Diabetes Mellitus is a Poor Prognostic Risk but Has a Therapeutic Potential for Functional Reversibility in Nonischemic Systolic Heart Failure

The 18th Annual Scientific Meeting O0.3mg/dl in serum creatinine level from baseline to follow up). All-cause mortality and renal death (fall into dialysis) were significantly higher in patients who complicated with WRF as compared without WRF. Efficacy of TLV and short-term prognosis were especially poor in end-stage renal disease patients who had the nephrotic syndrome. Conclusions: The clinical efficacy of TLV in patients with end-stage renal disease was modest, and especially in patients with nephrotic syndrome.

P-028 Renal Function Improvement in Chronic Heart Failure is Associated with Less Risk of Pump Failure Death but Not Sudden Death SATOSHI TAKAHASHI, TAKASHI MORITA, SHUNSUKE TAMAKI, MASATAKE FUKUNAMI, TAKAHISA YAMADA Division of Cardiology, Osaka General Medical Center To investigate the prognostic significance of the renal function improvement in patients with chronic heart failure (CHF), from a viewpoint of mode of death (sudden cardiac death (SCD) and pump failure death (PFD), we studied 123 CHF outpatients with LVEF!40%. Forty-nine pts had an improvement in eGFR (58615 to 64617 ml/min/1.73m2, p!0.01) at 1 year after the entry, while the remaining 74 pts had an eGFR decline (66621 to 59620ml/min/1.73m2, p!0.01). During a follow-up period of 7.464.4 years, PFD was significantly less frequently observed in pts with than without eGFR improvement, while there was no significant difference in SCD incidence between the two groups. Thus, CHF pts with eGFR improvement had less risk for PFD, while they are still at risk of SCD.



JHFS

S193

proteinuria. Results: Patients were divided into the groups with CKD (n530, 41%) and without CKD (n544, 59%). The age was 72610 and 57615 (years old), and eGFR was 4264 and 79616 (ml/min/1.73m2), respectively. The presence of traditional CVD risk factors was more evident in the patients with CKD compared to those without CKD. Serum albumin and HDL cholesterol were lower, and uric acid, fasting glucose and BNP were higher in the patients with CKD. eGFR was significantly related to age and several traditional risk factors. Conclusions: In patients with heart failure, kidney function was frequently deteriorated at admission. Aging and traditional CVD risk factors as well as impaired cardiac function may contribute to CKD in heart failure.

P-031 Effectiveness of Carperitide for Preventing Worsening Renal Function (WRF) in Patients with Heart Failure TARO SASAOKA, MIE SEYA, SHUNJI YOSHIKAWA, YASUHIRO MAEJIMA, MASAHIKO GOYA, TAKASHI ASHIKAGA, KENZO HIRAO, MITSUAKI ISOBE Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan Background: WRF is an important matter in heart failure. Some studies have demonstrated Carperitide might have a favorable effect in cardiorenal syndrome; however, the detail of its effect was not fully investigated. Method: A total of 66 non-hemodialysis patients admitted to our hospital for acute decompensated heart failure (ADHF) in 2010 and followed at 1 year were retrospectively reviewed. They were divided in 2 groups according to the Carperitide usage, Carperitide group (n541), and non-Carperitide group (n525). WRF was defined as the occurrence of both 25% increase and 0.3 mg/dL increase in serum creatinine levels during hospitalization. Result: Average dose of Carperitide was 0.026g. Left ventricular function and BNP levels at admission were not different. WRF was significantly lower in Carperitide Group (12/41, 29%) than non-Craperitide group (13/25, 52%, p!0.05). Survical rate at 1 year is tended to be lower in non-Carperitide group (85% vs 68%), but not significantly different. In Carperitide group, estimated glomerular filtration rate (eGFR) levels at admission, discharge, and 1year (45.5, 48.4, and 49.0ml/min/1.73m2, n.s.) were not significantly different. On the other hand, eGFR levels were significantly decreased at 1 year compared with admission in non-Carperitide group (62.7, 52.3, and 37.4 ml/min/ 1.73m2, p!0.05). Conclusion: In this study, Carperitide was effective to prevent WRF. Also, it had a favorable long-term renal protective effect.

P-032 P-029 The Impact of Kidney Dysfunction on Hypo-albuminemia and Cardiac Prognosis in Patients with Chronic Heart Failure YOICHIRO OTAKI, TETSU WATANABE, AKIRA FUNAYAMA, HIROKI TAKAHASHI, TAKANORI ARIMOTO, TETSURO SHISHIDO, TAKUYA MIYAMOTO, ISAO KUBOTA Yamagata University School of Medicine, Yamagata, Japan Background: Hypo-albuminemia is closely associated with poor prognosis in patients with chronic heart failure (CHF). Although kidney plays a pivotal role in excretion and reabsorption of albumin and amino acid, it remains to be fully elucidated the impact of kidney dysfunction on hypo-albuminemia in patients with CHF. The aim of the present study was to reveal the impact of kidney dysfunction on hypo-albuminemia and cardiac prognosis in patients with CHF. Methods and Results: We included consecutive 296 patients with CHF. Albuminuria and renal tubular damage (RTD) were defined as a urinary albumin to creatinine ratio (UCAR) O30mg/g and urinaryb2-microglobulin to creatinine ratio (UBCR) O300 mg/g, respectively. There was a modest correlation between kidney dysfunction and serum albumin (UACR, r50.300, P!0.0001; and UBCR, r50.434, P!0.0001). Multivariate logistic analysis showed that RTD was significantly related to hypo-albuminemia in patients with CHF after adjustment for confounding factors. During a median period of 1060 days, there were 87 cardiac events. Net reclassification index and C index were significantly improved by addition of RTD to basic risk factors. All patients were divided into 3 groups: hypo-albuminemia+RTD group, hypo-albuminaemia or RTD group, and control group. KaplanMeier analysis demonstrated that hypo-albuminemia+RTD group had the greatest risk among 3 groups. Conclusion: Kidney dysfunction, in particular RTD, is closely associated with hypo-albuminemia and could identify patients at high risk.

P-030 Chronic Kidney Disease in Hospitalized Patients with Heart Failure SATOKO NAKAMURA1, TOSHIHISA ANZAI2, YUHEI KAWANO1 1 Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan, 2Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan Background: Chronic kidney disease (CKD) and cardiovascular diseases (CVD) are related to the development of kidney impairment. However, the prevalence of CKD or kidney impairment and its consequences in hospitalized patients with CVD are not well clarified. Methods: We performed a prospective study, in which 74 consecutive patients with heart failure were enrolled. Blood and urine samples are collected at the time of hospitalization, interventions and discharge. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine and age using Japanese equation. CKD was defined by eGFR less than 60 (ml/min/1.73m2) and/or the presence of

Effects of Intensive Versus Mild Lipid Lowering with Statins in Congestive Heart Failure with Ischemic Origin HAE-YOUNG LEE1, HYUN-JAI CHO1, HEE-YUL KIM2, HEE-KYUNG JEON3, JOON HAN SHIN4, SUK-MIN KANG5, SANG HONG BAEK6 1 Seoul National University Hospital, 2The Catholic University of Korea Bucheon St.Mary’s Hospital, 3The Catholic University of Korea Uijeongbu St. Mary’s Hospital, 4Ajou University Hospital, 5Yonsei University Severance Hospital, 6The Catholic University of Korea Seoul St. Mary’s Hospital Background and Aim: As the role of statins in congestive heart failure (CHF) are still unclear, this study was designed to evaluate the dose-effect relationship of statins in ischemic CHF patients. Methods: The South koreAn Pitavastatin Heart FaIluRE Study (SAPHIRE) was designed to randomize ischemic CHF patients in pravastatin 10mg or in pitavastatin 4mg daily group. Results: 1) The LDL cholesterol level was reduced by 30% significantly greater in the pitavastatin 4mg group compared with 12% in the pravastatin 10 mg group 2) The left ventricular systolic dimensions were significantly reduced by 9% in the pitavastatin group and by 5% in the pravastatin group. The left ventricular ejections were significantly improved from 37% to 42% in the pitavastatin group and from 35% to 39% in the pravastatin group. Although the extent of the EF change was greater in the pitavastatin group (+16% vs + 11%), there was no statistical significance between two groups (p 5 0.3862). 3) The exercise capacity evaluated by 6-minute walk test was improved significantly in the pravastatin 10mg group (p 5 0.0002), however, there was no changes in the pitavastatin group (p 5 0.3707). Conclusions: In CHF patients with ischemic origin, ‘too much’ lowering of cholesterol might not be beneficial to CHF patients.

P-033 Diabetes Mellitus is a Poor Prognostic Risk but Has a Therapeutic Potential for Functional Reversibility in Nonischemic Systolic Heart Failure YUKI IKEDA, TAKAYUKI INOMATA, TEPPEI FUJITA, YUICHIRO IIDA, TAKERU NABETA, SHUNSUKE ISHII, TAKASHI NARUKE, HISAHITO SHINAGAWA, TOSHIMI KOITABASHI, JUNYA AKO Department of Cardiovascular Medicine, Kitasato University School of Medicine Purpose: To identify the association between diabetes mellitus (DM) and clinical outcome in patients with nonischemic heart failure with reduced ejection fraction (NI-HFrEF). Methods: We evaluated 248 patients with NI-HFrEF at baseline, 6 months, and 1 year, then observed for cardiac events (CEs) such as heart failure worsening or cardiac deaths. Results: Seventy-five (30%) patients had DM. Kaplan-Meier analysis revealed DM was related to higher incidence of CEs (Figure A). However, patients with DM and improved hemoglobin (Hb) A1c during 6 months showed lower incidence of CEs (Figure B), and higher HbA1c at baseline was independently related to normalization of left ventricular EF at 1 year (Table). Conclusion: Although concomitant DM is related to poor outcome in patients with NI-HFrEF, appropriate glycemic control might improve cardiac function and their prognosis.

S194 Journal of Cardiac Failure Vol. 20 No. 10S October 2014

P-035 Effect of Telmisartan on Heart Failure in Patient with Hypertensive Cardiomyopathy MEGUMI SHIMADA, AKIYASU BABA, RIE KOSUGI, MAKOTO AKAISHI Department of Cardiology, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan A 58-year-old man was referred to our hospital because of acute heart failure. He was diagnosed as hypertensive cardiomyopathy, and started treatment of heart failure and hypertension. After 6 months of combination therapy, we modified the treatment, and started telmisartan, then, follow-up examination of standard ECG-gated SPECT imaging was done. The SPECT data were reanalyzed by using new software, heart function view (Medi-Physics Co.), automatically. LVEF were used as markers of systolic function, and Peak phase, systolic phase standard deviation (Phase SD) and histogram bandwidth (Bandwidth) were used as markers of dyssynchrony. We also tested BNP concentration as a marker of heart failure. As shown in figure, telmisartan may have had favourable effects on heart failure in this case.

Figure. Event-free rate of CEs

Table. Multivariate analysis for predicting normalization of LVEF at 1 year

Variables at baseline Age, per 1 year increase Presence of significant MR BNP, per 1 pg/mL increase LVEF, per 1 % increase HbA1c, per 1 % increase

Adjusted odds ratio

95% confidence interval

Adjusted p

0.974

0.952 e 0.997

0.028

0.333

0.107 e 0.859

0.021

0.997

0.994 e 0.999

0.017

1.052

1.013 e 1.098

0.013

1.357

1.040 e 1.818

0.023

CEs: cardiac events, LVEF: left ventricular ejection fraction, MR: mitral regurgitation, BNP: plasma B-type natriuretic peptide, HbA1c: hemoglobin A1c

P-034 Azilsartan Improves Diastolic Function in Patients with Chronic Heart Failure MARI SAKAMOTO, TAKAHIRO OHARA, AKIRA FUNADA, MAKOTO AMAKI, TAKUYA HASEGAWA, YASUO SUGANO, HIDEAKI KANZAKI, MASANORI ASAKURA, TOSHIHISA ANZAI, MASAFUMI KITAKAZE Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan Background: Angiotensin receptor blocker (ARB) is reported to improve the prognosis of patients with chronic heart failure (CHF). It is not known that the effect is a class effect or not. Methods: We retrospectively assessed echocardiographic and clinical parameters in CHF patients, to whom azilsartan (Azilsartans, n515) or candesartan (Candesartans, n515) were newly prescribed. Results: At baseline, there were no significant differences between both groups in clinical, echocardiographic parameters, and BNP levels. At 3 months, blood pressure decreased to the similar levels in both groups. Whereas E/Ea significantly decreased in Azilsartans (13.064.2 vs. 10.963.2, p50.03), that of Candesartans did not (12.063.6 vs. 12.565.0, p50.58) (p for interaction50.04, Figure). Conclusions: Azilsartan improves diastolic function in the patients with CHF. Azilsartan may be more preferable in patients with CHF than other ARBs.

Treatment

Pre-treatment (amlodipine 2.5mg) amlodipine 2.5mg carvedilol 2.5mg losartan 25mg perindopril 2mg amlodipine 2.5mg carvedilol 2.5mg telmisartan 40mg

LVEF (%)

EDV (ml)

Peak Phase ( )

Phase SD (  )

Bandwidth ()

25.4

231

145

52.3

181

35.3

211

129

62.2

183

34.3

45.3 50.2 53.2

141 112 139

136 129 135

17.1 17.1 13.3

68 66 49

13.6 10 4.8

BNP (pg/ml)

302

P-036 The Efficacy and Safety of Febuxostat for Hyperuricemia in Hypertensive Patients with Chronic Heart Failure and Chronic Kidney Disease TOSHIO NAKA1, TOMOTAKA ANDOU2, TOHRU MASUYAMA2 1 Department of Internal Medicine, Kaizuka City Hospital, Kaizuka, Japan, 2 Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan Background: Febuxostat, a non-purine xanthine oxidase inhibitor, has been reported to have a stronger effect and more safety on hyperuricemia than allopurinol. However, there is not available on the effect of febuxostat in hypertensive patients with chronic heart failure (CHF) and chronic kidney disease (CKD). (Methods) The aim of this study is to examine the efficacy and safety of febuxostat in hypertensive patients with CHF and CKD for treating hyperuricemia. Twenty hyperuricemic patients with hypertension(HT), CHF and CKD were enrolled and treated with febuxostat(1020mg/day). Serum uric acid concentrations and serum estimated GFR levels in the 3 months before and after the start of febuxostat treatment were collected for HT, CHF and CKD patients switched from allopurinol after failing to achieve serum uric acid concentrations <6.0mg/dl. Results: Evaluable data were available for 20 patients, 20% of whom had advanced CKD (eGFR<30ml/min/1.73m2). Mean dose of febuxostat was 11 (63.7)mg/day. By using febuxostat, mean serum uric acid concentration decreased from 7.6 (61.2) mg/dl at baseline to 6.2 (60.9)&mg/dL at 3 months(p!0.001) 35% of patients achieved a level <6.0mg/dL. No serious adverse reactions were noted with febuxostat, and there were no significant changes in blood pressure, heart rate, total cholesterol, triglyceride, hemoglobin A1c, and hepatic and renal function. Conclusions: Febuxostat was effective for hyperuricemia in patients with HT, CHF and CKD without severe side effects.