- Email: [email protected]
Geriatric Nutritional Risk Index at Hospital Discharge Is a Useful Predictor of Adverse Outcome in Hospitalized Patients with Heart Failure
S32 Journal of Cardiac Failure Vol. 23 No. 10S October 2017 (CHF 947.7 ± 196.4 nmol/ml, control 1027.6 ± 205.1 nmol/ml, P = .003), BCAA (CHF 448.4 ± 112.9 nmol/ml, control 500.1 ± 117.6 nmol/ml, P < .001), and Fischer ratio (CHF 2.88 ± 0.64, control 3.16 ± 0.53, P < .001) were significantly lower. Conclusion: The serum concentrations of ESSAA, BCAA and Fischer ratio were lower in CHF patients than the controls.
O13-2 Geriatric Nutritional Risk Index at Hospital Discharge Is a Useful Predictor of Adverse Outcome in Hospitalized Patients with Heart Failure Masafumi Ono1, Atsushi Mizuno1, Ryoma Fukuoka2, Yasuyuki Shiraishi2, Takashi Kohno2, Yuji Nagatomo3, Ayumi Goda4, Yasumori Sujino5, Syun Kohsaka2, Tsutomu Yoshikawa3,5 on behalf of the West Tokyo Heart Failure Registry Investigators; 1 Department of Cardiology, St. Luke’s International Hospital, Tokyo, Japan; 2Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; 3Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; 4Second Department of Medicine, Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan; 5 Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan Background: Geriatric Nutritional Risk Index (GNRI) is known as simple nutritional evaluation tool for elderly patients. Past reports revealed lower GNRI on admission associates with higher mortality rate in hospitalized patients with heart failure (HF). On the other hand, GNRI at hospital discharge(dGNRI) had not been evaluated sufficiently. Methods: We retrospectively analyzed using database of the West Tokyo Heart Failure (WET-HF) Registry. We excluded the patients whose GNRI were not available. All-cause mortality rate was compared between 2 groups: lower GNRI (<92) with moderate or severe nutritional risk; and higher GNRI (>=92) with no or low nutritional risk. Results: Total 1077 patients (mean age, 72.9 years; 58% male) were analyzed. The absolute value of dGNRI was 92.3 ± 12.8, and total 536 (50%) patients had lower GNRI at discharge. Among lower dGNRI patients, 253 (33%) patients had higher GNRI on admission. During the follow-up period of 678 ± 539days, 217 (20%) patients died, 329 (31%) patients were re-hospitalized with HF. Kaplan-Meier curves and the log-rank test demonstrated the incidence of all-cause mortality was significantly higher in patients with lower dGNRI. At the multivariable Cox regression analysis, lower dGNRI was independently associated with higher mortality risk (HR: 2.22[1.54–3.26], and P < .0001) but not associated with HF re-hospitalization (P = .51). Conclusion: Lower GNRI at discharge is an independent predictor of allcause mortality in HF patients.
O13-3 Impact of Nutritional Index on Mortality in Heart Failure Patients Yuki Kanno, Akiomi Yoshihisa, Makiko Tatsumi, Satoshi Abe, Tskamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Atsushi Kobayashi, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan Background: Malnutrition is common, and is associated with adverse prognosis in patients with heart failure (HF). The controlling nutritional status (CONUT) is used objective indexes for evaluating nutritional status. We aimed to examine the ability of CONUT score for predicting mortality. Methods and Results: We measured CONUT in consecutive 710 patients with HF. First, we examined clinical background. In the multiple regression analysis to determine CONUT, age, the presence of diabetes and anemia were independent predictor of COUNT. Second, in the Kaplan-Meier analysis, allcause mortality progressively increased from normal to mild, moderate and severe disturbance groups (Figure). In the Cox proportional hazard analysis, CONUT score was an independent predictor of all-cause mortality in HF patients (HR 1.127, P < .001). Conclusion: CONUT score is useful for predicting mortality.
O14-1 A Case of Heart Failure Caused by Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis Yuki Yokomoto1, Haruhiko Higashi1, Makoto Saito2, Yuta Watanabe1, Chiharuko Iio1, Takuya Matsumoto3, Takafumi Okura1, Jitsuo Higaki1, Shuntaro Ikeda1; 1Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon, Japan; 2Department of Cardiology, Kitaishikai Hospital, Ozu, Japan; 3Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Toon, Japan A 58-year-old woman presented with increasing shortness of breath and fatigue for three months. Her medical history revealed that she had started suffering from bronchial asthma and numbness in both legs about one year before admission. A chest x-ray showed pulmonary congestion and cardiomegaly. Transthoracic echocardiography demonstrated diffuse hypokinesis of the left ventricle with an ejection fraction of 38%. Intracardiac thrombi were detected in the left ventricular apex and left atrial appendage. Brain magnetic resonance imaging showed multiple cerebellar infarctions, but fortunately the lesions were asymptomatic. Laboratory examination revealed that B-type natriuretic peptide was elevated to 2700 pg/dL and eosinophils was elevated to 59.4%. Based on these findings, we diagnosed heart failure due to cardiac involvement of eosinophilic granulomatosis with polyangiitis (EGPA). In addition to standard heart failure therapy, oral prednisolone was introduced at a dose of 30 mg daily. Right ventricular myocardial biopsy was performed 7 days after steroid therapy. The pathological findings were compatible with post-myocarditic change, but without eosinophil infiltration. Although her heart failure symptoms were improved and left ventricular ejection fraction was increased to 51%, severe numbness and pain remained uncontrolled. Therefore, we decided to treat the patient with intravenous cyclophosphamide and high-dose intravenous immunoglobulin in addition to steroid therapy. We herewith report a case of heart failure associated with cardiac involvement in an EGPA patient.
O14-2 A Case of Idiopathic Eosinophilic Myocarditis Recovered Spontaneously without Corticosteroids Therapy Miyuki Ito, Hiroshi Wada, Tatsuro Ibe, Yusuke Ugata, Kenichi Sakakura, Hideo Fujita, Shin-Ichi Momomura; Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan Case: A 22-year-old woman was referred to our institute because of chest pain, dyspnea, and syncope. White blood cell count (WBC) was high (16,670/µl) with marked elevation of eosinophils (10,418/µl, 62.5% of WBC). Troponin I and BNP levels were elevated to 561.3 pg/ml and 298.2 pg/ml respectively, whereas vital signs and physical examination showed no remarkable findings. ECG showed negative T-wave in precordial leads and echocardiography showed moderate pericardial effusion with preserved left ventricular ejection fraction. Endomyocardial biopsy revealed eosinophilic infiltration of the myocardium. Secondary causes of hyper-eosinophilia such as allergy, parasitic infections, vasculitis, and hematologic disorders were excluded by medical history, antibody of blood samples, and bone marrow aspiration biopsy. Four weeks after conservative treatment, the eosinophilia was normalized and her signs and symptoms including pericardial effusion disappeared spontaneously. Corticosteroid was not used throughout the clinical course. Conclusion: Eosinophilic myocarditis is relatively rare myocardial disease, and there are only little systematic evidences supporting the use of corticosteroid for all cases. We are reporting this case because this is an interesting case of idiopathic eosinophilic myocarditis which recovered spontaneously without corticosteroids treatment.
O14-3 Nivolumab-induced Autoimmune Myocarditis: A Case Report Shunsuke Sakai, Kazuko Tajiri, Jyunro Hasegawa, Naoaki Hashimoto, Masayoshi Yamamoto, Yoshihiro Seo, Akira Sato, Kazutaka Aonuma; Cardiovascular Division, Facurity of Medicine, University of Tsukuba Nivolumab, a checkpoint inhibitor directed against programmed death-1 (PD-1), was approved as the first specific immunotherapeutic agent as second-line therapy in previously treated metastatic renal cell carcinoma (RCC) patients. A 73-year-old man with metastatic RCC was treated with nivolumab. A few days after the second treatment with nivolumab, he presented with diffuse muscle pain and unilateral ptosis. ECG showed Mobitz type 2 AV block and ST—segment elevation in leads II, III, aVF, V5, and V6. The laboratory test was found to mark an increase in serum levels of creatine kinase, creatine kinase MB-isozyme and troponin T. Echocardiographic studies revealed a severely impaired left ventricular function. The histological analysis of a myocardial biopsy showed lymphocytic infiltration with a predominance of CD3, 4, and 8 positive T cells and macrophages. Nivolumab was discontinued and the patient was started on a high dose of steroids. The findings of this case indicated that nivolumab can cause myocarditis, rhabdomyolysis and myasthenia gravis.
O13-2 Geriatric Nutritional Risk Index at Hospital Discharge Is a Useful Predictor of Adverse Outcome in Hospitalized Patients with Heart Failure Masafumi Ono1, Atsushi Mizuno1, Ryoma Fukuoka2, Yasuyuki Shiraishi2, Takashi Kohno2, Yuji Nagatomo3, Ayumi Goda4, Yasumori Sujino5, Syun Kohsaka2, Tsutomu Yoshikawa3,5 on behalf of the West Tokyo Heart Failure Registry Investigators; 1 Department of Cardiology, St. Luke’s International Hospital, Tokyo, Japan; 2Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; 3Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; 4Second Department of Medicine, Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan; 5 Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan Background: Geriatric Nutritional Risk Index (GNRI) is known as simple nutritional evaluation tool for elderly patients. Past reports revealed lower GNRI on admission associates with higher mortality rate in hospitalized patients with heart failure (HF). On the other hand, GNRI at hospital discharge(dGNRI) had not been evaluated sufficiently. Methods: We retrospectively analyzed using database of the West Tokyo Heart Failure (WET-HF) Registry. We excluded the patients whose GNRI were not available. All-cause mortality rate was compared between 2 groups: lower GNRI (<92) with moderate or severe nutritional risk; and higher GNRI (>=92) with no or low nutritional risk. Results: Total 1077 patients (mean age, 72.9 years; 58% male) were analyzed. The absolute value of dGNRI was 92.3 ± 12.8, and total 536 (50%) patients had lower GNRI at discharge. Among lower dGNRI patients, 253 (33%) patients had higher GNRI on admission. During the follow-up period of 678 ± 539days, 217 (20%) patients died, 329 (31%) patients were re-hospitalized with HF. Kaplan-Meier curves and the log-rank test demonstrated the incidence of all-cause mortality was significantly higher in patients with lower dGNRI. At the multivariable Cox regression analysis, lower dGNRI was independently associated with higher mortality risk (HR: 2.22[1.54–3.26], and P < .0001) but not associated with HF re-hospitalization (P = .51). Conclusion: Lower GNRI at discharge is an independent predictor of allcause mortality in HF patients.
O13-3 Impact of Nutritional Index on Mortality in Heart Failure Patients Yuki Kanno, Akiomi Yoshihisa, Makiko Tatsumi, Satoshi Abe, Tskamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Atsushi Kobayashi, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan Background: Malnutrition is common, and is associated with adverse prognosis in patients with heart failure (HF). The controlling nutritional status (CONUT) is used objective indexes for evaluating nutritional status. We aimed to examine the ability of CONUT score for predicting mortality. Methods and Results: We measured CONUT in consecutive 710 patients with HF. First, we examined clinical background. In the multiple regression analysis to determine CONUT, age, the presence of diabetes and anemia were independent predictor of COUNT. Second, in the Kaplan-Meier analysis, allcause mortality progressively increased from normal to mild, moderate and severe disturbance groups (Figure). In the Cox proportional hazard analysis, CONUT score was an independent predictor of all-cause mortality in HF patients (HR 1.127, P < .001). Conclusion: CONUT score is useful for predicting mortality.
O14-1 A Case of Heart Failure Caused by Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis Yuki Yokomoto1, Haruhiko Higashi1, Makoto Saito2, Yuta Watanabe1, Chiharuko Iio1, Takuya Matsumoto3, Takafumi Okura1, Jitsuo Higaki1, Shuntaro Ikeda1; 1Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon, Japan; 2Department of Cardiology, Kitaishikai Hospital, Ozu, Japan; 3Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Toon, Japan A 58-year-old woman presented with increasing shortness of breath and fatigue for three months. Her medical history revealed that she had started suffering from bronchial asthma and numbness in both legs about one year before admission. A chest x-ray showed pulmonary congestion and cardiomegaly. Transthoracic echocardiography demonstrated diffuse hypokinesis of the left ventricle with an ejection fraction of 38%. Intracardiac thrombi were detected in the left ventricular apex and left atrial appendage. Brain magnetic resonance imaging showed multiple cerebellar infarctions, but fortunately the lesions were asymptomatic. Laboratory examination revealed that B-type natriuretic peptide was elevated to 2700 pg/dL and eosinophils was elevated to 59.4%. Based on these findings, we diagnosed heart failure due to cardiac involvement of eosinophilic granulomatosis with polyangiitis (EGPA). In addition to standard heart failure therapy, oral prednisolone was introduced at a dose of 30 mg daily. Right ventricular myocardial biopsy was performed 7 days after steroid therapy. The pathological findings were compatible with post-myocarditic change, but without eosinophil infiltration. Although her heart failure symptoms were improved and left ventricular ejection fraction was increased to 51%, severe numbness and pain remained uncontrolled. Therefore, we decided to treat the patient with intravenous cyclophosphamide and high-dose intravenous immunoglobulin in addition to steroid therapy. We herewith report a case of heart failure associated with cardiac involvement in an EGPA patient.
O14-2 A Case of Idiopathic Eosinophilic Myocarditis Recovered Spontaneously without Corticosteroids Therapy Miyuki Ito, Hiroshi Wada, Tatsuro Ibe, Yusuke Ugata, Kenichi Sakakura, Hideo Fujita, Shin-Ichi Momomura; Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan Case: A 22-year-old woman was referred to our institute because of chest pain, dyspnea, and syncope. White blood cell count (WBC) was high (16,670/µl) with marked elevation of eosinophils (10,418/µl, 62.5% of WBC). Troponin I and BNP levels were elevated to 561.3 pg/ml and 298.2 pg/ml respectively, whereas vital signs and physical examination showed no remarkable findings. ECG showed negative T-wave in precordial leads and echocardiography showed moderate pericardial effusion with preserved left ventricular ejection fraction. Endomyocardial biopsy revealed eosinophilic infiltration of the myocardium. Secondary causes of hyper-eosinophilia such as allergy, parasitic infections, vasculitis, and hematologic disorders were excluded by medical history, antibody of blood samples, and bone marrow aspiration biopsy. Four weeks after conservative treatment, the eosinophilia was normalized and her signs and symptoms including pericardial effusion disappeared spontaneously. Corticosteroid was not used throughout the clinical course. Conclusion: Eosinophilic myocarditis is relatively rare myocardial disease, and there are only little systematic evidences supporting the use of corticosteroid for all cases. We are reporting this case because this is an interesting case of idiopathic eosinophilic myocarditis which recovered spontaneously without corticosteroids treatment.
O14-3 Nivolumab-induced Autoimmune Myocarditis: A Case Report Shunsuke Sakai, Kazuko Tajiri, Jyunro Hasegawa, Naoaki Hashimoto, Masayoshi Yamamoto, Yoshihiro Seo, Akira Sato, Kazutaka Aonuma; Cardiovascular Division, Facurity of Medicine, University of Tsukuba Nivolumab, a checkpoint inhibitor directed against programmed death-1 (PD-1), was approved as the first specific immunotherapeutic agent as second-line therapy in previously treated metastatic renal cell carcinoma (RCC) patients. A 73-year-old man with metastatic RCC was treated with nivolumab. A few days after the second treatment with nivolumab, he presented with diffuse muscle pain and unilateral ptosis. ECG showed Mobitz type 2 AV block and ST—segment elevation in leads II, III, aVF, V5, and V6. The laboratory test was found to mark an increase in serum levels of creatine kinase, creatine kinase MB-isozyme and troponin T. Echocardiographic studies revealed a severely impaired left ventricular function. The histological analysis of a myocardial biopsy showed lymphocytic infiltration with a predominance of CD3, 4, and 8 positive T cells and macrophages. Nivolumab was discontinued and the patient was started on a high dose of steroids. The findings of this case indicated that nivolumab can cause myocarditis, rhabdomyolysis and myasthenia gravis.