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Objectives: Study population: among 850 consecutive patients with suspected VVS weobserved a cohort of 500 women at age 13-79 yrs (median of age 37,5), referred to HUTTaccording to the ESC 2009 guidelines, was recruited.Methods: Phase of menses period was described as phase II if covered last 14 days ofmenstruation cycle or phase I – when covered the period before phase II.According to results of HUTT the type of VVS, the duration of total HUTT and both

passive and active phase were evaluated in relation to presence of menstruation and thephase of menses period.Results: mong all studied women 315 pts were still menstruated (median of age 25 yrs;IQR 16-57): 170 (34.0%) in follicular, and 145 (29.0%) in luteal phase of the menstrualcycle whereas 185 (37.0%) underwent menopause (median of age 65 yrs; IQR 42-82);Mean age of first syncope was significantly lower in menstruated female in relation to

those after menopause (median of age: 30 [IQR 14-56] vs 15 [IQR 10-21] yrs, p<0,0001).There was no difference between menstruating women in whom HUTT was performed

at 1st and 2nd phase of menstruation cycle, regarding age of first syncope, number ofsyncope/presyncope episodes and CSSS results.Vasodepressive VVS response was more frequently observed in women after menopause

(29,9 vs 9,7%, p<0,0001), whereas cardioinhibitory (24,1 vs 9,0 %, p<0,0001) and mixed(45,7 vs 36,3%, p<0,001) responses were more frequent in menstruated ones.Younger woman (age < median of age in whole group – 37,5 yrs) have similar distri-

bution of type of VVS response during HUTT to menstruated ones, whereas type ofresponse distribution in women after menopause was parallel to older ones (> 37,5 ys)Conclusion:

1. Higher incidence of vasodepressive reaction in postmenopausal women in com-parison to premenopausal women was noticed. Differences of type of vasovagalresponse during HUTT seems to be more relative to the age of women than thepresence of menstruation.

2. Age of first syncope presentation was significantly lower in menstruating women inrelation to females after menopause – it may suggest different patomechanism ofvasovagal syncope in these group of women (classical VVS or vasovagal disease).

Disclosure of Interest: None Declared

PW033

Management of Cardiovascular Emergencies in the Dental Office

Lilia Timerman*1, Ana Carolina P. D. Andrade1, Gabriella A. M. D. C. D. Angelis1,Valeria C. L. D. Souza1, Viviane U. S. D. Souza1, Karen Abrão2, Sergio Timerman31Dentistry departament, Dante Pazzanese Institute of Cardiology, 2Medical department,Anhembi Morumbi University, 3Medical department, Laureate International Universities, SaoPaulo, Brazil

Introduction: Dentists must be prepared to manage medical emergencies which may arisein practice.Objectives: In Sao Paulo, Brazil, a study was conducted between 2011 and 2012 by DantePazzanese Institute of Cardiology Dental Depatment.Methods: The data was collected via self administered questionnaires prepared. Thequestionnaires were distributed among specialist dentists. Statistical analysis used:Descriptive statistics and analysis of variance were carried out, and a value of p, 0.05 wasconsidered to be significant.Results: The results from this study showed that anywhere from 21% to 42% of dentistshad a patient with a cardiovascular emergency in any one year. Most of these complica-tions, approximately 80%, were mild, but 3% were considered to be serious. It was foundthat 35% of the patients were known to have some underlying disease. Cardiovasculardisease was found in 73% of those patients.Medical emergencies were most likely to occurduring and after local anesthesia, primarily during tooth extraction and endodontics. Over60% of the emergencies were syncope, with hyperventilation the next most frequent at 7%.In addition to syncope, other emergencies reported to have occurred include allergic re-actions, angina pectoris/myocardial infarction, cardiac arrest, postural hypotension, sei-zures, bronchospasm and diabetic emergencies.Conclusion: The extent of treatment by the dentist requires preparation, prevention andthen management, as necessary. Prevention is accomplished by conducting a thoroughmedical history with appropriate alterations to dental treatment as required. The mostimportant aspect of nearly all medical emergencies in the dental office is to prevent, orcorrect, insufficient oxygenation of the brain and heart. Therefore, the management of allmedical emergencies should include ensuring that oxygenated blood is being delivered tothese critical organs. This is consistent with basic cardiopulmonary resuscitation, withwhich the dentist must be competent.Disclosure of Interest: None Declared

PW037

Management of heart failure patients admitted under cardiologists or generalphysicians

Ian G. Matthews*1, Daniel D’Souza1, David Prior2, John Santamaria3, Belinda Smith11General Medicine, 2Cardiology, 3Intensive Care, St Vincent’s Hospital, Melbourne, Australia

Introduction: Previous studies have suggested that patients treated in hospital for heart failurehave improved outcomes if treated by Cardiologists rather than other Physicians. A few studieshave also suggested that Cardiologists aremore likely to follow evidence-based practice in termsof heart failure management, but no studies have been conducted in Australia.Objectives: The objective of this study was to show a statistical significant difference in themanagement of patients looked after by the cardiology unit, with respect to evidence basedmanagement of heart failure, when compared to the general medicine teams.

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Methods: We did a retrospective comparison of 399 hospital admissions for heart failurebetween 1st January 2012 and 31st December 2012 admitted under Cardiology or GeneralMedical teams. We analysed the patients’ histories relating to these admissions looking intodifferent aspects of heart failure management, including; inpatient investigations, medicaltherapy, device therapy, coronary intervention, consideration of transplantation as well asfollow up plan for these patientsResults: Analysis of 399 patient admissions (307 admissions under cardiology unit and 92under general medical unit) demonstrated a significantly higher number of appropriate pa-tients treated with Angiotensin Converting Enzyme (ACE) inhibitor or Angiotensin ReceptorBlocker (ARB) therapy (P<0.001), Beta blocker therapy (P<0.001), spironolactone oreplerenone therapy (P¼0.002). There was also a significant increase in referrals to OutpatientHeart Failure Rehabilitation programs (P<0.001). Patients admitted under the Cardiologyunit were also much more likely to have certain inpatient investigations including Trans-thoracic Echocardiogram (TTE) and Coronary Angiogram (P<0.001 for both investigations).

Conclusion: Based on data from this retrospective study, there are many aspects ofinvestigation and management that may explain why outcomes of patients admitted withheart failure under cardiology teams have improved outcomes in other studies. This studyhighlights some areas that may be able to be improved by general medical teams tooptimise outcomes in patients admitted with heart failure.Disclosure of Interest: None Declared

PW038

How Active Are Heart Transplant Recipients After Their Transplant?

Scott C. Mckenzie*1,2, Rebecca Francis3, Martin R. Brown2, David G. Platts1,2, Jared Brunning4,Helen Seale4, James Walsh31Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital, 2School ofMedicine, University of Queensland, 3Physiotherapy, 4The Prince Charles Hospital, Brisbane,Australia

Introduction: Weight gain and obesity are common after heart transplantation. Obesityafter heart transplant is associated with worse prognosis. No studies have directly assessedthe effect of physical activity levels on weight gain after heart transplant.Objectives: This study was to quantify physical activity levels of heart transplant recipients.Methods: Transplant recipients > 6 months post heart transplant were invited to partic-ipate at the time of their attendance at outpatient clinic. Recipients were excluded if theyhad a rejection episode within 2 months, reduced left ventricular systolic function or arecent injury or illness that could reasonably be expected to reduce their mobility. Subjectswore a Sensewear Pro 3 Armband (“Sensewear”) for 7 days. This well validated deviceprovides information on energy expenditure, time spent above different METS levels, timelying down, sleeping duration and steps per day. Average daily physical activity level (PAL)can be expressed as an index, comparing activity whilst sleeping (1.0 METS) with activityfor the day as a whole. A PAL of 1.69 is considered physically active according to WorldHealth Organisation (WHO). The Sensewear data was analysed.Results: Thirty two patients were recruited. Mean age 60 years, 16% female. Mean BMI27.9. Mean daily PAL 1.65 (SD: 0.46). Only 25% of patients achieve a mean PAL > 1.67.Mean daily total energy expenditure 1.42 METs (SD: 0.42). Mean daily steps 7518 (SD:3654). Mean daily hours lying down: 8.7 (SD: 2.0). Mean sedentary hours 20.7 (as definedby MET < 3.0). Mean hours engaged in moderate activity: 1.7 (SD: 1.8). Mean hoursengaged in more than moderate activity: 0.35 (SD: 0.79).Conclusion: Despite having no disability precluding physical activity, most heart trans-plant recipients in good physical health do not achieve WHO recommended levels ofphysical activity.Disclosure of Interest: None Declared

PW041

Influence of high intensity training on erectile function of patients with heart failure

Sabrina W. Sties1, Anderson Z. Ulbrich1, Lourenço S. de Mara1, Ana I. Gonzáles1,Almir Schmitt Netto1, Gabriela D. de Carvalho1, Helena D. O. Braga1, Daiana C. Bundchen1,Daiane P. Lima1, Tales de Carvalho*11Cardiology and Exercise Medicine Center, Santa Catarina State University, Florianópolis, Brazil

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Introduction: It has been shown that high intensity training is more effective in treatingpatients with heart failure (HF) however studies haven’t been evaluated sexual function.Objectives: To compare moderate versus high intensity exercise with regard to sexual andcardiorespiratory function.Methods: Twenty patients with stable HF (aged 53.25 � 8.87 years), left ventricle ejectionfraction � 45%, were randomized to moderate continuous training (MCT) or high-in-tensity interval training (HIT). The subjects underwent 12 weeks of exercise training, threetimes per week, in MCT target zone of heart rate (HR) corresponding to anaerobicthreshold (first ventilatory threshold) and in HIT the HR corresponding to respiratorycompensation point (second ventilatory threshold) alternating with HR corresponding toanaerobic threshold (recovery period). Patients underwent assessment of sexual function bythe International Index of Erectile Function (IIEF), determination of VO2 peak by car-diopulmonary exercise testing (CPET), determination of distance walk by the six-minutewalk test (6MWT) and assessment of endothelial function by Doppler echocardiography. Instatistical analysis was used Shapiro-Wilk test, Chi-square (x2), Fisher exact test, t test,Mann-Whitney U and paired t test, with significance level of 5%.Results: Only in HIT was observed increase in erectile function (11 � 10.46 to 19.55 �9.07, p ¼ 0.030), desire (from 4.77 � 2.04 to 6.88 � 2.08, p ¼ 0.034), sexual satisfaction(from 4.00 � 4.63 to 8.33 � 5.36, p ¼ 0.017) and VO2 peak (from 21.07 � 4.30 to 23.79� 5.26, p ¼ 0.021) while in MCT was no significant changes in these outcomes. Distancewalked in 6MWT increased after MCT (462.63 � 63.10 to 603.45 � 67.50, p ¼ 0.003)and HIT(456.44 � 38.51 to 589.66 � 59, 69, p ¼ 0.008). No significant changes occurredin endothelial function (HIT: +43.6%, p ¼ 0.666; MCT:+193%, p ¼ 0.214).Conclusion: High-intensity training was superior than MCT for increase sexual andcardiorespiratory function in patients with heart failure.Disclosure of Interest: None Declared

PW042

Predictors of Mortality in Patients With Hypertrophic Cardiomyopathy - A HospitalAdmissions Study: 2000-2013

Niece K. Khouw1, Mohammed Wasim1, Hardeep Uppal2, Suresh Chandran3, Rahul Potluri*41General Medicine, Pennine Acute Hospital NHS Trust, Manchester, 2Coventry andWarwickshire Partnership NHS Trust, Coventry, 3Acute Medicine, Pennine Acute Hospital NHSTrust, Manchester, 4ACALM Study Unit in collaboration with School of Medical Sciences, AstonUniversity, Birmingham, United Kingdom

Introduction: Hypertrophic Cardiomyopathy (HCM) is a rare condition that can beassoociated with sudden cardiac death. The predictors of mortality in patients with HCMhas not been well studied.Objectives: The aim of this study is to investigate the predictors of mortality in patientswith HCM from a large sample of hospital admissions.Methods: Anonymous information on patients with Hypertrophic Cardiomyopathy, co-morbidities and procedures attending large multi-ethnic general hospitals in Manchester,United Kingdom in the period 2000-2012 was obtained from the local health authoritycomputerised hospital activity analysis register using ICD-10 and OPCS coding systems.Statistical analysis was performed using SPSS version 20.Results: Out of 1,221,216 patients admitted, there were 253 patients with HCM. Themean age of 55.8years�18.8(S.D) with 63.2% male patients VS 36.8% female patients. Themain co-morbidities were Hypertension (86;34.0%), Atrial Fibrillation (69;27.3%), HeartFailure (27;10.7%), Type 2 Diabetes Mellitus (24;9.5%), Ventricular Tachycardia(16;6.3%), Defibrillator Implant (16;6.3%). A multi-nominal logistic regression modelaccounting for variations in age, sex and ethnic group showed that only Atrial Fibrillation(RR3.8;C.I1.7-8.1) and Heart Failure (RR5.0;C.I1.9-13.5) are significant predictors ofmortality (p <0.05).Conclusion: We have shown that Atrial Fibrillation and Heart Failure are significantpredictors of mortality in patients with HCM from a large hospital based sample in the UK.This reflects the known complications of HCM affecting mortality. However, it is surprisingthat Defibrillator implantation does not confer improved mortality. Our improved un-derstanding of these predictors will guide clinicians to focus on these high risk groups toimprove clinical practice and outcomes in patients with HCM.Disclosure of Interest: None Declared

PW043

Predictors of outcome in takotsubo cardiomyopathy – a multicenter study

Nuno S. Marques*1, Olga Azevedo2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado1,Vitor Pereira2, Ana Rita Almeida3, SUNSHINE1Cardiology, Faro Hospital, Faro, 2Cardiology, CHAA, Guimarães, 3Cardiology, H. Garcia Orta,Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do Castelo,Portugal

Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ven-tricular (LV) dysfunction in the absence of significant coronary artery disease. The pre-dictors of prognosis of TC are not yet fully established.Objectives: To identify predictors of outcome in patients (P) diagnosed with TC.Methods: Multicenter studyinvolving 5 hospital centers that included all patients diag-nosed with TC in the last 10 years. We assessed demographic data, precipitating factors andclinical presentation, trying to establish the predictors of after discharge outcomes.Results: We included 71 P diagnosed with TC. During hospitalization (6.1 � 4.6 days)occurred complications: heart failure (31%), cardiogenic shock (15.5%), atrial fibrillation(9.9%), complete atrioventricular block (4.2 %), acute pulmonary edema (4.2%), stroke /TIA (2.8%), LV thrombus (1.4%) and death (1.4%).

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Over a follow-up of 31 � 29 months, there were: TC recurrence (4.2%), stroke / TIA(4.2%) and death (1.4%).The following variables were identified as predictors of complications at follow-up: (i) ST

segment depression on admission EKG was a predictor of TC recurrence (p¼0,016); (ii)Chronic renal failure was a predictor of stroke/TIA (p¼0.023) and death (p¼0,027).Conclusion: TC has a low rate of complications in the follow-up. Chronic renal failure is apredictor of death and also of stroke in the follow-up. The admission EKG may have aprognostic role and ST segment depression was the only identified predictor of TCrecurrence. Our results need confirmation in larger studies.Disclosure of Interest: None Declared

PW044

Predictors of in-hospital outcome in takotsubo cardiomyopathy – A multicenter study

Nuno S. Marques*1, Olga Azevedo2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado1,Vitor Pereira2, Ana Rita Almeida3, SUNSHINE1Cardiology, Faro Hospital, Faro, 2Cardiology, CHAA, Guimarães, 3Cardiology, H. Garcia deOrta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana doCastelo, Portugal

Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ven-tricular (LV) dysfunction in the absence of significant coronary artery disease. The pre-dictors of prognosis of TC are not yet fully established.Objectives: To identify predictors of outcome in patients (P) diagnosed with TC.Methods: Multicenter study involving 5 hospital centers that included all patients diag-nosed with TC in the last 10 years.Results: We included 71 P diagnosed with TC. During hospitalization (6.1 � 4.6 days)occurred complications: heart failure (31%), cardiogenic shock (15.5%), atrial fibrillation(9.9%), complete atrioventricular block (4.2 %), acute pulmonary edema (4.2%), stroke /TIA (2.8%), LV thrombus (1.4%) and death (1.4%).In the multivariate analysis, the following variables were identified as independent

predictors of in-hospital complications: (i) Predictors of complete atrioventricular blockwere angina pectoris (p¼0,028), syncope at presentation (p¼0,012), ST segment elevationon the admission EKG (p¼0,010) and T wave inversion (p¼0,043); (ii) ST segmentdepression on the admission EKG was identified as a predictor of acute pulmonary edema(p¼0,029); (iii) LV dysfunction was an independent predictor of heart failure (p¼0,003),acute pulmonary edema (p¼0,015), stroke/TIA (p¼0,035) and death (p¼0,049); (iv) Malegender was an independent predictor of stroke/TIA (p¼0,013) and death (p<0,001); (v)Other predictors of death were diabetes mellitus (p¼0,007), chronic renal failure(p¼0,048), syncope at presentation (p¼0,036).Conclusion: TC has a high rate of complications in the acute phase. TC, a disease of mainlyfemales, has worse in-hospital prognosis in males. Male gender is a predictor of in-hospitalstroke/TIA and death. Diabetes, chronic renal failure, syncope at presentation and LVdysfunction were also predictors of in-hospital death.Disclosure of Interest: None Declared

PW045

Is prognosis of takotsubo cardiomyopathy related with the speed of recovery of leftventricular function?

Olga Azevedo*1, Nuno S. Marques2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado2,Vitor Pereira1, Ana Rita Almeida3, SUNSHINE1Cardiology, CHAA, Guimarães, 2Cardiology, Faro Hospital, Faro, 3Cardiology, H. Garcia deOrta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana doCastelo, Portugal

Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ven-tricular (LV) dysfunction. The recovery rate of LV function is variable. There is lack of datawith respect to the impact of the rate of recovery of LV function in the prognosis of TC.Objectives: To determine if the patients diagnosed with TC that present a faster recovery ofLV function have better medium term prognosis.Methods: Multicenter study involving 5 hospitals that included all patients diagnosed withTC in the last 10 years. We assessed patients with echocardiography at admission,discharge and at follow-up. Full recovery was defined as complete normalization of LVglobal function and segmental motility. We established the discharge time and 15 days afteradmission as cut-offs for recovery of LV function. We determine if the patients with fasterrecovery of LV function had better medium term prognosis.Results: We included 71 patients with TC. Total recovery of LV function was observed athospital discharge in 27 patients (38,0%) and at 15 days after admission in 31 patients(43,7%).The recovery of LV function during the hospital stay was not associated with death (0%

vs 2,7%, p¼0,437), stroke/TIA (5,4% vs 4,5%, p¼0,884) or TC recurrence (0% vs 8,1%,p¼0,170) in the follow-up. In the multivariate analysis, the faster recovery of LV functionwas not an independent predictor of events.The recovery of LV function at 15 days after admission was not associated with death

(0% vs 2,8%, p¼0,410), stroke/TIA (4,2% vs 5,6%, p¼0,809) or TC recurrence (0% vs8,3%, p¼0,147) in the follow-up. In the multivariate analysis, the faster recovery of LVfunction was not an independent predictor of events.Conclusion: In this multicenter study, the patients with TC that present a faster recovery ofLV function do not have a better medium term prognosis. However, the low rate ofcomplications in the follow-up may have limited the study results. Our results need furtherconfirmation in larger studies.Disclosure of Interest: None Declared

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