Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Incidence and Clinical Course of Left Ventricular Systolic Dysfunction in Patients with Carbon Monoxide Poisoning

  • Lee, Jae-Hwan (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Hyun-Sook (Cardiovascular Center in Hallym University Sacred Heart Hospital) ;
  • Park, Jae-Hyeong (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Min Su (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Sun, Byung Joo (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Ryu, Seung (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Song Soo (Department of Diagnostic Imaging, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Jin, Seon Ah (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Jun Hyung (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Choi, Si Wan (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Jeong, Jin-Ok (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kwon, In-Sun (Clinical Trial Center, Chungnam National University Hospital) ;
  • Seong, In-Whan (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine)
  • Received : 2015.09.02
  • Accepted : 2016.02.04
  • Published : 2016.09.30
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Abstract

Background and Objectives: Carbon monoxide (CO) poisoning can cause tissue hypoxia and left ventricular systolic dysfunction (LVSD) requiring intensive medical management. Our objectives were to find incidence and clinical course of LVSD CO intoxicated patients and make a clinical scoring to predict LVSD. Subjects and Methods: We included all consecutive patients with CO exposure in the emergency room. LVSD was defined by LVEF <50% assessed by echocardiography. We compared their clinical, chemical, radiological and electrocardiographic patterns according to the presence of LVSD. Results: From May 2009 to June 2015, we included a total of 81 patients (48 men, $47{\pm}19$ years old) with CO exposure in this cohort. LVSD was found in about 25 patients (31%). Nine had regional wall motion abnormality. Follow up echocardiographic examinations were available in 21 patients. Of them, 18 patients showed complete recovery in about 3 days (mean $2.8{\pm}1.7$ days). Of 3 patients without recovery, 2 had significant coronary artery stenosis. LVSD was significantly associated with initial heart rate (>100/min), pulmonary edema on chest X-ray, serum NT pro-BNP (>100 pg/mL), troponin-I (>0.1 ng/mL) and lactic acid (>4.0 mg/dL) after a univariate analysis. Combining these into a clinical score, according to their beta score after a multivariate analysis (rage=0-16), allowed prediction of LVSD with a sensitivity of 84% and specificity of 91% (reference ${\geq}8$, area under the curve=0.952, p<0.001) Conclusion: About 31% showed LVSD in patients with CO poisoning, and most of them (86%, 18 of 21 patients) recovered within 3 days. Patients with a higher clinical score (${\geq}8$) might have LVSD.

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