Massive Audio PAT50 Instrukcja Użytkownika Pobierz pdf (Strona 3)

ÖKG-Jahrestagung – Abstracts

J KARDIOL 2008; 15 (5–6)

139

„Von der Forschung zur Klinik“

Chronic Heart Failure Leads to an Expanded Plasma

Volume and Pseudoanemia, But Does Not Lead To a

Reduction In The Body’s Red Cell Mass 044

C. Adlbrecht, S. Kommata, M. Huelsmann, T. Szekeres, C. Bieglmayer, G. Strunk,

G. Karanikas, R. Berger, D. Mörtl, K. Kletter, G. Maurer, I. M. Lang, R. Pacher

Abteilung für Kardiologie, Abteilung für Nuklearmedizin, Klinisches Institut für

Medizinische und Chemische Labordiagnostik, Universitätsklinik für Innere

Medizin II, Medizinische Universität Wien; Forschungsinstitut für Gesundheits-

management und Gesundheitsökonomie, WU-Wien (G. S.)

Background Chronic heart failure (CHF) is frequently associated

with a decreased hemoglobin level. Although in some patients renal

anemia may develop, the mechanisms underlying the decrease in

hemoglobin in isolated CHF remain largely unknown. We explored

robust determinants of anemia including red cell mass as well as

related markers and the plasma volume in patients with CHF with-

out renal dysfunction based on non-cardiac reasons.

Methods One-hundred consecutive CHF patients were enrolled.

The total red cell volume (RCV) was determined by a 51Cr assay.

Furthermore, serum ferritin, erythropoietin, hepcidin, and renal

function parameters were assessed. The influence of each factor on

hemoglobin concentrations was determined in a multiple regression

model.

Results Mean hemoglobin concentrations were slightly lower in

patients with CHF (13.7 ± 1.6 mg/dL) compared to a healthy control

group (14.6 ± 1.3 mg/dL). However, the RCV was not reduced

in CHF patients (CHF with decreased hemoglobin: 1718.8 ±

569.3 mL, CHF with normal hemoglobin: 1828.4 ± 641.3 mL,

healthy controls: 1634.4 ± 470.8 mL), and there was no severe defi-

ciency of iron or erythropoietin detectable in CHF patients. We

found that plasma volume levels were significantly higher in pa-

tients with CHF compared to healthy individuals, suggesting the

presence of pseudoanemia (p < 0.001). Correspondingly, the

plasma volume was the best predictor of hemoglobin concentrations

in the regression model applied (B = –0.483; p < 0.0001).

Conclusion Hemodilution leading to pseudoanemia is the key

determinant influencing hemoglobin levels in isolated CHF. The

observation that the RCV is normal in isolated CHF and there is no

iron- or erythropoietin deficiency is an argument against supple-

mentation therapy in this group of patients.

Incidence and Prognostic Impact of Coronary Flow

Restoration After Guidewire Insertion Before Balloon

Inflation in ST-Elevation Myocardial Infarction 084

C. Adlbrecht, K. Distelmaier, D. Gündüz, D. Bonderman, A. Kaider*, G. Christ,

I. M. Lang

Division of Cardiology, Department of Internal Medicine II, Medical University of

Vienna; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna;

*Core Unit of Medical Statistics and Informatics, Vienna

Background and Objective ST-elevation myocardial infarction

(STEMI) is characterized by an acute thrombotic obstruction of the

coronary artery. Recent randomized clinical trials evaluating

thrombectomy have yielded conflicting results. Patient inclusion

and randomization in these trials was performed after the initial an-

giogram, but importantly, before guidewire insertion. We hypo-

thesized that guidewire insertion alone, prior to balloon inflation or

thrombectomy, may lead to flow restoration in the infarct related

coronary artery (IRA), and that this phenomenon influences mortal-

ity. This may represent an important confounder in thrombectomy

trials.

Methods Angiograms of 1012 consecutive STEMI patients be-

tween January 2003 and December 2005 were evaluated and TIMI

flow was graded at the time of the initial angiogram and after

guidewire insertion. The incidence of coronary flow restoration af-

ter sole guidewire insertion was assessed and patient baseline char-

acteristics were collected by chart review. Subsequently, death and

death dates of all patients with an initial TIMI 0 flow were assessed.

Results An initial TIMI 0 was present in 476 (47.0 %) individuals.

Of these, full angiographic data were available of 403 (84.7 %) pa-

tients. Coronary flow restoration immediately after guidewire inser-

tion occurred in 150/403 (37.2 %) patients with an initial TIMI 0.

Kaplan Meyer analysis revealed improved survival in patients with

flow restoration after guidewire insertion (p = 0.17). Furthermore,

in a Cox regression model, flow restoration after guidewire inser-

tion had significant impact on mortality (p = 0.041). Finally, revas-

cularization guidewire insertion was more likely in the right coro-

nary artery (HR = 2.291, CI = 1.387–3.786; p = 0.005).

Discussion Coronary flow restoration following guidewire inser-

tion is a frequent event in emergency STEMI percutaneous coro-

nary intervention and significantly influences long-term clinical

outcome. Thus the exact time point of randomization in thrombec-

tomy studies appears to be more important than previously ex-

pected.

Prognosis of Acute Coronary Syndrome at High

versus Low Altitude Yemeni Patients 001

M. Ali Al-Huthi

, Y. A. Raja’a

, M. Al-Noami

, A. Rashid Abdul Rahman

Faculty of Medicine, Thamar University, Yemen;

Faculty of Medicine and Health

Science, Sana’a University, Yemen;

Advanced Medical and Dental Institute,

Penang, and Cyberjaya University College of Medical Sciences Malaysia

Background A cohort study design was employed for this study,

aimed at evaluating the prognosis of acute coronary syndrome

(ACS) among Yemeni patients at high and low altitudes.

Methods 157 ACS patients from high and low altitudes were

evaluated from admission to CCU up to 12 months. We evaluated

the possible effect of altitude on the rate of the prevalence of ACS

risk factors, in-hospital complications and one year treatment and

outcome of ACS.

Results The mean age of ACS patients at low altitude region was

higher (58.2 ± 6.8 years vs 55.5 ± 8.8 years; p = 0.042). The mean

heart rate (HR) was higher for altitude patients (94.4 ± 19.3 beat/

min vs 83.7 ± 17.1 beat/min; p < 0.001). High altitude patients were

seen to have higher mean of CK-MB, WBC, total cholesterol, LDL-

C and TG than low altitude patients. The prevalence of past history

Jahrestagung der

Österreichischen Kardiologischen Gesellschaft

28. bis 31. Mai 2008, Salzburg

Abstracts

(in alphabetischer Reihenfolge nach Erstautoren)

For personal use only. Not to be reproduced without permission of Krause & Pachernegg GmbH.

1 2 3 4 5 6 7 8 ... 45 46

Komentarze do niniejszej Instrukcji

Brak uwag

Massive Audio PAT50 Instrukcja Użytkownika Strona 3

Komentarze do niniejszej Instrukcji

Powiązane produkty i podręczniki dla Nie Massive Audio PAT50