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88: Truncal Obesity Is a Risk Factor Cardiorenal Syndrome in Patients with Heart Failure
S96
Abstracts
the transmitral E/A ratio, the circumferential dyssynchrony index and Asr showed predictive values for cardiac stability of between 80 and 90%. Asr ⬍ 0.3/s showed a positve and negative predictive value for short-term cardiac worseng of 89% and 90%, respectively. Conclusions: In clinically stable HTx candidates with IDCM, the transmitral flow profile and certain 2D-strain imaging parameters are predictive for the short-term (6 month) course of HF and may therefore be valuable in guiding listing procedures for HTx.
87 The Relationship of Right and Left Ventricular Filling Pressures in Patients Undergoing Cardiac Transplantation: A 17-Year Multi-Institutional Analysis M.H. Drazner1, R.N. Brown2, P.A. Kaiser1, B. Cabuay6, N.P. Lewis5, M.J. Semigran3, G. Torre-Amione4, D.C. Naftel2, J.K. Kirklin2 1University of Texas Southwestern Medical Center, Dallas, TX; 2University of Alabama at Birmingham, Birmingham, AL; 3Massachusetts General Hospital, Boston, MA; 4The Methodist Hospital, Houston, TX; 5Virginia Commonwealth University, Richmond, VA; 6University of Iowa, Iowa City, IA Purpose: Previous studies demonstrated a significant correlation between right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) in patients with advanced heart failure (HF). However, those studies were published nearly a decade ago and it is not known whether this relationship has remained stable over time. Further, it is not known which patient characteristics impact the RAP to PCWP relationship. Methods and Materials: Between 1990 and 2007, 5226 subjects off inotropic and mechanical support had 5829 pre-cardiac transplant right heart catheterizations in which RAP and PCWP were measured. RAP was considered elevated when ⱖ10 mm Hg and PCWP when ⱖ22 mm Hg. We classified subjects into 1 of 3 hemodynamic profiles: “Concordant” (RAP and PCWP both elevated or both not elevated); “Preserved RV” (RAP not elevated and PCWP elevated); and “RightLeft Equalizer” (RAP elevated and PCWP not elevated). The concordance rate was stratified by era of transplantation. Patient characteristics were compared between the three hemodynamic profiles. Results: RAP and PCWP were significantly correlated (r⫽0.59, p⬍0.001). The hemodynamic profiles of the cohort were 73% Concordant, 16% Preserved RV, and 11% Right-Left Equalizer. The concordance rate was stable over time when stratified into three time eras (74%, 73%, 73%, p⫽0.4). Patient characteristics associated (p⬍0.001) with hemodynamic profile (Concordant, Preserved RV, Right-Left Equalizer) included: congenital or restrictive etiology of cardiomyopathy (1.9% vs. 1.3% vs. 8.7%) and ⬎1 prior sternotomy (12.1% vs. 8.4% vs. 17.9%). Conclusions: In ⬃75% of subjects with advanced HF undergoing cardiac transplantation, right-sided filling pressures continue to reflect left-sided filling pressures, supporting the role of estimation of the jugular venous pressure to assess volume status in such patients. Certain patient characteristics including etiology of cardiomyopathy and ⬎1 prior sternotomy may alert clinicians about when to be cautious in using such estimates.
88 Truncal Obesity Is a Risk Factor Cardiorenal Syndrome in Patients with Heart Failure N. Huda1, M.Z. Hoque1, K.S. Murthy1, H. Ra1, S. Mehta1, D.H. Karia1 1Albert Einstein Medical Center, Philadelphia, PA; 2 Albert Einstein Medical Center, Philadelphia, PA; 3Albert Einstein Medical Center, Philadelphia, PA; 4Albert Einstein Medical Center, Philadelphia, PA
The Journal of Heart and Lung Transplantation February 2009
Purpose: Renal vein compression causes decreased renal blood flow and GFR and an increased plasma renin and aldosterone, and proteinuria. Similar renal physiology is also seen in acute abdominal compartment syndrome (AACS). These changes are reversed by decreasing renal vein pressure with abdominal decompression.We postulate that truncal obesity in patients with a high BMI leads to a physiologic phenomenon via renal vein compression and thereby decreasing GFR in patients with heart failure. Methods and Materials: We analyzed data from 577 patients who underwent cardiac catheterization. GFR was calculated using modified MDRD equation. BMI was calculated using standard BMI equation. The population was stratified based on the PCWP (⬍ or ⬎15mm Hg) to include congested patients(PCWP⬎15, N⫽307). Results: For congested patients, a negative correlation exists between BMI and GFR (r⫽ -0.60) that is statistically significant p⬍0.001, using a linear regression model and correcting for Age, Diabetes, Myocardial Infarction, Peripheral Vascular disease, Coronary artery disease and Hypertension. Conclusions: Raised BMI is negatively correlated with GFR in congested patients. The truncal fat extending higher abdominal and hence higher renal vein pressures might be a possible explanation.
89 Blackout Period for Urgent Heart Transplantation during Mechanical Circulatory Support Set by Eurotransplant for Germany T. Komoda, H.B. Lehmkuhl, R. Hetzer Deutsches Herzzentrum Berlin, Berlin, Germany Purpose: Eurotransplant heart allocation policy for Germany sets a blackout period for urgency listing during mechanical circulatory support until assist device complications occur. We compared survival rates in heart transplant (HTx) candidates who received a ventricular assist device (VAD) with those of patients with urgency listing. Methods and Materials: Three hundred and seventy-seven HTx candidates who were listed in urgent status or received a VAD in our center between 2001 and 2007 were studied. We defined the following patient groups: Group U (n⫽193, equivalent to UNOS Status 1A or 1B), patients who were primarily listed in urgent status without receiving a VAD; Group VAD-U (n⫽99, equivalent to UNOS Status 1A), patients listed in urgent status after VAD implantation due to assist device complications; Group VAD-T (transplantable, n⫽219, equivalent to UNOS Status 1A or 1B), those who underwent VAD implantation while listed as “transplant-
Abstracts
the transmitral E/A ratio, the circumferential dyssynchrony index and Asr showed predictive values for cardiac stability of between 80 and 90%. Asr ⬍ 0.3/s showed a positve and negative predictive value for short-term cardiac worseng of 89% and 90%, respectively. Conclusions: In clinically stable HTx candidates with IDCM, the transmitral flow profile and certain 2D-strain imaging parameters are predictive for the short-term (6 month) course of HF and may therefore be valuable in guiding listing procedures for HTx.
87 The Relationship of Right and Left Ventricular Filling Pressures in Patients Undergoing Cardiac Transplantation: A 17-Year Multi-Institutional Analysis M.H. Drazner1, R.N. Brown2, P.A. Kaiser1, B. Cabuay6, N.P. Lewis5, M.J. Semigran3, G. Torre-Amione4, D.C. Naftel2, J.K. Kirklin2 1University of Texas Southwestern Medical Center, Dallas, TX; 2University of Alabama at Birmingham, Birmingham, AL; 3Massachusetts General Hospital, Boston, MA; 4The Methodist Hospital, Houston, TX; 5Virginia Commonwealth University, Richmond, VA; 6University of Iowa, Iowa City, IA Purpose: Previous studies demonstrated a significant correlation between right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) in patients with advanced heart failure (HF). However, those studies were published nearly a decade ago and it is not known whether this relationship has remained stable over time. Further, it is not known which patient characteristics impact the RAP to PCWP relationship. Methods and Materials: Between 1990 and 2007, 5226 subjects off inotropic and mechanical support had 5829 pre-cardiac transplant right heart catheterizations in which RAP and PCWP were measured. RAP was considered elevated when ⱖ10 mm Hg and PCWP when ⱖ22 mm Hg. We classified subjects into 1 of 3 hemodynamic profiles: “Concordant” (RAP and PCWP both elevated or both not elevated); “Preserved RV” (RAP not elevated and PCWP elevated); and “RightLeft Equalizer” (RAP elevated and PCWP not elevated). The concordance rate was stratified by era of transplantation. Patient characteristics were compared between the three hemodynamic profiles. Results: RAP and PCWP were significantly correlated (r⫽0.59, p⬍0.001). The hemodynamic profiles of the cohort were 73% Concordant, 16% Preserved RV, and 11% Right-Left Equalizer. The concordance rate was stable over time when stratified into three time eras (74%, 73%, 73%, p⫽0.4). Patient characteristics associated (p⬍0.001) with hemodynamic profile (Concordant, Preserved RV, Right-Left Equalizer) included: congenital or restrictive etiology of cardiomyopathy (1.9% vs. 1.3% vs. 8.7%) and ⬎1 prior sternotomy (12.1% vs. 8.4% vs. 17.9%). Conclusions: In ⬃75% of subjects with advanced HF undergoing cardiac transplantation, right-sided filling pressures continue to reflect left-sided filling pressures, supporting the role of estimation of the jugular venous pressure to assess volume status in such patients. Certain patient characteristics including etiology of cardiomyopathy and ⬎1 prior sternotomy may alert clinicians about when to be cautious in using such estimates.
88 Truncal Obesity Is a Risk Factor Cardiorenal Syndrome in Patients with Heart Failure N. Huda1, M.Z. Hoque1, K.S. Murthy1, H. Ra1, S. Mehta1, D.H. Karia1 1Albert Einstein Medical Center, Philadelphia, PA; 2 Albert Einstein Medical Center, Philadelphia, PA; 3Albert Einstein Medical Center, Philadelphia, PA; 4Albert Einstein Medical Center, Philadelphia, PA
The Journal of Heart and Lung Transplantation February 2009
Purpose: Renal vein compression causes decreased renal blood flow and GFR and an increased plasma renin and aldosterone, and proteinuria. Similar renal physiology is also seen in acute abdominal compartment syndrome (AACS). These changes are reversed by decreasing renal vein pressure with abdominal decompression.We postulate that truncal obesity in patients with a high BMI leads to a physiologic phenomenon via renal vein compression and thereby decreasing GFR in patients with heart failure. Methods and Materials: We analyzed data from 577 patients who underwent cardiac catheterization. GFR was calculated using modified MDRD equation. BMI was calculated using standard BMI equation. The population was stratified based on the PCWP (⬍ or ⬎15mm Hg) to include congested patients(PCWP⬎15, N⫽307). Results: For congested patients, a negative correlation exists between BMI and GFR (r⫽ -0.60) that is statistically significant p⬍0.001, using a linear regression model and correcting for Age, Diabetes, Myocardial Infarction, Peripheral Vascular disease, Coronary artery disease and Hypertension. Conclusions: Raised BMI is negatively correlated with GFR in congested patients. The truncal fat extending higher abdominal and hence higher renal vein pressures might be a possible explanation.
89 Blackout Period for Urgent Heart Transplantation during Mechanical Circulatory Support Set by Eurotransplant for Germany T. Komoda, H.B. Lehmkuhl, R. Hetzer Deutsches Herzzentrum Berlin, Berlin, Germany Purpose: Eurotransplant heart allocation policy for Germany sets a blackout period for urgency listing during mechanical circulatory support until assist device complications occur. We compared survival rates in heart transplant (HTx) candidates who received a ventricular assist device (VAD) with those of patients with urgency listing. Methods and Materials: Three hundred and seventy-seven HTx candidates who were listed in urgent status or received a VAD in our center between 2001 and 2007 were studied. We defined the following patient groups: Group U (n⫽193, equivalent to UNOS Status 1A or 1B), patients who were primarily listed in urgent status without receiving a VAD; Group VAD-U (n⫽99, equivalent to UNOS Status 1A), patients listed in urgent status after VAD implantation due to assist device complications; Group VAD-T (transplantable, n⫽219, equivalent to UNOS Status 1A or 1B), those who underwent VAD implantation while listed as “transplant-