P1517 Prognostic value of echocardiographic parameters for RV function in long term follow up of patients presenting with ST elevation myocardial infarction

Funding Acknowledgements

Funding Acknowledgements : This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by theERDF

Background

The prognostic value of right ventricular (RV) function assessed by echocardiography in patients with acute ST elevation myocardial infarction ( STEMI ) treated by primary percutaneous coronary intervention (PCI) remains controversial, especially in terms of long term follow up .

AIMS

To evaluate the relation between RV function assessed by various echocardiographic parameters in patients presenting with STEMI and the occurrence of major cardiovascular adverse events (MACE) whithin a long period of follow-up.

Methods

We have prospectively analyzed a cohort of 37 patients (mean age: 62.49+/- 1.67 years, 28 males) presenting with a first STEMI treated successfully by PCI. Patients with history of cardiac or pulmonary diseases were excluded. All patients underwent serial conventional 2D echocardiography, tissue Doppler imaging ( TDI ), speckle tracking echocardiography (STE) and 3D echocardiography at 24 hours after the acute event, at discharge, at 6 month, 1 year and 4 years of follow up. We measured in each patient the following RV functional parameters : tricuspid annular plane systolic excursion (TAPSE) , RV free wall systolic velocity (St ) assessed by TDI , RV free wall strain (RVFWS) and RV global longitudinal strain (RVGLS), RV myocardial performance index assessed by pulsed wave Doppler (RV MPI -PW) and right ventricular ejection fraction (RVEF). The mean follow up duration was 36 +/-4 months . The combined end-point of MACE was defined as all cause mortality, recurrent myocardial infarction, need for repeat revascularization or stroke.

Results

During the follow-up period 8 patients ( 18.9 % ) reached the combined end-point . In the analyzed group we observed that of all the studied parameters that reflect RV function, only RV MPI –PW and St at discharge were predictors of worse outcomes independent of LVEF or the culprit coronary artery. RV MPI was predictive at a cut-off value greater than 0,56 with a sensitivity of 66,6% and a specificity of 85,7 % ( 95% CI 0.51 to 0.67, p = 0.017, AUC= 0.71), respectively St at a cut -off value lower than 0,13 m/s with a sensitivity of 92 % and a specificity of 41 % ( 95% CI 0.12 to 0.16 p = 0.012, AUC = 0.64 ).

Conclusions

In STEMI patients treated by primary PCI, RV global function and RV regional systolic function evaluated at discharge provide prognostic information for long term MACE, independendent of infarct size or location. Our results need to be confirmed in larger cohorts of patients.

P980 RV longitudinal dysfunction predicts outcomes in anterior ST elevation myocardial infarction treated by primary PCI

Funding Acknowledgements

This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF

Background

The prognostic value of LV function in the setting of an acute ST elevation myocardial infarction (STEMI) is well established, but data regarding the association between RV function and adverse events in this population of patients are still scarce, especially for the cases with anterior wall localization of necrosis. Two-dimensional speckle tracking echocardiography (STE) is able to detect subclinical changes in local or regional RV function.

AIMS

To evaluate the relation between STE parameters of RV global and regional function recorded 24 hours after admission and the occurrence of major non-fatal cardiovascular adverse events (MACE) in anterior STEMI patients treated by primary percutaneous intervention (PCI)

Methods

We have prospectively analyzed a cohort of 80 consecutive patients (mean age 61.17 years, 68.8% males) presenting with a first STEMI treated successfully by PCI. Patients with history of cardiac or pulmonary disease were excluded. All patients underwent conventional echocardiography and STE, 24 hours after the index event. RV strain was assessed as RV free wall strain (RVFWS) representing the average of peak strain values encountered in three segments of the RV free wall and RV global longitudinal strain (RVGLS) obtained by averaging peak strain values in six segments including RV free wall and interventricular septum . The mean follow-up duration was 8.2 ± 0.69 months.The combined endpoint of non fatal MACE was defined as recurrent myocardial infarction, need for repeat revascularization, hospitalization for heart failure or stroke.

Results

In the study population 45 patients (56%) had the culprit lesion on the anterior descendent artery. In this group we observed that RVGLS was predictive for non fatal MACE independent of LVEF or extension of necrosis expressed by wall motion score index with OR 0.89 95 % CI 0.7-0.9, p = 0.042, with a ROC curve with a sensitivity 73% and specificity 53%, AUC =0.7. In addition, in anterior STEMI complicated by LVEF <40 % , a RVFWS absolute value lower than -14.3 % has proved to be an additional parameter of negative prognosis with a sensitivity of 91 %, and a specificity of 40% (AUC 0.68, CI 95%: 0.3-0.7)

Conclusions

In anterior STEMI patients treated by primary PCI, global RV longitudinal dysfunction assessed by STE early after the index event is predictive for non fatal MACE independently of LV function or the infarct size. In addition, RV regional longitudinal dysfunction provides incremental prognostic information in patients with anterior STEMI with moderate or severe LV systolic dysfunction. These data highlight the importance of the assessment of subclinical RV dysfunction in this setting.

Cutaneous complications of molecular targeted therapy used in oncology

The new molecular targeted therapy has been developed over the past decades by using the molecular targeted molecular changes discovered in specific types of cancer. Unfortunately, most of these agents (epidermal growth factor receptors, multi-targeted small molecule tyrosine kinase inhibitors, monoclonal antibodies) have severe cutaneous adverse reactions, that not only interfere with the patient's quality of life, but also are dose-limiting and may require treatment interruptions. These cutaneous complications and their management must be very well known by any oncologist and dermatologist who treat oncologic patients.

ABBREVIATIONS

EGFR = epidermal growth factor receptors, EGFRI = epidermal growth factor receptors inhibitors.

Cutaneous adverse reactions specific to epidermal growth factor receptor inhibitors

Classical antineoplastic therapy is encumbered by extensively studied adverse reactions, most often of systemic nature. The emergence of new generations of anticancer treatments, including epidermal growth factor receptor inhibitors, besides improving the response to treatment and the survival rate, is accompanied by the occurrence of new specific side effects, incompletely studied. These side effects are most often cutaneous (hand foot syndrome, acneiform reactions), and in some cases are extremely severe, requiring dose reduction or drug discontinuation. The prevention of the cutaneous adverse effects and their treatment require a close collaboration between the oncologist and the dermatologist. The occurrence of some of these skin adverse effects may be a favorable prognostic factor for the response to the cancer treatment and the overall survival.

[Dermatologic preparations with erythromycin--the correlation of the pharmaceutical form-therapeutic effect]

Erythromycin associated with progesterone and A vitamin has been included in three dermatological pharmaceutical forms: a lotion, a L/H emulsion and a L/H nonionogenic ointment. Aspect of these preparations has been noticed for a 90 days period. pH and electrical conductance were also determined during this interval. All the formulations mentioned above revealed insignificant variations of these parameters proving an appreciable physico-chemical stability. Clinical investigative studies in juvenile acne, showed efficiency, particularly for the emulsion form.

Oral lyophilizate--an alternative for products with low-soluble drugs

The propyphenazone, a drug with pronounced anti-inflammatory, anti-fever, analgesic properties, is recommended in acute situations which require therapeutic blood levels in short time after administration. The review presented has the purpose of obtaining an oral lyophilizate, compared with the common tablets. Also, the specific parameters for oral solid dosage forms were determined. The procedure for the oral lyophilizate's preparation promotes the liquid form's mobility and activity, being designed as a solid product which disperses readily in small quantities of water. The presence of a solubilizing agent, included in formulation, will increase propyphenazone's dissolution and so, the analgesic, antiinflammatory effect will appear rapidly. The lyophilization of the selected formulation with a usifroid apparatus was conducted following the classic steps. The tablets were compared with compressed tablets having the same content in propyphenazone (0,250 g), being observed concerning the aspect, the diameter, the dissolution time and the percentage of dissolved substance in one hour. In comparison with compressed tablets, the substances associated in oral lyophilizate and the specific lyophilization technique determine propyphenazone's release in a shorter time interval.

Clinical manifestations in the West Nile virus outbreak

During the summer of 1996 an unusual clustering of meningoencephalitis cases was recorded in the Capital City, Bucharest, and in some areas from South-East Romania. After an initial suspicion of an enteroviral etiology was discarded, the West Nile etiology was confirmed by specific antibodies demonstration through hemagglutination-inhibition and ELISA tests. This study included 251 patients with the diagnoses of West Nile acute encephalitis (166 cases), acute meningitis (57 cases) and acute febrile disease (33 cases). The patients' age ranged from 1 to 89 years (mean 51.1 years). The most frequent clinical manifestations were: fever (95.7% of cases), cephalalgia (92.6%), stiffness of the neck (89.1%), vomiting (62.5%), marked asthenia (46.5%), myalgia (28.9%). In addition, patients with encephalitis exhibited: alteration of consciousness (89.2% of cases), tremor of extremities (40.4%), ataxia (44%), paralysis (15.1%). The fatality rate was 15.1% in acute encephalitis, 1.8% in acute meningitis and 0% in the acute febrile disease.

[Research to achieve a homeopathic lotion]

A formulation of homeopathic lotion was elaborated. It uses as mother-solutions: the Calendula tincture and the Fumaria tincture prepared according to the homeopathic rules, and a vegetal soft extract conventionally named by us Pt2a, and the 42 C alcohol was used as a vehicle. All dilutions were made at 3CH. The pH, the refraction index and the electrical conductivity of the three solutions prove a good stability of the preparation. The 2 CH a dilution was well tolerated at the administration with juvenile acne and the simple dry phthiriasis, an improving being noted after 3-4 days of treatment.

[The pharmacotechnical assessment of the types of sodium carboxymethylcellulose of Romanian origin (its synthetic appearance)]

Three indigenous varieties of sodium carboxymethylcellulose, types 1,000, 6,000 and 10,000, with properties comparable to those of similar imported products were investigated in view of determining their qualities of excipients for some pharmaceutical products. Thus, they were used for obtaining a potassium chloride containing syrup, buvable ampoules with diethylaminoethanol N-acetylglutamate. Ointment bases and tablets with favorable qualities were also obtained.

[The quality assessment of a product with adhesive properties for complete dental prostheses]

A formula of dental adhesive using as an agent responsible for this activity an indigenous product, C.M.C.Na 1080, gelified with preservative solution with added astringent agents was elaborated. The possible interaction between the constituents during preservation and the product qualities by determining the pH, extensibility index, sliding limit tension, antimicrobial activity and certain clinical aspects were evaluated.

[The production of tablets with diethylaminoethanol p-acetylaminobenzoate]

A formulation for tablets with diethylaminoethanol p-acetylaminobenzoate was set. The obtained tablets are adequate from the point of view of organoleptic qualities, mean weight weight variations, mechanical strength and disaggregation, both after processing and one year storage. The kinetics of water and artificial gastric juice, determined with the help of a Nogami device, by tablets capillarity reveals a homogeneous porosity, fact that determines the complete disintegration of the tablets in due time, and thus a good availability.

[Sensitivity to chemotherapeutic agents of bacteria isolated from generalized infections]

A study carried out on 206 bacteriemia infections showed that: the following bacterial flora was implicated in the etiology of bacteremia infections: Staphylococcus aureus in 28.6% of cases, Staphylococcus albus in 20.4% Enterobacteriaceae in 25.7% and Pseudomonas in 3.8%; an increase existed in the number of generalized infections caused by opportunists belonging to the Enterobacteriaceae family and Pseudomonas genus. Similarly, an increase in the resistance to the recently introduced antibiotics, Septrin and Gentamycin, was noted. These observation require antibiotic lebel control and, if it is necessary the association of two or more antibiotics in severe infections.