Byung-Joo Choi

The Potential Utility of Iodinated Contrast Media (ICM) Skin Testing in Patients with ICM Hypersensitivity

Both immediate and delayed hypersensitivity reactions to iodinated contrast media (ICM) are relatively common. However, there are few data to determine the clinical utility of immunologic evaluation of ICM. To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity, 23 patients (17 immediate and 6 delayed reactions) were enrolled from 3 university hospitals in Korea. With 6 commonly used ICM including iopromide, iohexol, ioversol, iomeprol, iopamidol and iodixanol, skin prick (SPT), intradermal (IDT) and patch tests were performed. Of 10 patients with anaphylaxis, 3 (30.0%) and 6 (60.0%) were positive respectively on SPTs and IDTs with the culprit ICM. Three of 6 patients with urticaria showed positive IDTs. In total, 11 (64.7%) had positive on either SPT or IDT. Three of 6 patients with delayed rashes had positive response to patch test and/or delayed IDT. Among 5 patients (3 anaphylaxis, 1 urticaria and 1 delayed rash) taken subsequent radiological examinations, 3 patients administered safe alternatives according to the results of skin testing had no adverse reaction. However, anaphylaxis developed in the other 2 patients administered the culprit ICM again. With 64.7% (11/17) and 50% (3/6) of the sensitivities of corresponding allergic skin tests with culprit ICM for immediate and delayed hypersensitivity reactions, the present study suggests that skin tests is useful for the diagnosis of ICM hypersensitivity and for selecting safe ICM and preventing a recurrence of anaphylaxis caused by the same ICM. Graphical Abstract

Impact of Changes in Myocardial Velocity Assessed by Tissue Doppler Imaging during Exercise on Dynamic Mitral Regurgitation in Patients with Nonischemic Cardiomyopathy

Background: We evaluated the myocardial contractile reserve related to exercise‐induced changes in functional mitral regurgitation (MR) by tissue Doppler imaging (TDI). Methods: Supine bicycle exercise was performed in 35 patients with nonischemic cardiomyopathy (age 51 ± 12 years; EF < 40%) and resting, and peak exercise 2D echocardiographic parameters, and TDI data were obtained. Vavg was defined as the average of peak systolic velocities of six basal LV segments by TDI. Myocardial contractile reserve, which was calculated by [peak exercise Vavg– baseline Vavg], was represented as ΔVavg. Dyssynchrony index was derived from the standard deviation of the time to the peak systolic velocity of 12 LV segments. Results: During exercise (9.7 ± 2.4 minutes), the mean Vavg increased from 4.0 ± 0.8 cm/s to 5.5 ± 1.0 cm/s. The effective regurgitant orifice area (ERO) and the ratio of MR jet area to the left atrial area (JLA%) were 1.9 ± 2.9 mm2 and 12 ± 12%, respectively. During exercise, ERO and JLA% significantly increased to 6.2 ± 6.4 mm2 and 21 ± 13% (P < 0.05), respectively, with individually variable changes. Tenting area was found to be an independent factor that showed a relationship with the baseline severity of MR (r = 0.561, P < 0.001). Dyssynchrony index and ΔVavg were found to correlate with both maximal MR severity at peak exercise and changes in MR during exercise. By multivariate analysis, ΔVavg was found to be an independent determinant of exercise‐induced changes in ERO (ΔERO; r =−0.707, P< 0.001) and changes in JLA% (ΔJLA%; r =−0.663, P< 0.001). Conclusion: In patients with nonischemic cardiomyopathy, impaired contractile reserve assessed by TDI velocity data may be an independent determinant affecting exercise‐induced changes in dynamic MR.

[PP.18.04] PROGRESSION OF LEFT VENTRICULAR HYPERTROPHY AFTER ST-ELEVATION MYOCARDIAL INFARCTION PREDICTS THE RECURRENCE OF MYOCARDIAL INFARCTION

Objective: Left ventricular hypertrophy (LVH) had been associated with increased adverse cardiovascular events. Prognostic significance of progression LVH in patients with ST-elevation myocardial infarction (STEMI) is uncertain. This study aimed to investigate prognostic impact of progression of LV mass in patients with STEMI. Design and method: We analyzed the data and clinical outcomes of patients with STEMI who received successful coronary intervention from 2003 to 2009. We finally enrolled 155 patients (133 males, 56 ± 11 year-old) performed echocardiographic follow-up (F/U) between 12 and 36 months. According to the change in left ventricular mass index (LVMI) compared with baseline LVMI, patients were classified into progression group and non-progression group. Progression of LVMI was defined as increment of LMVI greater than 10% compared with the baseline LVMI. Occurrence of major adverse cardiovascular events (MACE; death, recurrent MI, target vessel revascularization (TVR) within 5 years was evaluated. Results: Progression of LVMI was occurred in 41 patients (31 males, 57 ± 12 year-old). Baseline LVMI was significantly smaller in progression group than in non-progression group (97.1 ± 22.5 vs. 121.5 ± 60.4 g/m2, p < 0.001). Mean changes of LVMI in both groups were 28 ± 14% and −12 ± 15 %, respectively. Occurrence of MACE, death and TVR was similar (27 vs. 20 %, 7 vs.9 %, 15 vs. 11 %, respectively) between both groups. Rate of recurrent MI was significantly higher in progression group than in non-progression group (15 vs. 3 %, p = 0.011). By multivariate logistic regression, initial LVMI (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.000–1.023; p = 0.047] and F/U LVMI (OR, 1.016; 95%CI, 1.000–1.032, p = 0.049) were independent predictors for MACE. Progression of LVMI was only independent predictor of recurrent MI (OR, 6.069; 95% CI, 1.426–25.822, p = 0.015). Conclusions: In present study, progression of LVMI was an independent predictor for adverse events, especially for recurrent MI, in patients with STEMI who received successful coronary intervention.