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Cardiovascular Club I 11:00 AM Saturday, February 11, 2017 Abstracts J Investig Med: first published as 10.1136/jim-2016-000393.1 on 26 January 2017. Downloaded from Cardiovascular Club I Purpose of Study Multiple studies have demonstrated that concentric hypertrophy is associated with higher all-cause 11:00 AM mortality and incidence of cardiovascular death. The elec- Saturday, February 11, 2017 trocardiogram (ECG) is a cost-effective screening tool to help identify patients with left ventricular hypertrophy 1 INFERIOR VENA CAVA FILTER OBSTRUCTION IN (LVH). The objective of this study is to determine if one PATIENTS WITH NON-HEALING VENOUS ULCERS ECG pattern of LVH is more predictive of concentric vs. eccentric hypertrophy. 2 1 1 C Czerwinski, S Attanasio . Swedish Covenant Hospital, Chicago, IL; Methods Used A retrospective analysis of 3,202 patients 2 ’ St.George s University of London, London, United Kingdom. with ECG who presented to an urban medical center 10.1136/jim-2016-000393.1 between January 1, 2014 and June 30, 2015. Of the 1,370 (42.8%) patients with LVH present on ECG, 50 patients Purpose of Study Inferior vena cava filter placement has were randomly selected who had limb lead pattern (RI increased significantly. Risks of filter placement include +SIII>25 mm and RaVL>13 mm) and 50 patients with embolization and thrombosis both leading to obstruction. chest lead pattern (SV1+RV5>35 mm) of LVH. Obstruction of the IVC can lead to central venous hyperten- Echocardiograms of these patients were reviewed to sion with venous ulcers and furthermore is associated with confirm the presence of concentric or eccentric hyper- significant increase in morbidity. Current wound care proto- trophy based on relative wall thickness and left ventricular cols do not include IVC filter obstruction as a cause of mass index. venous ulcer disease. Furthermore, patients with IVC filter Summary of Results Of the 50 patients with limb lead placement have poor follow-up. In the Swedish Covenant pattern of LVH, 40 were found to have LVH on echocar- Hospital Wound Care Center, despite optimal local wound diogram, 2 with eccentric and 38 with concentric hyper- care, patients with central obstruction are difficult to heal and trophy. In the other 50 patients with chest lead pattern, 42 we are now identifying these pateints early using a multidis- patients were found to have LVH on echocardiogram, 11 ciplinary approach involving wound care providers and surgi- with eccentric and 31 with concentric hypertrophy. The cal/endovascular specialists to treat these patients more positive predictive value (PPV) for LVH was 0.80 and 0.84 optimally. in the limb lead and chest lead patterns, respectively. The Methods Used We conducted a review of active patients in PPV of concentric hypertrophy was 0.76 and 0.42 in the the wound care center with slow-healing or non-healing limb and chest lead pattern, respectively. The PPV for venous stasis ulcers. Of these patients who had not responded eccentric hypertrophy was 0.04 and 0.22 in the limb and to conventional therapy and had negative peripheral venous chest lead pattern, respectively. reflux scanning, we identified 10 patients thus far with IVC Conclusions We conclude that the chest lead pattern of filters. We then investigated these patients for filter obstruc- LVH is slightly more predictive of LVH by echocardiog- tion by chart review of imaging including central venography raphy. The limb lead pattern is strongly associated with inclusive of venogram, magnetic resonance venography and concentric hypertrophy and the chest lead pattern is super- CT venography. ior at identifying patients with eccentric hypertrophy. http://jim.bmj.com/ Summary of Results Of the ten patients identified, we Hence, the ECG will identify LVH, but it may not reliably found three patients with complete obstruction of the central identify the pattern of LVH. venous system including the IVC filter. Two patients had intervention to recanalize the IVC, both showing significant healing of their ulcers. The third patient is being followed. The remaining patients were found to have patency of their 3 MODERATE PRE AND POST RENAL DYSFUNCTION filters but partial central venous obstruction of the iliac veins PREDICTS A WORST OUTCOME IN PATIENTS WITH on September 24, 2021 by guest. Protected copyright. due to chronic DVTor iliac vein compression syndromes. HEART TRANSPLANTATION Conclusions Our study demonstrates the need to include W González,1 C García,1 PI Altieri,1,2 HL Banchs,1,2 IF González-Cancel,2 central venous obstuction, including IVC filter obstruction, as R Calderón,1,2 B Colón,1 JJ Nieves,1 N Escobales1. 1University of Puerto Rico, a cause of non-healing venous stasis ulcers. Treatment to Medical Sciences Campus, San Juan, PR; 2Cardiovascular Center of Puerto relieve the obstruction can lead to significant healing. We will Rico and the Caribbean, San Juan, PR. incorporate identification of central obstruction into our pro- 10.1136/jim-2016-000393.3 tocols. We identified patients with IVC filters and non-healing venous ulcers and reviewed not only the natural history, but Purpose of Study It is the purpose of this study to review validated the concept that increased vigilance is needed in fol- the renal function of the transplanted patients (P.) pre and lowing patients with IVC filter placement. post transplantation. Several reports have shown a poor prognosis in P. with heart transplantation who developed moderate renal dysfunction post transplantation. 2 PREDICTION OF ECCENTRIC AND CONCENTRIC Methods Used We reviewed our data and survival of 140 PATTERNS OF HYPERTROPHY BY STANDARD 12-LEAD P.who underwent heart transplants in our institution. ELECTROCARDIOGRAM Summary of Results 72% were males and 28% were females with a mean age of 46 years old. The ischemic MR Heckle, DM Flatt, KT Weber, N Garg. University of Tennessee Health period was 123 minutes. 62 P. developed moderate renal Science Center, Memphis, TN. dysfunction (creatinine >2.5 mg%). We compared the pre- 10.1136/jim-2016-000393.2 operative creatinine (1.83 mg%) with the creatinine at one 396 J Investig Med 2017;65:393–659 Abstracts J Investig Med: first published as 10.1136/jim-2016-000393.1 on 26 January 2017. Downloaded from year. There was an increase from 1.83±10 to 3.35 mg% pathophysiological significance and if they play a causal (P<0.5). The survival rate was from 1 to 5 years. The role in LV dysfunction. deaths were multifactorial, but the renal dysfunction was the culprit. Conclusions The preservation of the renal function during the first year is crucial due to the high comorbidities seen 5 INSULIN-LIKE GROWTH FACTOR I (IGF-1) in this group like diabetes mellitus, hypertension and the SUPPRESSED CHEMOKINES AND MONOCYTES sub-clinical rejection which was low proven by myocardial RECRUITMENT INTO ATHEROSCLEROTIC PLAQUE: biopsies (1 R). Strict control of these comorbidities or NOVEL MECHANISM CONTRIBUTING TO better selections of P. will improve total survival of our IGF-1-INDUCED ATHEROPROTECTION group. S Sukhanov, P Snarski, Y Higashi, P Delafontaine. University of Missouri at Columbia, Columbia, MO. 10.1136/jim-2016-000393.5 Purpose of Study We have shown that IGF-1 decreases 4 LEFT VENTRICULAR FALSE TENDONS ARE plaque macrophages (MF) and reduces atherosclerotic ASSOCIATED WITH LEFT VENTRICULAR DILATION burden in high fat fed Apoe-null mice. We hypothesized AND IMPAIRED LEFT VENTRICULAR SYSTOLIC AND that IGF-1 suppresses recruitment of circulating monocytes DIASTOLIC FUNCTION (MN) into atherosclerotic plaques. ME Hall, JA Halinski, TA Skelton, WF Campbell, MR McMullan, RC Long, Methods Used To quantify MN recruitment into plaques, MN Alexander, JD Pollard, JE Hall, ER Fox, MD Winniford, D Kamimura. Apoe-null mice were fed with a high fat diet for 8 wks, University of Mississippi Medical Center, Jackson, MS. IGF-1 was administrated for 7 d (25 ug/d, i.p) or for 4 wks 10.1136/jim-2016-000393.4 (1.5 mg/kg/d, mini-pumps) and circulating MN were specif- ically labeled by i.v. injection of red latex beads. To assess Purpose of Study Left ventricular false tendons (LVFTs) MN/MF-specific IGF-1 effects we generated scavenger are chord-like structures that traverse the LV cavity and are receptor A-promoter driven IGF-1 overexpressing generally considered to be benign. However, they have Apoe-null mice (SRA mice). been associated with arrhythmias, left ventricular hyper- Summary of Results IGF-1 injection (7 d) reduced levels trophy and LV dilation in some small studies. Our objective of Mac3-positive/red-labeled cells in plaques (IGF-1: 1.05 was to evaluate the relationships of LVFTs with LV struc- ±0.3 cells/plaque vs. control: 1.8±0.2, P<0.05) without tural and functional changes assessed by echocardiography. affecting labeled splenic MN. Similarly, IGF-1 long-term Methods Used We retrospectively evaluated echocardio- administration (4 wks) decreased labeled MF in plaques graphic and clinical parameters of 126 patients identified as (IGF-1: 1.3±0.3 cells/plaque vs. control: 2.6±0.4, having LVFTs within the past 2 years at a large tertiary care P<0.05), indicating that IGF-1 suppressed MN infiltration university medical center and compared them to 85 age into plaques. and sex-matched controls without LVFTs. Peritoneal MF from SRA mice had increased IGF-1 http://jim.bmj.com/ Summary of Results There were no significant differences secretion (52±9% vs. control). High fat diet fed SRA mice in age (52±2 vs 54±2 years), sex (55±5 vs 59±4 % men), had reduced plaque MF levels (Mac3 staining, 27.5±7% race (36 vs 23% white), systolic blood pressure (SBP, 131 decrease), and decreased atherosclerotic burden in both ±2 vs 132±2 mmHg) or body mass index (BMI, 31±1 vs aortic valve (23±6% decrease) and aorta (Enfaceanalysis, 29±1 kg/m2) between controls and patients with LVFTs, 28.4±1.2% decrease).
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