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Interruption of Supervised Exercise Training Reduced Ventilatory Threshold in Patients with Chronic Heart Failure
S172 Journal of Cardiac Failure Vol. 18 No. 10S October 2012 relevance for prognosis prediction. Methods & Results: Forty-six new-onset HF patients admitted to Kitasato University Hospital between April 2011 and March 2012 with New York Heart Association (NYHA) functional class IV HF and left ventricular ejection fraction of !50% were divided into 2 groups according to the clinical picture of HF decompensation: an FPE group (n 5 21) and a nonFPE group (n 5 25). FPE patients had significantly higher systolic blood pressure on admission (FPE patients vs non-FPE patients; 201 6 38 mmHg vs 153 6 43 mmHg; p ! 0.005) and significantly smaller left ventricular end-diastolic diameter (LVDd; 59 6 11 mm vs 51 6 8 mm; p ! 0.05) and left arterial diameter (LAD; 45 6 7 mm vs 39 6 7 mm; p ! 0.05), despite similar transmitral Doppler flow patterns. The Kaplan-Meier curve demonstrated that cardiac event-free survival rate was lower in FPE patients (no events) than in non-FPE patients (4 events; p 5 0.1139) during follow-up (164 6 117 days). Conclusions: Despite similar LV filling pressures in both groups, HF patients with smaller LVDd and LAD are prone to develop FPE and may have a better prognosis if they survive preceding FPE events.
P-031 Carperitide but not Nitroglycerin Suppresses Sympathetic Nervous Activity and Inflammation for Long in Patients with Acute Decompensated Heart Failure SHOICHI MIYAMOTO1, TOSHIAKI IZUMI1, MORIAKI INOKO1, TETSUYA HARUNA1, EISAKU NAKANE1, TAKAO KATOH1, YOSHIAKI SAJI1, KOJI UEYAMA1, MASATOSHI FUJITA2, TYUJI NOHARA1 1 Cardiovascular Center, Kitano Hospital, The Tazuke Kofukai, Medical Research Institute, Osaka, Japan, 2Department of Cardiovascular Medicine, Uji Hospital, Kyoto, Japan For the initial treatment of acute decompensated heart failure (ADHF), the infusion of carperitide or nitroglycerin is recommended. However, there have been few studies comparing their effects on sympathetic nervous activity (SNA) and inflammation. Thirty-nine patients with ADHF were prospectively randomized to receive carperitide (0.0125-0.025mg/kg/minute, n518, mean age 716 & 11 years) or nitroglycerin (0.2-2.0mg/kg/minute, n521, mean age 776 & 9 years) during the initial 72 hours of ADHF. We assigned patients with an even number of medical record to carperitide, and an odd number to nitroglycerin. We measured SNA (norepinephrine) and proinflammatory cytokine, interleukin-6, before, one month and three months after the administration. Plasma norepinephrine concentrations significantly decreased in both groups after one month (Carperitide group: 9746 & 286 to 2866 & 199 pg/ml, p!0.05, Nitroglycerin group: 12346 & 967 to 4636 & 284 pg/ml, p!0.05), and remained reduced in the carperitide group compared with the nitroglycerin group (Carperitide group vs. Nitroglycerin group 5 3216 & 180 pg/ml vs. 13536 & 2685 pg/ml). In addition, plasma interleukin-6 concentrations significantly decreased in the carperitide group compared with the nitroglycerin group after one month (Carperitide group: 11.86 & 9.6 to 3.46 & 2.4 pg/ml, p!0.05, Nitroglycerin group: 19.96 & 25.9 to 16.46 & 13.9 pg/ml, p5NS), and remained unchanged after three months. These results suggest that the infusion of carperitide have long-term beneficial effects on SNA and proinflammatory cytokines in ADHF patients.
P-032 Comparison Between Heart Failure with Preserved and Reduced Ejection Fraction who are Hospitalized with Acute Decompensated Heart Failure MAYUKO YAGAWA1, TSUTOMU YOSHIKAWA1, KEITARO MAHARA1, SYUN KOSAKA2, HITONOBU TOMOIKE1 1 Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan, 2Department of Cardiology, Keio University Hospital, Tokyo, Japan Heart failure (HF) with preserved ejection fraction (HFPEF) may have a different clinical presentation from HF with reduced ejection fraction (HFREF). We sought to delineate the difference between the two potentially distinct categories in a prospective institutional registry on acute decompensated HF. We analyzed consecutive 100 patients who were hospitalized with HF from November, 2011 to March, 2012. We defined HFPEF as patients with left ventricular ejection fraction (LVEF) O50% (n536), and HFREF with LVEF! 50% (n564). Age was significantly higher in HFPEF than HFREF (p!0.01). There were more female patients in HFPEF than HFREF (p50.01). There were no significant differences in underlying heart diseases except for dilated cardiomyopathy, which was significantly higher in HFREF. The number of patients who experienced the paroxysmal nocturnal dyspnea was lower in HFPEF than HFREF (p!0.01). Use of oral loop diuretics during hospitalization was more common in HFREF (p50.01). Plasma N-terminal-pro-brain natriuretic peptide level on admission was significantly lower in HFPEF than HFREF (469964339 pg/ml vs. 920768729 pg/ml, p!0.01). Left atrial volume measured by echocardiography (102632 ml vs. 1266168 ml, P50.39) was similar between the 2 groups. Conclusion: There are considerable differences in clinical profile between HFPEF and HFREF. Long-term follow-up is required to determine the differences in clinical outcome between the 2 groups.
P-033 Clinical Features Between Heart Failure and Sleep Disordered Breathing YOKO YAMADA, HIROSHI WADA, KENICHI SAKAKURA, NAOKO IKEDA, YOSHITAKA SUGAWARA, JUNYA AKO, SHIN-ICHI MOMOMURA Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan Introduction: Little has been known about clinical background of the patients with heart failure (HF) and sleep disordered breathing (SDB). The aim of this study was to elucidate the relationship between HF and SDB. Methods: 413 patients who admitted to our institute with the diagnosis of HF between 2009 and 2010 was enrolled. SDB was defined O5 of apnea-hypopnea index (AHI). Obstructive sleep apnea (OSA) group and sleep apnea (CSA) group and central sleep apnea (CSA) group were defined based on the data of type 3 sleep monitor (Morpheus). Results: Among 413 patients 137 (33%) was underwent screening of type 3 sleep monitor. In the 137 patients, 105 (77%) patients showed SDB. Among these 105 SDB patients, 84 (80%) were OSA, and 21 (20%) were CSA. AHI was significantly higher (OSA: 23.1617.4, CSA: 30.5614.5, P!0.05) and ejection fraction (EF) was significantly lower (OSA: 39.7616.4%, CSA: 23.6610.0%, P!0.05) between two groups. Conclusions: SDB was highly associated with HF and the clinical features between OSA and CSA with HF were different. This study suggested that SDB was one of an important target of treatment HF to treat HF according to these clinical subsets of SDB was clinically required in the future.
P-034 Vascular Endothelial Function is Impaired in Heart Failure Patients with Cheyne-Stokes Respiration AKIOMI YOSHIHISA1, SATOSHI SUZUKI1, TAKAMASA SATO2, KOICHI SUGIMOTO2, TAKAYOSHI YAMAKI2, HIROYUKI KUNII2, KAZUHIKO NAKAZATO2, HITOSHI SUZUKI2, SHU-ICHI SAITOH2, YASUCHIKA TAKEISHI1 1 Department of Advanced Cardiac Therapeutics, Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan, 2Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan Backgrounds: Sleep disordered breathing (SDB) including Cheyne-Stokes respiration (CSR) is often associated in patients with heart failure (HF). Vascular endothelial function plays an important role in cardiovascular dieases. Flow-mediated dilatation (FMD) is a novel clinical index for endothelial function. However, it is unclear whether FMD is clinically useful to assess vascular function in patients with HF and SDB. In addition, it is still controversial whether endothelial function is deteriorated in patients with CSR. Methods: In this study, 48 patients with HF and SDB were enrolled. %FMD, B type natriuretic peptide (BNP) and several echocardiographic parameters (left ventricular ejection fraction (LVEF), E/e‘, left ventricular mass index (LVMI) and left atrial volume index (LAVI) were determined. Apneahypopnea index (AHI), central apnea index, and obstructive apnea index were measured by polysomnography, and patients were divided into three groups: group N (AHI # 15 times/hr, n510), group O (AHI O 15 times/hr, Obstructive sleep apnea dominant, n518), and group C (AHI O 15 times/hr, CSR dominant, n520). Results: There were no significant differences in BNP, LVEF, E/e‘, LVMI and LAVI among three groups. Importantly, %FMD was significantly lower in group C than in group O and N (3.862.3 vs. 4.762.8 and 5.963.2, P!0.05, respectively). Conclusions: Although cardiac systolic and diastolic function was not different, vascular endothelial dysfunction was evident in HF patients with CSR.
P-035 Interruption of Supervised Exercise Training Reduced Ventilatory Threshold in Patients with Chronic Heart Failure YOSHIYUKI SUZUKI, MASARU ARAKI, YUTAKA OTUJI The 2nd Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan Background: Supervised exercise training is high priority in treatment of patients with chronic heart failure (CHF). Several CHF patients receive supervised exercise training which was interrupted for a short period with unsupervised exercise training at home in Japan. This unsupervised training may reduce exercise tolerance in these patients. We measured changes in physiologic parameters in CHF patients who had an interruption of supervised exercise training using cardiopulmonary exercise test (CPX). Methods: Data was obtained from 7 CHF patients who had received supervised exercise training for 20 to 40 minutes on a fitness bicycle and 10 to 20 minutes of resistance exercise, twice or three times a week for 1 year. After 1 year supervised exercise training, patients continued exercise training at home for 4 months. We measured variables from CPX and blood samples of the patients before and after the interruption of supervised exercise training. Results: We observed a significant decrease in ventilatory threshold after the interruption of supervised exercise training (12.661.4 mL/kg/min vs. 10.062.1 mL/kg/min, p50.003, before and after interruption, respectively). We found no significant differences in other variables, for example, V(E)/V(CO2) slope, heart rate at ventilatory threshold and plasma brain natriuretic peptide level. Conclusion: This finding suggests that continuing a supervised exercise training program avoids reduced exercise tolerance in CHF patients.
P-031 Carperitide but not Nitroglycerin Suppresses Sympathetic Nervous Activity and Inflammation for Long in Patients with Acute Decompensated Heart Failure SHOICHI MIYAMOTO1, TOSHIAKI IZUMI1, MORIAKI INOKO1, TETSUYA HARUNA1, EISAKU NAKANE1, TAKAO KATOH1, YOSHIAKI SAJI1, KOJI UEYAMA1, MASATOSHI FUJITA2, TYUJI NOHARA1 1 Cardiovascular Center, Kitano Hospital, The Tazuke Kofukai, Medical Research Institute, Osaka, Japan, 2Department of Cardiovascular Medicine, Uji Hospital, Kyoto, Japan For the initial treatment of acute decompensated heart failure (ADHF), the infusion of carperitide or nitroglycerin is recommended. However, there have been few studies comparing their effects on sympathetic nervous activity (SNA) and inflammation. Thirty-nine patients with ADHF were prospectively randomized to receive carperitide (0.0125-0.025mg/kg/minute, n518, mean age 716 & 11 years) or nitroglycerin (0.2-2.0mg/kg/minute, n521, mean age 776 & 9 years) during the initial 72 hours of ADHF. We assigned patients with an even number of medical record to carperitide, and an odd number to nitroglycerin. We measured SNA (norepinephrine) and proinflammatory cytokine, interleukin-6, before, one month and three months after the administration. Plasma norepinephrine concentrations significantly decreased in both groups after one month (Carperitide group: 9746 & 286 to 2866 & 199 pg/ml, p!0.05, Nitroglycerin group: 12346 & 967 to 4636 & 284 pg/ml, p!0.05), and remained reduced in the carperitide group compared with the nitroglycerin group (Carperitide group vs. Nitroglycerin group 5 3216 & 180 pg/ml vs. 13536 & 2685 pg/ml). In addition, plasma interleukin-6 concentrations significantly decreased in the carperitide group compared with the nitroglycerin group after one month (Carperitide group: 11.86 & 9.6 to 3.46 & 2.4 pg/ml, p!0.05, Nitroglycerin group: 19.96 & 25.9 to 16.46 & 13.9 pg/ml, p5NS), and remained unchanged after three months. These results suggest that the infusion of carperitide have long-term beneficial effects on SNA and proinflammatory cytokines in ADHF patients.
P-032 Comparison Between Heart Failure with Preserved and Reduced Ejection Fraction who are Hospitalized with Acute Decompensated Heart Failure MAYUKO YAGAWA1, TSUTOMU YOSHIKAWA1, KEITARO MAHARA1, SYUN KOSAKA2, HITONOBU TOMOIKE1 1 Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan, 2Department of Cardiology, Keio University Hospital, Tokyo, Japan Heart failure (HF) with preserved ejection fraction (HFPEF) may have a different clinical presentation from HF with reduced ejection fraction (HFREF). We sought to delineate the difference between the two potentially distinct categories in a prospective institutional registry on acute decompensated HF. We analyzed consecutive 100 patients who were hospitalized with HF from November, 2011 to March, 2012. We defined HFPEF as patients with left ventricular ejection fraction (LVEF) O50% (n536), and HFREF with LVEF! 50% (n564). Age was significantly higher in HFPEF than HFREF (p!0.01). There were more female patients in HFPEF than HFREF (p50.01). There were no significant differences in underlying heart diseases except for dilated cardiomyopathy, which was significantly higher in HFREF. The number of patients who experienced the paroxysmal nocturnal dyspnea was lower in HFPEF than HFREF (p!0.01). Use of oral loop diuretics during hospitalization was more common in HFREF (p50.01). Plasma N-terminal-pro-brain natriuretic peptide level on admission was significantly lower in HFPEF than HFREF (469964339 pg/ml vs. 920768729 pg/ml, p!0.01). Left atrial volume measured by echocardiography (102632 ml vs. 1266168 ml, P50.39) was similar between the 2 groups. Conclusion: There are considerable differences in clinical profile between HFPEF and HFREF. Long-term follow-up is required to determine the differences in clinical outcome between the 2 groups.
P-033 Clinical Features Between Heart Failure and Sleep Disordered Breathing YOKO YAMADA, HIROSHI WADA, KENICHI SAKAKURA, NAOKO IKEDA, YOSHITAKA SUGAWARA, JUNYA AKO, SHIN-ICHI MOMOMURA Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan Introduction: Little has been known about clinical background of the patients with heart failure (HF) and sleep disordered breathing (SDB). The aim of this study was to elucidate the relationship between HF and SDB. Methods: 413 patients who admitted to our institute with the diagnosis of HF between 2009 and 2010 was enrolled. SDB was defined O5 of apnea-hypopnea index (AHI). Obstructive sleep apnea (OSA) group and sleep apnea (CSA) group and central sleep apnea (CSA) group were defined based on the data of type 3 sleep monitor (Morpheus). Results: Among 413 patients 137 (33%) was underwent screening of type 3 sleep monitor. In the 137 patients, 105 (77%) patients showed SDB. Among these 105 SDB patients, 84 (80%) were OSA, and 21 (20%) were CSA. AHI was significantly higher (OSA: 23.1617.4, CSA: 30.5614.5, P!0.05) and ejection fraction (EF) was significantly lower (OSA: 39.7616.4%, CSA: 23.6610.0%, P!0.05) between two groups. Conclusions: SDB was highly associated with HF and the clinical features between OSA and CSA with HF were different. This study suggested that SDB was one of an important target of treatment HF to treat HF according to these clinical subsets of SDB was clinically required in the future.
P-034 Vascular Endothelial Function is Impaired in Heart Failure Patients with Cheyne-Stokes Respiration AKIOMI YOSHIHISA1, SATOSHI SUZUKI1, TAKAMASA SATO2, KOICHI SUGIMOTO2, TAKAYOSHI YAMAKI2, HIROYUKI KUNII2, KAZUHIKO NAKAZATO2, HITOSHI SUZUKI2, SHU-ICHI SAITOH2, YASUCHIKA TAKEISHI1 1 Department of Advanced Cardiac Therapeutics, Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan, 2Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan Backgrounds: Sleep disordered breathing (SDB) including Cheyne-Stokes respiration (CSR) is often associated in patients with heart failure (HF). Vascular endothelial function plays an important role in cardiovascular dieases. Flow-mediated dilatation (FMD) is a novel clinical index for endothelial function. However, it is unclear whether FMD is clinically useful to assess vascular function in patients with HF and SDB. In addition, it is still controversial whether endothelial function is deteriorated in patients with CSR. Methods: In this study, 48 patients with HF and SDB were enrolled. %FMD, B type natriuretic peptide (BNP) and several echocardiographic parameters (left ventricular ejection fraction (LVEF), E/e‘, left ventricular mass index (LVMI) and left atrial volume index (LAVI) were determined. Apneahypopnea index (AHI), central apnea index, and obstructive apnea index were measured by polysomnography, and patients were divided into three groups: group N (AHI # 15 times/hr, n510), group O (AHI O 15 times/hr, Obstructive sleep apnea dominant, n518), and group C (AHI O 15 times/hr, CSR dominant, n520). Results: There were no significant differences in BNP, LVEF, E/e‘, LVMI and LAVI among three groups. Importantly, %FMD was significantly lower in group C than in group O and N (3.862.3 vs. 4.762.8 and 5.963.2, P!0.05, respectively). Conclusions: Although cardiac systolic and diastolic function was not different, vascular endothelial dysfunction was evident in HF patients with CSR.
P-035 Interruption of Supervised Exercise Training Reduced Ventilatory Threshold in Patients with Chronic Heart Failure YOSHIYUKI SUZUKI, MASARU ARAKI, YUTAKA OTUJI The 2nd Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan Background: Supervised exercise training is high priority in treatment of patients with chronic heart failure (CHF). Several CHF patients receive supervised exercise training which was interrupted for a short period with unsupervised exercise training at home in Japan. This unsupervised training may reduce exercise tolerance in these patients. We measured changes in physiologic parameters in CHF patients who had an interruption of supervised exercise training using cardiopulmonary exercise test (CPX). Methods: Data was obtained from 7 CHF patients who had received supervised exercise training for 20 to 40 minutes on a fitness bicycle and 10 to 20 minutes of resistance exercise, twice or three times a week for 1 year. After 1 year supervised exercise training, patients continued exercise training at home for 4 months. We measured variables from CPX and blood samples of the patients before and after the interruption of supervised exercise training. Results: We observed a significant decrease in ventilatory threshold after the interruption of supervised exercise training (12.661.4 mL/kg/min vs. 10.062.1 mL/kg/min, p50.003, before and after interruption, respectively). We found no significant differences in other variables, for example, V(E)/V(CO2) slope, heart rate at ventilatory threshold and plasma brain natriuretic peptide level. Conclusion: This finding suggests that continuing a supervised exercise training program avoids reduced exercise tolerance in CHF patients.