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O13-06 Early administration of intracoronary verapamil improves myocardial perfusion during percutaneous coronary interventions for acute myocardial infarction
Abstracts/International Journal of Cardiology 97 SuppL 2 (2004) S 1 ~ 7 5 M e t h o d s : We examined consecutive patients with confirmed acute myocardial infarction between April and June 2003 who were categorized into case group while control group included normal healthy persons. The research method was observational analytic using prospective cohort study. The obtained data were statistically analized using multivariate analysis. Results: Of the 29 patiens (case group) and 30 persons (control group) of this study showed the significant differences in average value of myocardial infarction prognosis markers between case group and control group in CRP level (p< 0,005), IL 6 (p< 0,001) and fibrinogen (p< 0,005). There were significant positive association between VCAM 1 level (p< 0,05), CRP (p< 0,05), IL 6 (p< 0,05) and the prognosis of acute myocardial infarction. C o n c l u s i o n : The level of IL 6 represent a dominant factor as the most important role on the prognosis of acute myocardial infarction.
O13-05 R E D U C T I O N OF M Y O C A R D I A L I N F A R C T S I Z E B Y B R I E F P R E S S U R E O V E R L O A D OF T H E L E F T V E N T R I C L E IS N O T M E D I A T E D V I A ACTIVATION O F A D E N O S I N E R E C E P T O R S
Cheng Hsiung Huang 1, Shen Kou Tsal 2, Yi You Wang 1. 1Division of
Cardiovascular Surger~ Department of Surger~ cvtd 2Department of Anesthesia, National Yang-Ming University School of Medicine, and Taipei Veterans General Hospital, Taipei, Taiwan Background: We have reported brief pressure overload of the left ventricle pieconditioned rabbit myocardium and reduced infarct size. In this study, we investigated if the underlying mecha~ism is mediated via activation of adenosine receptoi~. M e t h o d s ; Brief pressure overload of the left ventricle was achieved by two 10 rain partial snaring of the ascending aorta so that left ventricular pressure was raised 50% above the baseline value. Ischemic precondition ing was elicited by two 10rain coronary artery occlusions. Ten minutes after different pretreatments, myocardial infarction was induced by 60 rain coronary artery occlusion followed by 3 hour repeffusion. Area at risk and myocardial infarct was determined by blue dye injection and triphenyl tetrazolium clfloride staining. Results: The myocardial infarct size, expressed as percentage of area at risk was significantly reduced in pressure overload group (18.5 ± 3.4%, p < 0.001, N 7) as well as in ischemic preconditioning group (20.1 ± 4.0%, p < 0.001, N ~ ) versus control group (30.0 ± 4.6%, N 7). Pretreatment with a blocker of adenosine receptors (8 p sulfophenyl theophylline, SPT, 7.5 mg/kg, intravenous) abolished the protection by ischemic preconditioning (25.2 ± 3.3%, N 7). However, SPT did not prevent reduction of myocardial size induce by brief plessure overload (20.7 ± 2.0%, p < 0.01, N ~ ) . SPT itself did not alter the extent of infarct. There was no significant difference in hemodynamics, area at risk and mortality among all groups of animals. Conclusions: Thus, brief plessure overload of the left ventricle by partial snaring of the ascending aorta preconditioned rabbit myocardium against infarction. The underlying mechanism is not mediated via activation of adenosine receptois.
O13-06 EARLY ADMINISTRATION OF INTRACORONARY VERAPAMIL IMPROVES MYOCARDIAL PERFUSION DURING PERCUTANEOUS CORONARY INTERVENTIONS FOR ACUTE MYOCARDIAL INFARCTION
Chi Ling Hang, Cha Ping Wang, Hon Kan Yip, Cheng Hsu Yang, G. Bih Fang Guo, Chiung Jen Wu, Shyh Ming Chen. Section of Cardiology,
Department of Internal Medicine, Chang Gun g Memorial Hospital, Kaohsiung Hsien, Taiwan, Republic of China Introduction: Intracoronary calcium channel blockers administered in the event of no re flow during percutaneous coronary interventions (PCI)
$43
in acute myocardial iilfarction (AMI) have been shown to improve myocardial perfusion. We conducted this study to evaluate the effects of a&ninistration of intracoronary verapamil before the occurrence of no reflow during direct PCI. M e t h o d : From September 2001 to December 2003, 50 consecutive pa tients with A M I were prospectively enrolled for intracoronary verapmnil treatment. Intracoronary verapmnil was a&ninistered mmlediately prior to balloon i~lflation, and 2 to 3 more doses were given at short intervals there after. Retrospectively, 50 consecutive A M I patients who had undergone direct PCI and had not received intracoronary calcium channel blocker were enrolled as controls. Patients had cardiogenic shock or received platelet glycoprotein IIb/IIIa inhibitor were excluded. Thrombolysis in Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count (CTFC), and TIMI myocardial perfusion grade (TMPG) were assessed before and after PCI by two independent cardiologists blinded to the procedules. Results: The 2 groups had Nmilar baseline and posbPCI angiographic characteristics, though patients treated with verapamil received more stent implantations than the controls (84% vs. 60%; p 0.008). There was no Ngnificant difference in posbPCI TIMI flow (p 0.68) and CTFC (p 0.36) between patients treated with verapamil and the controls. PosbPCI TMPG was significantly better in patients tleated with intracoronary verapamil (p 0.003). Forty two percent of the patients treated with verapamil were found to have TMPG 3, while only 14% of the controls were found to have the same degree of TMPG (p 0.004). Treatment with intracoronary verapamil (OR, 0.26; 95% CI, 0.12 0.58;p 0.001) andple P C I T I M I f l o w (OR, 0.54; 95% CI, 0.35 0.84; p 0.006) were found by multiple logistic regression to be independent predictors of TMPG. C o n c l u s i o n : Early administration of intracoronary verapamil duling direct PCI improves postprocedural myocardial perfusion.
ORAL SESSION O14
Electrophysiology and Pacing O14-01 THE VALUE OF THE CHRONOTROPIC RESPONSE AND HEART RATE R E C O V E R Y I N T H E T R E A D M I L L S T R E S S T E S T AS PREDICTORS OF SIGNIFICANT CORONARY ARTERY DISEASE
Marcellus Francis L. Ramirez~ Jillian Y. Ang, Claire D. Bautista, Maria Emilia A. Abadilla, Pilar Philamer I. Andles, Byron S. Angeles, Antonette Abigail A. Aprecio, Christine M. Aquino, April Lynly A. Aquitania, Ian Antonio G. Atienza, Jeffrey C. Chua, Jeffrey M. Chua, Marte B. Quelimit, Michael S. Sagun, Eduardo Vicente S. Caguioa, Milagros E. Yamamoto. Section of Cardiology, Department of Medicine,
University of Santo Tomas, Manila, Philippines Objective: This study alms to detelrnine the value of heart rate re sponse parameters during treadmill exercise testtng(TET), specifically chronotroptc response(ChR), chronotroptc index(ChrI), and heart rate re covery(HRR) in detecting stgilificant coronary artery disease(CAD), and the specific coronary artery involvement. M e t h o d s ; Subjects included patients who underwent TET and coronary angiography within 90 days. Parameters taken included ST segment devi ation, the ChR, the computed ChrI, and the HRR. Coronary angiography data included presence of stgilificant CAD, using >50% stenosis as the defiNng standard, and the specific coronary artery involved. Statistical analysts was done to evaluate the diagnostic value of the parameters and relation with stg~ificant CAD Results; 50 patients were included. 33 had stg~i ficant CAD on coronary angiography, 21 of whom had 3 vessel involvement. Combined effect of ST segment changes and heart rate response parameters increased the sensitivity of TET from 56% to 81%. Anlong patients without CAD by angiography, parameters showed: ChrI of 0.71±0.30, CI~R of 86±16.17, and HRR of 23±22. In patients with 3 vessel CAD, parameters were:
O13-05 R E D U C T I O N OF M Y O C A R D I A L I N F A R C T S I Z E B Y B R I E F P R E S S U R E O V E R L O A D OF T H E L E F T V E N T R I C L E IS N O T M E D I A T E D V I A ACTIVATION O F A D E N O S I N E R E C E P T O R S
Cheng Hsiung Huang 1, Shen Kou Tsal 2, Yi You Wang 1. 1Division of
Cardiovascular Surger~ Department of Surger~ cvtd 2Department of Anesthesia, National Yang-Ming University School of Medicine, and Taipei Veterans General Hospital, Taipei, Taiwan Background: We have reported brief pressure overload of the left ventricle pieconditioned rabbit myocardium and reduced infarct size. In this study, we investigated if the underlying mecha~ism is mediated via activation of adenosine receptoi~. M e t h o d s ; Brief pressure overload of the left ventricle was achieved by two 10 rain partial snaring of the ascending aorta so that left ventricular pressure was raised 50% above the baseline value. Ischemic precondition ing was elicited by two 10rain coronary artery occlusions. Ten minutes after different pretreatments, myocardial infarction was induced by 60 rain coronary artery occlusion followed by 3 hour repeffusion. Area at risk and myocardial infarct was determined by blue dye injection and triphenyl tetrazolium clfloride staining. Results: The myocardial infarct size, expressed as percentage of area at risk was significantly reduced in pressure overload group (18.5 ± 3.4%, p < 0.001, N 7) as well as in ischemic preconditioning group (20.1 ± 4.0%, p < 0.001, N ~ ) versus control group (30.0 ± 4.6%, N 7). Pretreatment with a blocker of adenosine receptors (8 p sulfophenyl theophylline, SPT, 7.5 mg/kg, intravenous) abolished the protection by ischemic preconditioning (25.2 ± 3.3%, N 7). However, SPT did not prevent reduction of myocardial size induce by brief plessure overload (20.7 ± 2.0%, p < 0.01, N ~ ) . SPT itself did not alter the extent of infarct. There was no significant difference in hemodynamics, area at risk and mortality among all groups of animals. Conclusions: Thus, brief plessure overload of the left ventricle by partial snaring of the ascending aorta preconditioned rabbit myocardium against infarction. The underlying mechanism is not mediated via activation of adenosine receptois.
O13-06 EARLY ADMINISTRATION OF INTRACORONARY VERAPAMIL IMPROVES MYOCARDIAL PERFUSION DURING PERCUTANEOUS CORONARY INTERVENTIONS FOR ACUTE MYOCARDIAL INFARCTION
Chi Ling Hang, Cha Ping Wang, Hon Kan Yip, Cheng Hsu Yang, G. Bih Fang Guo, Chiung Jen Wu, Shyh Ming Chen. Section of Cardiology,
Department of Internal Medicine, Chang Gun g Memorial Hospital, Kaohsiung Hsien, Taiwan, Republic of China Introduction: Intracoronary calcium channel blockers administered in the event of no re flow during percutaneous coronary interventions (PCI)
$43
in acute myocardial iilfarction (AMI) have been shown to improve myocardial perfusion. We conducted this study to evaluate the effects of a&ninistration of intracoronary verapamil before the occurrence of no reflow during direct PCI. M e t h o d : From September 2001 to December 2003, 50 consecutive pa tients with A M I were prospectively enrolled for intracoronary verapmnil treatment. Intracoronary verapmnil was a&ninistered mmlediately prior to balloon i~lflation, and 2 to 3 more doses were given at short intervals there after. Retrospectively, 50 consecutive A M I patients who had undergone direct PCI and had not received intracoronary calcium channel blocker were enrolled as controls. Patients had cardiogenic shock or received platelet glycoprotein IIb/IIIa inhibitor were excluded. Thrombolysis in Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count (CTFC), and TIMI myocardial perfusion grade (TMPG) were assessed before and after PCI by two independent cardiologists blinded to the procedules. Results: The 2 groups had Nmilar baseline and posbPCI angiographic characteristics, though patients treated with verapamil received more stent implantations than the controls (84% vs. 60%; p 0.008). There was no Ngnificant difference in posbPCI TIMI flow (p 0.68) and CTFC (p 0.36) between patients treated with verapamil and the controls. PosbPCI TMPG was significantly better in patients tleated with intracoronary verapamil (p 0.003). Forty two percent of the patients treated with verapamil were found to have TMPG 3, while only 14% of the controls were found to have the same degree of TMPG (p 0.004). Treatment with intracoronary verapamil (OR, 0.26; 95% CI, 0.12 0.58;p 0.001) andple P C I T I M I f l o w (OR, 0.54; 95% CI, 0.35 0.84; p 0.006) were found by multiple logistic regression to be independent predictors of TMPG. C o n c l u s i o n : Early administration of intracoronary verapamil duling direct PCI improves postprocedural myocardial perfusion.
ORAL SESSION O14
Electrophysiology and Pacing O14-01 THE VALUE OF THE CHRONOTROPIC RESPONSE AND HEART RATE R E C O V E R Y I N T H E T R E A D M I L L S T R E S S T E S T AS PREDICTORS OF SIGNIFICANT CORONARY ARTERY DISEASE
Marcellus Francis L. Ramirez~ Jillian Y. Ang, Claire D. Bautista, Maria Emilia A. Abadilla, Pilar Philamer I. Andles, Byron S. Angeles, Antonette Abigail A. Aprecio, Christine M. Aquino, April Lynly A. Aquitania, Ian Antonio G. Atienza, Jeffrey C. Chua, Jeffrey M. Chua, Marte B. Quelimit, Michael S. Sagun, Eduardo Vicente S. Caguioa, Milagros E. Yamamoto. Section of Cardiology, Department of Medicine,
University of Santo Tomas, Manila, Philippines Objective: This study alms to detelrnine the value of heart rate re sponse parameters during treadmill exercise testtng(TET), specifically chronotroptc response(ChR), chronotroptc index(ChrI), and heart rate re covery(HRR) in detecting stgilificant coronary artery disease(CAD), and the specific coronary artery involvement. M e t h o d s ; Subjects included patients who underwent TET and coronary angiography within 90 days. Parameters taken included ST segment devi ation, the ChR, the computed ChrI, and the HRR. Coronary angiography data included presence of stgilificant CAD, using >50% stenosis as the defiNng standard, and the specific coronary artery involved. Statistical analysts was done to evaluate the diagnostic value of the parameters and relation with stg~ificant CAD Results; 50 patients were included. 33 had stg~i ficant CAD on coronary angiography, 21 of whom had 3 vessel involvement. Combined effect of ST segment changes and heart rate response parameters increased the sensitivity of TET from 56% to 81%. Anlong patients without CAD by angiography, parameters showed: ChrI of 0.71±0.30, CI~R of 86±16.17, and HRR of 23±22. In patients with 3 vessel CAD, parameters were: