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PP-219 LEFT ANTERIOR DESCENDING CORONARY ARTERY OCLUSION MIMICKING ACUTE INFERIOR MYOCARDIAL INFARCTION
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Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-219 LEFT ANTERIOR DESCENDING CORONARY ARTERY OCLUSION MIMICKING ACUTE INFERIOR MYOCARDIAL INFARCTION 1 ¨ Turk V. Yavuz1 , M. Acar2 , N. Cetin ¸ , O. Dalgıc¸ 1 , U.O. ¨ 3 , T. Tavlı1 . 1 Department of Cardiology, Celal Bayar University, Manisa, Turkey; 2 Department of Cardiology, Alasehir Government Hospital, Manisa, ˙ Turkey; 3 Department of Cardiology, Central Hospital, Izmir, Turkey Objective: ST-elevated myocardial infarction (STEMI), a complete blockage of the coronary artery is the name given to the clinical situation as a result. The most important method of diagnosis is 12channel electrocardiogram (ECG). ECG is also detected ST-segment elevation. Diagnostic ECG, STEMI localization is responsible for the vessel, which gives enough information most often. However, in some cases with ECG localization STEMI’dan artery is responsible for the incompatibility with each other. In this case, clinical and ECG were suggestive of the diagnosis of STEMI, but coronary angiography revealed total occlusion of the LAD. Conclusions: Acute ST-elevated myocardial infarction, is the most common cause of death. The most important and easily accessible tool for diagnosing coronary heart disease on ECG. ECG and the presence of coronary ischemia, and ischemia in coronary artery which shows that might be. Responsible for STEMI patients, especially in detecting the lesion and the artery has a high precision. Classically, lesions of the LAD leads V1-V6, D1-D2-D3-aVL leads aVF leads lesions of the LAD and the diagonal shows the RCA lesions. As in our case, however, ECG findings do not match. The most important side of this issue is of primary PTCA or thrombolytic decision making by clinicians taking into consideration the infarct location and area of necrosis at the inferior STEMI. ECG and echocardiography in the diagnosis of STEMI must be combined. In addition, primary PTCA performed on patients in a center can be contacted at the appropriate time.
is a measure of vagal reactivation and is considered a marker of parasympathetic activity. Myocardial performance index (MPI) is measured overall cardiac dysfunction than systolic and diastolic measures alone. The aim of the study was to evaluated MPI and HRR and Associated with TIMI score in patients with CSFP. Methods: Twenty four CSFP patients (14 males and 10 females, mean age 54±9 years) and 20 control subjects (14 males, 6 females, mean age 52±10) were included in the study. Echocardiographic examination, treadmill exercise test, and Doppler were performed. Isovolumic myocardial acceleration (IVA) and myocardial performance index (MPI) were measured. Results: Doppler parameters for diastolic LV function were significantly impaired in SCF group with decreased IVA, E/A, and increased MPI (0.27±0.09 vs. 0.33±0.09, P < 0.03) compared to control (Table 1). Mean TIMI frame count was correlated with MPI and E/A. CSFP patients had decreased peak exercise capacity than the controls (8.7±1.4 METs vs. 11.3±2.3, P < 0.001). Patients with CSFP had significantly lower HRR at 1 minute (22±6 vs 28±9 beats/min; p < 0.01) compared to controls with normal coronary flow. Conclusions: There is impairment of diastolic function in CSFP patients with clinical impact on exercise capacity which emphasizes the importance of close follow-up of these patients for risk stratification. Attenuation in HRR at 1 minute suggests the presence of reduced vagal tone in patients with CSFP. Decreased parasympatic activity may responsible to the mechanisms for CSFP. Table 1. Doppler diastolic parameter, HRR, peak exercise and MPI values Parameters
Normal subjects (n = 20)
CSFP (n = 24)
p value
E/A ratio MPI peak exercise (min) HRR
1.4±0.2 0.27±0.09 11.3±2.5 28±9
0.9±0.2 0.32±0.09 8.7±1.4 22±6
0.001 0.03 0.001 0.01
MPI, myocardial performance index; HRR, heart rate recovery.
PP-221 THE RELATION OF SERUM GAMMA-GLUTAMYL TRANSFERASE LEVELS WITH CORONARY LESION COMPLEXITY AND LONG-TERM OUTCOME IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE E. Aksakal1 , I.H. Tanboga2 , M. Kurt2 , M.A. Kaygın2 , A. Kaya2 , T. Isık ¸ 2, 2 1 1 1 M. Ekinci , S. Sevimli , M. Acıkel ¸ . Ataturk University Medical School, Department of Cardiology, Erzurum, Turkey; 2 Erzurum Education and Research Hospital, Department of Cardiology, Erzurum, Turkey
Figure 1. ECG and Coronary Artery Angiography examination.
PP-220 HEART RATE RECOVERY AND MYOCARDIAL PERFORMANCE INDEX IN PATIENTS WITH CORONARY SLOW FLOW PHENOMENON 2 1 ¨ O. Dalgıc¸ 1 , F. Ozyurtlu , N. Cetin ¸ , V. Yavuz1 , T. Tavlı1 . 1 Department of Cardiology, Celal Bayar Universitesi, Manisa, Turkey; 2 Department ˙ of Cardiology, Sada Hospital, Izmir, Turkey Objective: The coronary slow flow phenomenon (CSFP) is an angiographic consept with is characterized by delayed passage of angiographic contrast along the coronary arteries in the absence of stenosis in the epicardial vessels. The importance of CSFP results from its association with acute myocardial infarction, arrhythmias and sudden cardiac death. Heart rate recovery index is a strong indicator of risk in asymptomatic and symptomatic coronary artery disease. Heart rate recovery (HRR) at 1 minute after peak exercise
Objective: Relation of serum gamma-glutamyl transferase (GGT) levels with extent, severity, and complexity of CAD have not been adequately studied. Therefore, we evaluated the relationship between GGT levels and coronary complexity, severity and extent assessed by SYNTAX score and long-term adverse events. Methods: We enrolled 444 consecutive patients with stable angina pectoris who underwent coronary angiography. Baseline serum GGT levels were measured and SYNTAX score was calculated from the study population. Median follow-up duration was 363 days. Endpoints were all cause mortality and any revascularization. Results: GGT levels demonstrated an increase from low SYNTAX tertile to high tertile. In multivariate analysis serum GGT, diabetes mellitus, HDL-cholesterol, eGFR and ejection fraction were found to be independent predictors of high SYNTAX score. The survival analysis showed that long-term revascularization rates were comparable between the GGT groups (for 40 U/l cut point) of the overall population (7.7% vs 8.6% logrank, p= 0.577), whereas long-term all cause mortality rate was higher in the GGT > 40U/l group (3, 6% vs 11.6% logrank, p = 0.001). In Cox proportional hazards regression model, GGT > 40 U/l group was found to be an independent predictor of long-term all cause mortality in the
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-219 LEFT ANTERIOR DESCENDING CORONARY ARTERY OCLUSION MIMICKING ACUTE INFERIOR MYOCARDIAL INFARCTION 1 ¨ Turk V. Yavuz1 , M. Acar2 , N. Cetin ¸ , O. Dalgıc¸ 1 , U.O. ¨ 3 , T. Tavlı1 . 1 Department of Cardiology, Celal Bayar University, Manisa, Turkey; 2 Department of Cardiology, Alasehir Government Hospital, Manisa, ˙ Turkey; 3 Department of Cardiology, Central Hospital, Izmir, Turkey Objective: ST-elevated myocardial infarction (STEMI), a complete blockage of the coronary artery is the name given to the clinical situation as a result. The most important method of diagnosis is 12channel electrocardiogram (ECG). ECG is also detected ST-segment elevation. Diagnostic ECG, STEMI localization is responsible for the vessel, which gives enough information most often. However, in some cases with ECG localization STEMI’dan artery is responsible for the incompatibility with each other. In this case, clinical and ECG were suggestive of the diagnosis of STEMI, but coronary angiography revealed total occlusion of the LAD. Conclusions: Acute ST-elevated myocardial infarction, is the most common cause of death. The most important and easily accessible tool for diagnosing coronary heart disease on ECG. ECG and the presence of coronary ischemia, and ischemia in coronary artery which shows that might be. Responsible for STEMI patients, especially in detecting the lesion and the artery has a high precision. Classically, lesions of the LAD leads V1-V6, D1-D2-D3-aVL leads aVF leads lesions of the LAD and the diagonal shows the RCA lesions. As in our case, however, ECG findings do not match. The most important side of this issue is of primary PTCA or thrombolytic decision making by clinicians taking into consideration the infarct location and area of necrosis at the inferior STEMI. ECG and echocardiography in the diagnosis of STEMI must be combined. In addition, primary PTCA performed on patients in a center can be contacted at the appropriate time.
is a measure of vagal reactivation and is considered a marker of parasympathetic activity. Myocardial performance index (MPI) is measured overall cardiac dysfunction than systolic and diastolic measures alone. The aim of the study was to evaluated MPI and HRR and Associated with TIMI score in patients with CSFP. Methods: Twenty four CSFP patients (14 males and 10 females, mean age 54±9 years) and 20 control subjects (14 males, 6 females, mean age 52±10) were included in the study. Echocardiographic examination, treadmill exercise test, and Doppler were performed. Isovolumic myocardial acceleration (IVA) and myocardial performance index (MPI) were measured. Results: Doppler parameters for diastolic LV function were significantly impaired in SCF group with decreased IVA, E/A, and increased MPI (0.27±0.09 vs. 0.33±0.09, P < 0.03) compared to control (Table 1). Mean TIMI frame count was correlated with MPI and E/A. CSFP patients had decreased peak exercise capacity than the controls (8.7±1.4 METs vs. 11.3±2.3, P < 0.001). Patients with CSFP had significantly lower HRR at 1 minute (22±6 vs 28±9 beats/min; p < 0.01) compared to controls with normal coronary flow. Conclusions: There is impairment of diastolic function in CSFP patients with clinical impact on exercise capacity which emphasizes the importance of close follow-up of these patients for risk stratification. Attenuation in HRR at 1 minute suggests the presence of reduced vagal tone in patients with CSFP. Decreased parasympatic activity may responsible to the mechanisms for CSFP. Table 1. Doppler diastolic parameter, HRR, peak exercise and MPI values Parameters
Normal subjects (n = 20)
CSFP (n = 24)
p value
E/A ratio MPI peak exercise (min) HRR
1.4±0.2 0.27±0.09 11.3±2.5 28±9
0.9±0.2 0.32±0.09 8.7±1.4 22±6
0.001 0.03 0.001 0.01
MPI, myocardial performance index; HRR, heart rate recovery.
PP-221 THE RELATION OF SERUM GAMMA-GLUTAMYL TRANSFERASE LEVELS WITH CORONARY LESION COMPLEXITY AND LONG-TERM OUTCOME IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE E. Aksakal1 , I.H. Tanboga2 , M. Kurt2 , M.A. Kaygın2 , A. Kaya2 , T. Isık ¸ 2, 2 1 1 1 M. Ekinci , S. Sevimli , M. Acıkel ¸ . Ataturk University Medical School, Department of Cardiology, Erzurum, Turkey; 2 Erzurum Education and Research Hospital, Department of Cardiology, Erzurum, Turkey
Figure 1. ECG and Coronary Artery Angiography examination.
PP-220 HEART RATE RECOVERY AND MYOCARDIAL PERFORMANCE INDEX IN PATIENTS WITH CORONARY SLOW FLOW PHENOMENON 2 1 ¨ O. Dalgıc¸ 1 , F. Ozyurtlu , N. Cetin ¸ , V. Yavuz1 , T. Tavlı1 . 1 Department of Cardiology, Celal Bayar Universitesi, Manisa, Turkey; 2 Department ˙ of Cardiology, Sada Hospital, Izmir, Turkey Objective: The coronary slow flow phenomenon (CSFP) is an angiographic consept with is characterized by delayed passage of angiographic contrast along the coronary arteries in the absence of stenosis in the epicardial vessels. The importance of CSFP results from its association with acute myocardial infarction, arrhythmias and sudden cardiac death. Heart rate recovery index is a strong indicator of risk in asymptomatic and symptomatic coronary artery disease. Heart rate recovery (HRR) at 1 minute after peak exercise
Objective: Relation of serum gamma-glutamyl transferase (GGT) levels with extent, severity, and complexity of CAD have not been adequately studied. Therefore, we evaluated the relationship between GGT levels and coronary complexity, severity and extent assessed by SYNTAX score and long-term adverse events. Methods: We enrolled 444 consecutive patients with stable angina pectoris who underwent coronary angiography. Baseline serum GGT levels were measured and SYNTAX score was calculated from the study population. Median follow-up duration was 363 days. Endpoints were all cause mortality and any revascularization. Results: GGT levels demonstrated an increase from low SYNTAX tertile to high tertile. In multivariate analysis serum GGT, diabetes mellitus, HDL-cholesterol, eGFR and ejection fraction were found to be independent predictors of high SYNTAX score. The survival analysis showed that long-term revascularization rates were comparable between the GGT groups (for 40 U/l cut point) of the overall population (7.7% vs 8.6% logrank, p= 0.577), whereas long-term all cause mortality rate was higher in the GGT > 40U/l group (3, 6% vs 11.6% logrank, p = 0.001). In Cox proportional hazards regression model, GGT > 40 U/l group was found to be an independent predictor of long-term all cause mortality in the