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OP-171: PERCUTANEOUS CORONARY SINUS INTERVENTIONS TO FACILITATE IMPLANTATION OF LEFT VENTRICULAR LEAD
Oral Presentations / International Journal of Cardiology 147S2 (2011) S37–S98
OP-171 PERCUTANEOUS CORONARY SINUS INTERVENTIONS TO FACILITATE IMPLANTATION OF LEFT VENTRICULAR LEAD A. Oto, K. Aytemir, S. Okutucu, L. Sahiner, U. Canpolat, U.N. Karakulak, B. Evranos, E.B. Kaya, G. Kabakci, L. Tokgozoglu, H. Ozkutlu. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Valves, stenosis and occlusion in the coronary sinus (CS) may affect the success of left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT). There are several cases and/or series in which LV lead implantation become feasible after successful CS angioplasty and/or stenting. Herein, we present our experience in CS angioplasty and/or stenting to facilitate LV lead implantation and stabilization. Methods: We evaluated the efficacy and safety of percutaneous CS interventions (PCSIs) in 255 patients (mean age, 61.0±12.5 years; 60 females, 160 ischemic etiologies) whom transvenous LV lead implantation attempted for CRT between January 2005 and November 2010. All patients were evaluated in terms of age, gender, coronary artery disease and other concomitant diseases. Results: Among this population, 17 (6.7%) patients needed PCSIs. PCSI indications were narrow venous segment in 10 patients, for coronary sinus valve in 5 patients, for chronic venous occlusion in 1 patient and for LV lead stabilization in 1 patient. CS angioplasty was performed in 16 (6.2%) patients and CS stenting was performed in 3 (1.2%) patients to facilitate LV lead placement. Two patients needed both balloon angioplasty and stenting. LV leads were successfully inserted in 15/17 (88.2%) of the patients needed PCSIs. Epicardial LV lead implantation (n = 1) and bifocal right ventricular pacing (n = 1) were performed in remaining 2 patients whom PCSIs failed. There was no complication because of PCSIs. The overall success rate of LV lead implantation increased from 238/255 (93.3%) to 253/255 (99.2%) with the use of PCSIs. Conclusions: PCSIs are useful and safe techniques in transvenous LV lead placement because of coronary sinus stenosis, valves and lead instability. OP-172 COMPARISON OF PLASMA UROCORTIN 1 LEVEL, PULMONARY ARTERY SYSTOLIC PRESSURE AND EJECTION FRACTION IN PATIENTS WITH SYSTOLIC HEART FAILURE I. Keles, E. Yildirim, H.A. Cakmak, B. Ikitimur, K. Cosansu, B. Ilerigelen, V.A. Vural. Department of Cardiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey Objective: Urocortin 1 (Ucn-1), which is a novel member of the corticotrophin-releasing factor (CRF) family, is expressed in heart, brain and gut. Ucn-1 has profound and sustained cardiovascular (reduced cardiac preload and afterload and increased cardiac output), hormonal (inhibition of vasopressin, endothelin and reninangiotensin-aldosterone axis) and renal effects (natriuresis, diuresis and augmented creatinine clearance). In humans, plasma urocortin levels have been shown to significantly increase in systolic heart failure. We have investigated plasma urocortin 1 as a potential diagnostic marker of heart failure and its relationship with ejection fraction (EF) and pulmonary artery systolic pressure in patients with systolic heart failure. Methods: In our study 90 patients (60 male, 30 female, average age of 64.82±12.14 years) who were admitted to our cardiology clinic between May 2010 and August 2010 with diagnosis of systolic heart failure (left ventricular EF <0.45%) were enrolled. At admission, EF and pulmonary artery systolic pressures were calculated with transthoracic echocardiography and plasma urocortin-1 levels measured in all patients. Ejection fractions (EF) and pulmonary artery systolic pressures were compared with plasma urocortin-1 levels with appropriate statistical methods (Pearson test for analysis of correlations).
S73
Results: Plasma urocortin-1 levels showed significant negative correlations with ejection fraction (p < 0.001, r = −0.46). There was also statistically significant positive correlation between pulmonary artery systolic pressures and plasma urocortin-1 levels (p < 0.001, r = 0.39). As a result, plasma urocortin 1 levels increased with decreasing left ventricular EF and increasing pulmonary artery systolic pressures. Conclusions: We have demonstrated a significant relationship between urocortin-1 levels, left ventricular EF and pulmonary artery systolic pressures. These findings suggest a potential role for plasma urocortin-1 as a biochemical marker in the diagnosis and follow-up of patients with systolic heart failure. The exact role of measuring urocortin-1 level during treatment of systolic heart failure remains to be determined with further studies. OP-173 PREVALENCE OF HYPOVITAMINOSIS D IN PATIENTS WITH STAGE C AND D HEART FAILURE O.C. Yilmaz1 , G. Keskin2 , Y. Selcoki1 , A. Temizkan1 , B. Eryonucu1 , O. Soran3 . 1 Department of Cardiology, University of Fatih, Ankara, Turkey; 2 Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey; 3 Department of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA Objective: Previous studies have shown that there is relationship between hypovitaminosis D and heart failure (HF). Since HF is the most common diagnosis-related group for people over the age of 65, patients with HF are at high risk for inadequate vitamin D level because of limited sunlight exposure. The aim of this study is to determine the prevalence of vitamin D deficiency in stage C and D HF patients, according to the ACC/AHA classification, and assess the alterations of vitamin D levels by advanced HF stages. Methods: 114 patients with HF stage C and D were enrolled into this prospective, multicenter study. Inclusion criteria included evidence of systolic dysfunction with a left ventricular ejection fraction of ≤40%. Data on patient demographics, medical history, fasting 25(OH) Vit D, blood glucose, parathormone and creatinine levels were collected. Hypovitaminosis D was defined as 25(OH) D levels >30ng/ml (10–30ng/ml) and Vitamin D deficiency was defined as 25(OH) Vit D levels <10 ng/ml. Pearson Correlation Analysis and ANOVA were used for statistical analysis. Results: The mean age of the study cohort was 66±10 years and 67% was men; 97% had at least one cardiovascular risk factor; 79% had documented coronary artery disease. The mean levels of 25(OH) D was 15.63 ng/ml. Ninety-one percent had low vitamin D levels. Of those, 53% had Hypovitaminosis D and 38% had Vitamin D deficiency. Baseline characteristics were similar in stage C and D HF patients. However, there was a statistically significant difference in regards to vitamin D levels (p < 0.005). Statistical analysis revealed that the level of vitamin D and the stage of the HF were positively correlated (p = 0.004, r = 0.267). As the HF stage worsened the frequency of vitamin D deficiency and parathormone levels increased (p < 0.001 r = −0.366). Conclusions: These results showed that the prevalence of hypovitaminosis D was high in stage C and D HF patients. In the context of these results; routine monitorization of Vitamin D levels in patients with advanced HF and replacement in case of deficiency could be encouraged. However, whether screening and supplement of Vitamin D in patients with advanced HF improve symptoms and clinical outcomes requires further study.
OP-171 PERCUTANEOUS CORONARY SINUS INTERVENTIONS TO FACILITATE IMPLANTATION OF LEFT VENTRICULAR LEAD A. Oto, K. Aytemir, S. Okutucu, L. Sahiner, U. Canpolat, U.N. Karakulak, B. Evranos, E.B. Kaya, G. Kabakci, L. Tokgozoglu, H. Ozkutlu. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Valves, stenosis and occlusion in the coronary sinus (CS) may affect the success of left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT). There are several cases and/or series in which LV lead implantation become feasible after successful CS angioplasty and/or stenting. Herein, we present our experience in CS angioplasty and/or stenting to facilitate LV lead implantation and stabilization. Methods: We evaluated the efficacy and safety of percutaneous CS interventions (PCSIs) in 255 patients (mean age, 61.0±12.5 years; 60 females, 160 ischemic etiologies) whom transvenous LV lead implantation attempted for CRT between January 2005 and November 2010. All patients were evaluated in terms of age, gender, coronary artery disease and other concomitant diseases. Results: Among this population, 17 (6.7%) patients needed PCSIs. PCSI indications were narrow venous segment in 10 patients, for coronary sinus valve in 5 patients, for chronic venous occlusion in 1 patient and for LV lead stabilization in 1 patient. CS angioplasty was performed in 16 (6.2%) patients and CS stenting was performed in 3 (1.2%) patients to facilitate LV lead placement. Two patients needed both balloon angioplasty and stenting. LV leads were successfully inserted in 15/17 (88.2%) of the patients needed PCSIs. Epicardial LV lead implantation (n = 1) and bifocal right ventricular pacing (n = 1) were performed in remaining 2 patients whom PCSIs failed. There was no complication because of PCSIs. The overall success rate of LV lead implantation increased from 238/255 (93.3%) to 253/255 (99.2%) with the use of PCSIs. Conclusions: PCSIs are useful and safe techniques in transvenous LV lead placement because of coronary sinus stenosis, valves and lead instability. OP-172 COMPARISON OF PLASMA UROCORTIN 1 LEVEL, PULMONARY ARTERY SYSTOLIC PRESSURE AND EJECTION FRACTION IN PATIENTS WITH SYSTOLIC HEART FAILURE I. Keles, E. Yildirim, H.A. Cakmak, B. Ikitimur, K. Cosansu, B. Ilerigelen, V.A. Vural. Department of Cardiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey Objective: Urocortin 1 (Ucn-1), which is a novel member of the corticotrophin-releasing factor (CRF) family, is expressed in heart, brain and gut. Ucn-1 has profound and sustained cardiovascular (reduced cardiac preload and afterload and increased cardiac output), hormonal (inhibition of vasopressin, endothelin and reninangiotensin-aldosterone axis) and renal effects (natriuresis, diuresis and augmented creatinine clearance). In humans, plasma urocortin levels have been shown to significantly increase in systolic heart failure. We have investigated plasma urocortin 1 as a potential diagnostic marker of heart failure and its relationship with ejection fraction (EF) and pulmonary artery systolic pressure in patients with systolic heart failure. Methods: In our study 90 patients (60 male, 30 female, average age of 64.82±12.14 years) who were admitted to our cardiology clinic between May 2010 and August 2010 with diagnosis of systolic heart failure (left ventricular EF <0.45%) were enrolled. At admission, EF and pulmonary artery systolic pressures were calculated with transthoracic echocardiography and plasma urocortin-1 levels measured in all patients. Ejection fractions (EF) and pulmonary artery systolic pressures were compared with plasma urocortin-1 levels with appropriate statistical methods (Pearson test for analysis of correlations).
S73
Results: Plasma urocortin-1 levels showed significant negative correlations with ejection fraction (p < 0.001, r = −0.46). There was also statistically significant positive correlation between pulmonary artery systolic pressures and plasma urocortin-1 levels (p < 0.001, r = 0.39). As a result, plasma urocortin 1 levels increased with decreasing left ventricular EF and increasing pulmonary artery systolic pressures. Conclusions: We have demonstrated a significant relationship between urocortin-1 levels, left ventricular EF and pulmonary artery systolic pressures. These findings suggest a potential role for plasma urocortin-1 as a biochemical marker in the diagnosis and follow-up of patients with systolic heart failure. The exact role of measuring urocortin-1 level during treatment of systolic heart failure remains to be determined with further studies. OP-173 PREVALENCE OF HYPOVITAMINOSIS D IN PATIENTS WITH STAGE C AND D HEART FAILURE O.C. Yilmaz1 , G. Keskin2 , Y. Selcoki1 , A. Temizkan1 , B. Eryonucu1 , O. Soran3 . 1 Department of Cardiology, University of Fatih, Ankara, Turkey; 2 Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey; 3 Department of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA Objective: Previous studies have shown that there is relationship between hypovitaminosis D and heart failure (HF). Since HF is the most common diagnosis-related group for people over the age of 65, patients with HF are at high risk for inadequate vitamin D level because of limited sunlight exposure. The aim of this study is to determine the prevalence of vitamin D deficiency in stage C and D HF patients, according to the ACC/AHA classification, and assess the alterations of vitamin D levels by advanced HF stages. Methods: 114 patients with HF stage C and D were enrolled into this prospective, multicenter study. Inclusion criteria included evidence of systolic dysfunction with a left ventricular ejection fraction of ≤40%. Data on patient demographics, medical history, fasting 25(OH) Vit D, blood glucose, parathormone and creatinine levels were collected. Hypovitaminosis D was defined as 25(OH) D levels >30ng/ml (10–30ng/ml) and Vitamin D deficiency was defined as 25(OH) Vit D levels <10 ng/ml. Pearson Correlation Analysis and ANOVA were used for statistical analysis. Results: The mean age of the study cohort was 66±10 years and 67% was men; 97% had at least one cardiovascular risk factor; 79% had documented coronary artery disease. The mean levels of 25(OH) D was 15.63 ng/ml. Ninety-one percent had low vitamin D levels. Of those, 53% had Hypovitaminosis D and 38% had Vitamin D deficiency. Baseline characteristics were similar in stage C and D HF patients. However, there was a statistically significant difference in regards to vitamin D levels (p < 0.005). Statistical analysis revealed that the level of vitamin D and the stage of the HF were positively correlated (p = 0.004, r = 0.267). As the HF stage worsened the frequency of vitamin D deficiency and parathormone levels increased (p < 0.001 r = −0.366). Conclusions: These results showed that the prevalence of hypovitaminosis D was high in stage C and D HF patients. In the context of these results; routine monitorization of Vitamin D levels in patients with advanced HF and replacement in case of deficiency could be encouraged. However, whether screening and supplement of Vitamin D in patients with advanced HF improve symptoms and clinical outcomes requires further study.