- Email: [email protected]
Elevated Left Ventricular End-Diastolic Pressure During Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Is a Predictor of Persistent Systolic Dysfunction
S102 Journal of Cardiac Failure Vol. 20 No. 8S August 2014 Table 1. Baseline patient characteristics (N5225)
Characteristic Age, years Female, N (%) Race, N (%) While Black Body mass index, kg/m2 Smoking, N (%) Current Former Coronary artery disease, N (%) Hypertension, N (%) Diabetes, N (%) Atrial fibrillation/flutter, N (%) Cerebrovascular disease, N (%) Lung disease, N (%) Sleep apnea, N (%) Depression, N (%) Systolic blood pressure, mmHg Diastolic blood pressure, mmHg Ejection fraction, % NYHA, N (%) I-II III-IV Not reported Hematocrit, % Sodium, mEq/L Glucose, mg/dL Creatinine, mg/dL Angiotensin converting enzyme inhibitors, N (%) Angiotensin receptor blockers, N (%) Mineralocorticoid receptor blockers, N (%) Beta-blockers, N (%) Calcium channel blockers, N (%) Diuretics, N (%) Statins, N (%) Nitrates, N (%) Hydralazine, N (%)
Value 71.7 6 13.8 133 (59.1) 107 (47.6) 106 (47.1) 32.7 6 9.5 17 (7.6) 65 (28.9) 94 (41.8) 212 (94.2) 104 (46.2) 89 (39.6) 39 (17.3) 63 (28.0) 58 (25.8) 35 (15.6) 136622 71612 54.866.8 102 (45.3) 90 (40.0) 33 (14.7) 36.065.0 13963 106 (89, 137)* 1.2 (0.9, 1.5)* 79 (35.1) 54 (24.0) 33 (14.7) 177 77 187 150 48 31
(78.7) (34.2) (83.1) (66.7) (21.3) (13.8)
* Median (25th, 75th percentile).
proposed by Goldstein. The purpose of this study is to compare health status, depression, and ED among Hispanic and non-Hispanic HF patients. Hypothesis: Hispanic and non-Hispanic HF patients will have similar rates of health status, depression and ED. Methods: Eighty-three uninsured male HF patients followed in the Olive ViewUCLA HF Disease Management Program were enrolled in the study. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire summary score (KCCQ-S), with KCCQ-S ! 50 indicating worse health status. The Patient Health Questionnaire-9 (PHQ-9) was used to assess for depression, with a score $ 10 indicative of depression. The Erectile Function (EF) domain of the International Index of Erectile Function (IIEF) was used to assess for ED. An IIEF-EF score of 17-25 was defined as mild-moderate ED, while an IIEF-EF score of 6-16 was defined as moderate-severe ED. An IIEF-EF score ! 6 was considered sexually inactive. Results: Of the 83 patients screened, 33% were sexually inactive. Those who were sexually active (n 5 56) had a mean age of 52 years with a mean left ventricular ejection fraction of 24%. Sixty-one percent of the sexually active patients were Hispanic, 50% spoke primarily Spanish, and 77% had a non-ischemic cardiomyopathy. Baseline characteristics including hypertension, diabetes mellitus, obesity, beta-blocker use, and NYHA class were similar for Hispanic vs. non-Hispanic patients. Hispanic patients did have a higher rate of hyperlipidemia (71% vs. 40%, p 50.04). Hispanic patients had a better health status (79% vs 41%, p 5 0.01) and lower prevalence of depression (21% vs 55%, p 5 0.02) compared to non-Hispanics. However, moderate-severe ED was no different among Hispanic and non-Hispanic patients (71% vs 50%, p 5 0.16). Conclusions: Despite Hispanic patients having similar rates of ED (with a trend towards higher rates of ED), these patients had a better health status and lower prevalence of depression than non-Hispanic HF patients. In this cohort of indigent HF patients, the mutually-reinforcing triad of HF, depression, and ED is not valid. Further investigation into ED among Hispanic patients is warranted.
256 Association of Therapeutic Effect on Functional and Physiological Markers and Change in Quality of Life in Patients With Heart Failure and Reduced Ejection Fraction Kevin J. Morine, Benjamin S. Wessler, Marvin A. Konstam, James E. Udelson; Tufts Medical Center, Boston, MA Introduction: Quality of life (QOL) is an individual’s perception of disease impact and treatment on physical and mental wellbeing. Chronic HF has been associated with a significantly impaired QOL. Understanding therapeutic effects on QOL through validated HF specific instruments may enhance patient centered care. The relationship between therapeutic effect on functional and physiological parameters and effects on change in QOL has not been examined. Methods: A systematic search for drug or device therapeutic effect on a QOL measure for which at least one randomized, controlled trial (RCT) lasting at least three months was performed. For each therapy, a search was then performed for RCTs assessing change in left ventricular ejection fraction (LVEF), end diastolic volume (EDV), end systolic volume (ESV), peak oxygen consumption (peak VO2), six minute walk (6MW) and natriuretic peptides. The correlation between the placebo-corrected change in these functional and physiologic parameters and the weighted mean of placebo-corrected change in QOL was evaluated by unweighted Spearman coefficients. Results: A majority of RCTs (46/49) meeting QOL search criteria reported the Minnesota Living with Heart Failure Questionnaire and this instrument was studied further. RCTs of 15 therapies reporting QOL data (n520,173 patients) directed the search for RCTs of the effects of those therapies on the markers. There were 57 LVEF reports (n510,153), 38 EDV reports (n59,043), 33 ESV reports (n59,156), 54 peak VO2 reports (n57,016), 39 6MW reports (n59,126), 9 BNP reports (n56,863) and 11 NT-proBNP reports (n54,186). The strongest correlation with change in QOL was observed with therapy induced change in 6MW (r5-0.51, P50.0009). Therapy induced change in LVEF (r50.42, P50.001), peak VO2 (r5-0.27, P50.047) and NT-proBNP (r50.67, P50.03) were also correlated. No significant correlation was observed between the therapy induced change in EDV (r5-0.03, P50.88), ESV (r5-0.17, P50.35) or BNP (r50.54, P50.14) and change in QOL. Conclusions: Drug and device induced effects on 6MW are correlated with change in QOL in RCTs of patients with heart failure and reduced ejection fraction, and suggest change in 6MW contributes to the multifactorial pathophysiology of compromised QOL.
Figure. Kaplan-Meier curves for mortality and composite endpoints.
257
255 Triad of Health Status, Depression and Erectile Dysfunction in Heart Failure Patients: Is it Applicable to Hispanics? Tracy L. Finegan, Daniel R. Sanchez, Gisele Munoz, Salvador Hernandez, Sheba K. Meymandi, Mahmoud I. Traina; Olive View-UCLA Medical Center, Sylmar, CA Introduction: Heart Failure (HF) has been associated with depression in several prior studies. Patients with both HF and depression have been shown to have poorer HF outcomes, increased clinical events, and increased mortality. HF has also been associated with erectile dysfunction (ED) in prior studies with overall prevalence rates up to 89%. A mutually-reinforcing triad of HF, depression, and ED has been
Elevated Left Ventricular End-Diastolic Pressure During Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Is a Predictor of Persistent Systolic Dysfunction Mohammed Eid Madmani1, Tilak Pasala2, Dinesh Sharma1, Sanjay Gandhi2; 1Case Western Resreve University/Metrohealth Medical Center, Cleveland, OH; 2Case Western Resreve University/Metrohealth Medical Center, Cleveland, OH Background: Left ventricular end-diastolic pressure (LVEDP) is frequently measured during primary percutaneous coronary intervention (PCI). However, little is known about the correlation between LVEDP and systolic function. We sought to determine the prognostic value of LVEDP for predicting long-term systolic function in patients with ST-Segment Elevation Myocardial Infarction (STEMI). Methods: Patients with acute STEMI without previous history of heart failure (N5224) who underwent primary PCI were studied retrospectively. LVEDP was measured invasively using the liquid-filled recording system at time of primary
The 18th Annual Scientific Meeting PCI. Patients were divided into tertiles according to LVEDP. Patients in the highest tertile (Group A, LVEDP O 25 mmHg, n566) were compared with the remainder of the cohort (Group B, n5158). Systolic function was assessed using 2D transthoracic echocardiogram within a week of primary PCI (n5219) and at follow up (n5129). Systolic dysfunction was defined as ejection fraction (EF) ! 40%. Results: In our study population, (mean age 55 611 years, male 63%) there was no difference in baseline characteristics and risk factors between the two groups. Mean EF for the entire cohort at admission was 48613%. Patient in Group A had significantly lower mean EF compared with group B at admission (42% vs. 51%) and follow up (44% vs. 55%) ( p!0.001for both). Patient in group A were more likely to have LAD as culprit lesion for STEMI (53 % vs 34 %) (p value 5 0.009). On follow up at a median of 167 days (IQR 75-524 days), 23 of 129 patients had persistent systolic dysfunction. Group A were significantly more likely to have persistent systolic dysfunction with adjusted (Age, sex, BMI, HTN, HLD, DM, smoking, CKD, medications) OR of 14.8 (4.07-53.9) respectively (p!0.001). Conclusion: Elevated LVEDP at the time of primary PCI are associated with increased risk of persistent systolic dysfunction in patients with STEMI.
258 Gender Differences in Risk of Neurologic Events during Support with Continuous Flow Left Ventricular Assist Device (LVAD) Alanna A. Morris, Ann Pekarek, Robert T. Cole, Divya Gupta, Kris Wittersheim, Duc Nguyen, S. Raja Laskar, Javed Butler, Andrew L. Smith, J. David Vega; Emory University, Atlanta, GA Background: Neurologic events (NE) are common after LVAD implantation, with 17% of patients experiencing an event after two years of support. There is increasing recognition that the risk of stroke after LVAD varies based on gender, with a higher risk in female patients. We sought to review our own data to determine gender differences in the risk of NE. Methods: Advanced heart failure patients (N5110) discharged from the hospital after implantation with a HeartMate II (N574) or HeartWare (N536) LVAD were retrospectively evaluated. NE were tracked from hospital discharge until the last day of patient follow-up, and classified as intracranial hemorrhage (ICH) or ischemic stroke (including transient ischemic attack). Logistic regression was used to determine which risk factors were associated with the risk of NE. Results: During a median follow-up of 410 days (interquartile range 226-787 days), 24 (21.8%) patients experienced a NE. Women were more likely to experience a NE than men (34.3% vs. 16.0%, P50.03). When stratified according to type of LVAD, there was a trend towards higher risk of ICH and ischemic stroke in women supported with a HeartMate II, while there was no difference in the number of events in men and women supported with a HeartWare (Table 1). Female sex (Odds Ratio [OR] 2.7, 95% confidence Interval [CI] 1.1,7.0; P50.03), and lower levels of albumin (OR 0.3, 95% CI 0.1,0.6; P50.003), hemoglobin (OR 0.7, 95% CI 0.5,0.9; P50.005), and platelets (OR 0.99, 95% CI 0.98,0.99; P50.01) were univariately associated with an increased risk of NE. In a multivariate model adjusting for these variables, the risk of NE associated with female sex was higher for support with a HeartMate II LVAD (OR 4.5, 95% CI 1.0,19.2; P50.04) than with a HeartWare LVAD (OR 0.8, 95% CI 0.1,6.3; P50.8). Conclusion: The risk of NE varies based on gender, and type of device. More research is needed to fully understand these differences, and whether anticoagulation regimens should be tailored based on gender. Table 1. Neurologic events according to gender and type of LVAD. Data are N (%).
HFSA
S103
centers performing heart transplant in Korea, 11 centers with multiple cases of heart transplants participated the data collection. Perioperative conditions of transplant recipients and the comprehensive outcomes of heart transplants were retrospectively reviewed and analyzed. Results: Total 665 adult heart transplants were performed in 11 centers in Korea from November 11th, 1992 to December 31st, 2012. The annual number of heart transplant recipients has been increased. Hence, the number of heart transplant in Korea is 164 before 2000, and 501 after 2000. The percentage of the elderly recipients ($60 years) is increased (7.9% before 2000 vs. 22.3% after 2000). In the primary cause of etiology, ischemic cardiomyopathy and hypertrophic cardiomyopathy was increased (5.9% vs. 16.3% and 1.3% vs. 4.1%), but dilated cardiomyopathy was decreased (77.6% vs. 56.5%). Preoperative mechanical support was mainly intra-arterial balloon pump before 2000 (11.1% among 13.0% of mechanically-supported recipients), but percutaneous cardiopulmonary support became more prevalent after 2000 (4.7% among 7.8% of mechanically-supported recipients). Recent long term survival rates was improved (estimated survival rates at 1 year, 3 year, 5 year, and 10 year; 83.4%, 77.1%, 71.6% and 57.0% before 2000, and 88.1%, 81.9%, 78.5%, and 70.0% after 2000, respectively). Mortality due to acute graft failure was decreased (16.9% vs. 9.3%), but mortality due to chronic graft failure and cardiovascular death was increased (3.9% vs. 4.6% and 11.7% vs. 19.4%). Conclusions: Long-term survival rates of heart transplant in Korea was improved in spite of more elderly recipients and larger proportion of more-invasive mechanical supports. Effort to improve survival rates of heart transplant should be sought.
Figure.
260 Clinical Implications of the PR Interval in Patients Hospitalized for Worsening Heart Failure and Reduced Ejection Fraction: Analysis of The EVEREST Study Benjamin S. Wessler1, Haris Subacius2, Mihai Gheorghiade3, Marvin A. Konstam1, Faiez Zannad4, James Udelson1; 1Tufts Medical Center, Boston, MA; 2 Northwestern University Feinberg School of Medicine, Chicago, IL; 3 Northwestern University Feinberg School of Medicine, Chicago, IL; 4Universite de Lorraine, Nancy, France
Type of Neurologic event
HeartMate II Males Females HeartWare Males Females
None
ICH
Ischemic stroke P
44 (86.3) 15 (65.2)
5 (9.8) 4 (17.4)
2 (3.9) 4 (17.4)
19 (79.2) 8 (66.7)
3 (12.5) 4 (33.3)
2 (8.3) 0 (0)
0.07
0.2
259 Current Status of Adult Heart Transplant in Korea: Twenty-Year Experience Ga Yeon Lee, Jin-Oh Choi, Eun Seok Jeon; Samsung Medical Center, Seoul, Republic of Korea Introduction: .Heart transplant is an invaluable option for the patients in the endstage of heart failure. In Korea, over 900 cases of heart transplant were performed since the first case in 1992. However, there has been a lack of data summarizing the trends and outcomes of heart transplants for twenty years in Korea. Hypothesis: There are expected to be a certain change in trends of the recipients’ characteristics as well as the outcomes of heart transplant in Korea. Methods: Among total 16
Objectives: There is increasing evidence that prolongation of the PR interval (PRI) on surface electrocardiogram (ECG) is associated with cardiovascular risk in general populations. It is unknown whether prolongation of the PRI is associated with adverse outcomes for patients hospitalized for worsening heart failure (HF) and reduced left ventricular ejection fraction (LVEF). We evaluate the clinical implications of prolonged PRI for patients hospitalized for HF and reduced LVEF. Methods: Post hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) Trial. Patients in sinus rhythm were characterized as having either normal or prolonged PRI based on whether this interval was O 200 ms on baseline ECG. We determined whether prolonged PRI is associated with all cause mortality or the composite of cardiovascular death or HF hospitalization. Results: For patients hospitalized for HF with a reduced LVEF in sinus rhythm (n52137), 26.9% (n 5 575) had a prolonged PRI. During a median follow up of 9.9 months, all-cause mortality was 18.7% for patients with a normal PRI and 30.4% for patients with prolonged PRI (unadjusted hazard ratio [HR] 1.70; 95% confidence interval [CI] 1.41-2.06) Figure 1. The composite of cardiovascular death or HF hospitalization occurred in 39.3% of patients with normal PRI and 50.4% in those with prolonged PRI (HR 1.39; 95% CI, 1.19-1.61) Figure 2. The increased risk associated with prolonged PRI was maintained after adjusting for multiple variables for all-cause mortality (adjusted HR, 1.36; 95% CI 1.11-1.67) and showed a strong trend towards significance after adjusting for multiple variables for cardiovascular death or HF hospitalization (HR 1.18; 95% CI 1.00-1.38). Conclusion: Prolongation of the PRI on surface ECG for patients hospitalized for HF with reduced LVEF is independently associated with long term morbidity and mortality. Future investigation is needed to explore potential causality which might justify therapeutically targeting PRI.
Characteristic Age, years Female, N (%) Race, N (%) While Black Body mass index, kg/m2 Smoking, N (%) Current Former Coronary artery disease, N (%) Hypertension, N (%) Diabetes, N (%) Atrial fibrillation/flutter, N (%) Cerebrovascular disease, N (%) Lung disease, N (%) Sleep apnea, N (%) Depression, N (%) Systolic blood pressure, mmHg Diastolic blood pressure, mmHg Ejection fraction, % NYHA, N (%) I-II III-IV Not reported Hematocrit, % Sodium, mEq/L Glucose, mg/dL Creatinine, mg/dL Angiotensin converting enzyme inhibitors, N (%) Angiotensin receptor blockers, N (%) Mineralocorticoid receptor blockers, N (%) Beta-blockers, N (%) Calcium channel blockers, N (%) Diuretics, N (%) Statins, N (%) Nitrates, N (%) Hydralazine, N (%)
Value 71.7 6 13.8 133 (59.1) 107 (47.6) 106 (47.1) 32.7 6 9.5 17 (7.6) 65 (28.9) 94 (41.8) 212 (94.2) 104 (46.2) 89 (39.6) 39 (17.3) 63 (28.0) 58 (25.8) 35 (15.6) 136622 71612 54.866.8 102 (45.3) 90 (40.0) 33 (14.7) 36.065.0 13963 106 (89, 137)* 1.2 (0.9, 1.5)* 79 (35.1) 54 (24.0) 33 (14.7) 177 77 187 150 48 31
(78.7) (34.2) (83.1) (66.7) (21.3) (13.8)
* Median (25th, 75th percentile).
proposed by Goldstein. The purpose of this study is to compare health status, depression, and ED among Hispanic and non-Hispanic HF patients. Hypothesis: Hispanic and non-Hispanic HF patients will have similar rates of health status, depression and ED. Methods: Eighty-three uninsured male HF patients followed in the Olive ViewUCLA HF Disease Management Program were enrolled in the study. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire summary score (KCCQ-S), with KCCQ-S ! 50 indicating worse health status. The Patient Health Questionnaire-9 (PHQ-9) was used to assess for depression, with a score $ 10 indicative of depression. The Erectile Function (EF) domain of the International Index of Erectile Function (IIEF) was used to assess for ED. An IIEF-EF score of 17-25 was defined as mild-moderate ED, while an IIEF-EF score of 6-16 was defined as moderate-severe ED. An IIEF-EF score ! 6 was considered sexually inactive. Results: Of the 83 patients screened, 33% were sexually inactive. Those who were sexually active (n 5 56) had a mean age of 52 years with a mean left ventricular ejection fraction of 24%. Sixty-one percent of the sexually active patients were Hispanic, 50% spoke primarily Spanish, and 77% had a non-ischemic cardiomyopathy. Baseline characteristics including hypertension, diabetes mellitus, obesity, beta-blocker use, and NYHA class were similar for Hispanic vs. non-Hispanic patients. Hispanic patients did have a higher rate of hyperlipidemia (71% vs. 40%, p 50.04). Hispanic patients had a better health status (79% vs 41%, p 5 0.01) and lower prevalence of depression (21% vs 55%, p 5 0.02) compared to non-Hispanics. However, moderate-severe ED was no different among Hispanic and non-Hispanic patients (71% vs 50%, p 5 0.16). Conclusions: Despite Hispanic patients having similar rates of ED (with a trend towards higher rates of ED), these patients had a better health status and lower prevalence of depression than non-Hispanic HF patients. In this cohort of indigent HF patients, the mutually-reinforcing triad of HF, depression, and ED is not valid. Further investigation into ED among Hispanic patients is warranted.
256 Association of Therapeutic Effect on Functional and Physiological Markers and Change in Quality of Life in Patients With Heart Failure and Reduced Ejection Fraction Kevin J. Morine, Benjamin S. Wessler, Marvin A. Konstam, James E. Udelson; Tufts Medical Center, Boston, MA Introduction: Quality of life (QOL) is an individual’s perception of disease impact and treatment on physical and mental wellbeing. Chronic HF has been associated with a significantly impaired QOL. Understanding therapeutic effects on QOL through validated HF specific instruments may enhance patient centered care. The relationship between therapeutic effect on functional and physiological parameters and effects on change in QOL has not been examined. Methods: A systematic search for drug or device therapeutic effect on a QOL measure for which at least one randomized, controlled trial (RCT) lasting at least three months was performed. For each therapy, a search was then performed for RCTs assessing change in left ventricular ejection fraction (LVEF), end diastolic volume (EDV), end systolic volume (ESV), peak oxygen consumption (peak VO2), six minute walk (6MW) and natriuretic peptides. The correlation between the placebo-corrected change in these functional and physiologic parameters and the weighted mean of placebo-corrected change in QOL was evaluated by unweighted Spearman coefficients. Results: A majority of RCTs (46/49) meeting QOL search criteria reported the Minnesota Living with Heart Failure Questionnaire and this instrument was studied further. RCTs of 15 therapies reporting QOL data (n520,173 patients) directed the search for RCTs of the effects of those therapies on the markers. There were 57 LVEF reports (n510,153), 38 EDV reports (n59,043), 33 ESV reports (n59,156), 54 peak VO2 reports (n57,016), 39 6MW reports (n59,126), 9 BNP reports (n56,863) and 11 NT-proBNP reports (n54,186). The strongest correlation with change in QOL was observed with therapy induced change in 6MW (r5-0.51, P50.0009). Therapy induced change in LVEF (r50.42, P50.001), peak VO2 (r5-0.27, P50.047) and NT-proBNP (r50.67, P50.03) were also correlated. No significant correlation was observed between the therapy induced change in EDV (r5-0.03, P50.88), ESV (r5-0.17, P50.35) or BNP (r50.54, P50.14) and change in QOL. Conclusions: Drug and device induced effects on 6MW are correlated with change in QOL in RCTs of patients with heart failure and reduced ejection fraction, and suggest change in 6MW contributes to the multifactorial pathophysiology of compromised QOL.
Figure. Kaplan-Meier curves for mortality and composite endpoints.
257
255 Triad of Health Status, Depression and Erectile Dysfunction in Heart Failure Patients: Is it Applicable to Hispanics? Tracy L. Finegan, Daniel R. Sanchez, Gisele Munoz, Salvador Hernandez, Sheba K. Meymandi, Mahmoud I. Traina; Olive View-UCLA Medical Center, Sylmar, CA Introduction: Heart Failure (HF) has been associated with depression in several prior studies. Patients with both HF and depression have been shown to have poorer HF outcomes, increased clinical events, and increased mortality. HF has also been associated with erectile dysfunction (ED) in prior studies with overall prevalence rates up to 89%. A mutually-reinforcing triad of HF, depression, and ED has been
Elevated Left Ventricular End-Diastolic Pressure During Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Is a Predictor of Persistent Systolic Dysfunction Mohammed Eid Madmani1, Tilak Pasala2, Dinesh Sharma1, Sanjay Gandhi2; 1Case Western Resreve University/Metrohealth Medical Center, Cleveland, OH; 2Case Western Resreve University/Metrohealth Medical Center, Cleveland, OH Background: Left ventricular end-diastolic pressure (LVEDP) is frequently measured during primary percutaneous coronary intervention (PCI). However, little is known about the correlation between LVEDP and systolic function. We sought to determine the prognostic value of LVEDP for predicting long-term systolic function in patients with ST-Segment Elevation Myocardial Infarction (STEMI). Methods: Patients with acute STEMI without previous history of heart failure (N5224) who underwent primary PCI were studied retrospectively. LVEDP was measured invasively using the liquid-filled recording system at time of primary
The 18th Annual Scientific Meeting PCI. Patients were divided into tertiles according to LVEDP. Patients in the highest tertile (Group A, LVEDP O 25 mmHg, n566) were compared with the remainder of the cohort (Group B, n5158). Systolic function was assessed using 2D transthoracic echocardiogram within a week of primary PCI (n5219) and at follow up (n5129). Systolic dysfunction was defined as ejection fraction (EF) ! 40%. Results: In our study population, (mean age 55 611 years, male 63%) there was no difference in baseline characteristics and risk factors between the two groups. Mean EF for the entire cohort at admission was 48613%. Patient in Group A had significantly lower mean EF compared with group B at admission (42% vs. 51%) and follow up (44% vs. 55%) ( p!0.001for both). Patient in group A were more likely to have LAD as culprit lesion for STEMI (53 % vs 34 %) (p value 5 0.009). On follow up at a median of 167 days (IQR 75-524 days), 23 of 129 patients had persistent systolic dysfunction. Group A were significantly more likely to have persistent systolic dysfunction with adjusted (Age, sex, BMI, HTN, HLD, DM, smoking, CKD, medications) OR of 14.8 (4.07-53.9) respectively (p!0.001). Conclusion: Elevated LVEDP at the time of primary PCI are associated with increased risk of persistent systolic dysfunction in patients with STEMI.
258 Gender Differences in Risk of Neurologic Events during Support with Continuous Flow Left Ventricular Assist Device (LVAD) Alanna A. Morris, Ann Pekarek, Robert T. Cole, Divya Gupta, Kris Wittersheim, Duc Nguyen, S. Raja Laskar, Javed Butler, Andrew L. Smith, J. David Vega; Emory University, Atlanta, GA Background: Neurologic events (NE) are common after LVAD implantation, with 17% of patients experiencing an event after two years of support. There is increasing recognition that the risk of stroke after LVAD varies based on gender, with a higher risk in female patients. We sought to review our own data to determine gender differences in the risk of NE. Methods: Advanced heart failure patients (N5110) discharged from the hospital after implantation with a HeartMate II (N574) or HeartWare (N536) LVAD were retrospectively evaluated. NE were tracked from hospital discharge until the last day of patient follow-up, and classified as intracranial hemorrhage (ICH) or ischemic stroke (including transient ischemic attack). Logistic regression was used to determine which risk factors were associated with the risk of NE. Results: During a median follow-up of 410 days (interquartile range 226-787 days), 24 (21.8%) patients experienced a NE. Women were more likely to experience a NE than men (34.3% vs. 16.0%, P50.03). When stratified according to type of LVAD, there was a trend towards higher risk of ICH and ischemic stroke in women supported with a HeartMate II, while there was no difference in the number of events in men and women supported with a HeartWare (Table 1). Female sex (Odds Ratio [OR] 2.7, 95% confidence Interval [CI] 1.1,7.0; P50.03), and lower levels of albumin (OR 0.3, 95% CI 0.1,0.6; P50.003), hemoglobin (OR 0.7, 95% CI 0.5,0.9; P50.005), and platelets (OR 0.99, 95% CI 0.98,0.99; P50.01) were univariately associated with an increased risk of NE. In a multivariate model adjusting for these variables, the risk of NE associated with female sex was higher for support with a HeartMate II LVAD (OR 4.5, 95% CI 1.0,19.2; P50.04) than with a HeartWare LVAD (OR 0.8, 95% CI 0.1,6.3; P50.8). Conclusion: The risk of NE varies based on gender, and type of device. More research is needed to fully understand these differences, and whether anticoagulation regimens should be tailored based on gender. Table 1. Neurologic events according to gender and type of LVAD. Data are N (%).
HFSA
S103
centers performing heart transplant in Korea, 11 centers with multiple cases of heart transplants participated the data collection. Perioperative conditions of transplant recipients and the comprehensive outcomes of heart transplants were retrospectively reviewed and analyzed. Results: Total 665 adult heart transplants were performed in 11 centers in Korea from November 11th, 1992 to December 31st, 2012. The annual number of heart transplant recipients has been increased. Hence, the number of heart transplant in Korea is 164 before 2000, and 501 after 2000. The percentage of the elderly recipients ($60 years) is increased (7.9% before 2000 vs. 22.3% after 2000). In the primary cause of etiology, ischemic cardiomyopathy and hypertrophic cardiomyopathy was increased (5.9% vs. 16.3% and 1.3% vs. 4.1%), but dilated cardiomyopathy was decreased (77.6% vs. 56.5%). Preoperative mechanical support was mainly intra-arterial balloon pump before 2000 (11.1% among 13.0% of mechanically-supported recipients), but percutaneous cardiopulmonary support became more prevalent after 2000 (4.7% among 7.8% of mechanically-supported recipients). Recent long term survival rates was improved (estimated survival rates at 1 year, 3 year, 5 year, and 10 year; 83.4%, 77.1%, 71.6% and 57.0% before 2000, and 88.1%, 81.9%, 78.5%, and 70.0% after 2000, respectively). Mortality due to acute graft failure was decreased (16.9% vs. 9.3%), but mortality due to chronic graft failure and cardiovascular death was increased (3.9% vs. 4.6% and 11.7% vs. 19.4%). Conclusions: Long-term survival rates of heart transplant in Korea was improved in spite of more elderly recipients and larger proportion of more-invasive mechanical supports. Effort to improve survival rates of heart transplant should be sought.
Figure.
260 Clinical Implications of the PR Interval in Patients Hospitalized for Worsening Heart Failure and Reduced Ejection Fraction: Analysis of The EVEREST Study Benjamin S. Wessler1, Haris Subacius2, Mihai Gheorghiade3, Marvin A. Konstam1, Faiez Zannad4, James Udelson1; 1Tufts Medical Center, Boston, MA; 2 Northwestern University Feinberg School of Medicine, Chicago, IL; 3 Northwestern University Feinberg School of Medicine, Chicago, IL; 4Universite de Lorraine, Nancy, France
Type of Neurologic event
HeartMate II Males Females HeartWare Males Females
None
ICH
Ischemic stroke P
44 (86.3) 15 (65.2)
5 (9.8) 4 (17.4)
2 (3.9) 4 (17.4)
19 (79.2) 8 (66.7)
3 (12.5) 4 (33.3)
2 (8.3) 0 (0)
0.07
0.2
259 Current Status of Adult Heart Transplant in Korea: Twenty-Year Experience Ga Yeon Lee, Jin-Oh Choi, Eun Seok Jeon; Samsung Medical Center, Seoul, Republic of Korea Introduction: .Heart transplant is an invaluable option for the patients in the endstage of heart failure. In Korea, over 900 cases of heart transplant were performed since the first case in 1992. However, there has been a lack of data summarizing the trends and outcomes of heart transplants for twenty years in Korea. Hypothesis: There are expected to be a certain change in trends of the recipients’ characteristics as well as the outcomes of heart transplant in Korea. Methods: Among total 16
Objectives: There is increasing evidence that prolongation of the PR interval (PRI) on surface electrocardiogram (ECG) is associated with cardiovascular risk in general populations. It is unknown whether prolongation of the PRI is associated with adverse outcomes for patients hospitalized for worsening heart failure (HF) and reduced left ventricular ejection fraction (LVEF). We evaluate the clinical implications of prolonged PRI for patients hospitalized for HF and reduced LVEF. Methods: Post hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) Trial. Patients in sinus rhythm were characterized as having either normal or prolonged PRI based on whether this interval was O 200 ms on baseline ECG. We determined whether prolonged PRI is associated with all cause mortality or the composite of cardiovascular death or HF hospitalization. Results: For patients hospitalized for HF with a reduced LVEF in sinus rhythm (n52137), 26.9% (n 5 575) had a prolonged PRI. During a median follow up of 9.9 months, all-cause mortality was 18.7% for patients with a normal PRI and 30.4% for patients with prolonged PRI (unadjusted hazard ratio [HR] 1.70; 95% confidence interval [CI] 1.41-2.06) Figure 1. The composite of cardiovascular death or HF hospitalization occurred in 39.3% of patients with normal PRI and 50.4% in those with prolonged PRI (HR 1.39; 95% CI, 1.19-1.61) Figure 2. The increased risk associated with prolonged PRI was maintained after adjusting for multiple variables for all-cause mortality (adjusted HR, 1.36; 95% CI 1.11-1.67) and showed a strong trend towards significance after adjusting for multiple variables for cardiovascular death or HF hospitalization (HR 1.18; 95% CI 1.00-1.38). Conclusion: Prolongation of the PRI on surface ECG for patients hospitalized for HF with reduced LVEF is independently associated with long term morbidity and mortality. Future investigation is needed to explore potential causality which might justify therapeutically targeting PRI.