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Effect on Survival of Treatment for Heart Failure with Tolvaptan in Addition to Low Dose Furosemide vs. High Dose Furosemide
The 20th Annual Scientific Meeting of hypertension or treatment for hypertension. Results: We studied 595 of 2622 patients who had registered from September 1st in 2010 to March 31st in 2016. 147 of 311 patients who had appearance of dilated cardiomyopathy, was diagnosed with idiopathic dilated cardiomyopathy and 66 of 284 patients who had appearance of hypertrophic cardiomyopathy, was diagnosed with idiopathic hypertrophic cardiomyopathy. Improvement more than 10% of ejection fraction was observed in 22% of patients with dilated cardiomyopathy and 80% of patients with cardiomyopathy caused by hypertension. Conclusion: Patients with cardiomyopathy caused by hypertension which has better response with treatment were observed a lot among patients who had appearance of idiopathic dilated cardiomyopathy.
O2-7 Direct Effect of Percutaneous Peripheral Intervention on the Heart in Patient with Peripheral Artery Disease Hidehiro Iwakawa, Kenji Iino, Hiroyuki Watanabe, Hiroshi Ito; Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan Background: The patient with peripheral artery disease (PAD) is known to have the adverse clinical outcome. Several studies have documented that the percutaneous peripheral intervention (PPI) for PAD improves the prognosis. However, the detailed mechanisms remain unclear. Augmentation index (AIx) or central aortic pressure (CAP) is shown to increase myocardial mechanical stress and facilitate myocardial hypertrophy. The aim of this study is to clarify the direct cardioprotective effects of PPI mediated by decreasing CAP and AIx. Methods and result: 28 patients with PAD were divided into two groups; control group (n = 12) and PPI group (n = 16). Both radial AIx and CAP were measured by applanation tonometry in radial artery. We used a plasma B-type natriuretic peptide (BNP) level as a marker of myocardial mechanical stress. In control group Aix, CAP and BNP levels remain unchanged. On the other hand, in PPI group AIx, CAP and BNP levels were significantly reduced after PPI. The reduction rates of AIx, CAP and BNP levels were -11.3 %, -8.9% and -34% respectively (P < .05). During 3 years observation, cardiovascular event-free rate was markedly lower in control group than in PPI group (33% vs 69% P < .05). Conclusion: These results suggest that PPI can decrease myocardial mechanical stress in patients with PAD. The mechanisms may be mediated in part by reduction of AIx and CAP.
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status (CONUT) are useful to identify malnourish heart failure (HF) patients with decreased exercise tolerance (ET). Methods: The present study enrolled 71 patients who were participated in multicenter HF nutritional epidemiology research (age 62 ± 12 years, male 78.9%, Body mass index 23.9 ± 3.9 kg/m2). We divided patients into two groups based on the median peak VO2; high-ET (≧16.4 ml/kg/min) and low-ET (<16.4 ml/kg/min). Results: Compared to patients in high-ET, those in lowET were more likely to be female and have past history of atrial fibrillation and cardiac resynchronization therapy (CRT) implantation. They had also significantly lower estimated glomerular filtration rate (eGFR), hemoglobin, and albumin, and higher B-type natriuretic peptide levels than those in high-ET. GNRI was significantly lower in low-ET group than in high-ET group (P < .05), but MNA and CONUT were not. Receiver operating characteristic curves showed that GNRI had moderate accuracy to predict Low-ET (area under the curve; AUC=0.712). In contrast, predictive value of MNA and CONUT was low (AUC<0.6). On multivariate logistic regression analysis, low GNRI was independently associated with low-ET as well as low eGFR and CRT implantation. Conclusion: GNRI was superior to MNA and CONUT in predicting low-ET in patient with HF.
O4-1 Tolvaptan Reduces the Exacerbation of Acute Kidney Injury in Patients with Acute Decompensated Heart Failure Associated with Acute Coronary Syndrome Yutaka Aoyama; Cardiovascular Center, Nagoya Daini Red Cross Hospital Background: The patients with acute decompensated heart failure (ADHF) associated with acute coronary syndrome (ACS) have the high risk of worsiening renal function due to use diuretic drugs as therapy for ADHF and contrast media in emergent percutaneous coronary intervention (PCI). We evaluated whether Tolvaptan prevent the exacerbation of acute kidney injury (AKI) with ADHF associated with ACS. Methods and Results: 75 patients with ADHF associated with ACS who underwent emergent PCI were admitted from April 2011 to Octover 2013. 14 patients were treated with Tolvaptan and 61 patients with conventional treatment. The toral urine vlume until days 3 at intensive care unit was significantly higher (9234 ml vs 6822 ml) and the numbers of patients with worsening renal function were significantly fewer (21.4% vs 44.3%) in the group treated with Tolvaptan than in the group with conventional treatment, respectively. Conclusions: Treatment with Tolvaptan could prevent the risk of worsening renal function in patients with ADHF associated with ACS.
O3-1 Prognostic Value of Controlling Nutritional Status Score for Patients with Heart Failure with Preserved Ejection Fraction Yusuke Uemura, Tsubasa Teraoka, Ryo Imai, Takayuki Mitsuda, Shinji Ishikawa, Masayoshi Koyasu, Tomohiro Uchikawa, Kenji Takemoto, Masato Watarai; Cardiovascular Center, Anjo Kosei Hospital, Aichi, Japan Background: Nutritional status is a significant prognostic factor in heart failure. The aim of this study was to assess the association between controlling nutritional status (CONUT) score with long-term prognosis in HFpEF patients who were hospitalized with acute decompensated heart failure. Methods: CONUT score, calculated by the serum albumin and total cholesterol levels, and lymphocyte number, was evaluated in 244 HFpEF patients admitted with acute heart failure from April 2010 to March 2013. Clinical, demographic, laboratory data were extracted and data on outcome were reviewed over a median follow up of 2.0 years. Results: The median value (interquartile range) of CONUT score was 4 (2–6). A Kaplan-Meier survival analysis demonstrated that high CONUT score was associated with higher mortality following acute heart failure. A multivariate Cox regression analysis revealed that CONUT score was independently correlated with all-cause mortality after adjusting for other risk factors (HR 1.188, P < .001). When causes of death were divided into cardiac or non-cardiac death, prognostic value of CONUT score was significant only in non-cardiac death (HR 1.256, P < .001). As a nutritional index, CONUT score had more incremental predictive value for mortality, compared with serum albumin alone. Conclusions: In patients with HFpEF, CONUT score independently predicts high mortality following acute heart failure and might be a more useful marker of nutritional status.
O4-2 Prediction of Response to Treatment with Tolvaptan in Patients with Decompensated Heart Failure: Development of a Simple Responsiveness Score Morihiko Takeda, Tsuyoshi Takada, Hiroyuki Satake, Hiroki Saitou, Hironori Kanemitsu, Nobuyuki Shiba; Department of Cardiovascular Medicine, International University of Health and Welfare Hospital Background: Recent clinical trials have demonstrated the efficacy of short-term treatment with tolvaptan (TLV), an novel oral vasopressin V2 receptor antagonist, in patients with heart failure. However, the response to tolvaptan varies among patients. Methods and Results: To develop a simple, broad-applicable and easily-calculatable clinical score to predict favorable response to TLV treatment, we retrospectively analyzed hospitalized patients with decompensated heart failure who were administered TLV (n = 61). Increase in urine volume (UV) on the day1, 2 and 7 after TLV administration was measured and the following parameters were analyzed: patient age, gender, renal function, Clinical Scenarios (CS) of heart failure (CS-1 to -5), plasma brain natriuretic peptide level, plasma sodium concentration, left ventricular ejection fraction, etiology of heart failure and inferior vena cava (IVC) diameter. Among these parameters, we found younger age (<80), absence of renal insufficiency (eGFR>45), CS-2 heart failure and large IVC diameter (>17 mm) to be predictors of higher response to treatment with TLV. The simple responsiveness score was computed by adding the number of four predictors and the scoring model was developed which ranges between 0 and 4 points. UV increased significantly as the responsiveness score increased in this cohort (P < .05). Conclusions: Simple responsiveness-score based on patient age, CS, renal function and IVC diameter may be useful to predict response to treatment with TLV.
O3-5 Nutritional Assessment in Patients with Heart Failure and Exercise Intolerance -Comparative Analysis of GNRI, MNA, and CONUTTakeshi Sota1, Yoshiharu Kinugasa2, Hiroko Kamitani2, Natsuko Nakayama3, Miyuki Makaya4, Shintaro Kinugawa5, Takahiro Naruse3, Masahiko Kato2, Hiroshi Hagino1, Kazuhiro Yamamoto2; 1Division of Rehabilitation, Tottori University Hospital, Tottori, Japan; 2Department of Cardiovascular Medicine, Tottori University Hospital, Tottori, Japan; 3Division of Nutrition, Tottori University Hospital, Tottori, Japan; 4School of Nursing Care System, Faculty of Nursing, Kitazato University, Tokyo, Japan; 5Faculty of Cardiovascular Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan Purpose: To investigate which nutritional assessment tools including Geriatric nutritional risk index (GNRI), Mini nutritional assessment (MNA), and Controlling Nutritional
O4-3 Effect on Survival of Treatment for Heart Failure with Tolvaptan in Addition to Low Dose Furosemide vs. High Dose Furosemide Takashi Morinaga; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan Background: The vasopressin type 2 receptor antagonist tolvaptan (TLV) is available to treat congestion in patients with heart failure. However, it is unknown that the proper dose of furosemide which TLV is added to. Method: We enrolled consecutive 124 patients were admitted to our hospital for acute decompensated heart failure in 2015. They began TLV in addition to standard therapy. Patients were divided into 2 groups according to doses of furosemide when TLV therapy was begun. Low dose
S170 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 furosemide group was defined as doses of daily furosemide was under 40 mg and high dose furosemide group was defined as over 40 mg. The primary endpoint was the rate of all cause death. Result: All cause death occurred in 10 of 71 patients (14.0%) in low dose furosemide group and 22 of 53 patients (41.5%) in high dose furosemide group. The risk of all cause death was decreased in low dose furosemide group compared with high dose furosemide group (hazard ratio, 0.29; 95% confidence interval, 0.13–0.60 at univariable analysis; and hazard ratio, 0.28; 95% confidence interval, 0.12–0.59 at multivariable analysis). Conclusion: We suggest that TLV is added to low doses of furosemide.
defined that the endpoint was death and hospital readmission for heart failure. Unadjusted Kaplan-Meier survival curves showed the similar results between the carperitide and nitrates treatment group by log-rank test (P = .27). Cox multivariate analysis showed use of carperitide was not significant (adjusted hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 0.65–2.07; P = .644) along with age (adjusted HR: 9.26; 95% CI: 1.23–90.22; P = .029), sex (adjusted HR: 1.25; 95% CI: 0.71–2.119; P = .433). The two drugs had similar impacts on prognosis in patients with acute heart failure.
O5-1 O4-4 The Efficacy of Tolvaptan on Dasatinib induced Pleural Effusions in Patients with Chronic Myelogenous Leukemia Rie aoyama1, Kenta Onodera1, Kouji Murai1, Yukichi Tokita1, Yayoi Tsukada1, Kuniya Asai1, Wataru Shimizu1, Yoko Manabe2, Jun Tanaka2, Kazumasa Harada2; 1Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan; 2Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan Dasatinib is a novel tyrosine-kinase inhibitor approved for treatment of BCR-ABL positive chronic myelogenous leukemia (CML). Dasatinib sometimes complicates exudative pleural effusions because of unknown etiology. The dasatinib induced pleural effusion is required to interrupt or reduce dasatinib, accompanied with the use of diuretics and corticosteroid. However, these effects are limited, and consequently patients CML with refractory pleural effusion show poor prognosis. Tolvaptan, an orally active vasopressin V2-receptor antagonist has powerful effects on the volume control in patients with congestive heart failure. We have experienced six cases of CML applied to use tolvaptan for treatment of dasatinib induced refractory pleural effusions. The age of the patients was 60.5 ± 11.5 years, and the dosage of dasatinib and tolvaptan were 58.3 ± 20.4 mg/day and 5.0 ± 1.9 mg/day respectively. Five cases out of six have obtained marked urine volume that reduced their pleural effusion. These patients could continue the standard dasatinib therapy and survive without any complication. Unfortunately, one case needed hemodialysis because of advanced chronic kidney disease (CKD) in which tolvaptan could not show the effect of aquaresis. In conclusion, tolvaptan may be useful to manage pleural effusion of the CML patients treated with dasatinib without advanced CKD.
Gender and Prognostic Significance of Anemia in Chronic Heart Failure Tetsuro Yokokawa, Akiomi Yoshihisa, Takamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Atsushi Kobayashi, Takayoshi Yamaki, Hiroyuki Kunii, Kazuhiko Nakazato, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan Background: Anemia is associated with poor prognosis in heart failure. Limited data are available for gender differences in heart failure related to anemia. Objective: The objective of this study was to describe gender differences in heart failure in association with anemia. Methods: We analyzed consecutive 1127 hospitalized heart failure patients. Gender differences were investigated between groups (men, n = 691; women, n = 436). Results: Compared with women, men were more likely to be younger and have reduced ejection fraction, coronary artery disease, diabetes mellitus, dyslipidemia, and chronic kidney disease, and were less likely to have anemia. In multivariate analysis, anemia was one of the independent predictors for cardiac mortality (HR 1.845, P = .004). In Kaplan-Meier analysis for cardiac mortality in patients with anemia (men, n = 330; women, n = 168), men had worse outcome compared to women (mortality, 65.6% vs. 34.4%, P = .049). On the other hand, patients without anemia (men, n = 361; women, n = 268) didn’t had significant differences for cardiac mortality between men and women (mortality, 7.0% vs. 5.4%, P = .538). Conclusion: Heart failure patients had gender differences in several commodities. Heart failure patients with anemia had a gender difference for cardiac mortality. Gender specific management is needed in heart failure patients especially in relation to anemia.
O5-2 O4-5 Dpc Cost was Spent Treating Patients with Acute Heart Failure by Doctors who used Carperitide for a Long Time Kensaku Higashi, Shun Ijuin, Yoshimasa Baba, Yusuke Ishikawa, Kiyohisa Hiramine, Hideki Tanaka, Norihito Nuruki, Masahiro Sonoda; The Second Department of Cardiology, Kagoshima Medical Center, National Hospital Organization Background: It is being happening heart failure pandemic in Japan. Carperitide is the first choice for treatment of acute heart failure (AHF) but it is expensive. We evaluated the relationship between Diagnostic Procedure Combination (DPC) cost and the duration of Carperitide use among attending doctor. Methods and Results: 632 consecutive patients with AHF were enrolled who were admitted in our hospital from July 2012 to March 2016. Receiver-operating-characteristic curve analysis assessed the cut-off value of the duration of Carperitide use for above-average DPC cost. The average duration of Carperitide use among attending doctor was calculated and their patients were divided into two groups by it (short-Carperitide group; the doctors who used Carperitide for less than average 5.5 days, long-Carperitide group; the doctors who used Carperitide for more than average 5.5 days). There were no significant differences of the factors for the severity of AHF. DPC cost of shortCarperitide group was significantly lower than that of long-Carperitide group (786766 ± 447201yen vs. 886537 ± 589921yen; P = .017). The length of stay of short-Carperitide group was shorter than that of long-Carperitide group (18.0 ± 10.7 days vs. 21.7 ± 16.3 days; P = .001). Conclusions: DPC cost for AHF is influenced by the duration of Carperitide use. The cost-consciousness of doctor will result in reducing medical cost.
O4-6 The Similar Prognosis between Carperitide and Nitrates in Patients with Acute Heart Failure Masayuki Shiba, Yukihito Satou, Shuhei Tsuji, Takashi Kuragaichi, Hiroyuki Nakayama, Hisayoshi Fujiwara, Yoshiki Takatsu; Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan Infusion of carperitide or nitrates is used as vasodilator in patients with acute heart failure. Whether carperitide improves prognosis is controversial in acute heart failure patients. We investigated effects of these drugs on acute heart failure prognosis. From April 1, 2009 to April 1, 2011, Ninty-four patients with acute heart failure who were infused carperitide (n = 55) or nitrates (n = 39) were retrospectively studied. We
Restrictive Lung Function is Associated with Increased Sympathetic Nerve Activity in Patients with Heart Failure Shuji Joho, Ryuichi Ushijima, Takashi Akabane, Tadakazu Hirai, Koichiro Kinugawa; The Second Department of Internal Medicine, University of Toyama, Toyama, Japan Background: Sympathoexcitation and impaired lung function are common in patients with severe heart failure (HF). However, the association between impaired lung function and sympathoexcitation remains unknown. Methods and Results: Muscle sympathetic nerve activity (MSNA) and clinical variables were determined in 83 HF patients with left ventricular ejection fraction (LVEF) < 0.45. Restrictive and obstructive changes on spirometry were defined as reduced forced vital capacity (%FVC) of <80% and a ratio of forced expiratory volume in the first second (FEV1.0%) to FVC of <70%. Restrictive and obstructive changes were identified in 17 and 21 patients, respectively. MSNA was higher in patients with restrictive changes than those without restrictive changes (84 vs. 66 bursts/100 beats, P < .01), but was comparable in those with and without obstructive changes. Univariate analyses showed that %FVC, glomerular filtration rate (GFR), specific activity scale, brain natriuretic peptide level, LVEF, age, and use of aldosterone receptor blockers were significant predictors of MSNA burst incidence. Multivariate analysis revealed that %FVC, LVEF, and GFR were independent factors for increased burst incidence. Changes in %FVC during follow-up negatively correlated with changes in burst rate (n = 11, P < .01). Conclusion: Restrictive lung function was associated with increased sympathetic nerve activity independent of HF severity.
O5-3 Associations between Depression and Adverse Prognosis in Heart Failure Patients with Reduced or Preserved Ejection Fraction Yu Sato, Akiomi Yoshihisa, Shunsuke Watanabe, Tetsuro Yokokawa, Shunsuke Miura, Takamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Shu-Ichi Saitoh, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Japan Background: Several studies have demonstrated that depression is associated with poor quality of life and an increased risk of hospitalization and death in patients with heart failure (HF). However, distinct impacts of depression on prognosis in HF patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) still remain unclear. Therefore, we compared prognostic impacts of depression between patient with HFrEF and HFpEF. Methods and Results: We analyzed 1268 HF patients who admitted to our hospital (689 HFrEF and 579 HFpEF patients). Out of 1268 HF patients, 201 patients were diagnosed as depression based on Center for Epidemiological StudiesDepression (CES-D) score. These patients were divided into 2 groups: depression group
O2-7 Direct Effect of Percutaneous Peripheral Intervention on the Heart in Patient with Peripheral Artery Disease Hidehiro Iwakawa, Kenji Iino, Hiroyuki Watanabe, Hiroshi Ito; Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan Background: The patient with peripheral artery disease (PAD) is known to have the adverse clinical outcome. Several studies have documented that the percutaneous peripheral intervention (PPI) for PAD improves the prognosis. However, the detailed mechanisms remain unclear. Augmentation index (AIx) or central aortic pressure (CAP) is shown to increase myocardial mechanical stress and facilitate myocardial hypertrophy. The aim of this study is to clarify the direct cardioprotective effects of PPI mediated by decreasing CAP and AIx. Methods and result: 28 patients with PAD were divided into two groups; control group (n = 12) and PPI group (n = 16). Both radial AIx and CAP were measured by applanation tonometry in radial artery. We used a plasma B-type natriuretic peptide (BNP) level as a marker of myocardial mechanical stress. In control group Aix, CAP and BNP levels remain unchanged. On the other hand, in PPI group AIx, CAP and BNP levels were significantly reduced after PPI. The reduction rates of AIx, CAP and BNP levels were -11.3 %, -8.9% and -34% respectively (P < .05). During 3 years observation, cardiovascular event-free rate was markedly lower in control group than in PPI group (33% vs 69% P < .05). Conclusion: These results suggest that PPI can decrease myocardial mechanical stress in patients with PAD. The mechanisms may be mediated in part by reduction of AIx and CAP.
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status (CONUT) are useful to identify malnourish heart failure (HF) patients with decreased exercise tolerance (ET). Methods: The present study enrolled 71 patients who were participated in multicenter HF nutritional epidemiology research (age 62 ± 12 years, male 78.9%, Body mass index 23.9 ± 3.9 kg/m2). We divided patients into two groups based on the median peak VO2; high-ET (≧16.4 ml/kg/min) and low-ET (<16.4 ml/kg/min). Results: Compared to patients in high-ET, those in lowET were more likely to be female and have past history of atrial fibrillation and cardiac resynchronization therapy (CRT) implantation. They had also significantly lower estimated glomerular filtration rate (eGFR), hemoglobin, and albumin, and higher B-type natriuretic peptide levels than those in high-ET. GNRI was significantly lower in low-ET group than in high-ET group (P < .05), but MNA and CONUT were not. Receiver operating characteristic curves showed that GNRI had moderate accuracy to predict Low-ET (area under the curve; AUC=0.712). In contrast, predictive value of MNA and CONUT was low (AUC<0.6). On multivariate logistic regression analysis, low GNRI was independently associated with low-ET as well as low eGFR and CRT implantation. Conclusion: GNRI was superior to MNA and CONUT in predicting low-ET in patient with HF.
O4-1 Tolvaptan Reduces the Exacerbation of Acute Kidney Injury in Patients with Acute Decompensated Heart Failure Associated with Acute Coronary Syndrome Yutaka Aoyama; Cardiovascular Center, Nagoya Daini Red Cross Hospital Background: The patients with acute decompensated heart failure (ADHF) associated with acute coronary syndrome (ACS) have the high risk of worsiening renal function due to use diuretic drugs as therapy for ADHF and contrast media in emergent percutaneous coronary intervention (PCI). We evaluated whether Tolvaptan prevent the exacerbation of acute kidney injury (AKI) with ADHF associated with ACS. Methods and Results: 75 patients with ADHF associated with ACS who underwent emergent PCI were admitted from April 2011 to Octover 2013. 14 patients were treated with Tolvaptan and 61 patients with conventional treatment. The toral urine vlume until days 3 at intensive care unit was significantly higher (9234 ml vs 6822 ml) and the numbers of patients with worsening renal function were significantly fewer (21.4% vs 44.3%) in the group treated with Tolvaptan than in the group with conventional treatment, respectively. Conclusions: Treatment with Tolvaptan could prevent the risk of worsening renal function in patients with ADHF associated with ACS.
O3-1 Prognostic Value of Controlling Nutritional Status Score for Patients with Heart Failure with Preserved Ejection Fraction Yusuke Uemura, Tsubasa Teraoka, Ryo Imai, Takayuki Mitsuda, Shinji Ishikawa, Masayoshi Koyasu, Tomohiro Uchikawa, Kenji Takemoto, Masato Watarai; Cardiovascular Center, Anjo Kosei Hospital, Aichi, Japan Background: Nutritional status is a significant prognostic factor in heart failure. The aim of this study was to assess the association between controlling nutritional status (CONUT) score with long-term prognosis in HFpEF patients who were hospitalized with acute decompensated heart failure. Methods: CONUT score, calculated by the serum albumin and total cholesterol levels, and lymphocyte number, was evaluated in 244 HFpEF patients admitted with acute heart failure from April 2010 to March 2013. Clinical, demographic, laboratory data were extracted and data on outcome were reviewed over a median follow up of 2.0 years. Results: The median value (interquartile range) of CONUT score was 4 (2–6). A Kaplan-Meier survival analysis demonstrated that high CONUT score was associated with higher mortality following acute heart failure. A multivariate Cox regression analysis revealed that CONUT score was independently correlated with all-cause mortality after adjusting for other risk factors (HR 1.188, P < .001). When causes of death were divided into cardiac or non-cardiac death, prognostic value of CONUT score was significant only in non-cardiac death (HR 1.256, P < .001). As a nutritional index, CONUT score had more incremental predictive value for mortality, compared with serum albumin alone. Conclusions: In patients with HFpEF, CONUT score independently predicts high mortality following acute heart failure and might be a more useful marker of nutritional status.
O4-2 Prediction of Response to Treatment with Tolvaptan in Patients with Decompensated Heart Failure: Development of a Simple Responsiveness Score Morihiko Takeda, Tsuyoshi Takada, Hiroyuki Satake, Hiroki Saitou, Hironori Kanemitsu, Nobuyuki Shiba; Department of Cardiovascular Medicine, International University of Health and Welfare Hospital Background: Recent clinical trials have demonstrated the efficacy of short-term treatment with tolvaptan (TLV), an novel oral vasopressin V2 receptor antagonist, in patients with heart failure. However, the response to tolvaptan varies among patients. Methods and Results: To develop a simple, broad-applicable and easily-calculatable clinical score to predict favorable response to TLV treatment, we retrospectively analyzed hospitalized patients with decompensated heart failure who were administered TLV (n = 61). Increase in urine volume (UV) on the day1, 2 and 7 after TLV administration was measured and the following parameters were analyzed: patient age, gender, renal function, Clinical Scenarios (CS) of heart failure (CS-1 to -5), plasma brain natriuretic peptide level, plasma sodium concentration, left ventricular ejection fraction, etiology of heart failure and inferior vena cava (IVC) diameter. Among these parameters, we found younger age (<80), absence of renal insufficiency (eGFR>45), CS-2 heart failure and large IVC diameter (>17 mm) to be predictors of higher response to treatment with TLV. The simple responsiveness score was computed by adding the number of four predictors and the scoring model was developed which ranges between 0 and 4 points. UV increased significantly as the responsiveness score increased in this cohort (P < .05). Conclusions: Simple responsiveness-score based on patient age, CS, renal function and IVC diameter may be useful to predict response to treatment with TLV.
O3-5 Nutritional Assessment in Patients with Heart Failure and Exercise Intolerance -Comparative Analysis of GNRI, MNA, and CONUTTakeshi Sota1, Yoshiharu Kinugasa2, Hiroko Kamitani2, Natsuko Nakayama3, Miyuki Makaya4, Shintaro Kinugawa5, Takahiro Naruse3, Masahiko Kato2, Hiroshi Hagino1, Kazuhiro Yamamoto2; 1Division of Rehabilitation, Tottori University Hospital, Tottori, Japan; 2Department of Cardiovascular Medicine, Tottori University Hospital, Tottori, Japan; 3Division of Nutrition, Tottori University Hospital, Tottori, Japan; 4School of Nursing Care System, Faculty of Nursing, Kitazato University, Tokyo, Japan; 5Faculty of Cardiovascular Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan Purpose: To investigate which nutritional assessment tools including Geriatric nutritional risk index (GNRI), Mini nutritional assessment (MNA), and Controlling Nutritional
O4-3 Effect on Survival of Treatment for Heart Failure with Tolvaptan in Addition to Low Dose Furosemide vs. High Dose Furosemide Takashi Morinaga; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan Background: The vasopressin type 2 receptor antagonist tolvaptan (TLV) is available to treat congestion in patients with heart failure. However, it is unknown that the proper dose of furosemide which TLV is added to. Method: We enrolled consecutive 124 patients were admitted to our hospital for acute decompensated heart failure in 2015. They began TLV in addition to standard therapy. Patients were divided into 2 groups according to doses of furosemide when TLV therapy was begun. Low dose
S170 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 furosemide group was defined as doses of daily furosemide was under 40 mg and high dose furosemide group was defined as over 40 mg. The primary endpoint was the rate of all cause death. Result: All cause death occurred in 10 of 71 patients (14.0%) in low dose furosemide group and 22 of 53 patients (41.5%) in high dose furosemide group. The risk of all cause death was decreased in low dose furosemide group compared with high dose furosemide group (hazard ratio, 0.29; 95% confidence interval, 0.13–0.60 at univariable analysis; and hazard ratio, 0.28; 95% confidence interval, 0.12–0.59 at multivariable analysis). Conclusion: We suggest that TLV is added to low doses of furosemide.
defined that the endpoint was death and hospital readmission for heart failure. Unadjusted Kaplan-Meier survival curves showed the similar results between the carperitide and nitrates treatment group by log-rank test (P = .27). Cox multivariate analysis showed use of carperitide was not significant (adjusted hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 0.65–2.07; P = .644) along with age (adjusted HR: 9.26; 95% CI: 1.23–90.22; P = .029), sex (adjusted HR: 1.25; 95% CI: 0.71–2.119; P = .433). The two drugs had similar impacts on prognosis in patients with acute heart failure.
O5-1 O4-4 The Efficacy of Tolvaptan on Dasatinib induced Pleural Effusions in Patients with Chronic Myelogenous Leukemia Rie aoyama1, Kenta Onodera1, Kouji Murai1, Yukichi Tokita1, Yayoi Tsukada1, Kuniya Asai1, Wataru Shimizu1, Yoko Manabe2, Jun Tanaka2, Kazumasa Harada2; 1Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan; 2Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan Dasatinib is a novel tyrosine-kinase inhibitor approved for treatment of BCR-ABL positive chronic myelogenous leukemia (CML). Dasatinib sometimes complicates exudative pleural effusions because of unknown etiology. The dasatinib induced pleural effusion is required to interrupt or reduce dasatinib, accompanied with the use of diuretics and corticosteroid. However, these effects are limited, and consequently patients CML with refractory pleural effusion show poor prognosis. Tolvaptan, an orally active vasopressin V2-receptor antagonist has powerful effects on the volume control in patients with congestive heart failure. We have experienced six cases of CML applied to use tolvaptan for treatment of dasatinib induced refractory pleural effusions. The age of the patients was 60.5 ± 11.5 years, and the dosage of dasatinib and tolvaptan were 58.3 ± 20.4 mg/day and 5.0 ± 1.9 mg/day respectively. Five cases out of six have obtained marked urine volume that reduced their pleural effusion. These patients could continue the standard dasatinib therapy and survive without any complication. Unfortunately, one case needed hemodialysis because of advanced chronic kidney disease (CKD) in which tolvaptan could not show the effect of aquaresis. In conclusion, tolvaptan may be useful to manage pleural effusion of the CML patients treated with dasatinib without advanced CKD.
Gender and Prognostic Significance of Anemia in Chronic Heart Failure Tetsuro Yokokawa, Akiomi Yoshihisa, Takamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Atsushi Kobayashi, Takayoshi Yamaki, Hiroyuki Kunii, Kazuhiko Nakazato, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan Background: Anemia is associated with poor prognosis in heart failure. Limited data are available for gender differences in heart failure related to anemia. Objective: The objective of this study was to describe gender differences in heart failure in association with anemia. Methods: We analyzed consecutive 1127 hospitalized heart failure patients. Gender differences were investigated between groups (men, n = 691; women, n = 436). Results: Compared with women, men were more likely to be younger and have reduced ejection fraction, coronary artery disease, diabetes mellitus, dyslipidemia, and chronic kidney disease, and were less likely to have anemia. In multivariate analysis, anemia was one of the independent predictors for cardiac mortality (HR 1.845, P = .004). In Kaplan-Meier analysis for cardiac mortality in patients with anemia (men, n = 330; women, n = 168), men had worse outcome compared to women (mortality, 65.6% vs. 34.4%, P = .049). On the other hand, patients without anemia (men, n = 361; women, n = 268) didn’t had significant differences for cardiac mortality between men and women (mortality, 7.0% vs. 5.4%, P = .538). Conclusion: Heart failure patients had gender differences in several commodities. Heart failure patients with anemia had a gender difference for cardiac mortality. Gender specific management is needed in heart failure patients especially in relation to anemia.
O5-2 O4-5 Dpc Cost was Spent Treating Patients with Acute Heart Failure by Doctors who used Carperitide for a Long Time Kensaku Higashi, Shun Ijuin, Yoshimasa Baba, Yusuke Ishikawa, Kiyohisa Hiramine, Hideki Tanaka, Norihito Nuruki, Masahiro Sonoda; The Second Department of Cardiology, Kagoshima Medical Center, National Hospital Organization Background: It is being happening heart failure pandemic in Japan. Carperitide is the first choice for treatment of acute heart failure (AHF) but it is expensive. We evaluated the relationship between Diagnostic Procedure Combination (DPC) cost and the duration of Carperitide use among attending doctor. Methods and Results: 632 consecutive patients with AHF were enrolled who were admitted in our hospital from July 2012 to March 2016. Receiver-operating-characteristic curve analysis assessed the cut-off value of the duration of Carperitide use for above-average DPC cost. The average duration of Carperitide use among attending doctor was calculated and their patients were divided into two groups by it (short-Carperitide group; the doctors who used Carperitide for less than average 5.5 days, long-Carperitide group; the doctors who used Carperitide for more than average 5.5 days). There were no significant differences of the factors for the severity of AHF. DPC cost of shortCarperitide group was significantly lower than that of long-Carperitide group (786766 ± 447201yen vs. 886537 ± 589921yen; P = .017). The length of stay of short-Carperitide group was shorter than that of long-Carperitide group (18.0 ± 10.7 days vs. 21.7 ± 16.3 days; P = .001). Conclusions: DPC cost for AHF is influenced by the duration of Carperitide use. The cost-consciousness of doctor will result in reducing medical cost.
O4-6 The Similar Prognosis between Carperitide and Nitrates in Patients with Acute Heart Failure Masayuki Shiba, Yukihito Satou, Shuhei Tsuji, Takashi Kuragaichi, Hiroyuki Nakayama, Hisayoshi Fujiwara, Yoshiki Takatsu; Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan Infusion of carperitide or nitrates is used as vasodilator in patients with acute heart failure. Whether carperitide improves prognosis is controversial in acute heart failure patients. We investigated effects of these drugs on acute heart failure prognosis. From April 1, 2009 to April 1, 2011, Ninty-four patients with acute heart failure who were infused carperitide (n = 55) or nitrates (n = 39) were retrospectively studied. We
Restrictive Lung Function is Associated with Increased Sympathetic Nerve Activity in Patients with Heart Failure Shuji Joho, Ryuichi Ushijima, Takashi Akabane, Tadakazu Hirai, Koichiro Kinugawa; The Second Department of Internal Medicine, University of Toyama, Toyama, Japan Background: Sympathoexcitation and impaired lung function are common in patients with severe heart failure (HF). However, the association between impaired lung function and sympathoexcitation remains unknown. Methods and Results: Muscle sympathetic nerve activity (MSNA) and clinical variables were determined in 83 HF patients with left ventricular ejection fraction (LVEF) < 0.45. Restrictive and obstructive changes on spirometry were defined as reduced forced vital capacity (%FVC) of <80% and a ratio of forced expiratory volume in the first second (FEV1.0%) to FVC of <70%. Restrictive and obstructive changes were identified in 17 and 21 patients, respectively. MSNA was higher in patients with restrictive changes than those without restrictive changes (84 vs. 66 bursts/100 beats, P < .01), but was comparable in those with and without obstructive changes. Univariate analyses showed that %FVC, glomerular filtration rate (GFR), specific activity scale, brain natriuretic peptide level, LVEF, age, and use of aldosterone receptor blockers were significant predictors of MSNA burst incidence. Multivariate analysis revealed that %FVC, LVEF, and GFR were independent factors for increased burst incidence. Changes in %FVC during follow-up negatively correlated with changes in burst rate (n = 11, P < .01). Conclusion: Restrictive lung function was associated with increased sympathetic nerve activity independent of HF severity.
O5-3 Associations between Depression and Adverse Prognosis in Heart Failure Patients with Reduced or Preserved Ejection Fraction Yu Sato, Akiomi Yoshihisa, Shunsuke Watanabe, Tetsuro Yokokawa, Shunsuke Miura, Takamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Shu-Ichi Saitoh, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Japan Background: Several studies have demonstrated that depression is associated with poor quality of life and an increased risk of hospitalization and death in patients with heart failure (HF). However, distinct impacts of depression on prognosis in HF patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) still remain unclear. Therefore, we compared prognostic impacts of depression between patient with HFrEF and HFpEF. Methods and Results: We analyzed 1268 HF patients who admitted to our hospital (689 HFrEF and 579 HFpEF patients). Out of 1268 HF patients, 201 patients were diagnosed as depression based on Center for Epidemiological StudiesDepression (CES-D) score. These patients were divided into 2 groups: depression group