Jaime Alfonso M. Aherrera

Cardiac events occurred commonly among apparently healthy Filipinos with the Brugada ECG pattern in the LIFECARE cohort

Background Brugada syndrome is the mechanism for sudden unexplained death. The Brugada ECG pattern is found in 2% of Filipinos. There is a knowledge gap on the clinical outcome of these individuals. The clinical profile and 5-year cardiac event rate of individuals with the Brugada ECG pattern were determined in this cohort. Methods This is a sub-study of LIFECARE (Life Course Study in Cardiovascular Disease Epidemiology), a community based cohort enrolling healthy individuals 20 to 50 years old conducted in 2009–2010. ECGs of all enrollees were screened independently by three cardiologists. The prevalence of the coved Brugada ECG pattern was ascertained, and the 5-year cardiac event rate was determined among those individuals with this pattern. The participants were contacted to determine the occurrence of cardiac events, which included syncope, presyncope, seizures, cardiac arrest and unexplained vehicular accidents. Results A total of 3072 ECGs were reviewed, and 14 subjects (0.4%) with the coved Brugada ECG pattern were identified. Four had a cardiac event on follow-up at 5 years, but all remained alive. Most of these 14 coved Brugada individuals were healthy and asymptomatic at baseline. Conclusion Cardiac events occurred commonly among initially asymptomatic Filipinos with the coved Brugada ECG pattern. Such patients need to be followed up closely.

A Rare Case of Pneumopericardium in the Setting of Tuberculous Constrictive Pericarditis

A 28-year-old Filipino male was admitted due to high-grade fevers and dyspnea on a background of chronic cough and weight loss. Due to clinical and echocardiographic signs of cardiac tamponade, emergency pericardiocentesis was performed on his first hospital day. Five days after, chest radiographs showed new pockets of radiolucency within the cardiac shadow, indicative of pneumopericardium. On repeat echo, air microbubbles admixed with loculated effusion were visualized in the anterior pericardial space. Constrictive physiology was also supported by a thickened pericardium, septal bounce, exaggerated respiratory variation in AV valve inflow, and IVC plethora. A chest CT scan confirmed the presence of an air-fluid level within the pericardial sac. The patient was started on a quadruple antituberculosis regimen and IV piperacillin-tazobactam to cover for superimposed acute bacterial pericarditis. Pericardiectomy was performed as definitive management, with stripped pericardium measuring 5–7 mm thick and caseous material extracted from the pericardial sac. Histopathology was consistent with tuberculosis. This report highlights pneumopericardium as a rare complication of pericardiocentesis. We focused on the utility of echocardiography for diagnosing and monitoring this condition on a background of tuberculous constrictive pericarditis, ultimately convincing us that pericardiectomy was necessary, instead of the usual conservative measures for pneumopericardium.

PS 08-01 THE NEUTROPHIL-LYMPHOCYTE RATIO (NLR) PREDICTS SEVERITY OF STABLE CORONARY ARTERY DISEASE DETERMINED BY THE SYNTAX SCORE

Objective: The neutrophil-lymphocyte ratio (NLR) is believed to be associated with the complexity of coronary artery disease (CAD). We aim to investigate the association between the NLR and severity of CAD using the SYNTAX scoring system among adult Filipinos. Design and Method: This is a cross-sectional study conducted at a tertiary hospital. The NLR of included patients, taken within 1 week prior to the angiogram, was computed (neutrophil divided by lymphocyte count). After coronary angiogram, the severity of CAD was determined independently, using the SYNTAX scoring system. The primary outcome was presence of severe CAD represented by a SYNTAX score of > 32. Results: A total of 211 patients with a mean age of 57 years were included. Diagnosis after coronary angiogram was 1-Vessel CAD in 64 (30%), 2-Vessel CAD in 34 (16%), and 3-Vessel CAD in 66 (31%). 46 patients (22%) were found to have severe CAD based on a SYNTAX score of > 32. The NLR, neutrophil, and lymphocyte count correlated with SYNTAX score using Pearsons correlation coefficient. The optimal cutoff value of NLR to predict high syntax score is 2.51. On multiple logistic regression, only the NLR (OR 6.98, p < 0.001) and smoking history (5.84, p 0.002) were associated with a SYNTAX score > 32. Conclusions: Among adult Filipinos with angina suspected of CAD, the NLR is a useful, inexpensive tool to predict severity of multi-vessel disease using the SYNTAX scoring system. A cut-off NLR of 2.51 may be used to stratify patients with a high NLR and predict the presence of severe CAD (SYNTAX > 32).

GW25-e0537 Association of the neutrophil–lymphocyte ratio (NLR) with outcomes in patients admitted for an acute coronary syndrome

Patients with documented acute coronary syndromes or ACS exhibit a wide spectrum of early risk of death, ranging from 1 to 10%. An elevated leukocyte count has been identified as an independent predictor of an increased risk for long-term mortality and myocardial infarction. An elevated neutrophil