WCIM 2014 SEOUL KOREA 63
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0064 Cardiology
Epidemiology and Clinical Aspects of Infectious Endo- carditis in a Tertiary Hospital
Yasser HESSEIN ABDOU1, NANCY GIOVANNA URIBE HEREDIA2 Valdepenas Hospital, Spain1, Ciudad Real Hospital, Spain2
Introduction and objectives: Infective endocarditis (IE) is a microbial infection of in- tracardiac structures, their importance derives from its high risk of mortality. The aim of this study is to describe the epidemiological and clinical characteristics of infective endocarditis in a population sample.
Methods: A descriptive study of all patients over 18 years who met the modifi ed Duke criteria for the diagnosis of IE between 2006-2010 in our hospital. Were included.
Results: Of the 27 cases, 77.8% (21 cases) have defi nitive IE and 22.2%(6 cases) have possible EI, mean age 62.5+15 years, with a minimum of 18 years and a maximum of 81 years. 44.4% (12 cases) were older than 70 years and 55.6% under 70 years (15 cases). 66.7% were male (18 cases) and 33.3% (9 cases) are women. Preexisting heart disease was rheumatic type (30%), degenerative (30%),congenital heart disease (11%) and previous EI(4%). 67% of the affected valves were native and 33% were prosthet- ic valve (22% mechanical and 11% organic). The affected valve was the mitral, aortic, or both in 30%, 41% and 10% respectively. The high degree of valvular regurgitation was mild, moderate and severe in 15%, 19% and 33%, respectively, in 33% there was no echocardiographic evidence of valvular insuffi ciency. In 88.9% of cases, serum cul- tures were positive and in 11.1% were negative. In the group of elderly (over 70 years) the most frequent germ were the coagulase-negative group with 6 cases (50%) and the under 70 group predominated catalase negative bacteria(60%), this difference was statistically signifi cant (p <0.05).
Conclusions: Having had a past history of EI, the presence of an embolic event during the course of the infection and having a metal valve prosthesis are associated with increased mortality. The overall mortality rate was 14.8%
PS 0065 Cardiology
Delay in Diagnosis and Mortality Due to Stemi – Expe- rience from a Community Hospital
Srinivasa Raghavan MADHAVAN1, Thomas HALDIS1, Susan FARKAS1 University of North Dakota, USA1
Background: Best practices suggest that an electrocardiogram (ECG) should be ob- tained within 10 minutes of presentation in patients with suspected acute coronary syndrome. Among them, patients with ST-Elevation Myocardial Infarction (STEMI) are at risk for higher short term mortality, as any delay in reperfusion is detrimental to survival. We sought to ascertain if a delay in diagnosis contributed to mortality among patients with STEMI.
Methods: Data for this study were obtained from a prospective STEMI database regis- try from a tertiary care community-based teaching hospital. Consecutive patients with STEMI, admitted between January 2010 and June 2013 were included in the study. All statistical tests were two tailed with p<0.05 considered to be signifi cant. Chi square test and t test of the means were performed.
Results: A total of 752 patients with STEMI were included in this study; 180 (23.9%) were women. ECG was obtained within 10 minutes of presentation in 520 (71%) pa- tients. There were 18 in hospital deaths, 10 (4.3%) in the delayed ECG group compared to 8 (1.5%) among early ECG group (p=0.035). More women had delay in ECG (32% vs 20% p=0.0002). There was no statistical difference in mean age or the number of pa- tients undergoing thrombolysis (14 vs 17%) between the two groups. The mean time to ECG was 3.8(±2.9) vs 21.9(±14.7) minutes (P<0.0001). Time to balloon from ECG diagnosis was similar among both the groups and did not reach statistical signifi cance (114.6±93 vs 121.2±81 minutes p=0.3535).
Conclusions: The results from our large prospective study showed an increased mor- tality among patients who had a delay in obtaining an initial ECG. The delay in obtain- ing an initial EKG appeared to impede the diagnosis of STEMI, which may have led to higher mortality despite similar duration from diagnosis-to-PCI.
PS 0066 Cardiology
Short Term Follow-Up of Acute Myocardial Infarction in Rural South Indian Population: Incidence of Sudden Death and Predictors of Mortality
Srinivasa Raghavan MADHAVAN1, Harikrishna TANDRI2 University of North Dakota, USA1, Johns Hopkins Hospital, USA2
Background: The mortality due to Coronary Artery Disease (CAD) in India is estimated to more than double from 13 million in the year 2000 to 30 million in 2015. Sudden cardiac death (SCD), defi ned as sudden unexpected death occurring within 1 hour of onset of symptoms, is a common initial manifestation of CAD. The primary objective of this study was to elicit the factors predicting mortality following Myocardial Infarc- tion (MI), the secondary objective was to look at the incidence and factors predicting SCD.
Methods: Patients with newly diagnosed MI, admitted to a tertiary care hospital in southern India, with no previous MI or cancer were eligible to participate. A case worker was assigned to each patient who contacted the patient every 3 months. Mul- tivariate COX proportional hazard regression model was used to predict survival.
Results: A total of 1027 participants were enrolled and followed for a mean 10.7(±7.45) months. Mean Age was 56(±12) years. During this period of time, 62 par- ticipants died and among those 26 deaths were adjudicated as SCD. While adjusting for other risk factors, age greater than 50 years, medication noncompliance and left ventricular ejection fraction (LVEF) < 30%, were signifi cant predictors of mortality (HR 3.48 (p 0.004), 14.32 (p <0.0001) and 2.58 (p 0.05) respectively).
Conclusions: The overall one year mortality post MI in this rural south Indian popu- lation was around 6%, SCD accounted for more than half of the deaths. Medication noncompliance, age greater than 50 years and LVEF<30% were found to be good predictors of overall mortality. Follow up strategies, aimed at increasing compliance of patients in using medications post MI, would improve the mortality post MI.
PS 0067 Cardiology
Cardioprotective Effects of Ecklonia Cava Polyphenol Against Doxorubicin-Induced Cardiotoxicity in an An- imal Rat Model with the Evidence of Electron Micro- scopic Finding
Hui Kyung JEON1, Hyo-Suk AHN1, Ki Tae KIM1, Ho-Joong YOUN2
The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Korea1, The Catholic University of Ko- rea, Seoul St. Mary’s Hospital, Korea2
Background: Long-term therapy with doxorubicin is associated with a high incidence of a cumulative and irreversible dilated cardiomyopathy, despite of its broad anti-ne- oplastic effectiveness. The goal of this study was to evaluate the cardioprotective effects and safety of seapolyphenol (polyphenol purifi ed from Ecklonia cava) against doxorubicin-induced cardiotoxicity in an animal rat model.
Methods and Results: In total 21 rats including doxorubicin and control groups, base- line and 6 weeks follow up echocardiography were practiced. Left ventricular ejection fraction signifi cantly decreased and the left ventricular end diastolic/systolic dimen- sion and LV mass index signifi cantly increased in single doxorubicin group compared to seapolynol plus doxorubicin group. Also, electron microscopic fi nding showed less impaired myofi ber and mitochondria in seapolynol plus doxorubicin group than in sin- gle doxorubicin group.
Conclusions: Our data showed that seapolynol had cardioprotective effects against doxorubicin-induced cardiotoxicity in an animal rat model with the evidence of elec- tron microscopic fi nding in addition to echocardiographic results.
