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Influence of Clinical Parameters on Tolvaptan for the Treatment of Acute Decompensated Heart Failure
The 19th Annual Scientific Meeting
OP41-3 Clinical Significance of Sequential Evaluations of Left Ventricular Ejection Fraction During Hospitalizations for Acute Decompensated Heart Failure TOMOFUMI NAKATSUKASA1, MASAYOSHI YAMAMOTO2, YOSHIE HARIMURA3, TOMOKO ISHIDU2, YOSHIHIRO SEO2, KAZUTAKA AONUMA2 1 Department of Cardiology, Hitachinaka General Hospital, Hitachinaka, Japan; 2 Cardiovascular Devision Faculty of Medicine University of Tsukuba, Tsukuba, Japan; 3Ryugasaki Saiseikai Hospital, Ryugasaki, Japan Background: Patient conditions are dramatically changed by treatments for acute decompensated heart failure (ADHF). We evaluate changes of left ventricular ejection fraction (LVEF) and the associated factors during hospitalizations for ADHF. Methods: We prospectively studied 514 patients with ADHF (318 men, 72612yrs). We confirmed 95% CI of differences between visual EF and Simpson’s rule was only 3.2% in our series (N5563), and initial LVEF was evaluated by visual EF at a primary care setting. LVEF were reevaluated by Simpson’ s rule at stable conditions before discharge. Results: Based on initial visual LVEF, we classified patients into 4-classes; Class-1, LVEFS 60% (N563); Class-2, 45 & LVEF!60% (N5128); Class-3, 35 & LVEF!45% (N5122); Class-4, LVEF!35% (N5201). At reevaluations, LVEF classes were improved in 181(35.4%) patients, in contrast, worsened in 77 (14.6%). In 42.9% patients of Class-1, LVEF class was worsened, however, only age associated clinical factors were determined. In Class-2, female and non-ischemic etiology and in class-3, systolic blood pressure was associated with LVEF Class improvement. In LVEF Class-4, higher heart rate, serum creatinine, CRP level and atrial fibliration at administration were associated with LVEF Class improvement. Conclusions: We confirmed changes of LVEF during hospitalizations in a half of patients. Since the changes could not be predicted simply, echocardiographic reevaluations are important in assessing clinical conditions and treatment effects.
OP41-4 The Change of Cardio-Thoracic Ratio and Outcome in Patients with Acute Decompensated Heart Failure TORU KONDO, TAKAHIRO OKUMURA, NAOKI WATANABE, NAOAKI KANO, HIROAKI MORI, KENJI HUKAYA, AKINORI SAWAMURA, RYOTA MORIMOTO, YASUKO BANDO, TOYOAKI MUROHARA Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan Background: Chest radiograph is routinely performed to evaluate disease condition during hospitalization in patients with acute decompensated heart failure (ADHF). Cardio-thoracic ratio (CTR) is reported to be associated with heart chamber dilation and often declines by management of ADHF. The purpose of this study, therefore, was to evaluate the change of CTR and prognosis in patients with ADHF. Methods: We enrolled 183 patients (106 male, 75.3 years) admitted in our hospital for ADHF. (CTRadmission - CTRdischarge)/CTRadmission100 was defined as CTR change (%). The patients were divided into 2 groups according to CTR change: !9.2% (median for the study group), Group A; S 9.2%, Group B. Results: The mean follow-up period was 228 days. The mean of left ventricular ejection fraction was 45.1% and brain natriuretic peptide level was 839.9 pg/ml. The prevalence of female and prior HF admission were higher in Group A (p50.004 and p50.017). In Kaplan-Meier survival analysis, the incidence of death and re-hospitalization due to worsening HF was significantly higher in Group A (p50.008). Multivariate Cox regression model showed that CTR change !12% (HR 2.49; 95% CI 1.18-5.25; p50.017) and body mass index (HR 0.894; 95% CI 0.822 to 0.972; p50.009) were independent predictors of adverse events. Conclusions: The change of CTR during hospitalization predicts future adverse event after discharge in patients with ADHF.
OP41-5 Influence of Clinical Parameters on Tolvaptan for the Treatment of Acute Decompensated Heart Failure MICHIRO MARUYAMA, KENJI EMOTO, SYUNICHIROU HONDOU, MASAKI KINOSHITA, TAKASHI KUSAYAMA, ISAO ABURADANI, YOSHIKI NAGATA, KAZUO USUDA Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan Background: In heart failure (HF), several studies have demonstrated that worsening renal function is associated with adverse outcomes. Tolvaptan has been reported to reduce signs of congestion without worsening renal function. This purpose is to assess the relationship between clinical parameters and response to tolvaptan in patients with HF. Methods: Objectives were 28 hospitalized patients with acute decompensated HF (73615 years, Male 21), in which dilated cardiomyopathy, valve disease, ischemic heart disease, hypertension, and others were 10, 6, 4, 3 and 5 patients. The clinical parameters were hemodynamics, renal function, ejection fraction (EF), pressure gradient of tricuspid regurgitation (TRPG). Response to tolvaptan was evaluated from urine volume (UV) change. Results: Systolic blood pressure (SBP), heart rate, blood urea nitrogen (BUN), Cr, sodium, potassium were 108617 mmHg, 81615 bpm, 33620 mg/dl, 13864 mEq/l, 3.960.5 mEq/l before tolvaptan administration. EF, TRPG were 41619%, 35613 mmHg. Administration dosage of tolvaptan
JHFS
S193
was 6.9663.78 mg/day and 24 patients (86%) reduced congestion. After tolvaptan administration SBP and UV increased significantly (p!0.05), but heart rate, BUN, Cr, sodium, potassium were unchanged. UV change was 4216632 ml/day and correlated with TRPG (r5-0.382, p50.072), TRPG/SBP (r5-0.471, p50.023), not other parameters. Conclusions: Tolvaptan improve congestion without worsening renal function in decompensated HF, and these results may suggest that the balance between preload and systemic blood pressure is important for response to tolvaptan.
OP42-1 Right Atrial Pressure Does Not Reflect Body Fluid Status in Repeater Patients with Acute Decompensated Heart Failure TAIKI SAKAGUCHI1, AKIO HIRATA1, KAZUNORI KASHIWASE1, YOSHIHARU HIGUCHI1, YUKIHIRO KORETSUNE2, HIDEO KUSUOKA3, YOSHIO YASUMURA1 1 Osaka Police Hospital, Division of Cardiology, Osaka, Japan; 2Osaka National Hospital, Institute for Clinical Research, Osaka, Japan; 3Osaka National Hospital, Division of Cardiology, Osaka, Japan Introduction: We have reported quantitative index of fluid retention using bioimpedance in patients with acute decompensated heart failure (ADHF). Right atrial pressure (RAP) is influenced by fluid status and right ventricular function, we assessed the relationship between RAP and the degree of fluid retention in ADHF patients. Methods: In 200 ADHF patients, we quantified the degree of extracellular fluid retention on admission by the ratio (M/P ratio) of measured volume using bioimpedance to predicted volume estimated by original regression equations that incorporate age, sex, height, and weight. RAP was estimated by the inferior vena cava diameter measured with echocardiography: RAP!10 mmHg, maximum!25 mm and respiratory variation S 50%; 10-15 mmHg, !25 mm and !50%; O15 mmHg, S 25 mm. All subjects were divided into either repeater group (n583) or new-onset group (n5117) with/without ADHF hospitalization during the past half year, and assessed the relationship between RAP and M/P ratio in each group. Results: M/P ratio on admission was lower in repeater group than in new-onset group (1.1660.23 vs 1.2460.24; p50.011). In new-onset group, a positive correlation was observed between RAP and M/P ratio (!10 mmHg, 1.0860.19; 10-15 mmHg, 1.2360.20; O15 mmHg, 1.3960.29; p!0.001), but not in repeater group (1.0760.25; 1.1760.23; 1.1660.22; p50.522). Conclusion: RAP reflects fluid status only in early-stage heart failure patients. Repeater patients are decompensated with milder fluid retention, and their RAP does not reflect the degree of fluid retention.
OP42-2 Clinical Usefulness of Urgent Echocardiography in Non-Cardiac Patients with Elevated Cardiac Enzyme and Chest Pain ILSUK SOHN, HUI-JEONG HWANG, CHANG-BUM PARK, EUN-SUN JIN, JIN-MAN CHO, CHONG-JIN KIM Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea Elevated cardiac enzyme is associated with increased morbidity and mortality in noncardiac patients. We investigated clinical usefulness of urgent echocardiography in these patients. Consecutive 351 patients (mean age 5 69 6 14 years) who were admitted in non-cardiac unit and underwent urgent echocardiography because of elevated cardiac enzyme and clinical symptoms and/or signs were analyzed. Echocardiographic positive findings (Echo (+)) were defined as new ischemia, ventricular dysfunction, or possible pulmonary embolism. Initial and peak levels of troponin I were collected. There were no significant differences in initial and peak levels of troponin I between groups with and without additional coronary angiography. Coronary angiography was performed in 64 patients (59%) with suspicious ischemia and in 23 patients (10%) without suspicious ischemia on echocardiography. Additional chest CT was performed in 13 patients (81.3%) with suspicious pulmonary thromboembolism and in 19 patients (5.7%) without sign of pulmonary thromboembolism on echocardiography. Initial cut-off levels of troponin I for sensitivity of 80% in prediction of Echo (+) were 0.067 ng/ml. In conclusion, urgent use of echocardiography in patients with elevated level of cardiac enzyme and chest pain is useful to determinate additional diagnostic tools. In addition, cut-off values of cardiac enzyme with high sensitivity might help to prevent an excessive echocardiographic usage.
OP42-3 The Impact of Infection Which Has Occurred during Hospitalization of Acute Heart Failure MASAYUKI HIRAI, YOICHIRO IWASAKI, AKIHIRO OKAMURA, ASAO MIMURA, FUMIYO TSUNODA, HIROSHIGE ISHII, YOSHIAKI INOUE, KINYA SHIROTA Department of Cardiology, Matsue Red Cross Hospital, Matsue, Japan Background: The onset of acute heart failure (AHF) is often influenced by infections. However, the significance of infection which has occurred after AHF admission is not well known. We investigated the characteristics and prognosis of the patients
OP41-3 Clinical Significance of Sequential Evaluations of Left Ventricular Ejection Fraction During Hospitalizations for Acute Decompensated Heart Failure TOMOFUMI NAKATSUKASA1, MASAYOSHI YAMAMOTO2, YOSHIE HARIMURA3, TOMOKO ISHIDU2, YOSHIHIRO SEO2, KAZUTAKA AONUMA2 1 Department of Cardiology, Hitachinaka General Hospital, Hitachinaka, Japan; 2 Cardiovascular Devision Faculty of Medicine University of Tsukuba, Tsukuba, Japan; 3Ryugasaki Saiseikai Hospital, Ryugasaki, Japan Background: Patient conditions are dramatically changed by treatments for acute decompensated heart failure (ADHF). We evaluate changes of left ventricular ejection fraction (LVEF) and the associated factors during hospitalizations for ADHF. Methods: We prospectively studied 514 patients with ADHF (318 men, 72612yrs). We confirmed 95% CI of differences between visual EF and Simpson’s rule was only 3.2% in our series (N5563), and initial LVEF was evaluated by visual EF at a primary care setting. LVEF were reevaluated by Simpson’ s rule at stable conditions before discharge. Results: Based on initial visual LVEF, we classified patients into 4-classes; Class-1, LVEFS 60% (N563); Class-2, 45 & LVEF!60% (N5128); Class-3, 35 & LVEF!45% (N5122); Class-4, LVEF!35% (N5201). At reevaluations, LVEF classes were improved in 181(35.4%) patients, in contrast, worsened in 77 (14.6%). In 42.9% patients of Class-1, LVEF class was worsened, however, only age associated clinical factors were determined. In Class-2, female and non-ischemic etiology and in class-3, systolic blood pressure was associated with LVEF Class improvement. In LVEF Class-4, higher heart rate, serum creatinine, CRP level and atrial fibliration at administration were associated with LVEF Class improvement. Conclusions: We confirmed changes of LVEF during hospitalizations in a half of patients. Since the changes could not be predicted simply, echocardiographic reevaluations are important in assessing clinical conditions and treatment effects.
OP41-4 The Change of Cardio-Thoracic Ratio and Outcome in Patients with Acute Decompensated Heart Failure TORU KONDO, TAKAHIRO OKUMURA, NAOKI WATANABE, NAOAKI KANO, HIROAKI MORI, KENJI HUKAYA, AKINORI SAWAMURA, RYOTA MORIMOTO, YASUKO BANDO, TOYOAKI MUROHARA Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan Background: Chest radiograph is routinely performed to evaluate disease condition during hospitalization in patients with acute decompensated heart failure (ADHF). Cardio-thoracic ratio (CTR) is reported to be associated with heart chamber dilation and often declines by management of ADHF. The purpose of this study, therefore, was to evaluate the change of CTR and prognosis in patients with ADHF. Methods: We enrolled 183 patients (106 male, 75.3 years) admitted in our hospital for ADHF. (CTRadmission - CTRdischarge)/CTRadmission100 was defined as CTR change (%). The patients were divided into 2 groups according to CTR change: !9.2% (median for the study group), Group A; S 9.2%, Group B. Results: The mean follow-up period was 228 days. The mean of left ventricular ejection fraction was 45.1% and brain natriuretic peptide level was 839.9 pg/ml. The prevalence of female and prior HF admission were higher in Group A (p50.004 and p50.017). In Kaplan-Meier survival analysis, the incidence of death and re-hospitalization due to worsening HF was significantly higher in Group A (p50.008). Multivariate Cox regression model showed that CTR change !12% (HR 2.49; 95% CI 1.18-5.25; p50.017) and body mass index (HR 0.894; 95% CI 0.822 to 0.972; p50.009) were independent predictors of adverse events. Conclusions: The change of CTR during hospitalization predicts future adverse event after discharge in patients with ADHF.
OP41-5 Influence of Clinical Parameters on Tolvaptan for the Treatment of Acute Decompensated Heart Failure MICHIRO MARUYAMA, KENJI EMOTO, SYUNICHIROU HONDOU, MASAKI KINOSHITA, TAKASHI KUSAYAMA, ISAO ABURADANI, YOSHIKI NAGATA, KAZUO USUDA Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan Background: In heart failure (HF), several studies have demonstrated that worsening renal function is associated with adverse outcomes. Tolvaptan has been reported to reduce signs of congestion without worsening renal function. This purpose is to assess the relationship between clinical parameters and response to tolvaptan in patients with HF. Methods: Objectives were 28 hospitalized patients with acute decompensated HF (73615 years, Male 21), in which dilated cardiomyopathy, valve disease, ischemic heart disease, hypertension, and others were 10, 6, 4, 3 and 5 patients. The clinical parameters were hemodynamics, renal function, ejection fraction (EF), pressure gradient of tricuspid regurgitation (TRPG). Response to tolvaptan was evaluated from urine volume (UV) change. Results: Systolic blood pressure (SBP), heart rate, blood urea nitrogen (BUN), Cr, sodium, potassium were 108617 mmHg, 81615 bpm, 33620 mg/dl, 13864 mEq/l, 3.960.5 mEq/l before tolvaptan administration. EF, TRPG were 41619%, 35613 mmHg. Administration dosage of tolvaptan
JHFS
S193
was 6.9663.78 mg/day and 24 patients (86%) reduced congestion. After tolvaptan administration SBP and UV increased significantly (p!0.05), but heart rate, BUN, Cr, sodium, potassium were unchanged. UV change was 4216632 ml/day and correlated with TRPG (r5-0.382, p50.072), TRPG/SBP (r5-0.471, p50.023), not other parameters. Conclusions: Tolvaptan improve congestion without worsening renal function in decompensated HF, and these results may suggest that the balance between preload and systemic blood pressure is important for response to tolvaptan.
OP42-1 Right Atrial Pressure Does Not Reflect Body Fluid Status in Repeater Patients with Acute Decompensated Heart Failure TAIKI SAKAGUCHI1, AKIO HIRATA1, KAZUNORI KASHIWASE1, YOSHIHARU HIGUCHI1, YUKIHIRO KORETSUNE2, HIDEO KUSUOKA3, YOSHIO YASUMURA1 1 Osaka Police Hospital, Division of Cardiology, Osaka, Japan; 2Osaka National Hospital, Institute for Clinical Research, Osaka, Japan; 3Osaka National Hospital, Division of Cardiology, Osaka, Japan Introduction: We have reported quantitative index of fluid retention using bioimpedance in patients with acute decompensated heart failure (ADHF). Right atrial pressure (RAP) is influenced by fluid status and right ventricular function, we assessed the relationship between RAP and the degree of fluid retention in ADHF patients. Methods: In 200 ADHF patients, we quantified the degree of extracellular fluid retention on admission by the ratio (M/P ratio) of measured volume using bioimpedance to predicted volume estimated by original regression equations that incorporate age, sex, height, and weight. RAP was estimated by the inferior vena cava diameter measured with echocardiography: RAP!10 mmHg, maximum!25 mm and respiratory variation S 50%; 10-15 mmHg, !25 mm and !50%; O15 mmHg, S 25 mm. All subjects were divided into either repeater group (n583) or new-onset group (n5117) with/without ADHF hospitalization during the past half year, and assessed the relationship between RAP and M/P ratio in each group. Results: M/P ratio on admission was lower in repeater group than in new-onset group (1.1660.23 vs 1.2460.24; p50.011). In new-onset group, a positive correlation was observed between RAP and M/P ratio (!10 mmHg, 1.0860.19; 10-15 mmHg, 1.2360.20; O15 mmHg, 1.3960.29; p!0.001), but not in repeater group (1.0760.25; 1.1760.23; 1.1660.22; p50.522). Conclusion: RAP reflects fluid status only in early-stage heart failure patients. Repeater patients are decompensated with milder fluid retention, and their RAP does not reflect the degree of fluid retention.
OP42-2 Clinical Usefulness of Urgent Echocardiography in Non-Cardiac Patients with Elevated Cardiac Enzyme and Chest Pain ILSUK SOHN, HUI-JEONG HWANG, CHANG-BUM PARK, EUN-SUN JIN, JIN-MAN CHO, CHONG-JIN KIM Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea Elevated cardiac enzyme is associated with increased morbidity and mortality in noncardiac patients. We investigated clinical usefulness of urgent echocardiography in these patients. Consecutive 351 patients (mean age 5 69 6 14 years) who were admitted in non-cardiac unit and underwent urgent echocardiography because of elevated cardiac enzyme and clinical symptoms and/or signs were analyzed. Echocardiographic positive findings (Echo (+)) were defined as new ischemia, ventricular dysfunction, or possible pulmonary embolism. Initial and peak levels of troponin I were collected. There were no significant differences in initial and peak levels of troponin I between groups with and without additional coronary angiography. Coronary angiography was performed in 64 patients (59%) with suspicious ischemia and in 23 patients (10%) without suspicious ischemia on echocardiography. Additional chest CT was performed in 13 patients (81.3%) with suspicious pulmonary thromboembolism and in 19 patients (5.7%) without sign of pulmonary thromboembolism on echocardiography. Initial cut-off levels of troponin I for sensitivity of 80% in prediction of Echo (+) were 0.067 ng/ml. In conclusion, urgent use of echocardiography in patients with elevated level of cardiac enzyme and chest pain is useful to determinate additional diagnostic tools. In addition, cut-off values of cardiac enzyme with high sensitivity might help to prevent an excessive echocardiographic usage.
OP42-3 The Impact of Infection Which Has Occurred during Hospitalization of Acute Heart Failure MASAYUKI HIRAI, YOICHIRO IWASAKI, AKIHIRO OKAMURA, ASAO MIMURA, FUMIYO TSUNODA, HIROSHIGE ISHII, YOSHIAKI INOUE, KINYA SHIROTA Department of Cardiology, Matsue Red Cross Hospital, Matsue, Japan Background: The onset of acute heart failure (AHF) is often influenced by infections. However, the significance of infection which has occurred after AHF admission is not well known. We investigated the characteristics and prognosis of the patients