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Characteristics of patients with stage D heart failure: Initial report from the Acute Decompensated Heart Failure National Registry Longitudinal Module (ADHERE®-LM)
The Journal of Heart and Lung Transplantation Volume 24, Number 2S
Abstracts
S131
273 CHANGE IN PLASMA BRAIN NATRIURETIC PEPTIDE IS A STRONG PREDICTOR OF PROGNOSIS IN PATIENTS WITH ADVANCED HEART FAILURE AWAITING FOR CARDIAC TRANSPLANTATION C. Campana,1 M. Pasotti,1 R. Albertini,2 S. Ghio,1 C. Klersy,3 L. Tavazzi,1 1Cardiology, Policlinico San Matteo, Pavia, Italy; 2 Laboratory of Clinical Chemistry, Policlinico San Matteo, Pavia, Italy; 3Biometry and Clinical Epidemiology, Policlinico San Matteo, Pavia, Italy
272 CHARACTERISTICS OF PATIENTS WITH STAGE D HEART FAILURE: INITIAL REPORT FROM THE ACUTE DECOMPENSATED HEART FAILURE NATIONAL REGISTRY LONGITUDINAL MODULE (ADHERE®-LM) C.W. Yancy,1 G.C. Fonarow,2 The ADHERE Scientific Advisory Committee,3 1Cardiology, UT Southwestern Medical Center, Dallas, TX; 2Cardiology, UCLA, Los Angeles, CA; 3Medical Affairs, Scios Inc., Fremont, CA Background: Patients (pts) with stage D heart failure (HF) are ill-defined, have few evidenced-based adjunctive treatment options beyond ventricular replacement strategies, and have poor outcomes. Data are needed to define the demographics, natural history, clinical status, and current treatment modes. ADHERE®-LM targets pts with severe HF on standard medical therapy. Registry objectives are to assess disease progression, describe best treatment practices, and measure outcomes. Methods: 2250 pts with NYHA class III/IV HF and multiple prior hospitalizations are targeted at 75 centers for a 2 year serial follow-up. Measured variables include quality of life and clinical/resource utilization endpoints. Results: Since July 2003, 663 pts have been enrolled. Mean age: 69 years; 67% male; 82% white/15% black/2% Hispanic. Past clinical history: smoking (54%), diabetes (50%), anemia (34%), CAD (73%), HTN (71%), s/p MI (52%), CABG (48%), PCI (25%), dilated CM (12%), pacemaker (39%), and ICD (32%). Mean LVEF: 27.7 ⫾ 13.0%; median QRS: 128 msec. 26% of pts had SCr ⬎2.0 mg/dL (mean 1.8 ⫾ 1.0 mg/dL); median BUN: 37 mg/dL and median BNP: 797 pg/mL. See Table for clinical status and therapy. Initial Clinical Status and Therapy Within 6 Months of Enrollment Fatigue Dyspnea on exertion Edema Jugular venous distension Oral diuretics* ACE inhibitors/ARBs* Beta-blockers* Digoxin* Inotopes Nesiritide
70% 76% 54% 27% 95% 50%/18% 78% 52% 34% 71%
*Therapy received within the last 30 days of enrollment
Conclusions: Severe HF pts are characterized by a high likelihood of CAD, HTN, prolonged QRS, and highly variable LVEF. Comorbidities, including renal insufficiency, anemia, and diabetes are common. There is substantial exposure to device therapy, inotropes, and natriuretic peptides. It is hoped that longitudinal data from this registry will identify best practices and help develop effective strategies for these high-risk pts.
Background: Aim of the study was to assess the prognostic role of change in brain natriuretic peptide (BNP) measured at first evaluation and during follow-up in patients (pts) with advanced heart failure (HF) awaiting for heart transplantation (HTx). Methods and Results: Eighty-nine pts [mean age 50⫾11 years (yr), 84% males] with advanced HF underwent a clinical and instrumental evaluation to assess eligibility to HTx waiting list; 45 pts were in NYHA class III, 44 in NYHA IV, mean left ventricular ejection fraction was 20⫾5%. Etiology was: ischemic heart disease (42 pts), dilated cardiomyopathy (41 pts), valvular (6 pts). Cardiac index was 1.85⫾0.49 l/min/m2, mean pulmonary arterial pressure 32⫾12 mmHg, pulmonary wedge pressure 23.5⫾8.9 mmHg, right atrial pressure 7.4⫾5.1 mmHg and right ventricular ejection fraction 18⫾10%. BNP was measured both at baseline and at 6 months using ADVIA BNP assay. Median baseline BNP level was 809 pg/ml (IQR 358 –1300 pg/ml); BNP measurements were dicotomized as ⬎ versus ⱕ996 pg/ml which turned out to be the optimal cut-off to discriminate NYHA III and IV [area under the ROC curve 0.82 (95%CI 0.73– 0.90), sensitivity 71.1% (95%CI 55.7– 83.6), specificity 86.4 (95%CI 72.6 –94.8)]. Changes in BNP at 6 months were dicotomized as any increase vs decrease/no change. After a median follow-up of 13.6 months (IQR 6.4 –26.5) the event (death, urgent HTx, cardiac assist device implantation) rate per 100 pts/yr was 9.4 (95%CI 5.1–17.5) in pts with BNP ⱕ 996 pg/ml and 35.5 (95%CI21.4 –58.8) in those with BNP ⬎ 996 pg/ml. The event rate per 100 pts/yr was even higher in presence of a BNP increase at six months [44.4 (95% CI 26.8 –73.7)] than in presence of decrease/no change in BNP [8.8 (95%CI 4.8 –16.5)]. Conclusions: In pts with advanced HF a further increase of BNP levels during follow-up is a strong predictor of events.
274 BODY TEMPERATURE LESS THAN 97.0 DEGREES FAHRENHEIT IS ASSOCIATED WITH INCREASED B-TYPE NATRIURETIC PEPTIDE AND WORSE RESPONSE TO THERAPY IN HEART FAILURE PATIENTS R.M. Delgado,1 G. Poulin,2 B. Radovancevic,1 B. Vrtovec,1 K. Albright,2 B. Kar,1 1Transplant Research, Texas Heart Institute, Houston, TX; 2Heart Failure Department, St. Luke’s Episcopal Hospital, Houston, TX Background: Heart failure is associated with tissue hypoperfusion and altered regulation of body temperature. We sought to investigate clinical and prognostic correlates of low body temperature (LBT) in heart failure patients in a specialized heart failure clinic. Methods: We measured body temperature in 148 consecutive outpatients with heart failure who displayed no evidence of local or systemic infection and recorded in CHFManager™ (BRIDGE Information Technologies), a specialized database for heart failure patient management. Body temperature was measured in a standard oral fashion with a PRO 200V2 Dinamap® (General Electric) thermometer. Low body temperature was arbitrarily defined as a body temper-
Abstracts
S131
273 CHANGE IN PLASMA BRAIN NATRIURETIC PEPTIDE IS A STRONG PREDICTOR OF PROGNOSIS IN PATIENTS WITH ADVANCED HEART FAILURE AWAITING FOR CARDIAC TRANSPLANTATION C. Campana,1 M. Pasotti,1 R. Albertini,2 S. Ghio,1 C. Klersy,3 L. Tavazzi,1 1Cardiology, Policlinico San Matteo, Pavia, Italy; 2 Laboratory of Clinical Chemistry, Policlinico San Matteo, Pavia, Italy; 3Biometry and Clinical Epidemiology, Policlinico San Matteo, Pavia, Italy
272 CHARACTERISTICS OF PATIENTS WITH STAGE D HEART FAILURE: INITIAL REPORT FROM THE ACUTE DECOMPENSATED HEART FAILURE NATIONAL REGISTRY LONGITUDINAL MODULE (ADHERE®-LM) C.W. Yancy,1 G.C. Fonarow,2 The ADHERE Scientific Advisory Committee,3 1Cardiology, UT Southwestern Medical Center, Dallas, TX; 2Cardiology, UCLA, Los Angeles, CA; 3Medical Affairs, Scios Inc., Fremont, CA Background: Patients (pts) with stage D heart failure (HF) are ill-defined, have few evidenced-based adjunctive treatment options beyond ventricular replacement strategies, and have poor outcomes. Data are needed to define the demographics, natural history, clinical status, and current treatment modes. ADHERE®-LM targets pts with severe HF on standard medical therapy. Registry objectives are to assess disease progression, describe best treatment practices, and measure outcomes. Methods: 2250 pts with NYHA class III/IV HF and multiple prior hospitalizations are targeted at 75 centers for a 2 year serial follow-up. Measured variables include quality of life and clinical/resource utilization endpoints. Results: Since July 2003, 663 pts have been enrolled. Mean age: 69 years; 67% male; 82% white/15% black/2% Hispanic. Past clinical history: smoking (54%), diabetes (50%), anemia (34%), CAD (73%), HTN (71%), s/p MI (52%), CABG (48%), PCI (25%), dilated CM (12%), pacemaker (39%), and ICD (32%). Mean LVEF: 27.7 ⫾ 13.0%; median QRS: 128 msec. 26% of pts had SCr ⬎2.0 mg/dL (mean 1.8 ⫾ 1.0 mg/dL); median BUN: 37 mg/dL and median BNP: 797 pg/mL. See Table for clinical status and therapy. Initial Clinical Status and Therapy Within 6 Months of Enrollment Fatigue Dyspnea on exertion Edema Jugular venous distension Oral diuretics* ACE inhibitors/ARBs* Beta-blockers* Digoxin* Inotopes Nesiritide
70% 76% 54% 27% 95% 50%/18% 78% 52% 34% 71%
*Therapy received within the last 30 days of enrollment
Conclusions: Severe HF pts are characterized by a high likelihood of CAD, HTN, prolonged QRS, and highly variable LVEF. Comorbidities, including renal insufficiency, anemia, and diabetes are common. There is substantial exposure to device therapy, inotropes, and natriuretic peptides. It is hoped that longitudinal data from this registry will identify best practices and help develop effective strategies for these high-risk pts.
Background: Aim of the study was to assess the prognostic role of change in brain natriuretic peptide (BNP) measured at first evaluation and during follow-up in patients (pts) with advanced heart failure (HF) awaiting for heart transplantation (HTx). Methods and Results: Eighty-nine pts [mean age 50⫾11 years (yr), 84% males] with advanced HF underwent a clinical and instrumental evaluation to assess eligibility to HTx waiting list; 45 pts were in NYHA class III, 44 in NYHA IV, mean left ventricular ejection fraction was 20⫾5%. Etiology was: ischemic heart disease (42 pts), dilated cardiomyopathy (41 pts), valvular (6 pts). Cardiac index was 1.85⫾0.49 l/min/m2, mean pulmonary arterial pressure 32⫾12 mmHg, pulmonary wedge pressure 23.5⫾8.9 mmHg, right atrial pressure 7.4⫾5.1 mmHg and right ventricular ejection fraction 18⫾10%. BNP was measured both at baseline and at 6 months using ADVIA BNP assay. Median baseline BNP level was 809 pg/ml (IQR 358 –1300 pg/ml); BNP measurements were dicotomized as ⬎ versus ⱕ996 pg/ml which turned out to be the optimal cut-off to discriminate NYHA III and IV [area under the ROC curve 0.82 (95%CI 0.73– 0.90), sensitivity 71.1% (95%CI 55.7– 83.6), specificity 86.4 (95%CI 72.6 –94.8)]. Changes in BNP at 6 months were dicotomized as any increase vs decrease/no change. After a median follow-up of 13.6 months (IQR 6.4 –26.5) the event (death, urgent HTx, cardiac assist device implantation) rate per 100 pts/yr was 9.4 (95%CI 5.1–17.5) in pts with BNP ⱕ 996 pg/ml and 35.5 (95%CI21.4 –58.8) in those with BNP ⬎ 996 pg/ml. The event rate per 100 pts/yr was even higher in presence of a BNP increase at six months [44.4 (95% CI 26.8 –73.7)] than in presence of decrease/no change in BNP [8.8 (95%CI 4.8 –16.5)]. Conclusions: In pts with advanced HF a further increase of BNP levels during follow-up is a strong predictor of events.
274 BODY TEMPERATURE LESS THAN 97.0 DEGREES FAHRENHEIT IS ASSOCIATED WITH INCREASED B-TYPE NATRIURETIC PEPTIDE AND WORSE RESPONSE TO THERAPY IN HEART FAILURE PATIENTS R.M. Delgado,1 G. Poulin,2 B. Radovancevic,1 B. Vrtovec,1 K. Albright,2 B. Kar,1 1Transplant Research, Texas Heart Institute, Houston, TX; 2Heart Failure Department, St. Luke’s Episcopal Hospital, Houston, TX Background: Heart failure is associated with tissue hypoperfusion and altered regulation of body temperature. We sought to investigate clinical and prognostic correlates of low body temperature (LBT) in heart failure patients in a specialized heart failure clinic. Methods: We measured body temperature in 148 consecutive outpatients with heart failure who displayed no evidence of local or systemic infection and recorded in CHFManager™ (BRIDGE Information Technologies), a specialized database for heart failure patient management. Body temperature was measured in a standard oral fashion with a PRO 200V2 Dinamap® (General Electric) thermometer. Low body temperature was arbitrarily defined as a body temper-