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Comparison of Usefulness of SYNTAX Score in Heart Failure Patients with Preserved Ejection Fraction Versus Those with Reduced Ejection Fraction
The 19th Annual Scientific Meeting function is a prime determinant of exercise capacity in patients with pEF. On the other hand, cardiac function has a less impact on exercise capacity in patients with rEF.
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multivariable Cox propotional hazard analyses after adjusting for confounding factors, hyperuricemia was an independent predictor of all-cause mortality. Conclusions: Hyperuricemia is an independent predictor of cardiovascular mortality in HFpEF.
OP9-3 Comparison of Usefulness of SYNTAX Score in Heart Failure Patients with Preserved Ejection Fraction Versus Those with Reduced Ejection Fraction MASATOSHI MINAMISAWA, TAKASHI MIURA, HIROHIKO MOTOKI, SOICHIRO EBISAWA, AYAKO OKADA, ATSUSHI IZAWA, JUN KOYAMA, UICHI IKEDA Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan Background: Coronary artery disease (CAD) is common in patients with heart failure (HF), but little is known about the prognostic significance of SYNTAX score, which is a coronary lesion complexity scoring system, in patients with HF with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF). Methods: We enrolled 200 patients (age, 73611 years) with prior HF who underwent percutaneous coronary intervention. Patients were tracked prospectively for 12 months. The study endpoint was the composite of major adverse cardiovascular events (MACE) including all-cause death, myocardial infarction, and stroke. Results: Adverse events were observed in 33 patients (16.5%). Ninety-nine patients were HFpEF (EF S 50%) and 101 patients were HFrEF (EF!50%). The incidence of MACE was significantly higher in patients with high SYNTAX scores (S 12.5) than those with low SYNTAX scores (!12.5) (27.2% vs. 7.4%, P!0.0001). Multivariate analyses revealed that SYNTAX score was significantly associated with MACE (HR: 1.08, 95% CI: 1.04 to 1.11; P!0.01). HFpEF patients with high SYNTAX scores showed worse prognoses than those with low SYNTAX scores (30.0% vs. 0%, P!0.001), whereas HFrEF patients did not show (25.0% vs. 16.3%, P50.30). Conclusions: In prior HF patients with CAD, high SYNTAX scores predicted a high incidence of MACE. SYNTAX score might be a more useful parameter to improve risk stratification in patients with HFpEF than those with HFrEF.
OP9-5 Association between Hyperuricemia and Mortality in Heart Failure Patients with Preserved Ejection Fraction TAKESHI SHIMIZU, AKIOMI YOSHIHISA, MAI TAKIGUCHI, SHUNSUKE MIURA, YUICHI NAKAMURA, HIROYUKI YAMAUCHI, TAKASHI OWADA, SATOSHI ABE, SATOSHI SUZUKI, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan Background: Hyperuricemia is a predictor of cardiovascular mortality in heart failure with reduced ejection fraction. However, the impact of uric acid on heart failure with preserved ejection fraction (HFpEF) is unclear. Methods and Results: Consecutive 345 patients, who admitted to our hospital for decompensated heart failure and diagnosed as HFpEF, were divided into two groups based on presence of hyperuricemia (serum uric acid S 7 mg/dl). In the follow up period (mean of 733 days), cardiac and all-cause mortalities were significantly higher in those with hyperuricemia. In the
OP10-1 Characteristics of Takotsubo Cardiomyopathy with Cardiac Complications YOHEI ONO, HIROTO TAKAMATSU Department of cardiology, Fujioka General Hospital, Gunma, Japan Background: In recent years, it is reported that prognosis of Takotsubo cardiomyopathy (TC) is not favorable than previously thought. Methods and Results: We investigated characteristics of TC with cardiac complications in our cases. We enrolled consecutive 41 patients who were diagnosed as TC in our hospital during January 2007 to April 2015. The mean age of patients was 78.0610.4 years old, 25 of them were female (61%). ST elevation was confirmed in 29 patients (71%). Fifteen patients showed Troponin T elevation (37%). There was elevation of BNP (4766522pg/ml) on admission. Severe cardiac complications (Death, acute heart failure, cardiogenic shock and fatal arrhythmia) were observed in 22 patients (54%). Six patients (15%) died in the hospital, cardiac rupture occurred in 1 patient (2%) and fatal arrhythmia occurred in 4 patients (10%). We compared clinical characteristics, hemodynamics and laboratory data on admission between patients with cardiac complications or not. There was no significant difference in CK, BNP, WBC and ST elevation of electrocardiogram. Age was significantly higher in patients with cardiac complications (81.266.9 vs. 74.3612.5, p50.030). Systolic blood pressure was significantly lower in patients with cardiac complications (115639 vs. 139628, p50.040). Conclusions: Cardiac complications in TC were not rare. Related factor was only age and systolic blood pressure in our cases.
OP10-2 Evidence for Brain Activation in Patients with Takotsubo Cardiomyopathy A New Finding of Cardio-Cerebral Connection HIDEAKI SUZUKI1, YASUHARU MATSUMOTO1, KOUICHIROU SUGIMURA1, JUN TAKAHASHI1, YOSHIHIRO FUKUMOTO2, HIROAKI SHIMOKAWA1 1 Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; 2Department of Internal Medicine, Division of CardioVascular Medicine, Kurume University School of Medicine, Kurume, Japan Background: Takotsubo cardiomyopathy (TTC) is a reversible cardiac wall motion abnormality without significant coronary artery diseases and is typically preceded by emotional or physical stress. However, it remains unknown whether brain activity is altered in takotsubo cardiomyopathy. Methods and Results: We thus examined cerebral blood flow (CBF), a well-established index of brain activity, in 3 patients with TTC (61.3619.9yrs, 2 females) using single photon-emission computed tomography (SPECT). The diagnosis for TTC was made based on (1) reversible cardiac wall motion abnormalities, (2) absence of significant obstructive coronary artery disease by coronary arteriography and (3) new ECG abnormalities. 99mTc ethyl cysteinate dimmer SPECT was scanned in the acute and chronic phases (1-4 and 27-35 days after the onset, respectively). The SPECT images were analyzed using easy-Z score imaging system. A preceding stressor was present in all 3 patients, whose cardiac wall motions were normalized in the chronic phase. Notably, the SPECT images demonstrated significant CBF increase in the brain regions associated with stress including the hippocampus, brainstem and basal ganglia in the acute phase, which significantly subsided but were still present in the chronic phase (P50.026). Conclusion: These findings provide for the first time a direct evidence for brain activation in human TTC, which indicates the potential association between TTC and long-lasting brain activation in the stress-related brain regions.
OP10-3 Takotsubo Cardiomyopathy in a Case of Recurrent Pheochromocytoma RYUZABURO KOCHI1, TATSUO AOKI2, KOICHIRO SUGIMURA2, SHUNSUKE TATEBE2, MASANOBU MIURA2, NOBUHIRO YAOITA2, JUN TAKAHASHI2, YASUHARU MATSUMOTO2, KIMIO SATOU2, HIROAKI SHIMOKAWA2 1 Resident Center, Tohoku University Hospital, Sendai, Japan; 2Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Figure.
A 78-year-old female, who had histories of recurrent pheochromocytoma, visited our hospital for shortness of breath and headache that had been worsening for the last 4 days. She had elevated blood pressure (171/110 mmHg), tachycardia (150/min) and cold sweating. EEG and chest X-ray showed inverted T waves in V1 to V6 and bilateral lung congestion, retrospectively, indicating congestive heart failure. Echocardiography showed left ventricular (LV) wall motion asynergy (apical hypokinesis and basal hyperkinesis), compatible with takotsubo cardiomyopathy (TCM). To rule out acute coronary syndrome, we performed coronary angiography, which showed no organic coronary stenosis. Left ventriculography showed consistent findings with those of echocardiography, and hemodynamic examination showed post capillary pulmonary hypertension. For the treatment of heart failure, we used phentolamine mesilate, carvedilol and carperitide, which resulted in normalization of
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multivariable Cox propotional hazard analyses after adjusting for confounding factors, hyperuricemia was an independent predictor of all-cause mortality. Conclusions: Hyperuricemia is an independent predictor of cardiovascular mortality in HFpEF.
OP9-3 Comparison of Usefulness of SYNTAX Score in Heart Failure Patients with Preserved Ejection Fraction Versus Those with Reduced Ejection Fraction MASATOSHI MINAMISAWA, TAKASHI MIURA, HIROHIKO MOTOKI, SOICHIRO EBISAWA, AYAKO OKADA, ATSUSHI IZAWA, JUN KOYAMA, UICHI IKEDA Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan Background: Coronary artery disease (CAD) is common in patients with heart failure (HF), but little is known about the prognostic significance of SYNTAX score, which is a coronary lesion complexity scoring system, in patients with HF with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF). Methods: We enrolled 200 patients (age, 73611 years) with prior HF who underwent percutaneous coronary intervention. Patients were tracked prospectively for 12 months. The study endpoint was the composite of major adverse cardiovascular events (MACE) including all-cause death, myocardial infarction, and stroke. Results: Adverse events were observed in 33 patients (16.5%). Ninety-nine patients were HFpEF (EF S 50%) and 101 patients were HFrEF (EF!50%). The incidence of MACE was significantly higher in patients with high SYNTAX scores (S 12.5) than those with low SYNTAX scores (!12.5) (27.2% vs. 7.4%, P!0.0001). Multivariate analyses revealed that SYNTAX score was significantly associated with MACE (HR: 1.08, 95% CI: 1.04 to 1.11; P!0.01). HFpEF patients with high SYNTAX scores showed worse prognoses than those with low SYNTAX scores (30.0% vs. 0%, P!0.001), whereas HFrEF patients did not show (25.0% vs. 16.3%, P50.30). Conclusions: In prior HF patients with CAD, high SYNTAX scores predicted a high incidence of MACE. SYNTAX score might be a more useful parameter to improve risk stratification in patients with HFpEF than those with HFrEF.
OP9-5 Association between Hyperuricemia and Mortality in Heart Failure Patients with Preserved Ejection Fraction TAKESHI SHIMIZU, AKIOMI YOSHIHISA, MAI TAKIGUCHI, SHUNSUKE MIURA, YUICHI NAKAMURA, HIROYUKI YAMAUCHI, TAKASHI OWADA, SATOSHI ABE, SATOSHI SUZUKI, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan Background: Hyperuricemia is a predictor of cardiovascular mortality in heart failure with reduced ejection fraction. However, the impact of uric acid on heart failure with preserved ejection fraction (HFpEF) is unclear. Methods and Results: Consecutive 345 patients, who admitted to our hospital for decompensated heart failure and diagnosed as HFpEF, were divided into two groups based on presence of hyperuricemia (serum uric acid S 7 mg/dl). In the follow up period (mean of 733 days), cardiac and all-cause mortalities were significantly higher in those with hyperuricemia. In the
OP10-1 Characteristics of Takotsubo Cardiomyopathy with Cardiac Complications YOHEI ONO, HIROTO TAKAMATSU Department of cardiology, Fujioka General Hospital, Gunma, Japan Background: In recent years, it is reported that prognosis of Takotsubo cardiomyopathy (TC) is not favorable than previously thought. Methods and Results: We investigated characteristics of TC with cardiac complications in our cases. We enrolled consecutive 41 patients who were diagnosed as TC in our hospital during January 2007 to April 2015. The mean age of patients was 78.0610.4 years old, 25 of them were female (61%). ST elevation was confirmed in 29 patients (71%). Fifteen patients showed Troponin T elevation (37%). There was elevation of BNP (4766522pg/ml) on admission. Severe cardiac complications (Death, acute heart failure, cardiogenic shock and fatal arrhythmia) were observed in 22 patients (54%). Six patients (15%) died in the hospital, cardiac rupture occurred in 1 patient (2%) and fatal arrhythmia occurred in 4 patients (10%). We compared clinical characteristics, hemodynamics and laboratory data on admission between patients with cardiac complications or not. There was no significant difference in CK, BNP, WBC and ST elevation of electrocardiogram. Age was significantly higher in patients with cardiac complications (81.266.9 vs. 74.3612.5, p50.030). Systolic blood pressure was significantly lower in patients with cardiac complications (115639 vs. 139628, p50.040). Conclusions: Cardiac complications in TC were not rare. Related factor was only age and systolic blood pressure in our cases.
OP10-2 Evidence for Brain Activation in Patients with Takotsubo Cardiomyopathy A New Finding of Cardio-Cerebral Connection HIDEAKI SUZUKI1, YASUHARU MATSUMOTO1, KOUICHIROU SUGIMURA1, JUN TAKAHASHI1, YOSHIHIRO FUKUMOTO2, HIROAKI SHIMOKAWA1 1 Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; 2Department of Internal Medicine, Division of CardioVascular Medicine, Kurume University School of Medicine, Kurume, Japan Background: Takotsubo cardiomyopathy (TTC) is a reversible cardiac wall motion abnormality without significant coronary artery diseases and is typically preceded by emotional or physical stress. However, it remains unknown whether brain activity is altered in takotsubo cardiomyopathy. Methods and Results: We thus examined cerebral blood flow (CBF), a well-established index of brain activity, in 3 patients with TTC (61.3619.9yrs, 2 females) using single photon-emission computed tomography (SPECT). The diagnosis for TTC was made based on (1) reversible cardiac wall motion abnormalities, (2) absence of significant obstructive coronary artery disease by coronary arteriography and (3) new ECG abnormalities. 99mTc ethyl cysteinate dimmer SPECT was scanned in the acute and chronic phases (1-4 and 27-35 days after the onset, respectively). The SPECT images were analyzed using easy-Z score imaging system. A preceding stressor was present in all 3 patients, whose cardiac wall motions were normalized in the chronic phase. Notably, the SPECT images demonstrated significant CBF increase in the brain regions associated with stress including the hippocampus, brainstem and basal ganglia in the acute phase, which significantly subsided but were still present in the chronic phase (P50.026). Conclusion: These findings provide for the first time a direct evidence for brain activation in human TTC, which indicates the potential association between TTC and long-lasting brain activation in the stress-related brain regions.
OP10-3 Takotsubo Cardiomyopathy in a Case of Recurrent Pheochromocytoma RYUZABURO KOCHI1, TATSUO AOKI2, KOICHIRO SUGIMURA2, SHUNSUKE TATEBE2, MASANOBU MIURA2, NOBUHIRO YAOITA2, JUN TAKAHASHI2, YASUHARU MATSUMOTO2, KIMIO SATOU2, HIROAKI SHIMOKAWA2 1 Resident Center, Tohoku University Hospital, Sendai, Japan; 2Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Figure.
A 78-year-old female, who had histories of recurrent pheochromocytoma, visited our hospital for shortness of breath and headache that had been worsening for the last 4 days. She had elevated blood pressure (171/110 mmHg), tachycardia (150/min) and cold sweating. EEG and chest X-ray showed inverted T waves in V1 to V6 and bilateral lung congestion, retrospectively, indicating congestive heart failure. Echocardiography showed left ventricular (LV) wall motion asynergy (apical hypokinesis and basal hyperkinesis), compatible with takotsubo cardiomyopathy (TCM). To rule out acute coronary syndrome, we performed coronary angiography, which showed no organic coronary stenosis. Left ventriculography showed consistent findings with those of echocardiography, and hemodynamic examination showed post capillary pulmonary hypertension. For the treatment of heart failure, we used phentolamine mesilate, carvedilol and carperitide, which resulted in normalization of