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N-Terminal proBNP Levels Predict Short-Term Outcomes in Non-Obese Patients Admitted with Acute Decompensated Heart Failure
S170 Journal of Cardiac Failure Vol. 13 No. 6 Suppl. 2007 hospitalizations. Baseline systolic blood pressure was 119 6 23 mmHg. Using UF, 7.1 6 3.9 liters of fluid were removed during 2.0 6 1.2 treatments per hospitalization. Baseline Cr was 1.8 6 0.8 and 1.9 6 1.2 at discharge (NS). Of the 15 in-hospital deaths, 14 occurred during initial hospitalization. Pump dysfunction was related to 13 (87%) of the 15 deaths; no deaths were related to UF use. In hospitalizations with a principal diagnosis of heart failure, in-hospital mortality was 7.6% compared to an ADHERE risk tree estimated mortality of 7.5%. Multivariate logistic regression identified a trend for decreased systolic blood pressure to predict patient initial hospitalization mortality (p 5 .06). Patient Kaplan-Meier survival was 75% at 1 year and 72% at 2 years. Cox regression found decreased systolic blood pressure as a predictor of long-term mortality (p 5 .025). Total volume of ultrafiltrate removed, ejection fraction, history of CAD, creatinine clearance, gender, age, and principal diagnosis of heart failure were not associated with long-term mortality. Conclusions: This series represents the largest number of reported consecutive cases of UF in patients with cardiovascular disorders. Despite marked volume overload, UF-treated patients with a principal diagnosis of heart failure had in-patient outcomes similar to the ADHERE registry. Systolic blood pressure was a significant factor associated with longterm outcome.
333 Left Ventricular Remodeling and Microvascular Circulation after Distal Coronary Protection during Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction Dong-Ju Choi1, Woo-young Chung1, Tae-Jin Yeon1, Yung-Seok Cho1, In-Ho Chae1; 1 Cardiovascular Center, Bundang, Seoul National University, Seongnam, Gyeonggido, Korea Background: It was known that distal coronary protection during primary percutaneous coronary intervention (PCI) had no effect on clinical outcome after 1 month after acute myocardial infarction (AMI), but long term effects on ventricular remodeling is not well established. This prospective randomized study was designed to validate the efficacy of distal coronary protection on infarct size, ventricular remodeling and micorvascular obstruction at 6 months after AMI. Methods: AMI patients with onset time of 12hr or less were randomly assigned into the distal coronary protection group (group P) with Percusurge guardwire, or no protection group (group N). Primary PCI was performed with standard method and stents were implanted in all patients. Immediate after PCI, antegrade flow and myocardial perfusion were evaluated according to TIMI, TMP grading, respectively. QCA (quantitative coronary angiography) analysis, at the time of immediate post PCI and 6 months follow up, and clinical outcome during follow up period. Before the discharge, Cardiac MRI imagings were obtained, including adenosine, dobutamine stress imaging. Microvascular obstruction (MVO) was graded in perfusion imaging. Grade III means severe degree of MVO showing no evidence of microperfusion after 10 minutes of contrast injection. Results: 88 patients were enrolled and among them, 66 patients including 2 mortality cased finished 6 months follow up. No difference was found in demographic characteristics and major risk factors. Stent was longer in group P (27.23 6 4.59mm vs 24.36mm, p 5 0.03) and similar in diameter (3.17 6 0.45mm vs 3.10 6 0.49mm, p 5 0.48). QCA analysis showed no difference in post PCI reference diameter, late loss (0.23mm vs 0.02mm, p 5 0.20), post PCI and follow up diameter stenosis (12.07 6 7.13% vs 10.89 6 6.13%, p 5 0.47; 21 6 18% vs 14 6 11%, p 5 0.13), restenosis rate (5% vs 11%, p 5 0.23) Distal protection didn’t show any benefit in terms of left ventricular volume, infarction size measured by cardiac MRI, post PCI and 6 mo follow-up. MRI ejection fraction had no difference both at baseline and 6 months follow up. TMP Grade III was 40% in group P, 29% in group N, (p 5 0.07) MVO Grade0/I was 27% in group P, 35% in group N immediately after PCI. Conclusion: Distal protection device have tendency to improve microvascular perfusion but it seems not to affect the ventricular remodeling and dysfunction.
335 N-Terminal proBNP Levels Predict Short-Term Outcomes in Non-Obese Patients Admitted with Acute Decompensated Heart Failure 1 Chetan V. Hampole1, Amit K. Mehrotra1, Sascha N. Goonewardena , George W. 1 Bell1, John E.A. Blair1, Richa Agarwal1, James Woodruff1; Internal Medicine, University of Chicago Medical Center, Chicago, IL Background: N-terminal proBNP (BNP) levels are elevated in patients with acute decompensated heart failure (ADHF). In the setting of ADHF, irrespective of cardiac filling pressures, obese patients have lower BNP levels than non-obese. While the prognostic value of BNP levels has been well described, little data exist on the short-term prognostic value of BNP levels in obese HF patients. Objective: To assess whether admission BNP levels have similar prognostic significance in obese and nonobese patients admitted with ADHF. Methods: Consecutive patients were enrolled with a primary diagnosis of ADHF validated using the Framingham Heart Failure criteria. Patient demographics, clinical history, and admission laboratory data were collected. The primary endpoint was hospital readmission or ER visit within 30-days of hospital discharge. Patients were categorized into two groups based on their body mass index (BMI, Kg/m2): Group I included patients with a BMI ! 30 and Group II included patients with a BMI O 30. Results: A total of 105 patients were enrolled. Thirty-day follow-up outcomes were available for 101 of these patients. Fifty-three percent (54/101) of patients were in Group I with the remaining in Group II. The mean BNP level was greater in Group I when compared to Group II (16041 vs. 7665; p ! 0.001). Within Group I, the mean BNP level was significantly higher in patients that met the primary endpoint than in those who did not (21013 vs. 12064; p 5 0.035). However, in Group II, the mean BNP level was not significantly different between those who met the primary endpoint and those who did not (5194 vs. 8823; p 5 0.27). Conclusions: In this prospective study, admission BNP levels of ADHF patients with a BMI ! 30 who were re-hospitalized or visited an ER within 30-days were significantly higher than in those who were not. However, in the obese group, BNP levels were not significantly different between those who met and did not meet the primary endpoint. Our study suggests that the short-term prognostic significance of admission BNP levels may be limited to non-obese HF populations.
336 Development of Cardiorenal Syndrome Predicts Development of Stage D Heart Failure and Hospice Admission 1 Jigar D. Patel1, Jie Li1, Soheni Channa1, J. Thomas Heywood1; Cardiology, Scripps Clinic, La Jolla, CA
334 In-Patient and Long-Term Outcomes in Volume Overloaded Patients Treated with Ultrafiltration Brian Jaski1, Andrew Romeo1, Bryan Ortiz1, Cindy Walsh1, Bonnie Eklund1, 1 1 2 1 Maureen Stone , Dale Glaser , Sidney Smith ; Sharp Memorial Hospital, San 2 Diego, CA; U of North Carolina, Chapel Hill, NC Background: Ultrafiltration (UF) can rapidly and predictably remove extracellular and intravascular fluid volume. To date, assessment of UF in cardiovascular patients has been limited to short and medium-term studies in patients with a principal diagnosis of acute heart failure. Methods: Outcomes were assessed from consecutive patients with cardiovascular disorders and recognized pulmonary and systemic volume overload treated with a simplified UF system with the capability for peripheral venovenous access. Trained abstractors reviewed both paper and electronic medical records. Patients with a principal diagnosis of heart failure versus other primary hospital discharge diagnoses were identified according to ICD-9 standards by independent coders. Results: Over a period of 43 months, 100 patients (76M/24F, 65.3 6 14.0 years of age, systolic dysfunction 53%) were treated with UF during 130
Introduction: Heart failure guidelines characterize Stage D as end-stage heart failure which may require transplantation hospice for relief of severe symptoms. However Stage D heart failure (SDHF) may be difficult for clinicians to identify. Methods: Retrospective chart review of heart failure patients who were admitted to hospice within 1 year. Controls were matched for age and LVEF. Univariate and multivariate comparisons were made between variables obtained from echocardiograms, medication regimens, symptom, and laboratory values. Results: Signficant univariate associations at 6 months prior to hospice admission: BUN, creatinine, use of ACEI/ARB, use of diuretic, NYHA class, chronic kidney disease, maximum fasting glucose over 6 months. Significant multivariate associations by linear regression: BUN, NYHA class. Hospice patients had significantly less use of ACEI/ARB and diuretics, although the majority continued on diuretics. Conclusions: Hospice patients are characterized by features conssitent with the cardiorenal syndrome. Despite severe heart failure, fewer patients are able to be continued on even such standard heart failure medications as ACE-inhibitors and diuretics. Earlier recognition of the cardiorenal syndrome in patients may allow earlier admission to hospice or the initiation of palliative care. Preservation of renal function should be an important goal if survival in heart failure is to be prolonged.
333 Left Ventricular Remodeling and Microvascular Circulation after Distal Coronary Protection during Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction Dong-Ju Choi1, Woo-young Chung1, Tae-Jin Yeon1, Yung-Seok Cho1, In-Ho Chae1; 1 Cardiovascular Center, Bundang, Seoul National University, Seongnam, Gyeonggido, Korea Background: It was known that distal coronary protection during primary percutaneous coronary intervention (PCI) had no effect on clinical outcome after 1 month after acute myocardial infarction (AMI), but long term effects on ventricular remodeling is not well established. This prospective randomized study was designed to validate the efficacy of distal coronary protection on infarct size, ventricular remodeling and micorvascular obstruction at 6 months after AMI. Methods: AMI patients with onset time of 12hr or less were randomly assigned into the distal coronary protection group (group P) with Percusurge guardwire, or no protection group (group N). Primary PCI was performed with standard method and stents were implanted in all patients. Immediate after PCI, antegrade flow and myocardial perfusion were evaluated according to TIMI, TMP grading, respectively. QCA (quantitative coronary angiography) analysis, at the time of immediate post PCI and 6 months follow up, and clinical outcome during follow up period. Before the discharge, Cardiac MRI imagings were obtained, including adenosine, dobutamine stress imaging. Microvascular obstruction (MVO) was graded in perfusion imaging. Grade III means severe degree of MVO showing no evidence of microperfusion after 10 minutes of contrast injection. Results: 88 patients were enrolled and among them, 66 patients including 2 mortality cased finished 6 months follow up. No difference was found in demographic characteristics and major risk factors. Stent was longer in group P (27.23 6 4.59mm vs 24.36mm, p 5 0.03) and similar in diameter (3.17 6 0.45mm vs 3.10 6 0.49mm, p 5 0.48). QCA analysis showed no difference in post PCI reference diameter, late loss (0.23mm vs 0.02mm, p 5 0.20), post PCI and follow up diameter stenosis (12.07 6 7.13% vs 10.89 6 6.13%, p 5 0.47; 21 6 18% vs 14 6 11%, p 5 0.13), restenosis rate (5% vs 11%, p 5 0.23) Distal protection didn’t show any benefit in terms of left ventricular volume, infarction size measured by cardiac MRI, post PCI and 6 mo follow-up. MRI ejection fraction had no difference both at baseline and 6 months follow up. TMP Grade III was 40% in group P, 29% in group N, (p 5 0.07) MVO Grade0/I was 27% in group P, 35% in group N immediately after PCI. Conclusion: Distal protection device have tendency to improve microvascular perfusion but it seems not to affect the ventricular remodeling and dysfunction.
335 N-Terminal proBNP Levels Predict Short-Term Outcomes in Non-Obese Patients Admitted with Acute Decompensated Heart Failure 1 Chetan V. Hampole1, Amit K. Mehrotra1, Sascha N. Goonewardena , George W. 1 Bell1, John E.A. Blair1, Richa Agarwal1, James Woodruff1; Internal Medicine, University of Chicago Medical Center, Chicago, IL Background: N-terminal proBNP (BNP) levels are elevated in patients with acute decompensated heart failure (ADHF). In the setting of ADHF, irrespective of cardiac filling pressures, obese patients have lower BNP levels than non-obese. While the prognostic value of BNP levels has been well described, little data exist on the short-term prognostic value of BNP levels in obese HF patients. Objective: To assess whether admission BNP levels have similar prognostic significance in obese and nonobese patients admitted with ADHF. Methods: Consecutive patients were enrolled with a primary diagnosis of ADHF validated using the Framingham Heart Failure criteria. Patient demographics, clinical history, and admission laboratory data were collected. The primary endpoint was hospital readmission or ER visit within 30-days of hospital discharge. Patients were categorized into two groups based on their body mass index (BMI, Kg/m2): Group I included patients with a BMI ! 30 and Group II included patients with a BMI O 30. Results: A total of 105 patients were enrolled. Thirty-day follow-up outcomes were available for 101 of these patients. Fifty-three percent (54/101) of patients were in Group I with the remaining in Group II. The mean BNP level was greater in Group I when compared to Group II (16041 vs. 7665; p ! 0.001). Within Group I, the mean BNP level was significantly higher in patients that met the primary endpoint than in those who did not (21013 vs. 12064; p 5 0.035). However, in Group II, the mean BNP level was not significantly different between those who met the primary endpoint and those who did not (5194 vs. 8823; p 5 0.27). Conclusions: In this prospective study, admission BNP levels of ADHF patients with a BMI ! 30 who were re-hospitalized or visited an ER within 30-days were significantly higher than in those who were not. However, in the obese group, BNP levels were not significantly different between those who met and did not meet the primary endpoint. Our study suggests that the short-term prognostic significance of admission BNP levels may be limited to non-obese HF populations.
336 Development of Cardiorenal Syndrome Predicts Development of Stage D Heart Failure and Hospice Admission 1 Jigar D. Patel1, Jie Li1, Soheni Channa1, J. Thomas Heywood1; Cardiology, Scripps Clinic, La Jolla, CA
334 In-Patient and Long-Term Outcomes in Volume Overloaded Patients Treated with Ultrafiltration Brian Jaski1, Andrew Romeo1, Bryan Ortiz1, Cindy Walsh1, Bonnie Eklund1, 1 1 2 1 Maureen Stone , Dale Glaser , Sidney Smith ; Sharp Memorial Hospital, San 2 Diego, CA; U of North Carolina, Chapel Hill, NC Background: Ultrafiltration (UF) can rapidly and predictably remove extracellular and intravascular fluid volume. To date, assessment of UF in cardiovascular patients has been limited to short and medium-term studies in patients with a principal diagnosis of acute heart failure. Methods: Outcomes were assessed from consecutive patients with cardiovascular disorders and recognized pulmonary and systemic volume overload treated with a simplified UF system with the capability for peripheral venovenous access. Trained abstractors reviewed both paper and electronic medical records. Patients with a principal diagnosis of heart failure versus other primary hospital discharge diagnoses were identified according to ICD-9 standards by independent coders. Results: Over a period of 43 months, 100 patients (76M/24F, 65.3 6 14.0 years of age, systolic dysfunction 53%) were treated with UF during 130
Introduction: Heart failure guidelines characterize Stage D as end-stage heart failure which may require transplantation hospice for relief of severe symptoms. However Stage D heart failure (SDHF) may be difficult for clinicians to identify. Methods: Retrospective chart review of heart failure patients who were admitted to hospice within 1 year. Controls were matched for age and LVEF. Univariate and multivariate comparisons were made between variables obtained from echocardiograms, medication regimens, symptom, and laboratory values. Results: Signficant univariate associations at 6 months prior to hospice admission: BUN, creatinine, use of ACEI/ARB, use of diuretic, NYHA class, chronic kidney disease, maximum fasting glucose over 6 months. Significant multivariate associations by linear regression: BUN, NYHA class. Hospice patients had significantly less use of ACEI/ARB and diuretics, although the majority continued on diuretics. Conclusions: Hospice patients are characterized by features conssitent with the cardiorenal syndrome. Despite severe heart failure, fewer patients are able to be continued on even such standard heart failure medications as ACE-inhibitors and diuretics. Earlier recognition of the cardiorenal syndrome in patients may allow earlier admission to hospice or the initiation of palliative care. Preservation of renal function should be an important goal if survival in heart failure is to be prolonged.