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Effect of Repeated Thermal Therapy on Arterial Stiffness in Patients with Chronic Heart Failure
S184 Journal of Cardiac Failure Vol. 12 No. 8 Suppl. 2006 1110 Is the Improvement in Ventilatory Efficiency Predictable from the Baseline Variables in Patients Participating in Exercise Cardiac Rehabilitation? RIKA TANEIKE, RIKA KAWAKAMI, TAIKI HIGO, YASUYO TANIGUCHI, TERUO NOGUCHI, JIYOONG KIM, HIROSHI TAKAKI, NAOHIKO AIHARA, YOICHI GOTO Division of Cardiology, Department of Medicine, National Cardiovascular Center, Osaka, Japan Purpose: Ventilatory efficiency is assessed by the slope of the minute ventilation-carbon dioxide output relation (VE/VCO2 slope) during cardiopulmonary exercise testing (CPX). The purpose of this study was to investigate whether the improvement in ventilatory efficiency after cardiac rehabilitation (CR) is predictable from the baseline variables in cardiac patients. Methods: We studied 164 CR participants (acute myocardial infarction [AMI] 92, cardiac surgery 46, heart failure [HF] 26) who initially presented impaired ventilatory efficiency (VE/VCO2 slope O534) on CPX and completed the 3-month CR with repeated CPX. Results: After CR, peak VO2 increased significantly (63 to 73%, p!0.0001) and VE/VCO2 slope decreased significantly (38.7 to 34.8, p!0.0001) for the entire group. The relative change in VE/VCO2 slope (%dVE/VCO2 slope) correlated significantly with the baseline VE/VCO2 slope (r5-0.25, p!0.01) and age (r50.16, p!0.05, in the range above 40 years), but not with ejection fraction (r50.11, NS), peak VO2 (r50.01, NS) or plasma BNP (r50.08, NS). In addition, post-surgery patients (-14.5%, p!0.01 vs AMI, p!0.05 vs HF) showed a significantly greater improvement in VE/VCO2 slope compared with AMI (-8.4%) and HF (-5.4%). Conclusion: Improvement in ventilatory efficiency after CR is predictable from underlying disease, age, and baseline VE/VCO2 slope. Post-surgery, young, or patients with high VE/VCO2 slope at baseline are likely to have a greater improvement in excessive ventilation after CR.
1111 Function Capacity Between the Skeletal Muscle Strength and the Skeletal Muscle Volume in Patients with Chronic Heart Failure KEISUKE KIDA, NAOHIKO OSADA, HIROMITSU SEKIZUKA, YUKI ISHIBASHI, AKIO HAYASHI, EIJI TAKAHASHI, KIHEI YONEYAMA, KOJI INOUE, KAZUTO OMIYA, FUMIHIKO MIYAKE Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan Background: Previous studies have reported that skeletal muscle strength is closely related to exercise capacity in patients with chronic heart failure (CHF). However, none of the previous studies have fully investigated the correlation between exercise capacity and the strength and volume of the skeletal muscle. Methods: Seventy-six patients with CHF underwent symptom-limited cardiopulmonary exercise testing using ergometer according to the ramp protocol. The muscle volume (MV) was evaluated by electrical impedance analysis and the maximal knee extension strength (PT) was measured by a Biodex. The subjects were divided into two groups according to the MV. (Group H, MV O 21kg; Group L, MV ! 21kg) Results: The PT was positively and significantly correlated with the peak VO2 in both the H and L groups (r50.78 vs r50.53). The lower muscle volume was also positively correlated with the peak VO2 in the L group (r50.50), but not in the H group. The lower muscle volume was positively and significantly correlated with PT in the L group (r50.42), but not in the H group. Conclusions: The exercise capacity of patients with CHF is thought to depend on both the strength and volume of the skeletal muscle. In CHF patients with high muscle volume, the exercise capacity was determined by the skeletal muscle strength alone.
1112 Effect of Repeated Thermal Therapy on Arterial Stiffness in Patients with Chronic Heart Failure TAKURO KUBOZONO, MASAAKI MIYATA, TAKASHI KIHARA, TSUYOSHI FUKUDOME, YOSHIYUKI IKEDA, TAKURO SHINSATO, SO KUWAHATA, SHOJI FUJITA, YUTAKA OTSUJI, CHUWA TEI Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University Background: We developed the thermal therapy and reported that it improved cardiac and vascular endothelial function in patients with chronic heart failure (CHF).
It is known that brachial-ankle pulse wave velocity (baPWV) is a noninvasive and simple examination, and able to evaluate arterial stiffness. We investigated the effect of repeated thermal therapy on arterial stiffness in patients with CHF. Methods: Fourteen patients with CHF due to dilated cardiomyopathy (n58) or ischemic cardiomyopathy (n56) were treated with a 60 degrees centigrade far infrared-ray dry sauna bath for 15 minutes and then kept in a bed covered with blankets for 30 minutes, once a day for 4 weeks. Cardiac function was evaluated by echocardiography and plasma level of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP). We measured baPWV by Form PWV/ABI. Results: LV Tei index, BNP and ANP decreased after four weeks of thermal therapy (LV Tei index: 0.7660.25 to 0.6760.16, BNP: 3806511 pg/ml to 1836203 pg/ml, ANP: 1276115 pg/ml to 62649 pg/ml). In addition, 4-week thermal therapy decreased baPWV (15716319 cm/sec to 13586263 cm/sec, P!0.01), suggesting that thermal therapy improves arterial stiffness in patients with CHF. Conclusion: Thermal therapy improves not only cardiac function but also arterial stiffness in patients with CHF.
1113 Chronic Effects of Home Oxygen Therapy on Brain-natriuretic Peptide in Chronic Heart Failure Complicated with Central Sleep Apnea SHIGEFUMI FUKUI, SHINOZAKI TSUYOSHI, SUGIMURA KOICHIRO, OGAWA HIROMASA, FUKUMOTO YOSHIHIRO, SHIMOKAWA HIROAKI Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine, Sendai, Japan Background: We have shown that the nocturnal oxygen therapy improved sleep apnea, caused sympatholysis, and reduced brain-natriuretic peptide (BNP) levels as an acute effects in chronic heart failure (CHF) with central sleep apnea (CSA). In the present study, we examined serial changes of BNP levels during 6 months followup treated with home oxygen therapy (HOT). Methods: Nine patients with CHF/CSA were evaluated (age 72612, left ventricular ejection fraction, LVEF 41611 %, BNP 6106523 pg/ml at baseline). We measured BNP levels before and 6 months after HOT, and then examined the baseline characteristics and prognosis of the patients. Results: HOT significantly reduced apnea-hypopnea index from 2869 to 1368/hr after 6 months (P!0.01). BNP increased in 4 patients (2286152 pg/ml to 3916282 pg/ml after 6 months), and decreased in 5 patients (9156518 pg/ml to 7006540 pg/ml after 6 months). During 22611 months follow-up, 7 patients had the major events, including 5 hospitalization due to heart failure symptom and 2 deaths. The events occurred in all of 4 patients who increased BNP levels, and in three who decreased BNP levels, however, these BNP levels were still high after HOT (9466597 pg/ml). The BNP levels in whom survived without events were 331616 pg/ml after HOT. Conclusion: Patients with CHF/CSA who showed high BNP levels have a high mortality even after nocturnal oxygen therapy.
1114 The Relationship Between Severity of Heart Failure and Sleep Disordered Breathing in Patients with Heart Failure NAOHIKO OSADA, KOJI INOUE, KEISUKE KIDA, EIJI TAKAHASHI, KIHEI YONEYAMA, KENGO SUZUKI, AKIO HAYASHI, YUKI ISHIBASHI, TAKASHI SHIMOZATO, YOSHIHIKO MIYAKE Cardiology St. Marianna University School of Medicine It is well known that sleep disordered breathing (SDB) widely accepted as common conditions in patients with chronic heart failure (CHF). Aim: This study was designed to investigate the clinical characteristics in patients who showed clinical improvement of SDB during natural CHF history. Methods: 26 clinically stable CHF patients were enrolled in this study. All patients underwent polysomnography(PSG), portable PSG, or pulse-oxymetry both at just before discharge and outpatient clinic. Results: The AHI(apnea hypopnea index) were significantly decreased from 25.5616.4/hour at the first time to 13.5613.0/hour at the second time. 8 patients were defined as mild SDB with AHI!5 (M group). 9 patients were significant decreased from 36.0613.0/hour to 7.866.6/hour (P group) and 9 patients kept high AHI value from 31.369.2 to 27.669.5/hour(D group).The BNP in P group maintained high level from 485.56412.6 to 460.06517.3 pg/ml at the second test. On the other hand, BNP in D group showed significant decreased from 328.26310.3 pg/ml to 100.66158.9 pg/ml. BNP level in M group kept a low blood level (173.3697.3 pg/ml to 115.26115.2 pg/ml).
1111 Function Capacity Between the Skeletal Muscle Strength and the Skeletal Muscle Volume in Patients with Chronic Heart Failure KEISUKE KIDA, NAOHIKO OSADA, HIROMITSU SEKIZUKA, YUKI ISHIBASHI, AKIO HAYASHI, EIJI TAKAHASHI, KIHEI YONEYAMA, KOJI INOUE, KAZUTO OMIYA, FUMIHIKO MIYAKE Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan Background: Previous studies have reported that skeletal muscle strength is closely related to exercise capacity in patients with chronic heart failure (CHF). However, none of the previous studies have fully investigated the correlation between exercise capacity and the strength and volume of the skeletal muscle. Methods: Seventy-six patients with CHF underwent symptom-limited cardiopulmonary exercise testing using ergometer according to the ramp protocol. The muscle volume (MV) was evaluated by electrical impedance analysis and the maximal knee extension strength (PT) was measured by a Biodex. The subjects were divided into two groups according to the MV. (Group H, MV O 21kg; Group L, MV ! 21kg) Results: The PT was positively and significantly correlated with the peak VO2 in both the H and L groups (r50.78 vs r50.53). The lower muscle volume was also positively correlated with the peak VO2 in the L group (r50.50), but not in the H group. The lower muscle volume was positively and significantly correlated with PT in the L group (r50.42), but not in the H group. Conclusions: The exercise capacity of patients with CHF is thought to depend on both the strength and volume of the skeletal muscle. In CHF patients with high muscle volume, the exercise capacity was determined by the skeletal muscle strength alone.
1112 Effect of Repeated Thermal Therapy on Arterial Stiffness in Patients with Chronic Heart Failure TAKURO KUBOZONO, MASAAKI MIYATA, TAKASHI KIHARA, TSUYOSHI FUKUDOME, YOSHIYUKI IKEDA, TAKURO SHINSATO, SO KUWAHATA, SHOJI FUJITA, YUTAKA OTSUJI, CHUWA TEI Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University Background: We developed the thermal therapy and reported that it improved cardiac and vascular endothelial function in patients with chronic heart failure (CHF).
It is known that brachial-ankle pulse wave velocity (baPWV) is a noninvasive and simple examination, and able to evaluate arterial stiffness. We investigated the effect of repeated thermal therapy on arterial stiffness in patients with CHF. Methods: Fourteen patients with CHF due to dilated cardiomyopathy (n58) or ischemic cardiomyopathy (n56) were treated with a 60 degrees centigrade far infrared-ray dry sauna bath for 15 minutes and then kept in a bed covered with blankets for 30 minutes, once a day for 4 weeks. Cardiac function was evaluated by echocardiography and plasma level of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP). We measured baPWV by Form PWV/ABI. Results: LV Tei index, BNP and ANP decreased after four weeks of thermal therapy (LV Tei index: 0.7660.25 to 0.6760.16, BNP: 3806511 pg/ml to 1836203 pg/ml, ANP: 1276115 pg/ml to 62649 pg/ml). In addition, 4-week thermal therapy decreased baPWV (15716319 cm/sec to 13586263 cm/sec, P!0.01), suggesting that thermal therapy improves arterial stiffness in patients with CHF. Conclusion: Thermal therapy improves not only cardiac function but also arterial stiffness in patients with CHF.
1113 Chronic Effects of Home Oxygen Therapy on Brain-natriuretic Peptide in Chronic Heart Failure Complicated with Central Sleep Apnea SHIGEFUMI FUKUI, SHINOZAKI TSUYOSHI, SUGIMURA KOICHIRO, OGAWA HIROMASA, FUKUMOTO YOSHIHIRO, SHIMOKAWA HIROAKI Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine, Sendai, Japan Background: We have shown that the nocturnal oxygen therapy improved sleep apnea, caused sympatholysis, and reduced brain-natriuretic peptide (BNP) levels as an acute effects in chronic heart failure (CHF) with central sleep apnea (CSA). In the present study, we examined serial changes of BNP levels during 6 months followup treated with home oxygen therapy (HOT). Methods: Nine patients with CHF/CSA were evaluated (age 72612, left ventricular ejection fraction, LVEF 41611 %, BNP 6106523 pg/ml at baseline). We measured BNP levels before and 6 months after HOT, and then examined the baseline characteristics and prognosis of the patients. Results: HOT significantly reduced apnea-hypopnea index from 2869 to 1368/hr after 6 months (P!0.01). BNP increased in 4 patients (2286152 pg/ml to 3916282 pg/ml after 6 months), and decreased in 5 patients (9156518 pg/ml to 7006540 pg/ml after 6 months). During 22611 months follow-up, 7 patients had the major events, including 5 hospitalization due to heart failure symptom and 2 deaths. The events occurred in all of 4 patients who increased BNP levels, and in three who decreased BNP levels, however, these BNP levels were still high after HOT (9466597 pg/ml). The BNP levels in whom survived without events were 331616 pg/ml after HOT. Conclusion: Patients with CHF/CSA who showed high BNP levels have a high mortality even after nocturnal oxygen therapy.
1114 The Relationship Between Severity of Heart Failure and Sleep Disordered Breathing in Patients with Heart Failure NAOHIKO OSADA, KOJI INOUE, KEISUKE KIDA, EIJI TAKAHASHI, KIHEI YONEYAMA, KENGO SUZUKI, AKIO HAYASHI, YUKI ISHIBASHI, TAKASHI SHIMOZATO, YOSHIHIKO MIYAKE Cardiology St. Marianna University School of Medicine It is well known that sleep disordered breathing (SDB) widely accepted as common conditions in patients with chronic heart failure (CHF). Aim: This study was designed to investigate the clinical characteristics in patients who showed clinical improvement of SDB during natural CHF history. Methods: 26 clinically stable CHF patients were enrolled in this study. All patients underwent polysomnography(PSG), portable PSG, or pulse-oxymetry both at just before discharge and outpatient clinic. Results: The AHI(apnea hypopnea index) were significantly decreased from 25.5616.4/hour at the first time to 13.5613.0/hour at the second time. 8 patients were defined as mild SDB with AHI!5 (M group). 9 patients were significant decreased from 36.0613.0/hour to 7.866.6/hour (P group) and 9 patients kept high AHI value from 31.369.2 to 27.669.5/hour(D group).The BNP in P group maintained high level from 485.56412.6 to 460.06517.3 pg/ml at the second test. On the other hand, BNP in D group showed significant decreased from 328.26310.3 pg/ml to 100.66158.9 pg/ml. BNP level in M group kept a low blood level (173.3697.3 pg/ml to 115.26115.2 pg/ml).