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Acetazolamide for Hypoventilation in a Congenital Myopathy Patient with Advanced Heart Failure after a Heart Transplant; a Case Report
The 21st Annual Scientific Meeting body surface area was larger in DCM group. Time to LVAD implant from a primary diagnosis was longer in DHCM group. Preoperative left ventricular end-diastolic diameter, interventricular septum thickness, ejection fraction, E/E’ ratio, systolic pulmonary artery pressure central venous pressure, cardiac index, gender, NYHA class and INTERMACS profiles did not differ between the two groups. Postoperative right heart failure, inhaled nitric oxide use and length of ICU stay were not significantly different between the two groups. Duration of postoperative inotropes support and postoperative intubation time were significantly longer in DHCM group. Conclusion: The present study demonstrated that DHCM patients compared with DCM have longer history of treatment for heart failure before LVAD therapy and need prolonged use of inotropes, ventilator support and ICU stay. Adequate preparations for right-sided heart failure are needed in LVAD therapy for DHCM.
O18-5 2 Case Reports of Successful Treatment by Central ECMO with LV Venting for Severe Heart Failure Complicated with Alveolar Hemorrhage Hyoe Komae1, Kan Nawata1, Osamu Kinoshita1, Yasuhiro Hoshino1, Mitsutosi Kimura1, Haruo Yamauchi1, Eisuke Amiya2, Yumiko Hosoya2, Masaru Hatano2, Minoru Ono1; 1 The Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan; 2The Department of Cardiology, University of Tokyo, Tokyo, Japan Severe heart failure patients are sometimes complicated with alveolar hemorrhage due to pulmonary congestion. Patients with alveolar hemorrhage have high pulmonary vascular resistance, so LVAD attachment induces relative right heart failure which may require right heart system assist. In such cases, hemodynamic management becomes very difficult. With high pulmonary perfusion as well as intensive anti-coagulation therapy, alveolar hemorrhage might worsen. Furthermore, it is difficult to tell whether the cause of alveolar hemorrhage is pulmonary congestion or other diseases like organized pneumonia. Our present strategy for particularly severe heart failure is as follows: we adopt central ECMO support with RA drainage and ascending aorta perfusion to get adequate circulatory flow support. At the same time, LV venting from the apex is also used to release pulmonary congestion, which leads to recover pulmonary function, and reduce pulmonary vascular resistance. And as a next step, we aim to maintain hemodynamics by supporting left heart system only. Recently, we experienced 2 severe heart failure cases complicated with alveolar hemorrhage whose etiologies were hard to differentiate, which were successfully treated according to our strategy. Here, we are going to report these 2 cases with some discussions.
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effects for diabetic patients with cardiovascular diseases. Thus, we decided to treat him with it. Administration of empagliflozin (10 mg) dramatically improved his HF condition within 1 month, including 6 kg weight loss (81 to 75 kg), 7% reduction in cardiothoracic ratio on chest X-ray (56 to 49%), and more than 100 pg/ml BNP reduction (347 to 211 pg/ml) without any adverse effects. Moreover, addition of empagliflozin enabled us to reduce a dose of furosemide, which is known to cause adverse cardiovascular effects when used at high-dose use. We here report a case of intractable HF associated with diabetes mellitus and ischemic cardiomyopathy despite CABG, CRT and optimal medical therapy, where empagliflozin dramatically improved the HF condition.
O19-2 Risk of Heart Failure in Myocardial Infarction with Reduced, mid Range and Preserved Ejection Fraction Hiroyuki Okura1, Toru Kataoka2, Yoshihiko Saito1, Kiyoshi Yoshida3; 1First Department of Internal Medicine, Nara Medical University, Kashihara, Japan; 2Bell land general Hospital, Sakai, Japan; 3The Sakakibara Heart Institute of Okayama, Okayama, Japan Background: Recent ESC guideline categorized heart failure (HF) patients with ejection fraction (EF) between 40–49% as gray area. Purpose: The aim of this study was to investigate risk of HF in myocardial infarction (MI) with preserved (MIpEF, EFP < 40%), mid range (MImrEF, EF 40–49%) and reduced EF (MIrEF, EF>50%). Methods: A total of 953 MI patients were enrolled and studied. Patients were grouped as either MIpEF, MImrEF or MIrEF. Incidence of HF was compared among the 3 groups. Results: MImrEF and MIrEF were similarly older than MIpEF (69.8 ± 11.7 vs. 70.3 ± 11.7 vs. 67.6 ± 11.7%, P < .01). Kaplan-Meier survival curves demonstrated that incidence of HF in MImrEF was initially mid range between MIpEF and MIrEF but was similar to MIrEF at long-term follow-up (Figure). Conclusion: Both MImrEF and MIrEF are at higher risk for the development of HF than MIpEF.
O18-6 Acetazolamide for Hypoventilation in a Congenital Myopathy Patient with Advanced Heart Failure after a Heart Transplant; a Case Report Chiharuko Iio, Koichi Tamita, Tomohiko Shimizu, Mika Maeda, Jun Yamamuro; Nishinomiya Watanabe Cardiovascular Center A 61-year-old man was admitted to our hospital for further treatment of worsening congestive heart failure with a mechanical ventilation. He had undergone a heart transplant due to dilated cardiomyopathy complicated with congenital myopathy at the age of 43. He had been suffering from cardiac allograft vasculopathy and had a history of right ventricular infarction complicated with acute inferior myocardial infarction when he was 59. Since then, refractory right-sided heart failure occurred and additional diuretics were required. A blood gas analysis on admission revealed mixed acid-base disorders with acidemia followed by respiratory acidosis and hypochloremic metabolic alkalosis due to diuretics and glucocorticoids. Advanced heart failure complicated with congenital myopathy could be the causes of the respiratory muscle failure and hypoventilation. The administration of acetazolamide is known to promote ventilator weaning and improve metabolic alkalosis, therefore, he was started on acetazolamide. His arterial blood gas analysis revealed that his pH and pCO2 had decreased after the administration of acetazolamide. He recovered from refractory heart failure and was successfully extubated. We report a case of a congenital myopathy patient with advanced heart failure after a heart transplant treated by acetazolamide for hypoventilation.
O19-1 Improvement of Heart Failure with Empagliflozin in a Patient with Diabetes Mellitus and Ischemic Cardiomyopathy Makoto Nakano, Yuhi Hasebe, Yoshitaka Kimura, Kyoshiro Fukasawa, Takahiko Chiba, Keita Miki, Susumu Morosawa, Hiroaki Shimokawa; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan A 54-year-old man with diabetes mellitus and ischemic cardiomyopathy due to old myocardial infarction of triple vessel disease admitted to our hospital because of worsening heart failure (HF). Although he was previously treated with coronary artery bypass graft (CABG) and cardiac resynchronization therapy (CRT) in addition to optimal medical therapy, he was non-responder of CRT and had experienced repetitive HF hospitalizations. Infusion of catecholamine transiently improved his HF condition, which did not last after tapering of the treatment. Recently, empagliflozin, one of the sodiumglucose cotransporter 2 (SGLT-2) inhibitors, has been reported to exert the beneficial
O19-3 Age Differences in the Development of Heart Failure After First-time Acute Myocardial Infarction Ryoichi Ushigome, Tadashi Sugie; Department of Cardiovascular Medicine, Sendai Open Hospital, Sendai, Japan Background: Mortality is very high in elderly patients with acute myocardial infarction (AMI). However, the influence on the onset of heart failure (HF) after first-time AMI hasn’t been investigated. Methods: We evaluated 870 consecutive patients admitted with first-time AMI visiting hospital within 24 hours of onset. Patients were divided into the age groups young: < 60 years, old: 60 to 80 years, and very old: > 80 years and were evaluated for clinical management and onset of HF. Results: Those with young, old, and very old comprised 243, 454, and 173 patients, respectively. As compared with young, old/very old groups were characterized by higher percentage of female, higher BNP, lower EF and lower rate of revascularization. In-hospital mortality was significantly high in the very old patients. The symptom-to-door time was the longest in the very old group. Kaplan-Meier analysis revealed that very old groups was highest rate of onset of HF. After adjustment with patient background, in comparison with old group, young group was found to be independently associated with lower rate of the onset of HF (adjusted HR, 0.30; 95% CI: 0.09 to 0.82, P = .02), while very old group was higher (adjusted HR, 2.58; 95% CI: 1.22–5.39, P = .01). Conclusion: In the very old patients, the risk of development of HF is very high after their first AMI.
O18-5 2 Case Reports of Successful Treatment by Central ECMO with LV Venting for Severe Heart Failure Complicated with Alveolar Hemorrhage Hyoe Komae1, Kan Nawata1, Osamu Kinoshita1, Yasuhiro Hoshino1, Mitsutosi Kimura1, Haruo Yamauchi1, Eisuke Amiya2, Yumiko Hosoya2, Masaru Hatano2, Minoru Ono1; 1 The Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan; 2The Department of Cardiology, University of Tokyo, Tokyo, Japan Severe heart failure patients are sometimes complicated with alveolar hemorrhage due to pulmonary congestion. Patients with alveolar hemorrhage have high pulmonary vascular resistance, so LVAD attachment induces relative right heart failure which may require right heart system assist. In such cases, hemodynamic management becomes very difficult. With high pulmonary perfusion as well as intensive anti-coagulation therapy, alveolar hemorrhage might worsen. Furthermore, it is difficult to tell whether the cause of alveolar hemorrhage is pulmonary congestion or other diseases like organized pneumonia. Our present strategy for particularly severe heart failure is as follows: we adopt central ECMO support with RA drainage and ascending aorta perfusion to get adequate circulatory flow support. At the same time, LV venting from the apex is also used to release pulmonary congestion, which leads to recover pulmonary function, and reduce pulmonary vascular resistance. And as a next step, we aim to maintain hemodynamics by supporting left heart system only. Recently, we experienced 2 severe heart failure cases complicated with alveolar hemorrhage whose etiologies were hard to differentiate, which were successfully treated according to our strategy. Here, we are going to report these 2 cases with some discussions.
•
JHFS
S37
effects for diabetic patients with cardiovascular diseases. Thus, we decided to treat him with it. Administration of empagliflozin (10 mg) dramatically improved his HF condition within 1 month, including 6 kg weight loss (81 to 75 kg), 7% reduction in cardiothoracic ratio on chest X-ray (56 to 49%), and more than 100 pg/ml BNP reduction (347 to 211 pg/ml) without any adverse effects. Moreover, addition of empagliflozin enabled us to reduce a dose of furosemide, which is known to cause adverse cardiovascular effects when used at high-dose use. We here report a case of intractable HF associated with diabetes mellitus and ischemic cardiomyopathy despite CABG, CRT and optimal medical therapy, where empagliflozin dramatically improved the HF condition.
O19-2 Risk of Heart Failure in Myocardial Infarction with Reduced, mid Range and Preserved Ejection Fraction Hiroyuki Okura1, Toru Kataoka2, Yoshihiko Saito1, Kiyoshi Yoshida3; 1First Department of Internal Medicine, Nara Medical University, Kashihara, Japan; 2Bell land general Hospital, Sakai, Japan; 3The Sakakibara Heart Institute of Okayama, Okayama, Japan Background: Recent ESC guideline categorized heart failure (HF) patients with ejection fraction (EF) between 40–49% as gray area. Purpose: The aim of this study was to investigate risk of HF in myocardial infarction (MI) with preserved (MIpEF, EFP < 40%), mid range (MImrEF, EF 40–49%) and reduced EF (MIrEF, EF>50%). Methods: A total of 953 MI patients were enrolled and studied. Patients were grouped as either MIpEF, MImrEF or MIrEF. Incidence of HF was compared among the 3 groups. Results: MImrEF and MIrEF were similarly older than MIpEF (69.8 ± 11.7 vs. 70.3 ± 11.7 vs. 67.6 ± 11.7%, P < .01). Kaplan-Meier survival curves demonstrated that incidence of HF in MImrEF was initially mid range between MIpEF and MIrEF but was similar to MIrEF at long-term follow-up (Figure). Conclusion: Both MImrEF and MIrEF are at higher risk for the development of HF than MIpEF.
O18-6 Acetazolamide for Hypoventilation in a Congenital Myopathy Patient with Advanced Heart Failure after a Heart Transplant; a Case Report Chiharuko Iio, Koichi Tamita, Tomohiko Shimizu, Mika Maeda, Jun Yamamuro; Nishinomiya Watanabe Cardiovascular Center A 61-year-old man was admitted to our hospital for further treatment of worsening congestive heart failure with a mechanical ventilation. He had undergone a heart transplant due to dilated cardiomyopathy complicated with congenital myopathy at the age of 43. He had been suffering from cardiac allograft vasculopathy and had a history of right ventricular infarction complicated with acute inferior myocardial infarction when he was 59. Since then, refractory right-sided heart failure occurred and additional diuretics were required. A blood gas analysis on admission revealed mixed acid-base disorders with acidemia followed by respiratory acidosis and hypochloremic metabolic alkalosis due to diuretics and glucocorticoids. Advanced heart failure complicated with congenital myopathy could be the causes of the respiratory muscle failure and hypoventilation. The administration of acetazolamide is known to promote ventilator weaning and improve metabolic alkalosis, therefore, he was started on acetazolamide. His arterial blood gas analysis revealed that his pH and pCO2 had decreased after the administration of acetazolamide. He recovered from refractory heart failure and was successfully extubated. We report a case of a congenital myopathy patient with advanced heart failure after a heart transplant treated by acetazolamide for hypoventilation.
O19-1 Improvement of Heart Failure with Empagliflozin in a Patient with Diabetes Mellitus and Ischemic Cardiomyopathy Makoto Nakano, Yuhi Hasebe, Yoshitaka Kimura, Kyoshiro Fukasawa, Takahiko Chiba, Keita Miki, Susumu Morosawa, Hiroaki Shimokawa; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan A 54-year-old man with diabetes mellitus and ischemic cardiomyopathy due to old myocardial infarction of triple vessel disease admitted to our hospital because of worsening heart failure (HF). Although he was previously treated with coronary artery bypass graft (CABG) and cardiac resynchronization therapy (CRT) in addition to optimal medical therapy, he was non-responder of CRT and had experienced repetitive HF hospitalizations. Infusion of catecholamine transiently improved his HF condition, which did not last after tapering of the treatment. Recently, empagliflozin, one of the sodiumglucose cotransporter 2 (SGLT-2) inhibitors, has been reported to exert the beneficial
O19-3 Age Differences in the Development of Heart Failure After First-time Acute Myocardial Infarction Ryoichi Ushigome, Tadashi Sugie; Department of Cardiovascular Medicine, Sendai Open Hospital, Sendai, Japan Background: Mortality is very high in elderly patients with acute myocardial infarction (AMI). However, the influence on the onset of heart failure (HF) after first-time AMI hasn’t been investigated. Methods: We evaluated 870 consecutive patients admitted with first-time AMI visiting hospital within 24 hours of onset. Patients were divided into the age groups young: < 60 years, old: 60 to 80 years, and very old: > 80 years and were evaluated for clinical management and onset of HF. Results: Those with young, old, and very old comprised 243, 454, and 173 patients, respectively. As compared with young, old/very old groups were characterized by higher percentage of female, higher BNP, lower EF and lower rate of revascularization. In-hospital mortality was significantly high in the very old patients. The symptom-to-door time was the longest in the very old group. Kaplan-Meier analysis revealed that very old groups was highest rate of onset of HF. After adjustment with patient background, in comparison with old group, young group was found to be independently associated with lower rate of the onset of HF (adjusted HR, 0.30; 95% CI: 0.09 to 0.82, P = .02), while very old group was higher (adjusted HR, 2.58; 95% CI: 1.22–5.39, P = .01). Conclusion: In the very old patients, the risk of development of HF is very high after their first AMI.