Young Investigator Award. Young Investigator Award. Date: 9th April 2016 Venue: Parry Room, Le Meridien KL YIA 1 YIA 1

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1 Young Investigator Award Young Investigator Award Date: 9th April 06 Venue: Parry Room, Le Meridien KL Date: 9th April 06 Venue: Parry Room, Le Meridien KL YIA Time: hr VALIDATION OF THE SAME-TTR SCORE IN ATRIAL FIBRILLATION PATIENTS ON WARFARIN THERAPY: A MULTICENTER, MULTIETHNIC ASIAN COHORT Cham Yee Ling, Melissa Lim Siaw Han,3, Tiong Lee Len,3, Shirley Tan Siang Ning,3, Ku Ming Ying,3, Crystal Tan Sing Yee,3, Eileen Lau Ruey Lee 4, Nor Azila Abdul Latif 4, Lum Kah Yee 3, Lee Qian Jin 3, Kwong Chea Ing 5, Kalyhani Nagappa 5, Ong Tiong Kiam, Alan Fong Yean Yip, Department of Cardiology, Sarawak Heart Centre, Kota Samarahan, Sarawak; Clinical Research Centre, Sarawak General Hospital, Kuching, Sarawak; 3 Department of Pharmacy, Sarawak Heart Centre, Kota Samarahan, Sarawak; 4 Department of Pharmacy, Sarawak General Hospital, Kuching, Sarawak; 5 Department of Pharmacy, Bau Hospital, Bau, Sarawak. YIA Time:35-50 hr VALIDATION OF THE SAME-TTR SCORE IN ATRIAL FIBRILLATION PATIENTS ON WARFARIN THERAPY : A MULTICENTER, MULTIETHNIC ASIAN COHORT Cham Yee Ling, Melissa Lim Siaw Han,3, Tiong Lee Len,3, Shirley Tan Siang Ning,3, Ku Ming Ying,3, Crystal Tan Sing Yee,3, Eileen Lau Ruey Lee 4, Nor Azila Abdul Latif 4, Lum Kah Yee 3, Lee Qian Jin 3, Kwong Chea Ing 5, Kalyhani Nagappa 5, Ong Tiong Kiam, Alan Fong Yean Yip,. Department of Cardiology, Sarawak Heart Centre, Kota Samarahan, Sarawak; Clinical Research Centre, Sarawak General Hospital, Kuching, Sarawak; 3 Department of Pharmacy, Sarawak Heart Centre, Kota Samarahan, Sarawak; 4 Department of Pharmacy, Sarawak General Hospital, Kuching, Sarawak; 5 Department of Pharmacy, Bau Hospital, Bau, Sarawak. ANNUAL SCIENTIFIC MEETING 06 4 YIA Time: hr LEFT VENTRICULAR GEOMETRY AND ITS IMPACT IN AORTIC VALVE AREA MEASUREMENTS FOR PATIENT WITH AORTIC STENOSIS USING REAL-TIME 3D TRANSOESOPHAGEAL ECHOCARDIOGRAPHY Effarezan Abdul Rahman, Johan Rizwal Ismail, Ding Zee Pin, Rizmy Najme Khir, Lim Chiao Wen, Nicholas Chua, Zubin Othman, Hafisyatul Aiza Zainal Abidin, Mohd Kamal Mohd Arshad, Sazzli Kasim Universiti Teknologi MARA (UiTM) and National Heart Centre Singapore YIA 3 Time: 05-0 hr EFFICACY AND SAFETY OF HIGH-DOSE ROSUVASTATIN LOADING AT EMERGENCY ROOM BEFORE PERCUTANEOUS CORONARY INTERVENTION AMONG PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROME, A PILOT STUDY. Koo Kim Lim, Oteh Maskon, Hamat Hamdi Che Hassan, Mohd. Rafizi Md Rus 4, Choor Chee Ken, Shawal Faizal Mohamad, Ismail Mohd Saiboon, Azmil Tamil 3. Department Of Medicine, Unit Cardiology, Department Of Emergency Medicine, 3 Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia 4 Department of Medicine, Unit Cardiology, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur Malaysia. YIA 4 Time: 0-35 hr THE HKL-IJN 4-HOUR STEMI NETWORK: EARLY OUTCOME OF THE PILOT PROJECT TO IMPROVE DELIVERY OF PRIMARY PCI FOR STEMI Jayakhanthan Kolanthaivelu, Al-Fazir Omar, Rahal Mohamed Yusoff, Mahathar Abdul Wahab, Alzamani Mohammad Idrose, Farina Mohd Salleh, Rossman Hawari, Intan Safarinaz, Aizai Azan Abd Rahim, Rosli Mohamed Ali Institut Jantung Negara, Kuala Lumpur, Malaysia Hospital Kuala Lumpur, Kuala Lumpur, Malaysia YIA 5 Time: hr EARLY AND LATE LEFT VENTRICULAR GLOBAL FUNCTION INDEX AS A PREDICTOR OF LEFT VENTRICULAR REMODELING AFTER SUCCESSFUL REPERFUSION IN ACUTE MYOCARDIAL INFARCTION Oon Yen Yee, Nor Hanim Mohd Amin, Koh Keng Tat, Asri Said,, Khiew Ning Zan, Voon Chi Yen, Oon Yen Yee, Cham Yee Ling, Tan Sian Kong, Alan Fong Yean Yip, Ong Tiong Kiam. Department of Cardiology, Sarawak Heart Centre, Sarawak Malaysia Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia YIA 6 Time: hr P WAVE DISPERSION AND ITS ASSOCIATION WITH HYPERTENSION Lim Chiao Wen, Johan Rizwal Ismail, Nicholas Chua Yul Chye, Rizmy Najme Khir, Effarezan Abdul Rahman, Hafisyatul Aiza Zainal Abidin, Zubin Othman Ibrahim, Sazzli Shahlan Kasim, Khalid Yusoff. Universiti Teknologi MARA BACKGROUND: The SAMe-TTR score is based on simple clinical parameters and predicts anticoagulation control in patients with atrial fibrillation (AF) on vitamin K antagonists (VKA). A score of 0- identifies patients with good anticoagulation control (indicated by time in therapeutic range (TTR) 65%) and score those with poor control (TTR<65%). The clinical implication is candidacy for novel oral anticoagulation drugs or additional interventions in patients likely to do poorly on VKA. However, this score has only been validated in monocentric, selected populations with no validation study in a multiethnic Asian population to date. OBJECTIVE: To validate the SAMe-TTR score in a multicenter, multiethnic Asian cohort. METHOD: 538 patients with AF on VKA from 3 outpatient anticoagulation clinics in Sarawak were recruited between November 05 to February 06. The inclusion criteria were VKA therapy for at least months or at least 0 available INR readings. The exclusion criteria were periods of dose initiation/adjustment, and intentional lowering/ discontinuation for interventional procedures. The TTR for each patient was calculated (Rosendaal method) and SAMe-TTR, CHADS-VASc and HASBLED scores determined. RESULTS: The cohort consisted of Chinese(4.8%), non-malay Bumiputera(30.7%) and Malay(6.6%). 99(55.6%) were males. The mean age was 65.6(+.4) years. The mean TTR was 64.3(+.38). 86 (53.%) and 5(46.8%) had stable TTR( 65%) and unstable TTR(<65%) respectively. The mean SAMe-TTR score was 3.44(+0.99). The mean CHADS- VASc and HASBLED scores were 3.04(+.69) and.5(+0.96) respectively. There is a progressive decline in mean TTR with increasing SAMe-TTR scores. Scores of, 3 and 4 corresponded with a mean TTR of 66.04(+8.89), 64.7(+.44) and 63.6(+.9)] respectively. However only score >4 was significant in discriminating poor anticoagulation control (95% CI.06-.8, p=0.09) with an odds ratio of.7. CONCLUSION: In this multicenter, multiethnic Asian cohort with AF on warfarin, only a SAMe- TTR score >4 was able to discriminate poor anticoagulation control. Therefore the proposed cut off score of may not be applicable in our population. A larger cohort is warranted to validate this finding. 5

2 Young Investigator Award Date: 9th April 06 Venue: Parry Room, Le Meridien KL YIA Time: hr LEFT VENTRICULAR GEOMETRY AND ITS IMPACT IN AORTIC VALVE AREA MEASUREMENTS FOR PATIENT WITH AORTIC STENOSIS USING REAL-TIME 3D TRANSOESOPHAGEAL ECHOCARDIOGRAPHY Effarezan Abdul Rahman, Johan Rizwal Ismail, Ding Zee Pin, Rizmy Najme Khir, Lim Chiao Wen, Nicholas Chua, Zubin Othman, Hafisyatul Aiza Zainal Abidin, Mohd Kamal Mohd Arshad, Sazzli Kasim Universiti Teknologi MARA (UiTM) and National Heart Centre Singapore YIA 3 Time: 05-0 hr EFFICACY AND SAFETY OF HIGH-DOSE ROSUVASTATIN LOADING AT EMERGENCY ROOM BEFORE PERCUTANEOUS CORONARY INTERVENTION AMONG PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROME, A PILOT STUDY Koo Kim Lim, Oteh Maskon, Hamat Hamdi Che Hassan, Mohd. Rafizi Md Rus 4, Choor Chee Ken, Shawal Faizal Mohamad, Ismail Mohd Saiboon, Azmil Tamil 3. Department Of Medicine, Unit Cardiology, Department Of Emergency Medicine, 3 Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia 4 Department of Medicine, Unit Cardiology, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur Malaysia. ANNUAL SCIENTIFIC MEETING 06 BACKGROUND: Variability in left ventricular outflow tract (LVOT) geometry has been described and exert important effect on aortic valve area (AVA) calculation in patients with aortic stenosis (AS). Studies have shown Asian population has a smaller aortic valve (AV) annulus area compared to Caucasion population and current consensus have not been consistent on the exact point of LVOT measurement by echocardiography.-3 OBJECTIVE: This study investigated the shape of LVOT in Asian population and impact of AVA calculation when LVOT diameter obtained by different methods and various distances from the AV annulus using real-time 3D transoeophageal echocardiography (RT-3DTEE). METHOD: 53 patients with AS planned for trancatheter aortic valve implantation were assessed with RT-3DTEE. LVOT diameter were measured at annulus, mm, 4mm and 6mm from the annulus. AVA was then calculated via direct planimetry, circumference and continuity equation using direct measurement of LVOT diameter as well as mean of maximum and minimum LVOT diameter (Dmean). Eccentricity index (EI) was also calculated using the maximum and minimum LVOT diameter as a marker for ellipticity. RESULT: The mean EI is 0.±0. indicating the LVOT shape in Asian population is elliptical. EI gets bigger when measured further away from the annulus (EI at annulus: 0.4± 0.09, EI mm from annulus: 0.6±0., EI 4mm from annulus: 0.6 ± 0., EI 6mm from annulus: 0.8±0., p<0.00). Of the various ways to measure AVA, direct planimetry, circumference and continuity equation using Dmean-derived LVOT diameter correlated the most with each other (r: 0.9, p<0.0) compared to continuity equation using direct LVOT diameter measurement at the level of annulus. However, when measured further away from the annulus, only AVA calculated by direct planimetry and continuity equation using Dmean-derived LVOT diameter showed highest correlation (r:0.8, p<0.0) CONCLUSION: Despite smaller aortic valve annulus, the LVOT geometry in this sample of Asian population with aortic stenosis is ellipitical, comparable to the Caucasion population. Therefore, using the standard continuity equation assuming LVOT is circular or measuring LVOT away from the AV annulus would result in innacurate AVA calculation. Real-time 3D transoesophageal echocardiography allows alternative method to improve accuracy for AVA calculation. References. Yoon SH, Ohno Y, Araki M et al. Comparison of aortic root anatomy and calcification distribution between Asian and Caucasian patients who underwent transcatheter aortic valve implantation. American Journal of Cardiology 05. 5;6: Baumgartner H, Hung J, Bermejo J et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. European Journal of Echocardiography 009;0: 5 3. Zamorano JL, Badano LP, Bruce C et al. EAE/ASE recommendations for the use of echocardigraphy in new transcatheter interventions for valvular heart disease. European Journal of Echocardiography 0;: BACKGROUND: High-dose statin loading prior to percutaneous coronary intervention (PCI) has been shown to reduce periprocedural myocardial injury and to improve long-term outcomes. However, no conclusive evidence exists to support early loading of high-dose statin in the Emergency Room (ER) among patients presenting with acute coronary syndrome (ACS). OBJECTIVE: We studied the safety and efficacy of early and high-dose rosuvastatin loading followed by high-intensity maintenance therapy as compared to standard practice of prescribing statin, among patients presenting with ACS who were intended to undergo PCI. MATERIALS & METHODS: In a prospective, single-center, randomised, controlled, openlabel pilot study, subjects with ACS were randomised at ER into rosuvastatin group (40mg rosuvastatin loading in ER within the first hours of diagnosis followed by maintenance of 0mg daily dose) or control group (no loading of statin in ER, statin were prescribed as per standard of care). Subsequently, the subjects underwent coronary angiography +/- PCI. We followed up all subjects up to 6 months. The main end points were peak cardiac biomarkers within 48 hours after PCI, and major adverse cardiac or clinical events (MACE) among the subjects received PCI. The secondary end-points included incidence of contrast-induced nephropathy (CIN), LDLcholesterol level reduction, and safety of the high-dose statin loading and chronic high-intensity statin therapy among all studied population. RESULTS: 70 subjects were eligible for study inclusion and randomised into rosuvastatin (n=35) and control (n=35) groups. out of 35 subjects in each group underwent PCI. Although the results were not statistically significant (p>0.05), patients with high-dose rosuvastatin loading in ER (n=) showed a trend to lower peak in cardiac biomarkers at 48 hours post PCI, a lower rate of MACE and CIN. The rosuvastatin group achieved better reductions in LDL (48.3% reduction VS 37.% in the control) though it was not statistically significant. There was improvement in left ventricular ejection fraction in rosuvastatin group (mean 4.03% improvement), compared to control (mean 4.06% reduction), (p<0.0). Both groups of statin treated patients showed no significant derangement in the liver function or side effects. CONCLUSIONS: High-dose statin loading prior to coronary angiography +/- PCI followed by high-intensity maintenance therapy among patients with ACS was safe and not associated with adverse event. There was trend favouring the benefit of high-dose statin loading though statistically not significant. 6 7

3 Young Investigator Award Date: 9th April 06 Venue: Parry Room, Le Meridien KL YIA 4 Time: 0-35 hr YIA 5 Time: hr THE HKL-IJN 4-HOUR STEMI NETWORK: EARLY OUTCOME OF THE PILOT PROJECT TO IMPROVE DELIVERY OF PRIMARY PCI FOR STEMI Jayakhanthan Kolanthaivelu, Al-Fazir Omar, Rahal Mohamed Yusoff, Mahathar Abdul Wahab, Alzamani Mohammad Idrose, Farina Mohd Salleh, Rossman Hawari, Intan Safarinaz, Aizai Azan Abd Rahim, Rosli Mohamed Ali. EARLY AND LATE LEFT VENTRICULAR GLOBAL FUNCTION INDEX AS A PREDICTOR OF LEFT VENTRICULAR REMODELING AFTER SUCCESSFUL REPERFUSION IN ACUTE MYOCARDIAL INFARCTION Oon Yen Yee, Nor Hanim Mohd Amin, Koh Keng Tat, Asri Said,, Khiew Ning Zan, Voon Chi Yen, Oon Yen Yee, Cham Yee Ling, Tan Sian Kong, Alan Fong Yean Yip, Ong Tiong Kiam. Institut Jantung Negara, Kuala Lumpur, Malaysia Hospital Kuala Lumpur, Kuala Lumpur, Malaysia Department of Cardiology, Sarawak Heart Centre, Sarawak Malaysia Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred method of reperfusion in patients with acute ST-segment elevation myocardial infarction (STEMI). This on-going prospective single cluster project is aimed at investigating the impact of a collaborative network on reperfusion time and prognosis of patients with acute STEMI. BACKGROUND: Left ventricular global function index (LVGFI) assessed with cardiovascular magnetic resonance (CMR) integrates LV structure with global function, giving a comprehensive characterization of cardiac performance. ANNUAL SCIENTIFIC MEETING 06 METHODS: Patients who presented with STEMI to HKL from October 04 to October 05 were enrolled. Symptom onset to first medical contact (FMC), door-in-door-out (DIDO), transfer time, FMC to balloon time, door to balloon time (DB IJN) and total ischemic time were recorded and analyzed. We also divided the data into Phase A (Oct 04 to March 05) and phase B (April 05 to Oct 05) and office versus after hours operations. RESULTS: Results are reported as median +/- interquartile range. A total of 55 patients were studied during this period. An increase of 9% (n=8) compared to 03. Majority were males (87%). Age was 5 years (IQR 3-79). Thirty-six percent was diabetic (36%), 39% hypertensive, 45% were smokers and 7% hypercholesterolemia. Anterior STEMI was the commonest (44%). Twenty-three percent was in cardiogenic shock at presentation. Symptom onset to FMC was 5 mins (IQR 75-8min), DIDO was 35 mins (IQR 5-65mins), transfer time was 6 min (IQR 0-3 mins), FMC-balloon was 96 mins (IQR 80- mins) and IJN DB was 4 mins (IQR 35-5mins) and total ischemic time was 57 mins (IQR mins). Length of stay was 3 days (3-5 days). In-hospital mortality was 4.7% and 30-day MACCE was.%. 30-day admission rate for heart failure was.4.%. There was a significant improvement between FMC-balloon between phase A vs. Phase B (.5 mins vs 88mins respectively, p<0.00). About fifty percent presented during office hours (n=8). No significant difference was noted between FMC-balloon between the operational hours (97mins vs 93 mins respectively, p=0.634). CONCLUSIONS: This is the first -year report of a systems timing for a STEMI network in Malaysia. Our study showed that by having a network, successful timely PPCI program can be implemented regardless during or after office hours. Our initial experience has led to a wider Klang-valley STEMI network. OBJECTIVE: To investigate associations of early and late LVGFI with infarct characteristics and LV remodeling. MATERIALS AND METHODS: Over a -year period, consecutive patients admitted with STelevation MI (STEMI) underwent CMR. Out of 9 patients, 80 had TIMI 3 flow during coronary angiography and optimal CMR images for analysis. CMR using a.5t scanner was done twice; at index admission (LVGFIIA) and 6 months later (LVGFI6M). LVGFI was a factor of LV stroke volume divided by LV global volume. LV remodeling was defined as 0% change in LV end-diastolic volume (LVEDV) from baseline. RESULTS: Mean age 53±0 years, 88% males and 3.5% active smokers. 45.8% anterior STEMI. 0% had LV remodeling. Median LVGFIIA was 3.% (IQR35.3) and LVGFI6M 34.5% (IQR4.). Patients were compared in groups - Low LVGFI (value IA and LVGFI6M. Significant associations were seen between infarct size and LVGFIIA (34.7% vs.%, p<0.00) and LVGFI6M (8.0% vs 8.5%, p<0.00). A Low LVGFIIA was associated with the presence of microvascular obstruction (MVO) (70% vs 45%, p=0.04), higher LV mass (.5 vs 0.9, p<0.0) and lower LVEF (39.5% vs 56.%, p<0.00). Similar associations were seen with Low LVGFI6M (6.5 vs 5.3%, p< 0.04), (5. vs 0., p=0.008) and (40. vs 57.67%, p<0.00) respectively. Greater changes in LVEDV were seen with Low LVGFIIA (4.3 vs 4.7mls, p <0.00) and Low LVGFI6M (8.4 vs 0.56mls, p=0.004). Consequently, greater LV remodeling was seen with Low LVGFIIA (38 vs.5%, p<0.00) and Low LVGFI6M (3.5 vs 7.7%, p=0.006). There were 7 MACEs but no significant associations with LVGFI or LVEF were found. CONCLUSIONS: Patients with Low LVGFI had larger infarct size, presence of MVO, higher LV mass and lower LVEF. LVGFI predicted LV remodeling even as late as 6 months. A larger sample size is needed to determine the prognostic value of measuring LVGFI and the optimal time for scanning. 8 9

4 Young Investigator Award Date: 9th April 06 Venue: Parry Room, Le Meridien KL YIA 6 Time: hr P WAVE DISPERSION AND ITS ASSOCIATION WITH HYPERTENSION Lim Chiao Wen, Johan Rizwal Ismail, Nicholas Chua Yul Chye, Rizmy Najme Khir, Effarezan Abdul Rahman, Hafisyatul Aiza Zainal Abidin, Zubin Othman Ibrahim, Sazzli Shahlan Kasim, Khalid Yusoff. Universiti Teknologi MARA Hypertension and obesity in adults have been associated with increased P wave dispersion. This is postulated from correlation of hypertension with diastolic dysfunction and atrial enlargement. Inhomogenous atrial conduction due to atrial enlargement could be identified by variation in p wave duration between differently oriented surface electrocardiogram (ECG) leads. Interlead variation in p wave duration is called P wave dispersion (PwD). PURPOSE: We aim to assess PwD and its association with hypertension in the CRisPs Malaysia population. METHODS: CRisPs is a community-based study conducted between the year 007 and 04. Participants were required to complete questionnaires on cardiovascular risk factors, medical history, physical examinations, blood tests, ECG and echocardiography examinations. P wave dispersions were calculated by measuring a minimum of nine leads of P wave duration on the leads ECG. PwD is defined by maximum P wave duration minimum P wave duration. Exclusion criterions include previous myocardial infarction, thyroid dysfunction, diabetes mellitus, valvular heart disease, cardiomyopathy, electrolyte imbalance, alcoholism and medications that affect atrial conduction. 5 participants with hypertension are randomly selected and their PwD are compared to 5 randomly selected healthy subjects. RESULTS: A total of 0, 805 subjects participated in the CRisPs. The mean age was 5.6 years (+/-.6) with 56% of females. 5.4% of subjects have a diagnosis of hypertension, 4.4 % ischaemic heart disease,.3% previous stroke and.7% with diabetes mellitus. FP. General Cardiology Date: 8th April 06 Venue: Sentral Accord, Hilton KL Time: 00-0 hr PERFORMANCE OF VARIOUS DIAGNOSTIC CRITERIA FOR FAMILIAL HYPERCHOLESTEROLAEMIA WHEN COMPARED TO DUTCH LIPID CLINIC CRITERIA IN AN ASIAN POPULATION Suraya Abdul Razak, Radzi Rahmat, Noor Alicezah Mohd Kasim, Thuhairah Abdul Rahman,, Suhaila Muid, Nadzimah Mohd Noor, Zubin Ibrahim, Sazzli Kasim, Abdul Rais Sanusi 3, Hapizah Nawawi,. Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Faculty of Medicine, Universiti Teknologi MAR A (UiTM), 3 National Heart Institute, Malaysia FP. Time: 0-0 hr BLEEDING RISKS OF WARFARIN WHEN USED WITH ANTIPLATELET AGENTS Darwina Bolkim, Rhema Sundram, Zulkeflee Muhammad, Koh Kok Wei, Barveen Aisha, Azlan Hussin, Surinder Kaur, Razali Omar, Yap Lok Bin. Institut Jantung Negara FP.3 Time: 0-30 hr PREDICTORS OF ABNORMAL CARDIOVASCULAR PROFILE IN SEDENTARY WOMEN PARTICIPATING IN A COMMERCIALIZED FITNESS PROGRAMME IN KLANG VALLEY Amir Aizuddin Bin Amal Nasir, Ahmad Zulhakim Bin Mokhtar, Wan Nur Ain Shaheera Binti Wan Ghazali, Norul Fateha Binti Mat Zuki, Johan Rizwal Ismail, Effarezan Abdul Rahman. Faculty of Medicine, Universiti Teknologi MARA (UiTM) FP.4 Time: hr GENERIC ATORVASTATIN IS AS EFFECTIVE AS THE BRAND-NAME DRUG (LIPITOR) IN LOWERING CHOLESTEROL LEVELS Alexander Loch, Daniel Kofink, Ramesh Singh Veria*, Ang CC, Imran Zainal Abidin, Dzafir Ismail, Wan Azman Wan Ahmad. University Malaya Medical Centre (UMMC), Lembah Pantai, Kuala Lumpur, Malaysia, Laboratory of Experimental Cardiology, Department of Cardiology, Division of Heart and Lung, University Medical Center Utrecht, ANNUAL SCIENTIFIC MEETING The mean age for hypertensive cohort was 55.8 years (+/-0.) while control group was 5.3(+/- 3.6). Mean BP for hypertensive cohort was 54/87mmHg compared to control group with 34/79mmHg. Maximum P wave duration is significantly increased in the hypertensive cohort with 6.8ms +/- 7.7 compared to 03.ms+/-.0 in the control group(p<0.00). There is also a significant increase in minimum P wave duration in hypertensive subjects at 53.7ms+/-.8 compared to control group with 48.6ms+/-5.7(P=0.004). There is a significant increase in the PwD in hypertensive group at 63.0ms+/-8. compared to normotensive subjects(54.6ms+/-.9) with P=0.00. CONCLUSION: P wave dispersion is significantly increased in hypertension. Use of P wave dispersion could be a simple, non-invasive method of predicting risk of hypertensive cardiomyopathy in prehypertensive and hypertensive patients. the Netherlands FP.5 Time: hr HIGH-SENSITIVITY TROPONIN I AMONG PATIENTS WITH A NONCARDIAC CAUSE OF CHEST PAIN LOCAL EXPERIENCE Johan Rizwal Ismail, Zubin Othman, Kamal Arshad, Effarezan Abd Rahman, Lim Chiao Wen, Hafisyatul Aiza, Nicholas Chua, Rizmy Najme, Sazzli Kasim. Cardiovascular and Thoracic Centre, Faculty of Medicine, UiTM Sg. Buloh. FP.6 Time: hr A NATIONAL AUDIT ON THE UTILIZATION AND DOCUMENTATION OF DABIGTRAN CHECKLIST FOR PATIENTS INITIATED ON DABIGATRAN Doris GV, Shakirin SR, Sahimi A 3, Noraini M, Pharmacy Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia Pharmacy Practice & Development, Pharmaceutical Services Division, Ministry of Health, Malaysia 3 Pharmacy Department, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia FP.7 Time: 00-0 hr RELATIONSHIP BETWEEN RESTING HEART RATE AND EXACERBATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AN Musa, MA Mohd Zim, MA Fadzil, N Mohd Razali, JL Wong, RMZ Md Kassim, T Ismail, MF Abdul Rani, AI Ismail 3

5 General Cardiology Date: 8th April 06 Venue: Sentral Accord, Hilton KL FP. Time: 00-0 hr FP. Time: 0-0 hr PERFORMANCE OF VARIOUS DIAGNOSTIC CRITERIA FOR FAMILIAL HYPERCHOLESTEROLAEMIA WHEN COMPARED TO DUTCH LIPID CLINIC CRITERIA IN AN ASIAN POPULATION Suraya Abdul Razak, Radzi Rahmat, Noor Alicezah Mohd Kasim, Thuhairah Abdul Rahman,, Suhaila Muid, Nadzimah Mohd Noor, Zubin Ibrahim, Sazzli Kasim, Abdul Rais Sanusi 3, Hapizah Nawawi,. Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Faculty of Medicine, Universiti Teknologi MARA (UiTM), 3 National Heart Institute, Malaysia BACKGROUND & OBJECTIVE: There are several clinical diagnostic criteria for FH available with the Dutch Lipid Clinic Criteria (DLCC) being widely used in Malaysia. Information regarding diagnostic performance of the other criteria against the DLCC is scarce. This study aims to examine the diagnostic performance of the Simon Broome (SB) Register criteria, the US Make Early Diagnosis to Prevent Early Deaths (USMEDPED) criteria and the Japanese Familial Hypercholesterolaemia Management Criteria (JFHMC) compared to DLCC. BLEEDING RISKS OF WARFARIN WHEN USED WITH ANTIPLATELET AGENTS Darwina Bolkim, Rhema Sundram, Zulkeflee Muhammad, Koh Kok Wei, Barveen Aisha, Azlan Hussin, Surinder Kaur, Razali Omar, Yap Lok Bin. Institut Jantung Negara BACKGROUND: Long term treatment with oral anticoagulants such as warfarin is necessary for several indications including for prevention of stroke with atrial fibrillation. Some of these patients however, have concomitant coronary artery disease that warrants percutaneous coronary Intervention with stenting. In these cases patients need to be on additional antiplatelet therapy. OBJECTIVE: We retrospectively reviewed the bleeding risks of warfarin when used with either single or dual antiplatelet therapy. MATERIALS & METHODS: Medical records of a total of 00 patients were examined. ANNUAL SCIENTIFIC MEETING 06 METHODS: 755 individuals from Specialist Clinics and community health screening programmes with LDL-c level 4.0 mmol/l were selected and diagnosed for FH by using the DLCC, SB Register criteria, US MEDPED criteria and JFHMC. The sensitivity, specificity, efficiency, positive and negative predictive values of individuals screened with the three diagnostic criteria were assessed against the DLCC. RESULTS: The SB register criteria identified more individuals with FH compared to the USMEDPED and the JFHMC ( vs. 05 vs. 95; p< 0.00) when assessed against the DLCC. The SB Register criteria, the US MEDPED and the JFHMC had low diagnostic sensitivity (5.% vs. 5.3% vs. 47.0% respectively). However, the SB Register criteria showed better diagnostic performance than the other criteria with 98.8% specificity, 8.6% efficiency, 98.% and 6.3% for positive and negative predictive values respectively. CONCLUSION: All the other criteria have low sensitivity compared to the DLCC implying that there are less suited for screening of FH cases. However, the SB Register criterion is comparable with the DLCC in terms of specificity. Therefore, the DLCC appear to be better at clinically screening FH cases whilst both DLCC and SB Register criteria are more useful in identifying the positive cases to be confirmed by genetic testing. RESULTS: Mean age /-.8 years. Patients were on warfarin for different indication atrial fibrillation (AF): 48%, deep vein thrombosis /Pulmonary Embolus: 6%, Left ventricular thrombus: 30%, Prosthetic valve: 0%, Mitral Valve Repair: 5%, aneurysmal coronaries: %. There were 56% patients on single antiplatelet therapy and 44% on dual antiplatelet therapy. Out of 00 patients there were: 3% bleeding events recorded; 8% minor bleed and 4% major bleeds, % ischemic stroke and 3% hemorrhagic stroke. There were similar numbers of bleeding events with warfarin and single antiplatelet therapy compared to those with warfarin and dual antiplatelet therapy. CONCLUSIONS: There were no differences in bleeding events when comparing patients on warfarin with single and dual antiplatelet agents. 3 33

6 General Cardiology Date: 8th April 06 Venue: Sentral Accord, Hilton KL FP.4 Time: hr FP.3 Time: 0-30 hr PREDICTORS OF ABNORMAL CARDIOVASCULAR PROFILE IN SEDENTARY WOMEN PARTICIPATING IN A COMMERCIALIZED FITNESS PROGRAMME IN KLANG VALLEY Amir Aizuddin Bin Amal Nasir, Ahmad Zulhakim Bin Mokhtar, Wan Nur Ain Shaheera Binti Wan Ghazali, Norul Fateha Binti Mat Zuki, Johan Rizwal Ismail, Effarezan Abdul Rahman. Faculty of Medicine, Universiti Teknologi MARA (UiTM) BACKGROUND: Commercialized fitness programmes are gaining popularity among young generations nowadays. To date, no studies have looked into the profiles of women participating in these unprescribed exercise programmes. OBJECTIVE: This study investigated cardiovascular profiles of women participating in one of the fitness programmes in Klang Valley. GENERIC ATORVASTATIN IS AS EFFECTIVE AS THE BRAND-NAME DRUG (LIPITOR) IN LOWERING CHOLESTEROL LEVELS Alexander Loch, Daniel Kofink, Ramesh Singh Veria*, Ang CC, Imran Zainal Abidin, Dzafir Ismail, Wan Azman Wan Ahmad. University Malaya Medical Centre (UMMC), Lembah Pantai, Kuala Lumpur, Malaysia, Laboratory of Experimental Cardiology, Department of Cardiology, Division of Heart and Lung, University Medical Center Utrecht, the Netherlands BACKGROUND: Generic drugs represent one major opportunity to ensure access to essential medicines for all people. Generic manufacturers solely develop bioequivalent versions to existing drugs without having to prove the safety and efficacy of the drugs through clinical trials. There is a perception both among patients and physicians that generics are inferior drugs. Physicians commonly have negative perceptions of generic drugs, attitudes created and cemented by company marketing and information policies. There are very few studies evaluating the efficacy of generic statins. OBJECTIVE: To study the lipid lowering effects of generic Atorvastatin compared with the original brand-name drug (Lipitor). METHODOLOGY ANNUAL SCIENTIFIC MEETING METHOD: This was a cross-sectional study conducted as part of an elective project by year 4 medical students. The cohort consisted of self-funded participants voluntarily enrolled into a 6-week fitness programme. Cardiovascular parameters such as weight, blood pressure (BP), fasting capillary glucose and body fat mass were measured from each participant before they embarked on the programme. Data were collected via questionnare, automated blood presure and body fat analysis machines. RESULTS: 38 participants were enrolled into this study. Majority of the women were married (74%, 8 subjects), worked for corporate (66%, 5 subjects), earned between RM5k-RM0k per month (50%, 9 subjects) and had degree as highest level of education (63%, 4 subjects). Most of them led a mildly active lifestyle (53%, 0 subjects) and exercised once a week (45%, 7 subjects). of the subjects had impaired fasting capillary glucose (>6.mmol/l) and 9 subjects had abnormal BP (>39/89mmHg). 36 subjects were categorized as obese based on body fat percentage exceeding 3% and subjects had abnormal visceral fat execeeding >3%. Multivariate analysis showed visceral fat was the strongest predictor for abnormal systolic BP (p<0.05) and weight was the strongest predictor for abnormal fasting capillary glucose (p<0.05). Marital status, level of education, income status, lifestyle activity and frequency of exercise were non-predictors for abnormal cardiovascular parameters. CONCLUSION: In a cohort of sedentary women about to embark in a commercialized fitness programme, 30% of them had at least one abnormal cardiovascular profile. Visceral fat and weight were the strongest predictors for abnormal systolic BP and fasting blood glucose respectively. Marital status, level of education, income status, lifestyle activity and frequency of exercise were non-determinants for abnormal cardiovascular profile. SETTING: This cross-sectional retrospective study was conducted at UMMC from st May 03 until 30st May 03. UMMC pharmacy started dispensing generic Atorvastatin on the 3rd July 0. Prior to this, all patients with a prescription for Atorvastatin were issued proprietary, branded Atorvastatin (Lipitor) exclusively. All patients switched from proprietary to generic Atrovastatin since July 0 were identified from the pharmacy s electronic drug prescription system. DATA COLLECTION: The data extracted from the electronic pharmacy drug prescription and dispensing system included patient demographics, date of onset of branded statin therapy, date of first issuance of generic statin and adjunctive lipid-lowering medications. For this analysis, the date of the first issuance of the generic statin was considered the date of the switch. LDL-C, total cholesterol, HDL and triglyceride levels were documented from the electronic blood investigation reporting system for the time before the switch and after. When multiple blood tests existed for a patient, the blood test closest to the switch date, but not later than the switch date was analyzed as the pre-switch test. Post switch blood had to be at least 3 months after the switch date. EXCLUSION CRITERIA: Any patient, with a record of transition from proprietary to generic atorvastatin was included in this analysis. Patients had to be on statin therapy for at least 3 months to be included. Patients with missing pre- or post-switch blood results were excluded. Patients that were started on other lipid-modifying medications during the transition period were excluded. Patients with dose changes during the transition period were excluded. STUDY OUTCOMES: This study assessed the change in pre-switch to post-switch mean LDL-C values. STATISTICAL METHODS: Difference in lipid levels were analysed with the use of a Wilcoxon signed-rank test for continuous variables. Two-sided P values<0.05 were considered statistically significant. Statistical analyses were performed in SPSS version 4. RESULTS: 69 Patients were switched from Lipitor to the generic drug. 35 had to be excluded from analysis for reasons like missing blood tests pre- and post change, dose adjustments or introduction of other lipid lowering medications during the switch over period. Average age was 64.3 (+/-9.5) years. The time of the pre-switch blood test was 99.5 days (median). The time of the post transition blood test was 80 days (median) after the switch over. There was no difference between pre- and post switch lipid levels (Wilcoxon signed-rank test, median values provided). TG: pre.50; post.50; V=440, p=0.453 LDL: pre.4; post.4; V=6760, p=0.878 HDL: pre.6; post.5 V=4039, p=0.009 Total: pre 4.60; post 4.50; V=5058, p=0.583 CONCLUSION: The lipid lowering properties of generic Atorvastatin are equal to those of Lipitor. Negative perceptions about generic Atorvastatin are unfounded. 35

7 General Cardiology Date: 8th April 06 Venue: Sentral Accord, Hilton KL FP.5 Time: hr FP.6 Time: hr HIGH-SENSITIVITY TROPONIN I AMONG PATIENTS WITH A NONCARDIAC CAUSE OF CHEST PAIN LOCAL EXPERIENCE. Johan Rizwal Ismail, Zubin Othman, Kamal Arshad, Effarezan Abd Rahman, Lim Chiao Wen, Hafisyatul Aiza, Nicholas Chua, Rizmy Najme, Sazzli Kasim. Cardiovascular and Thoracic Centre, Faculty of Medicine, UiTM Sg. Buloh. A NATIONAL AUDIT ON THE UTILIZATION AND DOCUMENTATION OF DABIGTRAN CHECKLIST FOR PATIENTS INITIATED ON DABIGATRAN Doris GV, Shakirin SR, Sahimi A 3, Noraini M, Pharmacy Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia Pharmacy Practice & Development, Pharmaceutical Services Division, Ministry of Health, Malaysia 3 Pharmacy Department, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia BACKGROUND: The availability of high-sensitivity cardiac troponin I (HS-cTnI) levels has made the diagnosis of myocardial injury easily diagnosed and treated. However, it is unknown to what extent noncardiac causes, including renal dysfunction, may contribute to the level elevation. METHODS: In a retrospective single-centre study, we enrolled consecutive patients presenting with acute chest pain to the emergency department. Of 846 patients enrolled, 60 were adjudicated by independent physicians to have a noncardiac cause of chest pain. Multivariate analyses were used to determine the important predictors of HS-cTnI. INTRODUCTION & OBJECTIVES: Dabigatran, a direct thrombin inhibitor, is an alternative to oral anticoagulant warfarin. Dabigatran was registered in Malaysia for the use of primary prevention for post total knee replacement (TKR) or total hip replacement (THR) in 009 and for stroke prevention in non valvular atrial fribrillation (SPAF) use in Malaysia in 0. Hence, the Dabigatran Prescribing and Dispensing Checklist were developed by the Pharmaceutical Services Division for Ministry of Health (MOH) facilities in 0. This audit has been designed to verify utilization of Dabigatran Checklist. Appropriate of dabigatran prescribing, monitoring and adverse drug reaction (ADR) was also audited. ANNUAL SCIENTIFIC MEETING 06 RESULTS: The median level of HS-cTnI was 7.6 (IQR 3) ng/l. A total of 89 patients (3.4%) had elevated HS-cTnI of more than 6 ng/l or 34 ng/l for female and male respectively. The main presenting complaint that necessicitate HS-cTnI level being investigated were chest pain, dyspnoea, fever and cough with.5%,.5% and 0.3% respectively. In decreasing order of importance, smoking, infection, presenting complaint as chest pain and abnormal glomerular filtration rate, were the significant factors in linear regression analysis to predict elevated HS-cTnI. Overall patients with elevated HS-cTnT were at increased risk of all-cause mortality (relative risk 8.8; 95% confidence interval, ; P <0.0) during the index admission. CONCLUSION: Among the known covariates, age and not renal dysfunction is the most important determinant of HS-cTnI. Because known cardiac and noncardiac factors, including renal dysfunction, explain less than 50% of HS-cTnI levels among patients with a noncardiac cause of chest pain, unknown or underestimated cardiac involvement during the acute presenting condition seems to be the major cause of elevated HS-cTnI. METHODOLOGY: The audit was conducted retrospectively through-out the MOH facilities which include 39 hospitals and 45 health centers for a period of years (03 04). Data from checklists (indication, dose, duration, renal function and ADR encountered) were extracted by pharmacist at each MOH facilities upon notification by Pharmaceutical Services Division. Data reported by facilities were verified with National Drug Usage and Costing Database and ADR reports submitted to the Malaysia Adverse Drug Committee (MADRAC). Reasons for discrepancies in data provided by facilities were confirmed by making phone calls to the facilities. RESULTS: Dabigatran Checklist was utilized in 5/56 (9.9%) of MOH facilities that purchased dabigatran. A total of 58 patients were monitoring with the checklist of which most the patients 503 (86.4%) were on dabigtran for SPAF. Dabigatran used for the approved indication in 569 (97.7%) of the patients. In regard to dosing, 555 (95.4%) patients were on approved dosing and 533 (9.6%) patients were on approved duration for dabigatran. In 3 patients (.3%) dabigatran was used for indications other than approved in MOH. Baseline monitoring of serum creatinine before initiating dabigatran was done in 469 (80.%) patients. A total of 3 ADRs were detected and documented in the checklist, but none was reported to MADRAC. Total ADR for dabigatran including not reported case amounted to 6 for the year period. CONCLUSION: Checklists can be used as a tool to monitor patients initiated with dabigatran however utilization of the Dabigatran Checklist needs to be optimized

8 General Cardiology FP.7 Time: 00-0 hr Date: 8th April 06 Venue: Sentral Accord, Hilton KL RELATIONSHIP BETWEEN RESTING HEART RATE AND EXACERBATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AN Musa, MA Mohd Zim, MA Fadzil, N Mohd Razali, JL Wong, RMZ Md Kassim, T Ismail, MF Abdul Rani, AI Ismail STUDY AIMS: To identify the association between resting heart rate and exacerbation. METHODOLOGY: This is a multicentre cohort study (6 months follow up) of COPD patients recruited during acute exacerbation of COPD requiring hospitalisation. Patient s sociodemographic data and baseline characteristics were recorded during acute exacerbation. At 3 months after recruitment (Month 0), patient s resting heart rate, spirometry and CAT score were collected in clinicm followed by a telephone interview (Month3) and clinic visit (Month 6) to collect data on exacerbation history. RESULTS: 47 patients were recruited. The mean age was /- 9.5 year. 76.9% of patients had heart rate > 80 bpm with mean resting heart rate of /- 3.0 bpm. There were significantly more exacerbators in patients with higher resting heart rate at month 3 with relative risk of.0 (p=0.03). There was also a significant positive correlation between resting heart rate and exacerbation frequency at month 3 and month 6 (r = 0.400, p < 0.00; r = 0.440, p < 0.00). The mean exacerbation frequency were also significantly higher in the higher resting heart rate group at month 3 and month 6 ( vs 0.48, p< 0.00; 3.4 vs.4, p = 0.004). CONCLUSION: COPD patients with higher resting heart rate demonstrated increased risk of exacerbation and higher exacerbation frequency. This may suggest that resting heart rate could be a potential taget of treatment in copd patients. FP. Imaging Date: 8th April 06 Venue: Sentral Exchange, Hilton KL Time: 00-0 hr THE PREVALENCE OF ULTRASONOGRAPHY-DIAGNOSED NON ALCOHOLIC FATTY LIVER DISEASE IN TYPE DIABETES MELLITUS AND PROVEN ISCHEMIC HEART DISEASE IN NORTHERN KUALA LUMPUR Nurazam Omar, Nor Juita Hassan, Rohana Ab Ghani, Sazzli Sahlan Kasim, Marymol Koshy, Mohammad Hanafiah and Bushra Johari. Department of Medicine, Faculty of Medicine Universiti Teknologi MARA Sungai Buloh Department of Medical Imaging, Faculty of Medicine Universiti Teknologi MARA Sungai Buloh FP. Time: 0-0 hr ASSOCIATION OF PLASMA ST LEVELS WITH ECHOCARDIOGRAPHIC PARAMETERS OF DIASTOLIC DYSFUNCTION IN DIABETIC PATIENTS AT AN OUTPATIENT CLINIC A PILOT STUDY Diana Hui Ping Foo, Alan Yean Yip Fong,, Ong Tiong Kiam, Stella Li Li Chan, Andrew Kilung, Rosnah Binti Mohidin, Salbiah Binti Sindot, Ruziah Binti Mat Sa at, Hasni Adha Binti Ibrahim, Sally Suriani Ahip 3. Clinical Research Centre, Sarawak General Hospital, Kuching, Sarawak Department of Cardiology, Sarawak General Hospital Heart Centre, Kota Samarahan, Sarawak 3 Klinik Kesihatan Kota Sentosa, Kuching, Sarawak FP.3 Time: 0-30 hr SCREENING OF ARTERIAL STIFFNESS IN PATIENT WITH RENAL IMPAIRMENT USING PULSE WAVE VELOCITY Ahmad Bakhtiar Md Radzi, Mohd Ariff Fadzil, Sazzli Shahlan Kasim 3.,3 Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia, Department of Population and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia FP.4 Time: hr BIOABSORBABLE VASCULAR SCAFFOLD(BVS) STENT ON COMPUTED TOMOGRAPH CORONARY ANGIOGRAM(CTCA) WITH POSITIVE REMODELING AS A MARKER FOR PLAQUE VULNERABILITY Gunasekaran Ramsamy MBBS,, Siong Sung Wong MD,3. FP.5 Time: hr OPTIMAL DOSE OF DOBUTAMINE DURING LOW-DOSE DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN CORRECTLY IDENTIFY VIABLE SEGMENTS ON CARDIOVASCULAR MAGNETIC RESONANCE Abdul Rahman E, Ismail JR, Najme Khir R, Lim CW, Chua N, Ibrahim ZO, Zainal Abidin HA, Mohd Arshad MK, Kasim SS Universiti Teknologi MARA (UiTM) ANNUAL SCIENTIFIC MEETING FP.6 Time: hr LEFT VENTRICLE HYPERTROPHY AND DIASTOLIC FUNCTION IN ELITE AHTLETES Foo DHP, Gerunsin J, Chan SLL, Kilung A, Salim R, Mohidin R, Sindot S, Ong TK, Lam KH 3, Fong AYY,. Clinical Research Centre, Sarawak General Hospital, Kuching, Sarawak Department of Cardiology, Sarawak General Hospital Heart Centre, Kota Samarahan, Sarawak 3 Assunta Heart Centre, Petaling Jaya, Selangor Darul Ehsan FP.7 Time: 00-0 hr NON ALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH PROVEN CORONARY ARTERY DISEASE: IS THERE ANY ASSOCIATION TO CAROTID INTIMA MEDIA THICKNESS? Nurazam Omar, Nor Juita Hassan, Mohammad Hanafiah, Bushra Johari, Marymol Koshy, Sazzli Sahlan Kasim, Rohana Ab Ghani. Department of Medicine, Faculty of Medicine Universiti Teknologi MARA Sungai Buloh, Department of Medical Imaging, Faculty of Medicine Universiti Teknologi MARA Sungai Buloh 39

9 Imaging Date: 8th April 06 Venue: Sentral Exchange, Hilton KL FP. Time: 00-0 hr FP. Time: 0-0 hr THE PREVALENCE OF ULTRASONOGRAPHY-DIAGNOSED NON ALCOHOLIC FATTY LIVER DISEASE IN TYPE DIABETES MELLITUS AND PROVEN ISCHEMIC HEART DISEASE IN NORTHERN KUALA LUMPUR Nurazam Omar, Nor Juita Hassan, Rohana Ab Ghani, Sazzli Sahlan Kasim, Marymol Koshy, Mohammad Hanafiah and Bushra Johari. Department of Medicine, Faculty of Medicine Universiti Teknologi MARA Sungai Buloh Department of Medical Imaging, Faculty of Medicine Universiti Teknologi MARA Sungai Buloh ASSOCIATION OF PLASMA ST LEVELS WITH ECHOCARDIOGRAPHIC PARAMETERS OF DIASTOLIC DYSFUNCTION IN DIABETIC PATIENTS AT AN OUTPATIENT CLINIC - A PILOT STUDY Diana Hui Ping Foo, Alan Yean Yip Fong,, Ong Tiong Kiam, Stella Li Li Chan, Andrew Kilung, Rosnah Binti Mohidin, Salbiah Binti Sindot, Ruziah Binti Mat Sa at, Hasni Adha Binti Ibrahim, Sally Suriani Ahip 3. Clinical Research Centre, Sarawak General Hospital, Kuching, Sarawak Department of Cardiology, Sarawak General Hospital Heart Centre, Kota Samarahan, Sarawak 3 Klinik Kesihatan Kota Sentosa, Kuching, Sarawak BACKGROUND: Non-Alcohollic Fatty Liver Disease is a spectrum disease from simple pure steatosis to steatohepatitis and cirrhosis. The association with the obesity, dyslipidaemia, hypertension, diabetes and cardiovascular disease, with the silence progression to liver cirrhosis arises concern amongst physicians globally. ANNUAL SCIENTIFIC MEETING 06 OBJECTIVES: The aim of the present study was to determine the prevalence of Ultrasonography diagnosed- Non Alcoholic Fatty Liver Disease amongst Type Diabetes Melltus and proven Ischemic Heart Disease in Universiti Teknologi MARA Sungai Buloh campus. MATERIALS AND METHODS: We included 95 patients between age 8 to 65 years old who had proven diagnosis of Ischemic Heart Disease with Type Diabetes Mellitus based on coronary angiogram, dobutamine stress echocardiogram or treadmill stress test. The patients with seropositive Hepatitis B or Hepatitis C, and alcohol intake more than units per week for male and more than4 units per week for female were excluded in this study. All of them underwent ultrasonography of abdomen by the two independent radiologists for diagnosis of fatty liver. RESULTS: 67.4% of individuals who had proven Ischemic Heart Disease were found to have Non Alcoholic Fatty Liver Disease. None of the patients had features of liver cirrhosis CONCLUSION: NAFLD is a common amongst those in Type Diabetes Mellitus and Ischemic Heart Disease. BACKGROUND: Plasma ST has also been shown to be associated with left ventricular diastolic dysfunction (DD) assessed by echocardiography. DD has been shown to be more prevalent in patients with Type diabetes mellitus (DM), and carry worse clinical outcomes, compared to those without DM. The association of ST and DD in diabetic patients (DM) in an ambulatory setting has not been established. OBJECTIVE: To investigate the association between plasma ST levels and DD diagnosed by echocardiography in patients with DM. METHODS: We enrolled 60 patients with Type DM who attended a diabetic clinic followup at a primary care setting. Clinical data was collected. Echocardiographic examination was performed in these patients. Bloods and urine samples were taken and sent for laboratory analysis for HbAc, renal profile and urine protein. Plasma levels of ST were determined using ASPECT-PLUS ST Assay (Critical Diagnostics). RESULTS: There were 3 (53.3%) female patients. Mean age was 56.3 (0.7); mean BMI was 8. (4.). 49 (8.7%) patients were also found with hypertension; 5 (85%) with dyslipidemia. 53 (88.3%) patients were found with NYHA Class. Mean HbAc was 8.% (.77); mean glomerular filtration rate was 70.0 (6.67). Patients with DD had significantly higher levels of ST levels compared to those without DD (4.8ng/ml vs 6.3ng/ml; p=0.004). ST levels increased with worsening DD. ST levels were significantly associated with left ventricle end-systolic volume, left ventricle filling pressure (E/e ), and indexed left atrial volume (p=0.0; p=0.08; and p=0.04, respectively), although the correlation between ST levels and these surrogate markers were weak (r= 0.80; r= 0.08; r= 0.094). CONCLUSION: ST levels were associated with worsening DD in patients with DM. Larger studies in this population are warranted. ST could identify patients with DD in DM patients at a clinic setting so that intervention strategies are prescribed to improve long term outcomes. 40 4

10 Imaging Date: 8th April 06 Venue: Sentral Exchange, Hilton KL FP.3 Time: 0-30 hr SCREENING OF ARTERIAL STIFFNESS IN PATIENT WITH RENAL IMPAIRMENT USING PULSE WAVE VELOCITY Ahmad Bakhtiar Md Radzi, Mohd Ariff Fadzil, Sazzli Shahlan Kasim 3., 3 Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia, Department of Population and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia BACKGROUND: Chronic kidney disease (CKD) is associated with increased arterial stiffness. Identification of arterial stiffness in early CKD patients is important as they are at risk to develop cardiovascular disease. FP.4 Time: hr BIOABSORBABLE VASCULAR SCAFFOLD(BVS) STENT ON COMPUTED TOMOGRAPH CORONARY ANGIOGRAM(CTCA) WITH POSITIVE REMODELING AS A MARKER FOR PLAQUE VULNERABILITY Gunasekaran Ramsamy MBBS,, Siong Sung Wong MD,3. AIM: The role of CTCA for demonstrating the evolution and restenosis with BVS stent. BACKGROUND: CTCA is emerging as non-invasive technique to detect restenosis in patients with post BVS stenting. OBJECTIVE: We aimed to study the arterial stiffness using pulse wave velocity (PWV) among patients with CKD stage to 4. METHODS: We studied a cohort of 50 patients with chronic kidney disease (5 patients stage, 9 patients stage 3, 6 patients stage 4). Each patient underwent a carotid-femoral PWV measurement to determine the arterial stiffness. RESULTS: The mean age of the patients was 47. years. The mean difference of PWV between CKD stage (7.3 m/s, SD 0.89) and stage 4 (9.05 m/s, SD 0.54) was -.7 ( P=0.000, 95% CI -.49, 0.9). The difference between the mean PWV in patients with non diabetes mellitus (7. m/s, SD 0.0) and diabetes mellitus (8. m/s, SD.60) was (P = 0.0, 95% CI -.77, 0.3). CONCLUSIONS: This study shows that increased arterial stiffness occur in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger age population. METHODS: We have a series of two patients who had an Acute coronary syndrome(stemi), subsequently both patient had primary PCI with BVS stent. Two years later both patient has been evaluated for non-specific chest pain. We used Somatom Dual Source Siemens CT scanner Turbo Flash, managed to delineate the vessel clearly and automatically constructed centre lumen line, the cross-sectional lumen area was measured at 0.3mm to 0.6mm longitudinal intervals within the stented segment. We have calculated the lumen diameter from the measured area, assuming the lumen is circular. RESULTS: There were no in-stent restenosis measurable on the first study, however noted to have positive remodelling. The second patient had complete occlusion (late stent thrombosis) which was confirmed by doing an angiogram and angioplasty. CONCLUSIONS: Despite tremendous advances in the treatment of coronary revascularization, in-stent restenosis (ISR) remains as a key problem after stenting. Newer CTCA scan with technical advance, one able to exclude the ISR and its progression such as plaque vulnerability. ANNUAL SCIENTIFIC MEETING