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Clinical Characteristics of Chronic Obstructive Pulmonary Disease in Patients with Acute Decompensated Heart Failure: A Single-Center Prospective Observational Study
S166 Journal of Cardiac Failure Vol. 21 No. 10S October 2015 OP5-5
OP6-3
Poor Flow-Mediated Dilation of Brachial Artery in Heart Transplant Recipients is Associated with Severity of Transplant Coronary Arterial Vasculopathy TAKUYA WATANABE, OSAMU SEGUCHI, TOMOYUKI FUJITA, MASANOBU YANASE, KUNIHIRO NISHIMURA, HIROKI HATA, YOSHIHIRO MIYAMOTO, NORIHIDE FUKUSHIMA, JUNJIRO KOBAYASHI, TAKESHI NAKATANI National Cerebral and Cardiovascular Center
Impact of Periodic Leg Movements during Sleep on Prognosis in Hospitalized Patients Following Acute Decompensated Heart Failure SHOICHIRO YATSU1, TAKATOSHI KASAI1,2, SHOKO SUDA1,2, HIROKI MATSUMOTO1,2, AZUSA MURATA1, TAKAO KATO1, MASARU HIKI1, KATSUMI MITAUCHI1, HIROYUKI DAIDA1 1 Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan; 2 Cardio Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
Background: Peripheral endothelial dysfunction (PED) assessed by flow mediated dilation (FMD) of brachial artery (BA) is known to be observed in patients with heart failure. It is still controversial whether heart transplantation (HTx) improve the PED. And clinical implication of peripheral endothelial function in heart transplant recipients is also unknown. Objective: Our aim was to investigate the association between FMD and severity of transplant coronary arterial vasculopathy (TCAV). Methods: This was a cross-sectional study. Forty three recipients underwent the measurements of FMD of the BA at mean 5.3 years after HTx, as well as intravascular ultrasounds (IVUS) examinations of coronary arteries (CA). Main underlying disease was nonischemic cardiomyopathy (95.3%). Associations between FMD of BA and volumetric IVUS data in TCAV were evaluated. PED was determined by FMD of BA lower than 7.0%. Results: Median FMD was 7.6% (interquartile range [IQR]; 5.210.7%). Impaired FMD was significantly associated with past smoking and low left ventricular ejection fraction after HTx (p50.005 and 0.018). Twenty recipients (46.5%) had PED. Recipients with PED had greater percent plaque volume (plaque volume/vessel volume 100%) of CA than those without PED (22.8 6 13.7 vs 11.7 6 7.2%, p50.002). PED was an independent predictor for severe TCAV (odds ratio 12.0, 95% CI 1.7-86.3, p50.013). Conclusions: PED was associated with severity of TCAV.
OP6-1 Predictors of Hyperactive Delirium Within 24-Hours after Hospitalization for Acute Heart Failure TAKATUSGU SEGAWA Kure Medical Center Background and Aims: Delirium has been reported to increase the mortality in patients with acute heart failure (AHF). However, risk factors for delirium that occurs shortly after hospitalization for AHF have not been fully investigated. Here, we aimed to reveal predictors of hyperactive delirium within 24 hours after hospitalization for AHF. Methods: The subjects were 287 patients with AHF who were delivered to cardiac intensive care unit (CCU) in our hospital. We retrospectively surveyed the incidence of hyperactive delirium, the backgrounds of AHF patients, treatments, in-hospital mortality, and duration of CCU stay. Results: Incidence rate of hyperactive delirium was 11.9%. There was no significant difference in killip class, and intravenous treatment between in those with and without hyperactive delirium. In univariate analysis, age, systolic blood pressure (sBP) on admission, BNP, BUN, SGA, total lymphocyte count (TLC) were significantly associated with the incidence of hyperactive delirium. Multivariate analysis revealed that age, sBP on admission and TLC were independent predictors of hyperactive delirium (p50.017, 0.003 and 0.03). Those with hyperactive delirium showed higher inhospital mortality, and longer CCU stay. Conclusions: The elderly patients with low sBP and undernutrition may be susceptible to hyperactive delirium. Those presenting hyperactive delirium within 24 hours after hospitalization may be at high risk for prolonged CCU stay and in-hospital death.
OP6-2 Clinical Characteristics of Chronic Obstructive Pulmonary Disease in Patients with Acute Decompensated Heart Failure: A Single-Center Prospective Observational Study RIKA KAWAKAMI, YASUKI NAKADA, TOMOYA UEDA, YUKIJI TAKEDA, HIROYUKI KAWATA, HIROYUKI OKURA, YOSHIHIKO SAITO First Department of Internal Medicine, Nara Medical University Background: We aimed to examine the impact of COPD in patients with acute decompensated heart failure (ADHF), and to characterize their clinical characteristics and medical management. Methods: This study was prospective prognostic study performed as part of screening for NARAHF2 study. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by spirometry. COPD was defined as FEV1/FVC!70% or self-reported COPD based on medical history and/or all available clinical data. Result: Among a total 202 patients, 29.7% (n560) had COPD and 10.4% (n521) had selfreported COPD. Of the patients with ADHF+COPD (n560), only 12 patients (20.0%) were treated with bronchodilators on admission. Patients with ADHF+COPD were significantly older (77.0 vs. 71.0 years, p!0.001), more frequently male (73.3 vs. 57.8%, p!0.05), had a higher prevalence of current or past smoking (p!0.001), and had a higher history of previous HF admission (p!0.05) compared to patients with ADHF only. On exam, 146 patients (72.6%) were treated with beta-blockers at discharge, with no difference in prescription rate between ADHF+COPD and ADHF only patients (p50.841). In patients with ADHF+COPD, bisoprolol was more frequently prescribed but this difference did not reach statistical significance (p50.291). Conclusions: COPD is frequent in patients with ADHF but 20% of patients were treated with bronchodilators. Cardiologists should take care of respiratory function in patients with ADHF.
Introduction: Periodic leg movements during sleep (PLM), regularly recurring movements of the legs during sleep, cause frequent arousal and intermittent elevations of blood pressure and heart rate. One study showed that PLM disorder (PLMD) was associated with increased mortality in patients with chronic heart failure. However, clinical significance of PLMD in hospitalized patients following acute decompensated heart failure (ADHF) remains unknown. Methods: After the initial improvement of acute signs and symptoms of ADHF, we performed polysomnography on consecutive patients who were left ventricular ejection fraction (LVEF) ! 50%, and were hospitalized due to ADHF between 2012 and 2014. PLMD was defined as PLM index S 25 that we thought was moderate-to-severe PLM. The risks for composite of all-cause mortality and re-hospitalization, were assessed by stepwise multivariable Cox proportional model including variables showing P!0.15 in univariate analyses. Results: Overall, 94 patients were enrolled. PLMD was found in 24 patients (26%). At a median follow-up of 5.2 months, 30 patients had an episode of rehospitalization and/or death (32%). In the multivariable analysis, presence of PLMD was significantly associated with increased risk of rehospitalization and/or mortality (hazard ratio, 2.34; P50.024) independent from hemoglobin level and severity of sleep disordered breathing. Conclusion: Presence of PLMD was independently associated with increased risk of rehospitalization and/or mortality even in hospitalized patient following ADHF.
OP6-4 Diversity of Clinical Courses in Patients with Acute Decompensated Heart Failure and Cold DAISHI NAKAGAWA, YOSHIHIRO SEO, YOSHIE HARIMURA, AKINORI SUGANO, MASAYOSHI YAMAMOTO, TOMOKO ISHIZU, KAZUTAKA AONUMA Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan Background: The Nohria classification has been widely used in assessing acute decompensated heart failure (ADHF), during which left ventricular (LV) function would be dramatically changed. The aim of this study was to identify the clinical courses in patients with ADHF and cold. Methods: We prospectively enrolled 540 ADHF patients (339male, 72613yrs). Changes of LV ejection fraction (D LVEF) were calculated as differences between on admission and at discharge, which was used as a surrogate of LV functional changes. Results: Among 540 patients, 102 had cold on admission. In hospital death was more prevalent in the cold group compared to the warm group (8.8% vs. 3.4%, p50.01). On the other hands, in the alive group, D LVEF was significantly higher in the cold group compared to the warm group (10.4% vs. 5.9%, p!0.0001). The alive group was divided into four groups based on LVEF on admission and at discharge using a cut-off point LVEF 50% at discharge (persistent preserved EF, worsened EF, recovered EF, and persistent low EF groups; 23%, 5%, 16%, 56%). In particular, the rate of patients with cold was more prevalent in recovered EF group compared to other groups (23.5% vs. 12.5%, p50.04). Conclusions: Patients with cold had poor prognosis, whereas cold was associated with LV functional recovery at discharge.
OP7-1 Transcatheter Aortic Valve Implantation to Low-Flow Low-Gradient Aortic Stenosis RYOSUKE HIGUCHI1, TETSUYA TOBARU1, KEITARO MAHARA1, KAZUHIRO NAITO2, JUN SHIMIZU3, ITARU TAKAMISAWA1, NOBUO IGUCHI1, SHUICHIRO TAKANASHI2, TSUTOMU TOSHIKAWA1, MORIMASA TAKAYAMA1 1 Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; 2Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan; 3Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan Transcatheter aortic valve implantation (TAVI) is recommended as a therapeutic option for inoperable or high surgical risk patients with severe aortic stenosis. It has been reported that TAVI improves poor prognosis of aortic stenosis as well as surgical aortic valve replacement. Although aortic stenosis is severe, some patients show low transvalvular pressure gradient due to low cardiac function. We describe an 87-yearold female who underwent TAVI in our hospital. She had old cerebral infarction with internal carotid artery stenosis and chronic kidney disease. She admitted our hospital due to congestive heart failure. Cineangiography proved severe stenosis of proximal left anterior descending artery, while echocardiography showed reduced systolic function and aortic stenosis (ejection fraction 38%, aortic valve area 0.77 cm2, peak transvalvular pressure gradient 47 mmHg). To evaluate whether aortic stenosis
OP6-3
Poor Flow-Mediated Dilation of Brachial Artery in Heart Transplant Recipients is Associated with Severity of Transplant Coronary Arterial Vasculopathy TAKUYA WATANABE, OSAMU SEGUCHI, TOMOYUKI FUJITA, MASANOBU YANASE, KUNIHIRO NISHIMURA, HIROKI HATA, YOSHIHIRO MIYAMOTO, NORIHIDE FUKUSHIMA, JUNJIRO KOBAYASHI, TAKESHI NAKATANI National Cerebral and Cardiovascular Center
Impact of Periodic Leg Movements during Sleep on Prognosis in Hospitalized Patients Following Acute Decompensated Heart Failure SHOICHIRO YATSU1, TAKATOSHI KASAI1,2, SHOKO SUDA1,2, HIROKI MATSUMOTO1,2, AZUSA MURATA1, TAKAO KATO1, MASARU HIKI1, KATSUMI MITAUCHI1, HIROYUKI DAIDA1 1 Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan; 2 Cardio Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
Background: Peripheral endothelial dysfunction (PED) assessed by flow mediated dilation (FMD) of brachial artery (BA) is known to be observed in patients with heart failure. It is still controversial whether heart transplantation (HTx) improve the PED. And clinical implication of peripheral endothelial function in heart transplant recipients is also unknown. Objective: Our aim was to investigate the association between FMD and severity of transplant coronary arterial vasculopathy (TCAV). Methods: This was a cross-sectional study. Forty three recipients underwent the measurements of FMD of the BA at mean 5.3 years after HTx, as well as intravascular ultrasounds (IVUS) examinations of coronary arteries (CA). Main underlying disease was nonischemic cardiomyopathy (95.3%). Associations between FMD of BA and volumetric IVUS data in TCAV were evaluated. PED was determined by FMD of BA lower than 7.0%. Results: Median FMD was 7.6% (interquartile range [IQR]; 5.210.7%). Impaired FMD was significantly associated with past smoking and low left ventricular ejection fraction after HTx (p50.005 and 0.018). Twenty recipients (46.5%) had PED. Recipients with PED had greater percent plaque volume (plaque volume/vessel volume 100%) of CA than those without PED (22.8 6 13.7 vs 11.7 6 7.2%, p50.002). PED was an independent predictor for severe TCAV (odds ratio 12.0, 95% CI 1.7-86.3, p50.013). Conclusions: PED was associated with severity of TCAV.
OP6-1 Predictors of Hyperactive Delirium Within 24-Hours after Hospitalization for Acute Heart Failure TAKATUSGU SEGAWA Kure Medical Center Background and Aims: Delirium has been reported to increase the mortality in patients with acute heart failure (AHF). However, risk factors for delirium that occurs shortly after hospitalization for AHF have not been fully investigated. Here, we aimed to reveal predictors of hyperactive delirium within 24 hours after hospitalization for AHF. Methods: The subjects were 287 patients with AHF who were delivered to cardiac intensive care unit (CCU) in our hospital. We retrospectively surveyed the incidence of hyperactive delirium, the backgrounds of AHF patients, treatments, in-hospital mortality, and duration of CCU stay. Results: Incidence rate of hyperactive delirium was 11.9%. There was no significant difference in killip class, and intravenous treatment between in those with and without hyperactive delirium. In univariate analysis, age, systolic blood pressure (sBP) on admission, BNP, BUN, SGA, total lymphocyte count (TLC) were significantly associated with the incidence of hyperactive delirium. Multivariate analysis revealed that age, sBP on admission and TLC were independent predictors of hyperactive delirium (p50.017, 0.003 and 0.03). Those with hyperactive delirium showed higher inhospital mortality, and longer CCU stay. Conclusions: The elderly patients with low sBP and undernutrition may be susceptible to hyperactive delirium. Those presenting hyperactive delirium within 24 hours after hospitalization may be at high risk for prolonged CCU stay and in-hospital death.
OP6-2 Clinical Characteristics of Chronic Obstructive Pulmonary Disease in Patients with Acute Decompensated Heart Failure: A Single-Center Prospective Observational Study RIKA KAWAKAMI, YASUKI NAKADA, TOMOYA UEDA, YUKIJI TAKEDA, HIROYUKI KAWATA, HIROYUKI OKURA, YOSHIHIKO SAITO First Department of Internal Medicine, Nara Medical University Background: We aimed to examine the impact of COPD in patients with acute decompensated heart failure (ADHF), and to characterize their clinical characteristics and medical management. Methods: This study was prospective prognostic study performed as part of screening for NARAHF2 study. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by spirometry. COPD was defined as FEV1/FVC!70% or self-reported COPD based on medical history and/or all available clinical data. Result: Among a total 202 patients, 29.7% (n560) had COPD and 10.4% (n521) had selfreported COPD. Of the patients with ADHF+COPD (n560), only 12 patients (20.0%) were treated with bronchodilators on admission. Patients with ADHF+COPD were significantly older (77.0 vs. 71.0 years, p!0.001), more frequently male (73.3 vs. 57.8%, p!0.05), had a higher prevalence of current or past smoking (p!0.001), and had a higher history of previous HF admission (p!0.05) compared to patients with ADHF only. On exam, 146 patients (72.6%) were treated with beta-blockers at discharge, with no difference in prescription rate between ADHF+COPD and ADHF only patients (p50.841). In patients with ADHF+COPD, bisoprolol was more frequently prescribed but this difference did not reach statistical significance (p50.291). Conclusions: COPD is frequent in patients with ADHF but 20% of patients were treated with bronchodilators. Cardiologists should take care of respiratory function in patients with ADHF.
Introduction: Periodic leg movements during sleep (PLM), regularly recurring movements of the legs during sleep, cause frequent arousal and intermittent elevations of blood pressure and heart rate. One study showed that PLM disorder (PLMD) was associated with increased mortality in patients with chronic heart failure. However, clinical significance of PLMD in hospitalized patients following acute decompensated heart failure (ADHF) remains unknown. Methods: After the initial improvement of acute signs and symptoms of ADHF, we performed polysomnography on consecutive patients who were left ventricular ejection fraction (LVEF) ! 50%, and were hospitalized due to ADHF between 2012 and 2014. PLMD was defined as PLM index S 25 that we thought was moderate-to-severe PLM. The risks for composite of all-cause mortality and re-hospitalization, were assessed by stepwise multivariable Cox proportional model including variables showing P!0.15 in univariate analyses. Results: Overall, 94 patients were enrolled. PLMD was found in 24 patients (26%). At a median follow-up of 5.2 months, 30 patients had an episode of rehospitalization and/or death (32%). In the multivariable analysis, presence of PLMD was significantly associated with increased risk of rehospitalization and/or mortality (hazard ratio, 2.34; P50.024) independent from hemoglobin level and severity of sleep disordered breathing. Conclusion: Presence of PLMD was independently associated with increased risk of rehospitalization and/or mortality even in hospitalized patient following ADHF.
OP6-4 Diversity of Clinical Courses in Patients with Acute Decompensated Heart Failure and Cold DAISHI NAKAGAWA, YOSHIHIRO SEO, YOSHIE HARIMURA, AKINORI SUGANO, MASAYOSHI YAMAMOTO, TOMOKO ISHIZU, KAZUTAKA AONUMA Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan Background: The Nohria classification has been widely used in assessing acute decompensated heart failure (ADHF), during which left ventricular (LV) function would be dramatically changed. The aim of this study was to identify the clinical courses in patients with ADHF and cold. Methods: We prospectively enrolled 540 ADHF patients (339male, 72613yrs). Changes of LV ejection fraction (D LVEF) were calculated as differences between on admission and at discharge, which was used as a surrogate of LV functional changes. Results: Among 540 patients, 102 had cold on admission. In hospital death was more prevalent in the cold group compared to the warm group (8.8% vs. 3.4%, p50.01). On the other hands, in the alive group, D LVEF was significantly higher in the cold group compared to the warm group (10.4% vs. 5.9%, p!0.0001). The alive group was divided into four groups based on LVEF on admission and at discharge using a cut-off point LVEF 50% at discharge (persistent preserved EF, worsened EF, recovered EF, and persistent low EF groups; 23%, 5%, 16%, 56%). In particular, the rate of patients with cold was more prevalent in recovered EF group compared to other groups (23.5% vs. 12.5%, p50.04). Conclusions: Patients with cold had poor prognosis, whereas cold was associated with LV functional recovery at discharge.
OP7-1 Transcatheter Aortic Valve Implantation to Low-Flow Low-Gradient Aortic Stenosis RYOSUKE HIGUCHI1, TETSUYA TOBARU1, KEITARO MAHARA1, KAZUHIRO NAITO2, JUN SHIMIZU3, ITARU TAKAMISAWA1, NOBUO IGUCHI1, SHUICHIRO TAKANASHI2, TSUTOMU TOSHIKAWA1, MORIMASA TAKAYAMA1 1 Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; 2Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan; 3Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan Transcatheter aortic valve implantation (TAVI) is recommended as a therapeutic option for inoperable or high surgical risk patients with severe aortic stenosis. It has been reported that TAVI improves poor prognosis of aortic stenosis as well as surgical aortic valve replacement. Although aortic stenosis is severe, some patients show low transvalvular pressure gradient due to low cardiac function. We describe an 87-yearold female who underwent TAVI in our hospital. She had old cerebral infarction with internal carotid artery stenosis and chronic kidney disease. She admitted our hospital due to congestive heart failure. Cineangiography proved severe stenosis of proximal left anterior descending artery, while echocardiography showed reduced systolic function and aortic stenosis (ejection fraction 38%, aortic valve area 0.77 cm2, peak transvalvular pressure gradient 47 mmHg). To evaluate whether aortic stenosis