- Email: [email protected]
Clinical Scenarios Based on Initial Systolic Blood Pressure Predict Effects of Noninvasive Positive Pressure Ventilation in Acute Heart Failure Syndromes
S164 Journal of Cardiac Failure Vol. 16 No. 9S September 2010 Conclusions: NHF had higher AF and HHA prevalence. Comorbidity of AF and HHA might be substantial determinants for beta-blocker use in Japanese HF patients. Table
Age (years) Male (%) Hypertension (%) Diabetes mellitus (%) Atrial fibrillation (%) Ventricular tachycardia (%) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Heart rate (beats/min) NYHA class History of HF admission (%) ACE inhibitor (%) ARB (%) Calcium channel antagonist (%) Loop diuretics (%) Spironolactone (%) LVDd (mm) LVEF (%) Hemoglobin (g/dl) Blood uria nitrogen (mg/dl) Creatinine (mg/dl) Brain natriuretic peptide (pg/dl) Carvedilol dose (mg/day)
IHF (N5673)
NHF (N5846)
P value
68.9 6 11.0 78.3 77.3 35.6 17 8.9 123.6 6 19.3 71.4 6 11.8 69.8 6 13.1 2.0 6 0.6 45.9 53.7 31.3 31.7 50.6 26.7 55.3 6 8.9 50.9 6 15.5 13.0 6 2.3 21.0 6 11.4 1.2 6 1.0 230 6 293 6.9 6 4.8
63.9 6 13.3 65.8 66.3 22.5 43 11.6 122.9 6 20.8 72.8 6 13.7 73.5 6 15.7 2.0 6 0.5 58.5 54.8 30.3 24.9 67.5 36.1 55.5 6 10.1 49.8 6 15.9 13.5 6 2.0 20.3 6 11.6 1.0 6 0.7 235 6 328 8.165.3
!0.001 !0.001 !0.001 !0.001 !0.001 0.241 !0.001 !0.001 !0.001 !0.001 !0.001 0.679 0.696 0.003 !0.001 !0.001 0.635 0.211 !0.001 0.251 0.001 0.742 !0.001
* HF: heart failure, ACE: angiotensin-converting enzyme, ARB: angiotensin receptor blocker, LVDd: left ventricular diastolic diameter, LVEF: left venticular ejection fraction
094 Corrected Transposition of the Great Arteries, Dextrocardia, Situs Inversus and Atrial Septal Defect in a 75-Year-Old Man TOMOYO SUGIYAMA1, SHIGEKI KIMURA1, MASAHIRO SEKIGAWA1, JUN NARUMI2, RYOKO AZUMA1, GO HARAGUCHI1, HIROSHI INAGAKI1, HITOSHI HACHIYA1, KENZO HIRAO1, MITSUAKI ISOBE1 1 Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 2 Department of Clinical Laboratory, University Hospital, Faculty of Medicine, Tokyo Medical and Dental University A 75-year-old male with a prior diagnosis of dextrocardia was admitted to our hospital because of shortness of breath and lower extremity edema. Chest x-ray showed cardiomegaly and pleural effusion. His functional status was New York Heart Association (NYHA) class III. Electrocardiogram showed paroxysmal atrial fibrillation. Echocardiography showed that the aorta originated from the morphological right ventricle (RV) that was identified by its muscle trabeculation, and the pulmonary trunk arose from the morphological left ventricle. Systemic ventricle (morphological RV) dilatation and severe tricuspid valve regurgitation with pulmonary hypertension were also detected. Three-dimensional transthoracic echocardiography and transesophageal echocardiography revealed the existence of the atrial septal defect (ASD) with left-to-right shunt. He was treated with diuretics, carperitide and amiodalone. Right heart catheterization showed a step-up in the oxygen saturation in the right atrium, and pulmonary to systemic flow ratio (Qp/Qs) of 4.91. Heart failure was thought to be caused by the systemic ventricle dysfunction and ASD shunt. Therefore, he underwent atrioventricular (tricuspid) valve replacement, aortic valve replacement, patch closure for the ASD, and pacemaker lead implantation providing for the incidence of atrioventricular block. His clinical course was uneventful after the operation and his NYHA class was improved to I. We observed a case of newly diagnosed corrected transposition of the great arteries with dextrocardia, situs inversus and ASD in his eighth decade.
095 Clinical Scenarios Based on Initial Systolic Blood Pressure Predict Effects of Noninvasive Positive Pressure Ventilation in Acute Heart Failure Syndromes SHOGO OISHI, HIROYUKI YOKOYAMA, MASATAKA WATANABE, KENICHI SEKIGUCHI, MASAFUMI KITAKAZE, HITONOBU TOMOIKE National Cerebral and Cardiovascular Center Hospital, Osaka, Japan Background: A recommendation for early in-hospital management of patients with acute heart failure syndromes (AHFS) based on an unique clinical scenarios (CS) considering the initial systolic blood pressure (sBP) was recently proposed. According to CS, noninvasive positive pressure ventilation (NPPV) is recommended for patients whose sBP over 90mmHg. However, the relationship between the outcome of
NPPV and initial sBP was unknown. Purpose and Methods: We aimed to examine the outcome of NPPV based on CS. National CardiovAScular Center Acute Decompensated Heart Failure (nCASCADE) database is a single-center registry designed to collect and analyze data of AHFS. 631 patients (male 238, aged 73614yr) were enrolled and divided into 3 groups according to sBP at presentation and compared the effect of NPPV. Patients with SBPO140mmHg belonged to CS1, SBP 100140mmHg to CS2, and SBP!100mmHg to CS3. Results: Patients were classified into 3 groups (CS1: n5281, CS2: n5277, CS3: n573). NPPV was used for 20%, 11%, and 10% in each group. Among them, 7%, 0%, and 13% of patients were finally intubated. Patients who intubated showed lower hemoglobin level, and showed slower heart rate in CS3 than those who recovered with NPPV. Conclusion: Our data demonstrated that different factors contributed to the failure in NPPV treatment in CS, suggesting that whole oxygen delivery is important in the early phase management of AHFS.
096 Comparison of the Long-term Effects of Losartan vs. Losartan/ Hydrochlorothiazide in Patients With Hypertension MASAYUKI YAMAJI, TAKAYOSHI TSUTAMOTO, CHIHO KAWAHARA, KEIZO NISHIYAMA, HIROSHI SAKAI, MASANORI FUJII, TAKASHI YAMAMOTO, MINORU HORIE Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan Background: Aldosterone (ALD) breakthrough generally occurs and is an important issue during long-term treatment with angiotensin receptor blockers (ARB). However, long-term effects of ARB with hydrochlorothiazide on plasma levels of ALD and left ventricular mass index (LVMI) remain unknown in patients with hypertension. Methods: Forty-eight stable outpatients with essential hypertension who had received amlodipine for more than one year were randomized to two groups [amlodipine was changed to losartan (L) (n524) or losartan/hydrochlorothiazide (L/H) (n524)]. Results: There was no difference in the baseline characteristics including LVMI and plasma levels of ALD between the two groups. The change of systolic blood pressure was significant greater in patients with L/H compared with patients with L (-12 vs. 0.3mmHg, p!0.001). There was no change of LVMI in patients with L (108 vs. 107g/m2) but LVMI was significantly decreased in patients with L/H after 18 months (111 vs. 104g/m2, p!0.01). Plasma BNP level was significantly decreased in patients with L/H (51 vs. 32pg/mL, p!0.01), but not in patients with L. During 18 months, the incidence of ALD breakthrough was 37% (n59) in patients with L and 8% (n52) in patients with L/H, respectively (p!0.05). Conclusions: These findings indicate that losartan with hydrochlorothiazide is more useful for management of patients with hypertension or heart failure than losartan.
097 The Disruption of Natural Killer T Cell Receptor Exacerbates Post-Infarct Heart Failure in Mice MOCHAMAD ALI SOBIRIN1, SHINTARO KINUGAWA1, TAISUKE ONO1, KAGAMI HIRABAYASHI1, TADASHI SUGA1, TAKASHI YOKOTA1, NAOKI ISHIMORI1, KAZUYA IWABUCHI2, HIROYUKI TSUTSUI1 1 Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan, 2Division of Immunobiology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan Background: Natural killer T !NKTO cells play an important role in tissue inflammation in various diseases due to their capacity to produce inflammatory cytokines and orchestrate tissue inflammation. Our previous study demonstrated that the activation of NKT cells attenuated the development of heart failure !HFO after myocardial infarction !MIO, which was mediated by the enhanced expression of interleukin-10. We, thus, hypothesized that the disruption of NKT cell receptor could exacerbate HF after MI in mice. Methods and Results: MI was created in male C57BL/6J and NKT cell receptor knockout !KOO mice, and sham operation was also performed. Sham, KO+sham, MI, and KO+MI, were studied, and observed for 28 days. Left ventricular !LVO end-diastolic dimension was greater, and LV fractional shortening was smaller in KO+MI than MI, although infarct size was comparable. LV end-diastolic pressure and lung weight/body weight in KO+MI were higher than those in MI. In parallel to the disruption of NKT cell receptor, tumor necrosis factor-a mRNA expression was significantly decreased, and interestingly interleukin-10 mRNA expression was completely abolished in non-infarcted area of LV in KO+MI compared to MI. In contrast, there were no significant changes in monocyte chemoattractant protein-1 and macrophage marker F4/80 mRNA expression. Conclusions: The disruption of NKT cell receptor exacerbated the development of HF after MI through the diminished expression of cardioprotective cytokine, interleukin-10.
Age (years) Male (%) Hypertension (%) Diabetes mellitus (%) Atrial fibrillation (%) Ventricular tachycardia (%) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Heart rate (beats/min) NYHA class History of HF admission (%) ACE inhibitor (%) ARB (%) Calcium channel antagonist (%) Loop diuretics (%) Spironolactone (%) LVDd (mm) LVEF (%) Hemoglobin (g/dl) Blood uria nitrogen (mg/dl) Creatinine (mg/dl) Brain natriuretic peptide (pg/dl) Carvedilol dose (mg/day)
IHF (N5673)
NHF (N5846)
P value
68.9 6 11.0 78.3 77.3 35.6 17 8.9 123.6 6 19.3 71.4 6 11.8 69.8 6 13.1 2.0 6 0.6 45.9 53.7 31.3 31.7 50.6 26.7 55.3 6 8.9 50.9 6 15.5 13.0 6 2.3 21.0 6 11.4 1.2 6 1.0 230 6 293 6.9 6 4.8
63.9 6 13.3 65.8 66.3 22.5 43 11.6 122.9 6 20.8 72.8 6 13.7 73.5 6 15.7 2.0 6 0.5 58.5 54.8 30.3 24.9 67.5 36.1 55.5 6 10.1 49.8 6 15.9 13.5 6 2.0 20.3 6 11.6 1.0 6 0.7 235 6 328 8.165.3
!0.001 !0.001 !0.001 !0.001 !0.001 0.241 !0.001 !0.001 !0.001 !0.001 !0.001 0.679 0.696 0.003 !0.001 !0.001 0.635 0.211 !0.001 0.251 0.001 0.742 !0.001
* HF: heart failure, ACE: angiotensin-converting enzyme, ARB: angiotensin receptor blocker, LVDd: left ventricular diastolic diameter, LVEF: left venticular ejection fraction
094 Corrected Transposition of the Great Arteries, Dextrocardia, Situs Inversus and Atrial Septal Defect in a 75-Year-Old Man TOMOYO SUGIYAMA1, SHIGEKI KIMURA1, MASAHIRO SEKIGAWA1, JUN NARUMI2, RYOKO AZUMA1, GO HARAGUCHI1, HIROSHI INAGAKI1, HITOSHI HACHIYA1, KENZO HIRAO1, MITSUAKI ISOBE1 1 Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 2 Department of Clinical Laboratory, University Hospital, Faculty of Medicine, Tokyo Medical and Dental University A 75-year-old male with a prior diagnosis of dextrocardia was admitted to our hospital because of shortness of breath and lower extremity edema. Chest x-ray showed cardiomegaly and pleural effusion. His functional status was New York Heart Association (NYHA) class III. Electrocardiogram showed paroxysmal atrial fibrillation. Echocardiography showed that the aorta originated from the morphological right ventricle (RV) that was identified by its muscle trabeculation, and the pulmonary trunk arose from the morphological left ventricle. Systemic ventricle (morphological RV) dilatation and severe tricuspid valve regurgitation with pulmonary hypertension were also detected. Three-dimensional transthoracic echocardiography and transesophageal echocardiography revealed the existence of the atrial septal defect (ASD) with left-to-right shunt. He was treated with diuretics, carperitide and amiodalone. Right heart catheterization showed a step-up in the oxygen saturation in the right atrium, and pulmonary to systemic flow ratio (Qp/Qs) of 4.91. Heart failure was thought to be caused by the systemic ventricle dysfunction and ASD shunt. Therefore, he underwent atrioventricular (tricuspid) valve replacement, aortic valve replacement, patch closure for the ASD, and pacemaker lead implantation providing for the incidence of atrioventricular block. His clinical course was uneventful after the operation and his NYHA class was improved to I. We observed a case of newly diagnosed corrected transposition of the great arteries with dextrocardia, situs inversus and ASD in his eighth decade.
095 Clinical Scenarios Based on Initial Systolic Blood Pressure Predict Effects of Noninvasive Positive Pressure Ventilation in Acute Heart Failure Syndromes SHOGO OISHI, HIROYUKI YOKOYAMA, MASATAKA WATANABE, KENICHI SEKIGUCHI, MASAFUMI KITAKAZE, HITONOBU TOMOIKE National Cerebral and Cardiovascular Center Hospital, Osaka, Japan Background: A recommendation for early in-hospital management of patients with acute heart failure syndromes (AHFS) based on an unique clinical scenarios (CS) considering the initial systolic blood pressure (sBP) was recently proposed. According to CS, noninvasive positive pressure ventilation (NPPV) is recommended for patients whose sBP over 90mmHg. However, the relationship between the outcome of
NPPV and initial sBP was unknown. Purpose and Methods: We aimed to examine the outcome of NPPV based on CS. National CardiovAScular Center Acute Decompensated Heart Failure (nCASCADE) database is a single-center registry designed to collect and analyze data of AHFS. 631 patients (male 238, aged 73614yr) were enrolled and divided into 3 groups according to sBP at presentation and compared the effect of NPPV. Patients with SBPO140mmHg belonged to CS1, SBP 100140mmHg to CS2, and SBP!100mmHg to CS3. Results: Patients were classified into 3 groups (CS1: n5281, CS2: n5277, CS3: n573). NPPV was used for 20%, 11%, and 10% in each group. Among them, 7%, 0%, and 13% of patients were finally intubated. Patients who intubated showed lower hemoglobin level, and showed slower heart rate in CS3 than those who recovered with NPPV. Conclusion: Our data demonstrated that different factors contributed to the failure in NPPV treatment in CS, suggesting that whole oxygen delivery is important in the early phase management of AHFS.
096 Comparison of the Long-term Effects of Losartan vs. Losartan/ Hydrochlorothiazide in Patients With Hypertension MASAYUKI YAMAJI, TAKAYOSHI TSUTAMOTO, CHIHO KAWAHARA, KEIZO NISHIYAMA, HIROSHI SAKAI, MASANORI FUJII, TAKASHI YAMAMOTO, MINORU HORIE Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan Background: Aldosterone (ALD) breakthrough generally occurs and is an important issue during long-term treatment with angiotensin receptor blockers (ARB). However, long-term effects of ARB with hydrochlorothiazide on plasma levels of ALD and left ventricular mass index (LVMI) remain unknown in patients with hypertension. Methods: Forty-eight stable outpatients with essential hypertension who had received amlodipine for more than one year were randomized to two groups [amlodipine was changed to losartan (L) (n524) or losartan/hydrochlorothiazide (L/H) (n524)]. Results: There was no difference in the baseline characteristics including LVMI and plasma levels of ALD between the two groups. The change of systolic blood pressure was significant greater in patients with L/H compared with patients with L (-12 vs. 0.3mmHg, p!0.001). There was no change of LVMI in patients with L (108 vs. 107g/m2) but LVMI was significantly decreased in patients with L/H after 18 months (111 vs. 104g/m2, p!0.01). Plasma BNP level was significantly decreased in patients with L/H (51 vs. 32pg/mL, p!0.01), but not in patients with L. During 18 months, the incidence of ALD breakthrough was 37% (n59) in patients with L and 8% (n52) in patients with L/H, respectively (p!0.05). Conclusions: These findings indicate that losartan with hydrochlorothiazide is more useful for management of patients with hypertension or heart failure than losartan.
097 The Disruption of Natural Killer T Cell Receptor Exacerbates Post-Infarct Heart Failure in Mice MOCHAMAD ALI SOBIRIN1, SHINTARO KINUGAWA1, TAISUKE ONO1, KAGAMI HIRABAYASHI1, TADASHI SUGA1, TAKASHI YOKOTA1, NAOKI ISHIMORI1, KAZUYA IWABUCHI2, HIROYUKI TSUTSUI1 1 Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan, 2Division of Immunobiology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan Background: Natural killer T !NKTO cells play an important role in tissue inflammation in various diseases due to their capacity to produce inflammatory cytokines and orchestrate tissue inflammation. Our previous study demonstrated that the activation of NKT cells attenuated the development of heart failure !HFO after myocardial infarction !MIO, which was mediated by the enhanced expression of interleukin-10. We, thus, hypothesized that the disruption of NKT cell receptor could exacerbate HF after MI in mice. Methods and Results: MI was created in male C57BL/6J and NKT cell receptor knockout !KOO mice, and sham operation was also performed. Sham, KO+sham, MI, and KO+MI, were studied, and observed for 28 days. Left ventricular !LVO end-diastolic dimension was greater, and LV fractional shortening was smaller in KO+MI than MI, although infarct size was comparable. LV end-diastolic pressure and lung weight/body weight in KO+MI were higher than those in MI. In parallel to the disruption of NKT cell receptor, tumor necrosis factor-a mRNA expression was significantly decreased, and interestingly interleukin-10 mRNA expression was completely abolished in non-infarcted area of LV in KO+MI compared to MI. In contrast, there were no significant changes in monocyte chemoattractant protein-1 and macrophage marker F4/80 mRNA expression. Conclusions: The disruption of NKT cell receptor exacerbated the development of HF after MI through the diminished expression of cardioprotective cytokine, interleukin-10.