Gender and Prognostic Significance of Anemia in Chronic Heart Failure

Gender and Prognostic Significance of Anemia in Chronic Heart Failure

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 ...

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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