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P1-1 EVALUATION OF LEFT VENTRICULAR THROMBUS AFTER ACUTE MYOCARDIAL INFARCTION WITH TRANSTHORACIC ECHOCARDIOGRAPHY
62
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
S45-7
P1-2
COMPARISON OF MODULATION OF APOPTOTIC FACTORS BETWEEN IONIC AND NON-IONIC CONTRAST MEDIA ON MONOCYTES
EFFECTS OF DIABETES MELLITUS ON OUTCOME OF PATIENTS WITH FIRST ACUTE MYOCARDIAL INFARCTION
Hsueh-Wei Yen, Ye-Hsu Lu, Hsiang-Chun Lee, Chih-Hsin Huang, Kun-Tai Lee, Chee-Siong Lee, Wen-Chol Voon, Wen-Te Lai, Sheng-Hsiung Sheu. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Asl Azin Alizadeh, Jahanbakhsh Samadikhah, Alireza Yaghoubi, Hakim Seyed Hadi, Salehi Rezvanieh, Azarfarin Rasoul. Tabriz University Of Medical Sciences, Iran
Monocytes play a key role in cellular inflammatory response. However, it is not known how contrast media modulate monocytes. There are diverge characteristics between different contrast media. In this experiment, we investigate the influence of adhesion molecule and apoptotic factors of monocytes by ionic (iothalamate, IOT) and non-ionic contrast media (iohexol, IOH). U937 (a human monocytic cell-line) was cultured in RPMI 1640 with 10% FCS at 37°C for 48 hours. These cells were then exposed to 4 series of concentration (0, 10, 50, 100 mgI/ml) of contrast medium for 30 minutes. Total RNA was extracted and converted to cDNA by commercial kit. RTPCR was performed in appropriate conditions to obtain the expression of ICAM-1, E-selectin, Fas and Bcl-2. β-actin was used as normalization. In this study, we demonstrate that E-selectin expression was increased at the concentration of 100mgI/ml both in IOT and IOH. However, ICAM-1 was constitutionally expressed and not changed by either contrast media. Expression of Fas was not significantly mediated either. Interestingly, the level of bcl-2 that has the antiapoptotic effect was decreased by both contrast media in dose-dependent manner. Furthermore, bcl-2 expression was suppressed more by IOH than IOT. Western blot showed that caspase-3 protein (the proapoptotic effect) was increased more significantly by IOH than IOH, even at 10mgI/ml. In summary, 1) both contrast media could induce E-selectin mRNA expression at high concentration. 2) Non-ionic IOH has the ability to induce more monocyte apoptosis with increased caspase-3 protein than ionic IOT does.
Background & Objectives: According to many studies among risk factors acute myocardial infarction (AMI), diabetes mellitus (DM) bas been known as one of the most important factors.(1,2,5,6) The purpose of this study was to evaluate the effects of DM on outcome and survival of patients (pts) with first ANI. Methods: In 500 patients (358 men and 142 women), 74 (12.6%) belonged to diabetic cases, and rest of them were non – diabetic. All diabetic pts were divided in to two groups, A and B. The A group included 13 pts with type 1 DM and the B group included 61 pts, with type 2 DM. Results: According to the our results the age – Adjusted mortality (In hospital and one year follow-up) for women with DM (22%) was significantly higher than women without DM (13%), (relative risk (RR) 1.69 and 95% confidence interval (CI) 1.21 to 2.06). For men with DM (21%) and without DM (16%) was also significant (RR 1.31 and 95% CI 1.05- 1.62). Thus the effects of DM on survival was great in women than men. Painless AMI occurred 15.4% of pts with type 1 and 14.4% of pts with type 2. Mortality rate (in hospital and one year follow – up) in both type 1 and 2 were 19.6% and 21.3% respectively, which revealed no statistically difference. According to angiographic data, diabetic pts had more involved arteries than non diabetic pts (mean 2.62 vessels vs 2.07 P<0.05). Left ventricular function study demonstrated 34.03% of diabetic pts had lower ejection fraction (<40%) P<0.05. Conclusion: Our results reinforce the role of DM as one of the most important risk factors and predictor of first AMI. Keywords: Acute myocardial infarction, diabetes mellitus type 1 & type 2, painless AMI, Mortality rate.
P1-3
POSTER SESSION POSTER SESSION 1
ATHEROSCLEROSIS P1-1 EVALUATION OF LEFT VENTRICULAR THROMBUS AFTER ACUTE MYOCARDIAL INFARCTION WITH TRANSTHORACIC ECHOCARDIOGRAPHY
Asl Azin Alizadeh, J. Samadikhah, S.H. Hakim, R. Azarfarin. From the Madani Cardiovascular Research Center of Tabriz University of Medical Sciences, Tabriz – Iran Background: Left ventricular thrombus is an important complication in patients with acute myocardial Infarction (AMI). The aim of the present study was determine the incidence, natural history, and outcome of left ventricular thrombus (LVT) following AMI. Methods: This investigation is a prospective Multivariate study (cohort type); among 340 Consecutive first infarct survivors who admitted to our heart center through 2 years (2005-2007). We performed echocardiography in all Consecutive patients with isolated AMI. All patients received oral anticoagulant therapy on admission and throughout the study period. Results: The LVT was identified in 25.9% patients with anterior and in 3% patients with inferior AMI. LVT was associated with a significantly higher peak value of creatine-kinase (CK) (203±181 Vs 1103±256, P<0.05) and CKmb (123±31 vs.73±33, p<0.05); also according to multivariate analyses, high admission killip class, segmental dyskinesia (relative risk 4.43 & 95% confidence interval 2.03 to 8.92, P<0.05), segmental akinesia (relative risk 2.52 & 95% confidence interval 1.14 to 4.85, P<0.05) during AMI were higher than patients without LVT. The incidence of embolic events was 0.06% (4) in our LVT patients. Embolic events in 3 patients occurred in cerebrovascular system. Conclusion: Thus, LVT usually develops in the early days following large anterior MI, Complicated by pump failure and segmental dyskinesia or Akinesia, even when patients receive oral anticoagulant therapy.
PROGNOSTIC VALUE OF ST-SEGMENT VARIATIONS IN LEAD AVR IN PATIENTS WITH FIRST ACUTE QWAVE MYOCARDIAL INFARCTION THAT INVOLVES THE ANTERIOR OR LATERAL MYOCARDIAL WALL
Asl Azin Alizadeh, Jahanbakhsh Samadikhah, Hakim Hadi, Azarfarin Rasoul. From the Madani Cardiovascular Research Center of Tabriz University of Medical Sciences, Tabriz – Iran Background: Patients (Pts) with all acute myocardial infarction (AMI) that involve anterior or lateral myocardial wall (anterior, anterolateral, extensive anterolateral, and lateral MI) have a worse prognosis, than those with inferior wall involvement, thus any factor can to predict outcome in these Pts will be very important. Methods: this investigation is a prospective multivariate study (cohort type) among 137 AMI pts with involvement anterior or lateral wall and undergoing thrombolytic therapy by streptokinase (SK) were classified according to Stsegment deviation in lead avR on admission electrocardiogram (ECG): group A, 31 Pts with ST elevation of ≥0.5 mm; group B, 61 Pts without ST deviation, and group C, 45 pts with ST depression of ≥0.5 mm. Results: there were no difference among the 3 groups in age and sex. In groups A,B, and C, the mean peak creatine kinase (CK) level was 1587±108U/L, 1932±226 U/l, 2549±316 U/L, also the mean peak Ckmb level was 186±35U/L, 222±39U/L, 298±51 U/L. According to the left ventricular ejection fraction (LVEF) measured by echocardiography 37.3% of group C pts had LVEF lower 40% while this ratio in group B pts was 24.6% and in group A pts was only 17.8% of all; thus during hospitalization congestive heart failure more frequently in group C than in groups A and B (P<0.05). In-hospital mortality rate was 16.2% in group C, 9.6% in group B and 6.9% in group A. Conclusion:We conclude that pts with an anterior or lateral wall AMI, that have ST-segment depression in lead avR on admission ECG have a worse prognosis and need to more attention. Keywords: acute Qwave myocardial infarction, lead avR, creatine kinase, left ventricular ejection fraction
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
S45-7
P1-2
COMPARISON OF MODULATION OF APOPTOTIC FACTORS BETWEEN IONIC AND NON-IONIC CONTRAST MEDIA ON MONOCYTES
EFFECTS OF DIABETES MELLITUS ON OUTCOME OF PATIENTS WITH FIRST ACUTE MYOCARDIAL INFARCTION
Hsueh-Wei Yen, Ye-Hsu Lu, Hsiang-Chun Lee, Chih-Hsin Huang, Kun-Tai Lee, Chee-Siong Lee, Wen-Chol Voon, Wen-Te Lai, Sheng-Hsiung Sheu. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Asl Azin Alizadeh, Jahanbakhsh Samadikhah, Alireza Yaghoubi, Hakim Seyed Hadi, Salehi Rezvanieh, Azarfarin Rasoul. Tabriz University Of Medical Sciences, Iran
Monocytes play a key role in cellular inflammatory response. However, it is not known how contrast media modulate monocytes. There are diverge characteristics between different contrast media. In this experiment, we investigate the influence of adhesion molecule and apoptotic factors of monocytes by ionic (iothalamate, IOT) and non-ionic contrast media (iohexol, IOH). U937 (a human monocytic cell-line) was cultured in RPMI 1640 with 10% FCS at 37°C for 48 hours. These cells were then exposed to 4 series of concentration (0, 10, 50, 100 mgI/ml) of contrast medium for 30 minutes. Total RNA was extracted and converted to cDNA by commercial kit. RTPCR was performed in appropriate conditions to obtain the expression of ICAM-1, E-selectin, Fas and Bcl-2. β-actin was used as normalization. In this study, we demonstrate that E-selectin expression was increased at the concentration of 100mgI/ml both in IOT and IOH. However, ICAM-1 was constitutionally expressed and not changed by either contrast media. Expression of Fas was not significantly mediated either. Interestingly, the level of bcl-2 that has the antiapoptotic effect was decreased by both contrast media in dose-dependent manner. Furthermore, bcl-2 expression was suppressed more by IOH than IOT. Western blot showed that caspase-3 protein (the proapoptotic effect) was increased more significantly by IOH than IOH, even at 10mgI/ml. In summary, 1) both contrast media could induce E-selectin mRNA expression at high concentration. 2) Non-ionic IOH has the ability to induce more monocyte apoptosis with increased caspase-3 protein than ionic IOT does.
Background & Objectives: According to many studies among risk factors acute myocardial infarction (AMI), diabetes mellitus (DM) bas been known as one of the most important factors.(1,2,5,6) The purpose of this study was to evaluate the effects of DM on outcome and survival of patients (pts) with first ANI. Methods: In 500 patients (358 men and 142 women), 74 (12.6%) belonged to diabetic cases, and rest of them were non – diabetic. All diabetic pts were divided in to two groups, A and B. The A group included 13 pts with type 1 DM and the B group included 61 pts, with type 2 DM. Results: According to the our results the age – Adjusted mortality (In hospital and one year follow-up) for women with DM (22%) was significantly higher than women without DM (13%), (relative risk (RR) 1.69 and 95% confidence interval (CI) 1.21 to 2.06). For men with DM (21%) and without DM (16%) was also significant (RR 1.31 and 95% CI 1.05- 1.62). Thus the effects of DM on survival was great in women than men. Painless AMI occurred 15.4% of pts with type 1 and 14.4% of pts with type 2. Mortality rate (in hospital and one year follow – up) in both type 1 and 2 were 19.6% and 21.3% respectively, which revealed no statistically difference. According to angiographic data, diabetic pts had more involved arteries than non diabetic pts (mean 2.62 vessels vs 2.07 P<0.05). Left ventricular function study demonstrated 34.03% of diabetic pts had lower ejection fraction (<40%) P<0.05. Conclusion: Our results reinforce the role of DM as one of the most important risk factors and predictor of first AMI. Keywords: Acute myocardial infarction, diabetes mellitus type 1 & type 2, painless AMI, Mortality rate.
P1-3
POSTER SESSION POSTER SESSION 1
ATHEROSCLEROSIS P1-1 EVALUATION OF LEFT VENTRICULAR THROMBUS AFTER ACUTE MYOCARDIAL INFARCTION WITH TRANSTHORACIC ECHOCARDIOGRAPHY
Asl Azin Alizadeh, J. Samadikhah, S.H. Hakim, R. Azarfarin. From the Madani Cardiovascular Research Center of Tabriz University of Medical Sciences, Tabriz – Iran Background: Left ventricular thrombus is an important complication in patients with acute myocardial Infarction (AMI). The aim of the present study was determine the incidence, natural history, and outcome of left ventricular thrombus (LVT) following AMI. Methods: This investigation is a prospective Multivariate study (cohort type); among 340 Consecutive first infarct survivors who admitted to our heart center through 2 years (2005-2007). We performed echocardiography in all Consecutive patients with isolated AMI. All patients received oral anticoagulant therapy on admission and throughout the study period. Results: The LVT was identified in 25.9% patients with anterior and in 3% patients with inferior AMI. LVT was associated with a significantly higher peak value of creatine-kinase (CK) (203±181 Vs 1103±256, P<0.05) and CKmb (123±31 vs.73±33, p<0.05); also according to multivariate analyses, high admission killip class, segmental dyskinesia (relative risk 4.43 & 95% confidence interval 2.03 to 8.92, P<0.05), segmental akinesia (relative risk 2.52 & 95% confidence interval 1.14 to 4.85, P<0.05) during AMI were higher than patients without LVT. The incidence of embolic events was 0.06% (4) in our LVT patients. Embolic events in 3 patients occurred in cerebrovascular system. Conclusion: Thus, LVT usually develops in the early days following large anterior MI, Complicated by pump failure and segmental dyskinesia or Akinesia, even when patients receive oral anticoagulant therapy.
PROGNOSTIC VALUE OF ST-SEGMENT VARIATIONS IN LEAD AVR IN PATIENTS WITH FIRST ACUTE QWAVE MYOCARDIAL INFARCTION THAT INVOLVES THE ANTERIOR OR LATERAL MYOCARDIAL WALL
Asl Azin Alizadeh, Jahanbakhsh Samadikhah, Hakim Hadi, Azarfarin Rasoul. From the Madani Cardiovascular Research Center of Tabriz University of Medical Sciences, Tabriz – Iran Background: Patients (Pts) with all acute myocardial infarction (AMI) that involve anterior or lateral myocardial wall (anterior, anterolateral, extensive anterolateral, and lateral MI) have a worse prognosis, than those with inferior wall involvement, thus any factor can to predict outcome in these Pts will be very important. Methods: this investigation is a prospective multivariate study (cohort type) among 137 AMI pts with involvement anterior or lateral wall and undergoing thrombolytic therapy by streptokinase (SK) were classified according to Stsegment deviation in lead avR on admission electrocardiogram (ECG): group A, 31 Pts with ST elevation of ≥0.5 mm; group B, 61 Pts without ST deviation, and group C, 45 pts with ST depression of ≥0.5 mm. Results: there were no difference among the 3 groups in age and sex. In groups A,B, and C, the mean peak creatine kinase (CK) level was 1587±108U/L, 1932±226 U/l, 2549±316 U/L, also the mean peak Ckmb level was 186±35U/L, 222±39U/L, 298±51 U/L. According to the left ventricular ejection fraction (LVEF) measured by echocardiography 37.3% of group C pts had LVEF lower 40% while this ratio in group B pts was 24.6% and in group A pts was only 17.8% of all; thus during hospitalization congestive heart failure more frequently in group C than in groups A and B (P<0.05). In-hospital mortality rate was 16.2% in group C, 9.6% in group B and 6.9% in group A. Conclusion:We conclude that pts with an anterior or lateral wall AMI, that have ST-segment depression in lead avR on admission ECG have a worse prognosis and need to more attention. Keywords: acute Qwave myocardial infarction, lead avR, creatine kinase, left ventricular ejection fraction