Pulmonary embolism and cardiovascular diseases

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					E-Communication Session                                                                                                 Room C9c - 10:45-12:45

                                           M ONDAY, S EPTEMBER 14 TH 2009

                                                                    187. Pulmonary embolism and cardiovascular

                                                                  Long term prognosis of pulmonary embolism: a two year follow-up from the
                                                                  master registry
                                                                  Riccardo Pistelli 1 , Sammarro Sandra 2 , Giancarlo Agnelli 3 , Walter Ageno 4 ,
                                                                  Davide Imberti 5 , Marco Moia 6 , Gualtiero Palareti 7 , Melina Verso 3 . 1 Respiratory
                                                                  Physiology, Catholic University, Roma, Italy; 2 Respiratory Disease, Ospedali
                                                                  Riuniti, Trieste, Italy; 3 Internal and Cardiovascular Medicine, University of
                                                                  Perugia, Perugia, Italy; 4 Clinical Medicine, University of Insubria, Varese, Italy;
                                                                    Thrombosis Center, Piacenza Hospital, Piacenza, Italy; 6 Hemophilia and
                                                                  Thrombosis Center, Maggiore Hospital, Milano, Italy; 7 Angiology and
                                                                  Coagulation Unit, University of Bologna, Bologna, Italy

                                                                  Pulmonary Embolism (PE) is a life threatening disease which accounts for a
                                                                  substantial number of deaths in Europe. Usually, death occurs in the acute phase of
                                                                  PE and the long term prognosis of survivors to an episode of PE is not well known.
                                                                  We report here about the final results of a two year follow-up of subjects enrolled in
                                                                  the MASTER registry for an acute episode of Venous Thromboembolism (VTE).
                                                                  From January 2002 to October 2004, 2119 patients were included in the MASTER
                                                                  registry. At entry, the mean patient age was 59.3±18.1 years (range 18-99 years).
                                                                  1541 patients (72.7%) were affected by deep vein thrombosis (DVT), 206 patients
                                                                  (9.7%) by PE and 372 patients (17.5%) by both DVT and PE. 676 patients (31.9%)
                                                                  received home-treatment. 899 patients (42.4%) had one or more temporary risk
                                                                  factors. 381 patients (18.0%) had an already known cancer and in 50 patients
                                                                  (2.4%) a new cancer was discovered at the time of the index event. 311 patients
                                                                  (14.7%) had a previous VTE episode. Overall, 2012 subjects contributed 1397722
                                                                  person-days of follow-up. However, only 1836 (86.6%) subjects had a complete
                                                                  two year follow-up. The survival of subjects affected by PE was compared with
                                                                  the survival of subjects not affected by PE, while adjusting in a Cox model for the
                                                                  following potential confounders: gender, age, date of enrollment, centre, therapy,
                                                                  home-treatment, presence of cancer, previous VTE, characteristics of the index
                                                                  event. The HR of PE was 1.18 (95% CL 0.81-1.71). This result is consistent with
                                                                  some preliminary analysis from the same registry and confirm that the presence
                                                                  of PE does not significantly affect the long term prognosis of subjects affected by

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E-Communication Session                                                                                                                      Room C9c - 10:45-12:45

                                                            M ONDAY, S EPTEMBER 14 TH 2009

E1938                                                                                  Conclusions: Implementation of VTE prophylaxis with LMWH in hospitalized
Venous thromboembolism (VTE) prophylaxis in acute medical admissions to                patients with pneumonia reached 94%. Adherence to ACCP guidelines was com-
a university hospital                                                                  plete in 41% of patients. Prolonged treatment with LMWH was associated with
Julian Kenrick Loh, Owen Lyons, Montasir Bashary, Deirdre O’Riordan. GEMS              non-fatal adverse effects which calls for timely withdrawal of LMWH once not
Directorate, St James Hospital, Dublin, Ireland                                        indicated anymore.

Introduction: VTE is the commonest preventable cause of inpatient mortality.
Despite evidence that clearly demonstrates the role of VTE prophylaxis in reduc-       E1941
ing the incidence of VTE, appropriate prescription rates of prophylaxis generally      Does the introduction of a treatment algorithm reduce the number of CT
remain low. The aim of the study was to assess VTE prophylaxis prescribing             pulmonary angiograms performed for pulmonary embolus (PE)? A
practices in a teaching hospital.                                                      retrospective audit
Methods: Patients admitted medically to this institute over a 28 day period (Dec       Elizabeth Ginn, Jon Goldman. Respiratory Medicine, Torbay Hospital, Torquay,
’08 –Jan ’09) were included. The presence of risk factors for VTE, contraindica-       South Devon, United Kingdom
tions to the use of heparin and prescription of VTE prophylaxis were recorded for
each patient. Patients were excluded if on treatment with warfarin or therapeutic      Introduction & Objectives: In 2007 an algorithm was introduced to guide risk
dose heparin or if admitted to the intensive care unit. Those patients that died or    stratification, imaging modalities and management of PE. It utilised the “modified
were discharged within 48 hours of admission were also excluded.                       Wells score”(MWS) to grade risk regarding subsequent investigations. We aimed
Results: 523 patients were admitted over the 28 day period.149 patients were           to assess the algorithm’s impact on the number of CTPAs performed.
excluded. Of the remaining 374 patients, 283 (76%) were identified as having one        Methods: Medical notes were retrospectively reviewed in all patients referred with
or more risk factors for VTE. Of these, heparin was contraindicated in 18 (6%)         suspected PE over a 5 month period from September 2007. The length of stay, risk
none of whom received mechanical thromboprophylaxis. Of the remaining 265              stratification using the MWS and outcome were recorded.
patients at risk for VTE 104 (39%) were placed on appropriate VTE prophylaxis.         Results: 320 patients were referred with suspected PE. A total of 275 notes were
Conclusions: The low rate of appropriate VTE prophylaxis prescription is of con-       reviewed (45/320 =14% unobtainable). The diagnosis of PE was excluded by
cern given the significant morbidity and mortality associated with VTE in medical       clinical examination and D-dimer in 52 (19%). The remaining 223 were stratified
in-patients. The rate of 39% is significantly lower than national rates for Ireland     into 62 low (28%), 140 intermediate (63%) and 21 high risk (9%).
recently published. Given our findings several steps have been taken to improve         A total of 239 CTPAs and 31 V/Q scans were performed in 5 months with 61
prescribing practice including re-education sessions for admitting physicians and      patients identified with PE (26% positive hit rate). In the low risk group 7 (11%)
a role for the clinical pharmacists in “red-flagging” those patients in whom VTE        were found to have PE, in the intermediate group 44 (31%) and in the high risk
prophylaxis is indicated.                                                              group 9 (43%).
                                                                                       On our unit in 2005, 37 CTPA scans were performed over a 3 month period. 16
                                                                                       PEs were confirmed (hit rate 43%).
E1939                                                                                  Conclusions: A 26% diagnostic rate for PE on CTPA is similar to the PIOPED II
Retrospective evaluation of our pulmonary embolism patients                            study (23%) and the Christopher study (20.4%).
Dilek Kanmaz, Aygün Gür, Esin Yentürk, Gülcihan Özkan, Derya Yenibertiz,               In 2005, 5 PEs per month were diagnosed. In 2008, 12 PEs per month were
Güngör Çamsari, Esin Tuncay, Gülsah Günlüoglu. Chest Diseases, Yedikule                diagnosed - doubling the pick up rate at the expense of performing more CTPA
Training and Research Hospital for Chest Diseases and Surgery, Istanbul, Turkey        scans (2005: 12 CTPA scans per month; 2008: 48 per month).
                                                                                       We conclude that the management algorithm increases the diagnostic rate of PE at
Pulmonary Embolism (PE) is a common condition with high morbidity and                  the expense of increasing the number of CTPAs performed.
mortality that is hard to diagnose. It’s really important to diagnose PE early and
corretly. Therefore in this study we evaluated definitely diagnosed 66 PE patients
symptoms, diagnosis methods, Wells clinical score, risk factors, x-ray findings,        E1942
D-dimer test results were taken into consideration. 26 (%39,4) cases were women        Can we modify the “modified Wells score” to better predict outcome when
and 40 (%60,6) were men. The avarege age was 54,15±17,4 (19-83). The most              managing patients with suspected pulmonary emboli (PE)? A retrospective
common symptom was dyspnea seen in half of the patients (30 (%45,5)). The              review
most common risc factor was immobilization found in 24 of the 66 cases (%36,4).        Elizabeth Ginn, Jon Goldman. Respiratory Medicine, Torbay Hospital, Torquay,
X-ray findings were plate atelectasis in 41 cases (%62,1) D-dimer was high in 56        South Devon, United Kingdom
of 61 cases (%84,8). Doopler ultrasonography was performed in 42 cases and deep
venous trombosis (DVT) was determined in 23 of them (%34). Wells clical score,         Introduction & Objectives: Using the“modified Wells score” (MWS) to guide
which was done to all of the cases, revealed high or medium risc in 62 of the cases    risk stratification, 3 points are given “if PE is as likely, or more likely than alterna-
(%93). Diagnosis was confirmed by V/P scintigraphy in 25 cases (%37,9), spiral          tive diagnosis, taking into account clinical features, chest radiograph and ECG”.
CT in 40 cases (%60) and thorax MRI in one case (%1,5). According to our study,        We were concerned that these points were being manipulated to obtain a CTPA
in pulmonary embolism; the most common symptom is dyspnea, immobilization is           and might not be discriminating in stratifying risk. We review the performance of
the most important risc factor and plate atelectasis is the most common radiological   further modification of the MWS to predict outcome.
finding. Wells clinical score was high or medium in %93 of our cases. In conclusion     Methods: Medical notes were retrospectively reviewed in all patients referred
we think that, because of the absence of any specific finding of pulmonary               to with suspected PE over a 5 month period. The MWS, imaging modality and
embolism that leads to definitive diagnosis, treatment must be started immediately      imaging result were recorded. We then modified the MWS by removing the 3
in the suspicion of PE supported by labaratory findings and clinical score.             points as above and created high and low risk groups with a cut off of 4 points.
                                                                                       Results: 320 patients were referred over the 5 month period with suspected PE.
                                                                                       275 notes were reviewed (45/320 =14% unobtainable).
E1940                                                                                  The diagnosis of PE was excluded by clinical examination and D-dimer in 52
Venous thromboembolism prophylaxis in hospitalized patients with                       (19%). The remaining 223 were stratified according to the MWS into 62 low
pneumonia: a prospective survey                                                        (28%), 140 intermediate (63%) and 21 high risk (9%).
Mitja Kosnk 3 , Petra Jancar 1 , Tina Morgan 1 , Ales Mrhar 2 , Mitja Lainscak 4 .     The diagnostic rate was 11% low risk (0-2 points), 31% intermediate (2-6 points)
  Hospital Pharmacy, University Clinic Golnik, Golnik, Slovenia; 2 Faculty of          and 43% high risk (>6 points).
Pharmacy, University of Ljubljana, Ljubljana, Slovenia; 3 Division of Pulmology,       The modification described placed 56% (124/223) in low risk (12% hit rate) and
University Clinic Golnik, Golnik, Slovenia; 4 Division of Cardiology, University       44% (99/223) in high risk group (46% hit rate). {Sensitivity 76%, specificity 68%,
Clinic Golnik, Golnik, Slovenia                                                        positive predictive power 47% and negative predictive power 88%}.
                                                                                       Conclusions: Our simple manipulation to modify the “modified Wells score” has
Background: Guidelines for venous thromboembolism prevention recognize pneu-           not allowed us to reduce the number of CTPAs performed as the diagnostic rate is
monia and changes in respiratory status as risk factors. There is little data on       similar to prior to the modification.
preventive use of low-molecular-weight heparin (LMWH) in hospitalized patients
with pneumonia.
Methods: We prospectively screened 1067 admissions to our hospital for preven-         E1943
tive use of LMWH according to American College of Chest Physicians (ACCP)              Pulmonary embolism: are there disparities considering different
guidelines. This analysis included patients with pneumonia (N=168, age 74±16           departments?
years, 56% men). Primary and secondary outcome was treatment with LMWH in              Teresa Gómez García, Jorge García Angulo, Javier De Miguel Díez, Elena
eligible patients and LMWH use according to guidelines (daily dose, duration of        Ojeda Castillejo, Marta Fuentes Alonso, Alicia Ferreira Moreno, M. Carmen
treatment).                                                                            Juárez Morales, Cesar Noriega Rocca, J. Luis Serrano Sainz, J.L. Cruz Ramos,
Results: LMWH use was indicated in 126 (75%) patients and 119 (94%) were               Julio Hernández Fernández. Neumología, Hospital general universitario gregorio
actually treated. In 41% of patients treatment was according to the ACCP guide-        marañon, Madrid, Spain
lines. Dose and duration of LMWH treatment was appropriate in 61% and 66%
of patients, respectively. Non-use of LMWHs was not associated with clinical and       Aim: to analyze possible differences in the characteristics of patients diagnosed
demographic characteristics. Adverse effects included bleeding (N=7) and throm-        of pulmonary embolism depending in the different departments’ hospitalization.
bocytopenia (N=2) but were not associated with fatality. Prolonged treatment with      Methods: to evaluate retrospectively all patients diagnosed of PE in a tertiary
LMWH was associated with adverse effects (p<0.05).                                     hospital in 2007. Hospital’s data base includes risk factors, clinical character-

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                                                            M ONDAY, S EPTEMBER 14 TH 2009

istic, diagnostic methods and prescribed treatment, as well as the department         E1946
hospitalization.                                                                      Comparision of the severity of the disease and 4 different clinical scoring
Results: We evaluated 208 patients diagnosed of PE in 2007. The departments hos-      systems in pulmonary embolism
pitalizations were: Pulmonologist (PMN) 27.8%, Internal medicine (IM)53.3%,           Funda Coskun, Dilber Yilmaz, Ahmet Ursavas, Mehmet Karadag, Ercument Ege.
others 18.9%. Patients hospitalized in IM department were significantly older          Chest Disease, Uludag University Medical faculty, Bursa, Turkey
(74.3±15.9 years old in IM vs 67,9±16,1 en PMN; p<0,05). Gasometric pa-
rameters offered no differences. Electrocardiogram showed most frequently sinus       Being suspicious is the first step to put the diagnosis of pulmonary embolism.
tachycardia, and x-ray were most commonly normal. Principal pulmonary arteries        The difficulties during diagnosis give rise to clinical scoring methods that consti-
were affected in 46.9%of the IM patients vs. 94.6% of the PMN (p<0.05). Deep          tude clinic, radiological and laboratory findings of patient. Wells, Geneva, Hyers
vein thrombosis was far less frequent in IM patients (10.9%) vs. 50% PMN. There       and Miniati are the clinical scoring methods which are used during diagnosis
were no differences in treatment.                                                     of pulmonary embolism. The aim of this study was evaluating of relationship
Conclusion: Patients diagnosed of PE in Pulmonologist deparment were compar-          between the pulmonary embolism severity and four clinical scoring methods.
atively younger, had more frequently affected principal pulmonary arteries and        Total 89 patients who had diagnosis of pulmonary embolism was included to
deep vein thrombosis.                                                                 study. The patients who have right ventricular dysfunction on ECHO and hemo-
                                                                                      dynamic instability composed the Group 1 (7M/7W) and others composed the
                                                                                      Group 2 (35M/40W). Mean age was 54±4.5 in Group 1 and 54.8±2.1 in Group
E1944                                                                                 2. There was not significant difference in age and gender between two groups
Characteristics of massive and other than massive embolism patients                   (p>0.05). When patients in Group 1 and 2 was compared according to Wells cri-
Funda Coskun, Dilber Yilmaz, Ahmet Ursavas, Dane Ediger, Ercument Ege.                teria respectively low-intermediate probability was seen in 50%, 74.3% and high
Chest Department, Uludag University, Bursa, Turkey                                    probability 50%, 25.7%; according to Geneva criteria low-intermediate probability
                                                                                      was 92.9%, 82.9% and high probability 7.1%, 17.1%; according to Hyers criteria
Pulmonary embolism (PE) is a disease which have high mortality rates. Man-            low-intermediate was %78.6, %96 and high probability 21.4%, 41.3%; according
agement was done acccording to whether being massive frequently. We aimed to          to Miniati criteria low-intermediate was 78.6%, 96% and high probability 21.4%,
evaluate the characteristics of massive embolism patients and other than massive      4%. When these all scores were evaluated, there was significant difference between
cases. We included 89 pulmonary embolism patients who hospitalised between            Group 1 and 2 only in Miniati scores. So Miniati scoring method was related with
2006-2008. The patents who have right ventricular dysfunction on ECHO and             the severity of disease. These scoring methods are used during diagnosis process
hemodynamic instability composed massive group (Group 1) and others composed          and except Miniati they can not give any opinion about the severity of the disease.
other than massive group (Group 2). Characteristics of two groups can be seen in
Table 1. In Group 1 35.7% and in Group 2 23% of patients had not any risk factor.
The most common risk factors in two groups respectively was immobilization in         E1947
21.4%, 17.6% and operation in 21.4%, 17.6% of patients. Clinical manifestations       Electrocardiographic features and scores in pulmonary embolism
was respectively; hemoptysis in %15.4, 26.1%, dyspnea in 85.7%, 80% and chest         Ozlem Salman Sever 1 , Yasemin Saygideger 1 , Burcu Oktay 1 , Ozlem Karakurt 2 ,
pain in 21.4%, 48% of patients. Deep venous thrombosis was detected in 42.9%          Sadik Ardic 1 . 1 Pulmonary Diseases Department, Ministery of Health Diskapi Y.B
of Group 1 and 42.5% of Group 2 (p>0.05). When scintigraphic findings were             Training and Research Hosbital, Ankara, Turkey; 2 Cardiology Department,
compared in Group 1 high probability were more than low-intermedite probability       Ministery of Health Diskapi Y.B Training and Research Hosbital, Ankara, Turkey
results (p<0.05). As a result, the diagnosis of potentially life-threatening PE was
frequently missed in many patients who subsequently died of the disease without       Aim: To evaluate the diffrences of clinical features and electrocardiographic
receiving appropriate treatment.                                                      findings in pulmonary emboli existing and non-existig patients.
                                                                                      Material and method: Patients who were suspected having pulmonary emboli
Table 1. Characteristics of Group 1 and Group 2                                       inclueded in the study from june to december 2008.The exclusion criteria were
                                     Group 1 (n=14)          Group 2 (n=75)           having any electrolit imbalance and acute coronary syndrome.PE was diagnosed
                                                                                      via of spiral thorax CT, ventilusion/perfusion (V/P) sintigraphy or pulmonary
Age (year)                               54±4.5                 54.8±2.1              angiography.The demographic features,leading symptoms, value of arterial blood
Gender (W/M)                               7/7                   35/40                analysis, D-Dimer levels, Well’ score and ECG sings (heart rate, axes, cQT
pO2 (mmHg)                              72.5±5.9                72.8±2.5              dispersion, P wave dispersion, existence of long QT, ECG score) recorded.
pCO2 (mmHg)                             32.3±1.4                33.9±0.9
                                                                                      Results: 39 patients were inclueded in the study 12 of them PE (-), 27 of all
Heart rate (min)                       108.8±3.3*              99.2±2.1*
                                                                                      PTE(+). None of the patient among PTE(+) were massive PE. 4 (%10) of patients
Systolic BP(mmHg)                       95±7.8*                124±2.3*
Diastolic BP (mmHg)                      61±6*                 77.2±1.5*
                                                                                      had submassive PTE. Demographic features were smilar in both groups. Body
Hospitalisation (days)                   12.7±1                 12.2±0.6              mass index (BMI) was statisticaly higher in PTE(+) group (p=0,047).Shortness of
Breathe per minute                      18.8±1.7                21.9±3.1              breath (%82) and pleuritic chest pain (%26) were the most frequent complaints at
                                                                                      addmision in each groups. Well’s score was statisticaly higher in PTE(+) group.The
                                                                                      estimated ECG signs were not diffrent in both groups.
                                                                                      Conclusion: The ECG sings that were used in the study appeared not to support
                                                                                      PE diagnosis in patients with non massiv pulmonary embolism however significant
                                                                                      results can be obtained in a larger and homogenusly ranged group.
Relationship between severity of disease and D-dimer levels which were
measured with two different methods in pulmonary embolism patients                    E1948
Funda Coskun, Dilber Yilmaz, Ahmet Ursavas, Esra Uzaslan, Ercument Ege.               Prevalence and characteristics of congestive heart failure in elderly patients
Chest Disease, Uludag University, Bursa, Turkey                                       with chronic lung disease
                                                                                      Irina Talysina, Dmitry Preobrazhensky, Boris Sidorenko, Maria Bugrimova.
Pulmonary embolism is diagnosed more day by day because of the developing             Department of Cardiology and Internal Medicine of Federal State Institution
diagnostic methods and being aware of disease. There is tendency to use nonin-        “Educational Scientific Centre”, Presidential Medical Centre, Moscow, Russian
vazive diagnostic methods for all disease. D-dimer is a fibrin degradation product.    Federation
We aimed to detect the relationship between disease severity and D-dimer levels
that was measured with two different methods. We compared D-dimer levels in           Background and methods: Congestive heart failure (CHF) on basis of chronic
massive pulmonary embolism and others. Total 89 patients was included to study        lung disease (CLD) constitutes at least 15% to 20% of all cases of heart failure. We
whose diagnosis was done between 2006 and 2008. Group 1 was obtined from              retrospectively analyzed the prevalence and characteristics of CHF in 180 elderly
the patients whose D-dimer was measured with Immunoturbidimetric polyclonal           patients (pts) with CLD of our community hospital. Mean age of study patients was
antibody method (D-Dimer PLUS® ) and Group 2 with Immunoturbidimetric mon-            69±11years; 49% were women. Of pts studied, 143 (79%) experienced chronic
oclonal antibody method (Innovance D-DIMER® ). In each group, D-dimer levels          obstructive pulmonary disease (COPD) and additional 37 pts had a history of
of massive and others were compared. Mann Whitney U test SPSS 13 was used for         bronchial asthma. Echocardiographic study was performed in 139 (77%) pts, of
statical analysis. Mean age of Group 1 (25W/26M) was 56.0±17.9 and Group 2            which sufficient image quality of left and right hearts for analysis was obtained in
(22W/16M) was 52.9±17.9. There was no statical difference in gender and mean          91% subjects.
age between two groups (p>0.05). Mean D-dimer levels of massive cases (n=7)           Results: CHF was noted in 38% pts with CLD. Its prevalence was not related
was 1444.9±657.9 and others (n=34) was 1304.7±350.5 in Group 1 (p>0.05).              to age and gender. The pts were divided into two groups based the presence or
Mean D-dimer levels of massive cases (n=6) was 9.7±2.2 and others (n=32)              absence of CHF. Compared with subjects with CLD but without CHF patients with
was 5.9±1.3 in Group 2 (p<0.05). Mean D-dimer levels of massive cases whose           CHF had a higher frequency of atrial fibrillation (49% vs 11%; p<0.001),diabetes
D-dimer was measured with monoclonal antibody method was significantly higher.         (24% vs 10%; p<0.05), chronic kidney disease (18% vs 6%; p<0.05). No signif-
As a result D-dimer levels that was measured with monoclonal antibody method          icant differences between groups were found in coronary artery disease, previous
is related to the disease severity. Pulmonary embolism patient whose D-dimer is       myocardial infarction, arterial hypertension, anemia or left ventricular (LV) dimen-
higher the possibility of being massive should kept in mind. Diagnostic procedures    sions and volumes. The pts with CLD and CHF had more right ventricular (RV)
amd management can be planned according to this finding.                               dimension (3.1±0.6 vs 2.7±0.3 cm; p<0.01) and a higher frequency of pulmonary
                                                                                      hypertension (47% vs 10%; p<0.001).
                                                                                      Conclusion: CHF was observed in about 40% hospitalized elderly patients with

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                                                               M ONDAY, S EPTEMBER 14 TH 2009

CLD but without LV systolic dysfunction. In patients with COPD occurrence of                Conclusions: Combination of three above mentioned risk factors occurs relatively
CHF is associated with atrial fibrillation, diabetes and chronic kidney disease as           rarely. Young people having such combination of risk factors require special
well as RV dilatation and pulmonary hypertension.                                           attention as they have increased risk of development of bronchopulmonary and
                                                                                            cardiovascular pathology. Great financial costs will be needed to treat it.

The relationship between chronic obstructive pulmonary disease                              E1952
exacerbations and right ventricular function                                                Medical aspects of the life sick quality of chronic cor pulmonale
Yasin Abul 1 , Sait Karakurt 1 , Ali Serdar Fak 2 , Turgay Celikel 1 . 1 Pulmonary and      Dilorom Rakhimova. Ministry of Health, Republican Specialized Scientific
Critical Care, Marmara University Faculty of Medicine, Istanbul, Turkey;                    Practical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
  Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
                                                                                            In the Republic of Uzbekistan actual problems of treatment in patients with chronic
The prognostic value of right ventricle in acute myocardial infarction and pul-             obstructive lung diseases (COLD) complicated by chronic cor pulmonale (CCP)
monary embolism was shown. The myocardial performance index (MPI)gives                      failure, get to high degree the life quality (LQ).
quantitative information about right ventricular function. Our aim is to study the          Purpose: To study parameters of the life quality in patients with COLD compli-
relation between MPI and disease activity, parameters of respiratory function tests         cated by chronic cor pulmonale failure.
and disease exacerbations in patients with chronic obstructive pulmonary disease            Material and methods: At screening-questioning on the Seattle questionaire were
(COPD), and also to evaluate if MPI is an independent marker of clinical course.21          27 patients. Depending on the level of pulmonary arterial pressure average and
stabile patients with COPD were included in the study. Echocardiographic mea-               the structurally presence of functional changes of right ventriculi (RV) of heart.
surements including pulmonary artery ejection time and right ventricle systolic             All patients are distributed on 2 groups: 1st group - 15 patients with a pulmonary
time were done, and MPI was found. The number of COPD flare ups, the number                  hypertension (PH) and 2nd group - 12 patients with dilatation right ventriculi
of ER or clinical visits, the need for antibiotic treatment, the number of hospital         (DRV) of heart.
admittance in the last year were noted. Pulmonary function tests and staging were           Results: It was established, that parameters of LQ were lowered at all patients with
done. SPSS χ2 test was used for statistical analysis.Right ventricle systolic time as       CCP in comparison with KG. 2nd sick groups were worse adapted for moderate
an indicator of MPI is shorter in patients with COPD exacerbations (419±75.3)               physical activity, and among them is sharp restriction of physical activity. More
compared to patients without disease exacerbations (421±74.1). In addition to this,         often difficulties were authentically observed at walk, that among patients with
MPI is lower in patients with COPD exacerbations (0.44±0.25) than patiens with-             PH was observed authentically less often (P<0,05) accordingly. At patients with
out any exacerbations (0.47±0.22). However there isn’t any statistically significant         DRV emotional distress was shown more expressed by low points of an emotional
difference (p>0.05).MPI may give clinical knowledge about COPD exacerbations.               condition’s estimation, in comparison with patients with PH is established. Patients
Prospective studies with more patients should be done.                                      with DRV authentically had fear of physical activity, more often than patients with
                                                                                            PH (P <0,03). The conclusion. At patients with DRV the expressed depression
                                                                                            of quality life degree becomes more perceptible on an emotional condition and
E1950                                                                                       professional suitability and satisfaction treatment that it is necessary to consider
Pleural NT-PROBNP and albumin gradient (serum-pleural levels difference)                    carrying out of rehabilitational actions.
in patients with exudative pleural effusion (PE) and previous diuretic therapy
Milena Encheva 1 , Kosta Kostov 1 , Dimitar Kalev 2 , Zorka Ramsheva 3 .
  Pulmonary Clinic, Military Medical Academy, Sofia, Bulgaria; 2 Clinic of
Medical Oncology, St. Marina University Hospital, Varma, Bulgaria;
  Department of Clinical Laboratoiy, Military Medical Academy, Sofia, Bulgaria

Background: In the recent papers the measurement of NT-proBNP in the pleural
fluid is accepted as test for differentiation of transudative PE due to congestive heart
failure (CHF). These patients are commonly treated with diuretics. The difference
between the albumin levels in the serum and the pleural fluid (albumin gradient,
AG) is an additional criterion for PE, which seems clinically to transudate, but
has the biochemical characteristics of exudative PE, usually after previous diuretic
Aim: To compare the values of pleural NT-proBNP and AG in exudative PE
considering previous diuretic treatment.
Patients and methods: This is prospective study of 44 patients with exudative
PE (according to Light’s criteria) with different etiology: pneumonia (n=25);
malignancy (n=8); bronchiectasis (n=4); tuberculosis (n=4); pulmonary embolism
(n=3). Sixteen of them were previously treated with diuretics because of presum-
able CHF. Pleural NT-proBNP was measured and AG was calculated. The data
has been statistically analyzed by Student’s t-test, in two groups: with (n=28) and
without diuretics (n=16).
Results: In diuretic treated patient group the mean value of NT-proBNP is sig-
nificantly higher 4054. 94±5858.81 pg/ml vs. 451.47± 658.85 pg/ml in group
without diuretic treatment (t=3.25; p=0.001). Significantly higher is also AG after
diuretic treatment – 14.31±6.19 g/l vs. 9.64± 5.33 g/l (t=2.64; p=0.005).
Conclusion: Our results suggest that previous diuretic therapy in patients with
exudative PE could modify predictive value of pleural NT-proBNP and AG.

Combination of risk factors of bronchopulmonary and cardiovascular
diseases in people of young age
Andrii Sidorov, Nataliya Slepchenko, Yuriy Mostovoy. Chair of Propedeutics of
Internal Medicine, Vinnitsa National Medical University n.a.M.I.Pirogov,
Vinnitsa, Ukraine

Bronchopulmonary and cardiovascular diseases have some common risk factors:
excessive weight, smoking, hypodynamia. Combination of these risk factors in
young people makes preconditions for the development of combined cardiores-
piratory pathology in mature age. The aim of the study was to determine the
prevalence of excessive weight and its association with other risk factors.
Materials and methods: Interviewing and clinical-and-anthropometric examina-
tion of 385 young people (18-25 years old) was performed.
Results: Preobesity was found in 14.3% of young men (BWI=25-29.9 kg/m2 );
I grade obesity – in 2% (BWI=30-34.9 kg/m2 ). Persons having preobesity when
compared with young people with normal weight (BWI=18.5-24.9 kg/m2 ) smoked
more often (32% versus 13%, p<0.05), had burdened family history (56% ver-
sus 41%, p<0.05) and absence of regular physical activity (71% versus 64.3%,
p<0.05). 4.7% of studied persons had combined preobesity/I grade obesity, nicotine
dependence of medium/severe degree and hypodynamia.

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