Biofeedback Training in Patients With Advanced Heart Failure



The 16th Annual Scientific Meeting performed offline (Syngo VVI, Siemens) from a mid-ventricular parasternal short axis view. Results: Doppler parameters for PSD and PDD subjects were similar, including medial E/e’ (15.7612.5 and 14.063.4, respectively) and right ventricular systolic pressure (3569 and 33610 mmHg). Plasma ANP (45628 and 42632 pg/ mL) and BNP (1116147 and 1096104 pg/mL) were also similar (all p5NS). Circumferential peak systolic strain was more negative and early diastolic strain rate was more positive in PDD (-23.964.5% and 1.28 s 1) compared to PSD (-12.965.3% and 0.7360.22 s 1, all p!0.05). Radial peak systolic strain was more positive and early diastolic radial strain rate was more negative in PDD (38.469.8% and -1.5360.5 s 1) than in PSD (24.9612.8% and -1.0160.39 s 1, all p!0.05). Conclusions: Despite having similar Doppler hemodynamic profiles and natriuretic peptide biomarker levels, subjects with PDD were differentiated from PSD by circumferential and radial strain/strain rates, both in systole and early diastole. These data suggest that circumferential and radial strain/strain rates may be useful in differentiating intrinsic myocardial diastolic dysfunction from increased left ventricular filling pressure.

S19

HFSA

outcomes in CHF. Therefore, we investigated the relationship between RDW and VE/ VCO2 slope in patients with CHF. Methods: Seventy two consecutive stable patients with CHF (58 men, 54.0611.1 years, mean ejection fraction 43.3615.3%, ischemic etiology 59.7%) were prospectively enrolled. Patients were divided into RDW tertile and clinical variables, laboratory findings, echocardiographic indices and cardiopulmonary exercise test results were analyzed. Results: Patients in the highest tertile (RDWO13.1%) had significantly lower VO2 peak (23.2 vs. 29.0 mL/kg/min, p50.009) and higher VE/ VCO2 slope (29.8 vs. 25.1, p50.005), compared with those in the lowest tertile (RDW!12.7%). Multivariate regression analysis revealed RDW was an independent predictor of VE/VCO2 slope (ß54.629, p50.012) when adjusted for age, gender, hemoglobin, body mass index, albumin, renal function, left ventricular ejection fraction and early mitral inflow velocity to early diastolic mitral annular velocity (E/E’). However RDW was not independently related to VO2 peak (ß5-3.206, p50.119). Conclusions: Higher RDW is independently related to ventilatory inefficiency, which is known to be of higher prognostic importance than VO2 peak in CHF. This finding may explain the novel relationship between RDW and VE/VCO2 slope in stable ambulatory HF patients.

059 Biofeedback Training in Patients With Advanced Heart Failure Dana L. Schneeberger1, Alison K. Reynard2, Gregory J. Bolwell1, Elizabeth F. Grossman1, Jerome Kiffer2, W.H. Wilson Tang1, James B. Young1, Randall C. Starling1, Michael G. McKee1, Christine S. Moravec1; 1Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; 2Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH Background: Biofeedback (BF) is a self-regulation technique that teaches individuals to alter autonomic balance to the cardiovascular system. In heart failure (HF), the sympathetic nervous system (SNS) is over-activated, and decreasing SNS activity with a beta blocker, ACE inhibitor or LVAD, improves clinical status and reverses the cellular and molecular alterations associated with HF. We hypothesized that HF patients could be trained to practice BF and that this method of regulating the SNS would also produce biological remodeling of the heart. Methods: 20 advanced heart failure patients (12 inpatients & 8 outpatients, 17 males & 3 females, mean age 56 +/- 10, mean LVEF 23 +/15%, NYHA class III/ IV), all listed for cardiac transplantation at the Cleveland Clinic, were trained in BF, using predominantly respiration and temperature feedback. At transplant, explanted hearts were taken to the lab, and the inotropic response of left ventricular trabecular muscles to a single dose of isoproterenol was used to measure the functional response to SNS stimulation. Results: The average inotropic response of muscles in the BF group (32 muscles from 11 hearts) was compared to those from non-failing (NF; 28 muscles from 10 hearts), failing (F; 30 muscles from 12 hearts) and LVAD-supported failing human hearts (LVAD; 39 muscles from 12 hearts). Figure 1 illustrates percent change in developed tension. There was no significant difference between the BF group and the NF group. Conclusions: These preliminary data suggest that BF is associated with positive remodeling of the myocardium in advanced HF patients, similar to what has been previously observed for other more invasive therapeutic options. These data provide encouraging trends for the design of a randomized trial using BF as an adjunctive therapeutic intervention.

061 Protection of Cardiac Function by Immune Cells: A Role for Mast Cells in Both Normal Function and Post-Ischemic Repair Mozow Y. Zuidema, Kevin C. Dellsperger, Michael A. Hill; Internal Medicine Cardiovascular Disease, Dalton CV Research Center, Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO Myocardial infarction is a common cause of heart failure. Although mast cells (MC) have previously been implicated in the development of heart failure, the accompanying effects on hemodynamic changes are not well known.

Group Parameter

060 Red Cell Distribution Width as a Marker of Ventilatory Inefficiency in Patients With Chronic Heart Failure Jong-Chan Youn, Jaewon Oh, Namki Hong, Sung-Jin Hong, Seok-Min Kang; Cardiology Division, Severance Cardiovascular Hospital, Yonse University College of Medicine, Seoul, Republic of Korea Background: Ventilatory efficiency, commonly assessed by VE/VCO2 slope, has proven to be a strong prognostic marker in patients with chronic heart failure (CHF). Recently, red cell distribution width (RDW) has emerged as an additional prognostic factor for clinical

WT sham

HR, beats/ 478 min ESV, ml 10 EDV, ml 27 ESP, 110 mmHg EDP, 13 mmHg SV, ml 19 EF, % 68 CO, ml/min 8996 SW, mmHg 1615 x ml dPdt max, 10085 mmHg/ sec dPdt min, 9082 mmHg/ sec Tau-weiss, 8 msec Maximal 17 Power (mWatts)

+ 32

WT I/R 503 + 23

kitW/kitW-V sham 315 + 34 * &

+ 3 &# +3 + 11 $

21 + 3 *$ 33 + 4 $ 94 + 3

8 + 3 &# 20 + 5 & 79 + 9 *#

+2

16 + 3

13 + 2

+ + + +

2# 7 &# 894 $# 207 &#

14 42 7148 907

+ + + +

2 14 + 3 *$# 71 + 956 $# 4460 + 113 * 1495 +

kitW/kitW-V I/R 358 + 20 * & 23 + 3 *$ 27 + 2 104 + 6 $ 15 + 2

3 7+ 6 &# 26 + 858 *& 2529 + 766 404 +

0.4 * 4 *&$ 147 *& 32 *

+ 1290 &$# 6760 + 607 *

6123 + 1404 *

5543 + 492 *

+ 974 &$#

5776 + 1409 *

5419 + 531 *

+ 1 $# + 5 &#

6685 + 356 *

10 + 1 8+1*

13 + 2 *& 14 + 4

13 + 1 *& 6+1*

p ! 0.05 vs (* WT Sham, & WT I/R, $ kitW/kitW-v sham, # kitW/kitW-v I/R)