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PP-224 DO WE UNDERESTIMATE HEPARIN INDUCED TROMBOCYTOPENIA?
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
unadjusted (HR 0.26, 95%CI 0.10–0.70, p = 0.008) and age- and gender-adjusted (HR 0.26, 95%CI 0.10–0.70, p = 0.008) models, as well as in a model including all covariates such as SYNTAX score. Conclusions: Serum GGT level was independently associated with coronary complexity and long-term mortality in patients with stable coronary artery disease. PP-222 RELATIONSHIP BETWEEN PREGNANCY AND CORONARY ARTER DISEASE SEVERITY H.E. Soydinc¸ 1 , M. Yuce ¨ 2 , Mustafa Oylumlu3 , S. Soydinc¸ 3 , I˙ . Sarı2 , Muhammed Oylumlu2 , S. Ercan2 , M. Akcay ¸ 2 , V. Davuto˘glu2 . 1 Department of Obstetric and Gynecology, Dicle University, Diyarbakır, Turkey; 2 Department of Cardiology, Gaziantep University, Gaziantep, Turkey; 3 Department of Cardiology, Dicle University, Diyarbakır, Turkey Objective: There is contraversy whether dyslipidemia during pregnancy increases incedence of coronary artery disease. We aimed to investigate the effect of number of pregnancy to the burden of atherosclerosis with Gensini score in women with the diagnosis of coronary artery disease. Methods: 200 postmenaposal women who underwent coronary angiography and had the diagnosis of coronary artery disease were included into the study and atherosclerosis burden was decided by using Gensini score. Cardiac risk factors, lipid profiles and demographic characteristics were obtained from hospital records. Results: There was no significant relation between pregnancy number and atherosclerosis burden as assessed with Gensini score (p = 0.61). There was no significant relation between pregnancy number and multivessel disease (p = 0.69). Gensini score was significantly correlated with diabetes (p = 0.003 and LDL cholesterol (p = 0.03). With the Gensini score being dependent variable, age (p = 0.001), diabetes (p = 0.004), HDL cholesterol (p = 0.035) and LDL cholesterol (p = 0.031) were significantly correlated with Gensini score. Conclusions: In this study, we investigated impact of pregnancy number on severity and prevalence of coronary artery disease. We were not able to find association between pregnancy number and atherosclerosis burden. Various antiatherogenic factors during pregnancy might be responsible from this situation. This topic should be evaluated with large scale prospective studies. PP-223 LEFT ATRIAL VOLUME AND FUNCTION IN PATIENTS WITH BEHCET’S DISEASE ASSESSED BY REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY E. Akturk ¨ 1 , J. Ya˘gmur2 , E. Kurto˘glu3 , N. Ermis2 , N. Acıkg ¸ oz ¨ 2, 4 S. Sener ¸ , Y. Karakus¸ 2 , S. Akturk ¨ 5 , Y. Karıncao˘glu4 , H. Pekdemir2 , 2 1 ¨ R. Ozdemir . Adıyaman University, Faculty of Medicine, Department of Cardiology, Adıyaman, Turkey; 2 Inonu University, Faculty of Medicine, Department of Cardiology, Malatya, Turkey; 3 Elazı˘g Education and Research Hospital, Department of Cardiology, Elazı˘g, Turkey; 4 Inonu University, Faculty of Medicine, Department of Dermatology, Malatya, Turkey; 5 Fırat University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Elazı˘g, Turkey Objective: Behcet’s ¸ disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including endomyocardial fibrosis of the right heart, atrial fibrillation, ventricular arrhythmias and sudden cardiac death. The incidence and nature of cardiac involvement in BD are not yet clearly documented [1–5]. Our aim was to evaluate left atrial (LA) volume and functions using real-time 3-dimensional echocardiography (RT3DE) in Behcet’s patients without any cardiac symptom. Methods: The study included 40 BD (16 female, 24 male, mean age 33±7 years) and 30 healthy (11 female, 19 male, mean age 35±6 years) subjects. All the patients’ demographic parameters
S175
such as age, gender, and duration of BD were recorded. All the individuals underwent comprehensive 2DE examination, and RT3DE was performed to assess LA volumes and mechanical functions. Results: LA maximum volume (Vmax) and before atrial contraction volume (V pre A), LA active stroke volume (ASV): and total stroke volumes (TSV), total emptying and active emptying fractions and expansion index were significantly higher in Behcet’s disease patients when compared with the controls (p < 0.0001 for all). LA Passive Emptying Fraction was significantly lower in the patients with BD than in the controls (41±7 vs. 44±5, p = 0.039). There were positive correlations between TSV and hs-CRP level (r = 0.413, P = 0.008), TSV and disease duration (r = 0.417, P < 0.007). Conclusions: Our study has show that LA mechanical functions and volumes are impaired in BD. These results may be an early form of subclinical cardiac involvement in patients with BD who have no clinical evidence for cardiovascular disease.
Figure 1. (A) Real-time three-dimensional echocardiography recordings of max left atrial volumes. (B) Real-time threedimensional echocardiography recordings of min left atrial volumes. Reference(s) [1] Lakhanpol S, Tani K, Lie JT, Katoh K, Ishigatsubo Y, Ohokubo T: Pathologic features of Behcet’s ¸ syndrome: a review of Japanese autopsy registry data. Hum Pathol 1985;16:790–5. [2] Lie JT: Cardiac and pulmonary manifestations of Behcet’s ¸ Syndrome. Pathol Res Pract 1988;183(3):347–55. [3] Mc Donald GSA, Gad-Al Rab J: Behcet’s ¸ disease with endocarditis and the Budd-Chiari syndrome. J Clin Pathol 1980;33(7):660–9. [4] Bletry O, Mohattane A, Wechsler B, Beaufils P, Valere ` P, Petit J, et al: Cardiac manifestations of Behcet’s ¸ disease: Twelve cases. Presse Med 1988;17(45):2388–91. [5] Morelli S, Perrone C, Ferrante L, Sgreccia A, Priori R, Voci P, et al:Cardiac involvement in Behcet’s ¸ disease. Cardiology. 1997;88(6):513–7.
PP-224 DO WE UNDERESTIMATE HEPARIN INDUCED TROMBOCYTOPENIA? A. Karakuzu. Department of Thoracic & Cardiovascular Surgery, Near East University, Nicossia, Turkish Republic of Northern Cyprus Objective: Heparin induced trombocytopenia if having severe clinical presentations can be considered as an immune mediated disease. Antibodies to platelet factor 4 and heparin complexes activates platelets. Activation of platelets induces endothelial lesions causing despite trombocytopenia commonly venous and arterial thrombosis. HIT has two forms. One is asymptomatic slight form characterised by mild trombocytopenia following the first few day of administrating heparin (probably non immune mediated form). Second form is having more complicated clinical presentation mainly characterized by severe thrombocytopenia following the 5th 6th day of heparin administration (probably immune mediated form). In this paper we are presenting a case which suffered from HIT following open heart surgery ie mitral valve replacement. Via this presentation we once more want to raise the question of do we underestimate HIT in cardiac surgery?. Methods: 83 years old male patient presented to emergency service due to shortage of breath. Severe mitral insufficiency diagnosed following coronary angiography and transthroacic and
unadjusted (HR 0.26, 95%CI 0.10–0.70, p = 0.008) and age- and gender-adjusted (HR 0.26, 95%CI 0.10–0.70, p = 0.008) models, as well as in a model including all covariates such as SYNTAX score. Conclusions: Serum GGT level was independently associated with coronary complexity and long-term mortality in patients with stable coronary artery disease. PP-222 RELATIONSHIP BETWEEN PREGNANCY AND CORONARY ARTER DISEASE SEVERITY H.E. Soydinc¸ 1 , M. Yuce ¨ 2 , Mustafa Oylumlu3 , S. Soydinc¸ 3 , I˙ . Sarı2 , Muhammed Oylumlu2 , S. Ercan2 , M. Akcay ¸ 2 , V. Davuto˘glu2 . 1 Department of Obstetric and Gynecology, Dicle University, Diyarbakır, Turkey; 2 Department of Cardiology, Gaziantep University, Gaziantep, Turkey; 3 Department of Cardiology, Dicle University, Diyarbakır, Turkey Objective: There is contraversy whether dyslipidemia during pregnancy increases incedence of coronary artery disease. We aimed to investigate the effect of number of pregnancy to the burden of atherosclerosis with Gensini score in women with the diagnosis of coronary artery disease. Methods: 200 postmenaposal women who underwent coronary angiography and had the diagnosis of coronary artery disease were included into the study and atherosclerosis burden was decided by using Gensini score. Cardiac risk factors, lipid profiles and demographic characteristics were obtained from hospital records. Results: There was no significant relation between pregnancy number and atherosclerosis burden as assessed with Gensini score (p = 0.61). There was no significant relation between pregnancy number and multivessel disease (p = 0.69). Gensini score was significantly correlated with diabetes (p = 0.003 and LDL cholesterol (p = 0.03). With the Gensini score being dependent variable, age (p = 0.001), diabetes (p = 0.004), HDL cholesterol (p = 0.035) and LDL cholesterol (p = 0.031) were significantly correlated with Gensini score. Conclusions: In this study, we investigated impact of pregnancy number on severity and prevalence of coronary artery disease. We were not able to find association between pregnancy number and atherosclerosis burden. Various antiatherogenic factors during pregnancy might be responsible from this situation. This topic should be evaluated with large scale prospective studies. PP-223 LEFT ATRIAL VOLUME AND FUNCTION IN PATIENTS WITH BEHCET’S DISEASE ASSESSED BY REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY E. Akturk ¨ 1 , J. Ya˘gmur2 , E. Kurto˘glu3 , N. Ermis2 , N. Acıkg ¸ oz ¨ 2, 4 S. Sener ¸ , Y. Karakus¸ 2 , S. Akturk ¨ 5 , Y. Karıncao˘glu4 , H. Pekdemir2 , 2 1 ¨ R. Ozdemir . Adıyaman University, Faculty of Medicine, Department of Cardiology, Adıyaman, Turkey; 2 Inonu University, Faculty of Medicine, Department of Cardiology, Malatya, Turkey; 3 Elazı˘g Education and Research Hospital, Department of Cardiology, Elazı˘g, Turkey; 4 Inonu University, Faculty of Medicine, Department of Dermatology, Malatya, Turkey; 5 Fırat University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Elazı˘g, Turkey Objective: Behcet’s ¸ disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including endomyocardial fibrosis of the right heart, atrial fibrillation, ventricular arrhythmias and sudden cardiac death. The incidence and nature of cardiac involvement in BD are not yet clearly documented [1–5]. Our aim was to evaluate left atrial (LA) volume and functions using real-time 3-dimensional echocardiography (RT3DE) in Behcet’s patients without any cardiac symptom. Methods: The study included 40 BD (16 female, 24 male, mean age 33±7 years) and 30 healthy (11 female, 19 male, mean age 35±6 years) subjects. All the patients’ demographic parameters
S175
such as age, gender, and duration of BD were recorded. All the individuals underwent comprehensive 2DE examination, and RT3DE was performed to assess LA volumes and mechanical functions. Results: LA maximum volume (Vmax) and before atrial contraction volume (V pre A), LA active stroke volume (ASV): and total stroke volumes (TSV), total emptying and active emptying fractions and expansion index were significantly higher in Behcet’s disease patients when compared with the controls (p < 0.0001 for all). LA Passive Emptying Fraction was significantly lower in the patients with BD than in the controls (41±7 vs. 44±5, p = 0.039). There were positive correlations between TSV and hs-CRP level (r = 0.413, P = 0.008), TSV and disease duration (r = 0.417, P < 0.007). Conclusions: Our study has show that LA mechanical functions and volumes are impaired in BD. These results may be an early form of subclinical cardiac involvement in patients with BD who have no clinical evidence for cardiovascular disease.
Figure 1. (A) Real-time three-dimensional echocardiography recordings of max left atrial volumes. (B) Real-time threedimensional echocardiography recordings of min left atrial volumes. Reference(s) [1] Lakhanpol S, Tani K, Lie JT, Katoh K, Ishigatsubo Y, Ohokubo T: Pathologic features of Behcet’s ¸ syndrome: a review of Japanese autopsy registry data. Hum Pathol 1985;16:790–5. [2] Lie JT: Cardiac and pulmonary manifestations of Behcet’s ¸ Syndrome. Pathol Res Pract 1988;183(3):347–55. [3] Mc Donald GSA, Gad-Al Rab J: Behcet’s ¸ disease with endocarditis and the Budd-Chiari syndrome. J Clin Pathol 1980;33(7):660–9. [4] Bletry O, Mohattane A, Wechsler B, Beaufils P, Valere ` P, Petit J, et al: Cardiac manifestations of Behcet’s ¸ disease: Twelve cases. Presse Med 1988;17(45):2388–91. [5] Morelli S, Perrone C, Ferrante L, Sgreccia A, Priori R, Voci P, et al:Cardiac involvement in Behcet’s ¸ disease. Cardiology. 1997;88(6):513–7.
PP-224 DO WE UNDERESTIMATE HEPARIN INDUCED TROMBOCYTOPENIA? A. Karakuzu. Department of Thoracic & Cardiovascular Surgery, Near East University, Nicossia, Turkish Republic of Northern Cyprus Objective: Heparin induced trombocytopenia if having severe clinical presentations can be considered as an immune mediated disease. Antibodies to platelet factor 4 and heparin complexes activates platelets. Activation of platelets induces endothelial lesions causing despite trombocytopenia commonly venous and arterial thrombosis. HIT has two forms. One is asymptomatic slight form characterised by mild trombocytopenia following the first few day of administrating heparin (probably non immune mediated form). Second form is having more complicated clinical presentation mainly characterized by severe thrombocytopenia following the 5th 6th day of heparin administration (probably immune mediated form). In this paper we are presenting a case which suffered from HIT following open heart surgery ie mitral valve replacement. Via this presentation we once more want to raise the question of do we underestimate HIT in cardiac surgery?. Methods: 83 years old male patient presented to emergency service due to shortage of breath. Severe mitral insufficiency diagnosed following coronary angiography and transthroacic and