135
￭ S-191 ￭
Left Ventricular Thrombus and Subsequent Thromboembolism, Comparison of Treatment Modalities
1Seoul National University Hospital, Seoul; 2Seoul National University Bundang Hospital, Seongnam, Korea
*
Joo Myung Lee
1, Jin Joo Park
1, Hee Won Jung
1, Young-Seok Cho
2, Il-Young Oh
2, Chang-Hwan Yoon
2, Jung-Won Suh
2, Eun Ju Chun
2, Sang Il Choi
2, Tae-Jin Youn
2, Cheong Lim
2, Goo-Yeong Cho
2,
In-Ho Chae
2, Kay-Hyun Park
2, Dong-Ju Choi
2Background: Left ventricular thrombus is one of the risk factors for systemic thromboembolism. The aims of this study were to compare the long-term clinical outcomes of LV thrombus of current therapeutics, anticoagulation, operative treatment, antiplatelet agents and to identify in- dependent predictors of systemic thromboembolism. Methods and Results: We screened 86,374 patients for intracardiac thrombus in electronic medical records and imaging databases. Records of 62 patients with LV thrombus, diagnosed between May 2003 to November 2011, were com- prehensively reviewed regarding baseline characteristics, thrombus outcomes, thromboembolic events and treatment complications by treatment group. The majority (80.6%) had ischemic etiology. Systemic thromboembolism developed in 18 patients; 8 (45%) were post-treatment throm- boembolisms while 10 events occurred before treatment began. No post-treatment thromboembolism occurred in the operative treatment group;
in contrast, 7 post-treatment thromboembolisms occurred in anticoagulation group (17%) (p=0.175). Independent predictors of post-treatment thromboembolism were dilated cardiomyopathy (HR 61.30, p=0.001), previous cerebrovascular events (HR 7.06, p=0.042), female gender (HR 7.11, p=0.031), and echocardiographic left ventricular end-diastolic diameter (HR 1.15, p=0.047). Conclusions: The rate of post-treatment throm- boembolism was not significantly different among the treatment groups. However, operative treatment tended towards less post-treatment throm- boembolism than other treatment groups.
￭ S-192 ￭
Normal NT pro-BNP in Patients with Systolic LV dysfunction after Acute Myocardial Infarction
1Chonnam National University Hospital; 2Kyungpook National University Hospital; 3Yeungnam University Hospital, Deagu; 4Chonbuk National University Hospital, Jeonju; 5Chungbuk National University Hospital, Chungju;
6Kyunghee University Hospital, Seoul, Korea
*
Shi Hyun Rhew
1, Youngkeun Ahn
1, Myung Ho Jeong
1, ShungChull Chae
2, Young Jo Kim
3, JeiKeon Chae
4, Myeong Chan Cho
5, Chong Jin Kim
6Background: Measurement of N-terminal probrain natriuretic peptide (NT-proBNP) improved diagnostic accuracy of myocardial infarction (MI) as well as heart failure, but some patients having left ventricular (LV) systolic dysfunction after MI shows normal NT-proBNP level. The present study was aimed to compare clinical characteristics and one-year outcomes of patients having LV systolic dysfunction after acute MI with normal and elevated NT-proBNP level. Methods: From November 2005 to December 2007, a total of 1,242 acute MI patients with LV systolic dysfunction (ejection fraction < 40%) who were enrolled in Korea Acute MI Registry (KAMIR) were retrospectively grouped into elevated NT-proBNP group (> 300 pg/mL, n=1,006) and normal NT-proBNP group (< 300 pg/mL, n=236). We evaluated clinical characteristics and one-year major adverse cardiac events (MACEs) including cardiac death, non-cardiac death, MI, target lesion revascularization (TLR), and coronary artery bypass graft (CABG). Results: Patients in normal group were younger, obese and males. Their symptom to door time were shorter with presenting chest pain rather than dyspnea. Angiographically, normal group had more total occlusive lesion with one vessel disease and A/B1 lesion according to ACC/AHA classification. The levels of cardiac enzymes, which reflect infarct size were higher in normal group.
However, cumulative 12-month cardiac death was lower in normal group without fatal arrhythmia, which could identify low risk patients from sudden cardiac death. Conclusions: This study suggest that the clinical characteristics and one-year outcomes of patients having LV systolic dysfunction after acute MI with normal NT-proBNP level were favorable than the patients with elevated NT-proBNP level.
Table 7. Adjusted Cumulative Clinical Outcomes at 12months (Cox Regression Analysis after Propensity Score Matching)
Unadjusted OR (95% Cl) p value Adjusted OR (95% Cl) p value
Outcome at 12 month
Cardiac death 3.28 (1.31-8.23) 0.011 54.12 (3.98-735.79) 0.003
OR, odds ratio; CI, confidence interval.
