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.
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 295
Poster Session
Table 1. Observed cardiac abnormalities Abnormal fi ndings N = 107
ST segment elevation on ECG 15 (14%)
ST segment depression or T wave inversion on ECG 10 (9%) Cardiac enzyme elevation 30 (28%)
Acute LV systolic dysfuction 11 (10%) LV hypertrophy on echocardiography 48 (45%)
PS 1193 Cardiology
Mitral Valve Obstruction by Rapid Regrowth of Left Atrial Myxoid Fibrosarcoma after Surgical Resection
Ji Won Seo1, Sang-Hak Lee1
Department of Internal Medicine, Yonsei University College of Medicine, Korea1
Malignant primary cardiac tumor is rare and the most common form is sarcomas.
However, myxoid sarcoma in the heart is very rare and differential diagnosis from cardiac myxoma is often diffi cult. Here, we reported a case of rapid regrowth of left atrial tumor after surgical resection which was fi nally diagnosed as cardiac myxoid fibrosarcoma. An 82-year-old man, who underwent resection of cardiac tumor 3 months ago, visited due to severe dyspnea and peripheral edema. He was diagnosed as mitral valve obstruction due to regrowth of huge left atrial tumor by trans-thoracic echocardiogram and contrast chest computer tomography (Fig A, B). The patient had second resection and the resected tumor was pathologically compatible with myxoid fi brosarcoma which was absolutely diffenet diagnosis compared with previous histi- opathological results (Fig C, D). After the second operation, the patient had been had radiological therapy for heart tumor at out patient clinic for 6months. Some fi brosar- comas with abundant myxoid stroma have been called myxoid fi brosarcoma but are not considered malignant variants of cardiac myxoma. It is very hard to distinguish the myxoid fi brosarcoma from the benign myxoma by histiopathologically. Therefore, we always have to pay more attention and use multi-modality approach to diagnosis of intracardiac tumor.
PS 1194 Cardiology
Congenital Partial Absence of the Pericardium Compli- cating with Phrenic Nerve Damage during Pericardial Resection
Dae Sung Ahn1, Jae Hoon Chung1, Woong Choi1, Moonyoung Eom1, Gil Soo Lee1 Sejong General Hospital, Division of Cardiovascular Center, Korea1
Introduction: Congenital absence of the pericardium is rare cardiac defect with a wide spectrum of clinical presentation. We present a case of partial congenital ab- sence of the pericardium that diagnosed with cardiac CT angio and suggested left phrenic nerve injury during operation.
Case: A 58 year-old women with no past medical history was admitted to the cardi- ology department complaining of frequent resting angina. She had a history of chest trauma, a left rib fracture that occurred in a traffi c accident 2 years previously. Physi- cal examinations were normal. ECG Showed 49beats/minute sinus bradycardia, V1~V4 T wave inversion. Chest radiograph showed normal. Laboratory investigations revealed mild leukocytosis(10.41*109/L). Echocardiography showed abnormal wall motion of focal mid RV free wall associated with extracardiac compression.(Figure 1A,1B) Con- genital absence of the pericardium was confi rmed by chest CT angio.(Figure 2A, 2B) Coronary angiography was normal. We decided to perform partial pericardial resection.
(Figure 3) Postoperative chest X-ray fi ndings revealed elevated left diaphragm.(Figure 4A, 4B, 4C) We suggested left phrenic nerve injury during operation. But the patient had no associated symptom. Follow-up transthoracic echocardiography was done and the wall motion abnormalities and external compression which were observed in previous study were no longer seen. We decided outpatient department follow-up and the patient was discharged on the six postoperative days with symptom free state.
Discussion: The prevalence of congenital absence of the pericardium, including cases with other congenital cardiopulmonary anomalies, has been described as only 0.002–
0.044% of surgical/pathologic investigations. All types of congenital pericardial defect can lead to serious complications such as incarceration of cardiac tissue, myocardial ischemia, aortic dissection or valvular insuffi ciency. Phrenic nerve injury was observed from 0.5% to 1.7% undergoing closed cardiac procedures. In general, these injuries gradually resolve spontaneously over time.
