- Email: [email protected]
A Case of Using Pedometer for Severe Heart Failure Patients
S192 Journal of Cardiac Failure Vol. 20 No. 10S October 2014 not been well evaluated. The aim of present study was to investigate the prognostic impact of preexisting hypertension in patients hospitalized with systolic heart failure. Method: We performed a pooled analysis of data from three multi-center, observational studies [KorHF, the Korean Heart Failure Registry; SUGAR, SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World; COAST, Clinical Outcomes in Relation with Serum Sodium Level in Asian Patients Hospitalized for Systolic Heart Failure] across Korea. We selected the patients with systolic heart failure (Ejection fraction (EF) !45%) and O 18 years old. Then we divided the subjects into 2 groups by presence of preexisting hypertension history: Hypertension group and No hypertension group. Study endpoints included all cause mortality and rehospitalization within 1 year. Results: Total 3877 patients were enrolled. Mean EF was 29.6 6 8.7%. The prevalence of preexisting hypertension was 51.5%. Patients with hypertension presented more often diabetes (44.4% vs. 23.3%, P!0.001), previous MI (15.5% vs. 12.2%, p!0.001), Stroke (16.3% vs.8.4%, p!0.001) and chronic kidney disease (14.7% vs. 6.1%, p!0.001). At 1 year follow-up, patient with hypertension had a higher rehospitalization rate (31.5 % vs. 26.6%, p50.001) but, mortality rate was not significant difference between 2 groups (14.1% vs. 14.7%, p50.624). After adjusting for baseline clinical variables (age, sex, diabetes, prior MI, atrial fibrillation, ejection fraction, LBBB, serum creatinine etc), the presence of hypertension was independently associated with lower 1 year mortality rate (OR 0.73 95% CI 0.548 - 0.966) and higher prescription of medications (ACE inhibitor or ARB OR 1.389 95%CI 1.118 - 1.724, beta blocker OR 1.517 95% CI 1.260 - 1.827). Conclusions: Preexisting hypertension was independently associated with lower 1 year mortality rates and higher prescription of medications in systolic heart failure.
P-026 Acute Kidney Injury Predicts Heart Failure and Mortality in Patients with STsegment Elevation Acute Coronary Syndrome SHINICHI OKINO, ATSUSHI IKEDA, SHIGERU FUKUZAWA, MASAYUKI INAGAKI Division of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center Aim: The aim of this study is to investigate the impact of acute kidney injury (AKI) on prognosis in patients with ST-segment elevation acute coronary syndrome (STEACS). Methods: The population consisted of 423 STE-ACS patients undergoing primary PCI. AKI was defined as an increase in serum creatinine level of 0.3 mg/dL or more from baseline within 48 hours. Mean follow-up period was 33.7618.9 months. Clinical event (CE) was defined as re-admission due to heart failure or death. Results: There were 78 AKI patients. AKI had more chronic kidney disease (CKD) and cardiogenic shock. AKI patients had higher incidence of CE than non-AKI patients regardless of CKD. Multivaritate analysis showed AKI, maximum CK-MB and cardiogenic shock were independent predictors of CE. Conclusion: AKI was a predictor of CE.
P-024 A Case of Using Pedometer for Severe Heart Failure Patients DAIKI GYOTOKU, YUKA KUSAKAWA, HIDEKUNI KIRIGAYA, NAO YAMADA, NAOKI IINUMA, YUKO MIKI, TASTUYA NAKACHI, KAZUKI FUKUI Cardiology, Kanagawa Cardiovascular and Respiratory Center We report a case that the pedometer (Lifecorder PLUS;SUZUKEN) was effective for prevention of heart failure exacerbation. A 80-year-old man with a chronic heart failure due to ischemic cardiomyopathy hospitalized 30 times. He had anterior myocardial infarction in 2005, and performed percutaneous coronay intervention in our hospital. Echocardiography showed LVEF was 30%, and a cavity of left ventricular was extremely dilated. We treated him with fully optimized medication, and introduced adaptive serve ventilations(ASV). However, he was hospitalized 3-4 times/year due to acute heart failure. Since Nov 2013, he was hospitalized every month. Frequency of the hospitalization increased. We suspected that hyperactivity participated in heart failure aggravation, we started to grasp of his daily steps using pedometer. It started from Apr 2014, and period of observation was 4 weeks. Average steps was 801 steps/day (max 1803 steps/day, min 146 steps/ day). His condition was stable after introduction with a pedometer. In this case, low physical activity contribute to prevent heart failure exacerbation.
P-025 Is There a Gender Difference of Obesity Paradox in Systolic Heart Failure? Gender Difference of Obesity Paradox BYUNG-SU YOO1, SEOK-MIN KANG2, EUN-SEOK JEON3, DONG-JU CHOI4, MYEONG-CHAN CHO5, SANG HONG BAEK6, SHUNG CHULL CHAE7, HYUN-YOUNG PARK8, BYUNG-HEE OH9 1 Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea, 2Division of Cardiology, Yonsei University Severance Hospital, Seoul, Korea, 3Division of Cardiology, Sungkyunkwan University Samsung Medical Center, Seoul, Korea, 4Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea, 5Chungbuk National University College of Medicine, Cheongju, Korea, 6The Catholic University of Korea, Seoul, Korea, 7Kyungpook National University College of Medicine, Daegu, Korea, 8National Institute of Health (NIH), Osong, Korea, 9Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Purpose: The aim of the present study was to investigate the prognostic value of the obesity in patients hospitalized with acute heart failure syndrome. Method: The Korean acute heart failure registry (KorAHF) is an on-going prospective multicenter cohort study for acute HF. As of November 2013, interim analysis of 4184 patients was performed. We categorized the study population into 4 groups by BMI value (kg/ m2); BMI!18.5, 18.5#BMI!25, 25#BMI!30 and 30#BMI. Study endpoint included all cause death and rehospitalization. Results: Of total 3618 patients, 549 (28.3%) and 489 (29.1%) reached study endpoints in men and women, respectively. After adjusting, the male patients with BMI$30 showed the lowest risk (Hazard ratio [HR]: 0.472, 95% CI: 0.267-0.836, p50.010) compared to those with BMI!18.5. This correlation between BMI and study endpoint was not remarkable in women. In male, patients with HF with reduced ejection fraction (EF!40%), patients with BMI$30 showed the lowest risk (HR: 0.323, 95% CI: 0.138-0.755, p50.009) for study endpoint compared to those with BMI!18.5. However this correlation was not noted in patients with preserved ejection fraction in male. Conclusions: In KorAHF registry, there was a gender difference of obesity paradox in patients with AHF. BMI was the independent risk factor for adverse cardiac events in men who have HF with reduced ejection fraction.
P-027 Clinical Response of Tolvaptan in Patients with Heart Failure Who Had Endstage Renal Function SHINSUKE HARASAWA1, KIYOSHI IIDA1, TADASHI ASHIDA1, DAISUKE KISO1, MASAKAZU MATSUZAKI1, TAKEHIKO WASHIO1, KATSUAKI OOKUBO1, HIROFUMI KAWAMATA1, NAOYA MATSUMOTO1, ATSUSHI HIRAYAMA2 1 Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan, 2 Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan Background: A newly-developed vasopressin-2 receptor antagonist, Tolvaptan (TLV), has been shown to improve volume overload through free water excretion, however, the effect of TLV on renal function is still unclear. Purpose and Methods: This study aimed to investigate whether TLV has a clinical efficacy in patients with heart failure who had renal dysfunction. We classified 67 patients who received TLV according to the renal function and examined the response of TLV using urine volume as well as short-term prognosis. Results: Urine volume increase with dose dependence fashion was observed in preserved eGFR group (O30), but did not observed in low eGFR group (!30). The higher in baseline serum creatinine level, the more frequent the occurrence of worsening renal function (WRF) (defined by absolute increase
P-026 Acute Kidney Injury Predicts Heart Failure and Mortality in Patients with STsegment Elevation Acute Coronary Syndrome SHINICHI OKINO, ATSUSHI IKEDA, SHIGERU FUKUZAWA, MASAYUKI INAGAKI Division of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center Aim: The aim of this study is to investigate the impact of acute kidney injury (AKI) on prognosis in patients with ST-segment elevation acute coronary syndrome (STEACS). Methods: The population consisted of 423 STE-ACS patients undergoing primary PCI. AKI was defined as an increase in serum creatinine level of 0.3 mg/dL or more from baseline within 48 hours. Mean follow-up period was 33.7618.9 months. Clinical event (CE) was defined as re-admission due to heart failure or death. Results: There were 78 AKI patients. AKI had more chronic kidney disease (CKD) and cardiogenic shock. AKI patients had higher incidence of CE than non-AKI patients regardless of CKD. Multivaritate analysis showed AKI, maximum CK-MB and cardiogenic shock were independent predictors of CE. Conclusion: AKI was a predictor of CE.
P-024 A Case of Using Pedometer for Severe Heart Failure Patients DAIKI GYOTOKU, YUKA KUSAKAWA, HIDEKUNI KIRIGAYA, NAO YAMADA, NAOKI IINUMA, YUKO MIKI, TASTUYA NAKACHI, KAZUKI FUKUI Cardiology, Kanagawa Cardiovascular and Respiratory Center We report a case that the pedometer (Lifecorder PLUS;SUZUKEN) was effective for prevention of heart failure exacerbation. A 80-year-old man with a chronic heart failure due to ischemic cardiomyopathy hospitalized 30 times. He had anterior myocardial infarction in 2005, and performed percutaneous coronay intervention in our hospital. Echocardiography showed LVEF was 30%, and a cavity of left ventricular was extremely dilated. We treated him with fully optimized medication, and introduced adaptive serve ventilations(ASV). However, he was hospitalized 3-4 times/year due to acute heart failure. Since Nov 2013, he was hospitalized every month. Frequency of the hospitalization increased. We suspected that hyperactivity participated in heart failure aggravation, we started to grasp of his daily steps using pedometer. It started from Apr 2014, and period of observation was 4 weeks. Average steps was 801 steps/day (max 1803 steps/day, min 146 steps/ day). His condition was stable after introduction with a pedometer. In this case, low physical activity contribute to prevent heart failure exacerbation.
P-025 Is There a Gender Difference of Obesity Paradox in Systolic Heart Failure? Gender Difference of Obesity Paradox BYUNG-SU YOO1, SEOK-MIN KANG2, EUN-SEOK JEON3, DONG-JU CHOI4, MYEONG-CHAN CHO5, SANG HONG BAEK6, SHUNG CHULL CHAE7, HYUN-YOUNG PARK8, BYUNG-HEE OH9 1 Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea, 2Division of Cardiology, Yonsei University Severance Hospital, Seoul, Korea, 3Division of Cardiology, Sungkyunkwan University Samsung Medical Center, Seoul, Korea, 4Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea, 5Chungbuk National University College of Medicine, Cheongju, Korea, 6The Catholic University of Korea, Seoul, Korea, 7Kyungpook National University College of Medicine, Daegu, Korea, 8National Institute of Health (NIH), Osong, Korea, 9Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Purpose: The aim of the present study was to investigate the prognostic value of the obesity in patients hospitalized with acute heart failure syndrome. Method: The Korean acute heart failure registry (KorAHF) is an on-going prospective multicenter cohort study for acute HF. As of November 2013, interim analysis of 4184 patients was performed. We categorized the study population into 4 groups by BMI value (kg/ m2); BMI!18.5, 18.5#BMI!25, 25#BMI!30 and 30#BMI. Study endpoint included all cause death and rehospitalization. Results: Of total 3618 patients, 549 (28.3%) and 489 (29.1%) reached study endpoints in men and women, respectively. After adjusting, the male patients with BMI$30 showed the lowest risk (Hazard ratio [HR]: 0.472, 95% CI: 0.267-0.836, p50.010) compared to those with BMI!18.5. This correlation between BMI and study endpoint was not remarkable in women. In male, patients with HF with reduced ejection fraction (EF!40%), patients with BMI$30 showed the lowest risk (HR: 0.323, 95% CI: 0.138-0.755, p50.009) for study endpoint compared to those with BMI!18.5. However this correlation was not noted in patients with preserved ejection fraction in male. Conclusions: In KorAHF registry, there was a gender difference of obesity paradox in patients with AHF. BMI was the independent risk factor for adverse cardiac events in men who have HF with reduced ejection fraction.
P-027 Clinical Response of Tolvaptan in Patients with Heart Failure Who Had Endstage Renal Function SHINSUKE HARASAWA1, KIYOSHI IIDA1, TADASHI ASHIDA1, DAISUKE KISO1, MASAKAZU MATSUZAKI1, TAKEHIKO WASHIO1, KATSUAKI OOKUBO1, HIROFUMI KAWAMATA1, NAOYA MATSUMOTO1, ATSUSHI HIRAYAMA2 1 Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan, 2 Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan Background: A newly-developed vasopressin-2 receptor antagonist, Tolvaptan (TLV), has been shown to improve volume overload through free water excretion, however, the effect of TLV on renal function is still unclear. Purpose and Methods: This study aimed to investigate whether TLV has a clinical efficacy in patients with heart failure who had renal dysfunction. We classified 67 patients who received TLV according to the renal function and examined the response of TLV using urine volume as well as short-term prognosis. Results: Urine volume increase with dose dependence fashion was observed in preserved eGFR group (O30), but did not observed in low eGFR group (!30). The higher in baseline serum creatinine level, the more frequent the occurrence of worsening renal function (WRF) (defined by absolute increase