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Impact of Worsening Renal Function during Hospitalization on Long-Term Clinical Outcome in Patients with Acute Decompensated Heart Failure
S184 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 area. So we think hospital and clinic cooperation and community cooperation is very important and future problem.
O18-3 Effectiveness of Cardiac Rehabilitation with an Acceleration Training Program in Patients with LVAD Junya Yokoyama, Koichi Toda, Teruya Nakamura, Shigeru Miyagawa, Yasushi Yoshikawa, Satsuki Fukushima, Shunsuke Saito, Daisuke Yoshioka, Keitaro Domae, Yoshiki Sawa; Department of Cardiovascular Surgery, Osaka University Hospital Objectives: Patients with chronic heart failure develop muscle weakness and exercise tolerance is reduced. Especially patients with severe heart failure, such as implanted continuous left ventricular assist device (LVAD) patients, require prolonged bed rest for a bad preoperative condition. So early ambulation is difficult because of muscle weakness. Recently, an acceleration training has recently been indicated as a resistance training in sports medicine, and also has increased exercise tolerance in the elderly. So we tried to introduce an acceleration training program into cardiac rehabilitation after LVAD implant. Methods: We selected postoperative LVAD patients and divided into two groups. The patients,who were divided into an acceleration group, added acceleration training with PowerPlate machine to a usual cardiac rehabilitation program for a month. We evaluated a six minute walk test(6MWT) and isometric knee extension strength. Results: In the acceleration training group, 6MWT prolonged from 404 ± 66.5m to 472 ± 88.1m (P < .01),and knee extension strength also improved from 57.1 ± 22.1% to 74.4 ± 22.0%. The group improved more than the control group. Ejection fraction did not improve. Conclusion: This study suggests that cardiac rehabilitation program including acceleration training is effective for exercise tolerance.
logistic regression analysis. Conclusion In elderly patients with mild to moderate CKD, higher level of parathyroid hormone is associated with left ventricular remodeling, which may cause cardiovascular event in these patients.
O19-2 Relation between Timing of Worsening Renal Function and Prognosis in Patients with Acute Heart Failure Yuichi Kawase, Reo Hata, Keiichiro Iwasaki, Takeshi Tada, Kazushige Kadota; Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan Background: In patients admitted for acute heart failure (HF), the relation between the timing of worsening renal function (WRF, serum creatinine rise >0.3 mg/dl from admission) and prognosis remains unclear. Methods: We investigated 464 consecutive patients admitted for acute HF between February 2015 and October 2015, and enrolled 377 patients in this study sample, eliminating those with acute coronary syndrome or end stage renal disease. WRF was dichotomized into early and late by the median day of the occurrence (day 3). The primary endpoints were all-cause death and a composite of all-cause death or rehospitalization for HF. Results: WRF occurred in 42% (n = 160: early, 56%; late, 44%). The Figure shows the Kaplan-Meier curves of death and death/rehospitalization for heart failure. Conclusion: Only early phase WRF is associated with poor prognosis.
O18-4 Comfortable Walking Speed Predicts the Readmission due to Decompensated Heart Failure in Elderly Patients with Chronic Heart Failure Minoru Tabata1, Ayako Akiyama2, Yumi Kamada2, Shinya Tanaka2, Nobuaki Hamazaki2, Kentaro Kamiya4, Michitaka Kato3, Takashi Masuda2; 1Department of Physical Therapy, School of Health Sciences, Toyohashi SOZO University, Toyohashi, Japan; 2Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; 3Faculty of Health Sciences, TOKOHA University, Shizuoka, Japan; 4Rehabilitation center, Kitasato University Hospital, Sagamihara, Japan Background: Patients with chronic heart failure (CHF) are frequently readmitted to the hospital. Although comfortable walking speed reflects their prognosis, the relationship between the walking speed and readmission is still unknown in elderly CHF patients. Purpose: This study aimed to investigate whether the walking speed at the hospital discharge predicted the readmission due to decompensated CHF in them. Methods: Patients who were admitted to the hospital were prospectively followed up for 3 years after the discharge, if they were >64 years and had the first hospitalization due to CHF with NYHA 3 or 4. Consequently, we studied 216 patients (74.66.8 ± years old, 138 males) and investigated their walking speed at the discharge and readmission over 3 years. We determined significant factors affecting the readmission due to CHF and their cut-off values using multivariate logistic regression analysis and the area under the receiver operating characteristics (ROC) curve. Results: Of 216 patients, 104 were readmitted within 3 years after the discharge. The multivariate logistic regression analysis detected the walking speed at the discharge as a significant predictor for readmission (P < .001). The ROC curve showed that its cut-off value was 62.5 meters/ minute. Conclusion: This study demonstrated that comfortable walking speed was a strong predictor for readmission due to decompensated CHF and its predictive cutoff value was 62.5 meters/minute in elderly CHF patients.
O19-1 Elevated Parathyroid Hormone is Associated with Left Ventricular Remodeling in Elderly Patients with Mild to Moderate Chronic Kidney Disease Atsushi Mori, Satoru Sakragi, Yuusuke Katayama, Machiko Tanakaya, Kenji Kawamoto, Daii Hasegawa, Tadashi Wada, Kazuhiko Yamamoto, Fumi Yokohama, Hiroyuki Ichikawa; National Hospital Organization Iwakuni Clinical Center Background Parathyroid hormone (PTH) plays an important role in bone metabolism. Aging and chronic kidney disease is recognized as an important factor associated with elevation in PTH. Although elevated PTH was associated with cardiovascular mortality, the association of PTH and left ventricular remodeling in elderly patients with mild to moderate kidney disease has not been elucidated. Methods and results238 patients over 65 years with CKD stage 2 or 3 were examined (101 male, 75 years). Subjects with LV dysfunction (LVEF < 50%), atrial fibrillation and advanced chronic kidney disease (eGFR < 15 ml/min/1.73 m2) were excluded. Patients were divided into two groups according to intact PTH level: below 65 pg/ml (normal PTH, n = 201) and above 65 pg/ml (high PTH, n = 37). High PTH groups had lower creatinine-based estimated GFR (57 ± 15 vs 63 ± 13 ml/min/1.73 m2, (ex.)P < .05) and higher cystatin C level (1.21 ± 0.44 vs 1.01 ± 0.30 mg/L, (ex.)P < .01). In echocardiography, high PTH group had lower e (5.3 ± 1.6 vs 5.9 ± 1.7 cm/sec, (ex.)P < .05), higher E/e (16.1 ± 21.9 vs 11.5 ± 3.6, (ex.)P < .01) and higher LVMI (119 ± 28 vs 107 ± 30g/m2, (ex.)P < .05). The intact PTH was significantly associated with LVMI, even after adjustment for confounding factors. Also, high PTH group had high prevalence of LVH in multivariable
O19-3 Impact of Worsening Renal Function during Hospitalization on Long-Term Clinical Outcome in Patients with Acute Decompensated Heart Failure Masaru Hiki1, Takatoshi Kasai1,2, Hiroki Matsumoto1,2, Azusa Murata1, Takao Kato1, Shoko Suda1,2, Tetsuro Miyazaki1, Atsutoshi Takagi1, Hiroyuki Daida1; 1Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan; 2 Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan Background: Despite advances in the management of heart failure, the prognosis of patients with acute decompensated heart failure (ADHF) remains poor. Worsening renal function (WRF) during hospitalization due to ADHF has been reported to relate with poor short-term clinical outcomes. However, few studies have examined the impact of WRF during hospitalization on long-term clinical outcomes. Methods: A cohort of 1684 consecutive patients admitted to the cardiac intensive-care unit from 2007 to 2011 was studied. Among them, Patients admitted due to ADHF (defined according to the current guideline) were enrolled. Patients with acute coronary syndrome, other lifethreatening condition such as neoplasm and shock were excluded. WRF was defined as an absolute increase in serum creatinine of over 0.3 mg/dl in combination with over 25% increase in serum creatinine during hospitalization. The risk of WRF for clinical events including all-cause deaths and re-hospitalizations was assessed by multivariable Cox regression analysis. Results: Finally, 548 patients were assessed. A median follow-up period was 0.7 years, WRF was observed in 58 patients (10.6%). Cumulative survivals were significantly worse in patients with WRF (log-rank test: P = .021). In the multivariable analysis, compared with patients without WRF, those with WRF during hospitalization have a greater risk of clinical events (hazard ratio, 1.44; P = .041). Conclusion: In patients with ADHF, WRF during hospitalization was associated with poor long-term clinical outcomes.
O19-4 Impact of Decongestion on Mortality of Acute Decompensated Heart Failure Yasuhiro Tomita, Sugao Ishiwata, Minoru Ohno; The Cardiovascular Center, Toranomon Hospital, Tokyo, Japan Introduction: Decongestion is related to improved clinical outcomes in patients with heart failure (HF). Worsening of renal function (WRF) is sometimes accompanied by the treatment for decongestion. Methods: 154 consecutive patients admitted with their first presentation of acute decompensated HF were enrolled. We investigated the
O18-3 Effectiveness of Cardiac Rehabilitation with an Acceleration Training Program in Patients with LVAD Junya Yokoyama, Koichi Toda, Teruya Nakamura, Shigeru Miyagawa, Yasushi Yoshikawa, Satsuki Fukushima, Shunsuke Saito, Daisuke Yoshioka, Keitaro Domae, Yoshiki Sawa; Department of Cardiovascular Surgery, Osaka University Hospital Objectives: Patients with chronic heart failure develop muscle weakness and exercise tolerance is reduced. Especially patients with severe heart failure, such as implanted continuous left ventricular assist device (LVAD) patients, require prolonged bed rest for a bad preoperative condition. So early ambulation is difficult because of muscle weakness. Recently, an acceleration training has recently been indicated as a resistance training in sports medicine, and also has increased exercise tolerance in the elderly. So we tried to introduce an acceleration training program into cardiac rehabilitation after LVAD implant. Methods: We selected postoperative LVAD patients and divided into two groups. The patients,who were divided into an acceleration group, added acceleration training with PowerPlate machine to a usual cardiac rehabilitation program for a month. We evaluated a six minute walk test(6MWT) and isometric knee extension strength. Results: In the acceleration training group, 6MWT prolonged from 404 ± 66.5m to 472 ± 88.1m (P < .01),and knee extension strength also improved from 57.1 ± 22.1% to 74.4 ± 22.0%. The group improved more than the control group. Ejection fraction did not improve. Conclusion: This study suggests that cardiac rehabilitation program including acceleration training is effective for exercise tolerance.
logistic regression analysis. Conclusion In elderly patients with mild to moderate CKD, higher level of parathyroid hormone is associated with left ventricular remodeling, which may cause cardiovascular event in these patients.
O19-2 Relation between Timing of Worsening Renal Function and Prognosis in Patients with Acute Heart Failure Yuichi Kawase, Reo Hata, Keiichiro Iwasaki, Takeshi Tada, Kazushige Kadota; Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan Background: In patients admitted for acute heart failure (HF), the relation between the timing of worsening renal function (WRF, serum creatinine rise >0.3 mg/dl from admission) and prognosis remains unclear. Methods: We investigated 464 consecutive patients admitted for acute HF between February 2015 and October 2015, and enrolled 377 patients in this study sample, eliminating those with acute coronary syndrome or end stage renal disease. WRF was dichotomized into early and late by the median day of the occurrence (day 3). The primary endpoints were all-cause death and a composite of all-cause death or rehospitalization for HF. Results: WRF occurred in 42% (n = 160: early, 56%; late, 44%). The Figure shows the Kaplan-Meier curves of death and death/rehospitalization for heart failure. Conclusion: Only early phase WRF is associated with poor prognosis.
O18-4 Comfortable Walking Speed Predicts the Readmission due to Decompensated Heart Failure in Elderly Patients with Chronic Heart Failure Minoru Tabata1, Ayako Akiyama2, Yumi Kamada2, Shinya Tanaka2, Nobuaki Hamazaki2, Kentaro Kamiya4, Michitaka Kato3, Takashi Masuda2; 1Department of Physical Therapy, School of Health Sciences, Toyohashi SOZO University, Toyohashi, Japan; 2Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; 3Faculty of Health Sciences, TOKOHA University, Shizuoka, Japan; 4Rehabilitation center, Kitasato University Hospital, Sagamihara, Japan Background: Patients with chronic heart failure (CHF) are frequently readmitted to the hospital. Although comfortable walking speed reflects their prognosis, the relationship between the walking speed and readmission is still unknown in elderly CHF patients. Purpose: This study aimed to investigate whether the walking speed at the hospital discharge predicted the readmission due to decompensated CHF in them. Methods: Patients who were admitted to the hospital were prospectively followed up for 3 years after the discharge, if they were >64 years and had the first hospitalization due to CHF with NYHA 3 or 4. Consequently, we studied 216 patients (74.66.8 ± years old, 138 males) and investigated their walking speed at the discharge and readmission over 3 years. We determined significant factors affecting the readmission due to CHF and their cut-off values using multivariate logistic regression analysis and the area under the receiver operating characteristics (ROC) curve. Results: Of 216 patients, 104 were readmitted within 3 years after the discharge. The multivariate logistic regression analysis detected the walking speed at the discharge as a significant predictor for readmission (P < .001). The ROC curve showed that its cut-off value was 62.5 meters/ minute. Conclusion: This study demonstrated that comfortable walking speed was a strong predictor for readmission due to decompensated CHF and its predictive cutoff value was 62.5 meters/minute in elderly CHF patients.
O19-1 Elevated Parathyroid Hormone is Associated with Left Ventricular Remodeling in Elderly Patients with Mild to Moderate Chronic Kidney Disease Atsushi Mori, Satoru Sakragi, Yuusuke Katayama, Machiko Tanakaya, Kenji Kawamoto, Daii Hasegawa, Tadashi Wada, Kazuhiko Yamamoto, Fumi Yokohama, Hiroyuki Ichikawa; National Hospital Organization Iwakuni Clinical Center Background Parathyroid hormone (PTH) plays an important role in bone metabolism. Aging and chronic kidney disease is recognized as an important factor associated with elevation in PTH. Although elevated PTH was associated with cardiovascular mortality, the association of PTH and left ventricular remodeling in elderly patients with mild to moderate kidney disease has not been elucidated. Methods and results238 patients over 65 years with CKD stage 2 or 3 were examined (101 male, 75 years). Subjects with LV dysfunction (LVEF < 50%), atrial fibrillation and advanced chronic kidney disease (eGFR < 15 ml/min/1.73 m2) were excluded. Patients were divided into two groups according to intact PTH level: below 65 pg/ml (normal PTH, n = 201) and above 65 pg/ml (high PTH, n = 37). High PTH groups had lower creatinine-based estimated GFR (57 ± 15 vs 63 ± 13 ml/min/1.73 m2, (ex.)P < .05) and higher cystatin C level (1.21 ± 0.44 vs 1.01 ± 0.30 mg/L, (ex.)P < .01). In echocardiography, high PTH group had lower e (5.3 ± 1.6 vs 5.9 ± 1.7 cm/sec, (ex.)P < .05), higher E/e (16.1 ± 21.9 vs 11.5 ± 3.6, (ex.)P < .01) and higher LVMI (119 ± 28 vs 107 ± 30g/m2, (ex.)P < .05). The intact PTH was significantly associated with LVMI, even after adjustment for confounding factors. Also, high PTH group had high prevalence of LVH in multivariable
O19-3 Impact of Worsening Renal Function during Hospitalization on Long-Term Clinical Outcome in Patients with Acute Decompensated Heart Failure Masaru Hiki1, Takatoshi Kasai1,2, Hiroki Matsumoto1,2, Azusa Murata1, Takao Kato1, Shoko Suda1,2, Tetsuro Miyazaki1, Atsutoshi Takagi1, Hiroyuki Daida1; 1Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan; 2 Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan Background: Despite advances in the management of heart failure, the prognosis of patients with acute decompensated heart failure (ADHF) remains poor. Worsening renal function (WRF) during hospitalization due to ADHF has been reported to relate with poor short-term clinical outcomes. However, few studies have examined the impact of WRF during hospitalization on long-term clinical outcomes. Methods: A cohort of 1684 consecutive patients admitted to the cardiac intensive-care unit from 2007 to 2011 was studied. Among them, Patients admitted due to ADHF (defined according to the current guideline) were enrolled. Patients with acute coronary syndrome, other lifethreatening condition such as neoplasm and shock were excluded. WRF was defined as an absolute increase in serum creatinine of over 0.3 mg/dl in combination with over 25% increase in serum creatinine during hospitalization. The risk of WRF for clinical events including all-cause deaths and re-hospitalizations was assessed by multivariable Cox regression analysis. Results: Finally, 548 patients were assessed. A median follow-up period was 0.7 years, WRF was observed in 58 patients (10.6%). Cumulative survivals were significantly worse in patients with WRF (log-rank test: P = .021). In the multivariable analysis, compared with patients without WRF, those with WRF during hospitalization have a greater risk of clinical events (hazard ratio, 1.44; P = .041). Conclusion: In patients with ADHF, WRF during hospitalization was associated with poor long-term clinical outcomes.
O19-4 Impact of Decongestion on Mortality of Acute Decompensated Heart Failure Yasuhiro Tomita, Sugao Ishiwata, Minoru Ohno; The Cardiovascular Center, Toranomon Hospital, Tokyo, Japan Introduction: Decongestion is related to improved clinical outcomes in patients with heart failure (HF). Worsening of renal function (WRF) is sometimes accompanied by the treatment for decongestion. Methods: 154 consecutive patients admitted with their first presentation of acute decompensated HF were enrolled. We investigated the