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s S201 Eur J Echocardiography Abstracts Supplement, December 2006 1139 Pulmonary vascular resistance estimated by echocardiography is elevated in patients with obstructive sleep apnea during daytime A. Romero-Corral 1 ; V.K. Somers 1 ; P.A. Pellikka 1 ; E.J. Olson 1 ; K.R. Bailey 1 ; F. Lopez-Jimenez 1 1Mayo Clinic College of Medicine, Cardiovascular Dept., Rochester, United States of America Background: Obstructive sleep apnea (OSA) has been related to an increased pulmonary vascular resistance (PVR) measured invasively. Objective: To determine if daytime Doppler derived pulmonary systolic pressure (PSP) and PVR estimated by echocardiography is associated with severity of OSA. Methods: A cross-sectional design of 85 subjects with suspected OSA who had their first overnight polysomnography (PSG) and a complete echocardiographic study performed within 2 months of the PSG without primary pulmonary hypertension, severe left ventricular dysfunction (EF 15 even after adjusting for PSP measured during daytime. Table 1. Pulmonary vascular resistance in OSA AHI Mean nocturnal PO2 sat % 15 CrudeAdjusted>92

Background In the United States, obesity is a major clinical and public health problem causing diabetes, dyslipidemia, and hypertension, as well as increasing cardiovascular and total mortality. Dietary restrictions of calories and saturated fat are beneficial. However, it remains unclear whether replacement of saturated fat with carbohydrates (as in the US National Cholesterol Education Program [NCEP] diet) or protein and monounsaturated fat (as in our isocaloric modified low-carbohydrate [MLC] diet, which is lower in total carbohydrates but higher in protein, monounsaturated fat, and complex carbohydrates) is optimal. Methods We randomized 60 participants (29 women and 31 men) to the NCEP or the MLC diet and evaluated them every 2 weeks for 12 weeks. They were aged 28 to 71 years (mean age, 44 years in the NCEP and 46 years in the MLC group). A total of 36% of participants from the NCEP group and 35% from the MLC group had a body mass index (calculated as weight in kilograms divided by the square of height in meters) greater than 27. The primary end point was weight loss, and secondary end points were blood lipid levels and waist-to-hip ratio. Results Weight loss was significantly greater in the MLC (13.6 lb) than in the NCEP group (7.5 lb), a difference of 6.1 lb (P = .02). There were no significant differences between the groups for total, low density, and high-density lipoprotein cholesterol, triglycerides, or the proportion of small, dense low-density lipoprotein particles. There were significantly favorable changes in all lipid levels within the MLC but not within the NCEP group. Waist-to-hip ratio was not significantly reduced between the groups (P = .27), but it significantly decreased within the MLC group (P = .009). Conclusions Compared with the NCEP diet, the MLC diet, which is lower in total carbohydrates but higher in complex carbohydrates, protein, and monounsaturated fat, caused significantly greater weight loss over 12 weeks. There were no significant differences between the groups in blood lipid levels, but favorable changes were observed within the MLC diet group.

Heavy alcohol drinking is associated with a dose-dependent increase in blood pressure, but data on the relation between alcohol consumption and mortality in hypertensive patients are sparse.To assess the relation between light to moderate alcohol consumption and total mortality from cardiovascular disease (CVD) among men with hypertension.From the Physicians' Health Study enrollment cohort of 88,882 men who provided self-reported information on alcohol intake, we identified a group of 14,125 men with a history of current or past treatment for hypertension who were free of myocardial infarction, stroke, cancer, or liver disease at baseline. Main Outcome Measure Comparison of total and CVD mortality among men with hypertension who had reported to be either nondrinkers or rare drinkers, or light to moderate drinkers.During 75,710 person-years of follow-up, there were 1018 deaths, including 579 from CVD. Compared with individuals who rarely or never drank alcoholic beverages, those who reported monthly, weekly, and daily alcohol consumption, respectively, had multivariate adjusted relative risks (RRs) for CVD mortality of 0.83 (95% confidence interval [CI], 0.62-1.13), 0.61 (CI, 0.49-0.77), and 0.56 (CI, 0.44-0.71) (P.001 for linear trend). In the same groups, RRs for total mortality were respectively 0.86 (CI, 0.67-1.10), 0.72 (CI, 0.60-0.86), and 0.73 (CI, 0.61-0.87) (P.001 for linear trend). Among men with a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher, the RRs for CVD mortality were, respectively, 1.00 (referent), 0.82 (CI, 0.56-1.21), 0.64 (CI, 0.48-0.85), and 0.56 (CI, 0.42-0.75) (P.001 for linear trend). On the other hand, we found no significant association between moderate alcohol consumption and cancer mortality (P =.8 for linear trend).These results, which require confirmation in other large-scale studies, suggest that light to moderate alcohol consumption is associated with a reduction in risk of total and CVD mortality in hypertensive men.

P83 Background: Alcohol drinking is associated with a dose-dependent increase in blood pressure, and JNC VI advises limiting alcohol consumption in patients with hypertension. Data are sparse on relationship between alcohol consumption and mortality in hypertensive patients. We therefore assessed whether alcohol consumption is associated with decrease in total, and cardiovascular mortality among subjects with hypertension. Methods: From the enrollment cohort of 89,251 men from the Physicians’ Health Study who provided self-reported information on alcohol intake and were free of myocardial infarction, stroke, cancer or liver disease at baseline, we identified a group of 14,125 persons with a history of current or past treatment for hypertension. Results: During 75,710 person-years of follow up, there were 1,018 deaths including 579 from cardiovascular disease and 224 from cancer. In multivariate analyses that controlled for several potential confounders, moderate alcohol intake was associated with significant decrease in cardiovascular mortality (P= 1 drink per day the RR was 0.57 (CI 0.44-0.72, P

P32 We sought to investigate the association between periodontal disease (PD) and total and cardiovascular (CV) mortality in a large cohort of men. Methods: Of 104,388 men in the Physician s Health Study enrollment cohort, 88,882 who had no history of cancer, myocardial infarction, stroke or liver disease and provided information on PD were included in this analysis. A total of 10,264 patients reported history of PD. Results: During a mean follow-up of 5 years, 2,921 patients died, from which 1,461 had a CV death. The crude, age adjusted RR, showed an association between PD and total mortality (RR=1.31, C.I. 1.2-1.4, p table. Conclusion: This prospective cohort study suggests that PD is associated with increased mortality, particularly among smokers. However, whether this mild association is real or only due to residual confounding remains to be clarified. Table 1.

Introducciónlas enfermedades cardiovasculares representan la primera causa de morbimortalidad en muchos países del mundo, entre los que se incluye Colombia. Es así como la rehabilitación cardiovascular se convierte en una estrategia de prevención secundaria con intervención integral y costo-efectiva para este tipo de pacientes.Objetivoevaluar la situación actual de los programas de Rehabilitación Cardiovascular en Colombia.Métodosestudio descriptivo, realizado por medio de un cuestionario escrito, aplicado al coordinador y/o responsable de cada programa de Rehabilitación Cardiovascular del país.Análisis de resultados44 de 49 centros contactados respondieron el cuestionario. 88,6% de los programas pertenece a la red privada y 6,8% a la pública; 75% funciona dentro de un hospital o clínica y 25% son extra hospitalarios. La enfermedad coronaria es la principal patología que genera la remisión de los pacientes a los centros de rehabilitación cardiovascular. El recurso humano es variable en cuanto a su conformación, permanencia y actividades al interior del programa. Todos los centros realizan la fase II, seguida por las fases III (84,1%), I (70,5%) y IV (45,5%). 58% de los programas siempre incluye pruebas diagnósticas de factores de riesgo convencionales (colesterol total y fracciones, triglicéridos y glicemia); 97,7% de los programas refiere evaluar al paciente de manera integral con la inclusión de aspectos de actividad física y nutrición; sin embargo, se evidencia menor porcentaje de implementación del manejo del tabaquismo (45,5%), así como de programas de salud cardiovascular en la mujer (15,95%), prevención cardiovascular para la comunidad (18,2%), pruebas para detección de depresión (25%), apnea del sueño (0%) y caminata de seis minutos (65,9%). La principal barrera detectada en la atención de pacientes corresponde a la falta de remisión por parte del médico tratante (65,9%).Conclusiónel desarrollo de los programas de Rehabilitación Cardiovascular en el país debe evaluarse de acuerdo con las cifras de morbimortalidad cardiovascular, la estratificación del riesgo de los pacientes, el acceso al servicio y los resultados más relevantes de este estudio, por lo cual se hace necesario trabajar en la definición de las líneas de base de los requerimientos de los programas que favorezcan el trabajo y la aproximación interdisciplinaria e integral así como el cumplimiento de los objetivos, dando prioridad a la seguridad del paciente.Introductioncardiovascular diseases are the leading cause of morbidity and mortality in many countries around the world, including Colombia. Thus, cardiovascular rehabilitation becomes a secondary prevention strategy with integral and cost-effective intervention for these patients.Objectiveto assess the current status of cardiac rehabilitation programs in Colombia.Methodsa descriptive study, carried out through a written questionnaire, applied to the coordinator and/or responsible for each cardiac rehabilitation program in the country.Result analysis44 of 49 centers contacted answered the questionnaire. 88.6% of the programs belonging to the private network and 6.8% to the public; 75% work within a hospital or clinic and 25% are outpatient. Coronary heart disease is the main pathology that generates the referral of patients to cardiovascular rehabilitation centers. Human resources are variable in their shape, stay and activities within the program. All centers perform phase II, followed by stages III (84.1%), I (70.5%) and IV (45.5%). 58% of the programs always include diagnostic tests for conventional risk factors (total cholesterol and fractions, triglycerides and glucose), 97.7% of the programs referred to assess the patient in a holistic manner including aspects of nutrition and physical activity; however, a lower percentage of implementation of the management of smoking (45.5%), of cardiovascular health programs in women (15.95%), cardiovascular prevention for the community (18.2%), testing detection of depression (25%), sleep apnea (0%) and six minute walk (65.9%) was noticed. The main barrier identified in the care of patients corresponds to the lack of referral by the treating physician (65.9%).Conclusionthe development of cardiac rehabilitation programs in the country should be assessed according to the cardiovascular morbidity and mortality rates, risk stratification of patients, access to the service and the most important results of this study, thereby making necessary to work on defining the baselines of the requirements of the programs that encourage work and interdisciplinary and integral approach as well as the fulfillment of the objectives, giving priority to patient safety.

Objectives. We sought to evaluate the prognostic significance of cardiac troponin T (TnT) serum levels after noncardiac surgery.Background. Cardiac TnT has been found to be a marker for myocardial injury, but elevations of TnT are common in patients undergoing noncardiac surgery without clinical evidence of severe ischemia.Methods. We studied 772 patients who underwent major noncardiac procedures and did not have major cardiovascular complications during their inpatient course. Total serum creatine kinase (CK) and cardiac TnT were measured according to a protocol that included sampling in the recovery room and during the next 2 days. A 6-month follow-up interview was performed for 722 (94%) of the patients.Results. Elevated cardiac TnT and CK-MB results were detected for 92 (12%) and 211 (27%) patients, respectively. During the follow-up period, there were 19 (2.5%) major cardiac complications, including 14 cardiac deaths, 3 nonfatal myocardial infarctions and 2 admissions for unstable angina. Compared with patients with cardiac TnT values 0.1 ng/ml was an independent correlate of cardiac events (adjusted odds ratio 4.6, p < 0.05). This correlation was a function of the relation of elevated TnT levels with postoperative in-hospital congestive heart failure and new sustained arrhythmias, suggesting that elevated postoperative TnT levels detected myocardial ischemia during these clinical events.Conclusions. We conclude that an abnormal TnT level in patients undergoing noncardiac surgery may be a useful marker of ischemic disease and a predictor of 6-month prognosis.(J Am Coll Cardiol 1997;29:1241–5)

This paper presents an experimental and numerical study of unidirectional carbon fiber composites with a silicone matrix, loaded transversally to the fibers. The experiments show nonlinear behavior with significant strain softening under cyclic loading. The numerical study uses a plane-strain finite element continuum model of the composite material in which the fiber distribution is based on experimental observations and cohesive elements allow debonding to take place at the fiber/matrix interfaces. It is found that accurate estimates of the initial tangent stiffness measured in the experiments can be obtained without allowing for debonding, but this feature has to be included to capture the non-linear and strain-softening behavior.

This paper presents an experimental and numerical study of the folding behavior of thin composite materials consisting of carbon fibers embedded in a silicone matrix. The soft matrix allows the fibers to microbuckle without breaking and this acts as a stress relief mechanism during folding, which allows the material to reach very high curvatures. The experiments show a highly non-linear moment vs. curvature relationship, as well as strain softening under cyclic loading. A finite element model has been created to study the micromechanics of the problem. The fibers are modeled as linear-elastic solid elements distributed in a hyperelastic matrix according to a random arrangement based on experimental observations. The simulations obtained from this model capture the detailed micromechanics of the problem and the experimentally observed non-linear response. The proposed model is in good quantitative agreement with the experimental results for the case of lower fiber volume fractions but in the case of higher volume fractions the predicted response is overly stiff.

We explore the effect of precisely defined geometric imperfections on the buckling load of spherical shells under external pressure loading, using finite-element analysis that was previously validated through precision experiments. Our numerical simulations focus on the limit of large amplitude defects and reveal a lower bound that depends solely on the shell radius to thickness ratio and the angular width of the defect. It is shown that, in the large amplitude limit, the buckling load depends on an single geometric parameter, even for shells of moderate radius to thickness ratio. Moreover, numerical results on the knockdown factor are fitted to an empirical, albeit general, functional form that may be used as a robust design guideline for the critical buckling conditions of pressurized spherical shells.

Paper folding is found across cultures for both aesthetic and functional purposes, with its most widely recognized exponent being the ancient art form of origami. More recently, there has been an upsurge of interest for translating origami designs into mathematics, natural sciences, engineering, and architecture. Across these different fields, origami is becoming a fountain of inspiration for new reconfigurable and multifunctional materials and structures. However, the use of origami designs as engineering elements is typically compromised by limitations in structural performance. A new study by Filipov et al. (1) presents an innovative approach for the design of strikingly rigid deployable structures. Their strategy is based on tubular building blocks, which are themselves built on Miura-ori; a regular folding pattern that maps a flat sheet into a one degree-of-freedom deployable structure (2). Two neighboring Miura tubes can be set in a zig-zag (“zipper”) arrangement; together, the pair is remarkably stiff and effectively possesses a single degree of freedom by resisting other bending and twisting modes. These zipper tubes can then be combined to generate other structures, including more complex tubular systems and cellular assemblies. In Fig. 1 A and B, we present two particular examples from their study: a model bridge with load-bearing capacity and an architectural canopy that can be deployed to cover a wide span. Filipov et al. (1) borrow well-established tools from structural mechanics that are commonly used in civil and mechanical engineering and port them to this new emerging field of origami-inspired design.

Background Cardiovascular disease is the most common cause of death and risk prediction formulae such as the Framingham Risk Score have been developed to easily identify patients at high risk that may require therapeutic interventions. Discussion Using cardiovascular risk formulae at a population level to estimate and compare average cardiovascular risk among groups has been recently proposed as a way to facilitate surveillance of net cardiovascular risk and target public health interventions. Risk prediction formulas may help to compare interventions that cause effects of different magnitudes and directions in several cardiovascular risk factors, because these formulas assess the net change in risk using easily obtainable clinical variables. Because of conflicting data estimates of the incidence and prevalence of cardiovascular disease, risk prediction formulae may be a useful tool to estimate such risk at a population level. Summary Although risk prediction formulae were intended on guiding clinicians to individualized therapy, they also can be used to ascertain trends at a population-level, particularly in situations where changes in different cardiovascular risk factors over time have different magnitudes and directions. The efficacy of interventions that are proposed to reduce cardiovascular risk impacting more than one risk factor can be well assessed by these means.

Background Cardiovascular diseases (CVD) are the leading cause of death globally. Cardiac rehabilitation (CR) is an evidence-based intervention recommended for patients with CVD, to prevent recurrent events and to improve quality of life. However, despite the proven benefits, only a small percentage of those would benefit from CR actually receive it worldwide. This paper by the International Council of Cardiovascular Prevention and Rehabilitation forwards the groundwork for successful CR advocacy to achieve broader reimbursement, and hence implementation. Methods First, the results of the International Council’s survey on national CR reimbursement policies by government and insurance companies are summarized. Second, a multi-faceted approach to CR advocacy is forwarded. Finally, as per the advocacy recommendations, the economic impact of CVD and the corresponding benefits of CR and its cost-effectiveness are summarized. This provides the case for CR reimbursement advocacy. Results Thirty-one responses were received, from 25 different countries: 18 (58.1 %) were from high-income countries, 10 (32.4 %) from upper middle-income, and 3 (9.9 %) from lower middle-income countries. When asked who reimburses at least some portion of CR services in their country, 19 (61.3 %) reported the government, 17 (54.8 %) reported patients pay out-of-pocket, 16 (51.6 %) reported insurance companies, 12 (38.7 %) reported that it is shared between the patient and another source, and 7 (22.6 %) reported another source. Conclusions Many patients pay out-of-pocket for CR. CR reimbursement around the world is inconsistent and insufficient. Advocacy campaigns forwarding the CR cause, supported by the relevant literature, enlisting sources of support in a unified manner with an organized plan, are needed, and must be pursued persistently. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1658-1) contains supplementary material, which is available to authorized users.

The objective of this retrospective study was to develop and validate a cardiovascular (CV) risk prediction algorithm in a referral population using exercise treadmill test (ETT) parameters. We assessed the predictive value of conventional CV risk factors and ETT parameters in 6546 consecutive

Cardiac rehabilitation (CR) is a proven model of risk reduction, yet is grossly under-used. The reasons are multifactorial, but most centrally this is due to lack of reimbursement for CR services. Recently surveys of CR leaders in the United States and Latin America have documented wide variation in