The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 289
Poster Session
PS 1174 Cardiology
A Case of Acute Hepatitis a Which Needs Extra-Cor- poreal Membrane Oxygenation Due to Concomitant Acute Myocarditis
Jah Yeon Choi1, Eun Jin Park1, Ji Young Song1, Sung Hun Park1, Hee Dong Kim1, Dong Oh Kang1, Jae Joong Lee1, Kwang No Lee1, Ji Bak Kim1, Sun Ki Lee1, Jin Oh Na1 Korea University Guro Hospital, Korea1
Hepatitis A infection with cardiac involvement, especially that needs Extra-Corporeal Membrane Oxygenation (ECMO), had been rarely reported. Here, we report a case of severe acute myocarditis that might be due to acute viral hepatitis A infection. A 35- year old women suffered from dyspnea, nausea, vomiting. Initial Electrocardiogram (ECG) showed sinus tachycardia, but soon it became wide QRS tachycardia and RBBB pattern and hypotension was shown. Liver transaminase and cardiac enzyme was el- evated and serologic studies for viral infection showed positive in IgM anti–HAV anti- bodies with negative in anti-HAV IgG. Echocardiography revealed a decreased ejection fraction of 18% with global hypokinesia of left ventricle. Despite of fl uid loading and inotropics application, hypotension was not corrected and Extra-Corporeal Membrane Oxygenation (ECMO) started. After conservative management for several days, ECMO was removed the patient recovered without any serious sequelae.
PS 1175 Cardiology
Long Term Prognostic Value of HbA1C in Acute Myo- cardial Infarction Patients without Known Diabetes
Il Hyung Jung1, Sang Cheol Cho1 Gwangju Veterans Hospital, Korea1
Background: The prognostic role of glycosylated hemoglobin (HbA1C) in non-diabetic (non-DM) patients with acute myocardial infarction (AMI) is still controversial. We evaluated the prognostic role of HbA1C in AMI patients without previously known diabetes.
Methods: From January 2008 to August 2011, 3,292 in AMI patients with non-DM, who underwent laboratory testing of HbA1C were enrolled retrospectively. Patients were divided into two groups by HbA1C [Group 1 = 6.5%, n=2,864 (87%); Group 2
> 6.5%, n=428 (13%)]. The primary end point was composite major adverse cardiac events (MACEs) including all cause death, cardiac death, re-MI, and revascularization of target or non-target vessel during 12 months follow up.
Results: Patients of in-hospital all cause death and cardiac death were 202 [169 (6.0%) vs. 33 (6.8%), p>0.05) and 145 [124 (4.4%) vs. 21 (4.3%), p>0.05], respectively. BMI (24.0±3.1 vs. 24.9±3.6), blood glucose (145±55 vs. 207±90 mg/dL), total cholesterol (184±44 vs. 196±47 mg/dL), triglyceride (121±88 vs. 157±118 mg/dL), LDL (118±39 vs. 127±41 mg/dL) and hs-CRP (5.35±20.3 vs. 8.76±34.9 mg/dL) were higher and HDL (44.4±14.7 vs. 42.2±11.7 mg/dL) was lower in group 2 (p of all variables < 0.01). The incidence of hyperlipidemia (9.2% vs. 12.4%, p=0.036), obesity (BMI = 30, 3.3% vs.
8.2%, p<0.01), current smoker (44.7% vs. 50.2%, p=0.032), and left ventricular (LV) dysfunction (ejection fraction<40%, 11.3% vs. 15.4%, p=0.021) were more frequent in group 2. There were no signifi cant difference in clinical outcomes at 12 months. In subgroup analysis (group 1 was divided by 5.5% of HbA1C), there were no signifi cant difference in short and long term clinical outcomes.
Conclusions: Korean AMI patients with non-DM and HbA1C > 6.5% were not associ- ated with worse outcomes during 12 months follow up.
PS 1176 Cardiology
Long-Term Prognostic Value of Coronary Computed Tomography Angiography and Exercise ECG in Rela- tion to Symptomatic Status in Patients with Suspected Coronary Artery Disease
Sang-Eun Lee1, Hyuk-Jae Chang1, Ji-Hyun Yoon1, In-Jeong Cho1, Chi Young Shim1, Geu-Ru Hong1, Young Jin Kim2, Byoung Wook Choi2, Namsik Chung1
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Korea1, Department of Radiology, Yonsei University College of Medicine, Korea2
Background: To explore the prognostic performance of coronary computed tomog- raphy angiography (CCTA) and exercise electrocardiography (XECG) in patients with suspected coronary artery disease (CAD) in relation to symptomatic status.
Methods: We retrospectively enrolled 3,456 (58±9 years, 52% male) patients with atypical chest pain (n=2,269) or asymptomatic patients (n=1,188) who had undergone concurrent CCTA and XECG from 2003 through 2009. Patients were followed-up for major adverse cardiac events (MACE): cardiac death, acute coronary syndrome, and revascularization after 90 days from index CCTA.
Results: During a mean follow-up of 3.3±1.4 years, 67 MACEs were observed. Ac- cording to the Diamond-Forrester criteria, all asymptomatic patients had very low-to- low pre-test probability of CAD while 77.9% of patients with atypical chest pain had intermediate probability. After risk adjustment, XECG independently predicted MACE in patients with atypical chest pain (HR: 3.3, 95% CI: 1.8 to 6.0; p<0.001), but not in asymptomatic patients (p=0.827). However, severe CAD (≥70% stenosis) and mul- ti-vessel CAD detected by CCTA independently predicted MACE in both asymptomatic patients (HR: 4.7, 95% CI: 1.4 to 15.8 and HR: 7.5, 95% CI: 2.3 to 24.4, all p < 0.05, respectively) and patients with atypical chest pain. (HR: 11.0, 95% CI: 6.1 to 20.0 and HR: 8.2, 95% CI: 4.3 to 15.5, all p<0.05, respectively). Stratifying patients by XECG and CTA fi ndings, XECG provided additional risk stratifi cation only in patients with atypical chest pain and signifi cant CAD on CCTA (n=346, 10.0% of the total patients).
Conclusions: In contrast to CCTA, XECG does not have incremental prognostic value in subjects without symptom and majority of patients with atypical chest pain. Direct assessment of coronary anatomy using CCTA might be considered in those populations.
PS 1177 Cardiology
Detection of Myocardial Infarction Caused by Multiple Coronary Artery Fistulas Using Multidetector Computed Tomography: A Case Report
Kyung Jin Kim1, Yong-Seob Kwon1, Juhyun Park1, June Hyoung Kim1 Busan St. Mary`s Medical Center, Korea1
Background: A coronary artery fi stula (CAF) is a rare vascular malformation of the coronary artery. However, CAF may cause coronary steal phenomenon and this can result in myocardial infarction (MI). Few cases of MI triggered by a CAF have been identifi ed in a patient by Multidetector Computed Tomography (MDCT).
Case: A 57-year-old male visited our hospital with chest pain lasting 2 hours, which had occurred immediately after playing badminton. Electrocardiography showed no ST change. Laboratory test revealed elevated cardiac biomarkers. Coronary angiography (CAG): There was no fi nding of coronary artery occlusion, but tortuous arteries esti- mated to be fi stulas were observed in the proximal right coronary artery (RCA) (Fig.
1A) and the proximal left anterior descending artery (LAD) (Fig. 1B). Reconstruction image of MDCT: Abnormal fi stular formation from the proximal RCA portion of the pulmonary trunk to the left upper pulmonary vein and from the proximal LAD to the left atrial appendage was observed (Fig 1C).
MDCT: Ischemic change was observed in the basal anterior segment of LV myocardi- um in the delayed enhancement phase (Fig. 1D). Dobutamine stress echocardiography (DSE): Hypokinesia of the midanterior and midseptal segments of LV was induced.
Treatment and progression: After treatment with antiplatelet angent, angiotensin converting enzyme inhibitor and beta blocker, the patient’s symptoms and cardiac bio- markes were normalized.
Conclusions: Although the CAG did not revealed any coronary occlusion, the MDCT verifi ed the myocardial infarction had occurred in the LAD territory, and the DSE also showed induced hypokinesia in the same territory. In case of MI accompanied by CAFs, MDCT may help indentifying culprit vessel and making decision of further treatment plan.
