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Renin may Have an Important Role in Cardio-Renal Interaction in Patients with Heart Failure
S50 Journal of Cardiac Failure Vol. 13 No. 6 Suppl. 2007 Method and Result: Total 247 patients who were admitted in our institution because of VT/VF. Mean follow-up period was 57 6 42 months. We examined the following parameters on the all-cause mortality: ejection fraction (LVEF), underlying heart diseases (ischemic or nonischemic), presence or absence of ICD. Multivariate analysis revealed that LVEF !40% is the most predictive factor for all-cause mortality. Among the patients with LVEF !40%, univariate analysis revealed that the most benefit of ICD was obtained in patients with ischemic heart disease with LVEF !40% (Fig). Conclusion: These data demonstrated that ischemic VT/VF patients with severe LV dysfunction should be implanted ICDs.
116 Physiologically Active BNP and C-reactive Protein Contributes the Regulation of Plasma Adiponectin in Patients with Chronic Heart Failure TOSHINARI TANAKA, TAKAYOSHI TSUTAMOTO, KEIZOU NISHIYAMA, HIROSHI SAKAI, MASANORI FUJII, MINORU HORIE Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan Purpose: Recent studies reported that negative correlation was observed between plasma adiponectin and CRP in patients with diabetes mellitus and atherosclerosis. However, relation between CRP and adiponectin in patients with CHF remains unknown. Method: We measured the plasma adiponectin and high sensitive CRP, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL), BNP, N terminal pro BNP (NTpBNP) and hemodynamic parameters in 156 CHF patients. Result: There were no correlation between plasma adiponectin and hemodynamic parameters, such as left ventricular ejection fraction and cardiac index. A negative correlation was observed between plasma adiponectin and body mass index (p ! 0.0001, r 5 0.497), male gender (p ! 0.0001, r 5 0.311), CRP (p 5 0.0012, r 5 0.257). A positive correlation was observed between plasma adiponectin and age (p 5 0.0142, r 5 0.196), HDL (p ! 0.0001, r 5 0.354), log BNP (p ! 0.0001, r 5 0.407), NTpBNP (p ! 0.0001, r 5 0.347). Stepwise multivariate analysis showed that male (p 5 0.0061), high HDL (p 5 0.0093), high BNP (p ! 0.0001) and low CRP (p 5 0.0015) were significant independent factors for regulation of plasma adiponectin in CHF patients. Conclusion: These findings suggest that inflammation and BNP contributes the regulation of plasma adiponectin in patients with CHF.
117 Effect of Thermal Therapy on Oxidative Stress in Patients with Chronic Heart Failure SHOJI FUJITA, TAKASHI KIHARA, MASAAKI MIYATA, TAKUROU SHINNSATO, TAKUROU KUBOZONO, SOU KUWAHATA, SYUUITI HAMASAKI, TYUUWA TEI Graduate School of Medicine, Kagoshima University, Kagoshima, Japan Background: In patients with chronic heart failure (CHF), excessive oxidative stress has been linked to peripheral hypoperfusion as a consequence of low cardiac output and peripheral endothelial dysfunction. We have applied thermal therapy using the 60 C dry sauna to patients with CHF and have found that thermal therapy improves cardiac function, endothelial function, neurohormonal factors, sympathetic nerve system, ventricular arrhythmias, and clinical symptoms in CHF patients. The purpose of this study is to clarify the effect of thermal therapy on oxidative stress in patients with CHF. Methods: Thermal therapy was performed in 20 patients with CHF for 4 weeks. Serum levels of hydroperoxide as a marker of oxidative stress were measured with FRAS systems at three points; before and just after the first thermal therapy, and after 4-week thermal therapy. Results: Serum levels of hydroperoxide significantly increased in patients with CHF compared with healthy control subjects. Serum levels of hydroperoxide did not changed just after the first thermal therapy. Serum levels of hydroperoxide and BNP significantly decreased after 4-week thermal therapy (Hydroperoxide: 437 6 27 to 384 6 26 U, p ! 0.05; BNP: 545 6 87 to 368 6 76 pg/ml, p ! 0.01). Conclusion: Thermal therapy decreased oxidative stress and improved cardiac function in patients with CHF.
118 Effects of Cardiac Resynchronization (CRT) in Patients with Right Bundle Branch Block (RBBB) and Left Ventricular (LV) Dysfunction TOSHIHIRO HONDA, SHINJI TAYAMA, JYUNJIRO KOYAMA, RYOKO OHE Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan Background: The effect of CRT in patients LV dysfunction and intraventricular dyssynchrony is widely recognized. However, in patients with RBBB, the effect is poorly discussed. Patients and Methods: Four patients with RBBB and LV dysfunction are included in this study (age 66 6 9, male 4). Underlying diseases are old myocardial infarction in 3, and dilated cardiomyopathy in 1, and QP interval is longer than 0.20 in 4. We implanted CRTs in the 4 patients, and compared symptoms, cardiothoracic ratio (CTR), brain natriuretic peptide (BNP) level, and echocardiography parameters between before and after the implantation. Results: In all patients, symptoms improved, but the improvement was a little (from NYHA III to NYHA IIm in 3, and from III to III in 1). CTR changed from 60 6 3% to 55 6 2% (P 5 0.067), and BNP level decreased from 892 6 496 pg/ml to 674 6 307 pg/ml (P 5 0.144). Tissue velocity images showed that the motion of the lateral wall was delayed from that of the septum in 3 patients in spite of CRBBB. End-diastolic dimension of LV changed from 67 6 5 mm to 67 6 6 mm (P 5 0.785). Ejection fraction improved from 21 6 4 % to 27 6 8 % (P 5 0.067). In 1 patient, severe mitral regurgitation disappeared by CRT. Conclusion: The possibility that CRT is useful in patients with RBBB and LV dysfunction was suggested.
119 Oxidative Stress Induces GLUT4 Translocation by Dual AMPK Kinase Activation in Cardiac Myocytes TAKAHIRO HORIE1, KOH ONO1, KAZUYA NAGAO1, HITOO NISHI1, MINAKO KINOSHITA1, TORU KITA1, KOJI HASEGAWA2 1 Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan, 2Division of Translational Research, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan Cardiac-selective GLUT4 deficiency develop profound and irreversible dysfunction after ischemia. Therefore, translocation of GLUT4 represents an important phenomenon for protecting against ischemic injury. To investigate the precise mechanisms of GLUT4 translocation in cardiomyocytes, we established a method for quantifying the relative proportion of sarcolemmal GLUT4 to total GLUT4 by monitoring c-MycGLUT4-GFP reporter gene. Stimulation with H2O2 resulted in a concentrationdependent increase in GLUT4 translocation, which peaked at 15 min. The dominant-negative (DN) form of PI3K or the PI3K inhibitor inhibited H2O2-induced GLUT4 translocation as well as the phosphorylation of Akt. The DN form of AMP-activated protein kinase (AMPK)a2 also inhibited H2O2-induced GLUT4 translocation as well as the phosphorylation of Akt. We further examined the effect of two AMPK kinases (AMPKKs), calmodulin-dependent protein kinase kinase (CaMKK)b and LKB1, on the translocation of GLUT4. The DN form of CaMKKb or LKB1 partialy inhibited translocation. These two AMPKKs had an additive effect. Thus, these results demonstrate that oxidative stress causes the translocation of myocardial GLUT4 to the sarcolemma through the dual activation of CaMKKb and LKB1, which leads to activation of the AMPK-PI3K/Akt pathway.
120 Renin may Have an Important Role in Cardio-Renal Interaction in Patients with Heart Failure TOSHINARI TANAKA, TAKAYOSHI TSUTAMOTO, KEIZOU NISHIYAMA, HIROSHI SAKAI, MASANORI FUJII, MINORU HORIE Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan Purpose: Renin receptors have been recently identified in the human heart and cardiac renin mainly derived from the kidney may contribute to the development of ventricular dysfunction, suggesting the cardio-renal interaction. Method: To evaluate whether plasma active renin concentration (ARC) is a useful prognostic predictor, we measured the ARC, angiotensin II, aldosterone, BNP, and hemodynamic parameters in 214 patients with left ventricular dysfunction [left ventricular ejection fraction (LVEF) !45%] who underwent cardiac catheterization.
The 11th Annual Scientific Meeting Result: Among clinical variables including pulmonary capillary wedge pressure, right atrial pressure, LVEF, and neurohumoral factors, only high log ARC (p ! 0.0001) and log BNP (p 5 0.0009) were independent prognostic predictors. The hazard ratio of patients with BNP O 93 pg/mL and ARC O 78 pg/mL was 5.5 (95% confidence interval, 2.24-13.52) compared to those with BNP O 93 pg/mL and ARC !78 pg/mL for cardiac death (p 5 0.0002). Conclusion: These findings indicate that ARC is a strong independent prognostic predictor and that combined ARC and BNP are more informative at predicting mortality than either marker alone in patients with CHF, suggesting the important interaction between the kidney and the heart in CHF.
121 Use of Nitric Oxide Inhalation for the Treatment of Pulmonary Hypertensive Crisis Bridging to Living-donor Lobar Lung Transplantation SOICHIRO FUKE1, KENGO FUKUSHIMA KUSANO1, KENKI ENKO1, MASATO MURAKAMI1, TAKEFUMI OKA1, SATOSHI NAGASE1, KAZUFUMI NAKAMURA1, SATORU SAKURAGI1, TOHRU OHE1, HIROSHI DATE2, HARUO HANAWA3, ICHIRO FUSE3, YOSHIFUSA AIZAWA3 1 Department of Cardiovascular Medicine, Okayama University, Okayama, Japan, 2 Department of Thoracic and Cancer Surgery, Okayama University, Okayama, Japan, 3First Department of Internal Medicine, Niigata University, Niigata, Japan Inhaled nitric oxide (NO) has been shown to be a selective vasodilator for pulmonary hypertension (PH). We report here a case of PH crisis which was successfully treated with NO inhalation for the bridge to lung transplantation. A 32-years-old lady with a history of primary pulmonary hypertension (PPH) since her pregnancy, May 2005, was admitted on our hospital. She had been treated with intensive medical therapy including bosentan, sildenafil and continuous epoprostenol infusion, but PH crisis developed on 8th August 2006 and she was referred to our hospital to receive living-donor lobar lung transplantation (LDLLT). On admission, her general condition was too poor (NYHA IV) to receive LDLLT and her blood pressure was below 80 mmHg. We immediately started NO inhalation and catecholamine administration. After starting NO inhalation, arterial oxygen saturation increased from 92 to 100 % and her general condition was improved. Finally she could receive LDLLT successfully next day. Histological analysis revealed that pulmonary arterial obstruction and venous obstruction were observed.
122 The Poor Prognosis of Dilated Cardiomyopathy Patients with Late Gadolinium Enhancement at Mid-wall of Left Ventricle by Cardiac Magnetic Resonance MASAFUMI KAWADE1, KUNIHIKO TERAOKA2, MASAO YAMADA3, SINTARO KIUCHI3, MASAHARU HIRANO3, KENJI TAKAZAWA1, AKIRA YAMASHINA3 1 Division of Cardiology, Hachioji Medical Center, Tokyo, Japan, 2Genaral Health Gxamination and Preventive Medical Center of Tokyo Medical University, Tokyo, Japan, 3The 2nd Division of Internal Medicine, Tokyo Medical University, Tokyo, Japan The DCM patients is divided into 2 groups according to late gadolinium enhancement (LGE) at LV mid-wall is positive or not by CMR. Purpose: We compared the cardiac function, BNP value, the frequency of VT and prognosis between the DCM patients with LGE at mid-wall positive or not. Method: 53 DCM patients having LVEF less than 40% was enrolled. Single and multivariate analysis was done with cardiac function, BNP, arrhythmia and LGE positive. Result: 1) There were 22 patients with absence of LGE (group A) and 27 patients with LGE at LV-midwall (group B). 4 patients showed patchy pattern or indistinguishable pattern of LGE from the CAD patients. 2) a) There were significant difference for LVESV (ml) (131.7 6 74.0 vs 182.5 6 70.2, P ! 0.04) and LVEF (%) (28.1 6 8.9 vs 18.7 6 7.9, P ! 0.0001) between group A and B. b) There were not significant difference for LVEDV, CO, LVM, IVS, PW. 3) The frequency of VT in group B was greater than in A. 4) By single variable quantities analysis with log-rank test, BNP (150), VT, EF (25%), LGE were independent factors significantly (P 5 0.026, P 5 0.022, P 5 0.01, P 5 0.003), respectively) and in multivariate analysis (Cox hazard model), only LGE was significant (relative hazards; 10.2, 95% CI 1.31e79.47, P 5 0.027). Conclusion: DCM with LGE at LV-midwall showed poor cardiac function and prognosis.
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123 Genetic Manipulation of Periostin Expression Reveals a Role in Cardiac Hypertrophy and Ventricular Remodeling TORU OKA1, ROBERT A. KAISER2, JAIME MELENDEZ2, JEFFERY D. MOLKENTIN2 1 Department of Cardiovascular Science and Medicine, Chiba University, Chiba, Japan, 2Division of Molecular Cardiovascular Biology, Children’s Hospital Medical Center, Cincinnati, OH, USA The cardiac extracellular matrix is a dynamic structural support network that is both influenced by, and a regulator of, pathological remodeling and hypertrophic growth. In response to pathologic insults the adult heart re-expresses the secreted extracellular matrix protein periostin (Pn). Here we show the Pn is critically involved in regulating the cardiac hypertrophy response, interstitial fibrosis, and ventricular remodeling following long-term pressure overload (TAC) and myocardial infarction (MI). Mice lacking the Pn (Pn/) were more prone to ventricular rupture in the first 10 days after MI, but surviving mice showed less fibrosis and better ventricular performance. Pn/ mice also showed less fibrosis and hypertrophy following long-term TAC, suggesting an intimate relationship between Pn and the regulation of cardiac remodeling. In contrast, inducible overexpression of Pn in the heart protected mice from rupture following MI and induced spontaneous hypertrophy with aging. With respect to a mechanism underlying these alterations, fibroblasts isolated from Pn/ hearts were more migratory in culture and were less effective in adherence to cardiac myocytes. These are the first genetic data detailing the function of Pn in the adult heart as a regulator of cardiac remodeling and hypertrophy.
124 Depressed Ankle Brachial Blood Pressure Index is a Risk for the Prognosis of CHF Patients TOMOMI MEGURO1, TSUTOMU YOSHIKAWA2, YUJI NAGATOMO2, KIMI KOIDE2, TOSHIHISA ANZAI2, SATOSHI OGAWA2 1 Department of Medicine, Tokyo Electric Power Company Hospital, Tokyo, Japan, 2 Department of Cardiology, Keio University, Tokyo, Japan Ankle Brachial Blood Pressure Index (ABI) is as a gauge of peripheral artery disease. The goal of this study was to elucidate whether depressed ABI can be a risk for the prognosis of CHF patients. Eighty-one CHF patients (age 68þ/14, NYHA II-III, EF55%þ/19%) were divided in low ABI group (L) and high ABI group (H) by the median value (1.1) of ABI. Patients were followed for a mean of 400 days. Re-admission by CHF or cardiac death was used as an end point of prognosis. Plasma creatinine (L:1.2þ/0.1 mg/dl, H:1.1þ/0.1) was higher in L than H. Age, EF, BNP and blood pressure were similar between groups. However, in comparison to H, L had significantly lower event free survival. In conclusion, depressed ABI is a risk of cardiac death or hospitalization for CHF patients.
116 Physiologically Active BNP and C-reactive Protein Contributes the Regulation of Plasma Adiponectin in Patients with Chronic Heart Failure TOSHINARI TANAKA, TAKAYOSHI TSUTAMOTO, KEIZOU NISHIYAMA, HIROSHI SAKAI, MASANORI FUJII, MINORU HORIE Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan Purpose: Recent studies reported that negative correlation was observed between plasma adiponectin and CRP in patients with diabetes mellitus and atherosclerosis. However, relation between CRP and adiponectin in patients with CHF remains unknown. Method: We measured the plasma adiponectin and high sensitive CRP, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL), BNP, N terminal pro BNP (NTpBNP) and hemodynamic parameters in 156 CHF patients. Result: There were no correlation between plasma adiponectin and hemodynamic parameters, such as left ventricular ejection fraction and cardiac index. A negative correlation was observed between plasma adiponectin and body mass index (p ! 0.0001, r 5 0.497), male gender (p ! 0.0001, r 5 0.311), CRP (p 5 0.0012, r 5 0.257). A positive correlation was observed between plasma adiponectin and age (p 5 0.0142, r 5 0.196), HDL (p ! 0.0001, r 5 0.354), log BNP (p ! 0.0001, r 5 0.407), NTpBNP (p ! 0.0001, r 5 0.347). Stepwise multivariate analysis showed that male (p 5 0.0061), high HDL (p 5 0.0093), high BNP (p ! 0.0001) and low CRP (p 5 0.0015) were significant independent factors for regulation of plasma adiponectin in CHF patients. Conclusion: These findings suggest that inflammation and BNP contributes the regulation of plasma adiponectin in patients with CHF.
117 Effect of Thermal Therapy on Oxidative Stress in Patients with Chronic Heart Failure SHOJI FUJITA, TAKASHI KIHARA, MASAAKI MIYATA, TAKUROU SHINNSATO, TAKUROU KUBOZONO, SOU KUWAHATA, SYUUITI HAMASAKI, TYUUWA TEI Graduate School of Medicine, Kagoshima University, Kagoshima, Japan Background: In patients with chronic heart failure (CHF), excessive oxidative stress has been linked to peripheral hypoperfusion as a consequence of low cardiac output and peripheral endothelial dysfunction. We have applied thermal therapy using the 60 C dry sauna to patients with CHF and have found that thermal therapy improves cardiac function, endothelial function, neurohormonal factors, sympathetic nerve system, ventricular arrhythmias, and clinical symptoms in CHF patients. The purpose of this study is to clarify the effect of thermal therapy on oxidative stress in patients with CHF. Methods: Thermal therapy was performed in 20 patients with CHF for 4 weeks. Serum levels of hydroperoxide as a marker of oxidative stress were measured with FRAS systems at three points; before and just after the first thermal therapy, and after 4-week thermal therapy. Results: Serum levels of hydroperoxide significantly increased in patients with CHF compared with healthy control subjects. Serum levels of hydroperoxide did not changed just after the first thermal therapy. Serum levels of hydroperoxide and BNP significantly decreased after 4-week thermal therapy (Hydroperoxide: 437 6 27 to 384 6 26 U, p ! 0.05; BNP: 545 6 87 to 368 6 76 pg/ml, p ! 0.01). Conclusion: Thermal therapy decreased oxidative stress and improved cardiac function in patients with CHF.
118 Effects of Cardiac Resynchronization (CRT) in Patients with Right Bundle Branch Block (RBBB) and Left Ventricular (LV) Dysfunction TOSHIHIRO HONDA, SHINJI TAYAMA, JYUNJIRO KOYAMA, RYOKO OHE Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan Background: The effect of CRT in patients LV dysfunction and intraventricular dyssynchrony is widely recognized. However, in patients with RBBB, the effect is poorly discussed. Patients and Methods: Four patients with RBBB and LV dysfunction are included in this study (age 66 6 9, male 4). Underlying diseases are old myocardial infarction in 3, and dilated cardiomyopathy in 1, and QP interval is longer than 0.20 in 4. We implanted CRTs in the 4 patients, and compared symptoms, cardiothoracic ratio (CTR), brain natriuretic peptide (BNP) level, and echocardiography parameters between before and after the implantation. Results: In all patients, symptoms improved, but the improvement was a little (from NYHA III to NYHA IIm in 3, and from III to III in 1). CTR changed from 60 6 3% to 55 6 2% (P 5 0.067), and BNP level decreased from 892 6 496 pg/ml to 674 6 307 pg/ml (P 5 0.144). Tissue velocity images showed that the motion of the lateral wall was delayed from that of the septum in 3 patients in spite of CRBBB. End-diastolic dimension of LV changed from 67 6 5 mm to 67 6 6 mm (P 5 0.785). Ejection fraction improved from 21 6 4 % to 27 6 8 % (P 5 0.067). In 1 patient, severe mitral regurgitation disappeared by CRT. Conclusion: The possibility that CRT is useful in patients with RBBB and LV dysfunction was suggested.
119 Oxidative Stress Induces GLUT4 Translocation by Dual AMPK Kinase Activation in Cardiac Myocytes TAKAHIRO HORIE1, KOH ONO1, KAZUYA NAGAO1, HITOO NISHI1, MINAKO KINOSHITA1, TORU KITA1, KOJI HASEGAWA2 1 Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan, 2Division of Translational Research, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan Cardiac-selective GLUT4 deficiency develop profound and irreversible dysfunction after ischemia. Therefore, translocation of GLUT4 represents an important phenomenon for protecting against ischemic injury. To investigate the precise mechanisms of GLUT4 translocation in cardiomyocytes, we established a method for quantifying the relative proportion of sarcolemmal GLUT4 to total GLUT4 by monitoring c-MycGLUT4-GFP reporter gene. Stimulation with H2O2 resulted in a concentrationdependent increase in GLUT4 translocation, which peaked at 15 min. The dominant-negative (DN) form of PI3K or the PI3K inhibitor inhibited H2O2-induced GLUT4 translocation as well as the phosphorylation of Akt. The DN form of AMP-activated protein kinase (AMPK)a2 also inhibited H2O2-induced GLUT4 translocation as well as the phosphorylation of Akt. We further examined the effect of two AMPK kinases (AMPKKs), calmodulin-dependent protein kinase kinase (CaMKK)b and LKB1, on the translocation of GLUT4. The DN form of CaMKKb or LKB1 partialy inhibited translocation. These two AMPKKs had an additive effect. Thus, these results demonstrate that oxidative stress causes the translocation of myocardial GLUT4 to the sarcolemma through the dual activation of CaMKKb and LKB1, which leads to activation of the AMPK-PI3K/Akt pathway.
120 Renin may Have an Important Role in Cardio-Renal Interaction in Patients with Heart Failure TOSHINARI TANAKA, TAKAYOSHI TSUTAMOTO, KEIZOU NISHIYAMA, HIROSHI SAKAI, MASANORI FUJII, MINORU HORIE Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan Purpose: Renin receptors have been recently identified in the human heart and cardiac renin mainly derived from the kidney may contribute to the development of ventricular dysfunction, suggesting the cardio-renal interaction. Method: To evaluate whether plasma active renin concentration (ARC) is a useful prognostic predictor, we measured the ARC, angiotensin II, aldosterone, BNP, and hemodynamic parameters in 214 patients with left ventricular dysfunction [left ventricular ejection fraction (LVEF) !45%] who underwent cardiac catheterization.
The 11th Annual Scientific Meeting Result: Among clinical variables including pulmonary capillary wedge pressure, right atrial pressure, LVEF, and neurohumoral factors, only high log ARC (p ! 0.0001) and log BNP (p 5 0.0009) were independent prognostic predictors. The hazard ratio of patients with BNP O 93 pg/mL and ARC O 78 pg/mL was 5.5 (95% confidence interval, 2.24-13.52) compared to those with BNP O 93 pg/mL and ARC !78 pg/mL for cardiac death (p 5 0.0002). Conclusion: These findings indicate that ARC is a strong independent prognostic predictor and that combined ARC and BNP are more informative at predicting mortality than either marker alone in patients with CHF, suggesting the important interaction between the kidney and the heart in CHF.
121 Use of Nitric Oxide Inhalation for the Treatment of Pulmonary Hypertensive Crisis Bridging to Living-donor Lobar Lung Transplantation SOICHIRO FUKE1, KENGO FUKUSHIMA KUSANO1, KENKI ENKO1, MASATO MURAKAMI1, TAKEFUMI OKA1, SATOSHI NAGASE1, KAZUFUMI NAKAMURA1, SATORU SAKURAGI1, TOHRU OHE1, HIROSHI DATE2, HARUO HANAWA3, ICHIRO FUSE3, YOSHIFUSA AIZAWA3 1 Department of Cardiovascular Medicine, Okayama University, Okayama, Japan, 2 Department of Thoracic and Cancer Surgery, Okayama University, Okayama, Japan, 3First Department of Internal Medicine, Niigata University, Niigata, Japan Inhaled nitric oxide (NO) has been shown to be a selective vasodilator for pulmonary hypertension (PH). We report here a case of PH crisis which was successfully treated with NO inhalation for the bridge to lung transplantation. A 32-years-old lady with a history of primary pulmonary hypertension (PPH) since her pregnancy, May 2005, was admitted on our hospital. She had been treated with intensive medical therapy including bosentan, sildenafil and continuous epoprostenol infusion, but PH crisis developed on 8th August 2006 and she was referred to our hospital to receive living-donor lobar lung transplantation (LDLLT). On admission, her general condition was too poor (NYHA IV) to receive LDLLT and her blood pressure was below 80 mmHg. We immediately started NO inhalation and catecholamine administration. After starting NO inhalation, arterial oxygen saturation increased from 92 to 100 % and her general condition was improved. Finally she could receive LDLLT successfully next day. Histological analysis revealed that pulmonary arterial obstruction and venous obstruction were observed.
122 The Poor Prognosis of Dilated Cardiomyopathy Patients with Late Gadolinium Enhancement at Mid-wall of Left Ventricle by Cardiac Magnetic Resonance MASAFUMI KAWADE1, KUNIHIKO TERAOKA2, MASAO YAMADA3, SINTARO KIUCHI3, MASAHARU HIRANO3, KENJI TAKAZAWA1, AKIRA YAMASHINA3 1 Division of Cardiology, Hachioji Medical Center, Tokyo, Japan, 2Genaral Health Gxamination and Preventive Medical Center of Tokyo Medical University, Tokyo, Japan, 3The 2nd Division of Internal Medicine, Tokyo Medical University, Tokyo, Japan The DCM patients is divided into 2 groups according to late gadolinium enhancement (LGE) at LV mid-wall is positive or not by CMR. Purpose: We compared the cardiac function, BNP value, the frequency of VT and prognosis between the DCM patients with LGE at mid-wall positive or not. Method: 53 DCM patients having LVEF less than 40% was enrolled. Single and multivariate analysis was done with cardiac function, BNP, arrhythmia and LGE positive. Result: 1) There were 22 patients with absence of LGE (group A) and 27 patients with LGE at LV-midwall (group B). 4 patients showed patchy pattern or indistinguishable pattern of LGE from the CAD patients. 2) a) There were significant difference for LVESV (ml) (131.7 6 74.0 vs 182.5 6 70.2, P ! 0.04) and LVEF (%) (28.1 6 8.9 vs 18.7 6 7.9, P ! 0.0001) between group A and B. b) There were not significant difference for LVEDV, CO, LVM, IVS, PW. 3) The frequency of VT in group B was greater than in A. 4) By single variable quantities analysis with log-rank test, BNP (150), VT, EF (25%), LGE were independent factors significantly (P 5 0.026, P 5 0.022, P 5 0.01, P 5 0.003), respectively) and in multivariate analysis (Cox hazard model), only LGE was significant (relative hazards; 10.2, 95% CI 1.31e79.47, P 5 0.027). Conclusion: DCM with LGE at LV-midwall showed poor cardiac function and prognosis.
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123 Genetic Manipulation of Periostin Expression Reveals a Role in Cardiac Hypertrophy and Ventricular Remodeling TORU OKA1, ROBERT A. KAISER2, JAIME MELENDEZ2, JEFFERY D. MOLKENTIN2 1 Department of Cardiovascular Science and Medicine, Chiba University, Chiba, Japan, 2Division of Molecular Cardiovascular Biology, Children’s Hospital Medical Center, Cincinnati, OH, USA The cardiac extracellular matrix is a dynamic structural support network that is both influenced by, and a regulator of, pathological remodeling and hypertrophic growth. In response to pathologic insults the adult heart re-expresses the secreted extracellular matrix protein periostin (Pn). Here we show the Pn is critically involved in regulating the cardiac hypertrophy response, interstitial fibrosis, and ventricular remodeling following long-term pressure overload (TAC) and myocardial infarction (MI). Mice lacking the Pn (Pn/) were more prone to ventricular rupture in the first 10 days after MI, but surviving mice showed less fibrosis and better ventricular performance. Pn/ mice also showed less fibrosis and hypertrophy following long-term TAC, suggesting an intimate relationship between Pn and the regulation of cardiac remodeling. In contrast, inducible overexpression of Pn in the heart protected mice from rupture following MI and induced spontaneous hypertrophy with aging. With respect to a mechanism underlying these alterations, fibroblasts isolated from Pn/ hearts were more migratory in culture and were less effective in adherence to cardiac myocytes. These are the first genetic data detailing the function of Pn in the adult heart as a regulator of cardiac remodeling and hypertrophy.
124 Depressed Ankle Brachial Blood Pressure Index is a Risk for the Prognosis of CHF Patients TOMOMI MEGURO1, TSUTOMU YOSHIKAWA2, YUJI NAGATOMO2, KIMI KOIDE2, TOSHIHISA ANZAI2, SATOSHI OGAWA2 1 Department of Medicine, Tokyo Electric Power Company Hospital, Tokyo, Japan, 2 Department of Cardiology, Keio University, Tokyo, Japan Ankle Brachial Blood Pressure Index (ABI) is as a gauge of peripheral artery disease. The goal of this study was to elucidate whether depressed ABI can be a risk for the prognosis of CHF patients. Eighty-one CHF patients (age 68þ/14, NYHA II-III, EF55%þ/19%) were divided in low ABI group (L) and high ABI group (H) by the median value (1.1) of ABI. Patients were followed for a mean of 400 days. Re-admission by CHF or cardiac death was used as an end point of prognosis. Plasma creatinine (L:1.2þ/0.1 mg/dl, H:1.1þ/0.1) was higher in L than H. Age, EF, BNP and blood pressure were similar between groups. However, in comparison to H, L had significantly lower event free survival. In conclusion, depressed ABI is a risk of cardiac death or hospitalization for CHF patients.