Low Dose Landiolol During Very Acute Phase of Acute Myocardial Infarction Improves Brain Natriuretic Peptide Level in the Chronic Phase

S150 Journal of Cardiac Failure Vol. 16 No. 9S September 2010 mmHg, p50.04); diastolic BP tended to decrease (7867 to 7067 mmHg, p50.17). There were no significant changes in serum creatinine (1.360.3 to 1.360.2 mg/dl, p50.78) and eGFR (4867 to 4566 ml/min, p50.46). Meanwhile, BNP significantly decreased (4296115 to 218643 pg/ml, p50.03). Conclusions: This study result demonstrated that the treatment with aliskiren had favorable neurohumoral effects in heart failure and appeared to be tolerated in Japanese patients with heart failure.

018 b Blocker Reduces Cardiac Troponin T Level in Patients With Heart Failure by Highly Sensitive Assay SEIJI TAKASHIO, MEGUMI YAMAMURO, HISAO OGAWA Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan Background: Cardiac troponin T (TnT) is established as a specific biomarker of ongoing myocardial damage (OMD). Because it is not fully understood how to reduce TnT level, we evaluated effect on OMD by bblocker (BB) in heart failure (HF) patients by measurement of high sensitive TnT (hs-TnT)level. Method and Result: Five HF patients due to dilated cardiomyopathy (male: 4, median age: 59 years, EF: 26.6%) with optimal therapy except BB were enrolled and added on BB. After 1 month, hsTnT level was significantly decreased (0.0148 to 0.0109 ng/mL: p50.043), but BNP tended to be increased (108 to 221.2pg/mL: p50.22). Conclusion: BB reduced hs-TnT level in HF patients, but BNP was increased after 1 month. This may suggest that BB ameliorated OMD independently of left ventricular filling pressure.

in heart failure patients and is associated with adverse prognosis. It has been reported that CSR is improved by optimal medications for heart failure and CRT. Recently, we have demonstrated that adaptive servo ventilation (ASV) improves cardiac function in heart failure patients with CSR. We report a case that ASV improved CSR remained after CRTD implantation. A 70 years old male patient had been implanted VDD pacemaker due to complete atrioventricular block in March 2000. He repeated hospitalization due to worsening heart failure several times, although medications for heart failure including beta-blocker were given. Therefore, he was implanted CRTD in December 2008. However, he again hospitalized for worsening heart failure, and polysomnography revealed severe CSR (apnea-hypopnea index 47.3 times/hr, central apnea index 24.2 times/hr). ASV was effective for CSR in this patient, and we also observed improvement in cardiac function after ASV. We here demonstrate that ASV improved CSR and cardiac function in heart failure patients with CRTD implantation.

021 Severe Mitral Regurgitation Induced by Straight Back Syndrome and a Congenital Epicardial Defect MASATO SHIMIZU1, HIROYUKI FUJII1, NORIYOSHI YAMAWAKE1, MITSUHIRO NISHIZAKI1, TADASHI MURAI2, NAOKI HASHIYAMA4, MAKOTO MO4, MITSUAKI ISOBE3 1 Department of Cardiology, Yokohama Minami-Kyosai Hospital, Yokohama, Japan, 2 Department of Cardiology, Tsuchiura-Kyodo General Hospital, Tsuchiura, Japan, 3 Department of cardiovascular medicine, Tokyo medical and dental university, Tokyo, Japan, 4Department of Cardiovascular Surgery, Yokohama Minami-Kyosai Hospital, Yokohama, Japan The patient was a 67-year-old man who was undergoing treatment for chronic heart failure since 1998. Since 2009, the dyspnea on effort exacerbated. Echocardiography revealed severe mitral regurgitation. The lateral thoracic X-ray film showed lack of natural kyphosis (straight back). Thoracic computed tomography revealed that the anteroposterior thoracic diameter had reduced and that his heart had prolapsed into the left thoracic cavity (see figure). Cardiac catheterization performed in February 2010 revealed Sellers IV degree mitral regurgitation, indicating the need for cardiac surgery. Mitral valve replacement was performed in February 2010 (31-mm St. Jude Medical valve). A left-sided epicardial defect was detected during surgery. The mitral regurgitation was thought to be induced by the patient’s straight back and the congenital epicardial defect. The postoperative course was good.

019 Antegrade Diastolic Pulmonary Artery Flow With Restrictive Right Ventricle: a Case Report TAKAKO IINO, HIROYUKI WATANABE, HIROSHI ITO Department of Cardiovascular Medicine Akita University Graduate School of Medicine, Akita, Japan End-diastolic opening of pulmonary valve and subsequent diastolic antegrade flow into the pulmonary artery are infrequently demonstrated by echocardiography in right heart failure. We show herein two patients in which antegrade diastolic pulmonary artery flow was observed as a result of restrictive right ventricle.Case 1: 44-year-old man with pulmonary stenosis after surgical treatment of complete transposition of great arteries. He has repeated hospitalization due to recurrent right heart failure.Case 2: 36-year-old woman with end-stage dilated cardiomyopathy with right ventriclular contractile dysfunction. Heart failure worsened despite intensive care including administration of catecholamines. She underwent implantation of left ventricular assist system for bridging to heart transplantation.In these patients, the simultaneous recording of right ventricle pressure and pulmonary artery pressure, revealed the marked elevation of right ventricular diastolic pressure which exceeded pulmonary artery pressure at the time of atrial contraction.These findings suggested that right ventricle compliance markedly reduced, and that the cavity became stiff and had a function as a passive conduit between the right atrium and the pulmonary artery during atrial systole.Antegrade diastolic pulmonary artery flow is useful sign for reduction of right ventricular compliance, and resultant right ventricle restrictivity.

022 020 Adaptive Servo Ventilation Improved Cheyne-Stokes Respiration in Heart Failure Patients After CRTD Implanta ATUROU MASUDA, AKIOMI YOSHIHISA, HIROYUKI MIZUKAMI, HIRONORI UEKITA, KOUICHI SUGIMOTO, HIROYUKI KUNII, KAZUHIKO NAKAZATO, HITOSHI SUZUKI, SHU-ICHI SAITHO, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical Uiversity Cardiac resynchronization therapy (CRT) is effective for heart failure patients with left ventricular dyssynchrony. Cheyne-Stokes respiration (CSR) is often observed

Low Dose Landiolol During Very Acute Phase of Acute Myocardial Infarction Improves Brain Natriuretic Peptide Level in the Chronic Phase MASAKI FUJITA, TATSUYA YAMASHITA, MAROHITO NAKATA, TOSHIYUKI NISHIKIDO, TOSHIYA CHINEN, TATSUO KIKUCHI, KENTARO NAKAMURA, KENTARO MEGURO, TAKEHIKO KEIDA, HIROSHI OHIRA Department of cardiology, Edogawa Hospital, Tokyo, Japan Background: Beta blockers have a proven benefit in the management of patients with acute myocardial infarction (AMI). The aim of this study was to investigate the long-term effect of landiolol therapy in very acute phase of AMI. Method: 48

The 14th Annual Scientific Meeting patients with AMI after primary percutaneous coronary intervention (PCI) were randomly assigned to landiolol group (n525) or control group (n523). All patients took oral beta blocker (carvedilol or bisoprolol) after they had left ICU. UCG and brain natriuretic peptide (BNP) were recorded in both groups at 6 months. Tc-MIBI scintigraphy was also performed and these data were analyzed by software, CardioBULL which quantifies infarct size. Result: Left ventricular ejection fraction in landiolol group was better than in control group though there were no significant differences (55.2611.5% vs 59.6611.5%). Infarct size was no significant difference at 6 months (7.569.5% vs 7.0612.9%). BNP level tended to be higher in landiolol group both in the acute phase (65.5670.6pg/ml vs 128.36219.7pg/ml, p50.18) and at the point of discharge (115.3678.1pg/ml vs 152.4699.6pg/ml, p50.25). However, 6 months after the procedure, BNP level in landiolol group was significantly lower than control group (63.1656.3pg/ml vs 40.0627.3pg/ml, p!0.05). Conclusion: Low dose landiolol during very acute phase of AMI improves BNP level in the chronic phase and may result in the reduction of cardiovascular event.

023 Mechanism of Destabilized RyR2 Channel in Catecholaminergic Polymorphic Ventricular Tachycardia TAKESHI SUETOMI, MASAFUMI YANO, MASAKAZU FUKUDA, AKIHIRO HINO, XIAOJUAN XU, MAKOTO ONO, HITOSHI UCHINOUMI, SHIGEKI KOBAYASHI, TAKESHI YAMAMOTO, MASUNORI MATSUZAKI Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan Catecholaminergic polymorphic ventricular tachycardia (CPVT) is known to be caused by single point mutation in cardiac ryanodine receptor (RyR2). Here, we examined the pathogenic role of the mutation-linked channel disorder in human CPVT-associated RyR2S2246L/+ knock-in (KI) mice model.Methods and results. Exercise with treadmill induced bidirectional or polymorphic VT in all KI mice, but not in WT mice. In saponin-permeabilized KI cardiomyocytes, the frequency of Ca2+ sparks was more increased in response to cAMP (1mM) than in WT cardiomyocytes, even though SR Ca2+ content was markedly reduced in KI cardiomyocytes. To clarify the pathogenic role of mutation-linked conformational disorder on channel gating, we assessed the binding characteristics of domain peptide (DP)2246 or DP2246mut; Ser is mutated to Leu (S2246L) like KI, to RyR2 recombinant fragment (1-610, 741-1260, 12451768, 1741-2270, 2234-2750) within the N-terminal half of RyR2, by using quartz crystal microbalance(QCM), which is a very high sensitive mass-measuring system. Both DP2246 and DP2246mut specifically bound only to the fragment 1741-2270. DP2246mut showed much higher binding affinity than DP2246.Conclusions. One of the CPVT-type mutations in RyR2 (S2246L) probably forms abnormally tight domain-domain interaction between the domain harboring S2246L and its neighboring domain, causatively induce aberrant Ca2+ release leading to lethal arrhythmia.

024 A Case of Severe Ischemic Cardiomyopathy Successfully Treated With Left Ventriculoplasty AYAKA TANABE1, NOBUYUKI SHIMIZU1, HIROYOSHI MORI1, FUYUKI ASANO1, MIO EBATO1, HIROSHI SUZUKI1, HIROSHI NAGANO2, KENICHIRO NOGUCHI2, HIROYUKI TANAKA2, YOUICHI TAKEYAMA1 1 Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan, 2Department of Cardiovascular Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan Fifty-nine-year old man who complained of chest pain and dyspnea was admitted to our hospital diagnosed as acutely decompensated heart failure. He has suffered from chest pain for 10 years, but has never had a physical checkup. In ultracardiography, wall motion was diffusely depressed, and his ejection fraction was 10%, and left ventricular diastolic dimension was 85 mm. Hemodynamic parameter was Forrester 4 (CI 2.1 ml/min/m2, PCWP 26 mmHg). Administration of carperitide and fulosemide was not enough to improve hemodynamic parameters, but additional administration of dobutamine and phosphodiesterase 3 inhibitor improved hemodynamic parameter to Forrester 1. Coronary angiography showed the total occlusion of left anterior descending artery, left circumflex artery with bridged collateral and right coronary artery. Tc MIBI radioisotope imaging showed the fixed ischemia of inferior wall and reduced uptake in anterior wall. After discontinuing carperitide, cardiac failure was aggravated and carperitide was restarted. Because discontinuation of carperitide was not possible, left ventriculoplasty of inferior wall, CABG (LITA-LAD, SVG-OM1-OM2-PL), mitral valve replacement and tricuspid annuloplasty were performed under the support of IABP. Speed of left ventricular outflow was improved from 0.42m/s to 0.82m/s after the operation, and cardiac symptom was dramatically improved. Brain natiruretic peptide was improved from 3,250 pg/ml before to 217pg/ml after the operation, We experienced a case of severe ischemic cardiomyopathy successfully treated with left ventriculoplasty.



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025 A Rare Case of Extreme Levocardia Presenting Heart Failure, Evaluated by Cardiac Computed Tomography and Magnetic Resonance Imaging SATOSHI OKAYAMA1, AYAKO SENO1, KAZUKUNI YAMASHITA3, TSUNENARI SOEDA1, SATOSHI SOMEKAWA1, YUKIJI TAKEDA2, MAKOTO WATANABE1, RIKA KAWAKAMI1, SHIRO UEMURA1, YOSHIHIKO SAITO1 1 First Department of Internal Medicine, Nara Medical University, Nara, Japan, 2 Department of Cardiology, Hirai Hospital, Nara, Japan, 3Department of Internal Medicine, Saiseikai Gose Hospital, Nara, Japan Extreme levocardia is a rare congenital anomaly of having the heart in the left chest but located even more leftward than usual, as may be sometimes associated with a hypoplastic left lung. We describe an adult patient with extreme levocardia presenting congestive heart failure. A 57-year-old male with a history of diabetes mellitus was referred to our department suffering from dyspnea on effort. Electrocardiography showed atrial fibrillation with a right bundle branch block. Chest radiography showed mild congestion and left complete atelectasis. Cardiac computed tomography showed extreme levocardia, and magnetic resonance imaging revealed diffuse left ventricular hypokinesis with aortic, mitral, and tricuspid regurgitation on cine images and a small hypersignal area in the septum on delayed enhancement images. Invasive coronary angiography showed normal coronary arteries. Angiotensin receptor blocker and diuretics improved heart failure.The combination of cardiac CT and MRI was useful for the non-invasive evaluation of detailed anatomical structures as well as of extreme levocardia. To the best of our knowledge, this is the first description of a non-invasive evaluation of extreme levocardia using cardiac CT combined with MRI.

026 A Case Developing Acute Heart failure 7 Days Later After Pacemaker Implantation to Asymptomatic Complete Atrioventricular Block SHIGETO MAEKAWA, MITSUAKI TANAKA, SYOHEI IKEDA, TAKANORI TAMARU, NORIKO ONOUE, TAKESHI ISHIZUKA, TSUYOSHI SHINOZAKI Department of Cardiovascular Medicine, National Hospital Organization, Sendai Medical Center, Sendai, Japan DDD pacemaker was implanted to a 84 years old male with asymptomatic complete atrioventricular block (junctional escape rhythm at 36 bpm, normal EF and normal coronary angiography) and his troponin I was persistently positive. The patient developed acute heart failure 7 days later after right ventricular apex pacing at 70 bpm. On the next day, postcapillary pulmonary hypertension disappeared with diuretic and keeping narrow QRS with back-up pacing at 30 bpm. In a stable state, cardiac function in pacing with wide QRS at 70 bpm and in escape narrow QRS at 36 bpm was evaluated to test the acute effect of dyssynchrony. LVEF and mitral regurgitation did not differ but wide QRS remarkably increased tricuspid regurgitation than narrow QRS. Finally narrow QRS with back-up pacing at 30 bpm was selected at discharge. Six months later, Torsade de Pointes with QT prolongation occurred. An increase in pacing rate to 70 bpm shortened QT and eliminated Torsade de Pointes. Echocardiogram and cardiac CT demonstrated thinning of LV septum suggesting cardiac sarcoidosis. Patient was discharged after ICD implantation. Conclusion: Pacinginduce dyssynchrony may be associated with rapid onset of heart failure in patients with organic heart disease.

027 201-Thallium SPECT Could Predict the Prognosis of Dilated Phase of Hypertrophic Cardiomyopathy YUICHI BABA, TORU KUBO, MAKOTO OKAWA, NAOHITO YAMASAKI, YOSHIHISA MATSUMURA, HIROAKI KITAOKA, YOSHINORI DOI Department of Medicine and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan Purpose: Although dilated phase of hypertrophic cardiomyopathy (D-HCM) is recognized to have a poor prognosis, there are some D-HCM patients who survive for a long period. The purpose of this study was to investigate whether thallium-201 single photon emission computed tomography (Tl-SPECT) could predict the prognosis in patients with D-HCM. Methods: We studied the relationship between the degree of myocardial perfusion defects on Tl-SPECT and the prognosis in patients with DHCM. For analysis of Tl-SPECT, semiquantitative 20-segment visual interpretation was performed using a 5-point scoring system and the summed rest scores (SRS) was obtained. Results: In 16 patients with D-HCM, we divided the patients into two groups by mean values of SRS: low SRS group (SRS ! 30) and high SRS group (SRS O 30). During follow-up (76.0 months), 9 patients suffered from cardiovascular deaths. The event-free rate of cardiovascular deaths in patients with high SRS was significantly worse (logrank p 5 0.003) than that in patients with low SRS, although there were no differences between the two groups in left ventricular size, fractional shortening, NYHA functional class, prevalence of ventricular tachycardia and atrial fibrillation at the time of D-HCM recognition. Conclusions: The prognosis in dilated