P1701 Biatrial thrombus detection in a patient with atrial paroxysmal fibrillation and asymptomatic massive pulmonary embolism

Abstract Introduction Computed tomography (CT) is a noninvasive test for detection of LA and LAA thrombus.Although the transesophageal echocardiogram is the gold standart method, it can have rare but potential life threatening complications.Case report:A 62 y.o woman presented to the ER complaining of palpitations started less then 12h ago with no chest pain or dispnea.She was diagnosed with high rate paroxysmal atrial fibrillation (HR∼120/min).The ECG showed AF with no specific changes,the troponin I (TPI) level was negative and a TTE revealed a dilated left atria.The other lab results were within normal range(TBC and blood chemistry).Her past medical history included hypertension and diabetes type 2 for 10 years and 6 months respectively both on regular treatment and obesity.Also 2 months ago she was diagnosed with Hashimoto thyroiditis and close monitoring of TSH was recommended but no treatment.Subsequently,LMWH (enoxaparin) and amiodarone loading dose for cardioversion were started.After 24h the pt was still in AF,with a controlled heart rate and no complains.However ECG changes were noticed (evolutive T negative waves in leads D1,D2,aVL,V3-V6).A D-Dimer was requested and came back negative,O2 saturation was 97%.The asymptomatic pt was transferred to the Cardiology ward for further evaluation.TPI remained negative.Due to the cardiac risk factors and the ECG changes it was decided to perfom a coronary angiography which resulted normal.An electrical cardioversion was considered.Both TEE and pulmonary angio CT were requested prior.Because of the ECG changes the CT was performed first and showed central and peripheric bilateral pulmonary artery clots present also in both the left and right atrial auricles.Due to the massive thromboembolism(PE) unfractioned heparin was immediately started (aPTT 50-70s).A new TTE showed a PAP of 50 mmHg.Approximately 10h after the heparin infusion,the pt became hypotensive and started complaining of dyspnea,tachypnea,cough,pleuritic pain and fever(high temperature 39.5-40ᵒC).Considering the deteriorating conditions she was consulted by a cardiac surgery team and it was decided to perform an emergency surgical pulmonary embolectomy despite the high risk.Within 24h,the pt underwent a surgical embolectomy of the right and left pulmonary branches after incision of the pulmonary artery, as well as a clot embolectomy of the right and left atria auricles (confirmed by intraoperatory TEE).She was put on an iv heparin regimen and recovered well.She was discharged 2 weeks later in good condition,with a PAP of 40 mmHg,on acenocoumarol with persistent AF.1.5 years later she is in NYHA class I,in sinus rhythm taking rivaroxaban 20 mg/d.Discussion: Biatrial thrombus detection in both atrial auricles is rare as well as in this case a massive PE without a stroke.CT can be used as an alternative modality for detecting thrombus in selected high risk patients because it shows a good diagnostic accuracy with high sensitivity and specificity. Abstract P1701 Figure. Biatrial clots on CT and removed ones </jats:sec

Characterization of low density lipoprotein receptor (LDLR) gene mutations in Albania

INTRODUCTION: Familial hypercholesterolaemia (FH) is a clinical syndrome characterised by elevated serum total cholesterol (TCHOL) levels due to an increase in low-density lipoprotein (LDL) cholesterol, by tendon xanthomata and clinical manifestations of ischaemic heart disease in early life. Typically, it results from mutations in the low-density lipoprotein receptor (LDLR) gene. So far, more than 800 mutations have been reported for the LDLR gene and account for FH. The nature of LDLR gene mutations varies among different ethnicities. Until now no mutations of LDLR have been reported in the Albanian population. MATERIAL AND METHODS: We assessed the contribution of the LDLR gene mutations as causes of FH in an Albanian population. Fifty probands with a clinical diagnosis of FH were included. We analysed all the exons and the promoter of the LDLR gene by using restriction isotyping or direct sequencing. RESULTS: Twenty-one patients were heterozygous for the 1646G>A mutation (FH Genoa) in exon 11 and 9 patients were heterozygous for the 81T>C mutation in exon 2 of the LDLR gene. CONCLUSIONS: This report describes two LDLR gene mutations accounting for FH in Albania (1646G>A, 81T>C).Archives of Medical Scienc

Contrast induced nephropathy in interventional cardiology; identification of high-risk patients and its prevention

Abstract Funding Acknowledgements Type of funding sources: None. Background CIN is a serious and potentially preventable complication of coronary angiography and/or percutaneous coronary interventions (PCI). The definition of CIN, its incidence and risk factors and therapeutic interventions are not well established . Purpose To study incidence and risk factors of CIN in patients undergoing coronary angiography and/or PCI, to investigate high-risk patients with CIN and to evaluate its preventive therapies (Hydration an Acetylcysteine). Method This was a prospective trial, in one center with patients undergoing coronary angiography and/or PCI, during 2010-2014. The renal function was evaluated through serum Creatinine (Cr) and GFR (Cockcroft –Gault formula ). CIN was defined as an increase in Creatinine by 25% and/or by 0.5 mg/dL at 48/72 h after the index procedures. Patients with CIN were considered high-risk when Creatinine increased more than 50% and/or by 2 mg/dL, or needing dialysis. We evaluated the major risk factors for CIN such as: Preexisting Renal Lesion (PRL), Age≥65 years, Heart Failure (HF), Diabetes Mellitus (DM), Anemia (Hb &amp;lt; 12 g/dL) and the Quantity of Contrast used. We evaluated the role of hydration with intravenous saline and acetylcysteine (ACC) in the prevention of CIN. Results Out of the 1231 patients enrolled, 804 patients fulfilled the inclusion criteria. The incidence of CIN resulted 14.4%, higher in the group of patients with risk factors for CIN (15.3%) versus without risk factors (9.1%); p=0.05. Risk factors HF (OD: 4.63; CI95%: 2.10-10.05, p&amp;lt;0.001), PRL (OD: 1.57; CI95%: 1.02-2.41, p=0.039) and Age ≥ 65 years (OD: 1.82; CI95%: 1.37-3.73, p=0.038 ) resulted independent risk factors, for CIN whereas Anemia (p=0.171), DM (p=0.502) and the Quantity of contrast used (p=0.479) did not result independent risk factors. Creatinine at 24 hours after the procedure resulted a predictive factor for the development of CIN. (sensitivity 64.7%, specificity 91.7%, positive predictive value 63.5%, negative predictive value 92.1% ). Creatinine &amp;gt; 1.5 mg/dL before the procedure resulted an independent risk factor for CIN, with a higher specificity than eGFR &amp;lt; 60 ml/min. The incidence of patients with CIN at high risk was 3.9% and HF resulted the only independent risk factor in this subgroup of patients (OD:4.49, CI 95%: 2.03-9.95). Intravenous hydration with saline resulted efficient in the prevention of the development of CIN (p=0.029), whereas ACC did not (p=0.485). Conclusions The frequency of CIN is higher in the group with risk factors. The HF, PRL, Age≥ 65 years resulted as independent risk factors for, and intravenous hydration with saline was a simple and efficient method for the prevention of CIN. Although our definition of CIN is widely used, the need for a universal definition for CIN is a contemporary need. </jats:sec

Impact of chronic coronary syndromes on cardiovascular hospitalization and mortality: the ESC-EORP CICD-LT registry

Abstract Aims In Europe, global data on guideline adherence, geographic variations, and determinants of clinical events in patients with chronic coronary syndrome (CCS) remain suboptimal. The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease Long-Term (CICD-LT) registry is a prospective European registry, and was designed to describe the profile, management, and outcomes of patients with CCS across the ESC countries. Methods and results We aimed to investigate clinical events at 1-year follow-up from the ESC EORP CICD-LT registry. One-year outcomes of 6655 patients from the 9174 recruited in this European registry were analysed. Overall, 168 patients (2.5%) died, mostly from cardiovascular (CV) causes (n = 97, 1.5%). Northern Europe had the lowest CV mortality rate, while southern Europe had the highest (0.5 vs. 2.0%, P = 0.04). Women had a higher rate of CV mortality compared with men (2.0 vs. 1.3%, P = 0.02). During follow-up, 1606 patients (27.1%) were hospitalized at least once, predominantly for CV indications (n = 1220, 20.6%). Among the population with measured low-density lipoprotein-cholesterol level at 1 year, 1434 patients (66.5%) were above the recommended target. Age, history of atrial fibrillation, previous stroke, liver disease, chronic obstructive pulmonary disease or asthma, increased serum creatinine, and impaired left ventricular function were associated with an increased risk of CV death or hospitalization. Conclusion In the CICD registry, the majority of patients with CCS have uncontrolled CV-risk factors. The 1-year mortality rate is low, but these patients are frequently hospitalized for CV causes. Early identification of comorbidities may represent an opportunity for enhanced care and better outcomes. </jats:sec