Massive Audio PAT50 Uživatelský manuál stáhnout pdf (Strana 8)

146 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

statin treatment. Independent risk factors, however, turned out to be

aortic valvular calcification (AVC), as assessed by multidetector

computed tomography (MDCT), and plasma levels of C-reactive

protein. As shown in a su/jointfilesconvert/272007/bgroup of 35 patients (19 randomly

assigned to atorvastatin and 16 to placebo), annular progression

in AVC was similar in both treatment groups. Within 24 months,

AVC raised from 2197 (± 1178) arbitrary units (AU) to 2749

(± 1376) AU in the placebo group, and from 2421 (± 1326) AU to

2979 (± 1228) AU in the atorvastatin group.

Conclusion Precise risk factor stratification of calcified aortic

stenosis should include quantification of valvular calcification by

MDCT and measurement of plasma C-reactive protein. This study

supports the concept that the natural history in these patients is

worse than previously considered. New-onset standard-dosed lipid-

lowering therapy with atorvastatin could not halt progression of

valvular calcification, the strongest risk factor for adverse clinical

outcome in multivariate regression analysis.

Local Complement Activation Triggers Leukocyte

Recruitment to the Site of Thrombus Formation in

Acute Myocardial Infarction 035

K. Distelmaier, M. Kubicek, Ch. Adlbrecht, D. Dunkler, S. Winkler, J. Jakowitsch,

Ch. Gerner, O. Wagner, I. M. Lang

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

Vienna

Atherosclerotic plaque rupture with subsequent mural thrombus

formation is considered the main event compromising epicardial

flow in acute myocardial infarction (AMI). The precise mechanisms

underlying acute coronary occlusion are unknown. To search for

soluble factors enriched at the culprit lesion site we compared the

proteomic profiles of systemic plasma and plasma derived from

fresh coronary thrombus aspirates of 34 patients (male 71 %, age 57

± 10 years) with ST-elevation myocardial infarction. Two-dimen-

sional gel electrophoresis and ELISA indicated a local activation of

the complement system, with a selective accumulation of the com-

plement activator C-reactive protein (CRP) and the downstream

effector products C3a and C5a. CRP in coronary thrombus colocal-

ized with C1q and C3 immunoreactivities, suggesting classical

complement activation. In vitro, culprit site derived plasma enhanced

leukocyte chemotaxis in a C3 dependent manner. We conclude that

localized complement activation at the site of coronary thrombosis

plays a key role in leukocyte recruitment, and contributes to vessel

occlusion in AMI.

Lipid Predictors of Cardiovascular Events in Statin-

Treated Coronary Patients With Type 2 Diabetes 032

H. Drexel, St. Aczel, T. Marte, A. Vonbank, C. H. Saely

VIVIT Institute, Feldkirch

Background Vascular risk in diabetic patients remains high de-

spite statin treatment.

Objective We aimed at identifying which lipid parameters drive

vascular risk in this important patient population despite statin treat-

ment.

Methods We recorded vascular events over 5.6 years in 491 con-

secutive statin-treated patients with angiographically proven stable

CAD, covering 2750 patient-years.

Results From our patients 116 (23.6 %) had type 2 diabetes

(T2DM). In the total cohort, low HDL cholesterol (standardized

adjusted hazard ratio [HR] 0.73 [0.60–0.89]; p = 0.001), low

apolipoprotein A1 HR 0.77 [0.65–0.92]; p = 0.003) a small LDL

particle diameter (0.76 [0.64–0.91]; p = 0.002), and high tri-

glycerides (1.20 [1.05–1.38]; p = 0.007) significantly predicted vas-

cular events, but not total cholesterol (p = 0.995), LDL cholesterol

(p = 0.961), or apolipoprotein B (p = 0.077). Patients with T2DM

were at a significantly higher vascular risk than non-diabetic sub-

jects (38.6 % vs 24.1 %; p < 0.001). Importantly, like in the total

population, low HDL cholesterol (HR = 0.58 [0.41–0.82]; p =

0.002), low apolipoprotein A1 (HR = 0.70 [0.51–0.95]; p = 0.022),

a small LDL particle diameter (0.67 [0.50–0.91]; p = 0.010), and

high triglycerides (1.30 [1.11–1.53]; p = 0.001) drove vascular risk

in our statin treated coronary patients with T2DM, whereas total

cholesterol (p = 0.822), LDL cholesterol (p = 0.235), and apolipo-

protein B (p = 0.366) did not.

Conclusions The pattern of low HDL cholesterol, low apolipo-

protein A1, small LDL particles, and high triglycerides is the main

lipid risk factor in statin treated coronary patients with T2DM.

Coronary Artery Bypass and Surgical Left Ventricular

Remodelling for Heart Failure in Patients with Isch-

emic Cardiomyopathy: Mid-Term Follow-up 066

O. Dzemali, A. Zierer, P. Risteski, F. Bakhtiary, P. Kleine, A. Moritz

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe

University, Frankfurt/Main, Germany

Background and Aim Optimal treatment strategies for patients

with ischemic cardiomyopathy remain controversial. We assessed

the early and mid-term outcomes after surgical revascularisation

alone vs. left ventricular (LV) remodelling combined with revascu-

larisation in these patients.

Methods Between 2000 and 2002, 285 consecutive patients with

ischemic cardiomyopathy were surgically treated with coronary ar-

tery bypass grafting alone (group A, n = 165) or open LV remodel-

ling (apex resection and pericardial patch reconstruction) in addi-

tion to revascularisation (group B, n = 120). Preoperatively, the

New York Heart Association (NYHA) Class, left ventricular ejec-

tion fraction and end-diastolic diameter were comparable (group A

3.2 ± 0.6, 37.7 ± 11.2 % and 59.1 ± 7.3 mm versus group B 3.1 ±

0.6, 40.9 ± 12.1 % and 57.8 ± 8.6). Early and mid-term outcomes,

hemodynamic performance and quality of life were evaluated dur-

ing a mean follow-up period of 70 months.

Results Operative mortality was significantly lower in group B

(7.5 %) compared to group A (12.8 %). Group B patients had sig-

nificantly longer ventilation times, higher blood loss and need for

blood transfusion. At last follow-up, survival was 74.3 ± 8.1 % in

group A vs 84.2 ± 5.4 % in group B (p < 0.05). Follow-up examina-

tions revealed greater reduction of functional class in group B with

mean 2.03 ± 0.8 vs 1.7 ± 0.7 in group A (p < 0.05). Both LV ejection

fraction and end-diastolic diameter improved significantly more in

group B compared to group A.

Conclusions Patients with ischemic cardiomyopathy, in which

surgical ventricular remodelling was performed, demonstrated

longer ventilation times and higher postoperative blood loss, but

superior early and mid-term outcomes regarding survival, func-

tional class and quality of life.

Hemodynamic Effects of Left Ventricular Pacing Site

in an Animal Model of Heart Failure 070

O. Dzemali

, F. Bakthiary

, A. Zierer

Th. Wittlinger

, H. Ackermann

, P. Kleine

A. Moritz

Department of Thoracic and Cardiovascular Surgery;

Department of Biomedical

Statistics, Johann Wolfgang Goethe University, Frankfurt/Main, Germany

Background Missing response to left ventricular (LV) pacing is

observed in 20–30 % of heart failure (HF) patients, possibly the

ideal pacing site was not reached by the coronary sinus lead. This

study investigates how different epicardial and endocardial pacing

sites influence hemodynamic performance in an animal model.

Methods In 6 adult sheep dilated HF was induced by rapid pac-

ing. Endocardial mapping and pacing were performed using a 64-

electrode basket catheter. Epicardial pacing was achieved by tem-

porary electrodes. LV volumes and diameters were measured by

Echocardiography.

Results Table 1 summarizes the hemodynamic and echocardio-

graphic results.

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