50 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0020 Cardiology
The La Salle Assessment of Return of Spontaneous Cir- culation in Adult Cardiac Arrest: A Case Control Study (The Lasarus Study)
Guntur DARMAWAN1, Danaida MARCELO2, David SALVADOR1
De La Salle University Medical Center, Philippines1, De La Salle Health Science Institute, Philippines2 Background: Out-of-hospital cardiac arrest (OHCA) is one of the major public health problems. To date, there is no scoring system available to predict the return of spon- taneous circulation (ROSC) in OHCA patients. We aimed to develop a simple, clinical scoring system to predict ROSC in OHCA patients.
Methods: A retrospective case control study was conducted by retrieving complete medical records of 370 consecutive adult, non-traumatic, OHCA patients in the emer- gency room at a tertiary, teaching hospital in the Philippines between January 2009 and December 2013. Age, gender, initial ECG rhythm, witnessed arrest, bystander cardiopulmonary resuscitation (CPR), interval between collapse and CPR initiation, presence of comorbidity were candidate variables. Variables with p-value < 0.2 in uni- variate analysis were included in logistic regression analysis. The regression coeffi cient was used as a value for the LASARUS scoring system. Receiver Operating Characteris- tic (ROC) curve was done to determine best cut-off score predicting ROSC. Based on the best cut-off score, we divided the cumulative score into 2 groups with different rate of ROSC.
Results: The initial ECG rhythm, witnessed arrest, bystander CPR, interval between collapse and CPR initiation were factors associated with ROSC (p-value were <0.001, 0.004, 0.13, <0.001, respectively). Logistic regression analysis assigned a value of 4 for initial ECG rhythm, 2 for bystander CPR, 2 for interval between collapse and CPR initiation, and 1 for witnessed arrest. ROC curve analysis showed 3 as the best cut-off score (accuracy 0.741, 95% CI: 0.689-0.792, p-value < 0.001). The cumulative score was divided into 2 groups (0-2 and =3) with the rate of ROSC in each group was 9.65%
and 47.26% respectively (p-value <0.001).
Conclusions: The LASARUS score is a simple clinical scoring system predicting ROSC.
PS 0022 Cardiology
Cardioprotective Effect of Fimasartan, A New Angio- tensin Receptor Blocker, In a Porcine Model of Acute Myocardial Infarction
Doo Sun SIM1, Myung Ho JEONG1, Ho Chun SONG2, Jahae KIM2, Hee Seung BOM2, In Seok JEONG3, Sang Gi OH3, Sang Hyung KIM3, Dae Sung PARK1, Jung Ha KIM1, Kyung Seob LIM1, Min Suk KIM1, Shi Hyun RYU1, Hyun Kuk KIM1, Sung Soo KIM1, Su Young JANG1, Jae Yeong CHO1, Hae Chang JEONG1, Ki Hong LEE1, Keun Ho PARK1, Nam Sik YOON1, Hyun Ju YOON1, Kye Hun KIM1, Young Joon HONG1, Hyung Wook PARK1, Ju Han KIM1, Youngkeun AHN1, Jeong Gwan CHO1, Jong Chun PARK1, Jung Chaee KANG1 Chonnam National University Hospital, Korea1, Chonnam National University Hospital, Korea2, Chonnam National University Hospital, Korea3
Background: The present study evaluated cardiop rotective effect of fi masartan, a new angiotensin receptor blocker (ARB), in a porcine model of acute myocardial in- farction (MI).
Methods: Fifty swine were randomized to group 1 (sham operation, n = 10), group 2 (no angiotensin-converting enzyme inhibitor (ACEI) or ARB, n = 10), group 3 (perindopril 2 mg daily, n = 10), group 4 (valsartan 40 mg daily, n = 10), or group 5 (fi masartan 30 mg daily, n = 10). Study medications were started orally after induction of acute MI by occlusion of the left anterior descending artery for 50 minutes and the dosage of medications was doubled at 2 weeks. Echocardiography, single photon emission computed tomography (SPECT) with technetium-99m sestamibi, and F-18 fl uorode- oxyglucose cardiac positron emission tomography (PET) were performed at baseline, 1 week, and 4 weeks to assess left ventricular (LV) function, infarct size, and viability.
Iodine-123 meta-iodobenzylguanidine (MIBG) scan was done at 6 weeks for visualiza- tion of cardiac sympathetic activity.
Results: No difference was observed in SPECT perfusion defect, matched and mis- matched segments between SPECT and PET across the groups at baseline, 1 week, and 4 weeks. MIBG scan showed similar uptake without difference in washout rate. On echocardiography, LV ejection fraction was lower in groups 2 to 5, compared to group 1 at 1 week but not different at 4 weeks. Pathologic analysis showed similar infarct size in groups 2 to 5.
Conclusions: Infarct size reduction was not observed with use of fi masartan as well as other ACEI and ARB in a porcine model of acute MI.
PS 0023 Cardiology
Biophysical Analysis of the Blood Flow in the Mitral Valve
Jun KIM1, Sheamin KHYEAM1, Yoon Ji JUNG1 CRG (Choice Research Group), USA1
Background: Blood exchange through capillaries is by diffusion which depends on the concentration of molecules between the interstitial fluid and blood. Assuming incompressibility of the blood in the arteriole and mitral valve, this paper applied the Poiseuille’s law to fi nd the relation between fl ow rate and viscosity. Study on the re- lationships between other factors such as diameter and viscosity of the arteriole and mitral valve, and blood fl ow were carried out.
Methods: Biomechanical stress and strain research using the static analysis was performed on a disk-type prosthetic mitral valve in heart. For the purpose of com- putational and mathematical modeling, laminar incompressible and two-dimensional steady fl ow of a homogeneous Newtonian fl uid were assumed.
Results: Due to increasing size of the opening of the valve, decrease in velocity was observed as the process goes from early diastolic period to end diastolic period. The fl ow was considered during the greater part of systole when the valve is fully open.
Stress and displacement distributions were computed at every grid point. Also two-di- mensional velocity profi les across anterior mitral valve were presented.
Conclusions: In this study, numerical method was attempted to analyze the mitral valve quantitatively by using fi nite element analysis, and high velocity fl ow through the mitral valve was observed due to pressure buildup during initial fi lling. A FE model of the mitral valve showed that the maximum stress occurs at the early diastolic peri- od.