Slide Session : OS-CAD-04 ; Cardiology : Effi cacy of Heart Type Fatty Acids Binding Protein Qualitative Evaluation in Early Diagnosis of Acute My-ocardial Infarction: One More Evidence

( Valentin Alexandrovich Kokorin ),( Anatoly Ivanovich Martynov ),( Andrey Alexandrovich Spassky ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: early diagnosis improves prognosis in acute coronary syndrome (ACS). Currently applied myocardial necrosis markers are not effective enough in early stages of ACS. Multicenter investiGation of clinlcal efficacy of eArly diagNosis of myocardial infarcTion with cardiac protein, binding fatty acids (GIANT) showed that express-test for qualitative evaluation of heart type fatty acid binding protein (hFABP) is more effective than troponin in patients admitted with suspected ACS. Pre-hospital efficacy of such tests remains unclear. Purpose: to evaluate efficacy of qualitative measurement of hFABP for differential diagnosis of ACS in ambulance service practice. Methods: 759 patients (387 men and 372 women, mean age 68, 3±0,5 y.o.) with suspected ACS and occurrence of chest pain 1-12 hours were enrolled in the study by 88 ambulance crews of Moscow station of emergency and first medical aid named after A.S. Puchkov. HFABP concentration was evaluated with qualitative immunochromatographic test <CardioFABP> (Biotest, Russia) before admission. 642 patients (84,6%) had acute myocardial infarction, 117 (15,4%) - other reasons of chest pain.Results: overall sensitivity of CardioFABP test was 88%, specificity - 92%, accuracy - 87%, positive predictive value - 99%, negative predictive value - 57%. In patients with ST-segment elevation (n=503) sensitivity of the test was 89%, specifi city - 65%, accuracy - 89%, positive predictive value - 99%, negative predictive value - 18%. In patients without ST-segment elevation (n=237) sensitivity of hFABP test was 86%, specificity - 82%, accuracy - 84%, positive predictive value - 88%, negative predictive value - 80%. Characteristics of the test did not differ significantly in intervals 1-6 and 6-12 hours. Conclusion: express-test for qualitative evaluation of hFABP has high efficacy in pre-hospital differential diagnosis of ACS and can be recommended for ambulance practice.

Poster Session : PS 0046 ; Cardiology : Risk Factors of Long-Term Mortality after Acute Myocardial Infarction

( Valentin Alexandrovich Kokorin ),( Ivan Gennadievich Gordeev ),( Ilya Alexandrovich Kokorin ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Complications of myocardial infarction may develop many months after MI occurred. Currently applied risk scales (GRACE, TIMI) have a number of shortcomings and not effective enough in prediction of such complications. Methods: 457 patients (mean age 59,7±0,5 y.o.) with STEMI survived at the moment of discharge were enrolled. During 28,8±0,8 months follow-up period 37 lethal cases (8,1%) occurred. 72 characteristics (demographic, anamnestic, clinical, laboratory, instrumental, treatment) was examined. Results: Risk factors of all-cause mortality was: age =60 y.o. (RR 2,94 (1,5-5,76), 95% CI), BMI <25 kg/m2 (RR 2,14 (1,13-4,06), 95% CI), history of previous MI (RR 2,75 (1,31-5,76), 95% CI), cerebrovascular disease (RR 2,55 (1,31-4,93), 95% CI), anemia (RR 5,09 (2,59- 10,01), 95% CI), anterior localization (RR 2,23 (1,18-4,23), 95% CI), admission =6 hours after clinical presentation (RR 2,18 (1,19-3,99), 95% CI), HR at admission =90 bpm (RR 2,62 (1,44-4,77), 95% CI), systolic BP at admission outside 120-140 mm Hg limits (RR 1,66 (0,89-3,15), 95% CI), acute heart failure during hospitalization (RR 3,03 (1,68-5,49), 95% CI), GFR <45 mL/min/1,73m2 (RR 3,38 (1,82-6,26), 95% CI), WBC count >15x109/l (RR 2,17 (1,13-4,18), 95% CI), BNP at admission =60 pg/ml (RR 5,08 (0,67-38,76), 95% CI), LVEF at admission <45% (RR 2,08 (1,12-3,85), 95% CI), LV EDV >140 ml (RR 2,06 (1,06-4,0), 95% CI), presence of LV aneurysm (RR 1,95 (1,07-3,58), 95% CI), overage HR by 24-hours monitoring =70 bpm (RR 3,18 (1,14-8,87), 95% CI), ventricular extrasystoles =50 per day (RR 3,18 (1,14-8,87), 95% CI). The factors decreasing mortality are: primary PCI (RR 0,49 (0,25-0,96), 95% CI), reperfusion achievement (RR 0,4 (0,21-0,75), 95% CI), beta-blockers intake during hospitalization (RR 0,27 (0,13-0,56), 95% CI) and statins in-hospital administration (RR 0,24 (0,14-0,44), 95% CI). Conclusions: According to the results new model predicting lethal outcomes can be elaborated.

Poster Session:PS 0573 ; Oncology : Cardiac Lymphoma: Case Report

( Valentin Kokorin ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Patient, 34 y.o. male, was admitted with complaints of fever (up to 39°C for 1 month) and dyspnea at night time. On ECG ST-segment elevation in inferior leads and ST-segment depression in V1-V3 was revealed. The patient was hospitalized to the intensive care unit with suspected STEMI. Condition at admission was moderate. HR 85/min, rhythm regular, BP 110/70 mm Hg. On echo: LV hypertrophy (2 cm), hypokinesis of inferior LV wall, ejection fraction 30% and pericardial effusion (0,8-2 cm). In lab tests: Hb 114 g/l, platelets 151x109/l, WBC 2.3x109/l, CK-MB 41 U/l, troponin T 321 ng/l, CRP 17 mg/l. On the next day the level of troponin T was 800 ng/l, D-dimer 705 ng/ml. On coronary angiography no abnormalities revealed. Differential diagnosis between myocardial infarction, pulmonary embolism, miocarditis and sepsis was performed. Patient was treated with anticoagulants, antiaggregants, ß-blockers, ACE inhibitors, statins, diuretics, antibiotics and anti-infi ammatory drugs. In serologic test mild elevation of IgM antibodies to Chlamidia trachomatis and cytomegalovirus was revealed. Blood culture and procalcitonin test was negative. On echo low LV EF and moderate pericardial effusion remained. In a week after admission the level of Hb was 94 g/l, creatinine 260 mcmol/l, hypoalbuminemia 28 g/l, CRP 212 mg/l, BNP 24809 pg/ml. Despite ongoing treatment patients` status progressively worsened, hyperthermia remained, dyspnea at rest, arterial hypotension, oliguria and fi nally cardiogenic shock developed. The patient died on day 12 after admission. On autopsy heart weight 480 g, on epicardium and endocardium grained whitish spots on a dark Background: Myocardium with multiple well-demarcated areas of whitish color. Microscopy: lymphocytic infi ltration and necrosis areas. Similar lesions in anterior mediastinum, thyroid gland, small intestine. final diagnosis: diffuse B-cell lymphoma with extranodal dominantly cardiac lesions. This case demonstrates diversity clinical picture of cardiac lymphoma and complexity of its diagnosis and treatment.

Slide Session : OS-CAD-07 ; Cardiology : Systemic Infl ammation and Clinical Course of Myocar-dial Infarction After Percutaneous Coronary Interven-tion

( Denis Belonosov ),( Valentin Kokorin ),( Anastasia Lebedeva ),( Ivan Gordeev ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Results of clinical course and systemic inflammation research in patients with ST-segment elevation myocardial infarction (STEMI) after successful percutaneous coronary intervention (PCI) are presented. Methods: 81 patients with STEMI admitted to cardiac intensive care unit of Moscow city clinical hospital #15 were observed. All patients underwent PCI in first 12 hours after disease onset. Clinical course was assessed (complications and lethal cases were registered). Blood samples for inflammatory markers testing were obtained. Levels of Interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), C-reactive protein (CRP) and white blood cell (WBC) count were assessed on day 1 and day 7 of hospitalization. Results: It was shown that in patients with lowered ejection fraction of left ventricle (< 45%) inflammatory markers were significantly higher than in rest patients (IL-1 beta was 17,99 (6,55-32,50) pg/ml vs 5,96 (3,51-17,85) pg/ml, р=0,039, CRP was 21,8 (11,3-33,5) mg/l vs 8,1 (3,8-23,3 мn/n), р=0,004), WBC count was 12,85 (10,40- 18,30)*109\l vs 10,5 (8,9-12,9) *109\l, р=0,004). Analysis of patients with acute heart failure (AHF) and acute heart aneurysm showed that CRP level in this subgroup was significantly higher than in rest patients (18,65 (9,200-52,5) mg/l vs 8,1 (4,40-17,50) mg/l, р=0,012). WBC count in these patients was also higher (13,4 (9,7-18,3) *109\l vs 10,8 (8,9-12,9)*109\l, p=0,022). IL-1beta level at day 1 had good prognostic value in heart aneurysm formation (AUC 0,668, р = 0,049 cut-off level 15,5 pg/ml, Se 70%, Sp 76%). IL-6 at day 1 is significant in hospital death prognosis (AUC = 0,902, p = 0,007, cut-off 49,5 pg/ml, Se 75%, Sp 99%). Conclusions: it was shown that inflammation level is significantly higher in patients with some STEMI complications after successful PCI. Several prognostic models of acute heart aneurysm and in-hospital death were obtained.