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Left Ventricular Diastolic Dysfunction and Exercise Intolerance in Type 2 Diabetes Patients with Endothelial Dysfunction
The 18th Annual Scientific Meeting (n516 [14%], July to September) and other seasons admission group (n565 [56%], March to June, October to November). HFpEF showed the trend of more prevalent in other seasons than winter season (n531 [48%] vs. 10 [29%], p50.06, Figure). Compared with patient admitted in winter, other seasons had significantly lower diuretic use (22% vs. 49%, p50.006) and higher prevalence of hypertensive heart disease (25% vs. 6%, p50.01). Conclusion: Onsets of HFpEF might be related with vulnerability of blood pressure in the change of the season.
O-115 Abnormal Circadian Blood Pressure Rhythm is Associated with Heart Failure with Preserved Ejection Fraction TAKAHIRO KOMORI, KAZUO EGUCHI, YOSHIOKI NISHIMURA, MASARU ICHIDA, SATOSHI HOSHIDE, KAZUOMI KARIO Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan Riser pattern, defined by higher nocturnal BP than awake BP, has been reported to be associated with adverse cardiovascular prognosis. However the significance of ambulatory blood pressure (ABP) in heart failure with preserved ejection fraction (HFpEF) has never been reported. We aimed to clarify the hypothesis that abnormal circadian BP rhythm is associated with HFpEF. HFpEF was defined as EF gt;45%. We enrolled 508 patients with hospitalized HF (age, 68613 years; male sex, 62%). There were 232 cases of HFpEF and 276 case of heart failure with reduced ejection fraction (HFrEF). Patients with HFpEF were older, higher rate of female and higher ambulatory BP levels. The riser pattern was more frequent in patients with HFpEF (28.9%) than in HFrEF (19.9%). In multivariable logistic regression analysis, riser pattern was associated with HFpEF (odds ratio 1.73, 95% confidence interval (CI) 1.02-2.91, p50.041) independent of other covariates. In conclusion, riser pattern was associated with HFpEF. Uncontrolled nocturnal BP could be one of the major risk factors of HFpEF.
O-116 Impact of Coronary Artery Calcification on the Development of Future Heart Failure in Patients with Preserved Left Ventricular Ejection Fraction KEIJI YAMADA, SATORU SAKURAGI, KEISHI ICHIKAWA, MASAFUMI TANIMOTO, TAKASHI MIKI, HIROAKI OTSUKA, KAZUHIKO YAMAMOTO, KENJI KAWAMOTO, MACHIKO TANAKAYA, YUSUKE KATAYAMA Department of cardiology, Iwakuni Clinical Center, Iwakuni, Japan Background: Coronary artery calcium score (CACS) is a predictor of coronary event in patients with subclinical atherosclerosis; however, the association of coronary artery calcification with heart failure has not been elucidated. In this study, we examined the impact of CACS on cardiac function and occurrence of future heart failure in patients with preserved left ventricular ejection fraction (LVEF). Methods and results: 578 subjects with preserved LVEF and without history of coronary artery disease (CAD) were enrolled. Subjects underwent CACS determination by MDCT. CACS was calculated using the Agaston criteria. Subjects were classified into four groups according to CACS: normal (!10, n5256), mild (11 to 100, n5104), moderate (101 to 400, n5105), severe (401!, n5113). Cardiac function was evaluated with echocardiography. Associations of CACS with cardiac function and future cardiovascular events were evaluated. There was no difference in LV systolic function among groups; however, diastolic dysfunction assessed by E/e was associated with CACS (p50.009). In univariable analysis, CACS was significantly associated with future occurrence of heart failure (r50.113, p50.007). In multivariable analysis, the association of CACS with the onset of heart failure was still significant even after adjustment for age, gender, kidney function, LVEF, prevalence of hypertension, diabetes mellitus and coronary artery disease. Conclusions: Coronary artery calcification was associated with the onset of heart failure in patients with preserved LVEF.
O-117 Association between Peripheral Endothelial Function and Left Ventricular Diastolic Function in Patients with Ischemic Heart Disease TETSUARI ONISHI, SHOKO TAKEDA, TAKAHIRO SAWADA, HARUMI UEDA, HIDEMI YASUGI, MASATO TSURU, HIROYA KAWAI Himeji Cardiovascular Center Background: Endothelial dysfunction is associated with adverse outcomes in patients with ischemic heart disease (IHD). However, it is not clear whether endothelial dysfunction is associated with the progression of left ventricular (LV) diastolic dysfunction and left atrial (LA) overload in IHD patients. Methods: We studied 107 consecutive patients with IHD (age 67610 years, 21 females) using echocardiography and reactive hyperemia peripheral arterial tonometry (RH-PAT). LV diastolic function by the ratio of transmitral peak E-wave velocity to peak A-wave velocity (E/A) and the deceleration time of E-wave (DT), LA overload by LA volume, and estimated LA pressure (eLAP) derived from the velocity of pulmonary valve regurgitation and LV systolic function by LV ejection fraction (EF) were assessed using echocardiography. Peripheral endothelial function was assessed by RH-PAT index as the ratio of the digital pulse volume during reactive hyperemia divided by that at baseline using RH-PAT. Results: RH-PAT index significantly correlated with
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DT, LA volume, and e-LAP, and EF (all p!0.05) but it did not with E/A. Multivariate analysis showed DT (p50.004) and LA volume (p50.009) were independent factors associated with RH-PAT index. Conclusions: Our results showed that the endothelial dysfunction was associated with the progression of LV diastolic dysfunction with LA overload. Therapeutic strategy for improving endothelial dysfunction may play an important role for management in patients with heart failure and IHD.
O-118 Left Ventricular Diastolic Dysfunction and Exercise Intolerance in Type 2 Diabetes Patients with Endothelial Dysfunction TADAFUMI SUGIMOTO1, MOTOKI OTSUJI2, KAZUKI MORI1, MASAHIDE HORIGUCHI1, TAKESHI TAKAMURA1, SHIGETOSHI SAKABE1, DAISUKE IZUMI1, TETSUYA SEKO1, KATSUNORI BETTOU2, ATSUNOBU KASAI1 1 Department of Cardiology, Ise Red Cross Hospital, Mie, Japan, 2Department of Clinical Laboratory, Ise Red Cross Hospita Purpose: Endothelial dysfunction plays a central role in the pathogenesis of diabetic vascular disease. Although resultant left ventricular diastolic dysfunction (LVDF) is hypothesized to reduce exercise capacity, limited data exist on the relation between endothelial function, LVDF and exercise capacity in patients with type 2 diabetes. Methods: We recruited 231 subjects with type 2 diabetes, a preserved ejection fraction, a negative stress test and a sodium-restricted diet. All subjects underwent a brachial artery flow-mediated dilation (FMD) measurement, a transthoracic echocardiography and a standard Bruce protocol treadmill exercise test. Results: Impaired FMD and impaired LVDF were found in 193 subjects and 174 subjects, respectively, of which 11 had diastolic dysfunction. Mean E/E’ by quartile (Q) were: Q1 6.9, Q2 8.9, Q3 10.4, and Q4 14.0. E/E’ was inversely correlated with %FMD (2.964.3%, r 5 -0.19, p 5 0.003) and exercise duration (4606150 sec, r 5 -0.30, p !0.001). Compared with subjects in Q4, those in Q1, Q2 and Q3 had longer exercise duration (Q1 5006150 sec, Q2 5106140 sec, Q3 4606140 sec and Q4 3906140 sec, p ! 0.001). After adjustment for potential confounders, %FMD and exercise duration were significantly associated with E/E’ (b 5 -0.1 and -0.003, p 5 0.006 and 0.014) in all subjects. Conclusions: Diabetes patients with impaired endothelial function have impaired LVDF potentially leading to exercise intolerance.
O-119 Respiratory Muscle Weakness is Associated with Exercise Intolerance in Patients with Heart Failure with Preserved Ejection Fraction KENSAKU YAMADA, YOSHIHARU KINUGASA, SHINOBU SUGIHARA, MASAHIKO KATO, KAZUHIRO YAMAMOTO The Department of Molecular Medicine and Therapeutics, Tottori University, Yonago, Japan Background: The relationship between respiratory muscle strength and exercise tolerance in patients with heart failure with preserved ejection fraction(HFpEF)remains undefined. Methods: The present study enrolled a total of 39 patients with HFpEF (EFO45%)who were hospitalized with worsening HF in author’s institution. Respiratory muscle strength as assessed by maximum inspiratory pressure(PImax) and 6-minute walk distance (6MWD)were evaluated before hospital discharge. Respiratory muscle weakness was defined as PImax!70% of predicted normal values. Results: Respiratory muscle weakness was prevalent in 41% of patients. PImax was positively correlated with vital capacity (VC), forced expiratory volume in one second (FEV 1.0), grip strength, weight bearing index(WBI), and limb muscle mass(VC:R50.677, FEV 1.0:R50.577, grip strength: R50.791, WBI: R50.459, limb muscle mass: R50492, all p!0.05). 6MWD was significantly decreased in patients with respiratory muscle weakness compared with those with normal respiratory muscle strength (2476132m vs. 3366134m, p!0.05). Conclusions: Respiratory muscle weakness is common, and associated with exercise intolerance in patients with HFpEF. Respiratory muscle training is a potential rehabilitation strategy for these patients.
O-120 Low Serum Concentrations of N-3 Polyunsaturated Fatty Acids Promote Left Atrial Remodeling Following Onset of Acute Myocardial Infarction NORIHIRO OKADA, KUNIO YUFU, YUKI EBATA, REIKA AYABE, TETSUJI SHINOHARA, YASUSHI TESHIMA, MIKIKO NAKAGAWA, NAOHIKO TAKAHASHI Department of Cardiology anf Clinical Examination, University of Oita, Oita, Japan Objectives: N-3 polyunsaturated fatty acids (N-3 PUFA) have been associated with a reduced incidence of adverse cardiovascular events. The aim of the present study is to evaluate the relationship between serum N-3 PUFA concentrations and echocardiographic parameters in patients with acute myocardial infarction (AMI). Methods and Result: Twenty patients with AMI (3 female and 17 male, mean age 71612 years), who admitted to our hospital, were enrolled. Echocardiographic study was evaluated at baseline and 6 months after the onset of AMI in all the patients. The serum concentrations of N-3 PUFA (eicosapentaenoic acid; EPA and arachidonic acid; AA) were measured at baseline period in all the patients. The association between the baseline
O-115 Abnormal Circadian Blood Pressure Rhythm is Associated with Heart Failure with Preserved Ejection Fraction TAKAHIRO KOMORI, KAZUO EGUCHI, YOSHIOKI NISHIMURA, MASARU ICHIDA, SATOSHI HOSHIDE, KAZUOMI KARIO Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan Riser pattern, defined by higher nocturnal BP than awake BP, has been reported to be associated with adverse cardiovascular prognosis. However the significance of ambulatory blood pressure (ABP) in heart failure with preserved ejection fraction (HFpEF) has never been reported. We aimed to clarify the hypothesis that abnormal circadian BP rhythm is associated with HFpEF. HFpEF was defined as EF gt;45%. We enrolled 508 patients with hospitalized HF (age, 68613 years; male sex, 62%). There were 232 cases of HFpEF and 276 case of heart failure with reduced ejection fraction (HFrEF). Patients with HFpEF were older, higher rate of female and higher ambulatory BP levels. The riser pattern was more frequent in patients with HFpEF (28.9%) than in HFrEF (19.9%). In multivariable logistic regression analysis, riser pattern was associated with HFpEF (odds ratio 1.73, 95% confidence interval (CI) 1.02-2.91, p50.041) independent of other covariates. In conclusion, riser pattern was associated with HFpEF. Uncontrolled nocturnal BP could be one of the major risk factors of HFpEF.
O-116 Impact of Coronary Artery Calcification on the Development of Future Heart Failure in Patients with Preserved Left Ventricular Ejection Fraction KEIJI YAMADA, SATORU SAKURAGI, KEISHI ICHIKAWA, MASAFUMI TANIMOTO, TAKASHI MIKI, HIROAKI OTSUKA, KAZUHIKO YAMAMOTO, KENJI KAWAMOTO, MACHIKO TANAKAYA, YUSUKE KATAYAMA Department of cardiology, Iwakuni Clinical Center, Iwakuni, Japan Background: Coronary artery calcium score (CACS) is a predictor of coronary event in patients with subclinical atherosclerosis; however, the association of coronary artery calcification with heart failure has not been elucidated. In this study, we examined the impact of CACS on cardiac function and occurrence of future heart failure in patients with preserved left ventricular ejection fraction (LVEF). Methods and results: 578 subjects with preserved LVEF and without history of coronary artery disease (CAD) were enrolled. Subjects underwent CACS determination by MDCT. CACS was calculated using the Agaston criteria. Subjects were classified into four groups according to CACS: normal (!10, n5256), mild (11 to 100, n5104), moderate (101 to 400, n5105), severe (401!, n5113). Cardiac function was evaluated with echocardiography. Associations of CACS with cardiac function and future cardiovascular events were evaluated. There was no difference in LV systolic function among groups; however, diastolic dysfunction assessed by E/e was associated with CACS (p50.009). In univariable analysis, CACS was significantly associated with future occurrence of heart failure (r50.113, p50.007). In multivariable analysis, the association of CACS with the onset of heart failure was still significant even after adjustment for age, gender, kidney function, LVEF, prevalence of hypertension, diabetes mellitus and coronary artery disease. Conclusions: Coronary artery calcification was associated with the onset of heart failure in patients with preserved LVEF.
O-117 Association between Peripheral Endothelial Function and Left Ventricular Diastolic Function in Patients with Ischemic Heart Disease TETSUARI ONISHI, SHOKO TAKEDA, TAKAHIRO SAWADA, HARUMI UEDA, HIDEMI YASUGI, MASATO TSURU, HIROYA KAWAI Himeji Cardiovascular Center Background: Endothelial dysfunction is associated with adverse outcomes in patients with ischemic heart disease (IHD). However, it is not clear whether endothelial dysfunction is associated with the progression of left ventricular (LV) diastolic dysfunction and left atrial (LA) overload in IHD patients. Methods: We studied 107 consecutive patients with IHD (age 67610 years, 21 females) using echocardiography and reactive hyperemia peripheral arterial tonometry (RH-PAT). LV diastolic function by the ratio of transmitral peak E-wave velocity to peak A-wave velocity (E/A) and the deceleration time of E-wave (DT), LA overload by LA volume, and estimated LA pressure (eLAP) derived from the velocity of pulmonary valve regurgitation and LV systolic function by LV ejection fraction (EF) were assessed using echocardiography. Peripheral endothelial function was assessed by RH-PAT index as the ratio of the digital pulse volume during reactive hyperemia divided by that at baseline using RH-PAT. Results: RH-PAT index significantly correlated with
JHFS
S165
DT, LA volume, and e-LAP, and EF (all p!0.05) but it did not with E/A. Multivariate analysis showed DT (p50.004) and LA volume (p50.009) were independent factors associated with RH-PAT index. Conclusions: Our results showed that the endothelial dysfunction was associated with the progression of LV diastolic dysfunction with LA overload. Therapeutic strategy for improving endothelial dysfunction may play an important role for management in patients with heart failure and IHD.
O-118 Left Ventricular Diastolic Dysfunction and Exercise Intolerance in Type 2 Diabetes Patients with Endothelial Dysfunction TADAFUMI SUGIMOTO1, MOTOKI OTSUJI2, KAZUKI MORI1, MASAHIDE HORIGUCHI1, TAKESHI TAKAMURA1, SHIGETOSHI SAKABE1, DAISUKE IZUMI1, TETSUYA SEKO1, KATSUNORI BETTOU2, ATSUNOBU KASAI1 1 Department of Cardiology, Ise Red Cross Hospital, Mie, Japan, 2Department of Clinical Laboratory, Ise Red Cross Hospita Purpose: Endothelial dysfunction plays a central role in the pathogenesis of diabetic vascular disease. Although resultant left ventricular diastolic dysfunction (LVDF) is hypothesized to reduce exercise capacity, limited data exist on the relation between endothelial function, LVDF and exercise capacity in patients with type 2 diabetes. Methods: We recruited 231 subjects with type 2 diabetes, a preserved ejection fraction, a negative stress test and a sodium-restricted diet. All subjects underwent a brachial artery flow-mediated dilation (FMD) measurement, a transthoracic echocardiography and a standard Bruce protocol treadmill exercise test. Results: Impaired FMD and impaired LVDF were found in 193 subjects and 174 subjects, respectively, of which 11 had diastolic dysfunction. Mean E/E’ by quartile (Q) were: Q1 6.9, Q2 8.9, Q3 10.4, and Q4 14.0. E/E’ was inversely correlated with %FMD (2.964.3%, r 5 -0.19, p 5 0.003) and exercise duration (4606150 sec, r 5 -0.30, p !0.001). Compared with subjects in Q4, those in Q1, Q2 and Q3 had longer exercise duration (Q1 5006150 sec, Q2 5106140 sec, Q3 4606140 sec and Q4 3906140 sec, p ! 0.001). After adjustment for potential confounders, %FMD and exercise duration were significantly associated with E/E’ (b 5 -0.1 and -0.003, p 5 0.006 and 0.014) in all subjects. Conclusions: Diabetes patients with impaired endothelial function have impaired LVDF potentially leading to exercise intolerance.
O-119 Respiratory Muscle Weakness is Associated with Exercise Intolerance in Patients with Heart Failure with Preserved Ejection Fraction KENSAKU YAMADA, YOSHIHARU KINUGASA, SHINOBU SUGIHARA, MASAHIKO KATO, KAZUHIRO YAMAMOTO The Department of Molecular Medicine and Therapeutics, Tottori University, Yonago, Japan Background: The relationship between respiratory muscle strength and exercise tolerance in patients with heart failure with preserved ejection fraction(HFpEF)remains undefined. Methods: The present study enrolled a total of 39 patients with HFpEF (EFO45%)who were hospitalized with worsening HF in author’s institution. Respiratory muscle strength as assessed by maximum inspiratory pressure(PImax) and 6-minute walk distance (6MWD)were evaluated before hospital discharge. Respiratory muscle weakness was defined as PImax!70% of predicted normal values. Results: Respiratory muscle weakness was prevalent in 41% of patients. PImax was positively correlated with vital capacity (VC), forced expiratory volume in one second (FEV 1.0), grip strength, weight bearing index(WBI), and limb muscle mass(VC:R50.677, FEV 1.0:R50.577, grip strength: R50.791, WBI: R50.459, limb muscle mass: R50492, all p!0.05). 6MWD was significantly decreased in patients with respiratory muscle weakness compared with those with normal respiratory muscle strength (2476132m vs. 3366134m, p!0.05). Conclusions: Respiratory muscle weakness is common, and associated with exercise intolerance in patients with HFpEF. Respiratory muscle training is a potential rehabilitation strategy for these patients.
O-120 Low Serum Concentrations of N-3 Polyunsaturated Fatty Acids Promote Left Atrial Remodeling Following Onset of Acute Myocardial Infarction NORIHIRO OKADA, KUNIO YUFU, YUKI EBATA, REIKA AYABE, TETSUJI SHINOHARA, YASUSHI TESHIMA, MIKIKO NAKAGAWA, NAOHIKO TAKAHASHI Department of Cardiology anf Clinical Examination, University of Oita, Oita, Japan Objectives: N-3 polyunsaturated fatty acids (N-3 PUFA) have been associated with a reduced incidence of adverse cardiovascular events. The aim of the present study is to evaluate the relationship between serum N-3 PUFA concentrations and echocardiographic parameters in patients with acute myocardial infarction (AMI). Methods and Result: Twenty patients with AMI (3 female and 17 male, mean age 71612 years), who admitted to our hospital, were enrolled. Echocardiographic study was evaluated at baseline and 6 months after the onset of AMI in all the patients. The serum concentrations of N-3 PUFA (eicosapentaenoic acid; EPA and arachidonic acid; AA) were measured at baseline period in all the patients. The association between the baseline