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Association between Spleen Volume and Clinical Outcome in Patients with Heart Failure
S26 Journal of Cardiac Failure Vol. 23 No. 10S October 2017 recuparation hospitals, and 21 patients were died in hospital. The level of care needed was tended to be higher (2.0 ± 1.8 vs. 1.2 ± 1.4, P = .066) and the frequency of intolerance to ambulation exercise was significantly higher (52.4% vs. 12.4%, P < .001) in hospital death group than in survival group. Time interval from hospitalization to team conference was significantly related to total length of hospitalization. Conclusions: In elder patients with CHF who need care, tolerance to ambulation exercise was important for alive discharge. Early-staged team conference might be helpful for early hospital discharge.
curve demonstrated that event rates of all-cause death, cardiac death, non-cardiac death, and cardiovascular event including worsening HF and cardiac death were higher as the severity of GWTG-HF risk score increased (P < .01, Figure). Conclusions: GWTGHF risk score is useful for prognostic prediction in HF patients in chronic phase as well as acute phase.
O5-8 Differences, If Any, in Prognostic Indicators of Heart Failure: Comparison between Octogenarians and Nonagenarians Satoru Abe1, Hiroaki Obata2, Akifumi Uehara1, Kanako Oishi1, Hiroshi Watanabe1, Akihiro Yokoyama1, Masayuki Onishi1, Norio Higuma1, Tohru Watanabe1, Tohru Izumi1; 1 Division of Medicine, Niigataminami Hospital, Niigata, Japan; 2 Division of Rehabilitation, Niigataminami Hospital, Niigata, Japan Super-elderly with heart failure needing hospitalization have a high mortality risk, but factors contributing to prognosis are unknown. Previously, activities of daily living (ADLs), nutritional status and mastication/swallowing ability upon admission, and not cardiovascular factors were indicated as contributors to this risk. It is unclear whether this tendency is similar between octogenarians and nonagenarians. Our study aims to investigate the point, comparing between octo- and nonagenarians. Patients and Methods: A retrospective analysis was performed in super-elderly (aged >80 years) hospitalized with congestive heart failure, who were diagnosed based on the Diagnosis Procedure Combination coding system. Clinical outcomes were assessed at the time of hospital discharge. Results: Over 18 months, we registered 146 patients with mean age being 89.2 years. We studied 82 octogenarians and 64 nonagenarians. Clinical outcomes were divided into three subgroups: those who died during hospitalization (n = 26), 27; those who needed additional nursing care (n = 15), 13; and those able to walk at discharge (n = 41), 24, respectively. Factors contributing to the outcomes were ADL and albumin values, presence of atrial fibrillation, and mastication/swallowing ability upon admission. No significant difference was observed between octo- and nonagenarians with respect to composition and tendency. Conclusion: In nonagenarians, index of living ability seems to be a more important prognostic indicator than cardiovascular factors as well as octogenarians.
O6-1 Gender Differences in Prognostic Impact of Appendicular Skeletal Muscle Mass in Patients with Acute Heart Failure Eiichi Akiyama1, Masaaki Konishi1, Kazuo Kimura1, Kouichi Tamura2; 1Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; 2Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
O6-3 Hemodynamic Residual Congestion Assessed by Right Heart Catheterization Was Related to Poor Prognosis in Patients with Clinically Compensated Heart Failure Kazushi Sakane, Ryoto Horai, Daichi Maeda, Kanako Akamatsu, Michishige Ozeki, Tomohiro Fujisaka, Kouichi Soumiya, Masaaki Hoshiga, Nobukazu Ishizaka; Department of Cardiology, Osaka Medical College, Osaka, Japan Background: Residual clinical congestion is known to be associated with poor prognosis. However, the prognostic importance of hemodynamic congestion remains uncertain. Methods: Among patients who were admitted with acute decompensated heart failure, 51 patients underwent right heart catheterization (RHC) in clinically compensated status after conventional treatment. We defined hemodynamic residual congestion as PCWP >15 mmHg and investigated its prognostic importance. Results: During the mean follow up period of 437 ± 251 days, patients with relatively high PCWP (>15 mmHg, n = 27) were more likely to have experienced major adverse cardiac events (death, heart failure re-hospitalization, LVAD implantation) than those with lower PCWP (<15 mmHg, n = 24, 51.9% versus 12.5%, Log-rank test, P = .01, Figure). Conclusion: Hemodynamic residual pulmonary congestion as assessed by RHC was associated with poor prognosis in patients with heart failure even in clinically compensated status.
Background: Clinical significance of skeletal muscle mass in patients with acute heart failure (AHF) remains unclear. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 108 hospitalized patients with AHF (age 72 ± 11, male 62%). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height2) was defined according to the Asia Working Group for Sarcopenia criteria (<7.0 kg/m2 in male, <5.4 kg/m2 in female). AHF patients were followed until occurring cardiovascular (CV) events (CV death, nonfatal myocardial infarction, ischemic stroke, unstable angina, HF re-hospitalization, or coronary revascularization). Results: The prevalence of low-ASMI was 56% (n=61) in whole cohort and higher in male compared with female (64% versus 44%, P=.04). Forty eight patients developed CV events (median follow-up, 17 months). The incidence of CV events was significantly higher in female AHF patients with low-ASMI than in those with normalASMI, but not male (female: 72% versus 17%, P=.001, male: 51% versus 38%, P=.32, log-rank test). Low-ASMI significantly correlated with the future CV events in female AHF patients (female: unadjusted hazard ratio 5.79, P=.002, male: unadjusted hazard ratio 1.48, P=.32, p for interaction=0.04). Multivariate Cox hazard analysis demonstrated that low-ASMI was an independent predictor for CV events in female AHF patients (hazard ratio 29.5, 95%-confidence interval 4.1–211.4, P=.001). Conclusions: LowASMI could predict the future CV events in female patients with AHF.
O6-2 Clinical Significance of Get With the Guidelines-heart Failure Risk Score in Heart Failure Patients after Hospitalization Satoshi Suzuki, Akiomi Yoshihisa, Yu Sato, Yuki Kanno, Syunsuke Watanabe, Satoshi Abe, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan Background: To predict in-hospital mortality of acute heart failure (HF), Get With The Guidelines-Heart Failure (GWTG-HF) risk score has been derived. We evaluated clinical impacts of GWTG-HF risk score on long term prognosis in HF patients after hospitalization. Methods and Results: We examined GWTG-HF risk score in 1452 HF patients who admitted to our hospital, and divided into three groups according to this score level. We followed up these patients after discharge. Kaplan-Meier survival
O6-4 Association between Spleen Volume and Clinical Outcome in Patients with Heart Failure Teppei Fujita1, Takayuki Inomata2, Mayu Yazaki1, Toyuji Kaida1, Yuichiro Iida1, Yuki Ikeda1, Takeru Nabeta1, Shunsuke Ishii1, Toshimi Koitabashi1, Junya Ako1; 1Department of Cardio-angiology, School of Medicine, Kitasato University; 2Kitasato University Kitasato Institute Hospital, Tokyo Introduction: A small spleen has been recognized to have an association with in-host immunologic disturbances. C-reactive protein (CRP) is one of the markers of
The 21st Annual Scientific Meeting inflammatory mediators and the predictors for prognosis in patients with heart failure (HF). However, it is unclear the relationship among spleen volume, CRP, and prognosis in patients with HF. Methods: We retrospectively enrolled 102 consecutive patients who were admitted for acute decompensated HF at 2012 and who had a computed tomography. We calculated spleen volume index (SpVi) using the prolate ellipsoid formula. Patients were stratified into 3 groups based on the tertile quantile of SpV. We followed all-cause mortality during 743 ± 517 days. Cardiac death was defined as death for worsening HF, ventricular fibrillation and sudden death. Results: There was an inverse correlation SpVi and serum levels of CRP (R = −0.29, P < .05). Kaplan-Meier curves showed that large SpVi had higher survival rates from both all-cause mortality and cardiac death. In multivariate analysis, SpVi (HR = 0.98, 95% CI 0.97–0.99; P < .01) was an independent predictor for cardiac death. Conclusion: Spleen volume is related to serum level of CRP and clinical outcome in patients with HF.
O6-5 Abnormal Circadian Blood Pressure Rhythm Was One of the Indicators of Fluid Retention in Heart Failure Patients Takahiro Komori, Kazuo Eguchi, Mizuri Taki, Yusuke Ishiyama, Ken Kono, Satoshi Hoshide, Kazuomi Kario; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan Background: Evaluation of fluid retention is an important issue in treatment of heart failure (HF) patients. However, the evaluation of fluid retention is difficult. Fluid retention could have an influence on circadian blood pressure (BP) rhythms. However, the association between abnormal circadian BP rhythms and fluid retention was not clearly understood. Method and Results: We enrolled 516 hospitalized HF patients and performed ambulatory BP measurements (ABPM) and echocardiography. The mean age was 69 ± 13 yrs, and 62% was male. The riser BP pattern, extreme phenotype of abnormal circadian BP rhythms, was significantly associated with plasma renin activity (PRA) (Odds ratio 0.78, 95% CI [0.65–0.92], P < .01) (Figure). Conclusion: The riser BP pattern was significantly associated with PRA in HF patients. ABPM could be used for the evaluation of fluid retention.
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JHFS
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scoring system [PP × HR × sCr] could strongly predict the improvement of eGFR in the patients with AHF.
O7-2 Simple Screening Test for Sarcopenia Predicts Future Cardiovascular Events in Patients with Chronic Kidney Disease Shinsuke Hanatani, Yasuhiro Izumiya, Masahiro Yamamoto, Toshifumi Ishida, Satoru Yamamura, Yuichi Kimura, Satoshi Araki, Kenichi Tsujita; Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan Introduction: Recently, a simple screening test that can identify sarcopenia using three variables (age, grip strength and calf circumference) has been developed. However, clinical utility of sarcopenia score for predicting future cardiovascular events in patients with kidney disease remains unclear. Methods and Results: We calculated sarcopenia score of 265 chronic kidney disease (CKD) patients, and followed the patients for cardiovascular events. The endpoint of this study was a composite of total mortality and cardiovascular hospitalization, including heart failure decompensation. The patients in high sarcopenia score (greater than or equal to 105 in men and 120 in women) group showed significantly higher plasma BNP levels (median 103.1, interquartile range [46.3–310.0] vs. 46.7, [18.0–91.8]pg/mL, P < .0001) than those in low sarcopenia score group. Kaplan-Meier curve revealed that the risk of adverse cardiovascular events was significantly increased in high sarcopenia score group (log-rank test: P < .0001), even after potential confounding factors were corrected using propensity score matching. Multivariate Cox hazard analysis identified high sarcopenia score (hazard ratio: 3.00; 95% confidence interval: 1.44–6.27; P = .0003) as independent predictor of primary endpoints. Furthermore, the combination of high sarcopenia score and high BNP identified patients with significantly higher probability of future events (P < .0001). Conclusions: Simple screening score for sarcopenia could be a useful tool for estimating future adverse event risk in patients with CKD.
O7-3 Microscopic Hematuria Is a Predictor of Mortality in Patients with Heart Failure Takanobu Yamada, Yasuhiro Tomita, Takahide Kodama, Haruo Mitani; The Cardiovascular Center of Toranomon Hospital, Tokyo, Japan Introduction: Chronic kidney disease (CKD) is associated with poor outcome in patients with heart failure (HF), but little is known about the prognostic value of urine results in these patients. We therefore investigated the relationship between urine results and the prognosis of hospitalized patients with HF. Methods: We retrospectively reviewed the database of the Cardiovascular Center of Toranomon Hospital, Japan and enrolled 128 consecutive patients who admitted with their first presentation of acute decompensated HF. Urine results were available in 76 patients between discharge and the first visits. We assessed the predictive value of hematuria for one-year mortality in addition to the renal function among these patients. Results: Ten patients (13%) had microscopic hematuria (++ or more) between discharge and the first visits. One-year mortality of the patients with microscopic hematuria was higher than those without (P = .029). In multivariate analysis including estimated glomerular filtration rate at discharge, age, and left ventricular ejection fraction, the predictive value of hematuria for the mortality remained significant (P = .017). Conclusions: Microscopic hematuria could predict the prognosis in patients with heart failure after discharge.
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O7-4
Our Novel Scoring System with Hemodynamics and Renal Function at Admission Predict Changes in Estimated GFR with Tolvaptan at Discharge Satomi Konno 1 , Ryo Nakamura 1 , Tomoyuki Tobushi 1 , Yasuhiro Sezutsu 1 , Akiko Nishizaki 1 , Hikaru Hatashima 1 , Takayuki Toyohara 1 , Shinichi Ando 2 , Takaya Fukuyama1, Toshiaki Kadokami1; 1Cardiology Division Saiseikai Futsukaichi Hospital Chikusihino, Japan; 2Sleep Apnea Center, Kyushu University Hosipital, Fukuoka, Japan
A Case of Left Ventricular Pseudoaneurysm Developed from Myocardial Abscess Yasutaka Inuzuka, Takefumi Kisimori, Takesi Inoue, Junya Seki, Sinsaku Takeda, Yuzou Takeuchi, Kunihiko Kosuga, Shigeru Ikeguchi, Masaharu Okada; Department of Cardiology, Shiga Medical Center for Adults
Renal dysfunction is a common comorbidity in acute heart failure (AHF), and the worsening renal function (WRF) is associated with the prognosis of AHF. Although diuretics often cause WRF, tolvaptan for AHF with renal dysfunction has showed a neutral effect on prognosis of AHF. However, no one knows how to predict the improvement of renal function by tolvaptan in the treatment for AHF. We hypothesized that assessment for hemodynamics and renal function could predict the benefit of tolvaptan for renal function. We assessed 16 AHF patients treated with tolvaptan admitted to out hospital in 2015. We calculated [Pulse pressure (PP) × heart rate (HR) × serum creatinine level (sCr)] at admission as the present novel “scoring system with hemodynamics and renal function”. In the patients with sCr < 2.0 mg/dl, the changes of estimated glomerular filtration rate (eGFR) between at admission and discharge were closely linear negative relationship to [PP × HR × sCr](R2 = 0.47, P < .05). ROC curve analysis for the improvement of eGFR showed the cut-off value of [PP × HR × sCr] was 5914 value. These results suggest that the present novel
The patient was a 57-year-old woman who had undergone maintenance hemodialysis due to diabetic nephropathy. She suddenly developed high fever of 40°C, lumbago and epigastralgia with hypotension and was diagnosed as having septic shock requiring vasopressors and endotoxin adsorption therapy. Laboratory test demonstrated severe inflammation and methicillin sensitive Staphylococcus aureus was cultured from blood samples, but clear source of infection was not detected. After the administration of specific intravenous antibiotics, inflammatory data gradually declined, but 10 days later, she developed high fever and pericarditis. Echocardiogram disclosed pericardial effusion and calcification of the posterior mitral leaflet but vegetation was not detected. Although the aspiration was negative for bacterial growth, we diagnosed her as bacterial pericarditis and continued the administration of antibiotics for four weeks. Thereafter she got well and discharge. One month later, she visited our hospital with anorexia and computed tomography revealed a large pseudoaneurysm of the posterior left ventricular wall just below the posterior mitral valve leaflet. She underwent emergent surgery. The left ventricular aneurysm orifice was closed. If patients on hemodialysis become complicated by long term fever, we need to pay attention to the onset of infective endocarditis.
curve demonstrated that event rates of all-cause death, cardiac death, non-cardiac death, and cardiovascular event including worsening HF and cardiac death were higher as the severity of GWTG-HF risk score increased (P < .01, Figure). Conclusions: GWTGHF risk score is useful for prognostic prediction in HF patients in chronic phase as well as acute phase.
O5-8 Differences, If Any, in Prognostic Indicators of Heart Failure: Comparison between Octogenarians and Nonagenarians Satoru Abe1, Hiroaki Obata2, Akifumi Uehara1, Kanako Oishi1, Hiroshi Watanabe1, Akihiro Yokoyama1, Masayuki Onishi1, Norio Higuma1, Tohru Watanabe1, Tohru Izumi1; 1 Division of Medicine, Niigataminami Hospital, Niigata, Japan; 2 Division of Rehabilitation, Niigataminami Hospital, Niigata, Japan Super-elderly with heart failure needing hospitalization have a high mortality risk, but factors contributing to prognosis are unknown. Previously, activities of daily living (ADLs), nutritional status and mastication/swallowing ability upon admission, and not cardiovascular factors were indicated as contributors to this risk. It is unclear whether this tendency is similar between octogenarians and nonagenarians. Our study aims to investigate the point, comparing between octo- and nonagenarians. Patients and Methods: A retrospective analysis was performed in super-elderly (aged >80 years) hospitalized with congestive heart failure, who were diagnosed based on the Diagnosis Procedure Combination coding system. Clinical outcomes were assessed at the time of hospital discharge. Results: Over 18 months, we registered 146 patients with mean age being 89.2 years. We studied 82 octogenarians and 64 nonagenarians. Clinical outcomes were divided into three subgroups: those who died during hospitalization (n = 26), 27; those who needed additional nursing care (n = 15), 13; and those able to walk at discharge (n = 41), 24, respectively. Factors contributing to the outcomes were ADL and albumin values, presence of atrial fibrillation, and mastication/swallowing ability upon admission. No significant difference was observed between octo- and nonagenarians with respect to composition and tendency. Conclusion: In nonagenarians, index of living ability seems to be a more important prognostic indicator than cardiovascular factors as well as octogenarians.
O6-1 Gender Differences in Prognostic Impact of Appendicular Skeletal Muscle Mass in Patients with Acute Heart Failure Eiichi Akiyama1, Masaaki Konishi1, Kazuo Kimura1, Kouichi Tamura2; 1Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; 2Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
O6-3 Hemodynamic Residual Congestion Assessed by Right Heart Catheterization Was Related to Poor Prognosis in Patients with Clinically Compensated Heart Failure Kazushi Sakane, Ryoto Horai, Daichi Maeda, Kanako Akamatsu, Michishige Ozeki, Tomohiro Fujisaka, Kouichi Soumiya, Masaaki Hoshiga, Nobukazu Ishizaka; Department of Cardiology, Osaka Medical College, Osaka, Japan Background: Residual clinical congestion is known to be associated with poor prognosis. However, the prognostic importance of hemodynamic congestion remains uncertain. Methods: Among patients who were admitted with acute decompensated heart failure, 51 patients underwent right heart catheterization (RHC) in clinically compensated status after conventional treatment. We defined hemodynamic residual congestion as PCWP >15 mmHg and investigated its prognostic importance. Results: During the mean follow up period of 437 ± 251 days, patients with relatively high PCWP (>15 mmHg, n = 27) were more likely to have experienced major adverse cardiac events (death, heart failure re-hospitalization, LVAD implantation) than those with lower PCWP (<15 mmHg, n = 24, 51.9% versus 12.5%, Log-rank test, P = .01, Figure). Conclusion: Hemodynamic residual pulmonary congestion as assessed by RHC was associated with poor prognosis in patients with heart failure even in clinically compensated status.
Background: Clinical significance of skeletal muscle mass in patients with acute heart failure (AHF) remains unclear. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 108 hospitalized patients with AHF (age 72 ± 11, male 62%). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height2) was defined according to the Asia Working Group for Sarcopenia criteria (<7.0 kg/m2 in male, <5.4 kg/m2 in female). AHF patients were followed until occurring cardiovascular (CV) events (CV death, nonfatal myocardial infarction, ischemic stroke, unstable angina, HF re-hospitalization, or coronary revascularization). Results: The prevalence of low-ASMI was 56% (n=61) in whole cohort and higher in male compared with female (64% versus 44%, P=.04). Forty eight patients developed CV events (median follow-up, 17 months). The incidence of CV events was significantly higher in female AHF patients with low-ASMI than in those with normalASMI, but not male (female: 72% versus 17%, P=.001, male: 51% versus 38%, P=.32, log-rank test). Low-ASMI significantly correlated with the future CV events in female AHF patients (female: unadjusted hazard ratio 5.79, P=.002, male: unadjusted hazard ratio 1.48, P=.32, p for interaction=0.04). Multivariate Cox hazard analysis demonstrated that low-ASMI was an independent predictor for CV events in female AHF patients (hazard ratio 29.5, 95%-confidence interval 4.1–211.4, P=.001). Conclusions: LowASMI could predict the future CV events in female patients with AHF.
O6-2 Clinical Significance of Get With the Guidelines-heart Failure Risk Score in Heart Failure Patients after Hospitalization Satoshi Suzuki, Akiomi Yoshihisa, Yu Sato, Yuki Kanno, Syunsuke Watanabe, Satoshi Abe, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan Background: To predict in-hospital mortality of acute heart failure (HF), Get With The Guidelines-Heart Failure (GWTG-HF) risk score has been derived. We evaluated clinical impacts of GWTG-HF risk score on long term prognosis in HF patients after hospitalization. Methods and Results: We examined GWTG-HF risk score in 1452 HF patients who admitted to our hospital, and divided into three groups according to this score level. We followed up these patients after discharge. Kaplan-Meier survival
O6-4 Association between Spleen Volume and Clinical Outcome in Patients with Heart Failure Teppei Fujita1, Takayuki Inomata2, Mayu Yazaki1, Toyuji Kaida1, Yuichiro Iida1, Yuki Ikeda1, Takeru Nabeta1, Shunsuke Ishii1, Toshimi Koitabashi1, Junya Ako1; 1Department of Cardio-angiology, School of Medicine, Kitasato University; 2Kitasato University Kitasato Institute Hospital, Tokyo Introduction: A small spleen has been recognized to have an association with in-host immunologic disturbances. C-reactive protein (CRP) is one of the markers of
The 21st Annual Scientific Meeting inflammatory mediators and the predictors for prognosis in patients with heart failure (HF). However, it is unclear the relationship among spleen volume, CRP, and prognosis in patients with HF. Methods: We retrospectively enrolled 102 consecutive patients who were admitted for acute decompensated HF at 2012 and who had a computed tomography. We calculated spleen volume index (SpVi) using the prolate ellipsoid formula. Patients were stratified into 3 groups based on the tertile quantile of SpV. We followed all-cause mortality during 743 ± 517 days. Cardiac death was defined as death for worsening HF, ventricular fibrillation and sudden death. Results: There was an inverse correlation SpVi and serum levels of CRP (R = −0.29, P < .05). Kaplan-Meier curves showed that large SpVi had higher survival rates from both all-cause mortality and cardiac death. In multivariate analysis, SpVi (HR = 0.98, 95% CI 0.97–0.99; P < .01) was an independent predictor for cardiac death. Conclusion: Spleen volume is related to serum level of CRP and clinical outcome in patients with HF.
O6-5 Abnormal Circadian Blood Pressure Rhythm Was One of the Indicators of Fluid Retention in Heart Failure Patients Takahiro Komori, Kazuo Eguchi, Mizuri Taki, Yusuke Ishiyama, Ken Kono, Satoshi Hoshide, Kazuomi Kario; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan Background: Evaluation of fluid retention is an important issue in treatment of heart failure (HF) patients. However, the evaluation of fluid retention is difficult. Fluid retention could have an influence on circadian blood pressure (BP) rhythms. However, the association between abnormal circadian BP rhythms and fluid retention was not clearly understood. Method and Results: We enrolled 516 hospitalized HF patients and performed ambulatory BP measurements (ABPM) and echocardiography. The mean age was 69 ± 13 yrs, and 62% was male. The riser BP pattern, extreme phenotype of abnormal circadian BP rhythms, was significantly associated with plasma renin activity (PRA) (Odds ratio 0.78, 95% CI [0.65–0.92], P < .01) (Figure). Conclusion: The riser BP pattern was significantly associated with PRA in HF patients. ABPM could be used for the evaluation of fluid retention.
•
JHFS
S27
scoring system [PP × HR × sCr] could strongly predict the improvement of eGFR in the patients with AHF.
O7-2 Simple Screening Test for Sarcopenia Predicts Future Cardiovascular Events in Patients with Chronic Kidney Disease Shinsuke Hanatani, Yasuhiro Izumiya, Masahiro Yamamoto, Toshifumi Ishida, Satoru Yamamura, Yuichi Kimura, Satoshi Araki, Kenichi Tsujita; Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan Introduction: Recently, a simple screening test that can identify sarcopenia using three variables (age, grip strength and calf circumference) has been developed. However, clinical utility of sarcopenia score for predicting future cardiovascular events in patients with kidney disease remains unclear. Methods and Results: We calculated sarcopenia score of 265 chronic kidney disease (CKD) patients, and followed the patients for cardiovascular events. The endpoint of this study was a composite of total mortality and cardiovascular hospitalization, including heart failure decompensation. The patients in high sarcopenia score (greater than or equal to 105 in men and 120 in women) group showed significantly higher plasma BNP levels (median 103.1, interquartile range [46.3–310.0] vs. 46.7, [18.0–91.8]pg/mL, P < .0001) than those in low sarcopenia score group. Kaplan-Meier curve revealed that the risk of adverse cardiovascular events was significantly increased in high sarcopenia score group (log-rank test: P < .0001), even after potential confounding factors were corrected using propensity score matching. Multivariate Cox hazard analysis identified high sarcopenia score (hazard ratio: 3.00; 95% confidence interval: 1.44–6.27; P = .0003) as independent predictor of primary endpoints. Furthermore, the combination of high sarcopenia score and high BNP identified patients with significantly higher probability of future events (P < .0001). Conclusions: Simple screening score for sarcopenia could be a useful tool for estimating future adverse event risk in patients with CKD.
O7-3 Microscopic Hematuria Is a Predictor of Mortality in Patients with Heart Failure Takanobu Yamada, Yasuhiro Tomita, Takahide Kodama, Haruo Mitani; The Cardiovascular Center of Toranomon Hospital, Tokyo, Japan Introduction: Chronic kidney disease (CKD) is associated with poor outcome in patients with heart failure (HF), but little is known about the prognostic value of urine results in these patients. We therefore investigated the relationship between urine results and the prognosis of hospitalized patients with HF. Methods: We retrospectively reviewed the database of the Cardiovascular Center of Toranomon Hospital, Japan and enrolled 128 consecutive patients who admitted with their first presentation of acute decompensated HF. Urine results were available in 76 patients between discharge and the first visits. We assessed the predictive value of hematuria for one-year mortality in addition to the renal function among these patients. Results: Ten patients (13%) had microscopic hematuria (++ or more) between discharge and the first visits. One-year mortality of the patients with microscopic hematuria was higher than those without (P = .029). In multivariate analysis including estimated glomerular filtration rate at discharge, age, and left ventricular ejection fraction, the predictive value of hematuria for the mortality remained significant (P = .017). Conclusions: Microscopic hematuria could predict the prognosis in patients with heart failure after discharge.
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O7-4
Our Novel Scoring System with Hemodynamics and Renal Function at Admission Predict Changes in Estimated GFR with Tolvaptan at Discharge Satomi Konno 1 , Ryo Nakamura 1 , Tomoyuki Tobushi 1 , Yasuhiro Sezutsu 1 , Akiko Nishizaki 1 , Hikaru Hatashima 1 , Takayuki Toyohara 1 , Shinichi Ando 2 , Takaya Fukuyama1, Toshiaki Kadokami1; 1Cardiology Division Saiseikai Futsukaichi Hospital Chikusihino, Japan; 2Sleep Apnea Center, Kyushu University Hosipital, Fukuoka, Japan
A Case of Left Ventricular Pseudoaneurysm Developed from Myocardial Abscess Yasutaka Inuzuka, Takefumi Kisimori, Takesi Inoue, Junya Seki, Sinsaku Takeda, Yuzou Takeuchi, Kunihiko Kosuga, Shigeru Ikeguchi, Masaharu Okada; Department of Cardiology, Shiga Medical Center for Adults
Renal dysfunction is a common comorbidity in acute heart failure (AHF), and the worsening renal function (WRF) is associated with the prognosis of AHF. Although diuretics often cause WRF, tolvaptan for AHF with renal dysfunction has showed a neutral effect on prognosis of AHF. However, no one knows how to predict the improvement of renal function by tolvaptan in the treatment for AHF. We hypothesized that assessment for hemodynamics and renal function could predict the benefit of tolvaptan for renal function. We assessed 16 AHF patients treated with tolvaptan admitted to out hospital in 2015. We calculated [Pulse pressure (PP) × heart rate (HR) × serum creatinine level (sCr)] at admission as the present novel “scoring system with hemodynamics and renal function”. In the patients with sCr < 2.0 mg/dl, the changes of estimated glomerular filtration rate (eGFR) between at admission and discharge were closely linear negative relationship to [PP × HR × sCr](R2 = 0.47, P < .05). ROC curve analysis for the improvement of eGFR showed the cut-off value of [PP × HR × sCr] was 5914 value. These results suggest that the present novel
The patient was a 57-year-old woman who had undergone maintenance hemodialysis due to diabetic nephropathy. She suddenly developed high fever of 40°C, lumbago and epigastralgia with hypotension and was diagnosed as having septic shock requiring vasopressors and endotoxin adsorption therapy. Laboratory test demonstrated severe inflammation and methicillin sensitive Staphylococcus aureus was cultured from blood samples, but clear source of infection was not detected. After the administration of specific intravenous antibiotics, inflammatory data gradually declined, but 10 days later, she developed high fever and pericarditis. Echocardiogram disclosed pericardial effusion and calcification of the posterior mitral leaflet but vegetation was not detected. Although the aspiration was negative for bacterial growth, we diagnosed her as bacterial pericarditis and continued the administration of antibiotics for four weeks. Thereafter she got well and discharge. One month later, she visited our hospital with anorexia and computed tomography revealed a large pseudoaneurysm of the posterior left ventricular wall just below the posterior mitral valve leaflet. She underwent emergent surgery. The left ventricular aneurysm orifice was closed. If patients on hemodialysis become complicated by long term fever, we need to pay attention to the onset of infective endocarditis.