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Impact of Vasodilator Therapy in Acute Heart Failure Syndrome with and without Clinical Scenario 1
S172 Journal of Cardiac Failure Vol. 20 No. 10S October 2014 O-161 Intermittent Infusion of Dobutamine in Cooperation with the Referred Physicians-experience in Two Elderly Cases with Advanced Heart Failure HIDEYUKI MAEZAWA1, MIO EBATO1, MIKI TSUJIUCHI1, MASAAKI KURATA1, TAKUYA MIZUKAMI1, SAKURA NAGUMO1, AYAKA TANABE1, NAOKO IKEDA1, YOSHITAKA ISO2, HIROSHI SUZUKI1 1 Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan, 2 Department of Cardiology Showa University Fujigaoka Rehabilitation Hospital Case1 was 83-year-old male with old myocardial infarction after CABG and CRT-D implantation. Case 2 was 79-year-old male who had seriously disturbed left ventricular systolic function long after the replacement of aortic and mitral valve (19 years before). Both patients had stage D heart failure and history of recurrent admissions under standard therapy. They easily developed low output syndrome and/or pulmonary congestion without cathecolamine infusion. Before discharge, intravenous dobutamine infusion was changed from continuous to intermittent, then the duration and frequency was gradually decreased to 7 hours, twice a week. After confirmation of stable clinical status for two or three weeks, patients had been treated with same dose, duration and frequency after discharge under control of the referred physician. The referred physicians checked clinical symptom, blood pressure, body weight, and physical examination frequently, and could modify other drugs adequately. If their heart failure turned worse, they could easily contact to our hospital and ask the visit to emergency room or out-patient clinic. Both patients and families hoped to have better quality of life at home rather than long hospital stay in terminal phase. Intermittent infusion of dobutamine by referred physician satisfied them at this point of view. More discussion about safety, efficacy and cost effectiveness of this treatment will be needed in the future.
O-162 Prognostic Value of Blood Pressure Alteration due to Cardioprotective agents in Low Blood Pressure Patients with Non-ischemic Dilated Cardiomyopathy AKINORI SAWAMURA, TAKAHIRO OKUMURA, NAOKI WATANABE, NAOAKI KANOH, HIROAKI MORI, KENJI FUKAYA, RYOTA MORIMOTO, AKIHIRO HIRASHIKI, YASUKO BANDOH, TOYOAKI MUROHARA Department of Cardiology, Nagoya University Graduate School of Medicine Background: We previously reported that systolic blood pressure (SBP)!113mmHg before the titration of cardioprotecitve agents was a useful predictor for cardiac events in asymptomatic or mildly-symptomatic patients with non-ischemic dilated cardiomyopathy (NIDCM). However, little is known about the prognostic value of SBP alteration in low-SBP patients. Purpose: This study aimed to investigate the prognostic value of SBP alteration due to titration of cardioprotecitve agents in low-SBP patients with NIDCM. Methods: We enrolled 65 NIDCM patients (48.4 years, 22% female) with SBP!113mmHg classified in NYHA functional class I or II. Pre-SBP and post-SBP were defined as SBP before and after the titration of cardioprotecitve agents, respectively and delta-SBP was calculated as post-SBP minus pre-SBP. Results: The mean left ventricular ejection fraction and BNP levels were 29.8% and 335pg/mL, respectively. All cardioprotective agents were up-titrated (ACEi/ARBs: 80% to 92%, b-blockers: 94% to 95%, and MRAs: 62% to 72%). The post-SBP (102614mmHg) tends to be higher than the pre-SBP (99610mmHg) (p50.11). In Cox proportional-hazard analysis, delta-SBP had inverse correlation with the risk for cardiac events (p50.03), additionally, was an independent determinant of cardiac events (p50.003). Conclusions: SBP elevation after titration of cardioprotective agents was associated with a lower risk for cardiac events. SBP alteration provides additional risk stratification for poor prognosis in low-SBP patients with NIDCM.
O-163 Impact of Vasodilator Therapy in Acute Heart Failure Syndrome with and without Clinical Scenario 1 NOBUYUKI KAGIYAMA1, YUYA MATSUE2, TERUYOSHI KUME3, MAKOTO SUZUKI2, AKIHIKO MATSUMURA2, HIROYUKI OKURA3, YUJI HASHIMOTO2, KIYOSHI YOSHIDA1 1 Department of Cardiology, The Sakakibara Institute of Okayama, Okayama, Japan, 2 Department of Cardiology, Kameda Medical Center, 3Division of Cardiology, Kawasaki Medical School Background: Clinical scenario (CS) is a simple novel classification of acute heart failure syndrome (AHFS), and vasodilator is recommended especially for CS1. Methods and Results: We retrospectively included 763 patients with AHFS and divided them into 2 groups according to blood pressure above 140mmHg (CS 1; 416 patients) or not (non-CS 1; 347 patients) on admission. Vasodilator (nitroglycerin or carperitide) was used within 48 hours from admission in 290 (69.7%) patients with CS1 and 144 (41.5%) patients with non-CS1. The endpoint was re-hospitalization due to AHFS or all-cause death. Kaplan-Meier curve analysis revealed that vasodilator significantly improved prognosis only in non-CS1. Furthermore, in multivariate analysis, vasodilator independently improved prognosis in patients with non-CS1 (p50.039) but not in CS1 (p50.23). Conclusion: Vasodilator therapy improve prognosis in non-CS1 but not in CS1.
O-164 Morphine Shortens Recovery from Acute Decompensated Heart Failure Categorized as Clinical Scenario 1 without Worsening Respiration TAKATSUGU SEGAWA, MORIHIRO MATSUDA, KANAKO YUASA, KOUTAROU KANNO, HARUYUKI KINOSHITA, ORIE ICHIKAWA, HIROHIKO NISHOYAMA, RITSU TAMURA, TOSHIHARU KAWAMOTO National Hospital Organization Kure Medical Center and Chugoku Cancer Center Background: Morphine has a potency to reduce distress associated with dyspnea, and reduce preload via venodilatation. Therefore, morphine is recommended for a treatment of acute decompensated heart failure (ADHF) by guidelines. However, there is little evidence showing the effects of morphine on the rapid improvement of ADHF. Here, we aimed to reveal the clinical benefit of morphine in patients with ADHF categorized as clinical scenario 1 (CS1). Methods: The subjects were 86 patients with ADHF categorized as CS1 who were delivered to emergency room (ER) in our hospital from January 2011 to February 2014. We retrospectively surveyed medications used in ER, changes of blood pressure (BP), heart rate (HR) and respiratory rate (RR) until an hour after hospitalization. Results: In the patients with morphine administration, the time to reach RR !20/min was shorter (p50.016), and the reduction ratio of HR was higher (p50.001). Multivariate logistic analysis adjusted for age, gender, RR, the use of non-invasive positive-pressure ventilation revealed that the use of morphine, but not nitrates or diuretic, was independently associated with the accomplishment of BP !140 mmHg (p50.04), RR !20/min (p50.003), reduction rate of HR $20% (p50.0006) at 30 minutes after hospitalization. There were no patients who developed respiratory failure requiring intubation after morphine use. Conclusion: Morphine may shorten the recovery from ADHF categorized as CS1 without worsening respiration.
O-165 Effects of Beta-blockade on Myocardial Stiffness in Patients of Heart Failure with Reduced Left Ventricular Ejection Fraction YUKO SOYAMA, TOSHIAKI MANO, SHINICHI HIROTANI, AYUMI NAKABO, AKIKO GODA, MITSURU MASAKI, MIHO FUKUI, SHOHEI FUJIWARA, MASATAKA SUGAHARA, TOHRU MASUYAMA Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan Diastolic dysfunction determines symptoms and prognosis in patients with left ventricular (LV) dysfunction.
O-162 Prognostic Value of Blood Pressure Alteration due to Cardioprotective agents in Low Blood Pressure Patients with Non-ischemic Dilated Cardiomyopathy AKINORI SAWAMURA, TAKAHIRO OKUMURA, NAOKI WATANABE, NAOAKI KANOH, HIROAKI MORI, KENJI FUKAYA, RYOTA MORIMOTO, AKIHIRO HIRASHIKI, YASUKO BANDOH, TOYOAKI MUROHARA Department of Cardiology, Nagoya University Graduate School of Medicine Background: We previously reported that systolic blood pressure (SBP)!113mmHg before the titration of cardioprotecitve agents was a useful predictor for cardiac events in asymptomatic or mildly-symptomatic patients with non-ischemic dilated cardiomyopathy (NIDCM). However, little is known about the prognostic value of SBP alteration in low-SBP patients. Purpose: This study aimed to investigate the prognostic value of SBP alteration due to titration of cardioprotecitve agents in low-SBP patients with NIDCM. Methods: We enrolled 65 NIDCM patients (48.4 years, 22% female) with SBP!113mmHg classified in NYHA functional class I or II. Pre-SBP and post-SBP were defined as SBP before and after the titration of cardioprotecitve agents, respectively and delta-SBP was calculated as post-SBP minus pre-SBP. Results: The mean left ventricular ejection fraction and BNP levels were 29.8% and 335pg/mL, respectively. All cardioprotective agents were up-titrated (ACEi/ARBs: 80% to 92%, b-blockers: 94% to 95%, and MRAs: 62% to 72%). The post-SBP (102614mmHg) tends to be higher than the pre-SBP (99610mmHg) (p50.11). In Cox proportional-hazard analysis, delta-SBP had inverse correlation with the risk for cardiac events (p50.03), additionally, was an independent determinant of cardiac events (p50.003). Conclusions: SBP elevation after titration of cardioprotective agents was associated with a lower risk for cardiac events. SBP alteration provides additional risk stratification for poor prognosis in low-SBP patients with NIDCM.
O-163 Impact of Vasodilator Therapy in Acute Heart Failure Syndrome with and without Clinical Scenario 1 NOBUYUKI KAGIYAMA1, YUYA MATSUE2, TERUYOSHI KUME3, MAKOTO SUZUKI2, AKIHIKO MATSUMURA2, HIROYUKI OKURA3, YUJI HASHIMOTO2, KIYOSHI YOSHIDA1 1 Department of Cardiology, The Sakakibara Institute of Okayama, Okayama, Japan, 2 Department of Cardiology, Kameda Medical Center, 3Division of Cardiology, Kawasaki Medical School Background: Clinical scenario (CS) is a simple novel classification of acute heart failure syndrome (AHFS), and vasodilator is recommended especially for CS1. Methods and Results: We retrospectively included 763 patients with AHFS and divided them into 2 groups according to blood pressure above 140mmHg (CS 1; 416 patients) or not (non-CS 1; 347 patients) on admission. Vasodilator (nitroglycerin or carperitide) was used within 48 hours from admission in 290 (69.7%) patients with CS1 and 144 (41.5%) patients with non-CS1. The endpoint was re-hospitalization due to AHFS or all-cause death. Kaplan-Meier curve analysis revealed that vasodilator significantly improved prognosis only in non-CS1. Furthermore, in multivariate analysis, vasodilator independently improved prognosis in patients with non-CS1 (p50.039) but not in CS1 (p50.23). Conclusion: Vasodilator therapy improve prognosis in non-CS1 but not in CS1.
O-164 Morphine Shortens Recovery from Acute Decompensated Heart Failure Categorized as Clinical Scenario 1 without Worsening Respiration TAKATSUGU SEGAWA, MORIHIRO MATSUDA, KANAKO YUASA, KOUTAROU KANNO, HARUYUKI KINOSHITA, ORIE ICHIKAWA, HIROHIKO NISHOYAMA, RITSU TAMURA, TOSHIHARU KAWAMOTO National Hospital Organization Kure Medical Center and Chugoku Cancer Center Background: Morphine has a potency to reduce distress associated with dyspnea, and reduce preload via venodilatation. Therefore, morphine is recommended for a treatment of acute decompensated heart failure (ADHF) by guidelines. However, there is little evidence showing the effects of morphine on the rapid improvement of ADHF. Here, we aimed to reveal the clinical benefit of morphine in patients with ADHF categorized as clinical scenario 1 (CS1). Methods: The subjects were 86 patients with ADHF categorized as CS1 who were delivered to emergency room (ER) in our hospital from January 2011 to February 2014. We retrospectively surveyed medications used in ER, changes of blood pressure (BP), heart rate (HR) and respiratory rate (RR) until an hour after hospitalization. Results: In the patients with morphine administration, the time to reach RR !20/min was shorter (p50.016), and the reduction ratio of HR was higher (p50.001). Multivariate logistic analysis adjusted for age, gender, RR, the use of non-invasive positive-pressure ventilation revealed that the use of morphine, but not nitrates or diuretic, was independently associated with the accomplishment of BP !140 mmHg (p50.04), RR !20/min (p50.003), reduction rate of HR $20% (p50.0006) at 30 minutes after hospitalization. There were no patients who developed respiratory failure requiring intubation after morphine use. Conclusion: Morphine may shorten the recovery from ADHF categorized as CS1 without worsening respiration.
O-165 Effects of Beta-blockade on Myocardial Stiffness in Patients of Heart Failure with Reduced Left Ventricular Ejection Fraction YUKO SOYAMA, TOSHIAKI MANO, SHINICHI HIROTANI, AYUMI NAKABO, AKIKO GODA, MITSURU MASAKI, MIHO FUKUI, SHOHEI FUJIWARA, MASATAKA SUGAHARA, TOHRU MASUYAMA Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan Diastolic dysfunction determines symptoms and prognosis in patients with left ventricular (LV) dysfunction.