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543 Diastolic dysfunction is not associated with acute systolic dysfunction in patients presenting with takotsubo cardiomyopathy
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tive, facilitators guided, documented, and analyzed the three sessions. RESULTS: The maps reflected the steps from having a worrisome health concern, to diagnoses of HF heart failure, to treatment plans from onset to stabilization, and to self-management activities. Improvement ideas were identified and are being implemented in each region. CONCLUSIONS: Common themes identified centered on the challenges with obtaining a diagnosis of HF and the lack of cohesion along the continuum of care. These themes are described as: delays to confirming the diagnosis of heart failure and access to diagnostics and informed care; impact of lack of shared information and uncoordinated care, impact of system delays for test results or information and systemic strengths and stabilizers. A key learning was insight into the roles and responsibilities of those involved in HF care and management. The journey mapping underscored the importance of completing quality improvement initiatives to increase access to education resources for patients, promote communication between HF clinics and primary care physicians and increasing knowledge of heart health resources island wide. Recommendations for future are to complete journey mapping with the special populations, e.g. the frail elderly, people with learning disabilities, Aboriginal persons, and persons living in remote areas. These recommendations were shared in a presentation with Cardiac Services BC and other BC health authorities in April 2011. Cardiac Services BC, PHSA
543 DIASTOLIC DYSFUNCTION IS NOT ASSOCIATED WITH ACUTE SYSTOLIC DYSFUNCTION IN PATIENTS PRESENTING WITH TAKOTSUBO CARDIOMYOPATHY S Butterly, AG Thompson, W Wang Brisbane, Australia BACKGROUND: Severe left ventricular (LV) systolic dysfunction
is associated severe diastolic dysfunction. Takotsubo cardiomyopathy is a disease of acute reversible LV systolic dysfunction with apical ballooning and preserved basal segment contractility. The systolic-diastolic relationship was examined using echocardiographic parameters in patients with takotsubo cardiomyopathy. METHODS: A clinical audit of all patients presenting to a tertiary referral hospital over four years with non-obstructive (⬍ 50% lumen loss) coronary artery angiography, elevated troponin I (TnI) and echocardiogram and left ventriculogram evidence of takotsubo cardiomyopathy who had serial echocardiography. RESULTS: A total of 3899 patients underwent coronary angiography because of suspicion of coronary artery disease and raised TnI. 252 patients had non-obstructive disease. Excluding patients with atrial fibrillation, a total of 19 patients with typical takotsubo cardiomyopathy were identified of which 9 had accessible serial imaging (89% female, mean age 58.5 years (range 52-77)). Mean LVEF at presentation was 36% (range 30-45) and at follow up 62% (range 55-71). Diastolic dysfunction was
Canadian Journal of Cardiology Volume 27 2011
all in grades I and II at presentation. At follow up, diastolic parameters E/A, E’, E/E’, deceleration time and diastolic grading correlated strongly with initial values and did not change significantly despite drastic LV systolic function recovery. CONCLUSIONS: Takotsubo cardiomyopathy is a unique syndrome whereby severe LV systolic dysfunction and recovery does not coincide with the degree of diastolic dysfunction. Although the majority of takotsubo cardiomyopathy patients will not have LV diastolic dysfunction, in a small subset of patients, LV diastolic dysfunction may persist despite systolic recovery which may represent other co-existing conditions.
544 LONG-TERM SURVIVAL IN PATIENTS RECEIVING AN IMPLANTABLE MICROAXIAL VENTRICULAR ASSIST DEVICE FOR CARDIOGENIC SHOCK S Cowan, M Toma, A Kaan, A Ignaszewski, A Cheung Vancouver, British Columbia OBJECTIVE: The purpose of this study was to review the longterm outcomes of patients receiving an implantable microaxial ventricular assist device (Impella) for cardiogenic shock. METHODS AND RESULTS: All patients who were admitted to St. Paul’s Hospital in Vancouver, Canada and had received an Impella for the treatment of cardiogenic shock were selected for the study. Patient demographics, clinical diagnoses, ventricular function, hemodynamic data and mortality at 30 days, 1 and 2 years were collected. Between August 20, 2007 and December 30, 2010, a total of 44 patients received an Impella for cardiogenic shock. Fifty percent of patients had an underlying diagnosis of ischemic cardiomyopathy while 23% had non-ischemic dilated cardiomyopathy and 27% had other diagnoses. The mean age of the cohort was 54 years. Twenty-seven percent were female. The 30 day mortality was 52%. Patients with ischemic cardiomyopathy and those undergoing a surgical intervention were less likely to survive beyond 30 days. Twenty-one patients (48%) survived beyond 30 days. Fifteen of these patients (71%) survived beyond 1 year and six (29%) survived beyond 2 years. Additionally, the six patients with long-term survival had recovery of their left ventricular function to a near-normal value. CONCLUSIONS: Early mortality is significantly high in patients with cardiogenic shock. The implantation of a microaxial ventricular assist device is associated with good long-term outcomes in those surviving beyond 30 days.
545 CARDIOPROTECTIVE EFFECTS MEDIATED BY AT1 RECEPTOR BLOCKADE AND ENHANCING ANG 1-7 IN EXPERIMENTAL HEART FAILURE IN ACE2-NULL MICE S Bodiga, Z JiuChang, W Wang, R Basu, SK Das, Z Kassiri, G Oudit Edmonton, Alberta INTRODUCTION: Loss of ACE2, and inability to metabolize Ang
tive, facilitators guided, documented, and analyzed the three sessions. RESULTS: The maps reflected the steps from having a worrisome health concern, to diagnoses of HF heart failure, to treatment plans from onset to stabilization, and to self-management activities. Improvement ideas were identified and are being implemented in each region. CONCLUSIONS: Common themes identified centered on the challenges with obtaining a diagnosis of HF and the lack of cohesion along the continuum of care. These themes are described as: delays to confirming the diagnosis of heart failure and access to diagnostics and informed care; impact of lack of shared information and uncoordinated care, impact of system delays for test results or information and systemic strengths and stabilizers. A key learning was insight into the roles and responsibilities of those involved in HF care and management. The journey mapping underscored the importance of completing quality improvement initiatives to increase access to education resources for patients, promote communication between HF clinics and primary care physicians and increasing knowledge of heart health resources island wide. Recommendations for future are to complete journey mapping with the special populations, e.g. the frail elderly, people with learning disabilities, Aboriginal persons, and persons living in remote areas. These recommendations were shared in a presentation with Cardiac Services BC and other BC health authorities in April 2011. Cardiac Services BC, PHSA
543 DIASTOLIC DYSFUNCTION IS NOT ASSOCIATED WITH ACUTE SYSTOLIC DYSFUNCTION IN PATIENTS PRESENTING WITH TAKOTSUBO CARDIOMYOPATHY S Butterly, AG Thompson, W Wang Brisbane, Australia BACKGROUND: Severe left ventricular (LV) systolic dysfunction
is associated severe diastolic dysfunction. Takotsubo cardiomyopathy is a disease of acute reversible LV systolic dysfunction with apical ballooning and preserved basal segment contractility. The systolic-diastolic relationship was examined using echocardiographic parameters in patients with takotsubo cardiomyopathy. METHODS: A clinical audit of all patients presenting to a tertiary referral hospital over four years with non-obstructive (⬍ 50% lumen loss) coronary artery angiography, elevated troponin I (TnI) and echocardiogram and left ventriculogram evidence of takotsubo cardiomyopathy who had serial echocardiography. RESULTS: A total of 3899 patients underwent coronary angiography because of suspicion of coronary artery disease and raised TnI. 252 patients had non-obstructive disease. Excluding patients with atrial fibrillation, a total of 19 patients with typical takotsubo cardiomyopathy were identified of which 9 had accessible serial imaging (89% female, mean age 58.5 years (range 52-77)). Mean LVEF at presentation was 36% (range 30-45) and at follow up 62% (range 55-71). Diastolic dysfunction was
Canadian Journal of Cardiology Volume 27 2011
all in grades I and II at presentation. At follow up, diastolic parameters E/A, E’, E/E’, deceleration time and diastolic grading correlated strongly with initial values and did not change significantly despite drastic LV systolic function recovery. CONCLUSIONS: Takotsubo cardiomyopathy is a unique syndrome whereby severe LV systolic dysfunction and recovery does not coincide with the degree of diastolic dysfunction. Although the majority of takotsubo cardiomyopathy patients will not have LV diastolic dysfunction, in a small subset of patients, LV diastolic dysfunction may persist despite systolic recovery which may represent other co-existing conditions.
544 LONG-TERM SURVIVAL IN PATIENTS RECEIVING AN IMPLANTABLE MICROAXIAL VENTRICULAR ASSIST DEVICE FOR CARDIOGENIC SHOCK S Cowan, M Toma, A Kaan, A Ignaszewski, A Cheung Vancouver, British Columbia OBJECTIVE: The purpose of this study was to review the longterm outcomes of patients receiving an implantable microaxial ventricular assist device (Impella) for cardiogenic shock. METHODS AND RESULTS: All patients who were admitted to St. Paul’s Hospital in Vancouver, Canada and had received an Impella for the treatment of cardiogenic shock were selected for the study. Patient demographics, clinical diagnoses, ventricular function, hemodynamic data and mortality at 30 days, 1 and 2 years were collected. Between August 20, 2007 and December 30, 2010, a total of 44 patients received an Impella for cardiogenic shock. Fifty percent of patients had an underlying diagnosis of ischemic cardiomyopathy while 23% had non-ischemic dilated cardiomyopathy and 27% had other diagnoses. The mean age of the cohort was 54 years. Twenty-seven percent were female. The 30 day mortality was 52%. Patients with ischemic cardiomyopathy and those undergoing a surgical intervention were less likely to survive beyond 30 days. Twenty-one patients (48%) survived beyond 30 days. Fifteen of these patients (71%) survived beyond 1 year and six (29%) survived beyond 2 years. Additionally, the six patients with long-term survival had recovery of their left ventricular function to a near-normal value. CONCLUSIONS: Early mortality is significantly high in patients with cardiogenic shock. The implantation of a microaxial ventricular assist device is associated with good long-term outcomes in those surviving beyond 30 days.
545 CARDIOPROTECTIVE EFFECTS MEDIATED BY AT1 RECEPTOR BLOCKADE AND ENHANCING ANG 1-7 IN EXPERIMENTAL HEART FAILURE IN ACE2-NULL MICE S Bodiga, Z JiuChang, W Wang, R Basu, SK Das, Z Kassiri, G Oudit Edmonton, Alberta INTRODUCTION: Loss of ACE2, and inability to metabolize Ang