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Comparison Between Delayed Enhancement Pattern of Cardiac Magnetic Resonance Imaging and Perfusion Abnormalities of 99mTC-sestamibi Scintigraphy in Cardiac Sarcoidosis
S146 Journal of Cardiac Failure Vol. 16 No. 9S September 2010 unclear.In myocardial samples from patients with heart failure, quantitative real-time PCR revealed an increase of mRNA for C/EBP homologous protein (CHOP), a transcriptional factor that mediates ER-initiated apoptotic cell death. We performed transverse aortic constriction (TAC) or sham operation on wild-type (WT) and CHOP-deficient mice. The CHOP-deficient mice showed less cardiac hypertrophy, fibrosis and cardiac dysfunction compared with WT mice at 4 weeks after TAC. In the hearts of CHOP-deficient mice, phosphorylation of eukaryotic translation initiation factor 2&alpha, which may reduce protein translation, was enhanced compared with WT mice. In the hearts of WT mice, the CHOP and apoptotic cell death with activation of caspase-3 were observed at 4 weeks after TAC. In contrast, CHOPdeficient mice had less apoptotic cell death and lower caspase-3 activation at 4 weeks after TAC. Furthermore, the Bcl2/Bax ratio was decreased in WT mice, while this change was significantly blunted in CHOP-deficient mice. Real-time PCR microarray analysis revealed that CHOP could regulate several Bcl2 family members in failing hearts. We propose the novel concept that CHOP, which may modify protein translation and mediate ER-initiated apoptosis, contributes to development of cardiac hypertrophy and failure induced by pressure overload.
YIA-C-01 Comparison Between Delayed Enhancement Pattern of Cardiac Magnetic Resonance Imaging and Perfusion Abnormalities of 99mTC-sestamibi Scintigraphy in Cardiac Sarcoidosis MITSUAKI HORIGOME1, YOSHIKAZU YAZAKI1, UICHI IKEDA2 1 Department of Cardiovascular Medicine, NHO Matsumoto Medical Center Matsumoto Hospital, Matsumoto, Japan, 2Department of Cardiovascular Medicine, Shinshu University School of Medicne, Matsumoto, Japan Background: Both cardiac magnetic resonance imaging (CMR) and myocardial perfusion imaging are useful in the detection of cardiac involvement in sarcoidosis. However, comparisons of delayed enhancement (DE) of CMR with myocardial perfusion abnormalities are not studied in cardiac sarcoidosis (CS). Methods: To compare the DE patterns and the incidence of perfusion abnormalities, we underwent CMR and 99mTc-sestamibi ECG-gated single photon emission computed tomography (SPECT) in 18 sarcoidosis patients with cardiac abnormalities. CMR and SPECT were analyzed in 17 segments of the left ventricle. Results: DE was detected in 10 patients and 35 of the 170 segments including transmural pattern in 17 (49%), epicardial pattern in 13 (37%), and endocardial or midlayer pattern in 5 segments (14%). DE of papillay muscle was observed in 3 patients who had moderate mitral regurgitation. Incidence of perfusion abnormalities detected by 99mTc-sestamibi was significantly higher than that of DE (51/170:30% vs. 35/170:21%, p!0.05), and the difference was prominent in the inferior segments (19/30:63% vs. 10/30:33%, p!0.01). Perfusion abnormalities were infrequent in segments of the endocardial or midlayer pattern (17/17:100% vs. 12/13:92% vs. 1/5:20%, p!0.01). Conclusions: Majority of the epicardial or transmural pattern of DE can be detected as perfusion abnormalities of 99mTc-sestamibi in CS. However, DE of the endocardial or midlayer pattern and the papillay muscle was difficult to detect using 99mTc-sestamibi.
YIA-C-02 Prognosis and Mechanism of Exercise Oscillatory Ventilation During Exercise Testing in Patients With Idiopathic Dilated Cardiomyopathy TAKAHIRO OKUMURA1, AKIHIRO HIRASHIKI1, YUJI KONO2, SATORU OHSHIMA1, KYOSUKE TAKESHITA1, XIAN WU CHENG1, SUMIO YAMADA2, TOYOAKI MUROHARA1 1 Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Nagoya University School of Health Sciences, Nagoya, Japan Background: Exercise oscillatory ventilation (EOV) during cardiopulmonary exercise testing (CPX) has been considered to be a useful predictor of poor outcome in patients with chronic heart failure. However, the mechanism of EOV remains unclear. The aim of this study was to investigate the relation between EOV and hemodynamic parameters in patients with idiopathic dilated cardiomyopathy (IDCM). Methods: One hundred and twenty-six consecutive IDCM patients underwent cardiac echocardiography, laboratory measurements and CPX. They were divided into two groups according to the presence (n549) or absence (n577) of EOV. EOV was defined as an oscillatory pattern that persists for O60% of the exercise test at an amplitude O15% of the average resting value in minute ventilation volume. Results: The mean age, left ventricular ejection fraction (LVEF), and plasma brain natriuretic peptide (BNP) level were 55 years, 37%, and 206 pg/mL, respectively. LVEF was significantly lower (p50.011) and the plasma BNP level was higher (p50.004) in the EOV group. Multivariate analysis revealed that the VE/VCO2 slope (p50.011), left ventricular end-diastolic diameter (p50.013) and hemoglobin level (p50.014) were significantly independent predictors of EOV. The probability of cardiovascular event was significantly higher in the EOV group than in the non-EOV group (p!0.001). Conclusions: EOV might be attributed to impaired ventilatory response, cardiac remodeling and lower hemoglobin levels, resulting in poor prognosis in patients with IDCM.
YIA-C-03 Clinical Impact of Corticosteroid Therapy on Eosinophilic Myocarditis TOMOYOSHI YANAGISAWA, TAKAYUKI INOMATA, ICHIRO WATANABE, EMI MAEKAWA, TOMOHIRO MIZUTANI, HISAHITO SHINAGAWA, TOSHIMI KOITABASHI, ICHIRO TAKEUCHI, TOHRU IZUMI Department of Cardio-Angiology, Kitasato University School of Medicine Background: Eosinophilic myocarditis (EM), pathologically defined as myocardial inflammation infiltrated with eosinophils, has been recommended to be treated with corticosteroids. Although EM has wide variety of clinical features including the degree of eosinophilic infiltrates, it has never been investigated whether corticosteroid therapy has significant clinical benefits to overcome EM irrespective of its pathological findings. Methods & Results: Thirty-seven consecutive patients with acute myocarditis hospitalized in our institute in 1996-2009 were enrolled. The subjects were divided in to 2 groups according to the existence of eosinophils in the interstitial myocardium observed on the endomyocardial biopsy specimen. There was no difference of clinical chacteristics on admission between the 2 groups: with (Group E, n522) or without (Group L, n57) eosinophilic infiltrates. Irrespective of pathological differences, the treatment policy had been consistent including intensive hemodynamic observation and support without corticosteroid administration not only in L but also in E. There was no significant difference of clinical recovery in the acute phase indicated by the hospitalized period, improved left ventricular ejection fraction or long-term prognosis in E without corticosteroid, compared to L. Conclusion: A conventional management strategy without corticosteroid administration can improve the acute and chronic prognosis of EM, similar to that of lymphocytic myocarditis.
YIA-C-04 Do the Effects of Exercise Training Differ Between Patients With Chronic Heart Failure Due to Ischemic vs Idiopathic Dilated Cardiomyopathy? TETSUO ARAKAWA, REON KUMASAKA, MICHIO NAKANISHI, HIROYUKI TAKAHAMA, MASANOBU YANASE, TERUO NOGUCHI, HIROSHI TAKAKI, NAOHIKO AIHARA, YOUICHI GOTOH National Cerebral and Cardiovascular Center Background: Although exercise training (ET) improves exercise capacity in patients with chronic heart failure (CHF), it remains unknown whether effects of ET differ between patients with CHF due to ischemic (ICM; including old myocardial infarction) and idiopathic dilated cardiomyopathy (DCM). Methods: A total of 118 CHF patients due to either ICM (n545) or DCM (n573) who participated in 3-month ET program and underwent cardiopulmonary exercise testing were studied. Exercise capacity and plasma B-type natriuretic peptide (BNP) were measured at the beginning and the end of the 3-month ET program. Results: At baseline, ICM group was older than DCM group (ICM 65 vs DCM 51 years. p!0.00l). However, there were no significant differences in left ventricular ejection fraction (LVEF; 26% vs 25%, NS) or peak oxygen uptake (PVO2: 60% vs 61%, NS) between the two groups. At three months, the increases in peak work rate (%dPWR; +9.5% vs +14.2%, NS) or PVO2 (%dPVO2; +8.9% vs +15.0%, NS) were not significantly different between the groups. In addition, BNP decreased significantly in both groups and the magnitudes of decreases were similar (dBNP; -141 vs -73 pg/ml, NS). Conclusion: The favorable effects of ET on exercise capacity and BNP reduction appear to be similar between CHF patients due to DCM and ICM.
YIA-C-01 Comparison Between Delayed Enhancement Pattern of Cardiac Magnetic Resonance Imaging and Perfusion Abnormalities of 99mTC-sestamibi Scintigraphy in Cardiac Sarcoidosis MITSUAKI HORIGOME1, YOSHIKAZU YAZAKI1, UICHI IKEDA2 1 Department of Cardiovascular Medicine, NHO Matsumoto Medical Center Matsumoto Hospital, Matsumoto, Japan, 2Department of Cardiovascular Medicine, Shinshu University School of Medicne, Matsumoto, Japan Background: Both cardiac magnetic resonance imaging (CMR) and myocardial perfusion imaging are useful in the detection of cardiac involvement in sarcoidosis. However, comparisons of delayed enhancement (DE) of CMR with myocardial perfusion abnormalities are not studied in cardiac sarcoidosis (CS). Methods: To compare the DE patterns and the incidence of perfusion abnormalities, we underwent CMR and 99mTc-sestamibi ECG-gated single photon emission computed tomography (SPECT) in 18 sarcoidosis patients with cardiac abnormalities. CMR and SPECT were analyzed in 17 segments of the left ventricle. Results: DE was detected in 10 patients and 35 of the 170 segments including transmural pattern in 17 (49%), epicardial pattern in 13 (37%), and endocardial or midlayer pattern in 5 segments (14%). DE of papillay muscle was observed in 3 patients who had moderate mitral regurgitation. Incidence of perfusion abnormalities detected by 99mTc-sestamibi was significantly higher than that of DE (51/170:30% vs. 35/170:21%, p!0.05), and the difference was prominent in the inferior segments (19/30:63% vs. 10/30:33%, p!0.01). Perfusion abnormalities were infrequent in segments of the endocardial or midlayer pattern (17/17:100% vs. 12/13:92% vs. 1/5:20%, p!0.01). Conclusions: Majority of the epicardial or transmural pattern of DE can be detected as perfusion abnormalities of 99mTc-sestamibi in CS. However, DE of the endocardial or midlayer pattern and the papillay muscle was difficult to detect using 99mTc-sestamibi.
YIA-C-02 Prognosis and Mechanism of Exercise Oscillatory Ventilation During Exercise Testing in Patients With Idiopathic Dilated Cardiomyopathy TAKAHIRO OKUMURA1, AKIHIRO HIRASHIKI1, YUJI KONO2, SATORU OHSHIMA1, KYOSUKE TAKESHITA1, XIAN WU CHENG1, SUMIO YAMADA2, TOYOAKI MUROHARA1 1 Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Nagoya University School of Health Sciences, Nagoya, Japan Background: Exercise oscillatory ventilation (EOV) during cardiopulmonary exercise testing (CPX) has been considered to be a useful predictor of poor outcome in patients with chronic heart failure. However, the mechanism of EOV remains unclear. The aim of this study was to investigate the relation between EOV and hemodynamic parameters in patients with idiopathic dilated cardiomyopathy (IDCM). Methods: One hundred and twenty-six consecutive IDCM patients underwent cardiac echocardiography, laboratory measurements and CPX. They were divided into two groups according to the presence (n549) or absence (n577) of EOV. EOV was defined as an oscillatory pattern that persists for O60% of the exercise test at an amplitude O15% of the average resting value in minute ventilation volume. Results: The mean age, left ventricular ejection fraction (LVEF), and plasma brain natriuretic peptide (BNP) level were 55 years, 37%, and 206 pg/mL, respectively. LVEF was significantly lower (p50.011) and the plasma BNP level was higher (p50.004) in the EOV group. Multivariate analysis revealed that the VE/VCO2 slope (p50.011), left ventricular end-diastolic diameter (p50.013) and hemoglobin level (p50.014) were significantly independent predictors of EOV. The probability of cardiovascular event was significantly higher in the EOV group than in the non-EOV group (p!0.001). Conclusions: EOV might be attributed to impaired ventilatory response, cardiac remodeling and lower hemoglobin levels, resulting in poor prognosis in patients with IDCM.
YIA-C-03 Clinical Impact of Corticosteroid Therapy on Eosinophilic Myocarditis TOMOYOSHI YANAGISAWA, TAKAYUKI INOMATA, ICHIRO WATANABE, EMI MAEKAWA, TOMOHIRO MIZUTANI, HISAHITO SHINAGAWA, TOSHIMI KOITABASHI, ICHIRO TAKEUCHI, TOHRU IZUMI Department of Cardio-Angiology, Kitasato University School of Medicine Background: Eosinophilic myocarditis (EM), pathologically defined as myocardial inflammation infiltrated with eosinophils, has been recommended to be treated with corticosteroids. Although EM has wide variety of clinical features including the degree of eosinophilic infiltrates, it has never been investigated whether corticosteroid therapy has significant clinical benefits to overcome EM irrespective of its pathological findings. Methods & Results: Thirty-seven consecutive patients with acute myocarditis hospitalized in our institute in 1996-2009 were enrolled. The subjects were divided in to 2 groups according to the existence of eosinophils in the interstitial myocardium observed on the endomyocardial biopsy specimen. There was no difference of clinical chacteristics on admission between the 2 groups: with (Group E, n522) or without (Group L, n57) eosinophilic infiltrates. Irrespective of pathological differences, the treatment policy had been consistent including intensive hemodynamic observation and support without corticosteroid administration not only in L but also in E. There was no significant difference of clinical recovery in the acute phase indicated by the hospitalized period, improved left ventricular ejection fraction or long-term prognosis in E without corticosteroid, compared to L. Conclusion: A conventional management strategy without corticosteroid administration can improve the acute and chronic prognosis of EM, similar to that of lymphocytic myocarditis.
YIA-C-04 Do the Effects of Exercise Training Differ Between Patients With Chronic Heart Failure Due to Ischemic vs Idiopathic Dilated Cardiomyopathy? TETSUO ARAKAWA, REON KUMASAKA, MICHIO NAKANISHI, HIROYUKI TAKAHAMA, MASANOBU YANASE, TERUO NOGUCHI, HIROSHI TAKAKI, NAOHIKO AIHARA, YOUICHI GOTOH National Cerebral and Cardiovascular Center Background: Although exercise training (ET) improves exercise capacity in patients with chronic heart failure (CHF), it remains unknown whether effects of ET differ between patients with CHF due to ischemic (ICM; including old myocardial infarction) and idiopathic dilated cardiomyopathy (DCM). Methods: A total of 118 CHF patients due to either ICM (n545) or DCM (n573) who participated in 3-month ET program and underwent cardiopulmonary exercise testing were studied. Exercise capacity and plasma B-type natriuretic peptide (BNP) were measured at the beginning and the end of the 3-month ET program. Results: At baseline, ICM group was older than DCM group (ICM 65 vs DCM 51 years. p!0.00l). However, there were no significant differences in left ventricular ejection fraction (LVEF; 26% vs 25%, NS) or peak oxygen uptake (PVO2: 60% vs 61%, NS) between the two groups. At three months, the increases in peak work rate (%dPWR; +9.5% vs +14.2%, NS) or PVO2 (%dPVO2; +8.9% vs +15.0%, NS) were not significantly different between the groups. In addition, BNP decreased significantly in both groups and the magnitudes of decreases were similar (dBNP; -141 vs -73 pg/ml, NS). Conclusion: The favorable effects of ET on exercise capacity and BNP reduction appear to be similar between CHF patients due to DCM and ICM.