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Metformin Use and Prognosis Among Patients with Diabetes and Heart Failure
The 15th Annual Scientific Meeting (continued ) Preoperative Patient 2 Age/Gender Outcomes LVEDVI (ml) LVESVI (ml) LVEF (%) LVMI (g) PVC (beats/day) Total implanted cells CD56 (+) cells (%) Patient 3 Age/Gender Outcomes LVEDVI (ml) LVESVI (ml) LVEF (%) LVMI (g) PVC (beats/day) Total implanted cells CD56 (+) cells (%) Patient 4 Age/Gender Outcomes LVEDVI (ml) LVESVI (ml) LVEF (%) LVMI (g) PVC (beats/day) Total implanted cells CD56 (+) cells (%)
Postoperative
23M Heart transplantation 182 148 19 112 221 (0.18%)
JHFS
S151
or re-hospitalization for median of 14 months. Patients treated with metformin had lower adverse events free rate than without metformin (Log-rank, P!0.05). Conclusion: These results suggested that metformin therapy is associated with lower rates of adverse events in patients with diabetes and HF.
241 201 16 147 452 (0.37%) 62108 95.1 31M LVAD removal
126 70 44 68 491 (0.51%)
102 51 50 53 143 (0.15%) 63108 92.9
33M LVAD remove but subsequently LVAD required 86 90 54 50 37 42 75 57 13889 (13%) 4436 (4.6%) 8 7.510 42.3
O-30 Effect of Atorvastatin versus Rosuvastatin on Cardiac Sympathetic Nerve Activity in Patients with Dilated Cardiomyopathy TAKAYOSHI TSUTAMOTO1, HIROSHI SAKAI2, CHIHO KAWAHAWA2, MINORU HORIE2, TAKEHIRO MATSUMOTO3, MASANORI FUJII3, MASATO OHNISHI3, ATSUYUKI WADA3 1 Cardiovasular Medicine, Toyosato Hospital, Shiga, Japan, 2Cardiovacular and Respiratory Medicine, Sgiga University of Medical Science, Otsu, Japan, 3 Cardiovasular Medicine, Kusatsu General Hospital, Kusatsu, Japan
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Background: Retrospective analyses have shown that lipophilic statin therapy may have a beneficial effect on patients with chronic heartfailure (CHF). However, recent prospective studies using hydrophilic rosuvastatin have not shown any beneficial effect on mortality. Methods: To compare the effects of lipophilic atorvastatin and hydrophilic rosuvastatin on cardiac sympathetic nerve activityin CHF patients with dilated cardiomyopathy (DCM), sixty-three stable outpatients with DCM, who were already receiving standard therapy for CHF, were randomized to atorvastatin (n532) or rosuvastatin (n531). We evaluated cardiac sympathetic nerve activity by cardiac 123I- metaiodobenzylguanidine (MIBG) scintigraphy and neurohumoral factors before and after 6 months of treatment. Results: There were nodifferences in baseline characteristics between the two groups. In the rosuvastatin group,there were no changes in MIBG parameters, LVEF or plasma NT-proBNP after 6months of treatment. In contrast, the atorvastatin group showed a significant increase in the delayed heart/mediastinum count ratio (2.1860.4 vs.2.3660.4, p! 0.0001), while the washout rate was significantly decreased (34.865.7 vs. 32.666.3%, p50.0001) after 6 months of treatment compared withthe baseline values. In addition, LVEF was significantly increased and the plasma NT-proBNP level wassignificantly decreased in the atorvastatin group. Conclusion: These findings suggest that lipophilic atorvastatin but not hydrophilic rosuvastatin increases LVEF and decreases NT-proBNP level with the improvement of cardiac sympathetic nerve activity in CHF patients with DCM.
Treatment of severe chronic heart failure is often challenge. Complication of chronic kidney disease makes the treatment of heart failure more difficult. We often encounter the patients of chronic heart failure who cannot be controlled by conventional loop or thiazide diuretics. Tolvaptan, vasopressin V2 receptor antagonist, new water diuretics has become a new therapeutic tool for heart failure in Japan. We have treated 26 patients of chronic heart failure with tolvaptan added standard medication. Mean age of patients was 76.6. Etiologies of heart failure were 11 diastolic dysfunctions, 6 ischemic heart diseases, 2 pulmonary hearts, 5 cardiomyopathies, 1 constrictive pericarditis, 1 mitral valve disease. Mean plasma concentration of brain natriuretic peptide was 368 ng/ml. Mean eGFR was 37.6. Three patients discontinued talvaptan due to progression of dementia, difficulty in 2 weeks regular outpatient treatment, and change of hospital. 23 patients have continued talvaptan therapy after leaving hospital. Urine volume incease and body weight loss were obtained by tolvaptan. During follow up of one month, hypernatremia, worsening of renal function were not seen. BNP levels after 1 month did not necessarily decrease. Only one patient died of ventricular fibrillation. Tolvaptan might reduce the opportunites of admission by cotrolling of body fluid, and could be a new promising therapeutic agent for severe chronic heart failure.
Short-term Outcomes of 26 Patients of Severe Chronic Heart Failure Treated with Tolvaptan HAYATO OGAWA, YOSUKE MURASE, YOSHIHISA NAKANO, AKITOSHI HARA, YUUSUKE FUJIKAWA, HIROYUKI OSANAI, YOSHIHITO NAKASHIMA, HIROSHI ASANO, MASAYOSHI AJIOKA, KAZUYOSHI SAKAI Department of Cardiology, Tosei General Hospital
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Metformin Use and Prognosis Among Patients with Diabetes and Heart Failure YUYA MATSUE, MAKOTO SUZUKI, WATARU NAGAHORI, MASAKAZU OHNO, AKIHIKO MATSUMURA, YUJI HASHIMOTO Department of Cardiology, Kamede Medical Center, Chiba, Japan
Safety and Efficacy of Tolvaptan in the Elderly Patients with Acute Decompensated Heart Failure Requiring Repetitive Hospitalization TOSHIMASA SEKI1, YOSHIKAZU YAZAKI1, MITSUAKI HORIGOME1, UICHI IKEDA2 1 Division of Cardiology, Matsumoto Medical Center Matsumoto Hospital, Matsumoto, Japan, 2Department of Cardiovascular Medicine, Shinshu University School of Medicine
Background: Metformin, which is recommended as first choice drug for patients with diabetes, is often not considered in patients with heart failure (HF) because of concerns about its safety. We examined retrospectively the prognostic implication of metformin use in patients with HF. Methods: Consecutive 72 patients who had been admitted to our hospital with HF from January 2009 to November 2010 with history of diabetes were included. We exclude the patients without drug therapy for diabetes. Results: Patients were followed up with an end-point of cardiac death
Background: Repetitive decompensations are often seen in the elderly patients with heart failure even if they are taking a large dose of classical diuretics. The aim of this study was to clarify the safety and efficacy of a new diuretics, tolvaptan (vasopressin V2 receptor antagonist) in the elderly patients with decompensated heart failure. Methods: Tolvaptan (3.75mg/day in 3, 7.5mg/day in 11 and 15mg/day in 4 patients) was added to conventional diuretics in 18 decompensated heart failure patients requiring repetitive hospitalization. There were 10 men and 8 women with an average
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Postoperative
23M Heart transplantation 182 148 19 112 221 (0.18%)
JHFS
S151
or re-hospitalization for median of 14 months. Patients treated with metformin had lower adverse events free rate than without metformin (Log-rank, P!0.05). Conclusion: These results suggested that metformin therapy is associated with lower rates of adverse events in patients with diabetes and HF.
241 201 16 147 452 (0.37%) 62108 95.1 31M LVAD removal
126 70 44 68 491 (0.51%)
102 51 50 53 143 (0.15%) 63108 92.9
33M LVAD remove but subsequently LVAD required 86 90 54 50 37 42 75 57 13889 (13%) 4436 (4.6%) 8 7.510 42.3
O-30 Effect of Atorvastatin versus Rosuvastatin on Cardiac Sympathetic Nerve Activity in Patients with Dilated Cardiomyopathy TAKAYOSHI TSUTAMOTO1, HIROSHI SAKAI2, CHIHO KAWAHAWA2, MINORU HORIE2, TAKEHIRO MATSUMOTO3, MASANORI FUJII3, MASATO OHNISHI3, ATSUYUKI WADA3 1 Cardiovasular Medicine, Toyosato Hospital, Shiga, Japan, 2Cardiovacular and Respiratory Medicine, Sgiga University of Medical Science, Otsu, Japan, 3 Cardiovasular Medicine, Kusatsu General Hospital, Kusatsu, Japan
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Background: Retrospective analyses have shown that lipophilic statin therapy may have a beneficial effect on patients with chronic heartfailure (CHF). However, recent prospective studies using hydrophilic rosuvastatin have not shown any beneficial effect on mortality. Methods: To compare the effects of lipophilic atorvastatin and hydrophilic rosuvastatin on cardiac sympathetic nerve activityin CHF patients with dilated cardiomyopathy (DCM), sixty-three stable outpatients with DCM, who were already receiving standard therapy for CHF, were randomized to atorvastatin (n532) or rosuvastatin (n531). We evaluated cardiac sympathetic nerve activity by cardiac 123I- metaiodobenzylguanidine (MIBG) scintigraphy and neurohumoral factors before and after 6 months of treatment. Results: There were nodifferences in baseline characteristics between the two groups. In the rosuvastatin group,there were no changes in MIBG parameters, LVEF or plasma NT-proBNP after 6months of treatment. In contrast, the atorvastatin group showed a significant increase in the delayed heart/mediastinum count ratio (2.1860.4 vs.2.3660.4, p! 0.0001), while the washout rate was significantly decreased (34.865.7 vs. 32.666.3%, p50.0001) after 6 months of treatment compared withthe baseline values. In addition, LVEF was significantly increased and the plasma NT-proBNP level wassignificantly decreased in the atorvastatin group. Conclusion: These findings suggest that lipophilic atorvastatin but not hydrophilic rosuvastatin increases LVEF and decreases NT-proBNP level with the improvement of cardiac sympathetic nerve activity in CHF patients with DCM.
Treatment of severe chronic heart failure is often challenge. Complication of chronic kidney disease makes the treatment of heart failure more difficult. We often encounter the patients of chronic heart failure who cannot be controlled by conventional loop or thiazide diuretics. Tolvaptan, vasopressin V2 receptor antagonist, new water diuretics has become a new therapeutic tool for heart failure in Japan. We have treated 26 patients of chronic heart failure with tolvaptan added standard medication. Mean age of patients was 76.6. Etiologies of heart failure were 11 diastolic dysfunctions, 6 ischemic heart diseases, 2 pulmonary hearts, 5 cardiomyopathies, 1 constrictive pericarditis, 1 mitral valve disease. Mean plasma concentration of brain natriuretic peptide was 368 ng/ml. Mean eGFR was 37.6. Three patients discontinued talvaptan due to progression of dementia, difficulty in 2 weeks regular outpatient treatment, and change of hospital. 23 patients have continued talvaptan therapy after leaving hospital. Urine volume incease and body weight loss were obtained by tolvaptan. During follow up of one month, hypernatremia, worsening of renal function were not seen. BNP levels after 1 month did not necessarily decrease. Only one patient died of ventricular fibrillation. Tolvaptan might reduce the opportunites of admission by cotrolling of body fluid, and could be a new promising therapeutic agent for severe chronic heart failure.
Short-term Outcomes of 26 Patients of Severe Chronic Heart Failure Treated with Tolvaptan HAYATO OGAWA, YOSUKE MURASE, YOSHIHISA NAKANO, AKITOSHI HARA, YUUSUKE FUJIKAWA, HIROYUKI OSANAI, YOSHIHITO NAKASHIMA, HIROSHI ASANO, MASAYOSHI AJIOKA, KAZUYOSHI SAKAI Department of Cardiology, Tosei General Hospital
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Metformin Use and Prognosis Among Patients with Diabetes and Heart Failure YUYA MATSUE, MAKOTO SUZUKI, WATARU NAGAHORI, MASAKAZU OHNO, AKIHIKO MATSUMURA, YUJI HASHIMOTO Department of Cardiology, Kamede Medical Center, Chiba, Japan
Safety and Efficacy of Tolvaptan in the Elderly Patients with Acute Decompensated Heart Failure Requiring Repetitive Hospitalization TOSHIMASA SEKI1, YOSHIKAZU YAZAKI1, MITSUAKI HORIGOME1, UICHI IKEDA2 1 Division of Cardiology, Matsumoto Medical Center Matsumoto Hospital, Matsumoto, Japan, 2Department of Cardiovascular Medicine, Shinshu University School of Medicine
Background: Metformin, which is recommended as first choice drug for patients with diabetes, is often not considered in patients with heart failure (HF) because of concerns about its safety. We examined retrospectively the prognostic implication of metformin use in patients with HF. Methods: Consecutive 72 patients who had been admitted to our hospital with HF from January 2009 to November 2010 with history of diabetes were included. We exclude the patients without drug therapy for diabetes. Results: Patients were followed up with an end-point of cardiac death
Background: Repetitive decompensations are often seen in the elderly patients with heart failure even if they are taking a large dose of classical diuretics. The aim of this study was to clarify the safety and efficacy of a new diuretics, tolvaptan (vasopressin V2 receptor antagonist) in the elderly patients with decompensated heart failure. Methods: Tolvaptan (3.75mg/day in 3, 7.5mg/day in 11 and 15mg/day in 4 patients) was added to conventional diuretics in 18 decompensated heart failure patients requiring repetitive hospitalization. There were 10 men and 8 women with an average
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