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Benefits of Cardiac Resynchronization Therapy for Heart Failure Patients with Narrow QRS
S176 Journal of Cardiac Failure Vol. 14 No. 7S September 2008 129 Body Mass Index (BMI) and Prognosis in Patients With Chronic Heart Failure KENJI MIYAGISHIMA1, SHINYA HIRAMITSU1, HISASHI KIMURA1, KAZUMASA MORI2, YASUCHIKA KATO1, SHIGERU KATO2, SHIN-ICHIRO MORIMOTO1, HITOSHI HISHIDA1, YUKIO OZAKI1 1 Division of Cardiology Department of Internal Medicine Fujita Health University, Aichi, Japan, 2Nagoya Memorial Hospital, Aichi, Japan Background: In a chronic heart failure, it is reported that it develops an increase of mortality rate that BMI is low. Purpose: In a chronic heart failure, we inspected about BMI and prognosis. Subjects and Methods: We intended for 678 patients that were able to be discharged from our hospital during 5 years(excluded:hemodialysis, malignant disease).We classified four groups by value of BMI, Group1(BMI O 25 kg/m2:n 5 78), Group2(22 ! BMI !25:n 5 160), Group3(18 ! BMI ! 22:n 5 276), Group4(BMI ! 18:n 5 164), and we investigated to retrospectively prognosis followed it for two years. Results: Low value BMI group was poor prognosis (Figure1), and when we assumed Group3 basis, the risk ratios were Group1:0.46(0.17e1.21), Group2:0.74(0.40e1.38), Group4:2.08(1.26e3.44). It became clear that risk of all cause death rose with BMI becoming a low value. Conclusion: For this study, low value BMI became clear as one factor, which elevated risk of all cause death.
years). Five patients were died of low output syndrome and one was infection before discharge. About these death group (n 5 6) and alive group (n 5 12) after successful weaning off mechanical support, we analyzed the factors related to their hospital mortality and their cardiac function at discharge. Peak CK and CKMB tend to be lower in the alive group (7558 6 1637 mg/dl and 12981 6 4069 mg/dl, 608 6 92 mg/dl and 866 6 209 mg/dl), however statistically showed no significant difference. The shock score and other early phase parameters didn’t have any significant change between these groups. On the other hand, the data of creatinin, BUN, and bililubin at weaning from PCPS are significant lower in alive group. The time managing with PCPS was significant shorter in alive group (45 6 9 hr and 109 6 2 hr). From the step-wise analysis, the ejection fraction at discharge can be depicted with two associate parameters (age and CK). For survivor from hemodynamically shock state, the severity of damaged myocardium and age play an important role.
132 Successful percutaneous coronary intervention in patient with typical apical ballooning syndrome triggered by intracranial hemorrhage MANABU IZUMI1, YUKIHIKO ONO1, MAKOTO SATO2 1 Department of Internal Medicine Division of Cardiology, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan, 2Department of Cardiology, Nakadori General Hospital
130 Benefits of Cardiac Resynchronization Therapy for Heart Failure Patients with Narrow QRS AZUSA FURUGEN, NAOKI MATSUDA, TSUYOSHI SHIGA, ASAKO MOCHIDA, KYOMI ASHIHARA, MORIO SHODA, NAOKO ISHIZUKA, NOBUHISA HAGIWARA Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan Cardiac resynchronization therapy (CRT) improves heart failure symptoms and decreases hospitalizations for heart failure for patients who have severe heart failure and a wide QRS. It is unclear if heart failure patient with narrow QRS would benefit from CRT. Methods: Thirteen heart failure patients with narrow QRS (# 120ms) who underwent CRT were enrolled. Tissue Doppler imaging (TDI) and speckle tracking imaging (STI) were employed to select patients with intra-ventricular dyssynchrony. Standard echocardiographic, electrocardiographic, plasma BNP level and clinical assessments were performed at baseline and 6 months after CRT. Results: There was significant reduction of left ventricular (LV) end-systolic volume (151 6 61 ml vs. 99.1 6 42 ml, p ! 0.005) and plasma BNP level (626 6 624 pg/ml vs. 354 6 358 pg/ml, p ! 0.05). Improvement of New York Heart Association functional class (p ! 0.01) and LV ejection fraction (23.6 6 9.3% vs. 34.4 6 7.1%, p ! 0.01) was also observed. Conclusion: CRT for heart failure patients with narrow QRS configuration and coexisting mechanical dyssynchrony by TDI and STI results in LV reverse remodeling and improvement of clinical status.
131 Which factors affect the cardiac performance after detaching percutaneous cardiopulmonary support in cardiogenic shock patients of acute myocardial infarction YASUYO TANIGUCHI, TAKUMI INOUE, SHINICHIRO YAMADA, SACHIYO IWATA, KAZUO MIZUTANI, AKIRA SHIMANE, MASAHIRO KUMADA, KIMITAKE IMAMURA, TAKATOSHI HAYASHI, TEISHI KAJIYA Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan We analyzed the factors that affect the patients who survived from cardiogenic shock utilizing percutaneous cardiopulmonary support (PCPS). Of 27 consecutive patients with cardiogenic shock complicating AMI (n 5 4), 18 patients could be wean off hemodynamic support with PCPS (since 2004 to 2007, 6 females, mean age 67 6 7
A novel syndrome with transient left ventricular dysfunction shows severe systolic dysfunction in apical segments and hyper-kinetic motion in basal segments, also known as apical ballooning syndrome (ABS), has been recently described with absence of coronary stenosis. We report the case of a 66-year-old woman presenting with hemiplegia, electrocardiographic abnormalities with ST segment elevation of precordial leads. Brain computed tomography (CT) revealed left putamenal hemorrhage. Trans-thoracic echocardiography showed a typical left ventricular apical ballooning. The patient treated with infusion of diltiazem and nitroglycerin. After confirmation of stop bleeding in brain CT, we administrated heparin and warfarin sodium to avoid embolic events. The value of creatine phosphokinase increased within twenty-four hours, but never overtook the twice of normal upper limits. Myocardial scintigraphy of thallium and 123I-MIBG revealed expand absence from middle to apical segments unexplainable as myocardial ischemia of a single coronary occlusion. Left ventricular dysfunction recovered within two weeks and its clinical course was typical as ABS, however, a novel 320-slice area detector CT (could scan coronary artery within three seconds) revealed severe stenosis in left anterior descending artery. Rehabilitation of hemiplegia considered of heart load as we expected. She underwent percutaneous coronary intervention (PCI) without any troubles. We could avoid cardiac events with PCI and a novel 320-area detector CT.
133 A patient on maintenance dialysis who has repeated hospitalizations due to severe heart failure provoked by ischemic mitral regurgitation MASATAKA WATANABE, TAKAHIRO OHARA, MAKOTO AMAKI, TAKUYA HASEGAWA, HIDEAKI KANZAKI, KAZUHIKO HASHIMURA, MASAFUMI KITAKAZE Department of Cardiovascular Medicine, National Cardiovascular Center, Osaka, Japan A 66-year-old male patient has undergone several percutaneous coronary interventions (PCIs) for ischemic heart disease in the past and has been on dialysis due to diabetic nephritis since last year. The ischemia-induced exacerbation of cardiac function and ischemic mitral regurgitation (MR) provoked by ventricular remodeling have progressed, and the patient has been treated for ischemic heart failure with an oral ACE inhibitor and an oral b-adrenergic blocking agent. Recently, however, the patient has repeated hospitalizations due to volume overload. The present hospitalization was due to the aggravation of chronic heart failure, treatment with dobutamine was initiated, and PCI and cardiac resynchronization therapy (CRT) were conducted to improve cardiac function. The patient presents highly risky MR and has been excluded from surgical indication. Heart transplantation is not indicated for the patient because of his age. A number of options in therapeutic drugs for heart failure have become available in recent years, and sorts of therapeutic means have been reported. However, it is difficult to figure out pharmacokinetics in blood when treating patients with heart failure who are on maintenance dialysis, and a limited number of drugs that can be used safely are available. We have encountered
years). Five patients were died of low output syndrome and one was infection before discharge. About these death group (n 5 6) and alive group (n 5 12) after successful weaning off mechanical support, we analyzed the factors related to their hospital mortality and their cardiac function at discharge. Peak CK and CKMB tend to be lower in the alive group (7558 6 1637 mg/dl and 12981 6 4069 mg/dl, 608 6 92 mg/dl and 866 6 209 mg/dl), however statistically showed no significant difference. The shock score and other early phase parameters didn’t have any significant change between these groups. On the other hand, the data of creatinin, BUN, and bililubin at weaning from PCPS are significant lower in alive group. The time managing with PCPS was significant shorter in alive group (45 6 9 hr and 109 6 2 hr). From the step-wise analysis, the ejection fraction at discharge can be depicted with two associate parameters (age and CK). For survivor from hemodynamically shock state, the severity of damaged myocardium and age play an important role.
132 Successful percutaneous coronary intervention in patient with typical apical ballooning syndrome triggered by intracranial hemorrhage MANABU IZUMI1, YUKIHIKO ONO1, MAKOTO SATO2 1 Department of Internal Medicine Division of Cardiology, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan, 2Department of Cardiology, Nakadori General Hospital
130 Benefits of Cardiac Resynchronization Therapy for Heart Failure Patients with Narrow QRS AZUSA FURUGEN, NAOKI MATSUDA, TSUYOSHI SHIGA, ASAKO MOCHIDA, KYOMI ASHIHARA, MORIO SHODA, NAOKO ISHIZUKA, NOBUHISA HAGIWARA Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan Cardiac resynchronization therapy (CRT) improves heart failure symptoms and decreases hospitalizations for heart failure for patients who have severe heart failure and a wide QRS. It is unclear if heart failure patient with narrow QRS would benefit from CRT. Methods: Thirteen heart failure patients with narrow QRS (# 120ms) who underwent CRT were enrolled. Tissue Doppler imaging (TDI) and speckle tracking imaging (STI) were employed to select patients with intra-ventricular dyssynchrony. Standard echocardiographic, electrocardiographic, plasma BNP level and clinical assessments were performed at baseline and 6 months after CRT. Results: There was significant reduction of left ventricular (LV) end-systolic volume (151 6 61 ml vs. 99.1 6 42 ml, p ! 0.005) and plasma BNP level (626 6 624 pg/ml vs. 354 6 358 pg/ml, p ! 0.05). Improvement of New York Heart Association functional class (p ! 0.01) and LV ejection fraction (23.6 6 9.3% vs. 34.4 6 7.1%, p ! 0.01) was also observed. Conclusion: CRT for heart failure patients with narrow QRS configuration and coexisting mechanical dyssynchrony by TDI and STI results in LV reverse remodeling and improvement of clinical status.
131 Which factors affect the cardiac performance after detaching percutaneous cardiopulmonary support in cardiogenic shock patients of acute myocardial infarction YASUYO TANIGUCHI, TAKUMI INOUE, SHINICHIRO YAMADA, SACHIYO IWATA, KAZUO MIZUTANI, AKIRA SHIMANE, MASAHIRO KUMADA, KIMITAKE IMAMURA, TAKATOSHI HAYASHI, TEISHI KAJIYA Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan We analyzed the factors that affect the patients who survived from cardiogenic shock utilizing percutaneous cardiopulmonary support (PCPS). Of 27 consecutive patients with cardiogenic shock complicating AMI (n 5 4), 18 patients could be wean off hemodynamic support with PCPS (since 2004 to 2007, 6 females, mean age 67 6 7
A novel syndrome with transient left ventricular dysfunction shows severe systolic dysfunction in apical segments and hyper-kinetic motion in basal segments, also known as apical ballooning syndrome (ABS), has been recently described with absence of coronary stenosis. We report the case of a 66-year-old woman presenting with hemiplegia, electrocardiographic abnormalities with ST segment elevation of precordial leads. Brain computed tomography (CT) revealed left putamenal hemorrhage. Trans-thoracic echocardiography showed a typical left ventricular apical ballooning. The patient treated with infusion of diltiazem and nitroglycerin. After confirmation of stop bleeding in brain CT, we administrated heparin and warfarin sodium to avoid embolic events. The value of creatine phosphokinase increased within twenty-four hours, but never overtook the twice of normal upper limits. Myocardial scintigraphy of thallium and 123I-MIBG revealed expand absence from middle to apical segments unexplainable as myocardial ischemia of a single coronary occlusion. Left ventricular dysfunction recovered within two weeks and its clinical course was typical as ABS, however, a novel 320-slice area detector CT (could scan coronary artery within three seconds) revealed severe stenosis in left anterior descending artery. Rehabilitation of hemiplegia considered of heart load as we expected. She underwent percutaneous coronary intervention (PCI) without any troubles. We could avoid cardiac events with PCI and a novel 320-area detector CT.
133 A patient on maintenance dialysis who has repeated hospitalizations due to severe heart failure provoked by ischemic mitral regurgitation MASATAKA WATANABE, TAKAHIRO OHARA, MAKOTO AMAKI, TAKUYA HASEGAWA, HIDEAKI KANZAKI, KAZUHIKO HASHIMURA, MASAFUMI KITAKAZE Department of Cardiovascular Medicine, National Cardiovascular Center, Osaka, Japan A 66-year-old male patient has undergone several percutaneous coronary interventions (PCIs) for ischemic heart disease in the past and has been on dialysis due to diabetic nephritis since last year. The ischemia-induced exacerbation of cardiac function and ischemic mitral regurgitation (MR) provoked by ventricular remodeling have progressed, and the patient has been treated for ischemic heart failure with an oral ACE inhibitor and an oral b-adrenergic blocking agent. Recently, however, the patient has repeated hospitalizations due to volume overload. The present hospitalization was due to the aggravation of chronic heart failure, treatment with dobutamine was initiated, and PCI and cardiac resynchronization therapy (CRT) were conducted to improve cardiac function. The patient presents highly risky MR and has been excluded from surgical indication. Heart transplantation is not indicated for the patient because of his age. A number of options in therapeutic drugs for heart failure have become available in recent years, and sorts of therapeutic means have been reported. However, it is difficult to figure out pharmacokinetics in blood when treating patients with heart failure who are on maintenance dialysis, and a limited number of drugs that can be used safely are available. We have encountered