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Early Detection of Left Ventricular Dysfunction in Asymptomatic Type 2 Diabetic Patients
The 15th Annual Scientific Meeting
HFSA
S101
with HF (EF#40; mean EF523 6 7%) completed the Dietary Compliance Survey, detailing consumption of high Na foods within the previous 3 days. Individuals were divided into 2 categories for comparative analyses - patients who reported consumption of 0 to 5 high-Na content foods (Lo Na) and those who reported consumption of six or more high-Na content foods (Hi Na). HF symptoms were assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ), and two HF biomarkers, btype natriuretic peptide (BNP) and C-reactive protein (CRP). Both BNP and CRP data were log transformed. Psychological factors, including stress and depressive symptoms, were examined as possible correlates of dietary compliance, using the Perceived Stress Scale (PSS) and Beck Depression Inventory (BDI), respectively. Results: Individuals reported consuming an average of 6 6 4 salty foods in the 3 days prior to assessment. CRP concentrations were significantly higher in the Lo Na group than in the Hi Na group (see Table). In examining KCCQ self-reported symptoms, individuals in the Hi Na group reported significantly fewer symptoms on multiple subscales. PSS scores did not differ between the two groups. However, subjects in the Lo Na group reported significantly more depressive symptoms than those in the Hi Na group.
Comparison of Means Between Na Intake Groups
Group
Number of Foods Consumed
log CRP
log BNP
KCCQ KCCQ KCCQ Overall Total Symptom Frequency Symptom Summary
BDI
Lo Na (n558) 3 6 2 0.66 6 0.49 2.42 6 0.51 67 6 28 68 6 27 67 6 23 14 6 10 Hi Na (n535) 10 6 4* 0.42 6 0.44* 2.32 6 0.53 76 6 19* 78 6 17* 77 6 16* 10 6 8*
324
*5p!.05 as compared to Lo Na
NT proBNP Can Predict the Cardiovascular Events in Patients with Dilated Cardiomyopathy Which Is the First Manifestation of Heart Failure Eun-Young Kim, Jin-Oh Choi, Soo-Hyeon Yun, Eun-Seon Ju Ju, Eun-Seok Jeon; Cardiology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Conclusions: Na non-compliance is often felt to be the cause of HF symptoms, but patients with more Na non-compliance appeared to be healthier in this study. Contrary to common assumptions, these data suggest that adverse consequences might lead to dietary compliance, while non-compliance may have fewer effects in healthier patients. The causes and effects of dietary non-compliance, including related psychological factors, warrant further exploration.
Objectives/Methods: To determine whether NT-proBNP can predict hospitalization or cardiac death in patients whose first clinical manifestation was dCMP, we measured serial NT-ProBNP levels and echocardiography at the time of first manifestation of HF at OPD or at the time of admission, !1 month or pre-discharge, 3-6 months after, and annually. 279 patients whose LVESD O 45 mm or LVEDD O55 mm by echocardiography at the time of HF diagnosis were enrolled. We excluded patients with Cr O 2.0 mg/dL, ischemic CMP after AMI or OMI. The cardiac events were defined as 1) cardiovascular death, 2) Hospitalization because of HF in OPD or discharged patients. Results: Mean follow-up was 736 6 31 days. Cardiac events were occurred in 90 patients (32.3%), death in 37 and hospitalization in 53. The event free survival rates were 0.82 at 1 year and 0.46 at 5 year. The optimal cut-off value of the mid-term NT-proBNP levels (measured at 3-6 months after first manifestation of HF) was 1000 pg/ml (AUC 0.787, sensitivity 0.776, specificity 0.71) and its hazard ratio was 8.463. In conclusion, this NT proBNP level may be used as therapeutic monitoring or prognostic guideline for dCMP treatment.
326 Early Detection of Left Ventricular Dysfunction in Asymptomatic Type 2 Diabetic Patients Angelina Stevanovic1, Mirjana Krotin2, Milica Dekleva3, Nevena Paunovic1, Snezana Trajic4; 1Cardiology Department, Railway Health Care Institute, Belgrade, Serbia; 2Cardiology Department, University Clinical Center “Bezanijska Kosa”, Belgrade, Serbia; 3Cardiology Department, University Clinical Center Zvezdara, Belgrade, Serbia; 4Cardiology Department, Institute for Cardiovascular Dedinje, Belgrade, Serbia Background: Subclinical left ventricular (LV) systolic and diastolic dysfunction has been reported to be prevalent in diabetic subjects, but this recognition could often be missed. Isovolumic contraction velocity (IVCv) and acceleration during isovolumic contraction (IVA) have been proposed as indexes of global LV contractility. Methods: The study included 35 asymptomatic typ 2 diabetic patients and 35 age and sex matched healthy subjects. Left atrial dimension, left atrial volume index and parameters of left ventricular geometry, including left ventricular mass index, were estimated by echocardiography. Maximal velocity of early and late diastolic LV filling (E, A, E/A), deceleration E time (DTE) and isovolumic relaxation time (IVRT) were measured from transmitral Doppler. Tissue Doppler (TDI) velocities were measured from medial and lateral annulus (e, a, e/a, s) including IVCv, IVA, acceleration time (tIVA), E/e and Doppler tissue myocardial performance index (tMPI). Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking. Results: There was close correlations between values of GLS and tIVA (r 5 -0.315, p50.009) and GLS and IVCv (r 5 -0.309, p50.009) with significantly lower values of GLS (-19.4 6 3.83% vs -25.41 6 4.18%; t56.34, p50.0001), IVCv (0.07 6 0.022m/s vs 0.09 6 0.026m/s; t5-2.73, p50.008) and tIVA (29.9 6 9.4ms vs 36.7 6 9.8ms; t5-2.90, p50.005) and significantly higher value of E/e (8.97 6 2.19 vs 7.20 6 1.91; t53.60, p50.001) in group of diabetic patients. Conclusion: Diabetes mellitus is asociated with subclinical LV diastolic and systolic dysfunction. Isovolumic contraction velocity, tIVA and GLS might be simple and helpful indicators in estimation and early detection of left ventricular dysfunction in diabetic patients.
325 The Association of Sodium Intake and Objective and Subjective Indicators of Heart Failure Severity Kristie M. Harris1, Andrew J. Wawrzyniak1, Jennifer M. Marshall2, Sarah M. Godoy1, Joanne P. Marshall2, Shawn W. Robinson2, David S. Krantz1, Stephen S. Gottlieb2; 1Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD; 2Medicine, University of Maryland, Baltimore, MD Background: Sodium (Na) restriction is a hallmark of heart failure (HF) care, but its effectiveness is unproven. We sought to assess the relationship between Na intake and HF symptoms and severity. Methods: 93 patients (73 males; mean557 6 12 years)
327 Technetium Pyrophosphate SPECT Imaging for Non-Invasive Identification of Transthyretin Cardiac Amyloidosis Mathew S. Maurer, Farhana Latif, Sabahat Bokhari; Cardiology, Columbia University Medical Center, New York, NY Background: Cardiac amyloidosis secondary to the deposits of transthyretin (TTR) is an under-recognized cause of heart failure with a preserved ejection fraction
HFSA
S101
with HF (EF#40; mean EF523 6 7%) completed the Dietary Compliance Survey, detailing consumption of high Na foods within the previous 3 days. Individuals were divided into 2 categories for comparative analyses - patients who reported consumption of 0 to 5 high-Na content foods (Lo Na) and those who reported consumption of six or more high-Na content foods (Hi Na). HF symptoms were assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ), and two HF biomarkers, btype natriuretic peptide (BNP) and C-reactive protein (CRP). Both BNP and CRP data were log transformed. Psychological factors, including stress and depressive symptoms, were examined as possible correlates of dietary compliance, using the Perceived Stress Scale (PSS) and Beck Depression Inventory (BDI), respectively. Results: Individuals reported consuming an average of 6 6 4 salty foods in the 3 days prior to assessment. CRP concentrations were significantly higher in the Lo Na group than in the Hi Na group (see Table). In examining KCCQ self-reported symptoms, individuals in the Hi Na group reported significantly fewer symptoms on multiple subscales. PSS scores did not differ between the two groups. However, subjects in the Lo Na group reported significantly more depressive symptoms than those in the Hi Na group.
Comparison of Means Between Na Intake Groups
Group
Number of Foods Consumed
log CRP
log BNP
KCCQ KCCQ KCCQ Overall Total Symptom Frequency Symptom Summary
BDI
Lo Na (n558) 3 6 2 0.66 6 0.49 2.42 6 0.51 67 6 28 68 6 27 67 6 23 14 6 10 Hi Na (n535) 10 6 4* 0.42 6 0.44* 2.32 6 0.53 76 6 19* 78 6 17* 77 6 16* 10 6 8*
324
*5p!.05 as compared to Lo Na
NT proBNP Can Predict the Cardiovascular Events in Patients with Dilated Cardiomyopathy Which Is the First Manifestation of Heart Failure Eun-Young Kim, Jin-Oh Choi, Soo-Hyeon Yun, Eun-Seon Ju Ju, Eun-Seok Jeon; Cardiology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Conclusions: Na non-compliance is often felt to be the cause of HF symptoms, but patients with more Na non-compliance appeared to be healthier in this study. Contrary to common assumptions, these data suggest that adverse consequences might lead to dietary compliance, while non-compliance may have fewer effects in healthier patients. The causes and effects of dietary non-compliance, including related psychological factors, warrant further exploration.
Objectives/Methods: To determine whether NT-proBNP can predict hospitalization or cardiac death in patients whose first clinical manifestation was dCMP, we measured serial NT-ProBNP levels and echocardiography at the time of first manifestation of HF at OPD or at the time of admission, !1 month or pre-discharge, 3-6 months after, and annually. 279 patients whose LVESD O 45 mm or LVEDD O55 mm by echocardiography at the time of HF diagnosis were enrolled. We excluded patients with Cr O 2.0 mg/dL, ischemic CMP after AMI or OMI. The cardiac events were defined as 1) cardiovascular death, 2) Hospitalization because of HF in OPD or discharged patients. Results: Mean follow-up was 736 6 31 days. Cardiac events were occurred in 90 patients (32.3%), death in 37 and hospitalization in 53. The event free survival rates were 0.82 at 1 year and 0.46 at 5 year. The optimal cut-off value of the mid-term NT-proBNP levels (measured at 3-6 months after first manifestation of HF) was 1000 pg/ml (AUC 0.787, sensitivity 0.776, specificity 0.71) and its hazard ratio was 8.463. In conclusion, this NT proBNP level may be used as therapeutic monitoring or prognostic guideline for dCMP treatment.
326 Early Detection of Left Ventricular Dysfunction in Asymptomatic Type 2 Diabetic Patients Angelina Stevanovic1, Mirjana Krotin2, Milica Dekleva3, Nevena Paunovic1, Snezana Trajic4; 1Cardiology Department, Railway Health Care Institute, Belgrade, Serbia; 2Cardiology Department, University Clinical Center “Bezanijska Kosa”, Belgrade, Serbia; 3Cardiology Department, University Clinical Center Zvezdara, Belgrade, Serbia; 4Cardiology Department, Institute for Cardiovascular Dedinje, Belgrade, Serbia Background: Subclinical left ventricular (LV) systolic and diastolic dysfunction has been reported to be prevalent in diabetic subjects, but this recognition could often be missed. Isovolumic contraction velocity (IVCv) and acceleration during isovolumic contraction (IVA) have been proposed as indexes of global LV contractility. Methods: The study included 35 asymptomatic typ 2 diabetic patients and 35 age and sex matched healthy subjects. Left atrial dimension, left atrial volume index and parameters of left ventricular geometry, including left ventricular mass index, were estimated by echocardiography. Maximal velocity of early and late diastolic LV filling (E, A, E/A), deceleration E time (DTE) and isovolumic relaxation time (IVRT) were measured from transmitral Doppler. Tissue Doppler (TDI) velocities were measured from medial and lateral annulus (e, a, e/a, s) including IVCv, IVA, acceleration time (tIVA), E/e and Doppler tissue myocardial performance index (tMPI). Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking. Results: There was close correlations between values of GLS and tIVA (r 5 -0.315, p50.009) and GLS and IVCv (r 5 -0.309, p50.009) with significantly lower values of GLS (-19.4 6 3.83% vs -25.41 6 4.18%; t56.34, p50.0001), IVCv (0.07 6 0.022m/s vs 0.09 6 0.026m/s; t5-2.73, p50.008) and tIVA (29.9 6 9.4ms vs 36.7 6 9.8ms; t5-2.90, p50.005) and significantly higher value of E/e (8.97 6 2.19 vs 7.20 6 1.91; t53.60, p50.001) in group of diabetic patients. Conclusion: Diabetes mellitus is asociated with subclinical LV diastolic and systolic dysfunction. Isovolumic contraction velocity, tIVA and GLS might be simple and helpful indicators in estimation and early detection of left ventricular dysfunction in diabetic patients.
325 The Association of Sodium Intake and Objective and Subjective Indicators of Heart Failure Severity Kristie M. Harris1, Andrew J. Wawrzyniak1, Jennifer M. Marshall2, Sarah M. Godoy1, Joanne P. Marshall2, Shawn W. Robinson2, David S. Krantz1, Stephen S. Gottlieb2; 1Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD; 2Medicine, University of Maryland, Baltimore, MD Background: Sodium (Na) restriction is a hallmark of heart failure (HF) care, but its effectiveness is unproven. We sought to assess the relationship between Na intake and HF symptoms and severity. Methods: 93 patients (73 males; mean557 6 12 years)
327 Technetium Pyrophosphate SPECT Imaging for Non-Invasive Identification of Transthyretin Cardiac Amyloidosis Mathew S. Maurer, Farhana Latif, Sabahat Bokhari; Cardiology, Columbia University Medical Center, New York, NY Background: Cardiac amyloidosis secondary to the deposits of transthyretin (TTR) is an under-recognized cause of heart failure with a preserved ejection fraction