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Tolerability and Efficacy of Subcutaneous Treprostinil Therapy in Patients with Pulmonary Arterial Hypertension
The 20th Annual Scientific Meeting
O30-2 The Dutch Objective Burden Inventory: Initial Validity and Reliability in a Japanese Population of Caregivers for Heart Failure Patients Miyuki Tsuchihashi-Makaya1, Shiho Matsuoka2, Hiroko Ishida3, Etsuko Nakatsugawa4; 1 School of Nursing, Kitasato University, Tokyo, Japan; 2Section of Liaison Psychiatry & Palliative Medicine, Tokyo Medical & Dental University, Tokyo, Japan; 3Department of Nursing, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan; 4 Department of Nursing, Edogawa Hospital, Tokyo, Japan Background: Caregivers of patients with heart failure (HF) often experience caregiver burden and emotional distress. However, a disease-specific tool measured caregiver’s experience was not available. The aim of this study was to assess a validity and reliability of the Dutch Objective Burden Inventory(DOBI), which was developed as a disease-specific tool measuring objective caregiver burden in a Dutch HF population, in a Japanese population. Methods: After we received permission from the original author to translate the DOBI into Japanese, we performed forward- and backtranslation according to standard translation processes for scale, semantic, and conceptual equivalence. Reliability was assessed using Cronbach’s α to determine internal consistency. We evaluated construct validity through associations between Japanese DOBI, Center for Epidemiologic Studies Depression Scale (CES-D), and State-Trait Anxiety Inventory (STAI) scores. Results: Total 64 caregivers of patients with HF (65.1 ± 13.9 years, 75% were female) was assessed. DOBI was consisted of 50 items, and internal consistency was acceptable for total DOBI score (Cronbach’s α = 0.947). Caregivers with higher levels of DOBI had higher depression and anxiety than caregivers with lower levels of DOBI. Conclusions: The Japanese version of the DOBI showed acceptable validity and reliability in the initial test. Further testing might be needed to develop the short version of DOBI.
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disorder group. However, peak VO2 did not differ significantly in two groups (13.9 ± 3.2 vs 12.9 ± 2.3 ml/kg/min P = .20). Mean pulmonary artery pressure and arterial blood oxygen saturation also did not differ significantly. Conclusion: In CTEPH, high prevalence rate of mental disorder was indicated. The discrepancy between cardiac index and exercise tolerance seems to be relate to condition and medicinal therapy of mental disorder.
O31-3 Severe Cases of Pulmonary Arterial Hypertension: Saving Patients Under Conditions of Hemodynamic Collapse is Not Easy Hisataka Maki, Masaru Hatano, Shun Minatsuki, Issei Komuro; Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
O30-5
Acute aggravation of hemodynamic status often cause a life-threatening problem in patients with severe pulmonary arterial hypertension (PAH). Clinical guidelines recommend intravenous epoprostenol therapy as the first-choice in world health organization functional class (WHO-FC) IV patients. However, the introduction of epoprostenol sometimes induces hemodynamic collapse in patients with unstable hemodynamic status. Also, when the patients need support of extracorporeal circuit, the combination use of anticoagulants and epoprostenol increases the bleeding risks and sometimes results in bad prognosis. Here we show five severely-ill PAH patients with unstable respiratory and hemodynamic status (4 idiopathic or heritable PAH and 1 portpulmonary PH). All 5 patients were woman with WHO-FC IV. All 5 patients have been introduced intravenous epoprostenol and intravenous catecholamine. Four patients needed ventilator and continuous hemodiafiltration, and 3 of these 4 patients were attached extracorporeal membrane oxygenation. Serious bleeding complications occurred in 4 patients and as the result, one patient recovered but three patients died. Saving PAH patients from hemodynamic collapse is difficult even if the maximum therapeutic agents and devices are devoted. Establishment of therapeutic strategy for very severe PAH patients is needed.
Our First Case of Multidisciplinary Team Conference for a Severe Heart Failure Patient, That Successfully Lead to Home Medical Care Akiko Nakazawa, Emi Mori, Rikako Koizumi, Takashi Suzuki; Cardiovascular center, Kin-ikyo Chuo Hospital, Sapporo, Japan
O31-4
The patient was a 60-year-old male with a history of myocardial infarction. He was referred by other clinic and admitted to our hospital with a chief complaint of exertional dyspnea. He was diagnosed with severe MR with 29% of LVEF. In response, OLVP+MAP+PMA+PMS+TAP+PFO closure were performed. He was discharged from the hospital one month after surgery. Within 6 months, he required hospitalization three times due to deterioration of the cardiac function. We discovered that the patient’s MR had relapsed. After discovering this, MVR and CRTP implantation was performed. The surgeries did not alleviate his condition. Left ventricular dyssynchronie appearance required to induct intravenous CRTP implantation. At that point, we decided to reinforce an intervention for heart failure treatments. Patient education was introduced during his each hospital stay by way of educational materials prepared specifically for him. Simultaneously, we discussed this patient care with multi-occupational specialists at the first team conference. Home care medical providers and caregivers were involved too. This triggered an expansion in team size both inside and outside of hospital. We also visited the patient’s home before patient discharge to better adapt our recommendations. Despite a severe heart failure case, we could successfully start a team of specialists to provide sufficient care. As a result of this experiences, multidisciplinary team conferences have been held continuously since then.
O31-2 The Clinical Characteristics of Chronic Thromboembolic Pulmonary Hypertension with Mental Disorder Shun Minatsuki1, Hisataka Maki1, Masaru Hatano2, Issei Komuro1; 1Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Background: It is generally agreed today that there is an association with mental disorder and chronic thromboembolic pulmonary hypertension (CTEPH). However, the actual prevalence rate of mental disorder in CTEPH and precise clinical characteristics of CTEPH with mental disorder compared with that with non-mental disorder have been unclear. Method: We retrospectively analyzed consecutive 63 patients with CTEPH (age 62.2 ± 15.2 year-old, 44 female) and divided into two group (mental disorder and non-mental disorder) based on a past medical history. Eleven patients had mental disorder (5 were schizophrenia, 6 were depression). Patients were received right heart catheterization and cardiopulmonary exercise test. We used initial data of each patient. Result: The prevalence rate of mental disorder among in our study group was higher than that among Japanese adult people. The significant characteristics, which were compared with two groups, were lower age at the onset (51.4 ± 9.6 vs 63.3 ± 15.3 P < .05) and high cardiac index (2.7 ± 0.9 vs 2.0 ± 0.7 P < .05) in mental
Tolerability and Efficacy of Subcutaneous Treprostinil Therapy in Patients with Pulmonary Arterial Hypertension Masaru Hatano1, Hisataka Maki2, Shun Minatsuki2, Issei Komuro2; 1Department of Therapeutic Strategy for Heart Failure, University of Tokyo, Tokyo, Japan; 2Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan Background: Subcutaneous treprostinil is the agent with new route of administration and is expected to broaden treatment options for pulmonary arterial hypertension (PAH). However, subcutaneous treprostinil therapy is not widely accepted because of its low tolerability attributed to infusion site pain. Aim: The purpose of this study to elucidate tolerability and efficacy of subcutaneous treprostinil therapy in patients with PAH. Objective: Consecutive 10 patients with PAH who were treated with subcutaneous treprostinil (age : 39.2 ± 12.4, male 10%, idiopathic/heritable PAH 7, associated PAH 2, pulmonary venous occlusive disease 1) were enrolled this study. Results: Five of ten patients were converted from intravenous epoprostenol and other 5 patients were not treated with parenteral prostanoid before receiving subcutaneous treprostinil. All patients were well-tolerated to subcutaneous treprostinil for full observation period (235 ± 175 days, range 41–574 days). Maintenance dose of treprostinil was 57.6 ± 27.6 ng/ kg/min. WHO functional class was significantly improved after introduction of subcutaneous treprostinil (from 2.6 ± 0.7 to 2.2 ± 0.9, P = .04). Hemodynamic parameters were also significantly improved in 5 patients newly introduced parenteral prostanoid (from 44.8 ± 1.6 to 36.0 ± 3.7 mmHg in mean pulmonary artery pressure, from 8.1 ± 2.4 to 5.0 ± 0.9 wood in pulmonary vascular resistance, P = .02, 0.04, respectively). Conclusion: Subcutaneous treprostinil therapy is well-tolerated and efficacious for patients with PAH.
O31-5 A Case of Chronic Heart Failure with Severe Pulmonary Hypertension Successfully Treated with PDE-5 Inhibitor Midori Takakura, Shingo Kato, Mai Azuma, Naoki Iinuma, Yuka Kusakawa, Satoru Shimizu, Yuko Miki, Tatsuya Nakachi, Kazuki Fukui; Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan A 65-year-old female with mycobacterium avium complex was referred to our department for the evaluation of fatigue, dyspnea and leg edema. Blood pressure was 89/ 56 mmHg. An electrocardiogram demonstrated atrial fibrillation, and chest X-ray showed cardiomegaly. Body weight was gradually increased by 8 kg in last 5 months. Blood test showed elevated BNP of 1684.9 pg/ml. Echocardiography revealed moderate mitral regurgitation and elevated right ventricular systolic pressure (RVSP) of 85.4 mmHg, suggesting presence of severe pulmonary hypertension. After the admission, she was treated by furosemide. However, urine volume wasn’t sufficiently increased. Therefore, we initiated intravenous dobutamine and tolvaptan. Urine volume was increased
O30-2 The Dutch Objective Burden Inventory: Initial Validity and Reliability in a Japanese Population of Caregivers for Heart Failure Patients Miyuki Tsuchihashi-Makaya1, Shiho Matsuoka2, Hiroko Ishida3, Etsuko Nakatsugawa4; 1 School of Nursing, Kitasato University, Tokyo, Japan; 2Section of Liaison Psychiatry & Palliative Medicine, Tokyo Medical & Dental University, Tokyo, Japan; 3Department of Nursing, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan; 4 Department of Nursing, Edogawa Hospital, Tokyo, Japan Background: Caregivers of patients with heart failure (HF) often experience caregiver burden and emotional distress. However, a disease-specific tool measured caregiver’s experience was not available. The aim of this study was to assess a validity and reliability of the Dutch Objective Burden Inventory(DOBI), which was developed as a disease-specific tool measuring objective caregiver burden in a Dutch HF population, in a Japanese population. Methods: After we received permission from the original author to translate the DOBI into Japanese, we performed forward- and backtranslation according to standard translation processes for scale, semantic, and conceptual equivalence. Reliability was assessed using Cronbach’s α to determine internal consistency. We evaluated construct validity through associations between Japanese DOBI, Center for Epidemiologic Studies Depression Scale (CES-D), and State-Trait Anxiety Inventory (STAI) scores. Results: Total 64 caregivers of patients with HF (65.1 ± 13.9 years, 75% were female) was assessed. DOBI was consisted of 50 items, and internal consistency was acceptable for total DOBI score (Cronbach’s α = 0.947). Caregivers with higher levels of DOBI had higher depression and anxiety than caregivers with lower levels of DOBI. Conclusions: The Japanese version of the DOBI showed acceptable validity and reliability in the initial test. Further testing might be needed to develop the short version of DOBI.
•
JHFS
S193
disorder group. However, peak VO2 did not differ significantly in two groups (13.9 ± 3.2 vs 12.9 ± 2.3 ml/kg/min P = .20). Mean pulmonary artery pressure and arterial blood oxygen saturation also did not differ significantly. Conclusion: In CTEPH, high prevalence rate of mental disorder was indicated. The discrepancy between cardiac index and exercise tolerance seems to be relate to condition and medicinal therapy of mental disorder.
O31-3 Severe Cases of Pulmonary Arterial Hypertension: Saving Patients Under Conditions of Hemodynamic Collapse is Not Easy Hisataka Maki, Masaru Hatano, Shun Minatsuki, Issei Komuro; Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
O30-5
Acute aggravation of hemodynamic status often cause a life-threatening problem in patients with severe pulmonary arterial hypertension (PAH). Clinical guidelines recommend intravenous epoprostenol therapy as the first-choice in world health organization functional class (WHO-FC) IV patients. However, the introduction of epoprostenol sometimes induces hemodynamic collapse in patients with unstable hemodynamic status. Also, when the patients need support of extracorporeal circuit, the combination use of anticoagulants and epoprostenol increases the bleeding risks and sometimes results in bad prognosis. Here we show five severely-ill PAH patients with unstable respiratory and hemodynamic status (4 idiopathic or heritable PAH and 1 portpulmonary PH). All 5 patients were woman with WHO-FC IV. All 5 patients have been introduced intravenous epoprostenol and intravenous catecholamine. Four patients needed ventilator and continuous hemodiafiltration, and 3 of these 4 patients were attached extracorporeal membrane oxygenation. Serious bleeding complications occurred in 4 patients and as the result, one patient recovered but three patients died. Saving PAH patients from hemodynamic collapse is difficult even if the maximum therapeutic agents and devices are devoted. Establishment of therapeutic strategy for very severe PAH patients is needed.
Our First Case of Multidisciplinary Team Conference for a Severe Heart Failure Patient, That Successfully Lead to Home Medical Care Akiko Nakazawa, Emi Mori, Rikako Koizumi, Takashi Suzuki; Cardiovascular center, Kin-ikyo Chuo Hospital, Sapporo, Japan
O31-4
The patient was a 60-year-old male with a history of myocardial infarction. He was referred by other clinic and admitted to our hospital with a chief complaint of exertional dyspnea. He was diagnosed with severe MR with 29% of LVEF. In response, OLVP+MAP+PMA+PMS+TAP+PFO closure were performed. He was discharged from the hospital one month after surgery. Within 6 months, he required hospitalization three times due to deterioration of the cardiac function. We discovered that the patient’s MR had relapsed. After discovering this, MVR and CRTP implantation was performed. The surgeries did not alleviate his condition. Left ventricular dyssynchronie appearance required to induct intravenous CRTP implantation. At that point, we decided to reinforce an intervention for heart failure treatments. Patient education was introduced during his each hospital stay by way of educational materials prepared specifically for him. Simultaneously, we discussed this patient care with multi-occupational specialists at the first team conference. Home care medical providers and caregivers were involved too. This triggered an expansion in team size both inside and outside of hospital. We also visited the patient’s home before patient discharge to better adapt our recommendations. Despite a severe heart failure case, we could successfully start a team of specialists to provide sufficient care. As a result of this experiences, multidisciplinary team conferences have been held continuously since then.
O31-2 The Clinical Characteristics of Chronic Thromboembolic Pulmonary Hypertension with Mental Disorder Shun Minatsuki1, Hisataka Maki1, Masaru Hatano2, Issei Komuro1; 1Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Background: It is generally agreed today that there is an association with mental disorder and chronic thromboembolic pulmonary hypertension (CTEPH). However, the actual prevalence rate of mental disorder in CTEPH and precise clinical characteristics of CTEPH with mental disorder compared with that with non-mental disorder have been unclear. Method: We retrospectively analyzed consecutive 63 patients with CTEPH (age 62.2 ± 15.2 year-old, 44 female) and divided into two group (mental disorder and non-mental disorder) based on a past medical history. Eleven patients had mental disorder (5 were schizophrenia, 6 were depression). Patients were received right heart catheterization and cardiopulmonary exercise test. We used initial data of each patient. Result: The prevalence rate of mental disorder among in our study group was higher than that among Japanese adult people. The significant characteristics, which were compared with two groups, were lower age at the onset (51.4 ± 9.6 vs 63.3 ± 15.3 P < .05) and high cardiac index (2.7 ± 0.9 vs 2.0 ± 0.7 P < .05) in mental
Tolerability and Efficacy of Subcutaneous Treprostinil Therapy in Patients with Pulmonary Arterial Hypertension Masaru Hatano1, Hisataka Maki2, Shun Minatsuki2, Issei Komuro2; 1Department of Therapeutic Strategy for Heart Failure, University of Tokyo, Tokyo, Japan; 2Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan Background: Subcutaneous treprostinil is the agent with new route of administration and is expected to broaden treatment options for pulmonary arterial hypertension (PAH). However, subcutaneous treprostinil therapy is not widely accepted because of its low tolerability attributed to infusion site pain. Aim: The purpose of this study to elucidate tolerability and efficacy of subcutaneous treprostinil therapy in patients with PAH. Objective: Consecutive 10 patients with PAH who were treated with subcutaneous treprostinil (age : 39.2 ± 12.4, male 10%, idiopathic/heritable PAH 7, associated PAH 2, pulmonary venous occlusive disease 1) were enrolled this study. Results: Five of ten patients were converted from intravenous epoprostenol and other 5 patients were not treated with parenteral prostanoid before receiving subcutaneous treprostinil. All patients were well-tolerated to subcutaneous treprostinil for full observation period (235 ± 175 days, range 41–574 days). Maintenance dose of treprostinil was 57.6 ± 27.6 ng/ kg/min. WHO functional class was significantly improved after introduction of subcutaneous treprostinil (from 2.6 ± 0.7 to 2.2 ± 0.9, P = .04). Hemodynamic parameters were also significantly improved in 5 patients newly introduced parenteral prostanoid (from 44.8 ± 1.6 to 36.0 ± 3.7 mmHg in mean pulmonary artery pressure, from 8.1 ± 2.4 to 5.0 ± 0.9 wood in pulmonary vascular resistance, P = .02, 0.04, respectively). Conclusion: Subcutaneous treprostinil therapy is well-tolerated and efficacious for patients with PAH.
O31-5 A Case of Chronic Heart Failure with Severe Pulmonary Hypertension Successfully Treated with PDE-5 Inhibitor Midori Takakura, Shingo Kato, Mai Azuma, Naoki Iinuma, Yuka Kusakawa, Satoru Shimizu, Yuko Miki, Tatsuya Nakachi, Kazuki Fukui; Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan A 65-year-old female with mycobacterium avium complex was referred to our department for the evaluation of fatigue, dyspnea and leg edema. Blood pressure was 89/ 56 mmHg. An electrocardiogram demonstrated atrial fibrillation, and chest X-ray showed cardiomegaly. Body weight was gradually increased by 8 kg in last 5 months. Blood test showed elevated BNP of 1684.9 pg/ml. Echocardiography revealed moderate mitral regurgitation and elevated right ventricular systolic pressure (RVSP) of 85.4 mmHg, suggesting presence of severe pulmonary hypertension. After the admission, she was treated by furosemide. However, urine volume wasn’t sufficiently increased. Therefore, we initiated intravenous dobutamine and tolvaptan. Urine volume was increased