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Association of Increase in Uric Acid Level With Worsening Renal Function in Patients With Congestive Heart Failure
The 20th Annual Scientific Meeting
P21-4 High Extracellular Water Is Associated With the Adverse Events in Acute Decompensated Heart Failure (ADHF) Yoshiyuki Yazaki, Hiroki Niikura, Tsuyoshi Ono, Raisuke Iijima, Hidehiko Hara, Masao Moroi, Masato Nakamura; The Division of Cardiovascular, Toho University Medical Center Ohashi Hospital, Tokyo, Japan Background: A problem of fluid volume overload is important in acute decompensated heart failure (ADHF). The aim of this study was to investigate whether body fluid composition provides prognostic value in patients with ADHF. Method and Results: This study enrolled 112 patients admitted for ADHF. On admission, all patients evaluated the total boy water/fat-free mass (TBW%) and the extracellular water/TBW (ECW%) by bioelectrical impedance analysis. 6-month outcomes focused on the adverse events (all-cause deaths and re-hospitalizations). Median TBW% and ECW% were 71.7%(IQR 68.8–75.9) and 43.1%(IQR 38.3–49.6). We divided to two groups according to median. The result showed in the Figure. Multivariate analysis identified that only high ECW% rather than high TBW% was an independent predictor of adverse events (HR 2.41, 95%CI 1.0–5.6, P = .043). Conclusions: The measurements of fluid composition is useful for stratify the high risk patients.
P21-5 Association of Increase in Uric Acid Level With Worsening Renal Function in Patients With Congestive Heart Failure Keishi Ichikawa, Satoru Sakuragi, Takahiro Nishihara, Masahiro Tuji, Atsushi Mori, Fumi Yokohama, Tadashi Wada, Daiji Hasegawa, Kenji Kawamoto, Yusuke Katayama; Department of Cardiology, Iwakuni Clinical Center, Iwakuni, Japan Background: Occasionally, increase in serum uric acid (SUA) levels during hospitalization was observed in patients with congestive heart failure (HF), and hyperuricemia is known as an independent predictor of adverse outcomes. In this study, we investigated the factors associated with SUA elevation during hospitalization in HF patients. Methods and Results: We enrolled 98 patients (80 ± 8.8 years, 45 male) hospitalized for congestive HF with normal SUA (<7.0 mg/dL). Blood test was performed on admission (1st measurement) and two weeks later (2nd measurement). Patients were divided into two groups according to the presence of hyperuricemia (SUA > 7.0 mg/dL) at 2nd measurement: high SUA group (n = 28) and normal SUA group (n = 70). No difference was found in the baseline characteristics, such as coronary risk factors, NTproBNP and renal function between the two groups. However, change in estimated glomerular filtration rate (eGFR) was significantly greater in hyperuricemia group (−8.3 vs −3.8 mL/min/1.73 m2, P = .037). Interestingly, NT-proBNP level was unchangeable between two measurements in high SUA group (5314 to 4540 pg/mL, ns), whereas NT-proBNP was significantly reduced in normal SUA group (2983 to 1966 pg/mL, P = .037). Conclusion: An increase in the SUA levels during hospitalization was associated with worsening renal function. Our study suggested that variation of SUA levels is also important predictor of clinical outcomes in patients with HF.
P21-6 Serum Uric Acid Increase Through the Treatment of ADHF Might Predict Adverse Outcome in Patients With Chronic Heart Failure Hironori Yamamoto1, Yuji Nagatomo1, Mayuko Yagawa1, Keitaro Mahara1, Hitonobu Tomoike1, Shun Kohsaka2, Tsutom Yoshikawa1; 1Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; 2Department of Cardiology, Keio University School of Medicine, Japan Background: Elevated serum uric acid (UA) is associated with an increased risk of adverse outcome in patients with chronic heart failure (CHF), but it remains still unknown
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whether the change of serum UA level predicts adverse events in CHF patients. Objective: The purpose of this study was to determine if in-hospital UA increase, after stabilization of acute decompensated heart failure (ADHF) predicts adverse events. Method: We retrospectively enrolled consecutive 378 patients who underwent hospitalization for ADHF, and their attending physicians evaluated UA levels both at the hospitalization and before discharge. We followed them up until they had composite endpoint of re-hospitalization for ADHF or death, for the first time after discharge. Results: In 225 patients, UA values increased during hospitalization (I group) and it decreased in the remaining 153 patients (D group). At hospitalization I group were significantly older (77.8 ± 10.4 vs 73.4 ± 11.9 years old, P = .0002) and their hemoglobin and serum UA level were significantly lower than D group (11.6 ± 1.9 vs 12.3 ± 2.3 g/dL, P = .0018 and 5.9 ± 1.6 vs 7.7 ± 2.0 mg/dL, P < .0001 respectively). Among the patients with high UA level at hospitalization (>7 mg/dL), UA increase during hospitalization was associated with higher incidence of endpoint (61.5% vs 37.5%, P = .048, logrank test). Conclusion: In CHF patients with hyperuricemia, further increase of UA through the treatment of ADHF might predict adverse outcome.
P22-4 A Case of Prevented Re-Hospitalization by Home-Based Intervention and Adaptive Servo-Ventilation Therapy in Repeated Hospitalization Due to Decompensated Heart Failure Masataka Kamiya1, Makoto Saitoh2; 1Kamiya Internal Medicine and Orthopedics Clinic, Aichi, Japan; 2Division of Cardiology, Department of Internal Medicine, Nishio Municipal Hospital, Aichi, Japan Re-hospitalization for acute decompensated heart failure (HF) carries a high risk for early mortality and impaired quality of life. A 91-year-old male who was hospitalized four times in one year for decompensated HF was assigned home-based intervention following the last discharge. He had been diagnosed with chronic HF resulting from ischemic cardiomyopathy with left ventricular ejection fraction of 25% and severe aortic stenosis, and chronic kidney disease (eGFR = 24 mL/min/1.73 m2). The initial apneahypopnea index recorded on the portable home sleep monitor was 42.8/hour and the patient subsequently underwent adaptive servo-ventilation (ASV) therapy. ASV was used for only 3 hours/day for the first month, but was gradually extended to 10 hours/ day following several recommendations by the physician. An urgent home visit for exacerbation of HF triggered by acute bronchitis occurred, and the symptom improved following instructions to use the ASV all day long and intravenous fluid infusion and furosemide administration for 5 days at home. He had no re-hospitalization more than one year. B-type natriuretic peptide and eGFR were unchanged from the start of home-based intervention, and plasma renin activity, aldosterone, and urinary livertype fatty acid binding protein were decreased. Functional status, depression, nutritional status and stress of the caregiver score were also improved. Home-based intervention and ASV therapy may be useful to prevent re-hospitalization in patients with repeated hospitalization for decompensated HF.
P23-2 A Rare Case of ADHF Due to Severe Aortic Insufficiency 3 Years After Aortic Valve Reconstruction Using Autologous Pericardium Masato Makino1, Hiroyuki Yamamoto1, Daisuke Iiduka1, Kazuo Misumi1, Yoshitsugu Nakamura1, Takaki Hori1, Hatsue Ueda2; 1Chiba-Nishi General Hospital, Matsudo-city, Chiba, Japan; 2National Cerebral and Cardiovascular Center Hospital, Japan A 86-year-old woman, who had undergone the aortic valve reconstruction using autologous pericardium (AVRec/AP) 3 years previously, was admitted to our hospital with a diagnosis of acute decompensated heart failure due to severe aortic regurgitation (AR). Redo surgery was performed. There was a hole and tearing of the pericardial leaflet, which caused severe AR. Although there was no evidence of endocarditis, the other two pericardial leaflets were intact. Aortic valve replacement (AVR) was performed with a mosaic 19 mm. She was discharged in good condition. Although there are many reports that AVRec/AP leads to a very low incidence of valve-related complications, we report the first case of severe AR after AVRec/AP.
P23-3 A Case of Severe Aortic Stenosis With Sarcoidosis Successfully Treated With Balloon Aortic Valvuloplasty to Control Heart Failure Shunsuke Netsu, Koki Omi, Jun Goto, Shigeo Sugawara; Nihonkai General Hospital, Sakata, Japan A 75 year-old male, who was not frail, visited to our hospital with complaints of dyspnea on exertion in 2015. He had past histories of sarcoid uveitis in 2005 and mild aortic stenosis (AS) in 2011. An echocardiogram showed severe AS with decreased ejection fraction (EF) of 33%. Chest X-ray showed cardiomegaly, pulmonary congestion, and bilateral hilar lymphadenopathy. Cardiac catheterization revealed severe AS with a mean transvalvular gradient of 54 mmHg and a valve area of 0.53 cm2. He was considered to be a high risk candidate for surgical aortic valve replacement (SAVR) and have the potential to be treated with steroids, our heart team decided to initially perform balloon aortic valvuloplasty (BAV). BAV was performed with a 25 mm balloon and led to hemodynamic improvement with a reduction in mean gradient to 30 mmHg and an increase in valve area to 1.14 cm2. Some examinations were performed in parallel with medical
P21-4 High Extracellular Water Is Associated With the Adverse Events in Acute Decompensated Heart Failure (ADHF) Yoshiyuki Yazaki, Hiroki Niikura, Tsuyoshi Ono, Raisuke Iijima, Hidehiko Hara, Masao Moroi, Masato Nakamura; The Division of Cardiovascular, Toho University Medical Center Ohashi Hospital, Tokyo, Japan Background: A problem of fluid volume overload is important in acute decompensated heart failure (ADHF). The aim of this study was to investigate whether body fluid composition provides prognostic value in patients with ADHF. Method and Results: This study enrolled 112 patients admitted for ADHF. On admission, all patients evaluated the total boy water/fat-free mass (TBW%) and the extracellular water/TBW (ECW%) by bioelectrical impedance analysis. 6-month outcomes focused on the adverse events (all-cause deaths and re-hospitalizations). Median TBW% and ECW% were 71.7%(IQR 68.8–75.9) and 43.1%(IQR 38.3–49.6). We divided to two groups according to median. The result showed in the Figure. Multivariate analysis identified that only high ECW% rather than high TBW% was an independent predictor of adverse events (HR 2.41, 95%CI 1.0–5.6, P = .043). Conclusions: The measurements of fluid composition is useful for stratify the high risk patients.
P21-5 Association of Increase in Uric Acid Level With Worsening Renal Function in Patients With Congestive Heart Failure Keishi Ichikawa, Satoru Sakuragi, Takahiro Nishihara, Masahiro Tuji, Atsushi Mori, Fumi Yokohama, Tadashi Wada, Daiji Hasegawa, Kenji Kawamoto, Yusuke Katayama; Department of Cardiology, Iwakuni Clinical Center, Iwakuni, Japan Background: Occasionally, increase in serum uric acid (SUA) levels during hospitalization was observed in patients with congestive heart failure (HF), and hyperuricemia is known as an independent predictor of adverse outcomes. In this study, we investigated the factors associated with SUA elevation during hospitalization in HF patients. Methods and Results: We enrolled 98 patients (80 ± 8.8 years, 45 male) hospitalized for congestive HF with normal SUA (<7.0 mg/dL). Blood test was performed on admission (1st measurement) and two weeks later (2nd measurement). Patients were divided into two groups according to the presence of hyperuricemia (SUA > 7.0 mg/dL) at 2nd measurement: high SUA group (n = 28) and normal SUA group (n = 70). No difference was found in the baseline characteristics, such as coronary risk factors, NTproBNP and renal function between the two groups. However, change in estimated glomerular filtration rate (eGFR) was significantly greater in hyperuricemia group (−8.3 vs −3.8 mL/min/1.73 m2, P = .037). Interestingly, NT-proBNP level was unchangeable between two measurements in high SUA group (5314 to 4540 pg/mL, ns), whereas NT-proBNP was significantly reduced in normal SUA group (2983 to 1966 pg/mL, P = .037). Conclusion: An increase in the SUA levels during hospitalization was associated with worsening renal function. Our study suggested that variation of SUA levels is also important predictor of clinical outcomes in patients with HF.
P21-6 Serum Uric Acid Increase Through the Treatment of ADHF Might Predict Adverse Outcome in Patients With Chronic Heart Failure Hironori Yamamoto1, Yuji Nagatomo1, Mayuko Yagawa1, Keitaro Mahara1, Hitonobu Tomoike1, Shun Kohsaka2, Tsutom Yoshikawa1; 1Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; 2Department of Cardiology, Keio University School of Medicine, Japan Background: Elevated serum uric acid (UA) is associated with an increased risk of adverse outcome in patients with chronic heart failure (CHF), but it remains still unknown
•
JHFS
S227
whether the change of serum UA level predicts adverse events in CHF patients. Objective: The purpose of this study was to determine if in-hospital UA increase, after stabilization of acute decompensated heart failure (ADHF) predicts adverse events. Method: We retrospectively enrolled consecutive 378 patients who underwent hospitalization for ADHF, and their attending physicians evaluated UA levels both at the hospitalization and before discharge. We followed them up until they had composite endpoint of re-hospitalization for ADHF or death, for the first time after discharge. Results: In 225 patients, UA values increased during hospitalization (I group) and it decreased in the remaining 153 patients (D group). At hospitalization I group were significantly older (77.8 ± 10.4 vs 73.4 ± 11.9 years old, P = .0002) and their hemoglobin and serum UA level were significantly lower than D group (11.6 ± 1.9 vs 12.3 ± 2.3 g/dL, P = .0018 and 5.9 ± 1.6 vs 7.7 ± 2.0 mg/dL, P < .0001 respectively). Among the patients with high UA level at hospitalization (>7 mg/dL), UA increase during hospitalization was associated with higher incidence of endpoint (61.5% vs 37.5%, P = .048, logrank test). Conclusion: In CHF patients with hyperuricemia, further increase of UA through the treatment of ADHF might predict adverse outcome.
P22-4 A Case of Prevented Re-Hospitalization by Home-Based Intervention and Adaptive Servo-Ventilation Therapy in Repeated Hospitalization Due to Decompensated Heart Failure Masataka Kamiya1, Makoto Saitoh2; 1Kamiya Internal Medicine and Orthopedics Clinic, Aichi, Japan; 2Division of Cardiology, Department of Internal Medicine, Nishio Municipal Hospital, Aichi, Japan Re-hospitalization for acute decompensated heart failure (HF) carries a high risk for early mortality and impaired quality of life. A 91-year-old male who was hospitalized four times in one year for decompensated HF was assigned home-based intervention following the last discharge. He had been diagnosed with chronic HF resulting from ischemic cardiomyopathy with left ventricular ejection fraction of 25% and severe aortic stenosis, and chronic kidney disease (eGFR = 24 mL/min/1.73 m2). The initial apneahypopnea index recorded on the portable home sleep monitor was 42.8/hour and the patient subsequently underwent adaptive servo-ventilation (ASV) therapy. ASV was used for only 3 hours/day for the first month, but was gradually extended to 10 hours/ day following several recommendations by the physician. An urgent home visit for exacerbation of HF triggered by acute bronchitis occurred, and the symptom improved following instructions to use the ASV all day long and intravenous fluid infusion and furosemide administration for 5 days at home. He had no re-hospitalization more than one year. B-type natriuretic peptide and eGFR were unchanged from the start of home-based intervention, and plasma renin activity, aldosterone, and urinary livertype fatty acid binding protein were decreased. Functional status, depression, nutritional status and stress of the caregiver score were also improved. Home-based intervention and ASV therapy may be useful to prevent re-hospitalization in patients with repeated hospitalization for decompensated HF.
P23-2 A Rare Case of ADHF Due to Severe Aortic Insufficiency 3 Years After Aortic Valve Reconstruction Using Autologous Pericardium Masato Makino1, Hiroyuki Yamamoto1, Daisuke Iiduka1, Kazuo Misumi1, Yoshitsugu Nakamura1, Takaki Hori1, Hatsue Ueda2; 1Chiba-Nishi General Hospital, Matsudo-city, Chiba, Japan; 2National Cerebral and Cardiovascular Center Hospital, Japan A 86-year-old woman, who had undergone the aortic valve reconstruction using autologous pericardium (AVRec/AP) 3 years previously, was admitted to our hospital with a diagnosis of acute decompensated heart failure due to severe aortic regurgitation (AR). Redo surgery was performed. There was a hole and tearing of the pericardial leaflet, which caused severe AR. Although there was no evidence of endocarditis, the other two pericardial leaflets were intact. Aortic valve replacement (AVR) was performed with a mosaic 19 mm. She was discharged in good condition. Although there are many reports that AVRec/AP leads to a very low incidence of valve-related complications, we report the first case of severe AR after AVRec/AP.
P23-3 A Case of Severe Aortic Stenosis With Sarcoidosis Successfully Treated With Balloon Aortic Valvuloplasty to Control Heart Failure Shunsuke Netsu, Koki Omi, Jun Goto, Shigeo Sugawara; Nihonkai General Hospital, Sakata, Japan A 75 year-old male, who was not frail, visited to our hospital with complaints of dyspnea on exertion in 2015. He had past histories of sarcoid uveitis in 2005 and mild aortic stenosis (AS) in 2011. An echocardiogram showed severe AS with decreased ejection fraction (EF) of 33%. Chest X-ray showed cardiomegaly, pulmonary congestion, and bilateral hilar lymphadenopathy. Cardiac catheterization revealed severe AS with a mean transvalvular gradient of 54 mmHg and a valve area of 0.53 cm2. He was considered to be a high risk candidate for surgical aortic valve replacement (SAVR) and have the potential to be treated with steroids, our heart team decided to initially perform balloon aortic valvuloplasty (BAV). BAV was performed with a 25 mm balloon and led to hemodynamic improvement with a reduction in mean gradient to 30 mmHg and an increase in valve area to 1.14 cm2. Some examinations were performed in parallel with medical