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172 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

ment of medical specialists within Europe harmonisation and stand-

ardisation of the training in cardiology is of utmost urgency and a

vital need.

Endothelial Progenitor Cells Are Reduced in Type 2

Diabetic Patients with Microalbuminuria and Macro-

albuminuria 089

G.-H. Schernthaner

, J. Brix

, A. Feder

, F. Hoellerl

, R. Koppensteiner

G. Schernthaner

Department of Internal Medicine II, Medical University of Vienna;

Department of

Internal Medicine I Rudolfstiftung Hospital, Vienna

Type 2 diabetic (T2D) patients presenting with microalbuminuria

(Mi-A) or macroalbuminuria (Ma-A) have an increased risk for car-

diovascular morbidity and mortality. Endothelial progenitor cells

(EPC) are bone marrow derived cells involved in adult neovascu-

larisation and endothelial homeostasis and may predict macro-

vascular disease and mortality. Thus, it was of interest to investigate

the potential role of EPC in T2D patients presenting with Mi-A or

Ma-A in comparison with normoalbuminuric (No-A) patients.

138 patients with T2D were included: 72 No-A, 42 Mi-A and 24

Ma-A. The patients in the 3 groups were carefully matched and did

not differ (by ANOVA) for the following: age (65.0 ± 10.6 years),

diabetes duration (13.1 ± 9.5 years), HbA1c (7.8 ± 1.6 %), BMI

(29.8 ± 5.1 kg/m

), systolic and diastolic blood pressure, total cho-

lesterol, LDL-cholesterol, triglyceride as well as serum creatinine

(1.2 ± 0.4 mg/dl) (given are mean of all patients). Circulating pro-

genitor cells (CPC; CD34+/133+) and EPC (CD34+/133+/309+)

were enumerated by flow cytometry in peripheral blood.

EPC were decreased in patients presenting with Mi-A compared

with patients with No-A (102 ± 54 vs 144 ± 84; p = 0.01). In patients

with Ma-A the number of EPC was even more decreased (53 ± 29 vs

144 ± 84; p < 0.001). Patients with Mi-A or Ma-A were also signifi-

cantly different for the number of EPC (102 ± 54 vs 53 ± 29;

p < 0.001). By contrast, total circulating progenitor cells, which

have mainly an important role in hematopoiesis, were not signifi-

cantly different among the 3 groups of T2D patients with No-A, Mi-

A or Ma-A (p = 0.16).

Multivariate regression analysis revealed that EPC were independ-

ently associated with diabetes duration (Beta = 0.165; p = 0.036)

and history of cardiovascular disease (Beta = –0.203; p = 0.01) but

strongest with status of albuminuria (Beta = –0.380; p < 0.001).

In conclusion, this is the first study demonstrating decreased num-

bers of endothelial progenitor cells in T2D patients with micro-

albuminuria or macroalbuminuria. Since low EPC are important

predictors of future cardiovascular morbidity and mortality in

nondiabetic high risk patients, these new findings could be relevant

for the understanding of the high cardiovascular risk of T2D

patients with microalbuminuria or macroalbuminuria.

Der transfemorale Aortenklappenersatz – Interims-

analyse der kardiologischen Abteilung der Medizini-

schen Universität Wien 104

S. Scherzer

, M. T. Kasimir

, G. Kreiner

, Th. Neunteufl

, G. Delle-Karth

R. Rosenhek

, Th. Binder

, P. Simon

, H. Baumgartner

, W. Wisser

, D. Glogar

Abteilung für Kardiologie, Innere Medizin II, Medizinische Universität Wien;

Abteilung für Herz-Thoraxchirurgie, Medizinische Universität Wien

Einleitung In mehreren rezenten Studien mit kleiner Fallzahl

konnte der transfemorale Aortenklappenersatz (transfem AKE) als

Option in multimorbiden Herzpatienten (EuroScore > 20) mit hoch-

gradiger Aortenstenose dargestellt werden. Dies ist eine Interims-

analyse aller bis zuletzt an unserem Zentrum durchgeführten

transfem AKEs.

Patienten und Methodik Seit Mai 2007 sind in unserem

Herzkatheterlabor 20 Aortenklappen (AK) implantiert worden.

Das durchschnittliche Alter dieser Patienten betrug 83 Jahre, der

durchschnittliche logistische EuroScore 25,88 % (NYHA-IV: n = 3,

NYHA-III: n = 11 und NYHA-II: n = 6). Nach entsprechen-

den Screening-Untersuchungen des vaskulären Zugangs erhielten

16 Patient/innen eine Edwards Sapiens Klappe und 4 eine Core

Valve.

Resultate Die Erfolgsrate der Klappenimplantation betrug 100 %.

Die durchschnittliche Interventionsdauer lag bei 176,73 min. Post-

interventionell zeigte sich in der Echokardiographie bei 11 Patient/

innen eine leichte valvuläre, bei 8 eine leichte paravalvuläre und bei

6 eine mittelgradige paravalvuläre Insuffizienz. Periprozedural

ereignete sich bei einer Patientin eine Perikardtamponade und bei

einer anderen ein Insult. Im Bereich der Beckenarterien kam es zu

5 Dissektionen und einer Perforation, welche 3× katheterinterven-

tionell und 3× konservativ geführt wurden. Im Follow-up lag die

30-Tage-Mortalität bei 0 %. Der durchschnittliche Intensivaufent-

halt betrug durchschnittlich 1,75 Tage (1–14 Tage), der Spitalsauf-

enthalt 18,11 Tage (6–84 Tage). Die Patienten zeigten postinter-

ventionell eine deutlichen Verbesserung des funktionellen Status

(NYHA-III: n = 4, NYHA-II: n = 5, NYHA-I: n = 11).

Konklusion Angesichts der hohen primären Erfolgsrate, der nied-

rigen 30-Tage-Moratlitätsrate und der guten funktionellen Ergeb-

nisse erscheint der transfem AKE als eine vielversprechende

Methode zur Therapie der hochgradigen Aortenklappenstenose bei

multimorbiden Patienten.

Accurately Measured and Heart-Rate Corrected QTc

Intervals Do Not Show Any Day-Time Variability 109

A. Schmidt

, B. Vogel

, P. Smetana

, K. Hnatkova

, K. Huber

, M. Malik

Wilhelminenhospital, Vienna, Austria;

St Paul’s Cardiac Electrophysiology,

London, United Kingdom

Background Circadian rhythm of heart rate corrected QTc inter-

val has been repeatedly reported with conflicting and inconsistent

results. At the same, QTc spontaneous variability is of particular im-

portance for clinical studies investigating proarrhythmic liability of

pharmaceutic compounds.

Aim The study investigated the extent of QTc variability due to

imprecise heart rate correction and inaccurate expression of RR in-

terval used in the correction of QT interval.

Methods 24-hour continuous 12-lead ECG recordings were ob-

tained in 54 male healthy volunteers. In each recording, ~ 200 ECG

samples of 10-sec duration were obtained throughout the whole

day-time recordings period, all preceded by relatively stable heart

rates (fluctuations ≤ ± 2 bpm). In each of the ECG samples, QT in-

terval was measured in 1000 Hz sampled superimposed images of

all 12 leads by two independent cardiologists. The measurement

was repeated and reconciled by a third cardiologist in case of dis-

agreement. Four different RR interval expressions were used: (a)

average of 3 first RR intervals of the ECG sample, (b) average of all

RR intervals in the 10-sec sample, (c) average of 250 RR intervals

within and preceding the 10-sec sample, and (d) these 250 RR inter-

vals processed by an independently established QT/RR hysteresis

profile optimised for each subject separately. With all RR interval

expressions, the QT intervals were corrected by Fridericia correc-

tion and by individually optimised curvature correction. The vari-

ability of QTc interval was expressed by intra-individual standard

deviation.

Results With Fridericia correction and the RR expressions (a)–

(d), the QTc variability obtained was (a) 8.6 ± 1.5 ms, (b) 6.9 ±

1.4 ms, (c) 6.3 ± 1.7 ms, and (d) 5.6 ± 1.7 ms, while with individu-

alised curvature correction, the QTc variability was (a) 7.4±1.5 ms,

(b) 5.8 ± 1.3 ms, (c) 5.2 ± 1.3 ms, and (d) 4.4 ± 1.3 ms. All differ-

ences (b) vs (a), (c) vs (b), and (d) vs (c) were highly statistically

significant (p < 1.0E-10 in all cases).

Conclusion The previously reported QTc variability was largely

resulting from methodological imprecision. Providing the ECG

signals are measured accurately and the QT interval is corrected for

RR interval expressing the appropriate heart rate, there is practically

no QTc variability in day-time recordings of healthy subjects.

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