264
2020년 제 71차 대한내과학회 추계학술대회
￭S-221 ￭ Transient ECG Changes in Patients With Biliary Disease
인하대병원 내과1, 인하대병원 심장내과2
윤인식1, 최성환2, 박상돈2, 권성우2, 신성희2, 우성일2, 김대혁2, 권준2, 백용수2
Background/Aims: The importance of ischemic electrocardiography (ECG) changes including ST- segment elevation, ST-segment depression or T wave inversion that indicate myocardial ischemia are well established and require appropriate investigation and treatment. However, there are limited data on serial ECG changes associated in patients with biliary disease despite no definite cardiac symptom. The aim of our study was to investigate dynamic ECG changes mimicking acute coronary syndrome in biliary disease, especially according to curability.
Methods: We enrolled 295 consecutive biliary patients with ischemic ECG changes (≥19 years, mean age 70 ± 13 years, 48.5% female) in a tertiary hospital from 2014 to April 2020. Biliary diseases were divided into two groups on curability: group 1 (297 patients with curable biliary disease including cholecystitis, cholangitis, pancreatitis, common bile duct (CBD) stone and gallbladder (GB) stone) and group 2 (64 patients with non-curable biliary disease including CBD cancer, GB cancer, pancreas cancer and Klatskin tumor). Clinical relevant variables including transthoracic echocardiography, coronary angiography (CAG) and blood cardiac enzymes were assessed and compared between the groups.
Results: There were no significant differences in age (p=0.737), female (p=0.052), LVEF (61.3 % vs. 60.4 %, p=0.480) and the proportions of comorbidities including hypertension (p=0.557), and stroke (p=0.833) between two groups. The group 1 with curability had higher proportions of mimicking ischemic ECG, but did not reach statistical significance (22.9% vs. 18.8%, p=0.470) than the group 2 without curability. Spontaneous EKG recovery after procedure or operation was significantly frequent in group 1 compared with group 2 (61.8% vs 16.7%, p=0.003). In the multivariate analysis, after adjusting relevant risk factors, curable biliary disease (hazards ratio [HR] 0.37, 95% CI 0.08-1.61, p=0.021) were associated with EKG recovery.
Conclusions: Physicians should be kept in mind meticulous ischemic ECG, however, given complete treatment in patients with the curable biliary disease who had no definite cardiac symptom, transient T wave abnormality might be associated spontaneous recovery to normal.
