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Heart, Lung and Circulation S272008;17S:S4–S53 Poster Presentations

Conclusions: The incidence of clinical events was lowerthan expected in patients with PMD despite low LVEF.The prognosis of the patients with PMD may be relativelybenign. Cardiac dysfunction in the patients with PMDcould not predict clinical event in this study.

doi:10.1016/j.hlc.2007.11.066

Predictive value of blood glucose and brain natriureticpeptides as prognostic factors in patients with congestiveheart failure under ventilator care

Sang Hyun Kim ∗, Joo Hee Zo, Myung A. Kim

Seoul Boramae Hospital, South Korea

Objectives: Risk stratification and management in thepatients with heart failure under ventilator care are veryimportant in the prognosis of disease. We investigatedthe usefulness of blood glucose, brain natriuretic peptide(BNP) and N-terminal-proBNP (NT-proBNP) in predictingprognosis of patients with heart failure under ventilatorcare.

Methods: Natriuretic peptides and blood chemistry weremeasured in 25 patients with heart failure under ventilatorcare (mean age 67 years, 75% males). And left ventricu-lar ejection fraction and blood pressure were evaluated.Medical records of these patients were reviewed.

Results: Left ventricular ejection fraction (LVEF) of thesepstNpghan

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Preoperative serum creatinine levels were 1.5–2 mg/dl in40 patients, 2–2.5 mg/dl in 21, 2.5–3 mg/dl in four and morethan 3 mg/dl in three patients. Triple vessel disease waspresent in 48, double vessel disease in 13 and single vesselswere affected in seven. Surgical myocardial revasculariza-tion was done (off pump 32, on pump CABG 31, Perfusionassisted beating heart 5).

Results: Mean ICU stay was 2.8 ± 1.4 days. Postoperativeworsening of renal function occurred in 30 patients (22 onpump, 6 off pump and 2 perfusion assisted) and hemodial-ysis was required in 12 patients (10 on pump CABG and2 off pump CABG). There were four mortalities (on pumpCABG 3, perfusion assisted 1). Diabetes, hypertension,recent acute coronary syndrome, Peripheral vascular dis-ease, Cardiopulmonary bypass time longer than 120 min,high inotropes and high postoperative drainage requir-ing multiple blood transfusions were found to be the riskfactors for an adverse outcome

Conclusion: In heart failure patients undergoing surgi-cal revascularization transient worsening of renal functionin preoperative renal dysfunction after surgical revascu-larization occurs, however, most patients do not requirehemodialysis. Morbidity and mortality is less when revas-cularization is performed off pump.

doi:10.1016/j.hlc.2007.11.068

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atients was 28.3„b11.4%. BNP and NT-proBNP wereignificantly related to age and blood pressure on mul-ivariate regression analysis (p = 0.01). The plasma BNP,

T-proBNP level and blood glucose level in patients ofoor prognosis group were higher than that of survivorroup (p = 0.02). And, in the patients with symptoms ofeart failure after hospital discharge, the blood glucosend BNP level was significantly associated with the prog-osis for 1 year.Conclusion: Blood glucose and BNP/NT-proBNP levels in

atients with heart failure under ventilator care were use-ul in predicting prognosis of disease. And blood glucosend BNP levels are closely related to long-term prognosisf heart failure after hospital discharge.

oi:10.1016/j.hlc.2007.11.067

yocardial revascularization in heart failure patientsith renal dysfunction

lka Kochar ∗, Deepak Puri, Arun Kumar, Ajay Sinha,anoranjan Sahoo

Fortis Hospital, Mohali, India

Objectives: Renal dysfunction increases morbidity andortality of heart failure patients who undergo surgicalyocardial revisualization. We studied risk factors, man-

gement strategies and outcome of these patients.Methods: 68 patients from July 01 to September 2006ith preoperative serum creatinine levels 1.5 mg/dl orore with impaired left ventricular function (left ven-

ricular ejection fraction [EF] < or =35%) were included.

redictors of surgical outcome in heart failure patients

run Kochar ∗, T.S. Mahant, Manoranjan Sahoo, Deepakuri

Fortis Hospital, Mohali, India

The objective of this prospective study was to eval-ate the predictors of surgical outcome in patientsith poor left ventricular function. Fifty-five consec-tive patients with impaired left ventricular function,ho underwent coronary artery bypass grafting (CABG),ere evaluated before discharge and at 6 months post-peratively. Fifty-five patients (mean age 60 ± 14 years)ith coronary artery disease and impaired left ventric-lar function (left ventricular ejection fraction [EF] < or35%) who underwent a coronary artery bypass surgeryere prospectively studied. Echocardiography and SPECTyocardial scintigraphy were preoperatively performed

o measure the left ventricular function and to assessyocardial viability. Postoperative echocardiography was

one before discharge and 6 months later to evaluateecovery of left ventricular function. Four patients (7.2%)ied in total: two deaths were cardiac related (3.6%)nd two patients (3.6%) died due to other causes. Theeft ventricular ejection fraction improved immediatelyfter the operation (from 32.2 ± 6% to 39.5 ± 8%, p = 0.01)nd showed a sustained improvement at later follow-upmean = 16.3 ± 4.5 months) (44.0 ± 4.0%, p = 0.01). The leftentricular wall motion score improved significantly onlyt later follow-up (from 12.2 ± 1.8 to 9.4 ± 2.0, p = 0.03).n 18 patients of whom a preoperative SPECT scintigra-hy was available, the presence of extensive reversibleefects correlated with significant improvement in EF. A

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S28 Heart, Lung and CirculationPoster Presentations 2008;17S:S4–S53

poor outcome was correlated with pathological Q waves inpreoperative ECG and with an increased left ventricularend-systolic volume index (>100 ml/m2). The presence ofextensive reversible defects on preoperative thallium-201scintigraphy is a strong predictor of postoperative recov-ery of myocardial function. A poor outcome of surgery canbe expected in the presence of pathological Q waves on thepreoperative ECG or when the left ventricular end systolicvolume index exceeds 100 ml/m2.

doi:10.1016/j.hlc.2007.11.069

Cardiac transplantation

Yogesh Kumar

Cardiac transplantation is the replacement of a person’sfailing heart with a healthy heart from an organ donor.Cardiac transplant may be the only treatment option forpatients who have heart failure caused by:

• Cardiomyopathy;• Viral infections;• Prolonged high blood pressure;• Heart attack; or• Coronary artery disease.

In rare cases, heart transplants are performed onpatients who have valvular heart disease or congenital

• Medications to help counteract the side effects of theimmunosuppressants, such as antacids, diuretics, andantihypertensives.

doi:10.1016/j.hlc.2007.11.070

Dynamics of heart failure and left ventricular parame-ters in patients with nonacute coronary artery disease andrecurrent ischaemia after percutaneous revascularization

Vadim Kuznetsov ∗, Grigoriy Kolunin, Igor Zyrianov,Albert Panin, Dmitriy Krinochkin, Marina Bessonova,Elena Gorbatenko

Tyumen Cardiology Center, Russia

Successful percutaneous revascularization (PR) mayimprove left ventricular (LV) function, remodelling anddiminish severity of heart failure (HF) in patients withnonacute coronary artery disease (CAD). But dynamics ofHF and LV parameters in patients after PR with recurrentischaemia remain unclear.

Aim: To assess and compare dynamics of HF and LVparameters in patients with nonacute CAD after PR hav-ing recurrent ischaemia and patients with nonacute CADreceived conservative therapy.

We examined 141 patients with nonacute CAD beforeand 1–87 months (mean 16 ± 14.6) after angiographicallysuccessful PR and signs of recurrent ischaemia: 57 with

heart disease.Heart transplant recipients must take immunosuppres-

sant medication for the rest of their lives and undergofrequent examinations.

At the transplant centre, the recipient will undergo aseries of tests to ensure that he or she is in satisfactorycondition to receive the donor organ, including:

• Blood tests;• Urine tests; and• Chest X ray.

The procedure is performed under general anaesthesia.To begin the operation, the surgeon performs a ster-

notomy and accesses the heart. The patient is connectedto a heart–lung machine, which stops blood from circu-lating through the coronary arteries when the surgeon isworking on the heart itself.

Surgeons will then remove the patient’s failing heart bymaking incisions in the atria, aorta, and pulmonary arter-ies. The surgeon then connects the donor heart’s bloodvessels to the patient’s. At this point, the heart either startsbeating on its own or receives a shock to restart it. Once thenew heart is beating without support from the heart–lungmachine, the patient is weaned from the machine and thechest will be closed. The procedure takes between 3 and5 h to complete.

Post treatment guidelines and care:Transplant patient should follow these medication for

the rest of his or her life:

• Immunosuppressants;• Antibiotics; and

angiographic restenosis of a target vessel (group 1A) and84 without (group 1B) and 83 patients with nonacute CADreceived conservative medical therapy (group 2). Groupswere matched for age, sex, cardiovascular risk factors andduration between first and second examinations.

Results: The prevalence of patients with more severe HF(II–IV classes NYHA) increased significantly in group 2only (from 53 to 71%, p = 0.007) and was unchanged ingroups 1A and 1B. According to echocardiographic data ingroup 2 LV ejection fraction decreased (from 54.7 ± 7.7 to51.5 ± 9.2%, p = 0.003), LV end diastolic diameter increased(from 50.8 ± 3.5 to 52.1 ± 4.5 mm, p = 0.029) as well as theextent of LV wall motion abnormalities (from 17 ± 14.5 to21.3 ± 16.9%, p = 0.024). Those parameters did not changesignificantly in group 1A. In group 1B LV ejection frac-tion increased (from 53.4 ± 7.9 to 55.3 ± 6.8%, p = 0.015), LVend diastolic diameter and the extent of LV wall motionabnormalities were unchanged.

Conclusion: There were no negative dynamics of HF andLV parameters in patients with nonacute CAD havingrecurrent ischaemia after PR even with restenosis of atarget vessel.

The dynamics of HF and LV parameters severity wereworse in CAD patients received conservative medical ther-apy compared to patients with recurrent ischaemia afterPR.

doi:10.1016/j.hlc.2007.11.071