel structure and function often
apparent from early life. Carotid-femoral pulse wave velocity (PWV)
is a validated non-invasive measure of arterial stiffness – a determi-
nant of vascular function. We hypothesised that features of metabolic
syndrome – obesity, insulin resistance and hypertension – would be
associated with higher PWV in children.
Materials andmethods: Carotid-femoral artery PWVwas performed
on a population cohort of 147 twin pairs aged 7–11 years. Fasting
bloods, blood pressure, anthropomorphic and other measures were
collected concurrently. The participants were analysed as individuals
by multiple linear regression, after adjusting for age and sex. Further
between-twin pair analysis was performed to investigate the effect of
twin-pair clustering.
Results: Of the 147 twin pairs, 47 were monozygotic and 100 were
dizygotic. Mean age was 9.03 years, and half were male. There were
no significant differences between the characteristics of monozygotic
and dizygotic twins. Mean PWV was 5.95 m/s, SD 0.655.
In individual-based analysis, age (β = 0.262, 95% confidence
interval [CI] 0.170–0.348) and height (β = 0.015, 95% CI 0.004–
0.027) were positively associated with PWV, as were markers of
adiposity; weight (β = 0.012, 95% CI 0.002–0.023), truncal skin-fold
thickness (β = 0.006 95% CI 0.001–0.010), waist circumference
(0.011 95% CI 0.000–0.021) and hip circumference (β = 0.010 95%
CI 0.000–0.020). Strong associations were found between markers
of insulin resistance – HOMA (β = 0.116 95% CI 0.051–0.181) and
c-peptide (β = 0.588 95% CI 0.248–0.927) – and increased PWV.
Dyslipidaemia was also associated with increased PWV, most strong-
ly with increased triglycerides (β = 0.278 95% CI 0.082–0.476).
There was a strong association with increased systolic (β = 0.015
95% CI 0.008–0.021) and diastolic blood pressure (β = 0.034 95% CI
0.023–0.044). Relationships weakened within twin pairs, suggesting
that the associations are at a familial level.
Conclusions: Accepted adult characteristics of metabolic syndrome
are associated with increased PWV in pre-pubertal children.
581: NEW PREDICTORS OF SUSTAINED VENTRICULAR
TACHYARRHYTHMIA IN REPAIRED TETRALOGY OF
FALLOT
Beatrice Bonello1, Aleksander Kempny1, Wei Li1, Philip J Kilner 1,
Gerhard-Paul Diller1, Dudley J Pennell1,2, Darryl F Shore1, Sabine I
Ernst1,2, Michael A Gatzoulis1,2, Sonya V Babu-Narayan 1,2
1Royal Brompton and Harefield NHS Foundation Trust, Sydney
Street, London
2NIHR Cardiovascular Biomedical Research Unit, Royal Brompton
Hospital and National Heart & Lung Institute, London
Objectives: Investigation of whether cardiac anatomy and function
predict arrhythmia.
Background: Repaired tetralogy of Fallot (rtoF) patients are at risk
of ventricular tachyarrhythmia and sudden cardiac death. Risk strati-
fication for arrhythmia remains difficult.
Methods: One-hundred-and-fifty-four adults with rtoF, median age
30.8 (21.9–40.2) years, were studied with a standardised protocol
including cardiovascular magnetic resonance (CMR) and prospec-
tively followed-up over median 5.6 (4.6–7.0) years for the prespeci-
fied endpoints of new-onset ventricular tachyarrhythmia (sustained
ventricular tachycardia/ventricular fibrillation).
Results: Nine patients had ventricular tachyarrhythmia (6%) during
follow-up. Patients who developed ventricular tachyarrhythmia were
older (42.5 [34.9–50.2] vs 29 [21–40] years; p = 0.01), had a later
repair (12.8 [6.2–13.9] vs 4.4 [2–8] years; p = 0.02), larger akinetic
right ventricular outflow track (RVOT) region (length 55 [34–60]
vs 30 [20–40] mm; p = 0.002) and a lower RV ejection fraction (42
[40–52] vs 53 [51–55] %; p = 0.01), compared to the other patients.
On univariate Cox analysis, RVOT akinetic region length and RV
ejection fraction were predictive of ventricular tachyarrhythmia. On
stepwise Cox regression analysis, the RVOT akinetic region length
was the only remaining predictor (hazard ratio 1.05, 95% confidence
interval 1.01–1.08 per mm; p = 0.004). The survival ROC curve anal-
ysis indicated a cut-off value of 30 mm as a predictor of ventricular
arrhythmia during 6-year follow-up with an AUC of 0.77, sensitivity
of 83% and specificity of 61%. RVOT akinetic area length >30 mm
predicted reduced ventricular arrhythmia-free survival (logrank p =
0.002)
Conclusions: RVOT akinetic region length predicts ventricular
arrhythmia in late follow-up of rtoF. This is a simple, feasible meas-
urement for inclusion in serial surveillance and risk stratification of
rtoF patients.
583: IS GROWN UP CONGENITAL HEART DISEASE (GUCH)
DIFFERENT IN A DEVELOPING COUNTRY? AN EXPERI-
ENCE FROMA TERTIARY CARE HOSPITAL IN PAKISTAN
Syed Shahabuddin, Shahid Sami, Shumaila Furnaz, Muneer
Amanullah
Section of Cardiothoracic Surgery, Aga Khan University Hospital,
Karachi, Pakistan
Background: In the current era grown up congenital heart disease
(GUCH) patients undergoing surgical intervention are increasing.
There is considerable literature to suggest that most of the inter-
ventions in developed countries are in the form of re-operation in
patients who had previously undergone repair, palliation or correc-
tion. However in a developing country like ours, most of the interven-
tions are primary and corrective.