- Email: [email protected]
P0786 THE EFFECT OF ANEMIA IN PATIENTS WITH ACUTE CORONARY SYNDROMES ON MORTALITY
S256
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
P<.001) and atrial fibrillation (54% vs.74%, P<.001). They had also a higher left ventricular ejection fraction (LVEF) (58% vs. 49%,P<.001). Treatment was different between both groups: Hypertensive HF patients used more beta-blockers (47% vs. 28%, P<.001) and ARA II (Angiotensin Receptor Antagonist II) (51% vs. 30%, P<.001), and less diuretics (72% vs. 94% P<.001) and antiplatelet drugs (25% vs. 36%, P=.003) compared with all causes of HF. Both groups received angiotensin-converting enzyme inhibitors (ACEI: 36% & 43%) and statins (31% & 28%) in the same percentage. Discussion & conclusion: – Patients hospitalized with hypertension as a unique cause of HF were younger, had a better functional class, less atrial fibrillation and a greater LVEF than patients with other causes of HF. – Although ACEI were similarly given in both groups, other drugs with a documented impact on survival, were given differently; i.e ARAII and beta-blockers were more used in hypertensive cardiopathy. This may reflect that when diabetes mellitus, severe COPD and other confounding HF variables are excluded, which difficult the use of beta-blockers, the number of patients that receive beta-blockers increases.
P0784 CAN YOU PREVENT “LAI TAI”* BY KNOWING ITS ECG FINDINGS!!?
Laith Alrubaiy 1 , Suji Yathindra 2 . 1 Ysbyty Gwynedd NHS Trust; 2 Northwest London Hospitals NHS Trust Aim: The lesson from this case is to be mindful of Brugarda syndrome* when looking at an ECG. Brugarda syndrome is thought to be responsible for 4 to 12% of all unexpected sudden deaths in patients with apparently normal hearts. *In the Northeast of Thailand, this form of death was known as Lai Tai (death during sleep). They believe that widow ghosts came to take the young men lives during sleep. Therefore, many young men used to dress as women at night with the hope that it would delude the widow ghost. Case report: This case report is of a 58-year old male patient who presented to us with a 2 week history of palpitations and one episode of syncope. His General Practitioner, Suspecting a myocardial infarction, referred him immediately to the accident and emergency department. While in the accident and emergency department the patient was comfortable and denied having any chest pain. His ECG showed downward sloping coved ST elevation in V1-3 and a right bundle branch block pattern. His troponin T and other cardiac enzymes were normal. Based on the ECG and clinical findings, the diagnosis of Brugarda syndrome was made. NB: A clear ECG picture will be included in the poster. Outcomes/Results: The patient was successfully fitted with an implantable cardiac defibrillator and had no further complications on follow up. The main risk of Brugarda syndrome is sudden death because of sudden ventricular arrhythmia.
in-hospital, 1-, and 2-year mortality rates of 92 patients hospitalized for acute myocardial infarction (MI) between January 2003 and December 2003 in Coronary Intensive Care Unit (ICU) of Istanbul Training and Research Hospital. Material & methods: Records of 92 patients were reviewed retrospectively. Discharged patients were contacted at the end of 1- or 2-year period following the discharge and information was obtained on their current status. For statistical evaluations, SPSS 16.0 for Windows software was used. Results: Mean age of 92 patients was 58.1±10.14 years. Seventy-three (79.3%) of the patients were male and 19 (20.6%) were female. 18.4% of the patients had diabetes mellitus (DM), 26.08% hypertension (HT), 60.8% were smoking, 36.9% had AVD and 19.5% had family history. Smoking rate was significantly higher among men (p < 0.001). Non-ST elevation MI was found in 8 (9%) patients and ST-elevation MI in 84 (91%). Seventeen patients (18.4%) died at admission, with 11 of them (64.7%) dying within 24 hours and 6 dying later than the first 24 hours. In-hospital mortality was higher among those elder than 65 years old (P = 0.01). Forty one (4%%) patients received thrombolytic treatment and 51 (65%) did not due to reaching to the hospital lately or several counter indication. Thirty-three (35.8%) patients developed complication at admission. Of these patients, 19 (57.5%) developed arrhythmias alone, 7 (21.2%) cardiogenic shock alone, 6 (18.1%) arythmia and cardiogenic shock, 1 (0.3%) non-fatal bleeding due to thrombolysis. Seventy-five patients were discharged, with a recommendation of cardiologic outpatient follow-up. Ten patients died at the end of 2 years. Cause of death was coronary artery disease in all of them. 2-years mortality was significantly higher among women (P = 0.02). No significant difference was found between the groups receiving and not receiving thrombolytic treatment in 2-years mortality rate (P = 0.17). Number of patients In-hospital mortality rate Those receiving thrombolytic treatment Those not receiving thrombolytic treatment
One-year mortality Two-year mortality Survivals
41 (45%) 51(65%)
9.76% 25.49%
Number of patient
Rate (%)
9 10 65
12 13.3 86.6
Discussion: Although cardiovascular death is the most common cause of death, a few centers in our country are able to perform interventions in acute coronary syndromes. This increases the importance of centers performing thrombolytic treatment such as our one. In the current study, a substantial proportion of patients did not receive thrombolytic treatment due to delayed admission to the hospital. Although no significant difference existed between groups receiving and not receiving thrombolytic treatment in our center, inhospital mortality was significantly lower among those receiving thrombolytic treatment. Hence, the community should be appropriately informed to allow the early admission to the hospital Key words: Infarction, two years,mortality
P0786 THE EFFECT OF ANEMIA IN PATIENTS WITH ACUTE CORONARY SYNDROMES ON MORTALITY
Rah¸san Gül, Fatma Alıbaz Öner, Selen Yurdakul, Mecdı Ergüney. Istanbul Education and Research Hospital, Clinic of Internal Medicine
Conclusion: Beware of the diagnosis of Brugarda Syndrome when you look at any ECG By making the correct diagnosis, one can save the patient’s life.
P0785 OUR 2-YEAR MORTALITY OUTCOMES IN THE PATIENTS WITH MYOCARDIAL INFARCTION
Fatma Alıbaz Öner, Zeynep Gürcan, Selen Yurdakul, Mustafa Kemal Arslanta¸s, Mecdı Ergüney. Istanbul Education and Research Hospital, 2.clinic of Internal Medicine Introduction and objectives: The study was aimed to examine clinical and demographic characteristics, therapeutic interventions, complications,
Introduction: Anemia is an important and independent risk factor for the occurrence of adverse cardiovascular events in patients within the spectrum of acute coronary syndrome. Anemia has the potential of increasing myocardial ischemia in acute MI and other coronary syndromes. Objectives: This study aims to compare the patients with acute coronary syndrome with anemia with those without anemia in terms of the mortality during hospitalization. Material & methods: The patients within the spectrum of acute coronary syndrome presented to emergency service were enrolled to study. The haemograms were taken in fasting condition in the first morning following the admission. Patients were divided in two groups as the patients with ACS with and without anemia. The patients were monitorized during the period of hospitalization (mean 7 days) and, their mortality within this period were investigated. For statistical evaluations, SPSS 10.0 package program for Windows software was used. Results: 570 patients were included to the study. 416 of the patients were male and 154 of patients were male. It was found that death rate was significantly higher in women than in men (p<0.05). The death rate was significantly
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 higher in the patients with anemia than those without anemia (p<0.05), that no significant difference were found in terms of death rates and that the death rate was significantly higher in the patients of >70 years old than those of <70 years old (p<0.001). Conclusion: In this study, it was shown that anemia is a risk factor for short-term mortality. Key words: Anemia, acute coronary syndrome
P0787 INFLAMMATION MARKERS, CARDIOVASCULAR RISK FACTORS AND EARLY CARDIOVASCULAR DISEASE
Mos Liana 1 , R. Gligor 2 , D. Zdremtan 2 , C. Pop 1 , I. Crasnic 2 , A. Wiener 1 , C. Zorila 1 . 1 Department of Internal Medicine, Faculty of Medicine, Pharmacy and Dentistry, West University “Vasile Goldis” Arad, Romania; 2 Department of Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, West University “Vasile Goldis” Arad, Romania Introduction IL-10 proved to have several protective features acting against atherosclerotic disease. Objectives: We investigated the relation between CRP, adiponectin and IL-10 levels in cardiovascular diseases. Materials & methods: In order to detect the levels of the inflammation markers, were recruited and investigated 60 patients with ages between 30 and 40. All the subjects presented at least 2 cardiovascular risk factors like: obesity, hypertension, or liver NASH. 30 patients were smokers and 30 were non-smokers, for result comparing. Peripheral blood samples were collected, including a questionnaire about the presence of cardiovascular risk factors, smoking, blood pressure and BMI. The blood was be checked for the levels of fasting glycemia, triglycerides, HDL, LDL, general markers of inflammation CRP, IL-10 and adiponectin by ELISA technique. We performed in all patients abdominal ultrasonography Discussion & ConclusionLow adiponectin levels may be a useful marker for early-stage atherosclerosis. Our results show the important relation between inflammation markers and cardiovascular risk in young smoking patients that present cardiovascular risk factors. Keywords: adiponectin, IL-10, CRP, cardiovascular risk
P0788 "ECG VARIABILITY CONTOUR" ANALYSIS DEMONSTRATES THE NET AMPLITUDE EFFECT OF DIPYRIDAMOLE ON THE ECG IN EXAMINEES WITH NORMAL MYOCARDIAL PERFUSION IMAGING SCAN
Guy Dori, Michal Gershinsky, Simona Ben-haim, Basil S. Lewis, Haim Bitterman. Lady Davis, Carmel Medical Center, Haifa, Israel Introduction: Recently, we described a graphic method for detecting ECG amplitude changes, termed the "ECG variability contour" (EVC) method, with which rest and stress ECG data sets are compared. Briefly, a 2-D space is created which delineates the contour of the "physiologic" variability of the baseline rest ECG set. If stress EVC variables are found outside this "physiologic" contour, it is concluded that significant amplitude changes exist between rest and stress ECG sets. Objectives: To study the net amplitude effect of Dipyridamole on EVC variables in examinees with normal myocardial perfusion imaging scan (MPI). Materials & methods: Cohort composed of truly negative examinees (e.g. negative MPI, no cardiovascular event during a mean 16-month follow-up, and no standard ST-T changes in the Dipyridamole stress ECG, compared with rest ECG). Two EVC variables were studied: 1) the difference between the area under curve of the normalized cumulative sum of the rest residue matrix (D1R1), AUC(NCS(D1R1)), and the corresponding area of the stress residue matrix, AUC(NCS(D1S)), where D1R1 was created by subtracting the average rest ECG complex from each ECG complex composing the rest data set (60 consecutive ECG complexes recorded at rest prior to Dipyridamole infusion). Stress residue matrix (D1S) was created by subtracting the average rest ECG complex from each ECG complex composing the stress data set (60 consecutive ECG complexes recorded during Dipyridamole stress). 2) The number of points of the NCS(D1S) which were found outside EVC per lead (p(NCS(D1S))) compared with the corresponding number of points of NCS(D1R1), p(NCS(D1R1)). Results: 19 examinees, 223 leads, composed the study group. Mean 664.4 (arbitrary units, a.u.) whereas ±AUC(NCS(D1R1))=802.1 3079.6 (p±AUC(NCS(D1S)) = 3393.30.01), the ratio between the AUCs 5.84.±STD)
S257
6.23± was on the average (10.5 for the QRS, ST±5.5 and 3.8±2.9, 0.6±p(NCS(D1R1)) was: 0.5 15, ±segment, and T wave components, respectively. p(NCS(D1S)) was: 12 31, for the QRS, ST segment, and T wave components, ±28, and 34±20 respectively (p0.01 for each component comparing to p(NCS(D1R1))). Conclusion: This study shows that in the clinical setting of MPI, Dipyridamole increased both EVC variables, reflecting the increased amplitude variability of the samples composing the ECG without causing myocardial ischemia. Though findings are statistically significant, the standard deviation of all EVC variables was large, a fact that may hinder diagnostic utility. Keywords: ECG waveform analysis, Dipyridamole, myocardial ischemia
P0789 SUPERFICIAL TEMPORAL ARTERY BLEEDING – AN UNUSUAL CAUSE OF CARDIAC ARREST
Sunanda Mavinamane, Antony White. Wrexham Maelor Hospital, UK Introduction: Hypovolaemia is a well known potentially reversible cause of cardiac arrest.We report a patient who had significant blood loss and cardiac arrest following torrential bleeding from her superficial temporal artery. Case report: An 84 yr old lady was transferred to Wrexham Maelor hospital for a period of rehabilitation following surgery for fracture right femur and left knee. During her admission she was noted to be confused as a consequence of urinary tract infection. On 15th day as an inpatient, a small amount of bleeding was noticed on her right temple which had developed after picking a scab. The haemorrhage was controlled by application of pressure with an absorbent pad for a few minutes. She was then advised not to pick that area again. Four days later, she was found soaked in blood with blood was spurting out from her right superficial temporal artery which was sutured. She was hypotensive, tachycardic and this was managed initially with fluid resuscitation. Twenty minutes later she went into cardiac arrest which was successfully reversed with CPR and fluid resuscitation. She subsequently had blood transfusion as her Hb had dropped by 3gm/dl. Discussion and conclusion: Bleeding from superficial temporal artery, following surgical procedures has been reported. But this was the first ever case of cardiac arrest having developed as a result of excoriating and picking the superficial temporal artery. Confused patients need more attention to prevent such complications from developing. References: 1. Goldwyn RM. Late bleeding after rhytidectomy from injury to the superficial temporal vessels. Plast Reconstr Surg. 1991 Sep;88(3):443-5. 2. Birnie AJ, Varma S, Holt PJ, Colver GB. Post-operative delayed bleeding from the superficial temporal artery. Clin Exp Dermatol. 2004 Sep;29(5):492-3.
P0790 CORRELATION BETWEEN ANTHROPOMETRIC INDEXES AND SEVERAL CARDIOVASCULAR RISK FACTORS. WHICH INDEX SHOULD I USE?
Juan Manuel Urbano Galvez, Waildo Ribeiro Dos Passos, Maria Del Mar Barba Dominguez, Osvaldo Barbosa. Hypertension and Cardiovascular Risk Unit, Santa Luzia Hospital, Elvas, Portugal Introduction: Obesity is one of the most common health problems, and is recognized worldwide as an “escalating epidemic.” For the establishment of an obesity-prevention it is important to assess the association between obesity and cardiovascular risk factors. Classical Obesity indexes, such as body mass index (BMI), waist circumference (WC) and alternative indexes as waist to height ratio (WHtR) and waist to wrist ratio (WWR) are considered useful, non-invasive anthropometric measurements that provide information on cardiovascular risks, such as hypertension, diabetes, and dislipidemia. Objective: To examine the relationships between classical and alternative anthropometric measurements and cardiovascular risk factors in a rural area of the east of Portugal. Methods: A descriptive, transversal study, from a worker population in an east Portuguese rural area was realized. The sample included 883 cases whose demographics, anthropometric measures (weight, height, waist circumference, BMI, waist to height ratio, waist to hip ratio, waist to wrist ratio), blood pressure and clinical laboratory data were available. Results and conclusions: When we analyzed the correlation between several cardiovascular risk factors and anthropometric indexes, we found significant correlation between the majority of cardiovascular risk factors and anthropometric indexes. Although, there is not an index that shows predominance with
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
P<.001) and atrial fibrillation (54% vs.74%, P<.001). They had also a higher left ventricular ejection fraction (LVEF) (58% vs. 49%,P<.001). Treatment was different between both groups: Hypertensive HF patients used more beta-blockers (47% vs. 28%, P<.001) and ARA II (Angiotensin Receptor Antagonist II) (51% vs. 30%, P<.001), and less diuretics (72% vs. 94% P<.001) and antiplatelet drugs (25% vs. 36%, P=.003) compared with all causes of HF. Both groups received angiotensin-converting enzyme inhibitors (ACEI: 36% & 43%) and statins (31% & 28%) in the same percentage. Discussion & conclusion: – Patients hospitalized with hypertension as a unique cause of HF were younger, had a better functional class, less atrial fibrillation and a greater LVEF than patients with other causes of HF. – Although ACEI were similarly given in both groups, other drugs with a documented impact on survival, were given differently; i.e ARAII and beta-blockers were more used in hypertensive cardiopathy. This may reflect that when diabetes mellitus, severe COPD and other confounding HF variables are excluded, which difficult the use of beta-blockers, the number of patients that receive beta-blockers increases.
P0784 CAN YOU PREVENT “LAI TAI”* BY KNOWING ITS ECG FINDINGS!!?
Laith Alrubaiy 1 , Suji Yathindra 2 . 1 Ysbyty Gwynedd NHS Trust; 2 Northwest London Hospitals NHS Trust Aim: The lesson from this case is to be mindful of Brugarda syndrome* when looking at an ECG. Brugarda syndrome is thought to be responsible for 4 to 12% of all unexpected sudden deaths in patients with apparently normal hearts. *In the Northeast of Thailand, this form of death was known as Lai Tai (death during sleep). They believe that widow ghosts came to take the young men lives during sleep. Therefore, many young men used to dress as women at night with the hope that it would delude the widow ghost. Case report: This case report is of a 58-year old male patient who presented to us with a 2 week history of palpitations and one episode of syncope. His General Practitioner, Suspecting a myocardial infarction, referred him immediately to the accident and emergency department. While in the accident and emergency department the patient was comfortable and denied having any chest pain. His ECG showed downward sloping coved ST elevation in V1-3 and a right bundle branch block pattern. His troponin T and other cardiac enzymes were normal. Based on the ECG and clinical findings, the diagnosis of Brugarda syndrome was made. NB: A clear ECG picture will be included in the poster. Outcomes/Results: The patient was successfully fitted with an implantable cardiac defibrillator and had no further complications on follow up. The main risk of Brugarda syndrome is sudden death because of sudden ventricular arrhythmia.
in-hospital, 1-, and 2-year mortality rates of 92 patients hospitalized for acute myocardial infarction (MI) between January 2003 and December 2003 in Coronary Intensive Care Unit (ICU) of Istanbul Training and Research Hospital. Material & methods: Records of 92 patients were reviewed retrospectively. Discharged patients were contacted at the end of 1- or 2-year period following the discharge and information was obtained on their current status. For statistical evaluations, SPSS 16.0 for Windows software was used. Results: Mean age of 92 patients was 58.1±10.14 years. Seventy-three (79.3%) of the patients were male and 19 (20.6%) were female. 18.4% of the patients had diabetes mellitus (DM), 26.08% hypertension (HT), 60.8% were smoking, 36.9% had AVD and 19.5% had family history. Smoking rate was significantly higher among men (p < 0.001). Non-ST elevation MI was found in 8 (9%) patients and ST-elevation MI in 84 (91%). Seventeen patients (18.4%) died at admission, with 11 of them (64.7%) dying within 24 hours and 6 dying later than the first 24 hours. In-hospital mortality was higher among those elder than 65 years old (P = 0.01). Forty one (4%%) patients received thrombolytic treatment and 51 (65%) did not due to reaching to the hospital lately or several counter indication. Thirty-three (35.8%) patients developed complication at admission. Of these patients, 19 (57.5%) developed arrhythmias alone, 7 (21.2%) cardiogenic shock alone, 6 (18.1%) arythmia and cardiogenic shock, 1 (0.3%) non-fatal bleeding due to thrombolysis. Seventy-five patients were discharged, with a recommendation of cardiologic outpatient follow-up. Ten patients died at the end of 2 years. Cause of death was coronary artery disease in all of them. 2-years mortality was significantly higher among women (P = 0.02). No significant difference was found between the groups receiving and not receiving thrombolytic treatment in 2-years mortality rate (P = 0.17). Number of patients In-hospital mortality rate Those receiving thrombolytic treatment Those not receiving thrombolytic treatment
One-year mortality Two-year mortality Survivals
41 (45%) 51(65%)
9.76% 25.49%
Number of patient
Rate (%)
9 10 65
12 13.3 86.6
Discussion: Although cardiovascular death is the most common cause of death, a few centers in our country are able to perform interventions in acute coronary syndromes. This increases the importance of centers performing thrombolytic treatment such as our one. In the current study, a substantial proportion of patients did not receive thrombolytic treatment due to delayed admission to the hospital. Although no significant difference existed between groups receiving and not receiving thrombolytic treatment in our center, inhospital mortality was significantly lower among those receiving thrombolytic treatment. Hence, the community should be appropriately informed to allow the early admission to the hospital Key words: Infarction, two years,mortality
P0786 THE EFFECT OF ANEMIA IN PATIENTS WITH ACUTE CORONARY SYNDROMES ON MORTALITY
Rah¸san Gül, Fatma Alıbaz Öner, Selen Yurdakul, Mecdı Ergüney. Istanbul Education and Research Hospital, Clinic of Internal Medicine
Conclusion: Beware of the diagnosis of Brugarda Syndrome when you look at any ECG By making the correct diagnosis, one can save the patient’s life.
P0785 OUR 2-YEAR MORTALITY OUTCOMES IN THE PATIENTS WITH MYOCARDIAL INFARCTION
Fatma Alıbaz Öner, Zeynep Gürcan, Selen Yurdakul, Mustafa Kemal Arslanta¸s, Mecdı Ergüney. Istanbul Education and Research Hospital, 2.clinic of Internal Medicine Introduction and objectives: The study was aimed to examine clinical and demographic characteristics, therapeutic interventions, complications,
Introduction: Anemia is an important and independent risk factor for the occurrence of adverse cardiovascular events in patients within the spectrum of acute coronary syndrome. Anemia has the potential of increasing myocardial ischemia in acute MI and other coronary syndromes. Objectives: This study aims to compare the patients with acute coronary syndrome with anemia with those without anemia in terms of the mortality during hospitalization. Material & methods: The patients within the spectrum of acute coronary syndrome presented to emergency service were enrolled to study. The haemograms were taken in fasting condition in the first morning following the admission. Patients were divided in two groups as the patients with ACS with and without anemia. The patients were monitorized during the period of hospitalization (mean 7 days) and, their mortality within this period were investigated. For statistical evaluations, SPSS 10.0 package program for Windows software was used. Results: 570 patients were included to the study. 416 of the patients were male and 154 of patients were male. It was found that death rate was significantly higher in women than in men (p<0.05). The death rate was significantly
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 higher in the patients with anemia than those without anemia (p<0.05), that no significant difference were found in terms of death rates and that the death rate was significantly higher in the patients of >70 years old than those of <70 years old (p<0.001). Conclusion: In this study, it was shown that anemia is a risk factor for short-term mortality. Key words: Anemia, acute coronary syndrome
P0787 INFLAMMATION MARKERS, CARDIOVASCULAR RISK FACTORS AND EARLY CARDIOVASCULAR DISEASE
Mos Liana 1 , R. Gligor 2 , D. Zdremtan 2 , C. Pop 1 , I. Crasnic 2 , A. Wiener 1 , C. Zorila 1 . 1 Department of Internal Medicine, Faculty of Medicine, Pharmacy and Dentistry, West University “Vasile Goldis” Arad, Romania; 2 Department of Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, West University “Vasile Goldis” Arad, Romania Introduction IL-10 proved to have several protective features acting against atherosclerotic disease. Objectives: We investigated the relation between CRP, adiponectin and IL-10 levels in cardiovascular diseases. Materials & methods: In order to detect the levels of the inflammation markers, were recruited and investigated 60 patients with ages between 30 and 40. All the subjects presented at least 2 cardiovascular risk factors like: obesity, hypertension, or liver NASH. 30 patients were smokers and 30 were non-smokers, for result comparing. Peripheral blood samples were collected, including a questionnaire about the presence of cardiovascular risk factors, smoking, blood pressure and BMI. The blood was be checked for the levels of fasting glycemia, triglycerides, HDL, LDL, general markers of inflammation CRP, IL-10 and adiponectin by ELISA technique. We performed in all patients abdominal ultrasonography Discussion & ConclusionLow adiponectin levels may be a useful marker for early-stage atherosclerosis. Our results show the important relation between inflammation markers and cardiovascular risk in young smoking patients that present cardiovascular risk factors. Keywords: adiponectin, IL-10, CRP, cardiovascular risk
P0788 "ECG VARIABILITY CONTOUR" ANALYSIS DEMONSTRATES THE NET AMPLITUDE EFFECT OF DIPYRIDAMOLE ON THE ECG IN EXAMINEES WITH NORMAL MYOCARDIAL PERFUSION IMAGING SCAN
Guy Dori, Michal Gershinsky, Simona Ben-haim, Basil S. Lewis, Haim Bitterman. Lady Davis, Carmel Medical Center, Haifa, Israel Introduction: Recently, we described a graphic method for detecting ECG amplitude changes, termed the "ECG variability contour" (EVC) method, with which rest and stress ECG data sets are compared. Briefly, a 2-D space is created which delineates the contour of the "physiologic" variability of the baseline rest ECG set. If stress EVC variables are found outside this "physiologic" contour, it is concluded that significant amplitude changes exist between rest and stress ECG sets. Objectives: To study the net amplitude effect of Dipyridamole on EVC variables in examinees with normal myocardial perfusion imaging scan (MPI). Materials & methods: Cohort composed of truly negative examinees (e.g. negative MPI, no cardiovascular event during a mean 16-month follow-up, and no standard ST-T changes in the Dipyridamole stress ECG, compared with rest ECG). Two EVC variables were studied: 1) the difference between the area under curve of the normalized cumulative sum of the rest residue matrix (D1R1), AUC(NCS(D1R1)), and the corresponding area of the stress residue matrix, AUC(NCS(D1S)), where D1R1 was created by subtracting the average rest ECG complex from each ECG complex composing the rest data set (60 consecutive ECG complexes recorded at rest prior to Dipyridamole infusion). Stress residue matrix (D1S) was created by subtracting the average rest ECG complex from each ECG complex composing the stress data set (60 consecutive ECG complexes recorded during Dipyridamole stress). 2) The number of points of the NCS(D1S) which were found outside EVC per lead (p(NCS(D1S))) compared with the corresponding number of points of NCS(D1R1), p(NCS(D1R1)). Results: 19 examinees, 223 leads, composed the study group. Mean 664.4 (arbitrary units, a.u.) whereas ±AUC(NCS(D1R1))=802.1 3079.6 (p±AUC(NCS(D1S)) = 3393.30.01), the ratio between the AUCs 5.84.±STD)
S257
6.23± was on the average (10.5 for the QRS, ST±5.5 and 3.8±2.9, 0.6±p(NCS(D1R1)) was: 0.5 15, ±segment, and T wave components, respectively. p(NCS(D1S)) was: 12 31, for the QRS, ST segment, and T wave components, ±28, and 34±20 respectively (p0.01 for each component comparing to p(NCS(D1R1))). Conclusion: This study shows that in the clinical setting of MPI, Dipyridamole increased both EVC variables, reflecting the increased amplitude variability of the samples composing the ECG without causing myocardial ischemia. Though findings are statistically significant, the standard deviation of all EVC variables was large, a fact that may hinder diagnostic utility. Keywords: ECG waveform analysis, Dipyridamole, myocardial ischemia
P0789 SUPERFICIAL TEMPORAL ARTERY BLEEDING – AN UNUSUAL CAUSE OF CARDIAC ARREST
Sunanda Mavinamane, Antony White. Wrexham Maelor Hospital, UK Introduction: Hypovolaemia is a well known potentially reversible cause of cardiac arrest.We report a patient who had significant blood loss and cardiac arrest following torrential bleeding from her superficial temporal artery. Case report: An 84 yr old lady was transferred to Wrexham Maelor hospital for a period of rehabilitation following surgery for fracture right femur and left knee. During her admission she was noted to be confused as a consequence of urinary tract infection. On 15th day as an inpatient, a small amount of bleeding was noticed on her right temple which had developed after picking a scab. The haemorrhage was controlled by application of pressure with an absorbent pad for a few minutes. She was then advised not to pick that area again. Four days later, she was found soaked in blood with blood was spurting out from her right superficial temporal artery which was sutured. She was hypotensive, tachycardic and this was managed initially with fluid resuscitation. Twenty minutes later she went into cardiac arrest which was successfully reversed with CPR and fluid resuscitation. She subsequently had blood transfusion as her Hb had dropped by 3gm/dl. Discussion and conclusion: Bleeding from superficial temporal artery, following surgical procedures has been reported. But this was the first ever case of cardiac arrest having developed as a result of excoriating and picking the superficial temporal artery. Confused patients need more attention to prevent such complications from developing. References: 1. Goldwyn RM. Late bleeding after rhytidectomy from injury to the superficial temporal vessels. Plast Reconstr Surg. 1991 Sep;88(3):443-5. 2. Birnie AJ, Varma S, Holt PJ, Colver GB. Post-operative delayed bleeding from the superficial temporal artery. Clin Exp Dermatol. 2004 Sep;29(5):492-3.
P0790 CORRELATION BETWEEN ANTHROPOMETRIC INDEXES AND SEVERAL CARDIOVASCULAR RISK FACTORS. WHICH INDEX SHOULD I USE?
Juan Manuel Urbano Galvez, Waildo Ribeiro Dos Passos, Maria Del Mar Barba Dominguez, Osvaldo Barbosa. Hypertension and Cardiovascular Risk Unit, Santa Luzia Hospital, Elvas, Portugal Introduction: Obesity is one of the most common health problems, and is recognized worldwide as an “escalating epidemic.” For the establishment of an obesity-prevention it is important to assess the association between obesity and cardiovascular risk factors. Classical Obesity indexes, such as body mass index (BMI), waist circumference (WC) and alternative indexes as waist to height ratio (WHtR) and waist to wrist ratio (WWR) are considered useful, non-invasive anthropometric measurements that provide information on cardiovascular risks, such as hypertension, diabetes, and dislipidemia. Objective: To examine the relationships between classical and alternative anthropometric measurements and cardiovascular risk factors in a rural area of the east of Portugal. Methods: A descriptive, transversal study, from a worker population in an east Portuguese rural area was realized. The sample included 883 cases whose demographics, anthropometric measures (weight, height, waist circumference, BMI, waist to height ratio, waist to hip ratio, waist to wrist ratio), blood pressure and clinical laboratory data were available. Results and conclusions: When we analyzed the correlation between several cardiovascular risk factors and anthropometric indexes, we found significant correlation between the majority of cardiovascular risk factors and anthropometric indexes. Although, there is not an index that shows predominance with