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Non-compaction of the Left Ventricular Myocardium and Heart Failure with Reduced EF: Case Report
S200 Journal of Cardiac Failure Vol. 21 No. 10S October 2015 enlargement of the aneurysm may induce the distortion of the mitral annulus and lead to the exacerbation of the MR.
of CPA, and had a significant lower mortality than neither witness nor bystander (50.0% vs. 83.3%, P50.0008). The critical patients who required PCPS support have a high mortality, especially in cardiovascular disease. CPA makes worsen the mortality but witnessed CPA and bystander CPR have a possibility to improve their mortality.
PP4-4 Rationale for Endomyocardial Biopsy of Heart Failure Patients Who Have Responded to Usual Care TOHRU WATANABE, TAKESHI KASHIMURA, HIROAKI OBATA, HARUO HANAWA, TOHRU MIJNAMINO Department of cardiovascular Biology and Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan Background: Endomyocardial biopsy (EBM) is the only method for histological evaluation of cardiac tissue; however, the AHA/ACC/ESC scientific statement 2007 did not recommend EBM to those who respond to usual care within 1 to 2 weeks (class IIb recommendation). Methods: We reviewed clinical charts of patients who had heart failure of unknown etiology with reduced ejection fraction (!40%) and underwent EBM as a part of diagnostic cardiac catheterization even if they well responded to usual care in Niigata University Hospital since April 2013 to March 2015. Results: Among 45 patients (54611 years old, 37 males, LVDd 63610mm LVDs 55611 mm, LVEF 28.769.0%), final diagnosis was idiopathic dilated cardiomyopathy in 39 cases (87%). EBM was crucial and helpful for final diagnosis in 6 cases (2 cases of chronic myocarditis due to collagen disease, 2 cases of arrhythmogenic right ventricular cardiomyopathy, 1 case of Fabry’s disease, and 1 case of mitochondrial cardiomyopathy). Conclusion: EBM would not be necessary for diagnosis in all of the patients who had heart failure with reduced ejection fraction and responded to usual care, but it was useful in some cases for definitive diagnosis. Comprehensive screening of secondary cardiomyopathy would be desirable before conducting EBM.
PP4-5 Non-compaction of the Left Ventricular Myocardium and Heart Failure with Reduced EF: Case Report NAOKO IKEDA, KAORU TANNO Department of Cardiology, Showa University Koto-Toyosu Hospital, Tokyo, Japan A 62-year-old man and a 49-year-old man in heart failure with low EF admitted to our hospital. They have been never pointed out almost all diseases since they were young. They have come to feel dyspnea on effort these days. And they were suffered from palpitation such as paroxysmal supraventricular tachycardia and atrial fibrillation, and younger one was suffered from cerebellar infarction. X-ray showed their hearts were enlarged and echocardiography exhibited cardiomegaly and low EF (LVDd 55-65mm, LVEF 30-35%) with apical spongy appearance. They did not have the coronary artery disease and cardiac MRI showed the partial abnormal enhancement in their hearts. We started the drug therapy using such as beta-blocker, diuretics and anticoagulations. We added cardiac ablation to treat arrhythmia. Then, their symptoms smoothly disappeared. These cases might have had apical noncompaction of the left ventricular myocardium. After treatment, their LV systolic function still does not recover. Their cardiac tissues showed hypertrophic myocardium with interstitial fibrosis in left ventricle by myocardiac biopsy. Because of the possibility of sudden death and thromboembolism, we need to give enough attention to their clinical course.
PP5-1 Expression of Let-7 Family microRNAs in Skin Correlates Negatively with Severity of Pulmonary Hypertension in Patients with Systemic Scleroderma YASUHIRO IZUMIYA, YUICHI KIMURA, YOSHIRO ONOUE, SHINSUKE HANATANI, SATOSHI ARAKI, HISAO OGAWA Department of Cardiovascular Medicine, Kumamoto University Background: Pulmonary hypertension (PH) is a serious complication in patients with systemic scleroderma (SSc), therefore it is important to identify the factors that predict the presence and progression of PH. Skin biopsy is performed in patients with SSc to examine the type and severity of the disease. MicroRNAs (miRNAs) are potential biomarkers for various cardiovascular diseases including PH. Methods and Results: We determined the skin miRNA expression profile in 15 SSc patients with and without PH. A mixture of equal amounts of miRNAs from PH and non-PH patients were prepared and used for miRNA PCR array analysis. The analysis identified 591 upregulated miRNAs and 57 downregulated miRNAs in the PH group. When a 1.5-fold difference was considered meaningful, 32 miRNAs were upregulated and 14 miRNAs were downregulated in the PH group. Interestingly, 5 out of 14 downregulated miRNAs belonged to the let-7 family. The results were validated by quantitative real-time PCR, which showed significant downregulation of five let-7 family members (let-7a, -7d, -7e, -7f, -7g). The expression levels of let-7d and 7b correlated negatively with pulmonary arterial pressure measured by echocardiography. Conclusions: The results suggest that skin miRNA is a potentially useful marker for the presence and severity of PH in patients with SSc.
PP5-3 Plasma Thrombomodulin Level in Patients with Acute Pulmonary Embolism is Correlated with the Number of Hospitalization Days TAIJU MATSUI, MAKOTO SHOJI, TAROU ADACHI, SHINJI KOBA, YOUICHI KOBAYASHI Department of Medicine Division of Cardiology, Showa University, Tokyo, Japan Objectives: To study whether the markers of coagulation could be predictive factors for prognosis in patients with Pulmonary embolism (PE) retrospectively. Subjects and Methods: Forty-five patients who were hospitalized in CCU from March 2012 to July 2014. The correlation between the markers of coagulation (D-dimer, thrombin-antithrombin III complex (TAT), prothrombin fragment 1+2 (PTF1+2), Plasma thrombomodulin (TM), plasminogen activator inhibitor-1 (PAI-1)) and the number of hospitalization days was evaluated. Results: As for the number of hospitalization days, no statistical differences were recognized whether thrombolytic agent was administered or not. TM, D-dimer, PTF1+2 were found to be correlated well with the number of hospitalization (TM: R50.75, p!0.0001 D-dimer: R50.36 p!0.05 PTF1+2: R50.50 p!0.005). According to multiple regression analysis, it is assumed that TM affected the number of hospitalization days the most. Conclusion: TM could be predictive factors for prognosis in patients with Pulmonary embolism.
PP4-7
PP5-4
Clinical Outcomes of Patients with Percutaneous Cardiopulmonary Support TOSHIHARU FUJII, TSUTOMU MURAKAMI, SHO TORII, TAKESHI IJICHI, MASATAKA NAKANO, YOHEI OHNO, GAKU NAKAZAWA, NORIHIKO SINOZAKI, FUMINOBU YOSHIMACHI, YUJI IKARI Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara, Japan
A Difficult Case of Pulmonary Hypertension Caused by Dermatomyositis MAKI KATO1, TAKUYA OKADA1, RYO KIMURA1, MASARU YUGE2, TAKEO KAWAGUCHI2 1 Department of General Medicine, Odawara Municipal Hospital, Odawara, Japan; 2 Department of Cardiology, Odawara Municipal Hospital, Odawara, Japan
The clinical outcomes of patients with hemodynamic collapse who require percutaneous cardiopulmonary support (PCPS) are not fully established. The purpose of present study is to assess the clinical outcomes of patients who required PCPS for cardiovascular disease or cardiopulmonary arrest (CPA). A total of 200 patients who used PCPS for any reason during January 2006 and January 2015 were analyzed retrospectively. The extracorporeal membrane oxygenation was excluded. Impact of cardiovascular disease or CPA on 30-days mortality was assessed. Thirty-days mortality of study population was 61.0%. Cardiovascular disease was accounted for 60.0% as baseline disease, and ischemic heart disease was most common. Cardiovascular disease had a significant higher mortality than non-cardiovascular disease (66.7% vs. 38.3%, P50.0054). CPA was most frequent reason for PCPS use (69.5%), and out-hospital (OHCA) and in-hospital CPA (IHCA) were accounted for 50.4% and 49.6% respectively. Their mortalities were equivalent but higher than non-CPA (70.0% vs. 71.1% vs. 39.3%, P!0.0001). OHCA with witnessed CPA and bystander cardiopulmonary resuscitation (CPR) was accounted for 63%
Case: 73 years old man has been followed up for hypertension and atrial fibrillation by the other clinic. The physician of the clinic consulted with the pulmonologist in our hospital about his dyspnea on effort. The diagnosis was interstitial pneumonia for his chest computed tomography. We were asked about the aggravation of his dyspnea. We suspected that congestive heart failure caused his dyspnea. He had pleural effusion. His echocardiograph showed D shape pattern and moderate mitral valve regurgitation. His mean pulmonary artery pressure was 33 mmHg and his pulmonary artery wedge pressure was 16 mmHg. Because the antiJo 1 antibody was positive, we diagnosed his pulmonary hypertension was caused by the dermatomyositis. We consulted with the rheumatologist about his disease and decided that the administration for his disease was needless for the stability of this disease. We treated him with sildenafil, bosentan and beraprost but his complaint was unstable. 7 months later, we aspirated his pleural effusion and this effusion was exudative. We used prednisolone because of this result. His pleural effusion disappeared and the mean pulmonary artery pressure was 14 mmHg finally. Conclusion: We treated a case of pulmonary hypertension caused
of CPA, and had a significant lower mortality than neither witness nor bystander (50.0% vs. 83.3%, P50.0008). The critical patients who required PCPS support have a high mortality, especially in cardiovascular disease. CPA makes worsen the mortality but witnessed CPA and bystander CPR have a possibility to improve their mortality.
PP4-4 Rationale for Endomyocardial Biopsy of Heart Failure Patients Who Have Responded to Usual Care TOHRU WATANABE, TAKESHI KASHIMURA, HIROAKI OBATA, HARUO HANAWA, TOHRU MIJNAMINO Department of cardiovascular Biology and Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan Background: Endomyocardial biopsy (EBM) is the only method for histological evaluation of cardiac tissue; however, the AHA/ACC/ESC scientific statement 2007 did not recommend EBM to those who respond to usual care within 1 to 2 weeks (class IIb recommendation). Methods: We reviewed clinical charts of patients who had heart failure of unknown etiology with reduced ejection fraction (!40%) and underwent EBM as a part of diagnostic cardiac catheterization even if they well responded to usual care in Niigata University Hospital since April 2013 to March 2015. Results: Among 45 patients (54611 years old, 37 males, LVDd 63610mm LVDs 55611 mm, LVEF 28.769.0%), final diagnosis was idiopathic dilated cardiomyopathy in 39 cases (87%). EBM was crucial and helpful for final diagnosis in 6 cases (2 cases of chronic myocarditis due to collagen disease, 2 cases of arrhythmogenic right ventricular cardiomyopathy, 1 case of Fabry’s disease, and 1 case of mitochondrial cardiomyopathy). Conclusion: EBM would not be necessary for diagnosis in all of the patients who had heart failure with reduced ejection fraction and responded to usual care, but it was useful in some cases for definitive diagnosis. Comprehensive screening of secondary cardiomyopathy would be desirable before conducting EBM.
PP4-5 Non-compaction of the Left Ventricular Myocardium and Heart Failure with Reduced EF: Case Report NAOKO IKEDA, KAORU TANNO Department of Cardiology, Showa University Koto-Toyosu Hospital, Tokyo, Japan A 62-year-old man and a 49-year-old man in heart failure with low EF admitted to our hospital. They have been never pointed out almost all diseases since they were young. They have come to feel dyspnea on effort these days. And they were suffered from palpitation such as paroxysmal supraventricular tachycardia and atrial fibrillation, and younger one was suffered from cerebellar infarction. X-ray showed their hearts were enlarged and echocardiography exhibited cardiomegaly and low EF (LVDd 55-65mm, LVEF 30-35%) with apical spongy appearance. They did not have the coronary artery disease and cardiac MRI showed the partial abnormal enhancement in their hearts. We started the drug therapy using such as beta-blocker, diuretics and anticoagulations. We added cardiac ablation to treat arrhythmia. Then, their symptoms smoothly disappeared. These cases might have had apical noncompaction of the left ventricular myocardium. After treatment, their LV systolic function still does not recover. Their cardiac tissues showed hypertrophic myocardium with interstitial fibrosis in left ventricle by myocardiac biopsy. Because of the possibility of sudden death and thromboembolism, we need to give enough attention to their clinical course.
PP5-1 Expression of Let-7 Family microRNAs in Skin Correlates Negatively with Severity of Pulmonary Hypertension in Patients with Systemic Scleroderma YASUHIRO IZUMIYA, YUICHI KIMURA, YOSHIRO ONOUE, SHINSUKE HANATANI, SATOSHI ARAKI, HISAO OGAWA Department of Cardiovascular Medicine, Kumamoto University Background: Pulmonary hypertension (PH) is a serious complication in patients with systemic scleroderma (SSc), therefore it is important to identify the factors that predict the presence and progression of PH. Skin biopsy is performed in patients with SSc to examine the type and severity of the disease. MicroRNAs (miRNAs) are potential biomarkers for various cardiovascular diseases including PH. Methods and Results: We determined the skin miRNA expression profile in 15 SSc patients with and without PH. A mixture of equal amounts of miRNAs from PH and non-PH patients were prepared and used for miRNA PCR array analysis. The analysis identified 591 upregulated miRNAs and 57 downregulated miRNAs in the PH group. When a 1.5-fold difference was considered meaningful, 32 miRNAs were upregulated and 14 miRNAs were downregulated in the PH group. Interestingly, 5 out of 14 downregulated miRNAs belonged to the let-7 family. The results were validated by quantitative real-time PCR, which showed significant downregulation of five let-7 family members (let-7a, -7d, -7e, -7f, -7g). The expression levels of let-7d and 7b correlated negatively with pulmonary arterial pressure measured by echocardiography. Conclusions: The results suggest that skin miRNA is a potentially useful marker for the presence and severity of PH in patients with SSc.
PP5-3 Plasma Thrombomodulin Level in Patients with Acute Pulmonary Embolism is Correlated with the Number of Hospitalization Days TAIJU MATSUI, MAKOTO SHOJI, TAROU ADACHI, SHINJI KOBA, YOUICHI KOBAYASHI Department of Medicine Division of Cardiology, Showa University, Tokyo, Japan Objectives: To study whether the markers of coagulation could be predictive factors for prognosis in patients with Pulmonary embolism (PE) retrospectively. Subjects and Methods: Forty-five patients who were hospitalized in CCU from March 2012 to July 2014. The correlation between the markers of coagulation (D-dimer, thrombin-antithrombin III complex (TAT), prothrombin fragment 1+2 (PTF1+2), Plasma thrombomodulin (TM), plasminogen activator inhibitor-1 (PAI-1)) and the number of hospitalization days was evaluated. Results: As for the number of hospitalization days, no statistical differences were recognized whether thrombolytic agent was administered or not. TM, D-dimer, PTF1+2 were found to be correlated well with the number of hospitalization (TM: R50.75, p!0.0001 D-dimer: R50.36 p!0.05 PTF1+2: R50.50 p!0.005). According to multiple regression analysis, it is assumed that TM affected the number of hospitalization days the most. Conclusion: TM could be predictive factors for prognosis in patients with Pulmonary embolism.
PP4-7
PP5-4
Clinical Outcomes of Patients with Percutaneous Cardiopulmonary Support TOSHIHARU FUJII, TSUTOMU MURAKAMI, SHO TORII, TAKESHI IJICHI, MASATAKA NAKANO, YOHEI OHNO, GAKU NAKAZAWA, NORIHIKO SINOZAKI, FUMINOBU YOSHIMACHI, YUJI IKARI Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara, Japan
A Difficult Case of Pulmonary Hypertension Caused by Dermatomyositis MAKI KATO1, TAKUYA OKADA1, RYO KIMURA1, MASARU YUGE2, TAKEO KAWAGUCHI2 1 Department of General Medicine, Odawara Municipal Hospital, Odawara, Japan; 2 Department of Cardiology, Odawara Municipal Hospital, Odawara, Japan
The clinical outcomes of patients with hemodynamic collapse who require percutaneous cardiopulmonary support (PCPS) are not fully established. The purpose of present study is to assess the clinical outcomes of patients who required PCPS for cardiovascular disease or cardiopulmonary arrest (CPA). A total of 200 patients who used PCPS for any reason during January 2006 and January 2015 were analyzed retrospectively. The extracorporeal membrane oxygenation was excluded. Impact of cardiovascular disease or CPA on 30-days mortality was assessed. Thirty-days mortality of study population was 61.0%. Cardiovascular disease was accounted for 60.0% as baseline disease, and ischemic heart disease was most common. Cardiovascular disease had a significant higher mortality than non-cardiovascular disease (66.7% vs. 38.3%, P50.0054). CPA was most frequent reason for PCPS use (69.5%), and out-hospital (OHCA) and in-hospital CPA (IHCA) were accounted for 50.4% and 49.6% respectively. Their mortalities were equivalent but higher than non-CPA (70.0% vs. 71.1% vs. 39.3%, P!0.0001). OHCA with witnessed CPA and bystander cardiopulmonary resuscitation (CPR) was accounted for 63%
Case: 73 years old man has been followed up for hypertension and atrial fibrillation by the other clinic. The physician of the clinic consulted with the pulmonologist in our hospital about his dyspnea on effort. The diagnosis was interstitial pneumonia for his chest computed tomography. We were asked about the aggravation of his dyspnea. We suspected that congestive heart failure caused his dyspnea. He had pleural effusion. His echocardiograph showed D shape pattern and moderate mitral valve regurgitation. His mean pulmonary artery pressure was 33 mmHg and his pulmonary artery wedge pressure was 16 mmHg. Because the antiJo 1 antibody was positive, we diagnosed his pulmonary hypertension was caused by the dermatomyositis. We consulted with the rheumatologist about his disease and decided that the administration for his disease was needless for the stability of this disease. We treated him with sildenafil, bosentan and beraprost but his complaint was unstable. 7 months later, we aspirated his pleural effusion and this effusion was exudative. We used prednisolone because of this result. His pleural effusion disappeared and the mean pulmonary artery pressure was 14 mmHg finally. Conclusion: We treated a case of pulmonary hypertension caused