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APSC2015-1216 Association Between Acute Myocardial Infarction and Carotid Arteriosclerosis
APSC2015-1216 Association Between Acute Myocardial Infarction and Carotid Arteriosclerosis Takanobu Tomaru*1, Takumi Matsubara1, Erika Matsubara1 1 Clinical Phyisiology, Toho University Medical Center, Sakura, Japan We evaluated clinical profiles of acute myocardial infarction (AMI) without severe carotid arteriosclerosis (CA). Methods: Plaque score (PS) was calculated by ultrasonography. Risk factor (RF) included hypertension, dyslipidemia, diabetes mellitu、smoking history (SMH). Results: In 28 AMI cases without plaque (mean age 59.88), there were only 2 (7.1%) with 3 vessel disease (VD) and 5 (17.8%) with 2 VD, and mean number of diseased vessel (MNDV) was 1.390.71 (meanSD). The mean number of RF (MNRF) was 2.100.96 and 24 (85.9%) had SMH. Sixteen patients (57.1%) were current smoker (CS). In 51 AMI cases (mean age 63.4) with mild CA (PS<5), there were 3 (5.8%) with 3 VD and 17 (33.3%) with 2 VD (MNDV 1.420.58 and MNRF 2.141.07). The 38 (74.5%) had SMH and 14(27.5%) were current smoker. In 37 AMI cases (mean age 63.4) with moderate CA (PS>5), there were 15 (40.5%) with 3VD and 12 (32.4%) with 2 VD (MNDV 2.00.81 and MNRF 2.221.01). The 28 (75.7%) had SMH and 9 (24.3%) were current smoker. In 17 AMI cases (mean age 5.4) with marked CA(PS>10), there were 8 (47.1%) with 3 VD and 4 (%) with 2 VD(MNDV 2.18+0.88 and MNRF 2.31.01). MNDV in moderate CS or marked CS was greater than that in no or mild CS. The 13 (76.5%) had SMH and 5 (29.4%) were current smoker. In 31 cases with stable angina (SAP) with mild CA (mean age 69.69), MNRF was 1.840.73 and MNDV was 1.630.68. The 12 (38.7%) had SMH, and the percentage of SMH in SAP was lower than that in AMI group (P<005). There were 2 current smoker (CS) (6.5 %) in SAP and the percentage of CS in SAP was lower than that in AMI group (P<0.005). Mean cardio ankle vascular index (CAVI) in AMI was 9.4 (8.6 in SAP). Conclusions: AMI may occur with no or mild CA, and smoking is an important risk factor for AMI. PS was associated with DV number. MNRF or MNDV was similar between AMI and SAP with no or mild arteriosclerosis. CAVI may predict high risk for AMI. Disclosure of Interest: None Declared Keywords: Acute Myocardial Infarction APSC2015-1260 Cardiac Dysfunction: The Predictor of Severity and Mortality in Sepsis Patients at Dr. Moewardi Hospital Surakarta, an Echocardiography Study Trisulo Wasyanto*1, Ahmad Yasa’1 1 Cardiology and Vascular Medicine, Dr.Moewardi Hospital/University of Sebelas Maret, Surakarta, Indonesia Background: Sepsis was one of health problem which cause a high risk of morbidity and mortality in the intensive care unit (ICU). Patients with severe sepsis or septic shock often exhibit significant cardiac dysfunction. Releasing cytokines pro inflammatory (TNFa, IL-1b and IL-6) in sepsis patients caused cardiac dysfunction. There are currently not many studies evaluate about it. Objectives: To determine the predictor of severity and mortality in sepsis patients observed from cardiac dysfunction, evaluated by echocardiography. Methods: A cohort observational study was conducted between January and June 2014 in the ICU of a tertiery care at Dr. Moewardi Hospital, Indonesia. The descriptions of sepsis were based on the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM). We reviewed the sequential organ failure assessment (SOFA) score and echocardiography examinations include the functions of Left Ventricle (LV) systolic, Right Ventricle (RV) systolic, and LV diastolic. LV systolic dysfunction if LVEF 45%. Anova, Kruskal Wallis, Log Regression, and Cox Hazard Survival were used for statistical analysis. P < 0.05 was considered significant. Results: A total of 71 sepsis patients were reviewed in this study. The patients were classified into 3 groups based on the severity of sepsis. There were 21 mild sepsis (29,6%), 35 severe sepsis (49,3%) and 15 septic shock (21,1%). Based on logistic regression analysis, only LV systolic dysfunction predicted the severity of sepsis (p<0.001, OR ¼ 0.665) as well as the SOFA scores (p<0.001, OR ¼ 3.399), both dysfunctions of RV systolic and LV diastolic were not significant. Of the three parameters, LV systolic dysfunction was the only predictor for mortality in sepsis patients during hospitalized (p ¼ 0.049, HR ¼ 1.71). Conclusions: This study suggests that LV Systolic Dysfunction can predict the severity and mortality in sepsis patients at Dr. Moewardi Hospital Surakarta, Indonesia Disclosure of Interest: None Declared Keywords: Cardiac Dysfunction, LV Systolic Dysfunction, Sepsis
GHEART Vol 10/2S/2015
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June, 2015
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APSC2015-1255 Mid Regional Pro Atrial Natriuretic Peptide (MR pro ANP) as Biomarker Left Ventricular Systolic Dysfunction in Sepsis Patients Trisulo Wasyanto*1, Guntur Hermawan2, Rochmad Romdoni3, Bambang Purwanto2 1 Cardiology and Vascular Medicine, 2Internal Medicine, Dr.Moewardi Hospital/University of Sebelas Maret., Surakarta, 3Cardiology and Vascular Medicine, Dr.Soetomo Hospital/University of Airlangga., Surabaya, Indonesia Background: Sepsis was one of health problem which cause a high risk of morbidity and mortality in the ICU. Releasing cytokines pro inflammatory (TNFa, IL-1b and IL-6) in sepsis patients caused Left Ventricular Systolic Dysfunction (LVSD). There was a releasing of MR pro ANP, PCT and TNF-a because of cytokines pro inflammatory stimulation. Objectives: To prove MR pro ANP as LVSD biomarker, to determine Area Under the Curve (AUC) value, sensitivity, specificity, cut off point value, and probability of MR pro ANP, PCT and TNF-a as LVSD predictor. Methods: Diagnostic test using cross sectional design. Variables examined were MR pro ANP, PCT, TNF-a and LVEF. LVSD occurred if LVEF was 45% (Simpson). Data were analysed using 2x2 table and Receiver Operating Characteristic (ROC) curve and statistically analysed with SPSS 22 for window. Results: We reviewed 71 sepsis patients between November 2013 and March 2014 in the ICU of a tertiery care hospital. There were 22 mild sepsis (30,9%), 40 severe sepsis (56,4%) and 9 septic shock (12,7%). AUC value of MR pro ANP was 0,84 (95% CI 0,73-0,95), p<0,001. Cut off point of MR pro ANP was 225,95 pmol/L with Diagnostic Odd Ratio (DOR) 12,11 (95% CI 3,66-40,12). AUC value of PCT was 0,81 (95% CI 0,71-0,91), p <0,001. Cut off point of PCT was 7,875 ng/mL with DOR 5,55 (95% CI 1,88-16,42). AUC value of TNF-a was 0,73 (95% CI 0,60 - 0,86), p <0,002. Cut off point of TNF-a was 7,36 pg/mL with DOR 5,03 (95% CI 1,71-14,77). Multivariate analysis found MR pro ANP as the best predictor for LVSD with AUC 0,78 (95% CI 0,66-0,90). Conclusions: MR pro ANP could be used as LVSD biomarker with AUC 0,84 (95% CI 0,730,95), p<0,001, cut off point value 225,95 pmol/L, DOR 12,11 (95% CI 3,66-40,12). PCT and TNF-a could be used as LVSD predictor but MR pro ANP was the best LVSD predictor. Disclosure of Interest: None Declared Keywords: Biomarker, Left Ventricular Systolic Dysfunction, MR pro ANP APSC2015-1041 Knowledge & Skill Retention After the Advanced Cardiac Life Support Workshop – A Study in Nursing Practitioners at the Udonthani General Hospital, Thailand Wisit Wichitkosoom*1, Bussaba Prasarnathikom1 1 Medicine, Udonthani general hospital, Udonthani, Thailand The advanced cardiac life support (ACLS) is an essential competency and is the basic requirement knowledge for everyone whom work with public health sector. In developing countries, there were many problems about critical patients management. One of many risks is skilful of ACLS which all nurses should acquire. However, there was no re- evaluation process after the ACLS workshop in the past. As a result, the retention of their ACLS knowledge and skills had yet to determine. After the advanced cardiac life support ACLS workshops were conducted with five batches of nurse practitioners, one batch with 58 participants was included in the study. Their ACLS knowledge was assessed immediately before, immediately after, and two months after the workshop. Repeated Measure ANOVA was used for data analysis. Moreover, their ACLS skills were assessed immediately after and two months after the workshop. The paired t-test was used for data analysis. The comparisons of their ACLS knowledge scores between (1) the pre-test and the immediate post-test and (2) the pre-test and the 2-month post-test were both statistically significantly different (p < .05). However, the immediate post-test and 2-month post- test scores were not statistically significantly different. Furthermore, there was statistically significant difference between the immediate post-test scores and the 2-month post-test scores of their ACLS skill assessment (p < .05). The advanced cardiac life support ACLS workshops should be repeated every two months expectedly in critical and emergency part. Disclosure of Interest: None Declared Keywords: None APSC2015-1166 The Effect of a Standardized Protocol in Right-Siting and Cardiovascular Risk Factor Control in Patients After Successful Percutaneous Coronary Intervention Ningyan Wong*1, Terrance Chua1, Fei Gao1, David Matchar2, Aaron Wong1, Khung Keong Yeo1, Jack Tan1, Chee Tang Chin1 1 National Heart Centre Singapore, 2Duke-NUS Graduate Medical School, Singapore, Singapore Background: Following percutaneous coronary intervention (PCI), patients are frequently followed-up in specialist outpatient clinics for a long duration, contributing to an increasing clinic load. We developed the Standardized Care for Optimal Outcomes, Right-Siting and Rapid Re-evaluation (SCORE) protocol and studied its effect on: the duration of outpatient clinic follow-up before discharge to primary care; and cardiovascular risk factor optimisation.
POSTER/20th Asian Pacific Society Cardiology Congress Posters
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POSTER ABSTRACTS
ventilation, furosemide and nitroglycerin, the accomplishments of RR < 20/min at hospitalization and HR reduction rate S20% at 15 minutes after hospitalization were significantly associated with the morphine use (Odds ratio (OR): 8.0 (95% Confidence interval (CI): 2.7-27.3), p ¼ 0.0001 and OR: 4.1 (95%CI: 1.5-12.2), p ¼ 0.0063). However, there was no significant difference in-hospital mortality between those with and without morphine treatment. Moreover, in propensity score-matched 64 patients, morphine-treated patients showed better improvement of HR at hospitalization (p ¼ 0.04) and RR at 15, 30, 60 minutes after hospitalization (p ¼ 0.05, p ¼ 0.03 and p ¼ 0.004). Conclusions: Intravenous morphine may be effective for shortening recovery from ADHF presenting PC. Disclosure of Interest: None Declared Keywords: Acute Decompensated Heart Failure, Morphine, Pulmonary Congestion
GHEART Vol 10/2S/2015
j
June, 2015
j
APSC2015-1255 Mid Regional Pro Atrial Natriuretic Peptide (MR pro ANP) as Biomarker Left Ventricular Systolic Dysfunction in Sepsis Patients Trisulo Wasyanto*1, Guntur Hermawan2, Rochmad Romdoni3, Bambang Purwanto2 1 Cardiology and Vascular Medicine, 2Internal Medicine, Dr.Moewardi Hospital/University of Sebelas Maret., Surakarta, 3Cardiology and Vascular Medicine, Dr.Soetomo Hospital/University of Airlangga., Surabaya, Indonesia Background: Sepsis was one of health problem which cause a high risk of morbidity and mortality in the ICU. Releasing cytokines pro inflammatory (TNFa, IL-1b and IL-6) in sepsis patients caused Left Ventricular Systolic Dysfunction (LVSD). There was a releasing of MR pro ANP, PCT and TNF-a because of cytokines pro inflammatory stimulation. Objectives: To prove MR pro ANP as LVSD biomarker, to determine Area Under the Curve (AUC) value, sensitivity, specificity, cut off point value, and probability of MR pro ANP, PCT and TNF-a as LVSD predictor. Methods: Diagnostic test using cross sectional design. Variables examined were MR pro ANP, PCT, TNF-a and LVEF. LVSD occurred if LVEF was 45% (Simpson). Data were analysed using 2x2 table and Receiver Operating Characteristic (ROC) curve and statistically analysed with SPSS 22 for window. Results: We reviewed 71 sepsis patients between November 2013 and March 2014 in the ICU of a tertiery care hospital. There were 22 mild sepsis (30,9%), 40 severe sepsis (56,4%) and 9 septic shock (12,7%). AUC value of MR pro ANP was 0,84 (95% CI 0,73-0,95), p<0,001. Cut off point of MR pro ANP was 225,95 pmol/L with Diagnostic Odd Ratio (DOR) 12,11 (95% CI 3,66-40,12). AUC value of PCT was 0,81 (95% CI 0,71-0,91), p <0,001. Cut off point of PCT was 7,875 ng/mL with DOR 5,55 (95% CI 1,88-16,42). AUC value of TNF-a was 0,73 (95% CI 0,60 - 0,86), p <0,002. Cut off point of TNF-a was 7,36 pg/mL with DOR 5,03 (95% CI 1,71-14,77). Multivariate analysis found MR pro ANP as the best predictor for LVSD with AUC 0,78 (95% CI 0,66-0,90). Conclusions: MR pro ANP could be used as LVSD biomarker with AUC 0,84 (95% CI 0,730,95), p<0,001, cut off point value 225,95 pmol/L, DOR 12,11 (95% CI 3,66-40,12). PCT and TNF-a could be used as LVSD predictor but MR pro ANP was the best LVSD predictor. Disclosure of Interest: None Declared Keywords: Biomarker, Left Ventricular Systolic Dysfunction, MR pro ANP APSC2015-1041 Knowledge & Skill Retention After the Advanced Cardiac Life Support Workshop – A Study in Nursing Practitioners at the Udonthani General Hospital, Thailand Wisit Wichitkosoom*1, Bussaba Prasarnathikom1 1 Medicine, Udonthani general hospital, Udonthani, Thailand The advanced cardiac life support (ACLS) is an essential competency and is the basic requirement knowledge for everyone whom work with public health sector. In developing countries, there were many problems about critical patients management. One of many risks is skilful of ACLS which all nurses should acquire. However, there was no re- evaluation process after the ACLS workshop in the past. As a result, the retention of their ACLS knowledge and skills had yet to determine. After the advanced cardiac life support ACLS workshops were conducted with five batches of nurse practitioners, one batch with 58 participants was included in the study. Their ACLS knowledge was assessed immediately before, immediately after, and two months after the workshop. Repeated Measure ANOVA was used for data analysis. Moreover, their ACLS skills were assessed immediately after and two months after the workshop. The paired t-test was used for data analysis. The comparisons of their ACLS knowledge scores between (1) the pre-test and the immediate post-test and (2) the pre-test and the 2-month post-test were both statistically significantly different (p < .05). However, the immediate post-test and 2-month post- test scores were not statistically significantly different. Furthermore, there was statistically significant difference between the immediate post-test scores and the 2-month post-test scores of their ACLS skill assessment (p < .05). The advanced cardiac life support ACLS workshops should be repeated every two months expectedly in critical and emergency part. Disclosure of Interest: None Declared Keywords: None APSC2015-1166 The Effect of a Standardized Protocol in Right-Siting and Cardiovascular Risk Factor Control in Patients After Successful Percutaneous Coronary Intervention Ningyan Wong*1, Terrance Chua1, Fei Gao1, David Matchar2, Aaron Wong1, Khung Keong Yeo1, Jack Tan1, Chee Tang Chin1 1 National Heart Centre Singapore, 2Duke-NUS Graduate Medical School, Singapore, Singapore Background: Following percutaneous coronary intervention (PCI), patients are frequently followed-up in specialist outpatient clinics for a long duration, contributing to an increasing clinic load. We developed the Standardized Care for Optimal Outcomes, Right-Siting and Rapid Re-evaluation (SCORE) protocol and studied its effect on: the duration of outpatient clinic follow-up before discharge to primary care; and cardiovascular risk factor optimisation.
POSTER/20th Asian Pacific Society Cardiology Congress Posters
e21
POSTER ABSTRACTS
ventilation, furosemide and nitroglycerin, the accomplishments of RR < 20/min at hospitalization and HR reduction rate S20% at 15 minutes after hospitalization were significantly associated with the morphine use (Odds ratio (OR): 8.0 (95% Confidence interval (CI): 2.7-27.3), p ¼ 0.0001 and OR: 4.1 (95%CI: 1.5-12.2), p ¼ 0.0063). However, there was no significant difference in-hospital mortality between those with and without morphine treatment. Moreover, in propensity score-matched 64 patients, morphine-treated patients showed better improvement of HR at hospitalization (p ¼ 0.04) and RR at 15, 30, 60 minutes after hospitalization (p ¼ 0.05, p ¼ 0.03 and p ¼ 0.004). Conclusions: Intravenous morphine may be effective for shortening recovery from ADHF presenting PC. Disclosure of Interest: None Declared Keywords: Acute Decompensated Heart Failure, Morphine, Pulmonary Congestion