Syncope, Dizziness and Falls Overlap Among Patients Referred to a Falls and Syncope Service at the University of Malaya Medical Centre S.Y. Gan a , N.I. Saedon a,b , S. Subramaniam a , N.F. Husna Alias a , S.S. Mohd Nasir a , N.F.I. Abu Hashim a , I.Z. Abidin c , K.H. Chee c , J.Y.L. Teo d , M.P. Tan a,b a Falls and Syncope Service, Cardiorespiratory Laboratory, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia b Division of Geriatric Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia c Division of Cardiology, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia d Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia Background: Falls and syncope are interrelated health problems in older persons. While this relationship has been described in Western countries, research evaluating falls and syncope in among Asians remains limited. Objective: To determine the characteristics and symptom overlap of patients attending a new falls and syncope service at the University of Malaya Medical Centre (UMMC). Materials & Methods: Demographic and clinical information of consecutive patients seen were collected from July 2014 till December 2016. Following a structured clinical assessment, patients were evaluat- ed according to clinical indications with head-up tilt test, carotid massage, active stand and autonomic function test. Results: A total of 205 patients, 61.5 % female, mean age (standard deviation) = 70 (17) years attended the clinic over the time period. There was a bimodal age distribution with a small peak at 25-30 years and a larger peak at 75-80 years. Of these, 37.6 % presented with dizziness, 35.1 % syncope, 12.7 % presyncope and 4.7 % vertigo. 73.7 % had fall(s) and 26.3 % sustained injuries. 36 % had two out of three while 7.3 % had all three symptoms of falls, dizziness and syncope. The two most common diagnoses were orthostatic hypotension (25.9 %) and reflex syncope (23.4 %). Conclusions: Symptoms of falls, syncope and dizziness overlap among patients attending our service with one in four experiencing injuries. The evaluation of these conditions requires close interdisciplin- ary working to ensure a cost-effective approach with good diagnostic yields. doi:10.1016/j.ijcard.2017.09.085 Identification of Metabolite Changes in Plasma Following Ticagrelor Cessation in Acute Coronary Syndrome Patients Using Metabolomics W.M. Kepli a , J. Dawson b , M. Walters b , C. Berry b a Pharmacy Department, Hospital Serdang, Selangor, Malaysia b Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK Background: Stopping dual antiplatelet therapy (DAPT) has been shown to increase the risk of adverse event following acute coronary syndrome (ACS). Objective: We explored whether metabolomic techniques could identify changes in metabolites before and after stopping DAPT. Materials & Methods: We used liquid chromatography-mass spectrometry to compare the serum metabolite profile of patients with ACS while on ticagrelor (within one month before DAPT ended) and after cessation (between 7 to 30 days after ticagrelor ended). Metabolite changes between before and after cessation were determined using paired t-tests with a p-value of b 0.05 considered significant. Results: The metabolomics analysis cohort included 7 patients [mean age 66.0 (SD 7.2) years], 5 ST-elevation myocardial infarction (STEMI) and 2 non-STEMI. All patients were treated with aspirin 75mg daily and combination with ticagrelor 90mg twice daily. Mean total duration (SD) of DAPT therapy following ACS was 167 (32.5) days. 311 putative metabolites were identified. We found 16 statistically signifi- cant metabolites of interest, of which 7 metabolites were from lipid pathway, 1 from carbohydrate metabolism and one from nucleotide metabolism. Notably, after stopping ticagrelor, adenosine pathway was upregulated to 2.6 fold (uncorrected p=0.028). Conclusions: In this preliminary study, we used an untargeted metabolomics approach to assess changes in metabolites after cessation of ticagrelor. Multiple metabolite changes were observed, including an up-regulation of the adenosine pathway. The clinical significance of these changes remains to be determined. doi:10.1016/j.ijcard.2017.09.086 The Effects of Peri-Percutaneous Coronary Intervention Oxygenation on Myocardial Protection and Cardiorespiratory Function: A Concept Proving Study S.C. Chan a , A. Suhami a , G.S. Sridhar b , T. Watson b,c a Cardiac Rehabilitation Service, Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Malaysia b Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, University of Malaya, Malaysia c Department of Medicine, University of Auckland, New Zealand Background: Elective percutaneous coronary intervention (PCI) is often associated with myocardial necrosis evidenced by peri-procedural troponin release and this is surrogate for subsequent cardiovascular events. There is no local study on effect of peri PCI oxygenation in in myocardial protection and cardiopulmonary fitness outcome. The effect of peri PCI oxygenation on cardiovascular fitness is not known. Objective: The aim of this study is to assess the utility of oxygen for reduction of ischaemia in patients with significant stable coronary artery disease scheduled for elective PCI. A secondary purpose is to evaluate further effect of peri- PCI oxygenation on cardiovascular fitness and autonomic response. Methods: Thirty subjects undergoing elective PCI were recruited in the study. 16 subjects were randomized to receive treatment (oxygen) or 14 randomized to placebo (medical air) for 30 minutes prior to PCI. Subjects were then assessed with submaximal exercise treadmill test. The primary outcome was Troponin I at 6 hours and 24 hours after PCI. Secondary outcomes include cardiopulmonary fitness and cardiovascular autonomic response. Results: PCI is associated with peri-procedural myocyte necrosis in both group; the median Troponin I at 24 hours is lower in the experimental group compared to the control group (0.165 versus 0.230ng/mL, P= 0.637). The experimental group achieved higher heart rate recovery (33.38 versus 29.71 bpm, P= 0.461). More subjects in experimental group achieved target heart rate recovery; 7 out of 16 subjects in the experimental group versus 4 out of 14 in the control group, P= 0.389. There is no significant difference in METs. Conclusions: Despite the insignificant result in the benefits of oxygen in myocardial protection and improving cardiopulmonary fitness; the experimental group experienced less myocardial necrosis as evidenced by lower median Troponin I. There are improvements in autonomic response as evidenced by more subjects achieving higher heart rate recovery and target chronotropic index in the experimental group. This group of subjects may have lower cardiovascular mortality as chronotropic index is a strong predictor for cardiovascular mortality and lesser myocardial Abstracts S22