- Email: [email protected]
Gender Difference in Cardiac Rehabilitation Outcome of Hospitalized Patients with Heart Failure
The 11th Annual Scientific Meeting
051 Unilateral Alveolar Hemorrhage in a Patient with Aortopulmonary Fistula SHINYA TOSA, HIROYUKI WATANABE, KENJI IINO, HIROSHI ITO Division of Cardiovascular Internal Medicine, Akita University School of Medicine, Akita, Japan We report a case of 70-year-old woman with hemoptysis caused by aortopulmonary fistula, who has undergone previous ascending aortic repair due to aortic dissection. She had first admitted to another hospital with a diagnosis of congestive heart failure. Despite diuretic treatments for presumed decompensated heart failure, hemodynamics and respiratory signs progressively deteriorated. After the patient had been a week in our hospital without improving, she presented with hemoptysis. Her chest X-rey or bronchoscopy showed unilateral infiltrates and continuous blood oozing only in right lung field. An echocardiography revealed continuous jet flow entered into right pulmonary artery. A CT scan of the chest exhibited a pseudo aneurysm of the ascending aorta. The patient was diagnosed as the aortopulmonary fistula with alveolar hemorrhage. Unfortunately, the patient’s hospital course was complicated with multiple organ failure, which resulted in death. The autopsy confirmed the communication between ascending aorta and right pulmonary artery, and diffuse alveolar hemorrhage in entire right lung. Conclusions: A patient who has an unexplained hemoptysis and a history of a previous thoracic aortic surgery should have appropriate clinical evaluation to exclude the presence of an aortopulmonary fistula.
052 The Effect of Imidaprilat, an ACE Inhibitor on Matrix Metalloproteinase-2 Activity in Human Cardiac Fibroblast TOSHIHIRO MIZUGUCHI, HIROYASU UZUI, YASUHIKO MITSUKE, JYUNJI SAKATA, JONG-DAE LEE Division of Cardiology, University of Fukui Hospital, Eiheiji, Japan Background: Myocardial extracellular matrix remodeling is regulated by matrix metalloproteinases (MMPs) involving MMP-2. MMP-2 plays an important role in digesting type I, II, and IV collagens. Angiotensin-converting enzyme (ACE) inhibition is used in the treatment of heart failure because of the attenuation of LV remodeling. In this study, we demonstrated that imidaprilat inhibited MMP-2 activity in human cardiac fibroblasts induced by IL-1b via NO-dependent pathway. Methods and results: Using geratin zymography and RT-PCR, we found that IL-1B increased the MMP-2 activity and transcription dose dependently, and this effect was inhibited by imdaprilat or the nitric oxide synthase inhibitor, L-NMMA. Sodium nitroprusside, a exogenous NO donor, reversed the effects of imidaprilat on MMP-2 inhibition. Imidaprilat without IL-1B stimulated didn’t affect MMP-2 activity and expression. Conculusion: the results presented that imidaprilat inhibits IL-1b-stimulated increases in MMP-2 activity in human cardiac fibroblasts by inhibiting MMP-2 expression and possibly through the inhibition of NO pathway. The accumulation of NO plays a key role in the regulation of MMP-2 activity. Our findings are consistent with the evidence that ACE inhibitor plays an important role in LV remodeling.
JHFS
S37
of orthopedic disorders (37% vs 24%, p!0.05), and gait disturbance (71% vs 45%, p!0.0001) were significantly higher and 6 minute walk distance (359 m vs 394 m, p!0.001) and possibility rate of climbing stairs (47% vs 69%, p!0.001) were respectively reduced. Consequently total CR period was significantly longer in female group (20 vs 16 days, p!0.05). Conclusion: Though female patients with HF had preserved systolic function, their ADL level and exercise capacity were respectively impaired and total CR period was prolonged. Thus, in female patients, CR outcome should be prudently verified by considering exercise capacity and underlying physical disorders.
054 Anemia Facilitates Concentric Ventricular Geometry in Presence of Heart Failure: High Prevalence of Anemia in Patients with Preserved Systolic Function MASAAKI LEE, MIKA MATUMOTO, TAKESHI TUJINO, SHINNJI NAKAO, AKIKO GOUDA, YOSHIRO NAITO, MISATO OTSUKA, CHIKAKO YOSHIDA, TOHORU MASUYAMA Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan We attempted to characterize the impacts of the association of anemia on left ventricular (LV) geometry and diastolic filling in patients with HF. Study population consisted of 101 patients with HF. LV ejection fraction was $40% in 46 patients (diastolic HF, DHF) and !40% in 55 patients (systolic HF, SHF). LV geometry was assessed with LV end-diastolic diameter (LVDd), and LV diastolic filling, with the ratio of peak mitral early diastolic flow velocity to tissue Doppler early diastolic mitral annular velocity (E/E0 ). These parameters were compared between those with and without anemia in each group. The hemoglobin (Hb) level was significantly lower in DHF than in SHF (11.062.0 vs 12.462.2 g/dl, p!0.01). There was no difference in E/E0 or LVDd between those with and without associated anemia (Hb!12.0 g/dl) in the SHF group. In contrast, anemia was associated with an increase in E/E0 (2468 vs 1665, p!0.01) and a decrease in LVDd (5068 vs 5669 mm, p!0.05) in the DHF group. There were weak but significant correlations between Hb and LVDd (r50.37, p!0.01), and between Hb and E/E0 ratio (r50.38, p!0.05) only in DHF group. LV concentric geometrical changes in patients with associated anemia may be at least partially due to anemia-induced neurohumoral activation.
055 Successful Treatment of Severe Chronic Heart Failure by Intermittent Administration of Carperitide who was Once Completely Dependent on It: Case Report NORIKO SASAKI1, KEIJI HIROOKA1, YUKIHIRO KORETSUNE2, HIDEO KUSUOKA1, YOSHIO YASUMURA1 1 Division of Cardiology, National Hospital Organization Osaka National Hospital, Osaka, Japan, 2Division of Clinical Research, National Hospital Organization Osaka National Hospital, Osaka, Japan
053 Gender Difference in Cardiac Rehabilitation Outcome of Hospitalized Patients with Heart Failure MINORU TABATA1, SUSUMU NAKAGAWA2, SUSUMU UI2, HIDEO MITAMURA2 1 Department of Cardiac Rehabilitation, Saiseikai Central Hospital, Tokyo, Japan, 2 Cardiovascular Center, Saiseikai Central Hospital, Tokyo, Japan Purpose and Method: Little is known about the gender difference in cardiac rehabilitation (CR) outcome of hospitalized patients with heart failure (HF). In order to clarify the gender difference in CR outcome, we analyzed consecutive 217 patients (115 male and 102 female) who admitted due to HF and underwent CR from 2005 to 2006. Data were compared by chi-square test and analysis of variance and p!0.05 was defined to be significant. Result: There was no difference in serum BNP level, CCU admission rate and the readmission rate between 2 groups. LVEF was improvement in female group than male group (47% vs 33%, p!0.001). In female group, however, complication rate
We report a 71-year-old female with chronic heart failure due to mild rheumatic valvular disease with post pacemaker implantation for bradycardiac atrial fibrillation. She had suffered from phlebitis of her left forearm, anasarca and bleeding tendency since May 2006, and required emergent admission on August. Transthoracic echocardiography showed hypertensive heart, severe transtricuspid regurgitation due to the pacing lead, giant left and right atria and pulmonary arterial hypertension. While treating infection with antibiotics, continuous intravenous carperitide 0.025 mg/kg/ min was administrated. After administration, her body weight decreased, though its decrease and cessation apparently worsened heart failure. Pimobendan was failed to administrate because of drug-induced interstitial pneumonia. Enarapril could not be increased because of dry cough. Continuous carperitide administration improved her functional class to class II but its cessation lead to anuria. We diminished carperitide gradually from 24 to 12 hours over one and a half months, and at last required only 3 days (four hours each) a week so that she could be discharged to out-patientclinic. The patient refractory to carperitide reduction could be finally discharged by intermittent carperitide therapy.
051 Unilateral Alveolar Hemorrhage in a Patient with Aortopulmonary Fistula SHINYA TOSA, HIROYUKI WATANABE, KENJI IINO, HIROSHI ITO Division of Cardiovascular Internal Medicine, Akita University School of Medicine, Akita, Japan We report a case of 70-year-old woman with hemoptysis caused by aortopulmonary fistula, who has undergone previous ascending aortic repair due to aortic dissection. She had first admitted to another hospital with a diagnosis of congestive heart failure. Despite diuretic treatments for presumed decompensated heart failure, hemodynamics and respiratory signs progressively deteriorated. After the patient had been a week in our hospital without improving, she presented with hemoptysis. Her chest X-rey or bronchoscopy showed unilateral infiltrates and continuous blood oozing only in right lung field. An echocardiography revealed continuous jet flow entered into right pulmonary artery. A CT scan of the chest exhibited a pseudo aneurysm of the ascending aorta. The patient was diagnosed as the aortopulmonary fistula with alveolar hemorrhage. Unfortunately, the patient’s hospital course was complicated with multiple organ failure, which resulted in death. The autopsy confirmed the communication between ascending aorta and right pulmonary artery, and diffuse alveolar hemorrhage in entire right lung. Conclusions: A patient who has an unexplained hemoptysis and a history of a previous thoracic aortic surgery should have appropriate clinical evaluation to exclude the presence of an aortopulmonary fistula.
052 The Effect of Imidaprilat, an ACE Inhibitor on Matrix Metalloproteinase-2 Activity in Human Cardiac Fibroblast TOSHIHIRO MIZUGUCHI, HIROYASU UZUI, YASUHIKO MITSUKE, JYUNJI SAKATA, JONG-DAE LEE Division of Cardiology, University of Fukui Hospital, Eiheiji, Japan Background: Myocardial extracellular matrix remodeling is regulated by matrix metalloproteinases (MMPs) involving MMP-2. MMP-2 plays an important role in digesting type I, II, and IV collagens. Angiotensin-converting enzyme (ACE) inhibition is used in the treatment of heart failure because of the attenuation of LV remodeling. In this study, we demonstrated that imidaprilat inhibited MMP-2 activity in human cardiac fibroblasts induced by IL-1b via NO-dependent pathway. Methods and results: Using geratin zymography and RT-PCR, we found that IL-1B increased the MMP-2 activity and transcription dose dependently, and this effect was inhibited by imdaprilat or the nitric oxide synthase inhibitor, L-NMMA. Sodium nitroprusside, a exogenous NO donor, reversed the effects of imidaprilat on MMP-2 inhibition. Imidaprilat without IL-1B stimulated didn’t affect MMP-2 activity and expression. Conculusion: the results presented that imidaprilat inhibits IL-1b-stimulated increases in MMP-2 activity in human cardiac fibroblasts by inhibiting MMP-2 expression and possibly through the inhibition of NO pathway. The accumulation of NO plays a key role in the regulation of MMP-2 activity. Our findings are consistent with the evidence that ACE inhibitor plays an important role in LV remodeling.
JHFS
S37
of orthopedic disorders (37% vs 24%, p!0.05), and gait disturbance (71% vs 45%, p!0.0001) were significantly higher and 6 minute walk distance (359 m vs 394 m, p!0.001) and possibility rate of climbing stairs (47% vs 69%, p!0.001) were respectively reduced. Consequently total CR period was significantly longer in female group (20 vs 16 days, p!0.05). Conclusion: Though female patients with HF had preserved systolic function, their ADL level and exercise capacity were respectively impaired and total CR period was prolonged. Thus, in female patients, CR outcome should be prudently verified by considering exercise capacity and underlying physical disorders.
054 Anemia Facilitates Concentric Ventricular Geometry in Presence of Heart Failure: High Prevalence of Anemia in Patients with Preserved Systolic Function MASAAKI LEE, MIKA MATUMOTO, TAKESHI TUJINO, SHINNJI NAKAO, AKIKO GOUDA, YOSHIRO NAITO, MISATO OTSUKA, CHIKAKO YOSHIDA, TOHORU MASUYAMA Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan We attempted to characterize the impacts of the association of anemia on left ventricular (LV) geometry and diastolic filling in patients with HF. Study population consisted of 101 patients with HF. LV ejection fraction was $40% in 46 patients (diastolic HF, DHF) and !40% in 55 patients (systolic HF, SHF). LV geometry was assessed with LV end-diastolic diameter (LVDd), and LV diastolic filling, with the ratio of peak mitral early diastolic flow velocity to tissue Doppler early diastolic mitral annular velocity (E/E0 ). These parameters were compared between those with and without anemia in each group. The hemoglobin (Hb) level was significantly lower in DHF than in SHF (11.062.0 vs 12.462.2 g/dl, p!0.01). There was no difference in E/E0 or LVDd between those with and without associated anemia (Hb!12.0 g/dl) in the SHF group. In contrast, anemia was associated with an increase in E/E0 (2468 vs 1665, p!0.01) and a decrease in LVDd (5068 vs 5669 mm, p!0.05) in the DHF group. There were weak but significant correlations between Hb and LVDd (r50.37, p!0.01), and between Hb and E/E0 ratio (r50.38, p!0.05) only in DHF group. LV concentric geometrical changes in patients with associated anemia may be at least partially due to anemia-induced neurohumoral activation.
055 Successful Treatment of Severe Chronic Heart Failure by Intermittent Administration of Carperitide who was Once Completely Dependent on It: Case Report NORIKO SASAKI1, KEIJI HIROOKA1, YUKIHIRO KORETSUNE2, HIDEO KUSUOKA1, YOSHIO YASUMURA1 1 Division of Cardiology, National Hospital Organization Osaka National Hospital, Osaka, Japan, 2Division of Clinical Research, National Hospital Organization Osaka National Hospital, Osaka, Japan
053 Gender Difference in Cardiac Rehabilitation Outcome of Hospitalized Patients with Heart Failure MINORU TABATA1, SUSUMU NAKAGAWA2, SUSUMU UI2, HIDEO MITAMURA2 1 Department of Cardiac Rehabilitation, Saiseikai Central Hospital, Tokyo, Japan, 2 Cardiovascular Center, Saiseikai Central Hospital, Tokyo, Japan Purpose and Method: Little is known about the gender difference in cardiac rehabilitation (CR) outcome of hospitalized patients with heart failure (HF). In order to clarify the gender difference in CR outcome, we analyzed consecutive 217 patients (115 male and 102 female) who admitted due to HF and underwent CR from 2005 to 2006. Data were compared by chi-square test and analysis of variance and p!0.05 was defined to be significant. Result: There was no difference in serum BNP level, CCU admission rate and the readmission rate between 2 groups. LVEF was improvement in female group than male group (47% vs 33%, p!0.001). In female group, however, complication rate
We report a 71-year-old female with chronic heart failure due to mild rheumatic valvular disease with post pacemaker implantation for bradycardiac atrial fibrillation. She had suffered from phlebitis of her left forearm, anasarca and bleeding tendency since May 2006, and required emergent admission on August. Transthoracic echocardiography showed hypertensive heart, severe transtricuspid regurgitation due to the pacing lead, giant left and right atria and pulmonary arterial hypertension. While treating infection with antibiotics, continuous intravenous carperitide 0.025 mg/kg/ min was administrated. After administration, her body weight decreased, though its decrease and cessation apparently worsened heart failure. Pimobendan was failed to administrate because of drug-induced interstitial pneumonia. Enarapril could not be increased because of dry cough. Continuous carperitide administration improved her functional class to class II but its cessation lead to anuria. We diminished carperitide gradually from 24 to 12 hours over one and a half months, and at last required only 3 days (four hours each) a week so that she could be discharged to out-patientclinic. The patient refractory to carperitide reduction could be finally discharged by intermittent carperitide therapy.