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￭♣ S-191 ￭
Impact of Endothelial Dysfunction on Prognosis of Coronary Artery Spasm
1Department of Internal Medicine, Division of Cardiology, Wonkwang University Sanbon Hospital, 2Department of Internal Medicine, Division of Cardiology, Korea University Guro Hospital, 3Future Convergence Research Division, Korea Institute of Science and Technology
*Kim Hyun Kiv1, Eun Mi Lee, MD, PhD1, Kyeong Ho Yun, MD, PhD1, Hong Seog Seo, MD, PhD2,3
Aim: The impact of endothelial dysfunction on long-term clinical outcomes in patients with coronary artery spasm (CAS) induced by the acetylcholine provocation test (ACH-test) remains unclear. Methods: A total of 202 patients performed ACH-test, and brachial flow- mediated dilation (FMD), as an index of endothelial function, and brachial nitroglycerine induced dilation (NMD), as an index of vascular smooth muscle contractility using high reso- lution ultrasound. CAS was defined as ＞70% luminal narrowing during ACH-test and endothelial dysfunction (ED) was defined as less than ＜6% by brachial FMD. We evaluated chest pain recurrence requiring follow-up angiography and major adverse cardiovascular events (MACEs) during 5 years.
Results: In a total 202 subjects, 109 patients showed positive result to ACH-test. Among them, 46 patients showed positive result to FMD (ED group) and 63 patients showed negative result (Non-ED group). Between two group, baseline and angiographic characteristics were not different. FMD was moderately positive correlated with NMD (r＝0.498, p＜0.001). CP recurred in 6.4% and was not different between two groups (ED vs Non-ED, 6.5%
vs 6.3%, p＝1.000) and and MACE were occurred only one patient (1.6%) in Non-ED group. Conclusions: These results suggest that long-term out- comes are relatively good and they are not independent of endothelial dysfuntion in CAS.
￭♣ S-192 ￭
Prevalence and predictors of mortality with Stress induced Cardiomyopathy in critically ill patients
Division of Pulmonology, Department of Internal medicine, Institute of Chest disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea1
*MyungJin Song1, Jisoo Choi1, Bora Yoon1, Ah Young Leem1, Joo Han Song1, Song Yee Kim1, Eun Young Kim1, Ji Ye Jung1, Young Sam Kim1, Se Kyu Kim1, Joon Chang1, Moo Suk Park1
Purpose: The aims of this study were to assess frequency of stress induced cardiomyopathy (SCMP) and predictors for incidence of SCMP in patients who admitted to medical ICU. We also explored the predictors of in-hospital mortality in patients with SCMP. Method: It is a retrospective cohort study. A total of 338 patients admitted to medical ICU and underwent transthoracic echocardiography (TTE) between January 2015 and December 2015 were enrolled. Definition of SCMP was defines as follows: 1) transient hypokinesis, akinesis of the left ventricular mid segments with or without apical involvement or the regional wall motion abnormalities extend beyond a single epicardial vascular distribution; 2) absence of obstructive coronary dis- ease; 3) new EKG abnormalities or modest elevation in cardiac troponin; 4) absence of pheochromocytoma, myocarditis. Logistic regression model was used to analysis predictors for incidence of SCMP and predictors of in-hospital mortality in SCMP respectively. Cox regression model was used to anal- ysis the influence of SCMP to mortality. Results: Of the 338 patients, SCMP was observed in 42 patients (12.4%). Compared to 296 patients without SCMP, patients with SCMP had lower frequency of DM (19% vs 29.2%, p＝0.01), COPD (4.8% vs 16.9%, p＝0.04) and higher prevalence of using mechanical ventilator (MV, 90.5% vs 71.9%, p＝0.03), and lower ejection fraction (EF, 38.0±15.6 vs 61.7±11.8, p＜0.001). In multivariate analysis, lower BMI (odd ratio, 0.88; 95% CI, 0.78 to 0.99; p＝0.04) and lower EF (odd ratio, 0.90; 95% CI, 0.87 to 0.92; p＜0.01) were associated with devel- opment of SCMP. In a Cox regression model adjusted with several confounders (age, DM, malignancy, liver cirrhosis, shock, acute kidney injury, use of MV) SCMP showed trend to increase of 60-day mortality (p＝0.052). Among 42 patients with SCMP, acute kidney injury(AKI) was the only risk factor for predicting in-hospital mortality (odd ratio, 8.19; 95% CI, 1.35 to 47.75; p＝0.02). Conclusions: Our study showed that prevalence of SCMP was 12.4% and trend to increase of 60-day mortality of critically ill patients. In patients with SCMP, AKI was the only risk factor for predicting in-hospital mortality.
