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P-307 Exercise Tolerance and Hemoglobin A1c During Cardiac Rehabilitation after Acute Myocardial Infarction: Impact of Gender
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Abstracts of the 17th Asian Pacific Congress of Cardiology
(95% CI: 1.19 to 28.47; P = 0.029) compared to lowest quartile, after being adjusted with other predictors. Conclusions: Elevated serum neopterin is associated with increased risk of CV events in ACS. P-305 Symmetrical T wave Inversion in Precordial ECG Leads; Should We Consult Dr. HJ Wellens? Ali Mehmood Raufi1 , Muaz Urabi1 , Muhammad Asad Ali1 , Muhammad Adnan Raufi2 . 1 Internal Medicine, Detroit Medical Center/Wayne State University, United States of America, 2 Cardiology, Detroit Medical Center/Wayne State University, United States of America 42-year-old female presented with pressure like mid chest pain radiating to the left arm with some difficulty in breathing but described no aggravating or relieving factor. She had no prior personal or family history of cardiovascular disease. She was hemodynamically stable and had normal physical examination relevant to cardiac and pulmonary systems. EKG showed biphasic T-waves in lead V2, V3 on presentation which later progressed to deep and symmetrical T wave inversions in precordial leads. Troponins were mildly elevated. Stress testing was positive. She had a cardiac catheterization revealing 99% stenosis in proximal LAD accompanied with 70% ostial stenosis in D1. Successful PTCA with stent placement in LAD and D1 branch was conducted. Her medication regimen was optimized and she was discharged home in stable condition. Critical high grade occlusion of the proximal LAD (Wellens Syndrome) was first described in 1982 by Dr. Hein J. Wellens. Diagnostic criteria include a recent history of chest pain, normal to slightly elevated serum markers, lack of pathological Q waves or ST-segment elevation. T waves are symmetrically and deeply inverted in the precordial leads or are biphasic in V2 and V3 leads (Wellen’s sign). Appropriate assessment with rapid intervention is paramount in managing these patients as unidentified cases can progress to extensive anterior wall MI and have a worse outcome. It is absolute essential not to rely on computer generated readings in such cases as this can lead to unwarranted noninvasive testing which may have untoward consequences. P-306 In an Asian Population of Patients with Inferior STEMI, Is the Current ECG Diagnostic Criteria of Atrial Infarction Still Applicable? Julian K.B. Tan, Daniel Chong, Chee Tang Chin, Soo Teik Lim. Department of Cardiology, National Heart Centre Singapore, Singapore Atrial infarction (AI) is uncommon, and often overlooked. Previously established ECG diagnostic criteria by Liu et al in 1961 is at best subtle, vague, frequently transient and often interpreted differently by physicians. Hence the real prevalence of AI is unknown. We evaluated the clinical applicability of Liu’s ECG criteria in our cohort of patients undergoing primary PCI for inferior MI. We studied the ECG and angiographic data of 110 patients with inferior STEMI undergoing primary PCI. PR segment deviations in both limb and precordial ECG leads of patients with occlusion of right coronary artery proximal to the right atrial branch (presumed to have right atrial infarction) were analysed. The ECGs were performed on average 4 hours after onset of chest pain. 5 patients (mean age 56.6 years; 3 males and 2 females) with inferior ST elevation MI had angiographic evidence of right atrial branch occlusion. None of the patients satisfied Liu’s Major Criteria 1 (PR segment elevation <0.5 mm in V5, V6 with reciprocal PR segment depression in V1, V2)
or Major Criteria 2 (PR segment elevation <0.5 mm in I with reciprocal PR segment depression in II, III). 1 of these 5 patients had instead PR segment elevation of 0.5 mm in aVR giving a sensitivity of 20%, specificity of 76.2% for RA branch occlusion. Liu’s Major criteria 1 and 2 for AI were not sensitive in diagnosing right AI in our series with angiographically documented right atrial branch occlusion. Instead a PR segment elevation 0.5 mm in aVR was found in this study. This needs further validation in a larger series. P-307 Exercise Tolerance and Hemoglobin A1c During Cardiac Rehabilitation after Acute Myocardial Infarction: Impact of Gender Tomomi Koizumi, Shigeru Makita, Kazuo Matsumoto, Nobuyuki Komiyama, Shigeyuki Nishimura. Division of Cardiology, Saitama Medical University International Medical Center, Japan Background: Recovery of exercise tolerance and improvement of glucose metabolism after acute myocardial infarction (AMI) are important factors in secondary prevention. However whether gender affects either of these is not fully elucidated. Methods: Between April 2005 and March 2006, consecutive 218 survivors from AMI patients less than 80 years old (age Men 64±9 year, Women 66±10 year, p = 0.15, Men 83%) were enrolled in this study. Conventional medications after AMI including statins were prescribed for the patients. Participation in a cardiac rehabilitation program (CR) was also recommended, where cardiopulmonary exercise testing using cycle ergometer was performed to measure VO2 /kg. Hemoglobin A1c (HBA1c) was also measured up to 12-month post AMI. Results: HBA1c of men was significantly decreased whereas those of women did not change after 12-month (HBA1c: Men 6.7±1.8% to 6.4±1.5% p = 0.04, vs. Women 5.9±1.1% to 5.7±1.0%, p = 0.16). A total of 73 patients, 37% (66/180) of men and 18% (7/38) of women (p = 0.04), participated in CR after AMI. In the population who participated in CR, %VO2 /kg of men was significantly increased (peak VO2 /kg: 20.0±3.9 to 22.4±5.2, p < 0.01) but that of women did not change (peak VO2 /kg: 16.6±3.2 to 16.0±3.2, p = 0.95). Conclusions: This study shows women improved less in exercise tolerance and glucose metabolism than men at 12-month after AMI, partly due to fewer women having participated in CR. P-308 The Prognostic Value of B-Type Natriuretic Peptide and GRACE Score in Patients with Acute Coronary Syndrome Yihong Sun, Dayi Hu, Yuanyuan Fu, Guilian Wang. Department of Cardiology, Peking University People’s Hospital, China Objective: The purpose of this study is to characterize the prognostic utility of B-type natriuretic peptide and to compare with other powerful markers-GRACE score in patients presenting with acute coronary syndrome. Method: Patients, admitted within 24 hours of the chest pain onset, were followed up to 30 days. Admission plasma levels of B-type natriuretic peptide were measure by point-of-care. The receiver operating characteristic (ROC) curve was used to evaluate prognostic utility of BNP and GRACE score. Results: Among the 246 patients, half of the patients (54.9%) were ST elevation myocardial infarction. During the follow up, there were 34 endpoints (13.82%), including 9 deaths (3.65%). The systolic blood pressure were lower in the
Abstracts of the 17th Asian Pacific Congress of Cardiology
(95% CI: 1.19 to 28.47; P = 0.029) compared to lowest quartile, after being adjusted with other predictors. Conclusions: Elevated serum neopterin is associated with increased risk of CV events in ACS. P-305 Symmetrical T wave Inversion in Precordial ECG Leads; Should We Consult Dr. HJ Wellens? Ali Mehmood Raufi1 , Muaz Urabi1 , Muhammad Asad Ali1 , Muhammad Adnan Raufi2 . 1 Internal Medicine, Detroit Medical Center/Wayne State University, United States of America, 2 Cardiology, Detroit Medical Center/Wayne State University, United States of America 42-year-old female presented with pressure like mid chest pain radiating to the left arm with some difficulty in breathing but described no aggravating or relieving factor. She had no prior personal or family history of cardiovascular disease. She was hemodynamically stable and had normal physical examination relevant to cardiac and pulmonary systems. EKG showed biphasic T-waves in lead V2, V3 on presentation which later progressed to deep and symmetrical T wave inversions in precordial leads. Troponins were mildly elevated. Stress testing was positive. She had a cardiac catheterization revealing 99% stenosis in proximal LAD accompanied with 70% ostial stenosis in D1. Successful PTCA with stent placement in LAD and D1 branch was conducted. Her medication regimen was optimized and she was discharged home in stable condition. Critical high grade occlusion of the proximal LAD (Wellens Syndrome) was first described in 1982 by Dr. Hein J. Wellens. Diagnostic criteria include a recent history of chest pain, normal to slightly elevated serum markers, lack of pathological Q waves or ST-segment elevation. T waves are symmetrically and deeply inverted in the precordial leads or are biphasic in V2 and V3 leads (Wellen’s sign). Appropriate assessment with rapid intervention is paramount in managing these patients as unidentified cases can progress to extensive anterior wall MI and have a worse outcome. It is absolute essential not to rely on computer generated readings in such cases as this can lead to unwarranted noninvasive testing which may have untoward consequences. P-306 In an Asian Population of Patients with Inferior STEMI, Is the Current ECG Diagnostic Criteria of Atrial Infarction Still Applicable? Julian K.B. Tan, Daniel Chong, Chee Tang Chin, Soo Teik Lim. Department of Cardiology, National Heart Centre Singapore, Singapore Atrial infarction (AI) is uncommon, and often overlooked. Previously established ECG diagnostic criteria by Liu et al in 1961 is at best subtle, vague, frequently transient and often interpreted differently by physicians. Hence the real prevalence of AI is unknown. We evaluated the clinical applicability of Liu’s ECG criteria in our cohort of patients undergoing primary PCI for inferior MI. We studied the ECG and angiographic data of 110 patients with inferior STEMI undergoing primary PCI. PR segment deviations in both limb and precordial ECG leads of patients with occlusion of right coronary artery proximal to the right atrial branch (presumed to have right atrial infarction) were analysed. The ECGs were performed on average 4 hours after onset of chest pain. 5 patients (mean age 56.6 years; 3 males and 2 females) with inferior ST elevation MI had angiographic evidence of right atrial branch occlusion. None of the patients satisfied Liu’s Major Criteria 1 (PR segment elevation <0.5 mm in V5, V6 with reciprocal PR segment depression in V1, V2)
or Major Criteria 2 (PR segment elevation <0.5 mm in I with reciprocal PR segment depression in II, III). 1 of these 5 patients had instead PR segment elevation of 0.5 mm in aVR giving a sensitivity of 20%, specificity of 76.2% for RA branch occlusion. Liu’s Major criteria 1 and 2 for AI were not sensitive in diagnosing right AI in our series with angiographically documented right atrial branch occlusion. Instead a PR segment elevation 0.5 mm in aVR was found in this study. This needs further validation in a larger series. P-307 Exercise Tolerance and Hemoglobin A1c During Cardiac Rehabilitation after Acute Myocardial Infarction: Impact of Gender Tomomi Koizumi, Shigeru Makita, Kazuo Matsumoto, Nobuyuki Komiyama, Shigeyuki Nishimura. Division of Cardiology, Saitama Medical University International Medical Center, Japan Background: Recovery of exercise tolerance and improvement of glucose metabolism after acute myocardial infarction (AMI) are important factors in secondary prevention. However whether gender affects either of these is not fully elucidated. Methods: Between April 2005 and March 2006, consecutive 218 survivors from AMI patients less than 80 years old (age Men 64±9 year, Women 66±10 year, p = 0.15, Men 83%) were enrolled in this study. Conventional medications after AMI including statins were prescribed for the patients. Participation in a cardiac rehabilitation program (CR) was also recommended, where cardiopulmonary exercise testing using cycle ergometer was performed to measure VO2 /kg. Hemoglobin A1c (HBA1c) was also measured up to 12-month post AMI. Results: HBA1c of men was significantly decreased whereas those of women did not change after 12-month (HBA1c: Men 6.7±1.8% to 6.4±1.5% p = 0.04, vs. Women 5.9±1.1% to 5.7±1.0%, p = 0.16). A total of 73 patients, 37% (66/180) of men and 18% (7/38) of women (p = 0.04), participated in CR after AMI. In the population who participated in CR, %VO2 /kg of men was significantly increased (peak VO2 /kg: 20.0±3.9 to 22.4±5.2, p < 0.01) but that of women did not change (peak VO2 /kg: 16.6±3.2 to 16.0±3.2, p = 0.95). Conclusions: This study shows women improved less in exercise tolerance and glucose metabolism than men at 12-month after AMI, partly due to fewer women having participated in CR. P-308 The Prognostic Value of B-Type Natriuretic Peptide and GRACE Score in Patients with Acute Coronary Syndrome Yihong Sun, Dayi Hu, Yuanyuan Fu, Guilian Wang. Department of Cardiology, Peking University People’s Hospital, China Objective: The purpose of this study is to characterize the prognostic utility of B-type natriuretic peptide and to compare with other powerful markers-GRACE score in patients presenting with acute coronary syndrome. Method: Patients, admitted within 24 hours of the chest pain onset, were followed up to 30 days. Admission plasma levels of B-type natriuretic peptide were measure by point-of-care. The receiver operating characteristic (ROC) curve was used to evaluate prognostic utility of BNP and GRACE score. Results: Among the 246 patients, half of the patients (54.9%) were ST elevation myocardial infarction. During the follow up, there were 34 endpoints (13.82%), including 9 deaths (3.65%). The systolic blood pressure were lower in the