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Impact of the Renin-Aldosterone System on in-Hospital Mortality in Patients with Acute Decompensated Heart Failure
S176 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 likely to older. Higher systolic blood pressure (r = −0.192, P = .045) and hemoglobin level (r = −0.328, P < .001) on admission were negatively correlated with %peak change of cTnT. Not carperitide (n = 50) and dobutamine (n = 17), but nitrate use (n = 33) was significantly greater %peak change of cTnT compared to nonuser (−37.4 ± 33.4% vs. −22.4 ± 22.4%, P = .02). Conclusion: Nitrate use might be useful for reduce myocardial damage in ADHF patients with high blood pressure and hemoglobin levels (e.g. clinical scenario 1).
O10-2 High-Sensitivity Troponin T and Chance of Survival in Acute Decompensated Heart Failure Keigo Hattori, Makoto Suzuki, Atsushi Seki, Yuji Nagatomo, Tetsuya Tobaru, Jin Komuro, Takato Mori, Hirotaka Ieki, Moto Shimada, Hitonobu Tomoike; Cardiovascular Department, Sakakibara Heart Institution, Tokyo, Japan To elucidate the role of serum levels of high-sensitivity troponin T (TnT) in the setting of acute decompensated heart failure (ADHF), we abstracted clinical features and levels of TnT on admission in a total of 115 hospitalized patients for ADHF between January 2013 and November 2015. Serum levels of TnT was strongly associated with in-hospital mortality (P = .0114) and also NYHA functional class at discharged (P = .0390) regardless of a preserved and/or decreased renal function. Long-term survival was also significantly different between high and low levels of TnT (Figure), suggesting a potential role of TnT in predicting chance of survival in those with ADHF.
O10-4 Impact of the Renin-Aldosterone System on in-Hospital Mortality in Patients with Acute Decompensated Heart Failure Michiro Maruyama, Yusuke Takeda, Youichiro Nakagawa, Mask Kinoshita, Takashi Kusayama, Akio Chikada, Yoshiki Nagata, Kazuo Usuda; Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan Backgrounds: In heart failure, although the adverse effects of neurohormonal activation are known, the prognostic significance of renin aldosterone system (RAS) in patients with acute decompensated heart failure (ADHF) has not been well studied. This purpose is to assess the relationship between RAS and in-hospital outcomes in patients with ADHF. Methods: Objectives were 140 cases with ADHF admitted in ICU (79 ± 12 years, Male 80) from April 2014 through March 2015, in which IHD, valve disease, dilated cardiomyopathy, hypertension, tachycardia, bradycardia and others were 50, 24, 18, 18, 8, 4, and 18 cases. The relationships between in-hospital outcomes and hemodynamics, renal function, serum electrolytes, neurohormonal factors at admission and pre-hospital medication were studied retrospectively. Results: Median of plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were 76.5 pg/ml and 1.2 ng/ml/h. Death in hospital was 12 cases (8.6%). Non-survivors have significantly lower systolic blood pressure (SBP), lower sodium, higher logPAC, higher logPRA, more pre-hospital medication of aldosterone receptor antagonist than survivors inhospital (P < .05). In Cox’s proportional hazards analysis, high PAC (>76.5) was an independent predictor of in-hospital death (HR0.113, 95%CI0.014–0.924, P < .01). SBP, sodium, PRA > 1.2, BNP, pre-hospital medication of RAS inhibitors were not independent predictor of in-hospital death. Conclusions: These results may suggest that activated RAS, especially serum aldosterone is the risk factor of short-term mortality in ADHF patients.
O10-5 Clinical Significance of the Measurement of Urinary Liver-Fatty Acid-Binding Protein (LFABP) Excretion in Acute Heart Failure Patients Akihiro Shirakabe1, Nobuaki Kobayashi1, Hirotake Okazaki1, Masato Matsushita1, Junsuke Shibuya1, Suguru Nishigoori1, Noritake Hata1,2, Kuniya Asai2, Wataru Shimizu2; 1 Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan; 2 Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
O10-3 Relationship between Admission C-Reactive Protein Level and Long-Term Mortality in Patients with Acute Decompensated Heart Failure Hiroki Matsumoto1,2,3, Takatoshi Kasai1,2, Shoichiro Yatsu1, Azusa Murata1, Takao Kato1, Shoko Suda1,2, Masaru Hiki1, Atsutoshi Takagi1, Katsumi Miyauchi1, Hiroyuki Daida1; 1 Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan; 2Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; 3Department of Cardiology, Tobu Chiiki Hospital, Tokyo, Japan Background: Admission C-reactive protein (CRP) level is an important predictor of poor prognosis among several cardiovascular diseases such as acute coronary syndrome. In patients with acute decompensated heart failure (ADHF), admission CRP level is also related to the increased in-hospital mortality, but its relationship to the long-term mortality has not demonstrated yet. Methods: A cohort of 1684 consecutive patients admitted to the cardiac intensive-care unit from 2007 to 2011 was studied. Among them, patients with acute coronary syndrome and neoplasms were excluded, and then patients with ADHF were divided into 4 groups based on quartiles of admission CRP level. Association between admission CRP level and long-term mortality was assessed by multivariable Cox proportional analysis including other independent variables which showed <0.1 in univariable analyses. Results: Overall, 527 patients were assessed. There were 142 deaths (27%) during a median follow-up of 2.0 years. In the multivariable analysis, hazard ratio (HR) increased with admission CRP levels in a significant dose-dependent manner for mortality (P for trend = .045). Multivariable analysis also showed a significant relationship between admission CRP level, when treated as a natural logarithm-transformed continuous variable, and increased mortality (HR, 1.18; P = .023). Conclusion: Admission CRP level is an important predictor of increased long-term mortality in patients with ADHF.
Background: The clinical significance of urinary liver-fatty acid-binding protein (uLFABP) in acute heart failure (AHF) patients was obscured yet. Methods and Results: Two hundred ninety-four AHF patients who admitted to the intensive care unit and measured u-LFABP on admission were analyzed. The median u-LFABP levels were 57.5 [14.5 to 183.5] ng/ml cre, and divided to two group according to the quartiles of u-LFABP (Q1 (Low-LFABP group) v.s. Q2, Q3 and Q4 (High-LFABP group)). We evaluate the diagnostic and prognostic value of u-LFABP in each chronic kidney disease (CKD) (n = 166) or non-CKD patients (n = 129). Acute kidney injury (AKI) on admission was evaluated based on the RIFLE classification, which was the ratio of the serum creatinine value recorded on admission to the baseline creatinine value. In CKD patients, the number of AKI patients and the prognosis was not different between Low and High-LFABP group. Meanwhile, in non-CKD group, the number of AKI patients was significantly more in High-LFABP group (38.0 % v.s. 19.4%). The sensitivity and specificity of u-LFABP for detecting AKI were 69.0% and 57.0% (AUC 0.638) at 42.6 ng/ml cre. A Kaplan-Meier curve, including all-cause death within 90 days, showed a significantly poor survival rate in High-LFABP than in Low-LFABP group (P = .029). Conclusions: The u-LFABP level is an effective biomarker for detecting AKI and predicting poor prognosis in non-CKD AHF patients.
O10-6 The Relationship between Urinary Liver-Type Fatty Acid Binding Protein Levels and Renal Function Markers in Acute Decompensated Heart Failure Takashi Kuragaichi, Yukihito Sato, Masayuki Shiba, Hiroyuki Nakayama; Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan Introduction: Urinary Liver-type Fatty Acid Binding Protein (uL-FABP) is known as a marker reflecting renal tubular impairment in worsening renal function (WRF). However, the role of uL-FABP in WRF has not been elucidated in patients with acute decompensated heart failure (ADHF). Our purpose is to investigate 1) the correlation between uL-FABP and various markers of renal function and 2) whether uL-FABP can predict WRF, in patients with ADHF. Methods and results: Fifty-three patients admitted for ADHF were analyzed. uL-FABP and urinary creatinine were measured at admission and before discharge. WRF was defined as a rise in serum creatinine >0.3 mg/dl within seven days. Median uL-FABP/uCr levels significantly decreased from 3.3 to 2.6 mg/gCr (P = .0002). Log[uL-FABP/uCr] levels at admission were positively correlated with log [urine albumin/uCr] (r = 0.59,P < .0001),and log[urinary N-acetyl-β-Dglucosaminidase (uNAG)/uCr] (r = 0.29,P = .032), although they were neither correlated with log[serum creatinine] nor log[cystatin C]. Log[uL-FABP/uCr] levels at admission were not associated with WRF in the univariate and multivariate logistic regression analysis after adjusted for age, gender, serum creatinine(P = .09 and .20, respectively). Conclusion: In patients with ADHF, uL-FABP at admission was significantly correlated with urine albumin and uNAG, though it was not associated with WRF.
O10-2 High-Sensitivity Troponin T and Chance of Survival in Acute Decompensated Heart Failure Keigo Hattori, Makoto Suzuki, Atsushi Seki, Yuji Nagatomo, Tetsuya Tobaru, Jin Komuro, Takato Mori, Hirotaka Ieki, Moto Shimada, Hitonobu Tomoike; Cardiovascular Department, Sakakibara Heart Institution, Tokyo, Japan To elucidate the role of serum levels of high-sensitivity troponin T (TnT) in the setting of acute decompensated heart failure (ADHF), we abstracted clinical features and levels of TnT on admission in a total of 115 hospitalized patients for ADHF between January 2013 and November 2015. Serum levels of TnT was strongly associated with in-hospital mortality (P = .0114) and also NYHA functional class at discharged (P = .0390) regardless of a preserved and/or decreased renal function. Long-term survival was also significantly different between high and low levels of TnT (Figure), suggesting a potential role of TnT in predicting chance of survival in those with ADHF.
O10-4 Impact of the Renin-Aldosterone System on in-Hospital Mortality in Patients with Acute Decompensated Heart Failure Michiro Maruyama, Yusuke Takeda, Youichiro Nakagawa, Mask Kinoshita, Takashi Kusayama, Akio Chikada, Yoshiki Nagata, Kazuo Usuda; Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan Backgrounds: In heart failure, although the adverse effects of neurohormonal activation are known, the prognostic significance of renin aldosterone system (RAS) in patients with acute decompensated heart failure (ADHF) has not been well studied. This purpose is to assess the relationship between RAS and in-hospital outcomes in patients with ADHF. Methods: Objectives were 140 cases with ADHF admitted in ICU (79 ± 12 years, Male 80) from April 2014 through March 2015, in which IHD, valve disease, dilated cardiomyopathy, hypertension, tachycardia, bradycardia and others were 50, 24, 18, 18, 8, 4, and 18 cases. The relationships between in-hospital outcomes and hemodynamics, renal function, serum electrolytes, neurohormonal factors at admission and pre-hospital medication were studied retrospectively. Results: Median of plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were 76.5 pg/ml and 1.2 ng/ml/h. Death in hospital was 12 cases (8.6%). Non-survivors have significantly lower systolic blood pressure (SBP), lower sodium, higher logPAC, higher logPRA, more pre-hospital medication of aldosterone receptor antagonist than survivors inhospital (P < .05). In Cox’s proportional hazards analysis, high PAC (>76.5) was an independent predictor of in-hospital death (HR0.113, 95%CI0.014–0.924, P < .01). SBP, sodium, PRA > 1.2, BNP, pre-hospital medication of RAS inhibitors were not independent predictor of in-hospital death. Conclusions: These results may suggest that activated RAS, especially serum aldosterone is the risk factor of short-term mortality in ADHF patients.
O10-5 Clinical Significance of the Measurement of Urinary Liver-Fatty Acid-Binding Protein (LFABP) Excretion in Acute Heart Failure Patients Akihiro Shirakabe1, Nobuaki Kobayashi1, Hirotake Okazaki1, Masato Matsushita1, Junsuke Shibuya1, Suguru Nishigoori1, Noritake Hata1,2, Kuniya Asai2, Wataru Shimizu2; 1 Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan; 2 Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
O10-3 Relationship between Admission C-Reactive Protein Level and Long-Term Mortality in Patients with Acute Decompensated Heart Failure Hiroki Matsumoto1,2,3, Takatoshi Kasai1,2, Shoichiro Yatsu1, Azusa Murata1, Takao Kato1, Shoko Suda1,2, Masaru Hiki1, Atsutoshi Takagi1, Katsumi Miyauchi1, Hiroyuki Daida1; 1 Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan; 2Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; 3Department of Cardiology, Tobu Chiiki Hospital, Tokyo, Japan Background: Admission C-reactive protein (CRP) level is an important predictor of poor prognosis among several cardiovascular diseases such as acute coronary syndrome. In patients with acute decompensated heart failure (ADHF), admission CRP level is also related to the increased in-hospital mortality, but its relationship to the long-term mortality has not demonstrated yet. Methods: A cohort of 1684 consecutive patients admitted to the cardiac intensive-care unit from 2007 to 2011 was studied. Among them, patients with acute coronary syndrome and neoplasms were excluded, and then patients with ADHF were divided into 4 groups based on quartiles of admission CRP level. Association between admission CRP level and long-term mortality was assessed by multivariable Cox proportional analysis including other independent variables which showed <0.1 in univariable analyses. Results: Overall, 527 patients were assessed. There were 142 deaths (27%) during a median follow-up of 2.0 years. In the multivariable analysis, hazard ratio (HR) increased with admission CRP levels in a significant dose-dependent manner for mortality (P for trend = .045). Multivariable analysis also showed a significant relationship between admission CRP level, when treated as a natural logarithm-transformed continuous variable, and increased mortality (HR, 1.18; P = .023). Conclusion: Admission CRP level is an important predictor of increased long-term mortality in patients with ADHF.
Background: The clinical significance of urinary liver-fatty acid-binding protein (uLFABP) in acute heart failure (AHF) patients was obscured yet. Methods and Results: Two hundred ninety-four AHF patients who admitted to the intensive care unit and measured u-LFABP on admission were analyzed. The median u-LFABP levels were 57.5 [14.5 to 183.5] ng/ml cre, and divided to two group according to the quartiles of u-LFABP (Q1 (Low-LFABP group) v.s. Q2, Q3 and Q4 (High-LFABP group)). We evaluate the diagnostic and prognostic value of u-LFABP in each chronic kidney disease (CKD) (n = 166) or non-CKD patients (n = 129). Acute kidney injury (AKI) on admission was evaluated based on the RIFLE classification, which was the ratio of the serum creatinine value recorded on admission to the baseline creatinine value. In CKD patients, the number of AKI patients and the prognosis was not different between Low and High-LFABP group. Meanwhile, in non-CKD group, the number of AKI patients was significantly more in High-LFABP group (38.0 % v.s. 19.4%). The sensitivity and specificity of u-LFABP for detecting AKI were 69.0% and 57.0% (AUC 0.638) at 42.6 ng/ml cre. A Kaplan-Meier curve, including all-cause death within 90 days, showed a significantly poor survival rate in High-LFABP than in Low-LFABP group (P = .029). Conclusions: The u-LFABP level is an effective biomarker for detecting AKI and predicting poor prognosis in non-CKD AHF patients.
O10-6 The Relationship between Urinary Liver-Type Fatty Acid Binding Protein Levels and Renal Function Markers in Acute Decompensated Heart Failure Takashi Kuragaichi, Yukihito Sato, Masayuki Shiba, Hiroyuki Nakayama; Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan Introduction: Urinary Liver-type Fatty Acid Binding Protein (uL-FABP) is known as a marker reflecting renal tubular impairment in worsening renal function (WRF). However, the role of uL-FABP in WRF has not been elucidated in patients with acute decompensated heart failure (ADHF). Our purpose is to investigate 1) the correlation between uL-FABP and various markers of renal function and 2) whether uL-FABP can predict WRF, in patients with ADHF. Methods and results: Fifty-three patients admitted for ADHF were analyzed. uL-FABP and urinary creatinine were measured at admission and before discharge. WRF was defined as a rise in serum creatinine >0.3 mg/dl within seven days. Median uL-FABP/uCr levels significantly decreased from 3.3 to 2.6 mg/gCr (P = .0002). Log[uL-FABP/uCr] levels at admission were positively correlated with log [urine albumin/uCr] (r = 0.59,P < .0001),and log[urinary N-acetyl-β-Dglucosaminidase (uNAG)/uCr] (r = 0.29,P = .032), although they were neither correlated with log[serum creatinine] nor log[cystatin C]. Log[uL-FABP/uCr] levels at admission were not associated with WRF in the univariate and multivariate logistic regression analysis after adjusted for age, gender, serum creatinine(P = .09 and .20, respectively). Conclusion: In patients with ADHF, uL-FABP at admission was significantly correlated with urine albumin and uNAG, though it was not associated with WRF.