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The incidence of undiagnosed cardiac sarcoidosis in explanted hearts following heart transplantation
S254
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
In contrast, neither ICAM-1 nor TF were increased in AMI patients versus control or SA patients (ICAM-1 = 84 ± 6 vs 101 ± 7 and 124 ± 7 ng/ml; TF = 350 ± 52 vs 234 ± 29 and 366 ± 46 pg/ml). Selective Egr-1-dependent molecules are increased acutely in humans in AMI. Egr-1 targeting may therefore provide some therapeutic benefit in AMI. doi:10.1016/j.hlc.2009.05.625 580 TAKOTSUBO CARDIOMYOPATHY: AN AUSTRALIAN SINGLE CENTRE EXPERIENCE WITH MEDIUM TERM FOLLOW-UP H. Samardhi, O.C. Raffel, T. Sirisena, D. Walters Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia Background: Takotsubo or Stress Cardiomyopathy (TC) is being increasingly recognized in patients presenting with clinical and biochemical features of acute coronary syndrome (ACS). We present a single centre experience of TC with a review of baseline features and medium term follow-up. Methods: Thirty-eight consecutive patients presenting to The Prince Charles Hospital with a diagnosis of TC from December 2006 to March 2009 were included. Results: Thirty-six (94.7%) patients were female with a mean age of 65 years. A stressful event preceded presentation in 22 (58%) patients of which 68% were emotional stressors. Chest pain was the commonest symptom (84%). One patient had an out of hospital cardiac arrest. ST segment elevation (50%) and Global T wave inversion (39%) were the most frequent ECG changes. 95% had a raised troponin. A diagnosis of TC was suspected in 5 patients with all others treated as an ACS. Thirty-five had typical angiographic apical ballooning and 3 had the mid segment variant. Thirty-four (89%) patients had an echocardiogram. Mean ejection fraction (EF) was 49% (20–70). Three had systolic anterior motion of the mitral valve with at least mild regurgitation. Mural thrombus was identified in two patients. In hospital complications occurred in 21% and included acute pulmonary edema (n = 6); cardiogenic shock (n = 3), stroke (n = 1) and atrial fibrillation (n = 3). Thirty-three (87%) had follow-up at a mean interval of 43 (1–115) weeks. There were no significant complications or recurrences at follow-up. Echocardiography (n = 15) demonstrated a significant improvement of EF (42.3% to 58.8%, p < 0.0001). Conclusions: The clinical demographics of our cohort are similar to those described in other regions. While TC is a reversible condition with low rates of complications and recurrence at follow-up it is, as demonstrated in our cohort, associated with significant in-hospital morbidity in a proportion of patients. doi:10.1016/j.hlc.2009.05.626
581 THE INCIDENCE OF UNDIAGNOSED CARDIAC SARCOIDOSIS IN EXPLANTED HEARTS FOLLOWING HEART TRANSPLANTATION D. Arumugam, M. Brown, A. Galbraith, G. Javorsky, D. Platts The Prince Charles Hospital Background: Sarcoidosis is a multi-system disorder of unknown aetiology resulting in non-caseating granulomas. The incidence in Australia has been estimated at 4–6 per 100,000 with cardiac involvement in 25% of cases. The aim of this study was to assess the incidence of sarcoidosis in our heart transplant population. Method: We performed a retrospective evaluation of all cardiac transplants done at our institution. Presence or absence of sarcoidosis pre-transplant or in the explanted heart was evaluated. The initial aetiology and diagnostic testing results were compiled. Results: 301 cardiac transplants have been performed at our institution since 1991. Six cases (2%) were found unexpectedly to have sarcoidosis in the explanted heart. Average age at cardiomyopathy diagnosis was 42.5 ± 9 years. 4 presented with heart failure, 2 with ventricular tachycardia. Pre-transplant diagnoses were idiopathic dilated cardiomyopathy (n = 5), ischaemic cardiomyopathy (n = 1). Pre-transplant investigations: MRI (n = 1) with no evidence of cardiac sarcoidosis, TTE (n = 6) with no evidence of cardiac involvement, ACE level (n = 1) normal. 5 patients were transplanted within 2 years of diagnosis of cardiomyopathy. One patient had pulmonary sarcoidosis (stage I-steroid treated) diagnosed post transplant. No cases have had recurrent sarcoidosis in the transplanted heart. 1 patient died two days post transplant (primary graft failure)—the remainder have survived to date. Conclusion: Cardiac sarcoidosis can present with heart failure or arrhythmias and can be difficult to diagnose. 2% of cardiac transplants had sarcoidosis diagnosed on explanted heart histology. There has been no recurrence in the transplanted hearts, with good long-term survival. doi:10.1016/j.hlc.2009.05.627 Paediatric Cardiology 582 INFLUENCE OF METABOLIC SYNDROME ON CARDIAC STRUCTURE AND FUNCTION AND ARTERIAL STIFFNESS IN HEALTHY CHILDREN Walter P. Abhayaratna 1,2, , Satoru Hayes 1 ,
Christine
1 Canberra
Brown 1 ,
Sakuragi 1 , Katrina
Richard D. Telford 2
Hospital, Canberra, Australia National University, Canberra, Australia
2 Australian
Background: The influence of the clustered effects of metabolic syndrome (MetS) on cardiovascular phenotype in young children has been incompletely evaluated. In
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
In contrast, neither ICAM-1 nor TF were increased in AMI patients versus control or SA patients (ICAM-1 = 84 ± 6 vs 101 ± 7 and 124 ± 7 ng/ml; TF = 350 ± 52 vs 234 ± 29 and 366 ± 46 pg/ml). Selective Egr-1-dependent molecules are increased acutely in humans in AMI. Egr-1 targeting may therefore provide some therapeutic benefit in AMI. doi:10.1016/j.hlc.2009.05.625 580 TAKOTSUBO CARDIOMYOPATHY: AN AUSTRALIAN SINGLE CENTRE EXPERIENCE WITH MEDIUM TERM FOLLOW-UP H. Samardhi, O.C. Raffel, T. Sirisena, D. Walters Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia Background: Takotsubo or Stress Cardiomyopathy (TC) is being increasingly recognized in patients presenting with clinical and biochemical features of acute coronary syndrome (ACS). We present a single centre experience of TC with a review of baseline features and medium term follow-up. Methods: Thirty-eight consecutive patients presenting to The Prince Charles Hospital with a diagnosis of TC from December 2006 to March 2009 were included. Results: Thirty-six (94.7%) patients were female with a mean age of 65 years. A stressful event preceded presentation in 22 (58%) patients of which 68% were emotional stressors. Chest pain was the commonest symptom (84%). One patient had an out of hospital cardiac arrest. ST segment elevation (50%) and Global T wave inversion (39%) were the most frequent ECG changes. 95% had a raised troponin. A diagnosis of TC was suspected in 5 patients with all others treated as an ACS. Thirty-five had typical angiographic apical ballooning and 3 had the mid segment variant. Thirty-four (89%) patients had an echocardiogram. Mean ejection fraction (EF) was 49% (20–70). Three had systolic anterior motion of the mitral valve with at least mild regurgitation. Mural thrombus was identified in two patients. In hospital complications occurred in 21% and included acute pulmonary edema (n = 6); cardiogenic shock (n = 3), stroke (n = 1) and atrial fibrillation (n = 3). Thirty-three (87%) had follow-up at a mean interval of 43 (1–115) weeks. There were no significant complications or recurrences at follow-up. Echocardiography (n = 15) demonstrated a significant improvement of EF (42.3% to 58.8%, p < 0.0001). Conclusions: The clinical demographics of our cohort are similar to those described in other regions. While TC is a reversible condition with low rates of complications and recurrence at follow-up it is, as demonstrated in our cohort, associated with significant in-hospital morbidity in a proportion of patients. doi:10.1016/j.hlc.2009.05.626
581 THE INCIDENCE OF UNDIAGNOSED CARDIAC SARCOIDOSIS IN EXPLANTED HEARTS FOLLOWING HEART TRANSPLANTATION D. Arumugam, M. Brown, A. Galbraith, G. Javorsky, D. Platts The Prince Charles Hospital Background: Sarcoidosis is a multi-system disorder of unknown aetiology resulting in non-caseating granulomas. The incidence in Australia has been estimated at 4–6 per 100,000 with cardiac involvement in 25% of cases. The aim of this study was to assess the incidence of sarcoidosis in our heart transplant population. Method: We performed a retrospective evaluation of all cardiac transplants done at our institution. Presence or absence of sarcoidosis pre-transplant or in the explanted heart was evaluated. The initial aetiology and diagnostic testing results were compiled. Results: 301 cardiac transplants have been performed at our institution since 1991. Six cases (2%) were found unexpectedly to have sarcoidosis in the explanted heart. Average age at cardiomyopathy diagnosis was 42.5 ± 9 years. 4 presented with heart failure, 2 with ventricular tachycardia. Pre-transplant diagnoses were idiopathic dilated cardiomyopathy (n = 5), ischaemic cardiomyopathy (n = 1). Pre-transplant investigations: MRI (n = 1) with no evidence of cardiac sarcoidosis, TTE (n = 6) with no evidence of cardiac involvement, ACE level (n = 1) normal. 5 patients were transplanted within 2 years of diagnosis of cardiomyopathy. One patient had pulmonary sarcoidosis (stage I-steroid treated) diagnosed post transplant. No cases have had recurrent sarcoidosis in the transplanted heart. 1 patient died two days post transplant (primary graft failure)—the remainder have survived to date. Conclusion: Cardiac sarcoidosis can present with heart failure or arrhythmias and can be difficult to diagnose. 2% of cardiac transplants had sarcoidosis diagnosed on explanted heart histology. There has been no recurrence in the transplanted hearts, with good long-term survival. doi:10.1016/j.hlc.2009.05.627 Paediatric Cardiology 582 INFLUENCE OF METABOLIC SYNDROME ON CARDIAC STRUCTURE AND FUNCTION AND ARTERIAL STIFFNESS IN HEALTHY CHILDREN Walter P. Abhayaratna 1,2, , Satoru Hayes 1 ,
Christine
1 Canberra
Brown 1 ,
Sakuragi 1 , Katrina
Richard D. Telford 2
Hospital, Canberra, Australia National University, Canberra, Australia
2 Australian
Background: The influence of the clustered effects of metabolic syndrome (MetS) on cardiovascular phenotype in young children has been incompletely evaluated. In