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Relationship between Heart Rate Response to Adenosine and Left Ventricular Synchronicity in Patients with Non-ischemic Heart Disease
The 17th Annual Scientific Meeting
O-046 Optimization of Cardiac Resynchronization Therapy(CRT) by Multi-Scale Heart Simulator: Experimental Validation Using Canine Model of Complete Left Bundle Branch Block NIRMAL PANTHEE1, CHIEKO YASUDA2, JUNICHI OKADA2, SEIRYO SUGIURA2, HIROSHI YAMASHITA3, HIDEKAZU KOYAMA4, RYOHEI SUZUKI4, YOUHEI MOCHIZUKI4, MINORU ONO1, TOSHIAKI HISADA2 1 Department of Cardiac Surgery, The University of Tokyo, 2Department of Human & Engineered Enviromental Studies, The University of Tokyo, 3Department of Cardiovascular Medicine, The University of Tokyo Hospital, 4Nippon Veterinary and Life Science University, Nippon Veterinary and Life Science University Objective: To evaluate the predictive ability of patient-specific computer heart simulation for the optimization of CRT in animal model of heart failure, and examine the feasibility of clinical application. Methods: In two male beagles (10kg), complete left bundle branch block (CLBBB) was induced by ablation. In the 3D models of heart and torso of each dog, CRT simulation was performed with 1 RV + either 1 or 2 LV epicardial leads positioned at various sites and the results were compared with CRT experiments in these dogs by measuring LV hemodynamic parameters and echocardiographic indices. Results: Dog 1: Simulation: CRT with LV lead at basal-lateral position (site 1) resulted in the highest systolic function among the 4 sites tested. LV site 4 (basal-anterior) produced the worst performance. Experiment: Highest performance with the shortest time-to-peak- strain was obtained at the site 1, whereas the site 4 performed the worst. Dog 2: Simulation: Triple-site-pacing with LV leads at basal-anterolateral and basal-inferior and RV lead at mid-anterior-septum resulted in best EF. Shorter QRS duration did not correlate with better EF. Experiment: Again we confirmed the simulation results. Furthermore, as in simulations, narrow QRS did not guarantee the better performance. Conclusion: CRT simulation using the 3D multi-scale-heart-simulator successfully predicted the therapeutic effect of CRT in dog model of CLBBB.
O-047 The Maintenance of Stable Cardiac Nuclear HMGB1 Levels Prevents the Development of Cardiac Hypertrophy and Heart Failure AKIRA FUNAYAMA Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
JHFS
S143
6 patients (age 38-67 year old, four after CRT-D) with heart failure in NYHA functional classII M or III, who repeatedly be hospitalized. All of six was given optimal medical therapy. Results: All patients who have continued Waon therapy improved systolic function (average EF 17.5%/26.8%) and degree of MR, but not changed cardiac volume. The BNP value was reduce(average 692 pg/ml/300 pg/ml), and month average 17 days Hospitalization was reduced to one day. Conclusion: Ambulant Waon therapy can be safely performed without cardiac events, and expected the reduction of readmission rate.
O-054 Influence of Right Ventricular Function on Heart Failure Onset in Cases without Left Ventricular Systolic Dysfunction KEIJI YAMADA, SATORU SAKURAGI Cardiology, Iwakuni Clinical Center Background: Recent studies indicated that right ventricular function is one of the factors affecting prognosis in patients with HF with reduced EF; however, clinical significance of right ventricular function in patients without reduced EF has not been clarified. Methods: Subjects comprised 225 cases (108 males, 73612 years) with preserved LVEF (LVEFO50%). Right ventricular function was assessed with tricuspid annular plane systolic excursion (TAPSE). All cases were classified into three groups with clinical and echocardiography findings: HF group (82 cases), preclinical HF group (E/eO10, 68 cases) and normal group (E/e!10, 75 cases). The clinical features were compared among the three groups. The association between HF onset and right ventricular function was also investigated. Results: Left atrial diameter (p50.0002), LVMI (p!0.0001) and E/e’ (p!0.0001) increased with HF severity, whereas LVEF was the comparable among three groups. TAPSE (p!0.0001) significantly decreased with HF severity. Lower TAPSE was significantly related to HF onset in univariable analysis (p!0.0001). The relationship between TAPSE and HF onset was still significant after adjustment for confounding factors including age, sex, coronary risk factors, CKD and LVEF. Conclusions: Our results indicated that right ventricular function was related to HF onset in cases with preserved left ventricular systolic function. TAPSE is measured easily and may be useful marker in treatment of heart failure even in patients without reduce LV systolic function.
O-055 Aims: High Mobility Group Box 1 (HMGB1) is an abundant and ubiquitous nuclear DNA-binding protein that has multiple functions dependent on its cellular location. HMGB1 binds to DNA, facilitating numerous nuclear functions including maintenance of genome stability, transcription, and repair. However, little is known about the effects of nuclear HMGB1 on cardiac hypertrophy and heart failure. The aim of this study was to examine whether nuclear HMGB1 plays a role in the development of cardiac hypertrophy induced by pressure overload. Methods and Results: Analysis of human biopsy samples by immunohistochemistry showed decreased nuclear HMGB1 expression in failing hearts compared with normal hearts. Nuclear HMGB1 decreased in response to both endothelin-1 (ET-1) and angiotensin II (Ang II) stimulation in neonatal rat cardiomyocytes, where nuclear HMGB1 was acetylated and translocated to the cytoplasm. Overexpression of nuclear HMGB1 attenuated ET-1 induced cardiomyocyte hypertrophy. Thoracic transverse aortic constriction (TAC) was performed in transgenic mice with cardiac-specific overexpression of HMGB1 (HMGB1-Tg) and wild type (WT) mice. Cardiac hypertrophy after TAC was attenuated in HMGB1-Tg mice. Nuclear HMGB1 expression was preserved in HMGB1-Tg mice compared with WT mice and preserved nuclear HMGB1 expression prevented DNA damage after TAC. Conclusion: These results suggest that the maintenance of stable nuclear HMGB1 levels prevents hypertrophy and heart failure by inhibiting DNA damage.
Determinants of Right Ventricular Function in Patients with Preserved Left Ventricular Systolic Function KEIJI YAMADA, SATORU SAKURAGI Cardiology, Iwakuni Clinical Center The prognosis of heart failure is similar in patients with or without reduced left ventricular ejection fraction (LVEF), indicating that other factor may be involved in poor prognosis of heart failure regardless of LVEF. Recently, much attention has been focused on right ventricular (RV) function as a key determinant of poor prognosis of heart failure; however, the determinants of RV function are still unclear. Methods and Results: 149 subjects without history of cardiovascular disease and with preserved LVEF (LVEFO50%) were enrolled. RV function was evaluated with tricuspid annular plane systolic excursion (TAPSE). Subjects were divided into two groups according to TAPSE: low TAPSE group (TAPSE!under 20mm, n562), high TAPSE group (TAPSEOover 20mm, n587). Low TAPSE group had higher age and higher incidence of atrial fibrillation compared with high TAPSE group (p!0.01 for both). Pulse wave velocity was higher and estimated GFR was lower in low TAPSE group (p!0.01 for both). In univariable analysis, age, PWV, estimated GFR and NT-proBNP were significantly associated with TAPSE. In multivariable analysis, TAPSE was negatively associated with age. On the other hands, there was no correlation between LVEF and age. Conclusion: High number of subjects had reduced right cardiac function even in subjects with normal LVEF. RV function should be taken into account in taking care of patients, especially in elderly persons.
O-048 Experience of Ambulant Waon Therapy to the Severe Heart Failure TOSHIHIRO MURAMATSU1, RYUSEI UTIDA2, JUN TANNO1, SHINTARO NAKANO1, YOSHIFUMI IKEDA1, KEIKI SUGI1, TAKAAKI SENBONMATSU1, NOBUYUKI KOMIYAMA1, KAZUO MATSUMOTO1, SHIGEYUKI NISHIMURA1 1 Cardiology, Saitama Medical University International Medical Center, 2Cardiac Rehabilitation, Saitama Medical University International Medical Center Background: It is known to perform a toal 10 times daily Waon Therapy. The purpose of this study was to investigate the effect of Ambulant Waon therapy on the severe heart failure. We performed Ambulant Waon therapy twice a week, and compared with the 6 months before and after treatment. Patients: We investigated
O-056 Relationship between Heart Rate Response to Adenosine and Left Ventricular Synchronicity in Patients with Non-ischemic Heart Disease MICHIKO SONE1, NAOTO TAKAHASHI1, MASAHIRO ISHIKAWA1, NAOKI SATO1, WATARU SHIMIZU2, SHINICHIRO KUMITA3 1 Internal Medicine, Cardiology, 2Internal Medicine, Cardiology, 3Radiology, Nuclear Medicine Background: The prognostic value of the heart rate response (HRR) to adenosine has been reported in diabetes mellitus. Objectives: The aim of this study was to assess the relationship between HRR and LV synchronicity (LVS) in non-ischemic heart
S144 Journal of Cardiac Failure Vol. 19 No. 10S October 2013 disease (NIHD). Methods: A total of 112 patients underwent adenosine stress/rest gated SPECT (GSPECT). For the evaluation of LVS, phase standard deviation (PSD) was determined by GSPECT. Ejection fraction, LVS, and NTproBNP were compared among three groups according to HRR: 56 low group (LG); HRR ! 1.080, 43 intermediate group (IG); 1.080 # HRR ! 1.259, and 13 high group (HG); HRR $ 1.259. Results: The measured EF, PSD, and NTproBNP in LG, IG, and HG are summarized in the figures. Conclusions: HRR might relate to impairment of LV synchronicity in NIHD.
more glucose, the gene expression related to gluconeogenesis was decreased, the gene expression related to lipogenesis was increased, and the triglyceride content of the liver was increased. The paradoxical production of triglycerides synthesis in fasting rats was associated with a pro-inflammatory response in liver. Conclusions: The cachexia was associated with abnormal hepatic metabolism that might work as a maladaptive response during the progression of heart failure when the body is losing weight and peripheral tissues need more substrates to maintain tissue homeostasis.
O-059 Right Ventricular Tei Index is a Useful Index to Evaluate the Prognosis in Patients with Chronic Heart Failure TAKURO KUBOZONO Cardiovascular Medicine and Hypertension, Kagoshima University
O-057 99m Tc-MIBI Washout Correlates with BNP Levels in Heart and Peak Oxygen Consumption in Legs of Heart Failure Patients TAKAO KATO, DAIKI NAGAKURA, EISAKU NAKANE, SHOICHI MIYAMOTO, TOSHIAKI IZUMI, TETSUYA HARUNA, RYUJI NOHARA, MORIAKI INOKO Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute
Introduction: We previously reported that the washout rate of 99mTc-MIBI was correlated with the mitochondrial function in vivo and ex vivo. We hypothesized that an increase of 99mTc-MIBI washout would occur in patients with chronic heart failure (CHF) associated with its severity or oxygen consumption. Methods and Results: After administration of 99mTc-MIBI, 45 patients with CHF after the treatment of acute exacerbation were examined by collecting signals from the heart and bilateral legs in early and delayed phases, in which washout rates were calculated. We tested the correlation between the washout rate and ejection fraction (EF) on echocardiography, brain natriuretic peptides (BNP), and other clinical values along with the parameters of an exercise tolerance test and muscle power of the thighs. The 99mTc-MIBI washout rate of the heart was positively correlated with BNP levels (r50.61, p50.005), but was not correlated with EF. Peak oxygen consumption was negatively correlated with the 99mTcMIBI washout rate of the legs (r50.66) and mildly correlated with the length of the circumflex of the thigh (r50.44), but not correlated with the washout rate of the heart. Conclusions: The 99mTc-MIBI washout rate of the heart is thought to be one of the markers of myocardial damage or dysfunction. The mitochondrial function of leg muscle may limit the exercise capacity in patients with CHF.
O-058 Abnormal Liver Metabolism and Pro-inflammatory Responses are Modulators of Cardiac Cachexia in a Rat Model of Heart Failure TAKAO KATO1, TETSUO SHIOI2, TAKESHI KIMURA2 1 Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, 2Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
Background: It is unknown whether RV Tei index is a prognostic predictor in patients with chronic heart failure (CHF). The purpose of this study is to investigate the prognostic power of RV Tei index in CHF. Methods: One hundred and twenty-three patients hospitalized with CHF were enrolled. Left ventricular ejection fraction (LVEF) and RV Tei index were measured by echocardiography, and brain natriuretic peptide (BNP) was measured at admission. We followed these patients after discharge, and cardiovascular death was analyzed. Results: Mean follow-up period was 152661064 days, and 33 patients died of cardiovascular diseases. In univariate Cox proportional hazards analysis, RV Tei index and log BNP were significant prognostic predictors of mortality. In multiple Cox proportional hazards analysis, RV Tei index was an independent predictor of mortality, but not log BNP. We performed the receiver operating characteristics (ROC) curve analysis to predict the cardiovascular death by RV Tei index. The area under the ROC curve for RV Tei index was 0.41, with the highest discriminating sensitivity and specificity being 0.70 and 0.71, respectively at RV Tei index50.41. The Kaplan-Meier survival curve was assessed using cut-off value50.41 of RV Tei index, and the difference in survival between the 2 groups was statistically significant. Conclusion: RV Tei index suggested to be a useful predictor for prognosis in CHF.
O-064 Transition in Focus of Palliative Care Service for Chronic Heart Failure from Alleviation of Symptoms to Advance Care Planning SHOGO OISHI Cardiology Department, Himeji Cardiovascular Center Background: The need for palliative care in advanced heart failure has been widely recognized. However, we cannot intervene enough because of the barriers like disease process characterized by exacerbations and remissions, inadequate knowledge about palliative care. Objectives: While treating over 500 emergent admissions for decompensated heart failure per year, we have engaged in palliative care for chronic heart failure since 2011. We introduce our experience and transition during 3 years. Results: At first we have focused on how to manage symptoms and developed protocol for administering opioid. 18 patients were administered of morphine hydrochloride during 7.969.4days , aged 77615, LVEF 33612%, 56649 in hospital days. On the other hand, we gathered and studied at journal club once a week, and conducted regular entire hospital meeting in order to share knowledge and experience. We have discussed many cases in those meeting, and now we have reached common conclusion that advance care planning defined as a voluntary process of discussion about future care is the most important process for palliative care. Conclusion: In near future, intervention not only for survival duration but quality of life will be much more important. Organized palliative care service for chronic heart failure based mainly on advance care planning is urgent issues to be discussed seriously.
O-065 Purposes: Congestive heart failure (CHF) often accompanies cachexia, namely body wasting. However, the mechanism by which this change is induced and causes the progression of CHF is not clear. Methods and Results: We examined energy metabolism in the liver of Dahl salt-sensitive rats, which show a transition from hypertension to CHF. In CHF rats, a failure to grow was observed and blood hepatic protein levels were decreased associated with increased blood pro-inflammatory cytokine levels, indicating that Dahl rats serve as a model of cardiac cachexia. Food intake was reduced, and blood sugar and insulin levels were decreased. Despite the apparent fasting condition, blood fatty acid levels were decreased and triglycerides levels were increased. In CHF rats, liver incorporated
Importance of Prehospital Time Interval for Risk Assessment in Acute Heart Failure Patients JUN MAKINO Department of Cardiology, Keio University Hospital Background: Acute heart failure (AHF) is a heterogeneous condition that possesses a significant clinical challenge. Precise risk prediction is essential for its management; however the patients’ background and outcome may vary between early and late presenters. We sought to compare the predictors of in-hospital mortality between the two groups. Methods: The Tokyo CCU Network Database was prospectively
O-046 Optimization of Cardiac Resynchronization Therapy(CRT) by Multi-Scale Heart Simulator: Experimental Validation Using Canine Model of Complete Left Bundle Branch Block NIRMAL PANTHEE1, CHIEKO YASUDA2, JUNICHI OKADA2, SEIRYO SUGIURA2, HIROSHI YAMASHITA3, HIDEKAZU KOYAMA4, RYOHEI SUZUKI4, YOUHEI MOCHIZUKI4, MINORU ONO1, TOSHIAKI HISADA2 1 Department of Cardiac Surgery, The University of Tokyo, 2Department of Human & Engineered Enviromental Studies, The University of Tokyo, 3Department of Cardiovascular Medicine, The University of Tokyo Hospital, 4Nippon Veterinary and Life Science University, Nippon Veterinary and Life Science University Objective: To evaluate the predictive ability of patient-specific computer heart simulation for the optimization of CRT in animal model of heart failure, and examine the feasibility of clinical application. Methods: In two male beagles (10kg), complete left bundle branch block (CLBBB) was induced by ablation. In the 3D models of heart and torso of each dog, CRT simulation was performed with 1 RV + either 1 or 2 LV epicardial leads positioned at various sites and the results were compared with CRT experiments in these dogs by measuring LV hemodynamic parameters and echocardiographic indices. Results: Dog 1: Simulation: CRT with LV lead at basal-lateral position (site 1) resulted in the highest systolic function among the 4 sites tested. LV site 4 (basal-anterior) produced the worst performance. Experiment: Highest performance with the shortest time-to-peak- strain was obtained at the site 1, whereas the site 4 performed the worst. Dog 2: Simulation: Triple-site-pacing with LV leads at basal-anterolateral and basal-inferior and RV lead at mid-anterior-septum resulted in best EF. Shorter QRS duration did not correlate with better EF. Experiment: Again we confirmed the simulation results. Furthermore, as in simulations, narrow QRS did not guarantee the better performance. Conclusion: CRT simulation using the 3D multi-scale-heart-simulator successfully predicted the therapeutic effect of CRT in dog model of CLBBB.
O-047 The Maintenance of Stable Cardiac Nuclear HMGB1 Levels Prevents the Development of Cardiac Hypertrophy and Heart Failure AKIRA FUNAYAMA Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
JHFS
S143
6 patients (age 38-67 year old, four after CRT-D) with heart failure in NYHA functional classII M or III, who repeatedly be hospitalized. All of six was given optimal medical therapy. Results: All patients who have continued Waon therapy improved systolic function (average EF 17.5%/26.8%) and degree of MR, but not changed cardiac volume. The BNP value was reduce(average 692 pg/ml/300 pg/ml), and month average 17 days Hospitalization was reduced to one day. Conclusion: Ambulant Waon therapy can be safely performed without cardiac events, and expected the reduction of readmission rate.
O-054 Influence of Right Ventricular Function on Heart Failure Onset in Cases without Left Ventricular Systolic Dysfunction KEIJI YAMADA, SATORU SAKURAGI Cardiology, Iwakuni Clinical Center Background: Recent studies indicated that right ventricular function is one of the factors affecting prognosis in patients with HF with reduced EF; however, clinical significance of right ventricular function in patients without reduced EF has not been clarified. Methods: Subjects comprised 225 cases (108 males, 73612 years) with preserved LVEF (LVEFO50%). Right ventricular function was assessed with tricuspid annular plane systolic excursion (TAPSE). All cases were classified into three groups with clinical and echocardiography findings: HF group (82 cases), preclinical HF group (E/eO10, 68 cases) and normal group (E/e!10, 75 cases). The clinical features were compared among the three groups. The association between HF onset and right ventricular function was also investigated. Results: Left atrial diameter (p50.0002), LVMI (p!0.0001) and E/e’ (p!0.0001) increased with HF severity, whereas LVEF was the comparable among three groups. TAPSE (p!0.0001) significantly decreased with HF severity. Lower TAPSE was significantly related to HF onset in univariable analysis (p!0.0001). The relationship between TAPSE and HF onset was still significant after adjustment for confounding factors including age, sex, coronary risk factors, CKD and LVEF. Conclusions: Our results indicated that right ventricular function was related to HF onset in cases with preserved left ventricular systolic function. TAPSE is measured easily and may be useful marker in treatment of heart failure even in patients without reduce LV systolic function.
O-055 Aims: High Mobility Group Box 1 (HMGB1) is an abundant and ubiquitous nuclear DNA-binding protein that has multiple functions dependent on its cellular location. HMGB1 binds to DNA, facilitating numerous nuclear functions including maintenance of genome stability, transcription, and repair. However, little is known about the effects of nuclear HMGB1 on cardiac hypertrophy and heart failure. The aim of this study was to examine whether nuclear HMGB1 plays a role in the development of cardiac hypertrophy induced by pressure overload. Methods and Results: Analysis of human biopsy samples by immunohistochemistry showed decreased nuclear HMGB1 expression in failing hearts compared with normal hearts. Nuclear HMGB1 decreased in response to both endothelin-1 (ET-1) and angiotensin II (Ang II) stimulation in neonatal rat cardiomyocytes, where nuclear HMGB1 was acetylated and translocated to the cytoplasm. Overexpression of nuclear HMGB1 attenuated ET-1 induced cardiomyocyte hypertrophy. Thoracic transverse aortic constriction (TAC) was performed in transgenic mice with cardiac-specific overexpression of HMGB1 (HMGB1-Tg) and wild type (WT) mice. Cardiac hypertrophy after TAC was attenuated in HMGB1-Tg mice. Nuclear HMGB1 expression was preserved in HMGB1-Tg mice compared with WT mice and preserved nuclear HMGB1 expression prevented DNA damage after TAC. Conclusion: These results suggest that the maintenance of stable nuclear HMGB1 levels prevents hypertrophy and heart failure by inhibiting DNA damage.
Determinants of Right Ventricular Function in Patients with Preserved Left Ventricular Systolic Function KEIJI YAMADA, SATORU SAKURAGI Cardiology, Iwakuni Clinical Center The prognosis of heart failure is similar in patients with or without reduced left ventricular ejection fraction (LVEF), indicating that other factor may be involved in poor prognosis of heart failure regardless of LVEF. Recently, much attention has been focused on right ventricular (RV) function as a key determinant of poor prognosis of heart failure; however, the determinants of RV function are still unclear. Methods and Results: 149 subjects without history of cardiovascular disease and with preserved LVEF (LVEFO50%) were enrolled. RV function was evaluated with tricuspid annular plane systolic excursion (TAPSE). Subjects were divided into two groups according to TAPSE: low TAPSE group (TAPSE!under 20mm, n562), high TAPSE group (TAPSEOover 20mm, n587). Low TAPSE group had higher age and higher incidence of atrial fibrillation compared with high TAPSE group (p!0.01 for both). Pulse wave velocity was higher and estimated GFR was lower in low TAPSE group (p!0.01 for both). In univariable analysis, age, PWV, estimated GFR and NT-proBNP were significantly associated with TAPSE. In multivariable analysis, TAPSE was negatively associated with age. On the other hands, there was no correlation between LVEF and age. Conclusion: High number of subjects had reduced right cardiac function even in subjects with normal LVEF. RV function should be taken into account in taking care of patients, especially in elderly persons.
O-048 Experience of Ambulant Waon Therapy to the Severe Heart Failure TOSHIHIRO MURAMATSU1, RYUSEI UTIDA2, JUN TANNO1, SHINTARO NAKANO1, YOSHIFUMI IKEDA1, KEIKI SUGI1, TAKAAKI SENBONMATSU1, NOBUYUKI KOMIYAMA1, KAZUO MATSUMOTO1, SHIGEYUKI NISHIMURA1 1 Cardiology, Saitama Medical University International Medical Center, 2Cardiac Rehabilitation, Saitama Medical University International Medical Center Background: It is known to perform a toal 10 times daily Waon Therapy. The purpose of this study was to investigate the effect of Ambulant Waon therapy on the severe heart failure. We performed Ambulant Waon therapy twice a week, and compared with the 6 months before and after treatment. Patients: We investigated
O-056 Relationship between Heart Rate Response to Adenosine and Left Ventricular Synchronicity in Patients with Non-ischemic Heart Disease MICHIKO SONE1, NAOTO TAKAHASHI1, MASAHIRO ISHIKAWA1, NAOKI SATO1, WATARU SHIMIZU2, SHINICHIRO KUMITA3 1 Internal Medicine, Cardiology, 2Internal Medicine, Cardiology, 3Radiology, Nuclear Medicine Background: The prognostic value of the heart rate response (HRR) to adenosine has been reported in diabetes mellitus. Objectives: The aim of this study was to assess the relationship between HRR and LV synchronicity (LVS) in non-ischemic heart
S144 Journal of Cardiac Failure Vol. 19 No. 10S October 2013 disease (NIHD). Methods: A total of 112 patients underwent adenosine stress/rest gated SPECT (GSPECT). For the evaluation of LVS, phase standard deviation (PSD) was determined by GSPECT. Ejection fraction, LVS, and NTproBNP were compared among three groups according to HRR: 56 low group (LG); HRR ! 1.080, 43 intermediate group (IG); 1.080 # HRR ! 1.259, and 13 high group (HG); HRR $ 1.259. Results: The measured EF, PSD, and NTproBNP in LG, IG, and HG are summarized in the figures. Conclusions: HRR might relate to impairment of LV synchronicity in NIHD.
more glucose, the gene expression related to gluconeogenesis was decreased, the gene expression related to lipogenesis was increased, and the triglyceride content of the liver was increased. The paradoxical production of triglycerides synthesis in fasting rats was associated with a pro-inflammatory response in liver. Conclusions: The cachexia was associated with abnormal hepatic metabolism that might work as a maladaptive response during the progression of heart failure when the body is losing weight and peripheral tissues need more substrates to maintain tissue homeostasis.
O-059 Right Ventricular Tei Index is a Useful Index to Evaluate the Prognosis in Patients with Chronic Heart Failure TAKURO KUBOZONO Cardiovascular Medicine and Hypertension, Kagoshima University
O-057 99m Tc-MIBI Washout Correlates with BNP Levels in Heart and Peak Oxygen Consumption in Legs of Heart Failure Patients TAKAO KATO, DAIKI NAGAKURA, EISAKU NAKANE, SHOICHI MIYAMOTO, TOSHIAKI IZUMI, TETSUYA HARUNA, RYUJI NOHARA, MORIAKI INOKO Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute
Introduction: We previously reported that the washout rate of 99mTc-MIBI was correlated with the mitochondrial function in vivo and ex vivo. We hypothesized that an increase of 99mTc-MIBI washout would occur in patients with chronic heart failure (CHF) associated with its severity or oxygen consumption. Methods and Results: After administration of 99mTc-MIBI, 45 patients with CHF after the treatment of acute exacerbation were examined by collecting signals from the heart and bilateral legs in early and delayed phases, in which washout rates were calculated. We tested the correlation between the washout rate and ejection fraction (EF) on echocardiography, brain natriuretic peptides (BNP), and other clinical values along with the parameters of an exercise tolerance test and muscle power of the thighs. The 99mTc-MIBI washout rate of the heart was positively correlated with BNP levels (r50.61, p50.005), but was not correlated with EF. Peak oxygen consumption was negatively correlated with the 99mTcMIBI washout rate of the legs (r50.66) and mildly correlated with the length of the circumflex of the thigh (r50.44), but not correlated with the washout rate of the heart. Conclusions: The 99mTc-MIBI washout rate of the heart is thought to be one of the markers of myocardial damage or dysfunction. The mitochondrial function of leg muscle may limit the exercise capacity in patients with CHF.
O-058 Abnormal Liver Metabolism and Pro-inflammatory Responses are Modulators of Cardiac Cachexia in a Rat Model of Heart Failure TAKAO KATO1, TETSUO SHIOI2, TAKESHI KIMURA2 1 Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, 2Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
Background: It is unknown whether RV Tei index is a prognostic predictor in patients with chronic heart failure (CHF). The purpose of this study is to investigate the prognostic power of RV Tei index in CHF. Methods: One hundred and twenty-three patients hospitalized with CHF were enrolled. Left ventricular ejection fraction (LVEF) and RV Tei index were measured by echocardiography, and brain natriuretic peptide (BNP) was measured at admission. We followed these patients after discharge, and cardiovascular death was analyzed. Results: Mean follow-up period was 152661064 days, and 33 patients died of cardiovascular diseases. In univariate Cox proportional hazards analysis, RV Tei index and log BNP were significant prognostic predictors of mortality. In multiple Cox proportional hazards analysis, RV Tei index was an independent predictor of mortality, but not log BNP. We performed the receiver operating characteristics (ROC) curve analysis to predict the cardiovascular death by RV Tei index. The area under the ROC curve for RV Tei index was 0.41, with the highest discriminating sensitivity and specificity being 0.70 and 0.71, respectively at RV Tei index50.41. The Kaplan-Meier survival curve was assessed using cut-off value50.41 of RV Tei index, and the difference in survival between the 2 groups was statistically significant. Conclusion: RV Tei index suggested to be a useful predictor for prognosis in CHF.
O-064 Transition in Focus of Palliative Care Service for Chronic Heart Failure from Alleviation of Symptoms to Advance Care Planning SHOGO OISHI Cardiology Department, Himeji Cardiovascular Center Background: The need for palliative care in advanced heart failure has been widely recognized. However, we cannot intervene enough because of the barriers like disease process characterized by exacerbations and remissions, inadequate knowledge about palliative care. Objectives: While treating over 500 emergent admissions for decompensated heart failure per year, we have engaged in palliative care for chronic heart failure since 2011. We introduce our experience and transition during 3 years. Results: At first we have focused on how to manage symptoms and developed protocol for administering opioid. 18 patients were administered of morphine hydrochloride during 7.969.4days , aged 77615, LVEF 33612%, 56649 in hospital days. On the other hand, we gathered and studied at journal club once a week, and conducted regular entire hospital meeting in order to share knowledge and experience. We have discussed many cases in those meeting, and now we have reached common conclusion that advance care planning defined as a voluntary process of discussion about future care is the most important process for palliative care. Conclusion: In near future, intervention not only for survival duration but quality of life will be much more important. Organized palliative care service for chronic heart failure based mainly on advance care planning is urgent issues to be discussed seriously.
O-065 Purposes: Congestive heart failure (CHF) often accompanies cachexia, namely body wasting. However, the mechanism by which this change is induced and causes the progression of CHF is not clear. Methods and Results: We examined energy metabolism in the liver of Dahl salt-sensitive rats, which show a transition from hypertension to CHF. In CHF rats, a failure to grow was observed and blood hepatic protein levels were decreased associated with increased blood pro-inflammatory cytokine levels, indicating that Dahl rats serve as a model of cardiac cachexia. Food intake was reduced, and blood sugar and insulin levels were decreased. Despite the apparent fasting condition, blood fatty acid levels were decreased and triglycerides levels were increased. In CHF rats, liver incorporated
Importance of Prehospital Time Interval for Risk Assessment in Acute Heart Failure Patients JUN MAKINO Department of Cardiology, Keio University Hospital Background: Acute heart failure (AHF) is a heterogeneous condition that possesses a significant clinical challenge. Precise risk prediction is essential for its management; however the patients’ background and outcome may vary between early and late presenters. We sought to compare the predictors of in-hospital mortality between the two groups. Methods: The Tokyo CCU Network Database was prospectively