The utility of B-type natriuretic peptide in differentiating decompensated heart failure from lung disease in patients presenting to the emergency department with dyspnea

Campos A, Mesquita, Villacorta H, Duarte N, Mesquita Et

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• Publié par: biomed
• Publié le: 01 janvier 2003
• Nombre de lectures: 9
• Langue: English

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Critical Care Volume 7 Suppl 3, 2003 Second International Symposium on Intensive Care and Emergency Medicine for Latin America São Paulo, Brazil, 25–28 June 2003

Published online: 25 June 2003 These abstracts are online at http://ccforum.com/supplements/7/S3 © 2003 BioMed Central Ltd (Print ISSN 13648535; Online ISSN 1466609X)

CARDIOLOGY P1 Impactof peroperative administration of steroid over inflammatory response and pulmonary dysfunction following cardiac surgery 1,2 11 11 22 2 HTF Mendonça Filho, LAA Campos, RV Gomes, FES Fagundes, EM Nunes, R Gomes, F Bozza, PT Bozza, 2 HC CastroFariaNeto 1 Surgical Intensive Care Unit, Hospital PróCardíaco, Rio de Janeiro, RJ, Brazil; 2 Laboratory of Immunopharmacology, Department of Pharmacodymamics, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P1 (DOI 10.1186/cc2197) IntroductionCardiac surgery with cardiopulmonary bypass (CPB)NS (nMIF circulating levels were assayed at the anesthesia= 37). is a recognized trigger of systemic inflammatory response, usuallyinduction, 3, 6, and 24 hours after CPB. A standard weaning proto related to postoperative acute lung injury (ALI). As an attempt tocol with fast track strategy was adopted, and indicators of organ dampen inflammatory response, steroids have been perioperativelydysfunction and therapeutic intervention were registered during the administered to patients. Macrophage migration inhibitory factorfirst 72hours postoperative. (MIF), a regulator of the endotoxin receptor, is implicated in the pathogenesis of ALI. We have previously detected peak circulatingResultshours post CPB correlatedLevels of MIF assayed 6 levels of MIF, 6hours post CPB. Experimental data have showndirectly to the postoperative duration of mechanical ventilation that steroids may induce MIF secretion by mononuclear cells. This(P/FiO ratioand inversely to PaOrho = 0.282)= 0.014, 2 2 study aims to correlate levels of MIF assayed 6 hours post CPB to(PNo difference in MIF levels was noted= 0.0021,rho = –0.265). the intensity of postoperative pulmonary dysfunction, analysing thebetween the groups. The duration of mechanical ventilation was impact of perioperative steroid administration.higher (Pin the group MP (7.92= 0.005)compared± 6.0 hours), with the group NS (4.92± 3.6 hours). MethodsWe included patients submitted to cardiac surgery with CPB, electively started in the morning, performed by the sameConclusionCirculating levels of MIF assayed 6hours post CPB are team under a standard technique except for the addition of methylcorrelated to postoperative pulmonary performance. Immunosup prednisolone (15mg/kg) to the CPB priming solution for patientspressive doses of methylprednisolone did not affect circulating levels from group MP (nbut not for the remaining patients — groupof MIF and may be related to prolonged mechanical ventilation.= 37), P2 Immediateand shortterm safety of catheterbased autologous bone marrowderived mononuclear cell transplantation into myocardium of patients with severe ischemic heart failure 1,2 11 11 1 11 1 HF Dohmann, E Perin, A Sousa, SA Silva, C Gonzáles, C Falcão, R Verney, L Belém, H Dohmann 1 2 Hospital PróCardíaco, Rio de Janeiro, RJ, Brazil;Texas Heart Institute, 6770 Bertner Avenue, Houston, TX 77030, USA Critical Care2003,7(Suppl 3):P2 (DOI 10.1186/cc2198) BackgroundBone marrowderived mononuclear cell (BMMNC)ventricular contractions (PVC) and QT dispersion using a 24hour transplantation into the myocardium has been proposed as a newHolter test at baseline, immediately after the procedure and then therapy for ischemic heart failure (HF). Successful cellular therapyafter 8weeks. Perfusion tests to quantify the left ventricular (LV) for HF using myoblast transplantation has been reported previouslyischemic mass and echocardiograms to evaluate the ejection frac but malignant arrhythmias (MA) were an issue. We investigated thetion (EF) were performed at baseline and then repeated at safety of BMMNC transplantation into the myocardium for MA.8 weeks. MethodsA prospective study to evaluate the safety of autologousResultsFourteen patients (12 males, 56.9± 10 years)with severe BMMNC transplantation in patients with severe ischemic HF notHF (LVEF 30 ± 6%)were enrolled. All patients had triplevessel amenable to myocardial revascularization was conducted. Bonedisease and 64% had previous myocardial revascularization. A 6 marrow was harvested from the iliac crest and BMMNCs weretotal of 30× 10BMMNC were injected at 15sites. All patients selected by Ficoll gradient. Hibernating myocardium areas werewere discharged from hospital 48hours after the procedure. The targeted using electromechanical mapping in catheterbasedestimated LV ischemic area on MIBI SPECT was measured by per subendocardial injections (MyoStar, Cordis, Miami Lakes, FL,centual of myocardial defect reverse, 14.8± 15%of LV mass at USA). All patients were evaluated for MA, number of prematurebaseline that was reduced to 5± 11%(Pat 8 weeks after= 0.009) S1

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procedure. EF increased 16% (Pat 8 weeks. The number of= 0.03)ConclusionBMMNC transplantation into myocardium of patients PVC was reduced at 24hours (483± 4598versus 236± 6243,with severe heart failure was safely performed and short term P= notsignificant) and at 8 weeks (483versus 191± 4598followup suggests electrical stability as observed by a decrease in± 1236, P= nothours or atsignificant). No MA were documented at 24the QT dispersion, maintenance in the number of PVC and an 8 weeks.QT dispersion decreased from 63± 24 msat baseline toabsence of MA. Possible mechanisms may be due to ischemic LV 54 ± 16 ms(Pat 2 months of followup.mass reduction and improvement in myocardium contractility.= 0.3) P3 Clinicalimprovement after autologous bone marrow mononuclear cell transplantation 1,2 11 1 11 11 11 HF Dohmann, E Perin, SA Silva, A Sousa, L Belém, A Rabichovisky, F Rangel, R Esporcatte, LA Campos, H Dohmann 1 2 Hospital PróCardíaco, Rio de Janeiro, RJ, Brazil;Texas Heart Institute, 6770 Bertner Avenue, Houston, TX 77030, USA Critical Care2003,7(Suppl 3):P3 (DOI 10.1186/cc2199) BackgroundOur group and others have reported symptoms,ResultsAll 14 patients (two females, 57 ± 10 years old) had multi myocardial perfusion and mechanical improvements with bonevessel disease and previous myocardial infarction. The patients marrow mononuclear cell (BMMNC) transplantation into areas ofpresented a significant 73% reduction in total reversibility defect hibernating myocardial in end stage ischemic heart disease (ESIHD)(P= 0.022,in an 8 weekto 4.53± 10.61%)from 15.15± 14.99% patients. However, there is no information about the course of thesefollowup. The NYHA class were 2.21± 0.89at baseline and improvements during time. We evaluated, week by week, the improveimproved to 1.14± 0.36at 8weeks (P= 0.0003).The CCS ments in New York Heart Association (NYHA) functional class, CCSangina class were 2.64± 0.84at baseline and improved to angina class and ejection fraction (EF) by echocardiography in ESIHD 1.28 ± 0.61(P± 5%The EF moved from 30= 0.0001).at the patients to BMMNC transendocardial delivery.baseline to 35± 7%at 8 weeks (P= 0.02).We obtained a signifi cant improvement of NYHA at the fourth week (P= 0.0002)and MethodsIn 14 patients, bone marrow was harvested from iliac for CCS at the seventh week (PConcomitantly we= 0.000006). crest and BMMNCs were selected by Ficoll gradient. Endocardialobserved a significant improvement in EF by echo between the injections targeting hibernated myocardial areas were performedsixth and eighth weeks (P= 0.04). utilizing electromechanical mapping (MyoStar, Cordis, Miami Lakes, FL, USA). At baseline and during a followup of 10weeks the patients were evaluated about their NYHA functional class,ConclusionThese preliminary data suggest a time window for clin CCS angina class, and EF by echo (Simpson). Ischemic area was ical, functional and myocardial perfusion improvements with evaluated by SPECTMIBI (Siemens ICON workstation) before andBMMNC transplantation during the second month of followup. 8 weeksafter BMMNC transplantation. The statistical analysisThis data, if confirmed in more powerful studies, may be useful for used for comparisons between baseline and 8 weeks was analysis informing patients submitted to BMMNC transplantation to hiber of variance, and that for evaluation of peak of improvements duringnating myocardial areas, as well as to identify the major mechanism time was a generalized linear model with time strata.involved in this approach. P4 Primaryangioplasty in a public hospital: initial results MA Mattos, DG Toledo, CE Mattos, RA Abitbol, MHV Assad, BR Tura, OS Oliveira Instituto Nacional de Cardiologia Laranjeiras, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P4 (DOI 10.1186/cc2200) BackgroundMany studies in the literature show that primaryof symptom onset. Of these patients, the mean age was 61 years. angioplasty is the best method for myocardial reperfusion.Males comprised 56.1% (31).

Traditional risk factors prevalence were 17.5% for diabetes melli ObjectivesThe aim of the study was to evaluate the angiographic tus, 73.7% for hypertension, 43.9% for current smoker, 52.6% and clinical results of primary angioplasty in patients with acute hypercholesterolemia and 56.1% for family history of CAD. Of the myocardial infarction (AMI). patients, 31.5% had a history of myocardial infarction. Anterior wall AMI occurred in 35patients and inferior in22. Of the MethodsWe prospectively studied 1055 patients with AMI, in apatients, 54.4% were submitted to direct angioplasty within coronary unit care, from March 1994 to March 2003. The angio12 hoursfrom symptom onset, the ejection fraction mean was graphic successful of revascularization was defined as a reduction56.8 ± 11.9%,and infarctrelated artery was descendent anterior of at least 20 percent points in the stenosis of at least one lesion,in 49.1% and right coronary in 38.6%. The extent of CAD was resulting in a residual stenosis of less than 50% of the luminalone vessel in 48.1% and three vessels in 15.8%. Angiographic diameter and Thrombolysis in Myocardial Infarction 3 flow. Clinicalsuccessful was demonstrated in 45 patients (81.8%) with stent successful was defined as angiographic successful without inhosimplantation in 61.4%, reinfarction in 3.51%, repeated percuta pital complications of death, reinfarction, repeated percutaneousneous procedure in 7%, CABG in 1.8% and mortality was 12.3% procedure, or referral for coronary artery bypass graft (CABG)(included five patients in cardiogenic shock). The clinical success surgery. For statistical analyse were used chisquare analyses orwas 75.5%. Fisher’s exact test and Student’sttest. ConclusionWe demonstrated good results of direct angio ResultsBetween March 1994 and March 2003, 1055 consecuplasty with the greatest mortality because of previous infarction, tive patients with AMI were hospitalized and 57 were referred tocardiogenic shock and the time from symptom onset to angio S2 plasty.our catheterization laboratory for direct angioplasty within 12 hours

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P5 Shouldleft ventricular failure be part of the risk score in acute ischemic syndrome without ST elevation? 1,2 1,2 M Araujo, ET Mesquita 1 2 Universidade Federal Fluminense, Niteroi, RJ, Brazil;Hospital PróCardíaco, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P5 (DOI 10.1186/cc2201) BackgroundFor the identification of cardiac prognostic risk Table 1 markers in the emergency room, in patients with ischemic heart syndrome without ST elevation, it is important to choose the best Standard and the most costeffective therapeutic strategy. Variable CoefficienterrorPvalueCstatistic Clinic LVF166.3 0.7130.012 0.66 GoalTo evaluate the prognostic impact of left ventricular failure (LVF) in patients with acute ischemic syndrome without ST segment elevation.

MethodsIncluded were 124 patients, most of them male (58%), with average age of 68.9± 12.3 years.A total of 8.9% had clinical LVF symptoms at admission, and 17.7% had events in the follow ing 180 days.

ResultsLVF was present in 41.7% of the patients with com bined events and only in 13.9% of patients without ischemic events.

Comparing the LVF group and the without LVF group in their admission we observed a grater prevalence of events (P= 0.02)

in the first group, relative risk= 3.16(95% confidence interval = 2.28–4.04).The positive Likelihood ratio was 4.28 and the negative Likelihood ratio was 0.8. In this multivariate analy sis, LVF (Pwas the only independent predictor of= 0.012) events.

ConclusionEvaluating the presence of clinical LVF is a main factor in the risk stratification of patients with acute ischemic syndrome without ST segment elevation.

P6 Identificationof subgroups of greater mortality in patients undergoing surgical cardiac valve replacement based on preoperative, perioperative, and postoperative variables RV Gomes, J Oscar Fº, B Tura, RS Vegni, C Weksler, LAA Campos, MAO Fernandes, PMM Nogueira, R Farina, HJF Dohmann Hospital PróCardíaco, Rio de Janeiro, RJ, Brazil and Instituto Nacional de Cardiologia Laranjeiras, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P6 (DOI 10.1186/cc2202) BackgroundThe identification of a subgroup with greater mortalitywhich were correlated with HM. A classification and regression among patients undergoing surgical cardiac valve replacementtree (CART; using the Gini index with a FACT stop rule of 0.10 and (SCVR) may prevent inadequate management and also identifyequal priori) was created and followed by pruning based on mis subgroups requiring review of the therapeutic strategies in surgicalclassification and crossvalidation. intensive care units (SICU). ResultsBased on CART, eight relevant variables were selected. ObjectivesThe model had an accuracy of 81.33, sensitivity of 95%, andTo define the inhospital mortality (HM) on the first post operative day (FPOD) using preoperative (PREOP), perioperativespecificity of 80% for HM prediction. (PEROP), and FPOD variables. ConclusionsCART may provide interesting solutions regarding the Case series and methodsA classical cohort with data consecumanagement of patients in the postoperative period of SCVR. Vari tively collected at a public SICU (A, 326 patients) from Januaryables: FPOD SOFA score, PEROP fluid balance, FPOD epinephrine 2001 to February 2003, and at a private SICU (B, 121 patients)> 0.1or norepinephrine >0.1, patient’s sex, left atrial length on from June 2000 to February 2003. All 46 variables were previouslyECHO, alveoloarterial Otension gradient >250, PREOP creatinine, 2 defined according to the major prognostic indices in the literature,body mass index <20.

P7 Endocardialdelivery of bone marrowderived mononuclear cells (BMMCs) in patients with severe ischemic heart failure HF Dohmann, E Perin, A Sousa, SA Silva, R Borojevic, MI Rossi, LA Carvalho, R Verney, N Mattos, H Dohmann Hospital PróCardíaco/Universidade Federal do Rio de Janeiro, Rio de Janiero, RJ, Brazil Critical Care2003,7(Suppl 3):P7 (DOI 10.1186/cc2203) BackgroundIntramyocardial injections of BMMCs have shownMethodsFourteen patients with endstage ischemic heart failure promising initial results regarding improvement in myocardial(mean ejection fraction [EF]= 20%)were submitted to endocardial ischemia. Experimental models have depicted the potential ofBMMC injections at targeted hibernated segments utilizing electro some cell phenotypes in differentiating into blood vessels. BMMCsmechanical mapping (MyoStar, Cordis, Miami Lakes, FL, USA). are a heterogeneous cell subpopulation group and the individualBMMCs phenotypes were determined utilizing flow cytometry contribution of each cell subpopulation to favorable clinical out(CD3, CD4, CD8, CD14, CD19, CD34, CD45, CD56 and comes remains unclear.HLADR). Clonogenic assays for fibroblast and granulocyte S3

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macrophage colony forming units (CFUF and CFUGM) was also Table 1 2 performed. We correlated the density (cells/mm , area determined by the Noga system) of each injected cell phenotype with the total Cell typeP RCell typeP R reversibility defect (objectively quantified by ICON workstation; + Total cells0.6 0.1CD19 0.60.1 Siemens) using exact Pearson moment correlation. + lo+ CD34 CD450.9 0.02CD14 0.20.3 ResultsAll 14 patients (2 females, 57old) had multivessel± 10 years + –+ disease and previous myocardial infarction. Cell viability analysis was CD34 HLADR0.6 0.1CD56 0.50.1 greater than 90% (96.2± 4.9%).There was a significant reduction in + + CD3 CD40.8 0.04CFUF 0.0330.6 total reversibility defect (from 15.15± 14.99%to 4.53± 10.61%, + + P= 0.022).Within the phenotypes studied, the only one that had a CD3 CD80.9 –0.01 significant correlation with the improvement in myocardial perfusion was the density of the CFUF subpopulation (P= 0.033,R= 0.6). ConclusionWithin the limits of the studied group, these data high light the relevance of quantitative cell phenotype analysis aimed toclinical improvement. The benefit of selection and/or expansion of identify the subpopulations that could play a major role to obtainBMMC subpopulations should be addressed by future studies. P8 Clinicalpresentation of patients with chest pain and acute aortic dissection admitted in the chest pain unit CM Clare, ET Mesquita, FM Albanesi Fo, M Scofano, H Villacorta Hospital PróCardíaco — PROCEP/UERJ, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P8 (DOI 10.1186/cc2204) BackgroundChest pain (CP) is one of the most common symptomscommon symptom presented in 28(82.4%) patients, and 75% of of presentation in emergency rooms around the world. Althoughthese were of type A dissection. The most common site of pain was uncommon, acute aortic dissection (AAD) is a lifethreatening medicalthe anterior chest, occurring in 82.2% of the patients with a preva emergency that is difficult to diagnose and so requires a high clinicallence of precordial CP in typeA dissection (P= 0.065).Back pain index of suspicion. The objective was to evaluate the characteristicswas observed only in 21.4% of the cases. The tearing and ripping of CP in patients with AAD admitted in a chest pain unit (CPU).pain was not described and the constrictive quality of pain was most described in typeA dissection (90%). The radiated pain was Patients and methodsshown in 82.3% of patients, with most frequency for the backWe evaluated in a crosssectional and prospective study patients admitted in a CPU, between March(42.9%). Associated with CP, syncope was observed in two 1997 and May 2001, with diagnosis of AAD. The authors carriedpatients (11.1%), everybody of typeA dissection, and disturbance out a descriptive analysis in the sample and they compared theof conscience and seizures in four patients (22.2%). proportions of the categorical variables between the types A and B (Fisher Test). Values ofPwere considered significant.< 0.05ConclusionsThe typical characteristics of CP as described in the past was less frequent. A meticulous medical history and clinical Resultsexamination must be carried out to increase clinical suspicion.Were evaluated 34 patients with diagnosisconfirmed AAD, 26 (76.5%)being of typeA and eight (23.5%) of typeB Stanford.Although CP is the most common symptom, syncope and distur Eighteen patients (52.9%) were male and 33 (97.1%) were blacks,bance of conscience should be valued, mainly when associated presenting an average age of 63.5± 13.5 years.CP was the most with the CP. P9 Prognosticimpact of troponin >0.2 µ g/ml and <0.5 µ g/m in UA/NSTIMI S Gomes de Sá, G Nobre, C Vilela Coronary Unit, Rio Mar Hospital, Av. Cândido Portinari 555, Barra da Tijuca, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P9 (DOI 10.1186/cc2205) Objectiveold (± 13 yearsTo evaluate the risk of coronary events in patients withwhile in group II the patients were 58.9P< 0.0003); troponin levels >0.2µg/ml and <0.5µI was 88.7%× 21.4%in groupIIg/ml. invasivetreatment, group (Pvessel obstruction, left anterior descending artery in< 0.002); MethodsII was 21% (was 91% and in groupgroup IFrom June 2000 to October 2002 we selected patientsP< 0.001);and right with UA/NSTIMI and divided them in two groups as follows:coronary artery, group I was 52% and group II was 4.2% (P< 0.001). group I, composed of 90 patients with troponin levels between 0.2 and 0.5µg/ml, measured at the first 24hours in the hospital; andWhile in hospital there were no significant differences in mortality group II, composed of 98 patients with a troponin level < 0.2µthe groups, there were much more refractory cardiac eventsg/ml. between We excluded all patients with a troponin level >0.5µg/ml. We anain group I (12.2%) versus group II (1%) (P< 0.001),and left ventricu lyzed the clinical results while in hospital and after the firstlar dysfunction was 10% in group I versus 1% in group II (P< 0.02). 6 months. At 6months, the global mortality was greater in groupI (12%) Resultsversus 5% in group II (There were no differences between the groups with regardP< 0.02). to sex, risk factors and antiischemic drugs used while in the hospital. However, there were important differences in some aspects as weConclusionPatients with AU/NSTIMI with troponin levels more S4 I (65.6will show: age, older patients belonged to groupthan 0.2± 12 years)µg/ml had more risk of death in 6 months.

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P10 Clinicalsecurity with association of four antithrombotic drugs in the treatment of UA/NSTEMI: experience of our unit

S Gomes de Sá, G Nobre, C Vilela Rio Mar Hospital, Av. Cândido Portinari 555, Barra da Tijuca, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P10 (DOI 10.1186/cc2206)

ObjectiveTo evaluate the clinical security of four antithromboticResultsThere were no significant difference between the groups drugs in association.with regard to sex, risk factors, antiischemic drugs and the number of obstructed vessels or bleeding events in the 30days following the beginning of the protocol. However, there were important dif MethodsFrom April 2000 to December 2002 we followed 287± 11 yearsferences with regard to the following: level of age, 57.4 patients with acute coronary syndrome (UA/NSTEMI), and dividedfor groupI and 64.1± 13 yearsfor groupII (Ptroponin< 0.001); them in two groups: group I (90 patients), at least 20% older thanelevation, 88.9% in groupI and 56.8% in groupII (P< 0.001); 70 years,who used the association of enoxiparin + aspirin +ST–T wave abnormality, 41.2% in groupI and 17.8% in groupII clopidogrel + glycoprotein IIb/IIIa inhibitor; groupII (remaining(P< 0.001);and treatment with angioplasty or surgery, 91.1% for patients), who used enoxiparin + aspirin with or without clopidogrel.group I and 61.7% for group II (P< 0.0001). ConclusionsIn our experience, the association of four antithrom We monitored the frequency of bleeding while in hospital and afterbotic drugs was shown to be safe, and the association of tirofiban 30 days as shown in TIMI (Ann Int Medenoxiparin did not lead to more bleeding events.1991). and P11 AdmissionalBtype natriuretic peptide is an independent predictor of outcome in patients with decompensated heart failure H Villacorta, M Vinícius Martins, E Tinoco, HJF Dohmann Hospital PróCardíaco, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P11 (DOI 10.1186/cc2207) BackgroundBtype natriuretic peptide (BNP) is a neurohormonefraction, serum sodium, C reactive protein, cardiothorax ratio, and secreted mainly by the cardiac ventricles in response to volumeBNP. The receiver operating characteristic curve was used to and pressure overload and is increased in patients with congestivedetermine the best cutoff value to predict worse outcome. heart failure (CHF), especially in those with more severe disease. The aim of this study was to determine the prognostic value of the ResultsDuring the study 29endpoints occurred (six hospital admissional BNP measurement in patients who present to the deaths, six deaths during the 30day followup and 17CHF re emergency department (ED) with decompensated CHF. admissions). BNP concentrations were higher in patients who had an adverse event than in those who did not (952± 440vs MethodsFrom April 2001 through January 2002, 70 patients 679 ± 456 pg/ml,P= 0.012).The independent predictors of were admitted to an ED with decompensated CHF. Mean age adverse outcomes were BNP (P= 0.012;Cmeanstatistic = 0.77), was 77± 12 yearsand 37 (53%) were male. BNP was measured blood pressure (P= 0.019)and heart rate (PBNP con= 0.034). in all patients during admission using a rapid bedside test centrations≥960 pg/mlhad sensibility of 70.2% and specificity of (Triage, Biosite, San Diego, CA, USA). We sought to determine 69% in predicting an adverse outcome. the utility of BNP in predicting the following combined endpoint: hospital mortality +30day mortality or readmission. The utility of BNP in predicting outcome was assessed using multivariateConclusionAdmissional BNP measurement in patients who logistic regression. The independent variables analysed in thepresent to the ED with decompensated CHF is useful in predicting model were age, sex, mean blood pressure, heart rate, ejectionshortterm outcomes. P12 Transendocardial,autologous bonemarrow cell transplant in severe, chronic ischemic heart failure 1,2 11 11 11 11 1 HF Dohman, E Perin, A Sousa, SA Silva, C Tinoco, R Esporcatte, F Rangel, LA Campos, MA Fernandes, H Dohmann 1 2 Hospital PróCardíaco, Rio de Janeiro, RJ, Brazil;Texas Heart Institute, 6770 Bertner Avenue, Houston, TX 77030, USA Critical Care2003,7(Suppl 3):P12 (DOI 10.1186/cc2208) 3 Backgroundcm ). Electroinjections of 0.2for injection by NOGA catheter (15This study evaluated the hypothesis that transendo cardial injections of autologous mononuclear bonemarrow cellsmechanical mapping (EMM) was used to identify viable myocardium in patients with endstage ischemic heart disease could promote(unipolar voltage≥for treatment. Patients underwent6.9 mV) neovascularization and improve perfusion and myocardial2month noninvasive and 4month invasive (treatment group only) fol contractility. lowupusing standard protocols and the same procedures as base line. Patient population demographics and exercise test variables did Methods and resultsnot differ significantly between the treatment and control groups;Twentyone patients were enrolled into this prospective, nonrandomized, openlabel, controlled study (first 14,only creatinine and BNP levels varied in laboratory evaluations. At treatment; last seven, control). Baseline evaluations included com2 months, there was a significant reduction in total reversible defect plete clinical and laboratory evaluations, exercise stress (ramp treadwithin the treatment group and between the treatment and control mill), twodimensional Doppler echocardiogram, SPECT perfusion groups (Pmonths,= 0.02)on quantitative SPECT analysis. At 4 scan, and 24hour Holter monitoring. Bonemarrow mononuclearthere was improvement in ejection fraction from a baseline of 20% to cells were harvested, isolated, washed, and resuspended in saline29% (P= 0.003)and a reduction in ESV (Pin the treated= 0.03) S5

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patients. EMM revealed significant mechanical improvement of the injected segments (P< 0.0005).

ConclusionsIn patients with chronic, ischemic heart failure, EMM technology was used to target viable, hibernating myocardium for transendocardial delivery of autologous bonemarrow mononuclear cells. At followup, treated patients had significantly improved myocardial perfusion and contractility.

P13 Epidemiologicprofile and clinical followup of a population with acute atrial fibrillation and age <60 yearsold in the emergency room

AI Costa, C Perez, M Scofano, H Villacota, M Tinoco PróCardíaco Hospital, Rio de Janiero, RJ, Brazil Critical Care2003,7(Suppl 3):P13 (DOI 10.1186/cc2209)

IntroductionAtrial fibrillation (AF) has a high prevalence in the elderly population. Nevertheless, it has been found in young patients.

ObjectivesTo show the clinical and epidemiological aspects of a population of patients with AF and age <60 years old in the emer gency room (ER), evaluating symptoms, triggering factors, related diseases and recurrence of AF.

MethodsFrom March 2000 to October 2002, 236 patients with AF were seen in the ER. Fiftyseven patients (24.1%) were aged < 60 yearsold. Fortysix patients (80%) were male, mean age 49.4 ± 8.3 yearsold. The patients were set on an algorithm for AF.

ResultsAll the patients were hemodynamically stable. Fortyfive patients (78.9%) presented palpitation and 10patients (17.5%) precordial pain to admission. Twelve patients (21%) had the first reported incident of AF; 39 patients (68.3%) had recurrent AF, six patients (10.5%) had >10 admissions per AF in the past year. Twentyfive patients (43.8%) indicated stress as the main trigger ing factor of the event and 23patients (40.3%) indicated alcohol intake. Thirtynine patients (68.4%) started AF at a rest period, 13 (22.8%)at activity and five patients (8.7%) after food intake. Among the risk factors for embolic events, 20patients (35.1%) were hypertensive; two patients (3.5%) had previous stroke; three

patients (5.2%) had mitral disease; four patients (7%) had hyper trophic cardiomyopathy; four patients (7%) had coronary artery disease; one patient (1.7%) had diabetes mellitus; and seven patients (12.3%) had thyroidal disease. Twentytwo patients (38.5%) had been using antiarrhythmic medications regularly. Fortyone patients (71.9%) showed <48 hoursof symptoms, and the others an unknown time or >48 hours. Thirty patients (52.6%) had arrhythmia reversed with oral medication, with mean reversion Δtof 5.7hours. Thirteen patients (22.8%) had successful ECV with an average charge of 200J. Ten patients (17.5%) had sponta neous reversion; three (5.26%) had unsuccessful. In a followup of 5 monthsto 2years, 32patients were observed. Fifteen patients (46.8%) had recurrence of AF despite use of antiarrhythmic med ication. Eighteen patients (31.5%) did not use anticoagulant or antiagglutinant. There was an embolic event in one patient (3.1%).

ConclusionsOur patients develop with hemodynamic stability to admission and present an elevated reversion rate in the ER (75.4%) with meanΔt< 6 hours.Hypertension was the main risk factor without correlation to recurrence (P= notsignificant). Stress was the factor correlated to recurrence (P= 0.038).Patients with Δtshowed a higher reversion rate of AF in the ER< 48 hours (PThe recurrent rate of AF in this population was high= 0.009). even with antiarrhythmic medication, but the number of thrombo embolic events was low.

P14 Compensatedmortality of cardiovascular disease in the States of Rio de Janeiro, São Paulo and Rio Grande do Sul from 1980 to 1999

GMM Oliveira, CH Klein, NA Souza e Silva Universidade Federal do Rio de Janeiro, Escola Nacional de Saúde Pública, Rio de Janeiro, RJ, Brazil Critical Care2003,7(Suppl 3):P14 (DOI 10.1186/cc2210) ObjectiveTo compare trends in mortality due to cardiovascularResultsThe annual rate declines of the compensated and adjusted diseases (CVD) in the State and City of Rio de Janeiro (RJ), Brazil,mortality due to CVD varied from –11.3 to –7.4 deaths per 100,000 with that observed in the States of Rio Grande do Sul and Sãoinhabitants in RJ and the city of SP, respectively. These declines Paulo (SP) and their capitals between 1980 and 1999.due to ischemic heart diseases (IHD) were similar among RJ and Porto Alegre, and lower in the city of SP (–2.5 deaths per 100,000 inhabitants). The declines due to cerebrovascular diseases (CRVD) Methodsvaried from –6.0 to –2.8 deaths per 100,000 inhabitants at theThe annual death data were collected from DATASUS, and population data from IBGE. The crude and adjusted (for ageState of Rio and Porto Alegre, respectively. and sex, by the direct method, with the standard population of RJ, age 20 or older, in 2000) mortality rates were obtained. BecauseConclusionsA steady decline in compensated and adjusted mor a considerable increase in mortality rates due to illdefinedtality rates due to CVD, IHD and CRVD was observed in all three causes of death in RJ was observed from 1990 onwards, definedstates and capitals, between 1980 and 1999. In RJ the decline of deaths were compensated by illdefined causes preliminary toIHD mortality rates was remarkable after 1990. The decline in mor S6 adjustments. The trends were analysed by linear regressions.tality rates due to CRVD occurred since 1980.