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ÖKG-Jahrestagung – Abstracts

J KARDIOL 2008; 15 (5–6)

163

Atrial Fibrillation is a Strong and Independent Predic-

tor of Death and Coronary Events in Angiographied

Coronary Patients 025

T. Marte, C. H. Saely, F. Schmid, L. Koch, H. Drexel

VIVIT Institute, Feldkirch

Background The impact of atrial fibrillation on future coronary

events is uncertain. In particular, the prognostic impact of atrial

fibrillation in the clinically important population of angiographied

coronary patients is unknown.

Objective The aim of our study was to investigate 1.) the preva-

lence of atrial fibrillation, 2.) its association with coronary athero-

sclerosis, and, 3.) its impact on future events in angiographied pa-

tients.

Methods In a consecutive series of 613 patients who underwent

coronary angiography we evaluated electrocardiograms. Prospec-

tively, we recorded death and cardiovascular events over 4.0 ± 0.6

years.

Results From our patients, 37 (5.9 %) at baseline had atrial fibril-

lation, and 576 (92.6 %) exhibited sinus rhythm. Presence of atrial

fibrillation was associated with a lower prevalence of coronary

artery disease and of significant coronary stenoses ≥ 50 % at the

baseline angiography. However, prospectively, patients with atrial

fibrillation were at a strongly increased risk of all-cause mortality

(adjusted hazard ratio [HR] = 0.15 [2.36–11.26]; p < 0.001), coro-

nary death (HR = 8.16 [2.89–23.09]; p < 0.001), and major coro-

nary events (HR = 3.80 [1.45–9.94]; p = 0.007).

Conclusions Although inversely associated with the presence of

angiographically determined coronary atherosclerosis, atrial fibril-

lation is a strong predictor of death and future coronary events in

angiographied coronary patients.

Prevalence of Pulmonary Hypertension in Patients

after Splenectomy 067

D. Bonderman, B. Dareb, A. Martischnig, N. Skoro-Sajer, I. M. Lang

Division of Cardiology, Department of Internal Medicine II, Medical University of

Medicine Vienna

Background Patients after splenectomy are at increased risk

of developing chronic thromboembolic pulmonary hypertension

(CTEPH). However, the prevalence of CTEPH among splen-

ectomized individuals is unknown.

Methods In the context of the pulmonary hypertension (PH)

screening program at the Medical University of Vienna, 1100 gen-

eral practitioners and internal medicine specialists in Vienna and

Lower Austria were invited to refer patients (pts) at least one year

after splenectomy. Screening was performed by transthoracic echo-

cardiography with Doppler. In cases of elevated systolic pulmonary

arterial pressure (sPAP > 40 mmHg) and absence of left ventricular

or valvular dysfunction, right heart catheterization was performed.

Results Between November 2006 and October 2007, 91 patients

were referred (50 males/41 females). Mean age was 52.6 ± 14.2

years. Median time since splenectomy was 143 months. Reasons for

splenectomy were trauma (n = 39), hematological disorders (n = 18),

surgical complications (n = 18) and others (n = 16). CTEPH was

newly diagnosed in 4 pts who had suffered from exertional dyspnea.

Conclusion CTEPH was diagnosed in 4.4 % of pts after splen-

ectomy. Echocardiographic screening for CTEPH is useful after

splenectomy, especially in pts with unexplained dyspnea.

The Role of Myeloid Dendritic Cells in Calcific Aortic

Stenosis 068

A. Martischnig, A. Panzenboeck, M. Pfeffer, I. M. Lang, D. Bonderman

Division of Cardiology, Department of Internal Medicine II, Medical University of

Medicine Vienna

Background The degree of valvular calcification predicts disease

progression in calcific aortic stenosis (CAS). Recently, dendritic

cells (DCs) that ingress from circulating blood have been identified

in aortic valves explanted from patients with CAS. We hypoth-

esized that the number of circulating DCs is increased in affected

individuals and correlates with the degree of valvular calcification.

Methods Venous blood and aortic valve tissue were obtained

from 13 otherwise healthy patients undergoing valve replacement

surgery for CAS. Eight healthy individuals served as controls.

Circulating myeloid DCs (mDCs) defined as CD14

–

CD16

–

CD85

CD33

, plasmacytoid DCs (pDCs) defined as CD14

–

CD16

–

CD85

CD123

and respective cytokines, such as interleukin-1,

interleukin-2 and tumor necrosis factor α (TNFα) were analyzed

using 5-color flow cytometry. After explantation, the degree of

aortic valve calcification was quantified by computed tomography

utilizing the Agatston score.

Results Compared with controls, CAS patients displayed higher

numbers of circulating mDCs with increased levels of correspond-

ing cells-bound cytokines interleukin-1 and TNFα. There was a bor-

derline correlation between the number of peripheral blood mDCs

and the Agatston score (ρ = 0.66, p = 0.07).

Conclusion The number of circulating mDCs and corresponding

cell-bound cytokines are increased in CAS and may serve as bio-

markers for calcification and disease progression in affected pa-

tients (Table 6).

Chronic Thromboembolic Pulmonary Hypertension

and Associated Medical Conditions 069

D. Bonderman

, H. Wilkens

, S. Wakounig

H.-J. Schäers

, P. Jansa

, J. Lindner

I. Simkova

, A. Martischnig

, J. Dudczak

, R. Sadushi

, N. Skoro-Sajer

W. Klepetko

, I. M. Lang

Division of Cardiology;

Core Unit for Medical Statistics and Informatics;

Division

of Cardiothoracic Surgery, Vienna General Hospital, Medical University of Vienna,

Austria;

Cardiology Clinic, National Institute for Cardiovascular Diseases, Medical

University of Slowakia, Internal Medicine V, Slowakia;

University Hospital of

Saarland, Pneumology, Allergology, and Environmental Medicine, Germany;

Department of Thoracic and Cardiovascular Surgery, Homburg/Saar, Germany;

General Teaching Hospital, 2

Medical Department-Clinical Department of

Cardiology and Angiology;

General Teaching Hospital, 2

Surgical Department-

Clinical Department of Cardiovascular Surgery, Prague, Czech Republic

Rationale CTEPH is characterized by nonresolving pulmonary

thromboemboli. Although traditional thrombosis risk factors are

generally absent, specific CTEPH-predisposing medical conditions,

such as splenectomy, ventriculo-atrial (VA-) shunt and certain in-

flammatory disorders have been identified.

Objective We sought to confirm known and to identify novel

CTEPH risk factors in a large cohort of prevalent CTEPH cases col-

lected in 3 European centers offering pulmonary endarterectomy.

Methods and Measurements Data from CTEPH patients were

compared with pulmonary arterial hypertension cohorts at the par-

ticipating institutions utilizing logistic regression analysis.

Main Results The study population comprised 585 patients

assessed at the time of diagnosis between 1996 and 2007. Among

401 patients with CTEPH were 53 % females, mean age was 56 ± 14

years and the median (lower quartile, upper quartile) pulmonary

vascular resistance was 822 (571, 1095) dynes.s.cm-5. Data con-

firmed that patients with VA-shunts and patients with infected

Table 6: A. Martischnig et al.

Parameter Patients Controls p-value

(n = 13) (n = 8)

Age (years) 72.8 ± 8.4 54.4 ± 18.7 0.023

Sex (male) 4 4 0.239

mDCs (%) 0.19 ± 0.07 0.10 ± 0.52 0.012

pDC (%) 0.97 ± 0.10 0.06 ± 0.03 0.282

TNF-alpha (%) 53.73 ± 13.06 32.76 ± 24.07 0.048

IL1-beta (%) 52.90 ± 4.94 41.93 ± 23.37 0.478

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