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Efficacy of Positive Airway Pressure Therapy for Secondary Prevention in Elderly Patients with Cardiovascular Disease and Sleep Disordered Breathing
S164 Journal of Cardiac Failure Vol. 18 No. 10S October 2012 ASV therapy is effective even in elderly patients or not. In this study, we investigate the effect of ASV therapy in elderly patients with severe heart failure. Methods: Between February 2011 and January 2012, 7 patients with over eighties and New York Heart Association (NYHA) class III or IV treated with ASV therapy. ASV therapy was started for 30 to 60 minutes during daytime, and then 4 patients finally treated during nighttime and 3 patients during daytime. Results: ASV therapy improved NYHA class and achieved discharge. In addition, ASV therapy avoided readmission. However 3 patients died within 1 year after induction of ASV therapy because of heart failure, renal failure and sepsis. Conclusions: These results suggest ASV therapy improves the quality of life in elderly patients with severe heart failure.
O-088 Effect of Adaptive Servo Ventilation Therapy on Patinets of Cardiac Resynchronization Therapy Non Responders TAE ISHIKAWA1, SEIJI FUKAMIZU1, RINTARO HOJO1, TAKEKUNI HAYASHI1, KOTA KOMIYAMA1, YASUHIRO TANABE1, TAMOTSU TEJIMA1, MITSUHIRO NISHIZAKI2, HARUMIZU SAKURADA3 1 The Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan, 2 The Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan, 3Tokyo Metropolitan Health and Medical Treatment Corporation, Ohkubo Hospital, Tokyo, Japan Background: The effect of adaptive servo ventilation (ASV) therapy on cardiac resynchronization therapy (CRT) non responders is not clear. Method: This study included 28 patients who received CRT (male, 19; age, 70 6 11 years; follow-up period, 40 6 18 months). We assessed the ejection fraction (EF), left ventricular end-systolic volume (LVESV), BNP levels, NYHA class, and number of hospitalizations before and after ASV therapy. Response to CRT was defined as a O15% reduction in LVESV at 1 year after CRT device implantation. Result: Nine patients did not respond to CRT (32%). Of these 9 patients, 4 who were hospitalized repeatedly because of heart failure after CRT device implantation started ASV therapy during the night at home. ASV therapy did not result in a significant change in BNP levels (246 pg/dl before ASV vs 198 pg/dl after ASV), LVESV, EF, NYHA class, and the number of hospitalizations. In the 5 patients of CRT non responders and did not receive ASV therapy, LVESV, EF, NYHA class, and the number of hospitalizations did not change significantly, but BNP increased significantly (294 pg/dl vs 340 pg/dl, p 5 0.026). Conclusion: Among the patients of CRT non responder without ASV therapy showed significantly increased BNP levels during observation. Therefore, ASV therapy might be considered for the treatment of heart failure in CRT non responders.
O-089 Efficacy of Positive Airway Pressure Therapy for Secondary Prevention in Elderly Patients with Cardiovascular Disease and Sleep Disordered Breathing YOSUKE NISHIHATA, YOSHIFUMI TAKATA, KOTA KATO, TASUKU YAMAGUCHI, KAZUKI SHIINA, YASUHIRO USUI, AKIRA YAMASHINA Department of Cardiology, Tokyo Medical University, Tokyo, Japan Objectives: The aim of this study is to determine whether positive airway pressure (PAP) therapy affects cardiovascular outcomes of elderly patients with cardiovascular disease (CVD) and sleep-disordered breathing (SDB). Methods: We studied 1693 patients who underwent polysomnography between November 2004 and July 2011, and enrolled 131 elderly patients (ageO65) with SDB (apnea-hypopnea indexO15) who had been admitted to hospital due to CVD before polysomnography. They were divided into two groups; PAP-treated group and untreated SDB group. The frequency of death and hospitalization due to CVD was compared between the groups. Results: The mean follow-up period was 31.8623.4 months and Kaplan-Meier curves showed that event-free survival rate was significantly higher in PAP-treated group than in untreated SDB group (p!0.01). Conclusions: PAP-therapy is effective for secondary prevention in elderly patients with CVD and SDB.
O-090 Clinical Outcomes of Chronic Heart Failure Patients with Unsuppressed Sleep Apnea by Positive Airway Pressure Therapy TAKATOSHI KASAI1,2, KOJI NARUI1, TOMOTAKA DOHI1,2, YASUHIRO TOMITA2,3, KEN-ICHI MAENO2, SATOSHI KASAGI2, SUGAO ISHIWATA3, MINORU OHNO3, TETSU YAMAGUCHI3, SHIN-ICHI MOMOMURA3,4 1 Cardio-Respiratory Sleep Medicine, Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan, 2Sleep Center, Toranomon Hospital, Tokyo, Japan, 3Cardiovascular Center, Toranomon Hospital, Tokyo, Japan, 4Cardiovascular Division, Saitama Medical Center, Jichi Medical University, Saitama, Japan Background: In patients with chronic heart failure (CHF), the presence of sleep apnea (SA), including either obstructive or central SA (OSA or CSA, respectively) is associated with poor clinical outcomes. It was also reported that positive airway pressure (PAP) therapy can improve clinical outcomes in CHF patients with SA. However, some studies suggested that PAP therapy may be beneficial on clinical outcomes only when SAwas effectively suppressed. We investigated clinical outcomes of CHF patients with unsuppressed SA by PAP therapy. Methods: Between 2001 and 2005, patients were enrolled if they met the following criteria: 1) the presence of CHF (LVEF!550% and NYHA class O5II); 2) stable clinical status; 3) having significant SA (apnea-hypopnea index [AHI]O515/h); 4) initiated into PAP therapy (continuous or bi-level PAP). Patients were classified into 2 groups according to AHI on PAP O515/h (unsuppressed SA) or !15/h. The incidence of clinical events (composite of death and hospitalization) were compared. Results: Overall, 111 patients were enrolled. During 22.1615.4 months, the events rate was 45%. Multivariate analysis showed that the risk for the clinical events was increased in the unsuppressed SA group (HR 2.01, P50.042) in addition to the presence of predominant CSA and lower systolic blood pressure. Conclusion: CHF patients with SA had poor clinical outcomes even on PAP therapy if the SA was not effectively suppressed.
O-091 Technetium-99m Sestamibi Retention and Washout in a Rat Model of Heart Failure and Rats Administered a Mitochondrial Uncoupler AKIRA KAWAMOTO1, TAKAO KATO1,2, TETSUO SHIOI1, TSUNEAKI KAWASHIMA1, YODO TAMAKI1, SHINICHIRO NIIZUMA1, JUNJI OKUDA1, YOHEI TANADA1, TAKESHI KIMURA1 1 Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 2Cardiovascular Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan Background and Objectives: Measurements of technetium-99m sestamibi (99mTcMIBI) with single-photon emission computed tomography (SPECT) are used for the diagnosis of ischemic heart disease. In addition, the washout of 99mTc-MIBI is reported to be correlated with the severity of heart failure (HF). Since it is difficult to obtain an absolute value of 99mTc-MIBI retention using SPECT, we measured 99mTc-MIBI retention and washout in extracted myocardial tissue in rats with HF or rats administered a mitochondrial uncoupler. Methods: To examine 99mTc-MIBI retention and washout in a failing heart, we administered 99mTc-MIBI to Dahl salt-sensitive (DS) rats fed a high-salt (HS) diet, which develop hypertension and HF. Next, we administered 99mTc-MIBI to rats injected a mitochondrial uncoupler Carbonyl cyanide m-chlorophenylhydrazone (CCCP). Results: 99mTc-MIBI washout was increased in HF rats compared with control rats. 99m Tc-MIBI washout was positively correlated with heart weight and ANF gene expression in the heart. 99mTc-MIBI retention positively correlated with 125I-15-(p-iodophenyl)9-R, S-methylpentadecanoic acid (125I-9MPA), a fatty acid analog, retention. CCCP increased 99mTc-MIBI washout associated with decreased cardiac function and cardiac energy reserve. Conclusions: 99mTc-MIBI washout was increased in HF rats and rats administered a mitochondrial uncoupler. Cardiac hypertrophy is likely to be associated with abnormal mitochondrial membrane potential in an animal model of HF.
O-093 Prognostic Implication of Extent of Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance after Steroid Therapy in Patients with Cardiac Sarcoidosis TAKAYUKI ISE1, TAKUYA HASEGAWA1, YOSHIAKI MORITA2, NAOAKI YAMADA2, AKIRA FUNADA1, HIDEAKI KANZAKI1, HIDEO OKAMURA1, SHIRO KAMAKURA1, TOSHIHISA ANZAI1, MASAFUMI KITAKAZE1 1 Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan, 2Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan Background: Gadolinium-enhanced cardiac magnetic resonance imaging is an emerging tool for diagnosis of cardiac sarcoidosis (CS). The presence of late gadolinium enhancement (LGE) reflects myocardial involvement. However, the extent of LGE on adverse outcomes and efficacy of steroid therapy have not been well known in patients with CS. Methods: We reviewed 43 consecutive LGE-positive CS patients before steroid therapy. The patients were divided into two groups based on the extent of LGE: large-extent LGE (LGE mass ! 40% of left ventricular (LV) mass) and small-extent LGE (LGE mass O 40% of LV mass). LV ejection fraction was measured by echocardiography before and 6 months after steroid therapy. Results: Twenty-two patients had large-extent LGE and 21 patients had small-extent LGE. During follow-up, 5 patients died and 10 were hospitalized for heart failure. The extent of LGE inversely correlated with
O-088 Effect of Adaptive Servo Ventilation Therapy on Patinets of Cardiac Resynchronization Therapy Non Responders TAE ISHIKAWA1, SEIJI FUKAMIZU1, RINTARO HOJO1, TAKEKUNI HAYASHI1, KOTA KOMIYAMA1, YASUHIRO TANABE1, TAMOTSU TEJIMA1, MITSUHIRO NISHIZAKI2, HARUMIZU SAKURADA3 1 The Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan, 2 The Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan, 3Tokyo Metropolitan Health and Medical Treatment Corporation, Ohkubo Hospital, Tokyo, Japan Background: The effect of adaptive servo ventilation (ASV) therapy on cardiac resynchronization therapy (CRT) non responders is not clear. Method: This study included 28 patients who received CRT (male, 19; age, 70 6 11 years; follow-up period, 40 6 18 months). We assessed the ejection fraction (EF), left ventricular end-systolic volume (LVESV), BNP levels, NYHA class, and number of hospitalizations before and after ASV therapy. Response to CRT was defined as a O15% reduction in LVESV at 1 year after CRT device implantation. Result: Nine patients did not respond to CRT (32%). Of these 9 patients, 4 who were hospitalized repeatedly because of heart failure after CRT device implantation started ASV therapy during the night at home. ASV therapy did not result in a significant change in BNP levels (246 pg/dl before ASV vs 198 pg/dl after ASV), LVESV, EF, NYHA class, and the number of hospitalizations. In the 5 patients of CRT non responders and did not receive ASV therapy, LVESV, EF, NYHA class, and the number of hospitalizations did not change significantly, but BNP increased significantly (294 pg/dl vs 340 pg/dl, p 5 0.026). Conclusion: Among the patients of CRT non responder without ASV therapy showed significantly increased BNP levels during observation. Therefore, ASV therapy might be considered for the treatment of heart failure in CRT non responders.
O-089 Efficacy of Positive Airway Pressure Therapy for Secondary Prevention in Elderly Patients with Cardiovascular Disease and Sleep Disordered Breathing YOSUKE NISHIHATA, YOSHIFUMI TAKATA, KOTA KATO, TASUKU YAMAGUCHI, KAZUKI SHIINA, YASUHIRO USUI, AKIRA YAMASHINA Department of Cardiology, Tokyo Medical University, Tokyo, Japan Objectives: The aim of this study is to determine whether positive airway pressure (PAP) therapy affects cardiovascular outcomes of elderly patients with cardiovascular disease (CVD) and sleep-disordered breathing (SDB). Methods: We studied 1693 patients who underwent polysomnography between November 2004 and July 2011, and enrolled 131 elderly patients (ageO65) with SDB (apnea-hypopnea indexO15) who had been admitted to hospital due to CVD before polysomnography. They were divided into two groups; PAP-treated group and untreated SDB group. The frequency of death and hospitalization due to CVD was compared between the groups. Results: The mean follow-up period was 31.8623.4 months and Kaplan-Meier curves showed that event-free survival rate was significantly higher in PAP-treated group than in untreated SDB group (p!0.01). Conclusions: PAP-therapy is effective for secondary prevention in elderly patients with CVD and SDB.
O-090 Clinical Outcomes of Chronic Heart Failure Patients with Unsuppressed Sleep Apnea by Positive Airway Pressure Therapy TAKATOSHI KASAI1,2, KOJI NARUI1, TOMOTAKA DOHI1,2, YASUHIRO TOMITA2,3, KEN-ICHI MAENO2, SATOSHI KASAGI2, SUGAO ISHIWATA3, MINORU OHNO3, TETSU YAMAGUCHI3, SHIN-ICHI MOMOMURA3,4 1 Cardio-Respiratory Sleep Medicine, Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan, 2Sleep Center, Toranomon Hospital, Tokyo, Japan, 3Cardiovascular Center, Toranomon Hospital, Tokyo, Japan, 4Cardiovascular Division, Saitama Medical Center, Jichi Medical University, Saitama, Japan Background: In patients with chronic heart failure (CHF), the presence of sleep apnea (SA), including either obstructive or central SA (OSA or CSA, respectively) is associated with poor clinical outcomes. It was also reported that positive airway pressure (PAP) therapy can improve clinical outcomes in CHF patients with SA. However, some studies suggested that PAP therapy may be beneficial on clinical outcomes only when SAwas effectively suppressed. We investigated clinical outcomes of CHF patients with unsuppressed SA by PAP therapy. Methods: Between 2001 and 2005, patients were enrolled if they met the following criteria: 1) the presence of CHF (LVEF!550% and NYHA class O5II); 2) stable clinical status; 3) having significant SA (apnea-hypopnea index [AHI]O515/h); 4) initiated into PAP therapy (continuous or bi-level PAP). Patients were classified into 2 groups according to AHI on PAP O515/h (unsuppressed SA) or !15/h. The incidence of clinical events (composite of death and hospitalization) were compared. Results: Overall, 111 patients were enrolled. During 22.1615.4 months, the events rate was 45%. Multivariate analysis showed that the risk for the clinical events was increased in the unsuppressed SA group (HR 2.01, P50.042) in addition to the presence of predominant CSA and lower systolic blood pressure. Conclusion: CHF patients with SA had poor clinical outcomes even on PAP therapy if the SA was not effectively suppressed.
O-091 Technetium-99m Sestamibi Retention and Washout in a Rat Model of Heart Failure and Rats Administered a Mitochondrial Uncoupler AKIRA KAWAMOTO1, TAKAO KATO1,2, TETSUO SHIOI1, TSUNEAKI KAWASHIMA1, YODO TAMAKI1, SHINICHIRO NIIZUMA1, JUNJI OKUDA1, YOHEI TANADA1, TAKESHI KIMURA1 1 Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 2Cardiovascular Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan Background and Objectives: Measurements of technetium-99m sestamibi (99mTcMIBI) with single-photon emission computed tomography (SPECT) are used for the diagnosis of ischemic heart disease. In addition, the washout of 99mTc-MIBI is reported to be correlated with the severity of heart failure (HF). Since it is difficult to obtain an absolute value of 99mTc-MIBI retention using SPECT, we measured 99mTc-MIBI retention and washout in extracted myocardial tissue in rats with HF or rats administered a mitochondrial uncoupler. Methods: To examine 99mTc-MIBI retention and washout in a failing heart, we administered 99mTc-MIBI to Dahl salt-sensitive (DS) rats fed a high-salt (HS) diet, which develop hypertension and HF. Next, we administered 99mTc-MIBI to rats injected a mitochondrial uncoupler Carbonyl cyanide m-chlorophenylhydrazone (CCCP). Results: 99mTc-MIBI washout was increased in HF rats compared with control rats. 99m Tc-MIBI washout was positively correlated with heart weight and ANF gene expression in the heart. 99mTc-MIBI retention positively correlated with 125I-15-(p-iodophenyl)9-R, S-methylpentadecanoic acid (125I-9MPA), a fatty acid analog, retention. CCCP increased 99mTc-MIBI washout associated with decreased cardiac function and cardiac energy reserve. Conclusions: 99mTc-MIBI washout was increased in HF rats and rats administered a mitochondrial uncoupler. Cardiac hypertrophy is likely to be associated with abnormal mitochondrial membrane potential in an animal model of HF.
O-093 Prognostic Implication of Extent of Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance after Steroid Therapy in Patients with Cardiac Sarcoidosis TAKAYUKI ISE1, TAKUYA HASEGAWA1, YOSHIAKI MORITA2, NAOAKI YAMADA2, AKIRA FUNADA1, HIDEAKI KANZAKI1, HIDEO OKAMURA1, SHIRO KAMAKURA1, TOSHIHISA ANZAI1, MASAFUMI KITAKAZE1 1 Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan, 2Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan Background: Gadolinium-enhanced cardiac magnetic resonance imaging is an emerging tool for diagnosis of cardiac sarcoidosis (CS). The presence of late gadolinium enhancement (LGE) reflects myocardial involvement. However, the extent of LGE on adverse outcomes and efficacy of steroid therapy have not been well known in patients with CS. Methods: We reviewed 43 consecutive LGE-positive CS patients before steroid therapy. The patients were divided into two groups based on the extent of LGE: large-extent LGE (LGE mass ! 40% of left ventricular (LV) mass) and small-extent LGE (LGE mass O 40% of LV mass). LV ejection fraction was measured by echocardiography before and 6 months after steroid therapy. Results: Twenty-two patients had large-extent LGE and 21 patients had small-extent LGE. During follow-up, 5 patients died and 10 were hospitalized for heart failure. The extent of LGE inversely correlated with