A. Ülgen

Serum uric acid levels predict the severity and morphology of coronary atherosclerosis detected by multidetector computed tomography.

In this study, we aimed to evaluate whether serum uric acid (UA) was associated with the severity and morphology of coronary atherosclerotic plaques (CAP) shown by multidetector computed tomography (MDCT). The study population consisted of 982 patients (58% men) who underwent dual-source 64 slice MDCT for the assessment of coronary artery disease (CAD). Coronary arteries were evaluated on 16 segment basis and critical coronary plaque was described as luminal narrowing >50%, whereas plaque morphology was assessed on per segment basis. Serum UA levels were determined using commercially available assay kits. The critical atherosclerotic lesions were detected in 454/982 (46.2%) subjects by MDCT. Serum UA levels were found to be higher in patients with any coronary plaque (6.9 ± 1.5mg/dL vs. 5.1 ± 1.3mg/dL, p<0.01). Also UA level was higher in patients with critical stenosis compared to non-critical stenosis (6.1 ± 1.5mg/dL vs. 5.4 ± 1.3mg/dL, p<0.001). Subjects having primarily calcified plaques have higher UA levels compared to other plaque subtypes (5.5 ± 1.3 for non-calcified plaques, and 5.6 ± 1.2 for mixed plaques, 6.6 ± 1.6 for calcified plaques, p<0.001). This independent association was remained after multinominal regression analysis (OR: 1,987; 95% CI; 1.69-2.32; p<0.01). Our study demonstrated that serum UA level was significantly associated with the severity and the calcified morphology of CAP detected by MDCT. Further prospective clinical studies are needed to clarify the exact physiopathologic role of UA in CAD.

OP-093 PREDICTIVE VALUE OF FRAGMENTED QRS IN NONISCHEMIC DILATED CARDIOMYOPATHY PATIENTS WHO RECEIVE IMPLANTABLE CARDIOVERTER DEFIBRILLATORS FOR PRIMARY PREVENTION

dialysis ECG was significantly correlated with the ultrafiltration volume (b =0.282, 0.041). Conclusion: Increased dispertion of QTc and P wave may indicate abnormally increased inhomogeneity of electrical activity of myocardium and atrium which could precede sustained arrhythmia. In patients with dialysis, older ages over 40 years and presence of ischemic heart disease may lead increased dispertion of QTc and also probability of ventricular arrhythmia. Additionally usage of Ca antagonists was positively and beta blockers was negatively correlated with QTcd. Positive correlation of Increased P wave dispertion to ultrafiltration volume support the volume overload may increase the tendency to atrial arrhythmia via increase P wave dispertion.

OP-054 THE RELATIONSHIP BETWEEN HSCRP LEVELS AND P WAVE DURATION IN LONE PAROXYSMAL ATRIAL FIBRILLATION PATIENTS

LA thrombus prior to DC cardioversion were identified from our department. A CHA2DS2-VASc score was calculated for each patient. 3D TEE examination were performed for the presence of LA thrombus and LAA volume evaluation. Results: The mean CHA2DS2-VASc score was 3.7±1.5. among 64 patients with nonvalvular atrial fibrillation only 32% had been taken oral anticoagulants. From all patients 81.8% of patients with stroke were under 65 years old. Hypertension was present in 81%, diabetes mellitus in 32%, CAD in 20%, Stroke in 25%, PAH in 12%, and congestive heart failure was present in 21% of patients with AF. The mean LAA volume (3mm) was 9.3±2.6. A significant association was present between CHA2DS2-VASc score and LAA volume (p < 0.001). There were 5 patients with low CHA2DS2VASc score (0–1), 37 patients with intermediate score (2–4), and 22 patients with high (5–9) score. The volume of LAA in low, intermediate and high CHA2DS2-VASc score groups was 8.8±1.1, 8.7±2.3, 10.8±2.6, respectively. Conclusion: High CHA2DS2-VASc score is significantly associated with LAA volume in patients with non valvular AF.

PP-035: CARDIAC MAGNETIC RESONANCE IMAGING FOR DETERMINATION OF VENTRICULER TACHYCARDIA FOCUS

normal left atrium and normal valves with no evidence of stenosis or regurgitation. The patient was discharged on the second day with oral 150mg propafenone twice a day for one week then after oral propafenone treatment was stopped. One week later, he brought to us a similar insect that stung him and this insect was European hornet (Vespa Crabro). Conclusions: Hornet stings have been associated with a wide variety of local and systemic reactions including atrial fibrillation episodes. Clinical condition is usually self-limiting; electrical cardioversion and/or propafenone are successful therapeutic options.

OP-029: EPICARDIAL ADIPOSE TISSUE THICKNESS PREDICTS DESCENDING THORACIC AORTA ATHEROSCLEROSIS SHOWN BY MULTIDETECTOR COMPUTED TOMOGRAPHY

Human epicardial adipose tissue (EAT) is a type of visceral adipose tissue functioning as an endocrine organ by secreting hormones and adipocytokines which have an important role in the atherosclerotic process. In this study, we aimed to assess the relationship between EAT measured by dual source multidetector computed tomography (MDCT) and descending thoracic aorta (DTA) atherosclerosis. A total of 148 patients who underwent MDCT for the evaluation of coronary artery disease were enrolled in this study. Thickness of the EAT was measured on contrast enhanced multiplanar reformat images with parasternal short axis view at basal, mid-ventricular and apical levels and horizontal long axis view. The atherosclerotic plaque was scored from 0 to 4 points by the percentage of the luminal surface at the cross sectional area of proximal, mid and distal segments of descending aorta. Among the study population, 84 (56.8%) were male and age was (mean ± standart deviation) 56.9 ± 11.7 years. In patients with critical coronary atherosclerosis, DTA atherosclerosis had a significant relationship with EAT (P = 0.012). Multivariate linear regression analysis revealed that in addition to critical coronary stenosis, age and total epicardial fat thickness were associated with aortic atherosclerosis (β value, 0.058 and 0.035; t value, 4.74 and 2.28, respectively; P < 0.05) after adjustment for traditional cardiovascular risk factors. In this study we demonstrated that atherosclerotic plaque burden of DTA was associated with the amount of EAT thickness among patients with suspected CAD shown by MDCT. Further large scale prospective studies are needed to address the interaction of EAT as well as the mediators of inflammation and adipocytokines with the development of atherosclerotic plaques in aorta and effects on cardiovascular outcomes.

PP-175 THE IMPORTANCE OF LEFT ATRIAL DIVERTICULUM DURING CATHETER ABLATION FOR ATRIAL FIBRILLATION: A CASE REPORT

Objective: Inappropriate therapy for rhythm other than ventricular fibrillation and sustained ventricular tachycardia is common adverse event associated with ICD implantation. In the absence of damage to leads, electrical interference with ICD devices has rarely been identified as a cause of inappropriate therapy. We report a different case of inappropriate ICD shock which saved the patient from severe electrocution injury initiated by the leakage of alternating current in an external source. Conclusions: In this case the ICD recorded typical electromagnetic interference (EMI) arising from regular 50-Hz alternating current leak. The amount of current flow is the most important factor in deciding the degree of electrical injury, which may range from transient muscle tremors to death. There are some reports about ICD shocks given after EMI, but this is the report of a rare case about an ICD shock that terminated the contact from the source of electric leakage and prevent the patient from damage with electrical injury.

PP-150 PERCUTANEOUS EXTRACTION OF CARDIAC PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LEADS WITH A NEW TOOL; A SINGLE CENTER EXPERIENCE

Methods: A 70 year old man who presented with a history of class II heart failure was found to have a left ventricular pseudoaneurysm. Cardiac magnetic resonance angiography and echocardiography showed a large pseudoaneurysm with a neck of approximately 24 mm, and a high velocity bi-directional jet between the posterolateral wall of the left ventricle (LV) and a vast sump. Hand contrast angiography together with conventional angiography confirmed a communication between the LV cavity and a large false cavity. A trans-septal catheterization was deemed suitable as the delivery catheter length would preclude a femoral arterial approach. Results: A 24 mm Amplatzer sizing balloon was advanced into the pseudoaneurysm cavity which sized the orifice at 22 mm. A 10 French Amplatzer sheath was passed through the defect and a 26 mm Amplatzer septal occluder was deployed across the defect (1F). We noticed a collapse in the center of the discus deployed on the ventricular site suggesting that the design of the device may not be strong enough to withstand the pressure difference. Upon release of the delivery system, the device was dislocated. We attempted to retrieve the device with a snare catheter but we were unsuccessful. Afterwards the patient was given to surgery for device removal, and pseudoaneurysm resection. Unfortunately he died during early post-operative period. Conclusions: The novel and important aspects of our intervention is that a femoral vein approach with trans-septal puncture is safe and effective for percutaneous closure of a left ventricular pseudoaneurysm. We recommend a gentile Minnesota maneuver to be employed just to make sure releasing the delivery system is safe. A different Amplatzer device with a more robust design on one discus, which would be deployed on the ventricular site could be more appropriate for closure of a larger left ventricular pseudoaneurysm.