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.
The Korean Association of Internal Medicine
294 32nd World Congress of Internal Medicine (October 24-28, 2014)
PS 1190 Cardiology
The Association Between Epicardial Fat Thickness and Coronary Artery Calcifi cation According to Blood Pres- sure Status in Non-Hypertensive Individuals
Tae Hoon Lee1, Byung Jin Kim1, Jung Gyu Kang2, Bum Soo Kim1, Jin Ho Kang1 Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea1, Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea2
Background: Epicardial adipose tissue represents visceral adiposity, while the coronary artery calcium score has been suggested as a reasonable surrogate for coronary ather- osclerosis. Epicardial fat thickness (EFT) and blood pressure status can be attributed to coronary artery calcifi cation. The present study was performed to evaluate the associ- ation between EFT and coronary artery calcifi cation according to blood pressure status in non-hypertensive individuals.
Methods: The coronary artery calcium score (CACS) and echocardiographic EFT measurement were performed in a total of 1880 non-hypertensive individuals (1536 men; mean age, 44±8.3 years). Subjects were divided into quartiles according to EFT (=2.575, 2.576-3.167, 3.168-3.900, and >3.900 mm) and into two groups according to presence of CAC. Additionally, individuals were classifi ed as normotensives (n=1064) or pre-hypertensives (n=816).
Results: The prevalence of CAC(+) in pre-hypertensive individuals was 6.0%, 18.1%, 22.5%, and 29.9% in the lowest, second, third, and highest EFT quartiles, respectively (p<0.001), and 7.3%, 13.2%, 13.9%, and 13.9% in normotensive individuals (p=0.051).
On multivariate regression analysis, the second, third, and highest quartile EFT groups had higher odds ratios (ORs) for the presence of CAC compared with that of the low- est quartile (OR [95% confi dence interval (CI)], 3.904 [1.230, 12.385], 4.201 [1.274, 13.856], and 4.470 [1.409, 14.183], respectively), though only in pre-hypertensive indi- viduals. Moreover, an increased absolute EFT level was also associated with increased CACS in pre-hypertensive individuals (standardized β=0.109, p=0.023).
Conclusions: This study showed an independent relationship between epicardial fat thickness and coronary artery calcifi cation in non-hypertensive individuals, with varia- ble differences in this association according to blood pressure status.
PS 1191 Cardiology
The Infl uence of Repetitive Occurence of Atrial Fibril- lation to Left Atrial Function and Structure
HD KIM1, MN KIM1, SA KIM1, SM PARK1, SW PARK1, YH KIM1, WJ SHIM1 Korea University Anam Hospital, Korea1
Background: It has been well known that persistent atrial fibrillation(AF) causes mechanical and electrical remodeling of left atrium(LA). But the effect of paroxysmal atrial fibrillation(PAF) on the LA size and function is still controversy. The purpose of this study was to evaluate the changes of LA function and structure change by comparing two groups of PAF patients (who recurred PAF vs maintained sinus rhythm after radiofrequency catheter ablation(RFCA).
Methods: 48 consecutive(F/M=11/37, 58.5±10.5yrs) patients with PAF who undergone RFCA were enrolled. Baseline 2D-chocardioggraphy was performed before ablation and followed up at 1yr after ablation. The patients were categorized into 2 groups with and without a recurrence during 3 months to 1yr after ablation. LA size and function by volumetric and Doppler data were measured in each examination. All echocardio- graphic measurement was done during sinus rhythm.
Results: At baseline, there were no difference in LA volume and LAEF(LAVI: 28.6±7.59 vs 26.9±8.33, P-value=0.74, LAEF: 36.1±7.85 vs 40.2±8.1, P-value=0.78). But 1yr after ablation, LAEF was signifi cantly lower in the patients with recurrence(31.7±10.5 vs 49.5±7.2, P-value=0.035), LAVI was not significantly different between 2 groups(29.4±8.28 vs 25.9±8.24, P-value=0.106). The LA volume was increased from baseline to follow up in patients with recurred PAF, while it was decreased in patients with maintenance of sinus rhythm(ΔLAVI +2.76±12.4 vs -0.17±4.9 ml/m2, P-val- ue>0.001). Furthermore, LAEF was more impaired than baseline in the patients with recurrence. But in the patients without recurrence LAEF was improved at follow up- (ΔLAEF -4.35±11.0 vs +9.32±5.8, P-value<0.001)
Conclusions: LA volume increased and LA function deteriorated by the presence of PAF for 1yr after ablation, but not in groups who maintained sinus rhythm. These fi ndings suggest early management of PAF may be benefi cial before the irreversible LA structural and functional remodeling process ensues.
PS 1192 Cardiology
Characteristics of Cardiac Dysfuction Associated with Acute Brain Hemorrhage
Kyung Been Lee1, Mi rae Lee1 Samsung Changwon Hospital, Korea1
Background: Cardiac dysfunction associated with brain hemorrhage was not well studied. We evaluated the incidence and characteristics of acute cardiac dysfunction related with acute brain hemorrhage.
Methods: Between january and September in 2013, consecutive patient who were diagnosed with acute spontaneous or traumatic brain hemorrhage and admitted to surgical ICU were prospectively enrolled, ECG, cardiac enzyme, and echocardiography was considered as acute cardiac dysfunction related with brain hemorrhage when all the following criteria were satisfi ed.
(1) Accompanied ECG change and abnormal cardiac enzyme level (2) No previous history of cardiac disease
(3) Regional wall motion abnormality extending beyond a single coronary arterial dis- tribution
Otherwise, LV dysfunction was considered as cardiac dysfunction not related with brain hemorrhage. Clinical characteristics, laboratoy fi ndings, and in-hospital outcome were retrospectively reviewed.
Results: Total of 107 patients (age : 59 ± 16 years, 64 men) were collected, LV systolic dysfunction on echocardiography was observed in 18 patients. Among them 11 (10%) patients were classifi ed as having acute cardiac dysfunction related with brain hem- orrhage. while 5 patients in 11 patients with acute cardiac dysfunction showed typical apical balloning, 6 patients showed inverted takotsubo pattern. Other abnormalities were observed in ECG, cardiac enzyme level and echocardiography were shown in the table. In - hospital motality was observed in 19 (18%) patients. 6 patients in 11 patients with acute cardiac dysfuction had in-hospital motality (p= 0.004).
Conclusions: Acute cardiac dysfunction associated with acute brain hemorrhage was observed in 10% of patients and half of them showed inverted takotsubo pattern.
