S33-2 LONG TERM PROGNOSIS OF PULMONARY ARTERIAL HYPERTENSION WITH

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Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007

LVG have poor prognosis necessitating close follow-up and treatment. Concomitant coronary artery disease doesn’t influence the clinical features and outcome in this cohort.

S32-6 THE APPLICATION OF OXYGEN SATURATION OF CENTRAL VENOUS BLOOD (SCVO2) IN COMPLICATED ACUTE CORONARY SYNDROME AS A PROBABLE DISEASE MONITOR

Ho-Tsung Hsin, Yui-Wei Chui, Chi-Yu Yang, Dong-Feng Yeih, Chao-Lun Lai, Pen-Chih Liao. Cardiovascular Center, Far-Eastern Memorial Hospital, Taipei County, Taiwan Background: The oxygen saturation of central vein (ScVO2) has been regarded as a surrogate of tissue perfusion in patients of severe sepsis and major surgery. However, ScVO2 in acute coronary syndrome was not addressed. The study tried to observe the trend of ScVO2 in patients of acute coronary syndrome. Methods and Patients: This is a prospective observational study in the coronary care unit of a tertiary-care hospital. Patients of acute coronary syndrome with acute lung edema or cardiogenic shock were enrolled. Co-oxymetry study of blood samples from central vein (via 3-lumen catheter in superior vena cava) and peripheral artery immediately after admission, 24 and 48 hours later. The primary endpoint was “event-fatality”. The secondary endpoint was in-hospital all-cause mortality. Results: Forty-three patients were enrolled in the period of 3 months. There were 5 event-fatality (event-fatality rate: 11.6%). The non-survivors had low event-ScVO2 (39.4±12.9%, median 44.5%), while the survivors had higher eventScVO2 of 65.6±9.9% (median 66.2%) (p<0.05). The APACHE II score (17.4±6.3 median 18 vs. 27.8±8.8 median 30.5, p<0.05) and TISS score (44±13.7 median 42.5 vs. 51±22.4, median 51, p<0.05) showed the same trend. The time series showed heterogeneity during the course, but the overall trend showed increment of ScVO2 as the disease improved. Conclusion: ScVO2 could be one of the integral indices of tissue perfusion in critical patients of primary cardiac events, and it was more practical and accessible than SVO2.

S32-7 COMPARISON OF THE PREVALENCE OF METABOLIC SYNDROME BETWEEN THE CRITERIA FOR TAIWANESE AND JAPANESE, THE RISK FACTOR DISTRIBUTION, AND THE PROJECTED PROBABILITY OF STROKE IN ELDERLY HYPERTENSIVE TAIWANESE

Hung-I. Yeh 1 , Kwo-Chang Ueng 2 , Chung-Hsiang Liu 3 , Charles Jia-Yin Hou 1 , Chun-Yen Chen 1 , Cheng-Ho Tsai 1 . 1 Cardiology Department, Mackay Memorial Hospital, 2 Cardiology Department, Chung Shan Medical University Hospital, 3 Neurology Department, China Medical University Hospital, Taipei, Taiwan Background: Current criteria for metabolic syndrome (MS) in Taiwan and Japan differ in the cut-off of abdominal circumference. However, whether such a difference has an impact on the prevalence of MS, the risk factor distribution, and the probability of stroke in people with MS remained unclear. Methods: A population-based cross-sectional survey in a hypertensive sample of 3,472 participants (aged 55 to 80 years; 1,709 women) from 38 sites across Taiwan was conducted from November 2005 through December 2006. The presence of MS was defined using the current criteria for Taiwanese or Japanese modified from the International Diabetes Federation. The distribution of other risk factors, including urine albumin excretion rate, and 10-year probability of stroke estimated from Framingham equation were compared. Results: The prevalence of MS was 56.3% by the criteria for Taiwanese and 47.2% by those for Japanese. Although Taiwanese criteria of MS are associated with more congestive heart failure (8.7% vs 8.3%), left ventricular hypertrophy defined by Sokolow-Lyon voltage criteria (5.2% vs 5.1%), microalbuminuria/proteiuria (46.4% vs 45.8%), and diabetes (41.1% vs 39.4%), Japanese criteria are associated with more myocardial infarction (7.2% vs 6.3%), smokers (17.0% vs 12.9%), angina (23.2% vs 22.1.0%), significant murmur (8.2% vs 8.1%), atrial fibrillation (3.8% vs 3.6%), and prior stroke/transient ischemic attack (24.7% vs 21.7%). Both criteria showed that, compared to the non-MS, the MS has higher 10-year probability of stroke estimated from Framingham

equation (15.5±11.7% vs 13.2±10%.4 for Taiwanese criteria, 16.0±11.0% vs 13.2±11.2% for Japanese criteria; both P<0.0001). Conclusions: Both criteria demonstrate that MS is highly prevalent in the elderly hypertensive patients in Taiwan. Although there is 9% gap in the prevalence of MS between the 2 criteria, the distribution of risk factors is not proportional to the prevalence. In addition, probability of stroke is higher in the MS compared to nonMS, as defined by the both criteria. Further collection of the data of cardiovascular outcomes in this population is required to determine which criteria predict higher cardiovascular risk in Taiwan.

SYMPOSIUM 33

GENERAL S33-1 PREINFARCTION ANGINA ASSOCIATES WITH ABSENCE OF RIGHT VENTRICULAR INFARCTION AFTER FIRST ACUTE INFERIOR MYOCARDIAL INFARCTION

Asl Azin Alizadeh, Samadikhah Jahanbakhsh, Azarfarin Rasoul. Tabriz University Of Medical Sciences, Iran Background: in clinical setting of acute myocardial infarction (AMI), shortlasting and transient anginal pain, precedes the development of acute MI, is regarded as a symptom representing ischemic preconditioning. Some experimental and clinical data suggeste that preinfarction angina may favorably influence the course and extension of acute MI. We sought to examine the association between preinfarction angina and a lower risk of right ventricular infarction (RVMI) in patients whit first acute inferior myocardial infarction. Methods: One hundred seventy patients who admitted to cardiac care unit due to first acute inferior MI whit ST segment elevation and symptom duration<12 hours and received thrombolysis. Preinfarction angina within 24 hours prior to MI was present in 62 patients (Angina group) whereas the remaining 108 patients (Cohort group) had no chest pain preceding acute MI. The course of the in-hospital phase of MI (mean 5 days) was analyzed. The main studied outcomes were presence of RVMI together with inferior MI, major complications and in-hospital mortality. Result: In angina group 15 (24.2%) patients had RVMI, while in control group 70 (64.8%) patients suffered from RVMI.Thus angina 24 hours before infarction was most strongly associated with reduction in the rates of right ventricular infarction (adjusted odds ratio,0.32 percent confidence interval,0.09 to 0.86 P=0.01), absence of preinfarction angina was predict or the development of RVMI (P<0.001), complete atrioventricular block; (P<0.01), cardiogenic shock (P<0.001) and inhospital mortality (P=0.02). Conclusion: Patients with Preinfarction angina,occurring within 24 hours of acute MI, have a lower risk of right ventricular infarction and better in-hospital outcome than patient without antecedent angina. These result may be attributed to the protective effects of ischemic preconditioning. Keywords: Preinfarction Angina; Right ventricular Myocardial Infarction Outcome

S33-2 LONG TERM PROGNOSIS OF PULMONARY ARTERIAL HYPERTENSION WITH

Shingo Kyotani. Division Of Cardiology, National Cardiovascular Center, Japan Pulmonary arterial hypertension (PAH) is well known that is severely poor prognostic disease. Continuous intravenous prostacyclin has been shown to be effective on physical activity and life longevity in PAH. We tried to show our experience on survival of them with prostacyclin therapy and to compare with conventional one. We followed 108 patients with severe PAH not more than 10 years. They were all once administrated and introduced prostacyclin therapy. All patients were NYHA functional class III to IV at their administration. In the beginning we started prostacyclin at the dose of 0.5-2 ng/kg/min and then tried to raise their dosage every 3 to 7 days unless they cannot tolerate their side effects. For the severe patients they were treated with intravenous inotropin, usually dobutamine,

Abstract of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13–16 December, 2007 simultaneously until heart failure was stabilized. After discharging they used portable infusion pumps. During therapy 37 patients were died from severe right heart failure. Some patients had troubles related to implanted intravenous catheter system, but were not fatal. The Kaplan-Meier survival curves demonstrated that the 1, 3, 5 and 10 years survival rates for the prostacyclin therapy group were 95%, 73%, 63% and 51%, respectively, as compared with 77% (1 year) and 44%(3 years) in the conventional therapy group (p<0.01). Continuous intravenous prostacyclin therapy for the patients with PAH is surprisingly effective even if they were severe. It is a promising therapy for severe PAH.

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Results: Successful deployment of the stent graft in the intended position was achieved in all patients. Vascular access was achieved through the femoral artery (n=27), including one require iliac artery conduit, and antegrade method via sternotomy (n=4). Major perioperative morbidity occurred in 9 patients, including temporary paraplegia in 1, whom lumbar drain was inserted later-on, stroke in 2 and pneumonia in 9. One patient developed residual type B dissection and require re-intervention during hospitalization. There was no patient mortality occurred in simple stent graft treatment and cervical reconstruction groups. 3 mortalities occurred in extracoporeal circulation support group. The thoracic hybrid surgery and extracoporeal circulation group was associated with longer operation time, blood loss, ICU stay and postoperation hospital stay (P<0.05) Conclusion: Hybrid endovascular stent-graft repair is a technically feasible and effective treatment modality for thoracic aortic aneurysms and dissections.

S33-3 FLUVASTATIN IMPROVES ARTERIAL STIFFNESS IN PATIENTS WITH CORONARY ARTERY DISEASE AND HYPERLIPIDEMIA: A 5-YEAR FOLLOW-UP STUDY

Minoru Hongo 1 , Setsuo Kumazaki 2 , Hiroshi Tsutsui 2 , Eiichiro Mawatari 2 , Yoshikazu Yazaki 2 , Osamu Kinoshita 2 , Uichi Ikeda 2 . 1 Department of Cardiovascular Medicine, Shinshu University School of Health Sciences, 2 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan

S33-5 ATERONON: FIRST CLINICALLY PROVEN ANTI-ATHEROGENIC ANTIOXIDANT.

Ivan Petyaev, Pavel Dovgalevsky. Cambridge Theranostics, Cambridge, UK; Saratov Institute of Cardiology, Russian Federation

Background: Recent study suggests that fluvastatin has stronger effects on vascular walls than do other statins and is considered “vascular statin”. The present study was designed to test our hypothesis that fluvastatin might improve aortic stiffness in patients with coronary artery disease (CAD) and hyperlipidemia. Methods and Results: One hundred patients were randomly assigned to either 20-40 mg/day of fluvastatin (Group A, n=50) or nonstatin antihyperlipidemic drugs (200-400 mg/day of bezafibrate or 500-750 mg/day of probucol, Group B, n=50) and followed up for 5 years. There was no difference in the clinical findings between the 2 groups. In Group A, the brachial-ankle pulse wave velocity (PWV) and serum low-density lipoprotein cholesterol and CRP levels were significantly decreased after 3 months of fluvastatin. This improvement was further enhanced for next 9 months and the variables kept constant thereafter. In Group B, despite identical lowering of serum lipid levels, the PWV was significantly increased at 12 months after treatment and the increase lasted over the follow-up period. There was no change in the serum CRP levels. In Group A, the percent change in the PWV was significantly correlated with the percent change in the serum CRP levels (r=0.49, p<0.001), but not with the changes in the serum LDL levels (r=0.02, p=NS) at 5 years after treatment. Conclusions: Continuous, long-term treatment with fluvastatin may be beneficial to improve arterial stiffness in patients with CAD and hyperlipidemia.

The objectives of this study was to validate the biochemical and clinical effects of ATERONON, a new generation of highly bioavailable anti-atherogenic antioxidants. 6 mg of this product, once a day, were administered orally for 4 months to 17 patients with Coronary Heart Disease. This resulted in a complete inhibition of lipoprotein oxidising antibodies in the serum of 15 patients after the first 2 months, and for two other patients by the end of the trial. It was noticed that at the same time the levels of total cholesterol and triglycerides were reduced in patients’ serum from 242±8.7 to 166±7.7, p<0.001, and from 152±11.4 to 97.5 ±7.5, p<0.001, respectively. There were some trends in reduction of ApoB and LDL-cholesterol and also an increase of HDL-cholesterol concentrations, but they were insignificant. It was interesting to note that in 5 patients who had an elevated CRP level before the trial, 25.7±10.0, administration of Ateronon resulted in normalisation or reduction of this parameter, 8.8±3.0, p>0.05. There were no changes in the systolic or diastolic blood pressure of the patients. However, there was some improvement in the clinical condition of the patients, estimated by the Rose-Blackburn Questionnaire. This score was decreased in 10 of the patients from this group from 9.7 to 6.9. In order to evaluate how sustainable these biochemical and clinical improvements could be, we are planning to initiate a longer one year trial to test Ateronon.

S33-4

S33-6

HYBRID ENDOVASCULAR TREATMENT OF THORACIC AORTIC ANEURYSM AT TAIPEI VETERAN GENERAL HOSPITAL

THIAZOLIDINEDIONESAN EFFICACY TREATMENT STRATEGY FOR DIABETIC PATIENTS WITH ANGIOGRAPHY PROVED CORONARY ARTERY DISEASE

Chih-Pei Ou Yang, Chun-Che Shih. Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital; National Yang Ming University School of Medicine Purpose: To report our preliminary experience with endovascular stent graft repair of a variety of thoracic aortic pathology, and to evaluate and compare the feasibility, safety, and clinical outcomes of the treatment. Materials and Methods: During Nov. 2006 – June. 2007, endovascular stent graft repair was performed in 31 patients including 13 emergent repair under ruptured and unstable status: Chronic type B dissection (n=8), Descending thoracic aortic aneurysm (n=7), aortic arch aneurysm (n=6), residual type A dissection (n=6), Marfan syndrome (n=2), traumatic rupture (n=1) and residual type B dissection (n=1). The deployed stent graft system was Zenith® TX2™ thoracic endoprostheses under general anesthesia in all patients. Eight patients were treated without arterial bypass, 9 patients received cervical reconstruction (carotid-carotid or caortido-subcalvian bypass), 6 patients received hybrid thoracic surgery (aortocarotid bypass) and 7 patients required extracoporeal support and circulatory arrest. A post-deployment aortogram was obtained to confirm the exact location of the stent-graft, the absence of perigraft leakage, and the patency of adjacent branch vessels. Postoperative CT scan was performed within 1 week of the procedure.

Chi-Liang Chen, Chin-Chung Fang, Ching-Lung Yu, Shih-Pu Wang. Tainan Municipal Hospital, Taiwan Background: Recent studies have shown that thiazolidinediones (TZDs) could reduce in-stent restenosis and improve clinical outcomes in patients with type 2 diabetes after coronary stent implantation. But a potential safety issue related to rosiglitazone was reported with a significant increase in the risk of myocardial infarction and with an increase in the risk of death in a meta-analysis. The purpose of this study is to evaluate the TZDs efficacy at clinical and angiographic outcomes, and to analyze whether different thiazolidinedione outcomes after coronary intervention in diabetic patients. Methods: From January 2000 to April 2007, 1098 diabetic patients with coronary angiography proved coronary artery disease were enrolled and divided to two groups control and TZDs. The primary clincial outcome endpoint is any death and cardiac death. The 2nd end poinst is non fatal myocardial infarction. Five patients received CABG, 91 patients with chronic renal disease Cr more than 3.0, two patients with left ventricular ejection fraction less than 35%, and 8 patients loss follow up were excluded at angiographic follow up. 992 type 2 DM patients with coronary artery disease were included. Angiographic followed were obtained 498 patients with 1099 lesions. Digital caliper quantitative coronary an-