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Risk Predictor of In-hospital Mortality after Acute Myocardial Infarction
The 16th Annual Scientific Meeting administration of nicorandil reduced infarction size. Furthermore, combined administration of low-dose carperitide and high-dose nicorandil can be expected to have an unloading effect for the LV.
JHFS
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targeting subunit (MYPT-1), and NAD(P)H oxidase p22phox, p47phox, gp91phox, and decreased eNOS phosphorylation, and fasudil improved these indices. These findings suggest that cardio-renoprotective effect of Rho-kinase inhibitor in cardiorenal damage after MI may play an important role in UMI rats. Thus, Rho-kinase pathway may provide a potential therapeutic target in the kidney and heart after MI.
P-025 Risk Predictor of In-hospital Mortality after Acute Myocardial Infarction MASAYUKI YAMAJI, MOTOYOSHI MAENAKA, YUTAKA TADANO, TOMOKO SAKAGUCHI, TERUKI TAKEDA, KEIKO MAEDA, HIROSHI MABUCHI, TOMOYUKI MURAKAMI Department of Cardiovascular Medicine, Koto Memorial Hospital, Shiga, Japan Backgrounds: The aim of this study is to investigate the prognosis of patients in our hospital following acute myocardial infarction (AMI) and the potential role of risk predictors for in-hospital mortality. Methods: We evaluated clinical characteristics, cardiac events and prognosis retrospectively in 246 patients with AMI who underwent percutaneous coronary intervention (PCI) between 2006 and 2011. Results: The total number of in-hospital deaths for all causes was 17 (6.9%). Mean blood pressure were significantly lower and heart rate were significantly higher in patients with in-hospital deaths than the others. TIMI flow grade after PCI were significantly worse and PCI procedure time was significantly longer in patients with in-hospital deaths than the others. Peak CPK were significantly higher and LVEF at admission was significantly lower in patients with in-hospital deaths than the others. The numbers of coronary heart risk factors were significantly smaller in patients with in-hospital deaths than the others. On multivariate analyses, age (p50.04), heart rate (p50.002), PCI procedure time (p50.02) and TIMI flow less than grade II (p50.04) were independent predictor of in-hospital mortality. Conclusions: The in-hospital mortality of patients with AMI in our hospital was concomitant with previous reports and age, heart rate, PCI procedure time and TIMI flow were important risk predictors of in-hospital mortality.
P-028 Effectiveness of Diuretics to Patients with Acute Decompensated Heart Failure TAKESHI YAGYU, MASASHI FUJINO, HIROYUKI TAKAHAMA, HIDEAKI KANZAKI, YOICHI GOTO, MASAFUMI KITAKAZE, MASAHARU ISHIHARA, SATOSHI YASUDA, HISAO OGAWA, HIROYUKI YOKOYAMA National Cerebral and Cardiovascular Center, Osaka, Japan Background: Although diuretics are generally recognized as key drugs in chronic heart failure, their significance in acute decompensated heart failure(ADHF) remains unknown. We assessed clinical effects of diuretics for ADHF. Method: We divided 402 patients with ADHF into four groups by dose of furosemide and administration of human atrial natriuretic peptide(hANP), and examined change in body weight, serum creatinine level, serum brain natriuretic peptide(BNP) level and length of hospital stay. Results: Administration of hANP or high dose furosemide was associated with great reduction of body weight. There was no significant difference of change in serum creatinine, BNP or length of hospital stay. Conclusions: Administration of hANP or high dose furosemide for ADHF could achieve aggressive volume reduction. We couldn’t confirm effect of diuretics on reduction of BNP or shortening of hospital stay. Table 1. Low dose furosemide (w 99 mg/5days)
P-026 Chronic Phase Effect of Landiolol about Left Ventricular Volume in Patients with Acute Myocardial Infarction after Primary Percutaneous Coronary Intervention MASAKI FUJITA, HIROSHI OHIRA, TATSUYA YAMASHITA, MARUHITO NAKATA, TOSHIYUKI NISHIKIDO, TOSHIYA CHINENN, TATSUO KIKUCHI, KENTARO NAKAMURA, KENTARO MEGURO, TAKEHIKO KEIDA Depertment of Cardiology, Edogawa Hospital, Tokyo, Japan Background: Beta blockers have a proven benefit in the management of patients with acute myocardial infarction (AMI). The aim of this study is to investigate the long-term effect of landiolol therapy in very acute phase of AMI. Method: Seventy-nine patients with AMI after primary percutaneous coronary intervention (PCI) were randomly assigned to langiolol group (n542) or control group (n537). UCG and brain natriuretic peptide were recorded in both groups at 6 months. Tc-MIBI scintigraphy was also performed and these data were analyzed by software, CardioBULL which quantifies infarct size, left ventricular ejection fraction (LVEF) and left ventricular volume. Result: Improvement of LVEF in landiolol group was better than in control group by UCG (3.06 6 8.26% vs. 8.21 6 10.91% : p50.04) and TcMIBI scintigraphy (8.83 6 7.44% vs. 3.35 6 10.11% : p50.041). Left ventricular diastolic volume in the landiolol group was significantly smaller than in the control group at the chronic phase (89.9 6 27.1ml vs. 113.2 6 48.6ml : p50.040). Left ventricular systolic volume was comparable (38.9 6 16.4ml vs. 57.5 6 41.5ml: p50.047). 6 months after the procedure, BNP in the landiolol group was lower than in the control group (51 6 38pg/ml vs. 69 6 67pg/ml: p50.47). Conclusion: Landiolol therapy in the very acute phase of AMI may have beneficial effect on left ventricular remodeling and may result in the reduction of cardiovascular event.
P-027 Renal Damage after Myocardial Infarction is Prevented by Rho-kinase Inhibitor for Cardio-renal Protection NAOHIKO KOBAYASHI1, HIROSHI TAKESHIMA1, WATARU KOGUCHI1, MAYUKO ISHIKAWA1, FUMIHIRO SUGIYAMA1, SHOU ONODA1, HISATO HIRATA2, NORIKO SUZUKI3, FUMIE YOKOTSUKA3, TOSHIHIKO ISHIMITSU1 1 Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University School of Medicine, Saitama, Japan, 2Laboratory Animal Research Center, Dokkyo Medical University School of Medicine, Saitama, Japan, 3Clinical Research Center, Dokkyo Medical University School of Medicine, Saitama, Japan Myocardial infarction (MI) aggravates preexistent mild renal damage that is elicited by unilateral nephrectomy in rats. However, cardio-renal protection after MI is unclear. We evaluate whether fasudil, Rho-kinase inhibitor, improves cardiovascular remodeling and renal damage after MI in unilateral nephrectomized (UNX) rats. MI was induced after UNX by ligation of the left coronary artery (UMI). Vehicle and fasudil (100 mg/kg/day) were administration in UMI rats for 4 weeks. Glomerular sclerosis damage and decreased nephrin and podocin expression in the kidney of UMI rats was significantly ameliorated by fasudil. Decreased %FS and increased fibrosis area in the LV was significantly improved by fasudil. UMI rats in the kidney and LV were characterized by increased phosphorylation of myosin phosphatase
n D Body Weight [kg] D Cre [mg / dl] D BNP [pg / ml] Length of hospital stay [days]
High dose furosemide (100 mg w / 5days)
233
93
50
26
-5.10 -0.03 -659 30.4
-6.09 -0.08 -757 33.3
-6.21 0.02 -509 35.6
-7.69 0.14 -639 39.3
P-029 Efficacy of Tolvaptan Therapy during Acute Phase of Acute Heart Failure AKIHIRO SHIRAKABE, NORITAKE HATA, TAKURO SHINADA, KAZUNORI TOMITA, MASAFUMI TSURUMI, MASATO MATSUSHITA, HIROTAKE OKAZAKI, YOSHIYA YAMAMOTO Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan Background: Tolvaptan was mainly used for uncontrollable chronic heart failure (HF), however it was rarely used during acute phase of acute HF (AHF). Methods: Fourteen AHF patients, who needed diuretics, were enrolled. Tolvaptan was administrated of 7.5mg in emergency setting with continuous intravenous furosemide, and it was administrated additionally at 12-hour intervals till HF was compensated. When intravenous furosemide was changed to peroral use, the administration of tolvaptan was finished. There were no limitations in HF therapy except tolvaptan use. Serum levels of BNP, NT-pro-BNP, urinary albumin, LFABP excretion were measured on admission (Day 1), Day 4 and Day 14. Result: The total amount of tolvaptan which were needed to compensate for HF was 27.9610.2 mg with 18.064.4 mg/day (1.7260.66 days) continuous intravenous furosemide. Serum levels of BNP significantly decreased on Day 4 (501.76367.3 pg/ml) and Day 14 (221.06195.9 pg/ ml) from Day 1 (878.46691.1 pg/ml), NT-pro-BNP tended to decrease on Day 4 (3,590.163,391.0 pg/ml) and significantly decreased on Day 14 (1,251.461,120.2 pg/ml) from Day 1 (5,879.466,702.1pg/ml). U-albumin tended to decrease on Day 4 (43.1645.5 mg/g creatinine) and Day 14 (25.2631.1 mg/g creatinine) from Day 1 (1,492.462,726.3 mg/g creatinine), u-LFABP significantly decreased on Day 4 (12.3612.1 mg/g creatinine) and Day 14 (9.367.9 mg/g creatinine) from Day 1 (283.76441.4 mg/g creatinine). Conclusion: Tolvaptan can be effective to compensate for AHF with the reduction of renal stress.
P-030 Clinical Significance of Flush Pulmonary Edema and Its Characterization MIWA IWAMOTO, TAKAYUKI INOMATA, SHUNSUKE ISHII, ICHIRO WATANABE, TAKASHI NARUKE, HISAHITO SHINAGAWA, TOSHIMI KOITABASHI, MOTOTSUGU NISHII, ICHIRO TAKEUCHI, TORU IZUMI Department of Cardio-Angiology, Kitasato University, School of Medicine, Sagamihara, Japan Purpose: Flash pulmonary edema (FPE) is observed in severe decompensated heart failure (HF); however, little information exists regarding its clinical
JHFS
S171
targeting subunit (MYPT-1), and NAD(P)H oxidase p22phox, p47phox, gp91phox, and decreased eNOS phosphorylation, and fasudil improved these indices. These findings suggest that cardio-renoprotective effect of Rho-kinase inhibitor in cardiorenal damage after MI may play an important role in UMI rats. Thus, Rho-kinase pathway may provide a potential therapeutic target in the kidney and heart after MI.
P-025 Risk Predictor of In-hospital Mortality after Acute Myocardial Infarction MASAYUKI YAMAJI, MOTOYOSHI MAENAKA, YUTAKA TADANO, TOMOKO SAKAGUCHI, TERUKI TAKEDA, KEIKO MAEDA, HIROSHI MABUCHI, TOMOYUKI MURAKAMI Department of Cardiovascular Medicine, Koto Memorial Hospital, Shiga, Japan Backgrounds: The aim of this study is to investigate the prognosis of patients in our hospital following acute myocardial infarction (AMI) and the potential role of risk predictors for in-hospital mortality. Methods: We evaluated clinical characteristics, cardiac events and prognosis retrospectively in 246 patients with AMI who underwent percutaneous coronary intervention (PCI) between 2006 and 2011. Results: The total number of in-hospital deaths for all causes was 17 (6.9%). Mean blood pressure were significantly lower and heart rate were significantly higher in patients with in-hospital deaths than the others. TIMI flow grade after PCI were significantly worse and PCI procedure time was significantly longer in patients with in-hospital deaths than the others. Peak CPK were significantly higher and LVEF at admission was significantly lower in patients with in-hospital deaths than the others. The numbers of coronary heart risk factors were significantly smaller in patients with in-hospital deaths than the others. On multivariate analyses, age (p50.04), heart rate (p50.002), PCI procedure time (p50.02) and TIMI flow less than grade II (p50.04) were independent predictor of in-hospital mortality. Conclusions: The in-hospital mortality of patients with AMI in our hospital was concomitant with previous reports and age, heart rate, PCI procedure time and TIMI flow were important risk predictors of in-hospital mortality.
P-028 Effectiveness of Diuretics to Patients with Acute Decompensated Heart Failure TAKESHI YAGYU, MASASHI FUJINO, HIROYUKI TAKAHAMA, HIDEAKI KANZAKI, YOICHI GOTO, MASAFUMI KITAKAZE, MASAHARU ISHIHARA, SATOSHI YASUDA, HISAO OGAWA, HIROYUKI YOKOYAMA National Cerebral and Cardiovascular Center, Osaka, Japan Background: Although diuretics are generally recognized as key drugs in chronic heart failure, their significance in acute decompensated heart failure(ADHF) remains unknown. We assessed clinical effects of diuretics for ADHF. Method: We divided 402 patients with ADHF into four groups by dose of furosemide and administration of human atrial natriuretic peptide(hANP), and examined change in body weight, serum creatinine level, serum brain natriuretic peptide(BNP) level and length of hospital stay. Results: Administration of hANP or high dose furosemide was associated with great reduction of body weight. There was no significant difference of change in serum creatinine, BNP or length of hospital stay. Conclusions: Administration of hANP or high dose furosemide for ADHF could achieve aggressive volume reduction. We couldn’t confirm effect of diuretics on reduction of BNP or shortening of hospital stay. Table 1. Low dose furosemide (w 99 mg/5days)
P-026 Chronic Phase Effect of Landiolol about Left Ventricular Volume in Patients with Acute Myocardial Infarction after Primary Percutaneous Coronary Intervention MASAKI FUJITA, HIROSHI OHIRA, TATSUYA YAMASHITA, MARUHITO NAKATA, TOSHIYUKI NISHIKIDO, TOSHIYA CHINENN, TATSUO KIKUCHI, KENTARO NAKAMURA, KENTARO MEGURO, TAKEHIKO KEIDA Depertment of Cardiology, Edogawa Hospital, Tokyo, Japan Background: Beta blockers have a proven benefit in the management of patients with acute myocardial infarction (AMI). The aim of this study is to investigate the long-term effect of landiolol therapy in very acute phase of AMI. Method: Seventy-nine patients with AMI after primary percutaneous coronary intervention (PCI) were randomly assigned to langiolol group (n542) or control group (n537). UCG and brain natriuretic peptide were recorded in both groups at 6 months. Tc-MIBI scintigraphy was also performed and these data were analyzed by software, CardioBULL which quantifies infarct size, left ventricular ejection fraction (LVEF) and left ventricular volume. Result: Improvement of LVEF in landiolol group was better than in control group by UCG (3.06 6 8.26% vs. 8.21 6 10.91% : p50.04) and TcMIBI scintigraphy (8.83 6 7.44% vs. 3.35 6 10.11% : p50.041). Left ventricular diastolic volume in the landiolol group was significantly smaller than in the control group at the chronic phase (89.9 6 27.1ml vs. 113.2 6 48.6ml : p50.040). Left ventricular systolic volume was comparable (38.9 6 16.4ml vs. 57.5 6 41.5ml: p50.047). 6 months after the procedure, BNP in the landiolol group was lower than in the control group (51 6 38pg/ml vs. 69 6 67pg/ml: p50.47). Conclusion: Landiolol therapy in the very acute phase of AMI may have beneficial effect on left ventricular remodeling and may result in the reduction of cardiovascular event.
P-027 Renal Damage after Myocardial Infarction is Prevented by Rho-kinase Inhibitor for Cardio-renal Protection NAOHIKO KOBAYASHI1, HIROSHI TAKESHIMA1, WATARU KOGUCHI1, MAYUKO ISHIKAWA1, FUMIHIRO SUGIYAMA1, SHOU ONODA1, HISATO HIRATA2, NORIKO SUZUKI3, FUMIE YOKOTSUKA3, TOSHIHIKO ISHIMITSU1 1 Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University School of Medicine, Saitama, Japan, 2Laboratory Animal Research Center, Dokkyo Medical University School of Medicine, Saitama, Japan, 3Clinical Research Center, Dokkyo Medical University School of Medicine, Saitama, Japan Myocardial infarction (MI) aggravates preexistent mild renal damage that is elicited by unilateral nephrectomy in rats. However, cardio-renal protection after MI is unclear. We evaluate whether fasudil, Rho-kinase inhibitor, improves cardiovascular remodeling and renal damage after MI in unilateral nephrectomized (UNX) rats. MI was induced after UNX by ligation of the left coronary artery (UMI). Vehicle and fasudil (100 mg/kg/day) were administration in UMI rats for 4 weeks. Glomerular sclerosis damage and decreased nephrin and podocin expression in the kidney of UMI rats was significantly ameliorated by fasudil. Decreased %FS and increased fibrosis area in the LV was significantly improved by fasudil. UMI rats in the kidney and LV were characterized by increased phosphorylation of myosin phosphatase
n D Body Weight [kg] D Cre [mg / dl] D BNP [pg / ml] Length of hospital stay [days]
High dose furosemide (100 mg w / 5days)
233
93
50
26
-5.10 -0.03 -659 30.4
-6.09 -0.08 -757 33.3
-6.21 0.02 -509 35.6
-7.69 0.14 -639 39.3
P-029 Efficacy of Tolvaptan Therapy during Acute Phase of Acute Heart Failure AKIHIRO SHIRAKABE, NORITAKE HATA, TAKURO SHINADA, KAZUNORI TOMITA, MASAFUMI TSURUMI, MASATO MATSUSHITA, HIROTAKE OKAZAKI, YOSHIYA YAMAMOTO Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan Background: Tolvaptan was mainly used for uncontrollable chronic heart failure (HF), however it was rarely used during acute phase of acute HF (AHF). Methods: Fourteen AHF patients, who needed diuretics, were enrolled. Tolvaptan was administrated of 7.5mg in emergency setting with continuous intravenous furosemide, and it was administrated additionally at 12-hour intervals till HF was compensated. When intravenous furosemide was changed to peroral use, the administration of tolvaptan was finished. There were no limitations in HF therapy except tolvaptan use. Serum levels of BNP, NT-pro-BNP, urinary albumin, LFABP excretion were measured on admission (Day 1), Day 4 and Day 14. Result: The total amount of tolvaptan which were needed to compensate for HF was 27.9610.2 mg with 18.064.4 mg/day (1.7260.66 days) continuous intravenous furosemide. Serum levels of BNP significantly decreased on Day 4 (501.76367.3 pg/ml) and Day 14 (221.06195.9 pg/ ml) from Day 1 (878.46691.1 pg/ml), NT-pro-BNP tended to decrease on Day 4 (3,590.163,391.0 pg/ml) and significantly decreased on Day 14 (1,251.461,120.2 pg/ml) from Day 1 (5,879.466,702.1pg/ml). U-albumin tended to decrease on Day 4 (43.1645.5 mg/g creatinine) and Day 14 (25.2631.1 mg/g creatinine) from Day 1 (1,492.462,726.3 mg/g creatinine), u-LFABP significantly decreased on Day 4 (12.3612.1 mg/g creatinine) and Day 14 (9.367.9 mg/g creatinine) from Day 1 (283.76441.4 mg/g creatinine). Conclusion: Tolvaptan can be effective to compensate for AHF with the reduction of renal stress.
P-030 Clinical Significance of Flush Pulmonary Edema and Its Characterization MIWA IWAMOTO, TAKAYUKI INOMATA, SHUNSUKE ISHII, ICHIRO WATANABE, TAKASHI NARUKE, HISAHITO SHINAGAWA, TOSHIMI KOITABASHI, MOTOTSUGU NISHII, ICHIRO TAKEUCHI, TORU IZUMI Department of Cardio-Angiology, Kitasato University, School of Medicine, Sagamihara, Japan Purpose: Flash pulmonary edema (FPE) is observed in severe decompensated heart failure (HF); however, little information exists regarding its clinical