The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 293
Poster Session
PS 1187 Cardiology
The Prognostic Value of CA-125 Levels in Patients with Acute Decompensated Heart Failure: Correlation with Clinical and Echocardiographic Parameters
Jung A Koh1, Seon Jae Kim1, Hak Chul Lee1, Seong Taek Chu1, Si Eun Kim1, Seung Min Choi1, Shin Bae Joo1, Jung Ju Sir1
National Medical Center, Cardiovascular Center, Korea1
Background: Serum carbohydrate antigen 125 (CA-125), known as a tumor marker, has been reported to be a prognostic indicator of acute decompensated heart failure (ADHF).
The aim of this study was to investigate the prognostic value of serum CA-125 levels on admission in patients with ADHF due to ischemic and non-ischemic etiologies.
Methods: We prospectively studied 110 patients admitted with ADHF from ischemic heart disease 51(46%), hypertensive cardiomyopathy 4(4%), dilated cardiomyopathy 16(15%), atrial fibrillation 24 (22%), valvular heart disease 8(7%), Cor pulmonale 3(3%), congenital heart disease 2 (2%), hypertrophic cardiomyopathy 1(1%), stress-in- duced cardiomyopathy 1 (1%). All patients underwent transthoracic echocardiographic study and measurement of serum CA-125 and NT-proBNP on admission.
Results: The median (interquartile range) levels of CA-125 on admission were signifi - cantly higher according to the severity of HF symptoms (13.0 (9.1-28.7) vs. 47.6 (15.1- 156.9) vs. 58.0 (22.52-192.5) U/ml for NYHA FC II/III/IV, respectively; p=0.001). There were statistically signifi cant correlations between CA-125 levels and NT-proBNP, free T4, T3, LV EF (calculated by biplane method), LVEDD, LAVI, DT, and RV systolic pressure (r = 0.514, 0.228, -0.391, -0.376, 0.254, -0.523, 0.420, 0.401, respectively, all with P <
0.05). Patients with cardiovascular deaths + re-hospitalizations had signifi cantly high- er serum CA-125 levels on admission than those without (53.2 (16.6-175.1) vs. 28.2 (11.2-91.0) U/ml, respectively, p<0.05). Analysis of receiver operating characteristic curves identifi ed CA-125 level for increased risk of adverse cardiac events (AUC=0.651;
p=.0.23; optimal cut-off value: 43.9 U/ml).
Conclusions: In this heterogeneous group of patients hospitalized with ADHF, CA-125 levels have prognostic value with respect to short-term mortality and re-hospitaliza- tion. This study indicated that CA-125 could serve as prognostic biomarker of heart failure, although the pathophysiology remains to be established.
PS 1188 Cardiology
A Case of Eosinophilic Myocarditis with Hypereosino- philia
Seong Jin Choi1, Hye Young Lee1, Min Kwan Kwon1, Jong Ho Lee1, Hyun Ho Oh1, Moon Park1, Soo Ya Bae1
Inje University Sanggye Paik Hospital, Korea1
In hypereosinophilic syndrome, severe clinical manifestation might be accompanied when invaded into the heart or the lung. Eosinophilic myocarditis is turned out to be a rare cause of heart failure and myocarditis. A case occurred in this hospital where hypereosinophilic syndrome was developed into myocarditis is to be reported.
An age-24 female was brought to the emergency department, appealing for the tightening pain on her chest. She had no special disease history, but has been taking medicine for the allergic rhinitis, prescribed at a local clinic. Chest pain has persisted constantly, accompanied by numbness on her left arm. On that time of his visit, blood pressure was 100/80mmHg, heart rate 130/min, body temperature 36.2℃, breathe rate 20/min. Cardiac murmur and lung crackle was not heard in her physical examina- tion. In laboratory data, Hemoglobin is 14.3g/dL, WBC 10,290/mm³, eosinophil 2,360/
mm³(22.7%), Platelet 269,000/mm³, CK 291U/L, CKMB 32.6ng/ml, Troponin-I 4.490ng/
ml. In chest x-ray, cardiomegaly and pulmonary edema was not found. In EKG, sinus tachycardia was found, but the change in ST segment was not found. Accoridng to echocardiography, diffuse LV wall thickening and global LV dysfunction and mild peri- cardial effusion was showed It matched to myocarditis. On the third day, methylpred- nisolone 60 mg was used as a result of esosinophic myocarditis. On the seventh day, chest pain was relieved, eosinophil was reduced to 70/mm³. In echocardiography, her heart was recovered to normal LV contractility and normal LV wall thickness. To rule out other causes for eosinophilia, Parasite antigen was done, and showed negative.
Steroid prescription was ceased due to the reduction of eosinophil to normal level. In a week eosinophil was increased to be 1052/mm³, and she began to take prednisolone by PO medication and gradually is decreasing the amount.
PS 1189 Cardiology
A Case of Stress Induced Cardiomyopathy Accompanied by Panhypopituitarism
Seoung Wan Nam1, Jun Won Lee1, Jung Soo Lim1, Sung Gyun Ahn1, Yong Jae Han1, Hyun Sung Pack1
Wonju Christian Hospital, Korea1
Stress induced cardiomyopathy, otherwise known as Takotsubo cardiomyopathy(TC), is a cardiac syndrome characterized by transient LV dysfunction in the absence of coronary artery disease. We report an unique TC case that accompanied panhypopi- tuitarism. A 52 year old male patient visited our emergency room due to dyspnea. The patient had been on hormone replacement therapy after undergoing transsphenoidal adenectomy for pituitary adenoma 18 months ago. Patient reported that he skipped hormone therapy for 7 days and it led him to have secondary adrenal insuffi ciency, thyroid hormone defi ciency, hyponatremia, and hyperkalemia. After admitting to ER, his dyspnea and hypoxic status rapidly worsened and his initial EKG showed sinus bradycardia that progressed to pulseless electrical activity. His spontaneous circulation returned after 2 minute cardiopulmonary resuscitation. Thereafter he was emergently treated with glucocorticoid hormone replacement and appropriate hormone replace- ment therapy was performed accordingly. Transthoracic echocardiography revealed typical pattern of stress induced cardiomyopathy and coronary angiography result was normal. We treated both his hormonal defi ciency status and heart failure. Conse- quentially, his clinical status improved and follow up echocardiography showed normal heart function in two months. We report the unique case of stress induced cardio- myopathy caused by acute adrenal crisis owing to secondary adrenal insuffi ciency in patient with panhypopituitarism.
