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Differences in Clinical Characteristics of Anemic Patients with Chronic Heart Failure between Ischemic and Dilated Cardiomyopathy the CHART-2 Study
The 18th Annual Scientific Meeting
JHFS
S155
O-060
O-063
Differences in Clinical Characteristics of Anemic Patients with Chronic Heart Failure between Ischemic and Dilated Cardiomyopathy the CHART-2 Study TAKESHI YAMAUCHI1, YASUHIKO SAKATA1, KOTARO NOCHIOKA1, SATOSHI MIYATA2, MASANOBU MIURA1, SOICHIRO TADAKI1, RYOICHI USHIGOME1, KENJIRO SATO1, TAKEO ONOSE1, HIROAKI SHIMOKAWA1 1 Department of Cariovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan, 2Depertment of Evidence-Based Cardiovascular Medicine
A Case of Cardiac Sarcoidosis Resembling Dilated Cardiomyopathy KOKI OMI, TAKU TOSHIMA, SHINTAROU HONDA, SHUNSUKE NETSU, AKIHIRO KIKUCHI, NOBUYUKI KIRIBAYASHI, SHIGEO SUGAWARA Nihonkai General Hospital
Background: Differences in clinical characteristics of anemic patients with chronic heart failure (CHF) between ischemic (ICM) and dilated cardiomyopathy (DCM) remain to be elucidated. Methods: We compared the differences in the impacts of anemia between ICM (n5309) and DCM (n5646) patients registered in our CHART-2 study (N510,219). Results: The prevalence of anemia (WHO criteria) was 61% and 77% in ICM and DCM, respectively (P!0.001). Compared with anemic DCM patients, anemic ICM patients were characterized by more female gender (84 vs. 62%, P! 0.001) and lower LVEF (32 vs. 45%, P!0.001). There was no significant differences in age (71 vs. 71 years, P50.799) or eGFR (50.1 vs. 52.9 mL/min/1.73m2, P50.315). While anemic ICM patients were less frequently treated with diuretics (65 vs. 79 %, P50.009), there was no difference in the use of b-blockers (66 vs 75 %, P50.107) or renin-angiotensin system inhibitors (81 vs. 88 %, P50.129). Importantly, although the mortality rate was comparable during the median 3.1-year follow-up between ICM and DCM (19.5 vs. 19.7%, P51.00), anemia had a significant prognostic impact in ICM (adjusted hazard ratio (HR) 0.345, P50.002) but not in DCM (adjusted HR 1.14, P50.62) (P for interaction P!0.01). Conclusions: These results indicate that anemia has different impacts on clinical characteristics and long-term prognosis in CHF with more impacts in ICM than in DCM.
O-061 Does Preoperative MR Affect Long-term Outcome of CABG in Ischaemic Cardiomyopathy? SATSUKI FUKUSHIMA, KOICHI TODA, TERUYA NAKAMURA, SHIGERU MIYAGAWA, YASUSHI YOSHIKAWA, MASASHI KAWAMURA, DAISUKE YOSHIOKA, TAKAYOSHI UENO, TORU KURATANI, YOSHIKI SAWA Department of Cardiovascular Surgery, Osaka University, Osaka, Japan Background: Indication of additional mitral valve surgery is inconsistent in CABG for ischaemic cardiomyopathy. This study was to explore influence of preoperative mitral regurgitation (MR) on long-term postoperative outcome after CABG for ischaemic cardiomyopathy. Methods and Results: Of a consecutive series of CABG in our institution between 2002 and 2012, 95 cases who had preoperative EF being 40% or less were included in this study. Degree of preoperative MR was less than mild in 36 cases, mild in 42 cases, mild-moderate in 11 cases and moderate in 6 cases. By the latest follow-up, 16 cases presented with cardiac death including unexpected sudden death in 7 cases, while actuarial cardiac death or cardiac event rate, assessed by Kaplan-Meier method, were not different between cases with mild or more preoperative MR and those without. Of 27 cases who were postoperatively examined by echocardiography for more than 2 years, 10 cases showed EF more than 50% at the latest follow-up, whereas 6 cases failed to show improvement of EF postoperatively and showed increase of MR grade. Conclusion: Presence of preoperative mild MR did not adversely affect mid-term outcomes of CABG for ischaemic cardiomyopathy. Although some cases showed substantial improvement of EF postoperatively, other cases showed progression of MR without functional improvement, suggesting that additional mitral valve surgery may be indicated in the latter cases.
A 70’s Japanese woman with a past history of uveitis was seen in our hospital for treatment of congestive heart failure. Echocardiography showed severe left ventricular (LV) systolic dysfunction with LV enlargement resembling dilated cardiomyopathy (DCM) and moderate mitral valve regurgitation. We initiated therapy with betablocker, diuretic, and pimobendan. This therapy resulted in improvement of pulmonary congestion, however, she presented with nonsustained ventricular tachycardia (NSVT) frequently. Computed tomography revealed bilateral hilar lymphadenopathy and skin biopsy of facial erythema nodosum showed noncaseating granulomas. These findings confirmed the diagnosis of cardiac sarcoidosis. She was treated with corticosteroids and gradual escalation of beta-blocker dose and received cardiac rehabilitation. One year later, she had a marked improvement in LV ejection fraction from 19% to 42% without the occurrence of NSVT. She has maintained brain natriuretic peptide levels below 100 pg/ml and New York Heart Association functional class I. We report a case of cardiac sarcoidosis resembling DCM and that multimodal therapy including corticosteroids is effective in improvement of cardiac systolic function, and adding consideration from literatures to cardiac sarcoidosis.
O-064 A Case of Cardiac Sarcoidosis with Progressive Right Ventricular Dilatation TOMOAKI NAKANO1, HIDETAKA KIOKA1, TOMOHITO OHTANI1, MACHIKO KANZAKI1, YASUMASA TSUKAMOTO1, OSAMU YAMAGUCHI1, KOUICHI TODA2, HATSUE ISHIBASHI-UEDA3, YOSHIKI SAWA2, YASUSHI SAKATA1 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan, 2Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan, 3Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan A 64-year-old woman visited to the hospital with complaints of cough and was suspected to heart failure in 2011. Transthoracic echocardiogram (TTE) showed 33% of left ventricular (LV) ejection fraction. She was initially diagnosed with idiopathic dilated cardiomyopathy (DCM). Despite standard therapy with beta blocker, angiotensin II receptor blocker and diuretics, her symptoms of heart failure including face edema was getting worse (NYHA class III) and serial TTE showed progressive right ventricular (RV) dilatation. She was referred to our hospital for the treatment of heart failure in 2014. Chest X-ray showed cardiomegaly without bilateral hilar lymphadenopathy. A 12-lead electrocardiogram showed normal sinus rhythm with first-degree AV block and intraventricular conduction disorder. TTE revealed the basal thinning of the interventricular septum which is a characteristic feature of cardiac sarcoidosis and severe TR due to impaired coaptation of tricuspid valve secondary to marked RV dilatation. Cardiac magnetic resonance imaging with gadolinium enhancement represented extensive delayed myocardial enhancement. Endomyocardial biopsy showing noncaseating granuloma with multinucleate giant cells confirmed the diagnosis of cardiac sarcoidosis and right heart catheterization showed increased right atrial pressure and severely reduced cardiac output. We report a case of cardiac sarcoidosis initially diagnosed with idiopathic DCM and showed progressive right ventricular dilatation and severe TR.
O-065 A Case of the Cardiac Sarcoidosis Presented the Wall Motion Abnormality of the LAD Rule Domain HIROTAKA NODA Department of Bioscience and Biotechnology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka, Japan
Combination with FDG Positron Emission Tomography/computed Tomography (PET/CT) and Electroanatomic Mapping (CARTO) System are Useful for Diagnosing Isolated Cardiac Sarcoidosis KATSUHITO SEKI, YUUSUKE KOBUKAI, YOSHIKAZU TAMURA, TAKASHI KOYAMA, KENJI IINO, HIROYUKI WATANABE, HIROSHI ITO Department of Cardiovascular Medicine Akita University Graduate School of Medicine, Akita, Japan
(Case) 62 yo, female (chief compliment) exertional dyspnea, palpitation (history) She began to feel exertional dyspnea and palpitation from around the summer of 2013. When she had a gallstone pointed out by a medical examination in November, her heart function was investigated. The coronary arteries were normal although the wall motion abnormality from septal mid to apex severe hypokinesis and EF 42%. Moreover, nonsustained ventricular tachycardia was documented by the exercise electrocardiogram. We doubted cardiomyopathy and investigated more. We can saw uptake to the latelal and inferior wall in PET-CT, and the delay contrast of from cardiac septal mid to apex in heart MRI. Moreover, since it was a view of an epithelioid cell granuloma in the myocardial biopsy, it was diagnosed as cardiac sarcoidosis. (Consideration) since it was a wall motor abnormality of the left anterior descending branch rule domain, this case suspected the old myocardial infarction. Even if in agreement with a rule domain, the time when the coronary arteries are normal, and when there are few coronary risk factors, it is thought that it is necessary to also perform screening of cardiac sarcoidosis.
Cardiac sarcoidosis is a potentially fatal complication of sarcoidosis. Moreover, the diagnosis of isolated cardiac sarcoidosis can be challenging. We report a case of 70-year-old woman with unexplained left ventricular (LV) dysfunction. She presented with chronic heart failure with low ejection fraction 31% and anterior wall thinning estimated by echocardiography. Pacemaker implantation was performed 7 years ago due to atrioventricular block. Therefore, we suspected the cardiac sarcoidosis. FDG PET/CT revealed the presence of high up take of FDG in LV, most notably in the anterior, anteroseptal, and inferior walls. It is reported that standerd endomyocardial biopsy for definitive diagnosis of cardiac sarcoidosis is low rate for conclusive. Therefore, we performed the endomyocardial biopsy by using CARTO system. Electroanatomic mapping-guidance facilitated the acquisition of 5 tissue samples form the low voltage region at the RV septum. Samples revealed non-caseating granulomas which confirmed the diagnosis of cardiac searcoidosis. The patient received the corticosteroid therapy. Three months after treatment with prednisone, marked improvement is seen in cardiac FDG uptake.
O-062
JHFS
S155
O-060
O-063
Differences in Clinical Characteristics of Anemic Patients with Chronic Heart Failure between Ischemic and Dilated Cardiomyopathy the CHART-2 Study TAKESHI YAMAUCHI1, YASUHIKO SAKATA1, KOTARO NOCHIOKA1, SATOSHI MIYATA2, MASANOBU MIURA1, SOICHIRO TADAKI1, RYOICHI USHIGOME1, KENJIRO SATO1, TAKEO ONOSE1, HIROAKI SHIMOKAWA1 1 Department of Cariovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan, 2Depertment of Evidence-Based Cardiovascular Medicine
A Case of Cardiac Sarcoidosis Resembling Dilated Cardiomyopathy KOKI OMI, TAKU TOSHIMA, SHINTAROU HONDA, SHUNSUKE NETSU, AKIHIRO KIKUCHI, NOBUYUKI KIRIBAYASHI, SHIGEO SUGAWARA Nihonkai General Hospital
Background: Differences in clinical characteristics of anemic patients with chronic heart failure (CHF) between ischemic (ICM) and dilated cardiomyopathy (DCM) remain to be elucidated. Methods: We compared the differences in the impacts of anemia between ICM (n5309) and DCM (n5646) patients registered in our CHART-2 study (N510,219). Results: The prevalence of anemia (WHO criteria) was 61% and 77% in ICM and DCM, respectively (P!0.001). Compared with anemic DCM patients, anemic ICM patients were characterized by more female gender (84 vs. 62%, P! 0.001) and lower LVEF (32 vs. 45%, P!0.001). There was no significant differences in age (71 vs. 71 years, P50.799) or eGFR (50.1 vs. 52.9 mL/min/1.73m2, P50.315). While anemic ICM patients were less frequently treated with diuretics (65 vs. 79 %, P50.009), there was no difference in the use of b-blockers (66 vs 75 %, P50.107) or renin-angiotensin system inhibitors (81 vs. 88 %, P50.129). Importantly, although the mortality rate was comparable during the median 3.1-year follow-up between ICM and DCM (19.5 vs. 19.7%, P51.00), anemia had a significant prognostic impact in ICM (adjusted hazard ratio (HR) 0.345, P50.002) but not in DCM (adjusted HR 1.14, P50.62) (P for interaction P!0.01). Conclusions: These results indicate that anemia has different impacts on clinical characteristics and long-term prognosis in CHF with more impacts in ICM than in DCM.
O-061 Does Preoperative MR Affect Long-term Outcome of CABG in Ischaemic Cardiomyopathy? SATSUKI FUKUSHIMA, KOICHI TODA, TERUYA NAKAMURA, SHIGERU MIYAGAWA, YASUSHI YOSHIKAWA, MASASHI KAWAMURA, DAISUKE YOSHIOKA, TAKAYOSHI UENO, TORU KURATANI, YOSHIKI SAWA Department of Cardiovascular Surgery, Osaka University, Osaka, Japan Background: Indication of additional mitral valve surgery is inconsistent in CABG for ischaemic cardiomyopathy. This study was to explore influence of preoperative mitral regurgitation (MR) on long-term postoperative outcome after CABG for ischaemic cardiomyopathy. Methods and Results: Of a consecutive series of CABG in our institution between 2002 and 2012, 95 cases who had preoperative EF being 40% or less were included in this study. Degree of preoperative MR was less than mild in 36 cases, mild in 42 cases, mild-moderate in 11 cases and moderate in 6 cases. By the latest follow-up, 16 cases presented with cardiac death including unexpected sudden death in 7 cases, while actuarial cardiac death or cardiac event rate, assessed by Kaplan-Meier method, were not different between cases with mild or more preoperative MR and those without. Of 27 cases who were postoperatively examined by echocardiography for more than 2 years, 10 cases showed EF more than 50% at the latest follow-up, whereas 6 cases failed to show improvement of EF postoperatively and showed increase of MR grade. Conclusion: Presence of preoperative mild MR did not adversely affect mid-term outcomes of CABG for ischaemic cardiomyopathy. Although some cases showed substantial improvement of EF postoperatively, other cases showed progression of MR without functional improvement, suggesting that additional mitral valve surgery may be indicated in the latter cases.
A 70’s Japanese woman with a past history of uveitis was seen in our hospital for treatment of congestive heart failure. Echocardiography showed severe left ventricular (LV) systolic dysfunction with LV enlargement resembling dilated cardiomyopathy (DCM) and moderate mitral valve regurgitation. We initiated therapy with betablocker, diuretic, and pimobendan. This therapy resulted in improvement of pulmonary congestion, however, she presented with nonsustained ventricular tachycardia (NSVT) frequently. Computed tomography revealed bilateral hilar lymphadenopathy and skin biopsy of facial erythema nodosum showed noncaseating granulomas. These findings confirmed the diagnosis of cardiac sarcoidosis. She was treated with corticosteroids and gradual escalation of beta-blocker dose and received cardiac rehabilitation. One year later, she had a marked improvement in LV ejection fraction from 19% to 42% without the occurrence of NSVT. She has maintained brain natriuretic peptide levels below 100 pg/ml and New York Heart Association functional class I. We report a case of cardiac sarcoidosis resembling DCM and that multimodal therapy including corticosteroids is effective in improvement of cardiac systolic function, and adding consideration from literatures to cardiac sarcoidosis.
O-064 A Case of Cardiac Sarcoidosis with Progressive Right Ventricular Dilatation TOMOAKI NAKANO1, HIDETAKA KIOKA1, TOMOHITO OHTANI1, MACHIKO KANZAKI1, YASUMASA TSUKAMOTO1, OSAMU YAMAGUCHI1, KOUICHI TODA2, HATSUE ISHIBASHI-UEDA3, YOSHIKI SAWA2, YASUSHI SAKATA1 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan, 2Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan, 3Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan A 64-year-old woman visited to the hospital with complaints of cough and was suspected to heart failure in 2011. Transthoracic echocardiogram (TTE) showed 33% of left ventricular (LV) ejection fraction. She was initially diagnosed with idiopathic dilated cardiomyopathy (DCM). Despite standard therapy with beta blocker, angiotensin II receptor blocker and diuretics, her symptoms of heart failure including face edema was getting worse (NYHA class III) and serial TTE showed progressive right ventricular (RV) dilatation. She was referred to our hospital for the treatment of heart failure in 2014. Chest X-ray showed cardiomegaly without bilateral hilar lymphadenopathy. A 12-lead electrocardiogram showed normal sinus rhythm with first-degree AV block and intraventricular conduction disorder. TTE revealed the basal thinning of the interventricular septum which is a characteristic feature of cardiac sarcoidosis and severe TR due to impaired coaptation of tricuspid valve secondary to marked RV dilatation. Cardiac magnetic resonance imaging with gadolinium enhancement represented extensive delayed myocardial enhancement. Endomyocardial biopsy showing noncaseating granuloma with multinucleate giant cells confirmed the diagnosis of cardiac sarcoidosis and right heart catheterization showed increased right atrial pressure and severely reduced cardiac output. We report a case of cardiac sarcoidosis initially diagnosed with idiopathic DCM and showed progressive right ventricular dilatation and severe TR.
O-065 A Case of the Cardiac Sarcoidosis Presented the Wall Motion Abnormality of the LAD Rule Domain HIROTAKA NODA Department of Bioscience and Biotechnology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka, Japan
Combination with FDG Positron Emission Tomography/computed Tomography (PET/CT) and Electroanatomic Mapping (CARTO) System are Useful for Diagnosing Isolated Cardiac Sarcoidosis KATSUHITO SEKI, YUUSUKE KOBUKAI, YOSHIKAZU TAMURA, TAKASHI KOYAMA, KENJI IINO, HIROYUKI WATANABE, HIROSHI ITO Department of Cardiovascular Medicine Akita University Graduate School of Medicine, Akita, Japan
(Case) 62 yo, female (chief compliment) exertional dyspnea, palpitation (history) She began to feel exertional dyspnea and palpitation from around the summer of 2013. When she had a gallstone pointed out by a medical examination in November, her heart function was investigated. The coronary arteries were normal although the wall motion abnormality from septal mid to apex severe hypokinesis and EF 42%. Moreover, nonsustained ventricular tachycardia was documented by the exercise electrocardiogram. We doubted cardiomyopathy and investigated more. We can saw uptake to the latelal and inferior wall in PET-CT, and the delay contrast of from cardiac septal mid to apex in heart MRI. Moreover, since it was a view of an epithelioid cell granuloma in the myocardial biopsy, it was diagnosed as cardiac sarcoidosis. (Consideration) since it was a wall motor abnormality of the left anterior descending branch rule domain, this case suspected the old myocardial infarction. Even if in agreement with a rule domain, the time when the coronary arteries are normal, and when there are few coronary risk factors, it is thought that it is necessary to also perform screening of cardiac sarcoidosis.
Cardiac sarcoidosis is a potentially fatal complication of sarcoidosis. Moreover, the diagnosis of isolated cardiac sarcoidosis can be challenging. We report a case of 70-year-old woman with unexplained left ventricular (LV) dysfunction. She presented with chronic heart failure with low ejection fraction 31% and anterior wall thinning estimated by echocardiography. Pacemaker implantation was performed 7 years ago due to atrioventricular block. Therefore, we suspected the cardiac sarcoidosis. FDG PET/CT revealed the presence of high up take of FDG in LV, most notably in the anterior, anteroseptal, and inferior walls. It is reported that standerd endomyocardial biopsy for definitive diagnosis of cardiac sarcoidosis is low rate for conclusive. Therefore, we performed the endomyocardial biopsy by using CARTO system. Electroanatomic mapping-guidance facilitated the acquisition of 5 tissue samples form the low voltage region at the RV septum. Samples revealed non-caseating granulomas which confirmed the diagnosis of cardiac searcoidosis. The patient received the corticosteroid therapy. Three months after treatment with prednisone, marked improvement is seen in cardiac FDG uptake.
O-062