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Impact of Infarct Location on Development of Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction
S200 Journal of Cardiac Failure Vol. 20 No. 10S October 2014 pneumonia was more frequent (55% vs. 28%, p50.07) in F group than in S group. Conclusions: A high PCO2 value and suffering pneumonia were associated with unsuccessful NPPV treatment of the patients with AHF.
P-077 Effect of Non-invasive Positive Pressure Ventilation on Outcome in Patients with Acute Heart Failure MITSUTOSHI ASAI1,2, KAZUNORI KASHIWASE1, AKIO HIRATA1, TAKAYOSHI NEMOTO1, KOSHI MATSUO1, MASATO OKADA1 1 Cardiovascular Division, Osaka Police Hospital, Osaka, Japan, 2Cardiovascular Division, Higashiosaka City General Hospital, Osaka, Japan Background: Non-invasive positive pressure ventilation (NPPV) has been established for patients with acute heart failure (AHF). However, many patients cannot be discharged home after treatment, although NPPV can avoid endotracheal intubation (ETI). Objective: We examined the factors that influenced whether or not the patients could be discharged home among the patients with AHF treated with NPPV. Methods and Results: We analyzed 784 patients with AHF who admitted to Osaka Police Hospital between January 2010 and December 2012. The patients (n5110) treated with NPPV without ETI were divided into those who were discharged home (H group; n582) and those who died during hospitalization or those who were transferred to other hospital for a longer chronic treatment (DC group; n528). The blood pressure, heart rate, respiratory rate, LVDd, and LVEF on admission were not different between the groups. On the other hand, the patients treated with continuous sedation (21% vs. 5%, p50.01) and those who suffered pneumonia (55% vs. 21%, p50.07) were more frequent in DC group than in H group. Conclusions: The use of continuous sedation and suffering pneumonia were negatively associated with the outcome among the patients with AHF treated with NPPV.
P-078 WITHDRAWN
P-080 Endothelial Function is Associated with Ventilatory Efficiency rather than Exercise Tolerance in Patients after Acute Myocardial Infarction ETSUSHI KYUNO1, YOSHITAKA ISO2, NAOKO IKEDA1, CHISATO SATO2, HIDEYUKI MAEZAWA1, HIROSHI SUZUKI2 1 Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, 2 Division of Cardiology, Showa University Fujigaoka Hospital Ventilatory efficiency assessed by cardiopulmonary exercise testing (CPX) predicts prognosis of heart failure patients. Aim of this study was to investigate the crosssectional association between exercise capacity, ventilatory efficiency and endothelial function determined by flow-mediated dilation (FMD) in patients with lower exercise capacity after acute myocardial infarction (MI). Methods and Results: We studied 20 acute-MI patients with low exercise capacity (peak oxygen consumption (VO2) !16 ml/min/kg). FMD and CPX were performed in sub-acute phase of the MI. The %FMD were inversely and significantly correlated with the VE/VCO2 slope (r5 -0.44, p!0.05) but not associated with the VO2 levels at anaerobic threshold and peak. The patients were divided by VE/VCO2 slope value at 35 (O35, n57; !35, n5 13). %FMD was significantly lower in the patients with VE/VCO2 slope O35 than in the patients with!35, whereas there were no significant differences between the two groups in peak VO2 levels, plasma BNP concentration, ejection fraction documented by echocardiography and the clinical characteristics. Conclusion: Results of the present study demonstrated that FMD was associated with ventilatory efficiency rather than exercise tolerance in acute MI patients. FMD may reflect and stratify the severity in in the lower exercise capacity patients after acute MI.
P-081 Impact of Infarct Location on Development of Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction KITAE KIM, SHUICHIRO KAJI, TAKESHI KITAI, TOMOKO TANI, MAKOTO KINOSHITA, NATSUHIKO EHARA, ATSUSHI KOBORI, YASUHIRO SASAKI, TORU KITA, YUTAKA FURUKAWA Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital Background: It has been reported that patients with inferior myocardial infarction (MI) have higher incidence of ischemic mitral regurgitation (IMR) compared with patients with anterior MI. However, the impact of infarct location on development of IMR after acute MI during long-term follow-up period has not been fully investigated. Methods and Results: We studied 652 consecutive patients with acute MI from 2000 to 2008 who underwent emergent coronary angiography and transthoracic echocardiography during index hospitalization. The mean age was 65611 years and 509 patients (78%) were men. A total of 44 patients had combined anterior and infero-posterior (Ant+IP) infarct locations (Ant+IP-MI group) including prior MI (n537) or second MI during follow-up (n57). The remaining 610 patients had isolated anterior (n5271; Ant-MI group) or infero-posterior MI (n5337; IP-MI group) location. At late follow-up echocardiography, the incidence of significant IMR (moderate or severe) was significantly higher in Ant+IP-MI group, compared to Ant-MI group and IP-MI group (36% vs. 6% vs. 10%, P!0.001). Cox proportional model revealed that combined Ant+IP infarct locations was associated with a significant increase in the risk of heart failure independent of age, gender, and baseline IMR. Conclusions: Combined Ant+IP infarct location, which was associated with increased risk of heart failure, was an independent predictor of late IMR development in patients after acute MI.
P-082 P-079 A Case of Heart Failure and Coronary Spasm HIROKI TERAGAWA1, YUICHI FUJII1, TOMOHIRO UEDA1, SHUICHI NOMURA2 1 Department of Cardiovascular Medicine, Hiroshima General Hospital of West Japan Railway Company, 2Department of General Physician, Hiroshima General Hospital of West Japan Railway Company As the cause of heart failure, there are several cardiac disorders. Coronary spasm, which causes vasoconstriction of epicardial coronary arteries, leading to myocardial ischemia. Recently, it has been reported that coronary spam causes heart failure. We also experienced a case of heart failure and coronary spasm. A 69-year-old woman was admitted for further examination and treatment of chest pain. Emergency cardiac catheterization showed no significant stenosis on coronary angiograms, but on a left ventriculogram, diffuse wall hypokinesis was observed. After treating heart failure, cardiac catheterization was performed again. A spasm provocation test showed coronary spasm of the right and left coronary arteries. Under taking vasodilators and standard treatment for heart failure, she had experienced no readmission. Coronary spasm should be considered as one of causes of heart failure.
Effect of Left Ventricular Ejection Fraction on 2-year Clinical Cutcomes in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention with Drug-eluting Stents WOONG JEON1, SANG-HO PARK1, SEUNG-WOON RHA2, KANHAIYA L. PODDAR2, MEERA KUMARI2, YUN KYUNG KIM2, JIN OH NA2, CHEOL UNG CHOI2, HONG EUY LIM2, JIN WON KIM2, EUNG JU KIM2, CHANG GYU PARK2, HONG SEOG SEO2, DONG JOO OH2 1 Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, Korea, 2Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea Background: The purpose of this study is to evaluate the effect of left ventricular ejection fraction (LVEF) on clinical outcomes in patients with acute myocardial infarction (AMI). Methods: A total of 464 patients with AMI undergoing primary percutaneous coronary intervention between 2004 to 2009 were enrolled. They were divided into two group; LVEF$40% (n5279) and LVEF!40% (n5185). The clinical follow-up end-point was total major adverse cardiac event (MACE) including death, AMI, TVR, Non-TVR. Results: At 2-year (follow-up, 89.2%), major clinical outcomes was similar to two groups except total MACE and cardiac death. However, when in-hospital mortality was excluded, total MACE and cardiac death were also similar to two groups (Table, Figure). Conclusions: LVEF is associated with in-hospital cardiac death and total MACE. However, LVEF doesn’t seem to be independent predictor for a major clinical outcomes except in-hospital period.
P-077 Effect of Non-invasive Positive Pressure Ventilation on Outcome in Patients with Acute Heart Failure MITSUTOSHI ASAI1,2, KAZUNORI KASHIWASE1, AKIO HIRATA1, TAKAYOSHI NEMOTO1, KOSHI MATSUO1, MASATO OKADA1 1 Cardiovascular Division, Osaka Police Hospital, Osaka, Japan, 2Cardiovascular Division, Higashiosaka City General Hospital, Osaka, Japan Background: Non-invasive positive pressure ventilation (NPPV) has been established for patients with acute heart failure (AHF). However, many patients cannot be discharged home after treatment, although NPPV can avoid endotracheal intubation (ETI). Objective: We examined the factors that influenced whether or not the patients could be discharged home among the patients with AHF treated with NPPV. Methods and Results: We analyzed 784 patients with AHF who admitted to Osaka Police Hospital between January 2010 and December 2012. The patients (n5110) treated with NPPV without ETI were divided into those who were discharged home (H group; n582) and those who died during hospitalization or those who were transferred to other hospital for a longer chronic treatment (DC group; n528). The blood pressure, heart rate, respiratory rate, LVDd, and LVEF on admission were not different between the groups. On the other hand, the patients treated with continuous sedation (21% vs. 5%, p50.01) and those who suffered pneumonia (55% vs. 21%, p50.07) were more frequent in DC group than in H group. Conclusions: The use of continuous sedation and suffering pneumonia were negatively associated with the outcome among the patients with AHF treated with NPPV.
P-078 WITHDRAWN
P-080 Endothelial Function is Associated with Ventilatory Efficiency rather than Exercise Tolerance in Patients after Acute Myocardial Infarction ETSUSHI KYUNO1, YOSHITAKA ISO2, NAOKO IKEDA1, CHISATO SATO2, HIDEYUKI MAEZAWA1, HIROSHI SUZUKI2 1 Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, 2 Division of Cardiology, Showa University Fujigaoka Hospital Ventilatory efficiency assessed by cardiopulmonary exercise testing (CPX) predicts prognosis of heart failure patients. Aim of this study was to investigate the crosssectional association between exercise capacity, ventilatory efficiency and endothelial function determined by flow-mediated dilation (FMD) in patients with lower exercise capacity after acute myocardial infarction (MI). Methods and Results: We studied 20 acute-MI patients with low exercise capacity (peak oxygen consumption (VO2) !16 ml/min/kg). FMD and CPX were performed in sub-acute phase of the MI. The %FMD were inversely and significantly correlated with the VE/VCO2 slope (r5 -0.44, p!0.05) but not associated with the VO2 levels at anaerobic threshold and peak. The patients were divided by VE/VCO2 slope value at 35 (O35, n57; !35, n5 13). %FMD was significantly lower in the patients with VE/VCO2 slope O35 than in the patients with!35, whereas there were no significant differences between the two groups in peak VO2 levels, plasma BNP concentration, ejection fraction documented by echocardiography and the clinical characteristics. Conclusion: Results of the present study demonstrated that FMD was associated with ventilatory efficiency rather than exercise tolerance in acute MI patients. FMD may reflect and stratify the severity in in the lower exercise capacity patients after acute MI.
P-081 Impact of Infarct Location on Development of Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction KITAE KIM, SHUICHIRO KAJI, TAKESHI KITAI, TOMOKO TANI, MAKOTO KINOSHITA, NATSUHIKO EHARA, ATSUSHI KOBORI, YASUHIRO SASAKI, TORU KITA, YUTAKA FURUKAWA Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital Background: It has been reported that patients with inferior myocardial infarction (MI) have higher incidence of ischemic mitral regurgitation (IMR) compared with patients with anterior MI. However, the impact of infarct location on development of IMR after acute MI during long-term follow-up period has not been fully investigated. Methods and Results: We studied 652 consecutive patients with acute MI from 2000 to 2008 who underwent emergent coronary angiography and transthoracic echocardiography during index hospitalization. The mean age was 65611 years and 509 patients (78%) were men. A total of 44 patients had combined anterior and infero-posterior (Ant+IP) infarct locations (Ant+IP-MI group) including prior MI (n537) or second MI during follow-up (n57). The remaining 610 patients had isolated anterior (n5271; Ant-MI group) or infero-posterior MI (n5337; IP-MI group) location. At late follow-up echocardiography, the incidence of significant IMR (moderate or severe) was significantly higher in Ant+IP-MI group, compared to Ant-MI group and IP-MI group (36% vs. 6% vs. 10%, P!0.001). Cox proportional model revealed that combined Ant+IP infarct locations was associated with a significant increase in the risk of heart failure independent of age, gender, and baseline IMR. Conclusions: Combined Ant+IP infarct location, which was associated with increased risk of heart failure, was an independent predictor of late IMR development in patients after acute MI.
P-082 P-079 A Case of Heart Failure and Coronary Spasm HIROKI TERAGAWA1, YUICHI FUJII1, TOMOHIRO UEDA1, SHUICHI NOMURA2 1 Department of Cardiovascular Medicine, Hiroshima General Hospital of West Japan Railway Company, 2Department of General Physician, Hiroshima General Hospital of West Japan Railway Company As the cause of heart failure, there are several cardiac disorders. Coronary spasm, which causes vasoconstriction of epicardial coronary arteries, leading to myocardial ischemia. Recently, it has been reported that coronary spam causes heart failure. We also experienced a case of heart failure and coronary spasm. A 69-year-old woman was admitted for further examination and treatment of chest pain. Emergency cardiac catheterization showed no significant stenosis on coronary angiograms, but on a left ventriculogram, diffuse wall hypokinesis was observed. After treating heart failure, cardiac catheterization was performed again. A spasm provocation test showed coronary spasm of the right and left coronary arteries. Under taking vasodilators and standard treatment for heart failure, she had experienced no readmission. Coronary spasm should be considered as one of causes of heart failure.
Effect of Left Ventricular Ejection Fraction on 2-year Clinical Cutcomes in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention with Drug-eluting Stents WOONG JEON1, SANG-HO PARK1, SEUNG-WOON RHA2, KANHAIYA L. PODDAR2, MEERA KUMARI2, YUN KYUNG KIM2, JIN OH NA2, CHEOL UNG CHOI2, HONG EUY LIM2, JIN WON KIM2, EUNG JU KIM2, CHANG GYU PARK2, HONG SEOG SEO2, DONG JOO OH2 1 Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, Korea, 2Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea Background: The purpose of this study is to evaluate the effect of left ventricular ejection fraction (LVEF) on clinical outcomes in patients with acute myocardial infarction (AMI). Methods: A total of 464 patients with AMI undergoing primary percutaneous coronary intervention between 2004 to 2009 were enrolled. They were divided into two group; LVEF$40% (n5279) and LVEF!40% (n5185). The clinical follow-up end-point was total major adverse cardiac event (MACE) including death, AMI, TVR, Non-TVR. Results: At 2-year (follow-up, 89.2%), major clinical outcomes was similar to two groups except total MACE and cardiac death. However, when in-hospital mortality was excluded, total MACE and cardiac death were also similar to two groups (Table, Figure). Conclusions: LVEF is associated with in-hospital cardiac death and total MACE. However, LVEF doesn’t seem to be independent predictor for a major clinical outcomes except in-hospital period.