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Nutritional Characteristics of Patients With Worsening Heart Failure Over 75 Years of Age
S230 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 institutionalization in patients with acute illness and acute delirium was common and predicted motility in non-intubated cardiac patients. We investigate influence of acute delirium on short-term prognosis in elderly ADHF patients. Methods: We analyzed 209 consecutive patients who were over 65 and urgently admitted due to ADHF in our hospital from April 2015 through March 2016, and we investigated retrospectively patient background, therapeutic procedure, and outcome. We diagnosed acute delirium based on the Confusion Assessment Method. Result: Of 209 patients, survival discharge was 191 patients (91.4%), and 30 days-survival was 183 patients (87.6%). Acute delirium was 48 patients (23.0%), and delirious patients had an decreased survival discharge (n = 40, 83.3% vs 93.8%, P = .0367) and 30 days-survival (n = 36, 75% vs 91.3%, P = .0052) compared to non-delirious patients. Conclusion: In elderly ADHF patients with acute delirium survival discharge and 30 days-survival was decreased compared to non-delirious patients. In elderly society delirium come to be more common and we need to pay attention to care patients.
(see Table). By multivariate analysis, only new onset infection was the significant independent factor (Odds ratio: 16.5, 95%CI: 2.9–138.8, P = .001). Conclusion: New onset infection during hospital stay is the strong factor to hinder home discharge in super-elderly patients admitted with ADHF.
P26-3 A Case of Elderly Heart Failure Patient With Cardiac Cachexia; How Should We Improve Malnutrition? Akito Kuwano, Daisuke Nagatomo, Yurie Higashi, Norihiko Kotooka, Kouichi Node; The Department of Cardiovascular Medicine, Japan A 78 year-old-man who was received aortic valve replacement for aortic regurgitation 36 years ago had attended our hospital for management of heart failure (HF) with reduced ejection fraction. He had suffered from decompensation of HF many times and repeated hospitalization, and dietary intake, body weight, and activity gradually decreased, which indicate progression of cardiac cachexia. He also suffered from the chronic obstructive pulmonary disease, and showed marasmus type of malnutrition. Although the status of HF has compensated in the past few years, we asked him to hospitalize for control of malnutrition and cardiac rehabilitation. After 10-days of hospitalization, dietary intake improved with the slight increase of body weight. On the other hand, his cognitive function mildly impaired by the changes of environment due to hospitalization. On the next day of discharge, he was transported to our emergency unit for acute decompensation of heart failure. Cognitive decline progressed and he died in spite of the intensive treatment 2 weeks after readmission. Cardiac cachexia is frequently observed among progressively increasing HF patients in the aging society, and are the prognostic factors. However, the consensus has not been reached on how to improve cachexia. In the present case, nutrition intervention for cachexia was supposed to be an exacerbating factor of HF, which shows us many clinical implications for management of cardiac cachexia.
P26-4 Nutritional Characteristics of Patients With Worsening Heart Failure Over 75 Years of Age Yasuhiro Ikeda, Toru Ueda, Takahiro Shinohara, Takamasa Oda, Masashi Kanemoto, Fumiaki Nakao, Takashi Fujii; Department of Cardiology, Yamaguchi Grand Medical Center, Japan We investigated whether patients with heart failure over 75 years of age has different characteristics in their nutritional status than those under 75 years. From January 2013 to May 2015, 425 patients with acute or acute-on-chronic heart failure admitted to our prefectural critical care medical center were recruited (male/female = 235/190). All patients with nimble discharge (n = 304) were retrospectively analyzed; number of patients under 75/over 75 = 108/196. The body mass indexes of patients with heart failure over 75 and under 75 years were 22.8 ± 5 vs 21 ± 4, respectively. The percentage of LV systolic dysfunction in over 75 years of age was significantly smaller than those under 75 years (67% vs 42%, P < .01). HF patients over 75 years showed significantly higher frequency of delirium, dysphagia and accompanying pneumonia after admission. Serum albumin levels were similar on admission between these two groups, but that over 75 years of age was significantly decreased at discharge compared to those under 75 years. In conclusion, elderly patients with heart failure showed a higher frequency of malnutrition and frailty that was associated with eating disorder. These data suggest that nutritional management is essential in the elderly patients with heart failure.
P26-5 New Onset Infection Is the Risk Facor to Hinder Home Discharge in Super-Elderly Patients With Acute Decompensated Heart Failure Sakura Nagumo, Miki Tsujiuchi, Takuya Mizukami, Ayaka Nogi, Hideyuki Maezawa, Mio Ebato; Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan Background: The factors to hamper home discharge in super-elderly patients admitted with acute decompensated heart failure (ADHF) have not fully studied. Methods and Results: Forty-seven consecutive super-elderly (≥85 yo) patients admitted with ADHF from home were enrolled from prospective ADHF registry of Showa University Fujigaoka Hospital in 2015 (n = 270). Thirty-four patients (72%) went back to home and 13 patients moved to other hospitals/facilities after discharge. Duration of hospital stay, new onset infections in hospital, presence of dementia, LVEF and E/e,+ at admission were factors associated with discharge to transfer/facility other than home
P27-1 An Adult Case of Cor Triatriatum Causing Congestive Heart Failure Shunsuke Kimura, Katsuhito Seki, Mai Shinbo, Yuuta Sutou, Kenji Iino, Hiroyuki Watanabe, Hiroshi Itou; Department of Internal Medcine, Division of Cardiovascular and Respiratory Medcine, Akita University School of Medicine, Japan A 68-year-old man was admitted to our hospital for congestive heart failure. The patient had been healthy until 2 months prior, when dyspnea on exertion developed. On chest radiograph, a mild enlargement of the cardiac silhouette and bilateral pulmonary congestion were noticed. An ECG showed an atrial fibrillation. Transthoracic echocardiography showed preserved LV contractile function and normal valvular function, but revealed a membrane-like, echo-dense structure in left atrium (LA), which divided the LA into posterior-superior (accessory) and anterior-inferior (true) chambers. Color Doppler showed an open communication in the flow between both chambers, which was charaterized by a jet flow with 1.6 m/s of peak velocity. Transesophageal echocardiography and contrast CT confirmed the intraatrial septum and segmented LA chamber. Based on those findings, we made a diagnosis of cor triatriatum. On cardiac catheterization, the mean pressure gradient between pulmonary capillary and diastolic LV chamber was 12 mmHg which was similar to the hemodynamic characteristics of mitral stenosis. Surgical resection was performed successfully. Cor triatriatum is a rare congenital cardiac malformation. In almost all cases, it is diagnosed in childhood, whereas adult cases including this patient are extremely rare. He had an uneventfulpostoperative course.
P27-2 Cardiac Hypertrophy in Neonates With Congenital Heart Disease Delays Maturational Alterations in Cardiac Energy Metabolism by Modifying Myocardial Acetylation Control Arata Fukushima1,2, Alda Huqi2, Liyan Zhang2, Victoria H. Lam2, Tariq Altamimi2, Shintaro Kinugawa1, Hiroyuki Tsutsui1, Ivan M. Rebeyka2, Paul F. Kantor2, Gary D. Lopaschuk2; 1Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan; 2Cardiovascular Translational Science Institute, University of Alberta, Canada Background: Maturational changes in cardiac energy metabolism are characterized by a rapid increase in fatty acid oxidation following birth. However, cardiac hypertrophy secondary to congenital heart diseases (CHDs) delays this normal maturation of fatty acid oxidation, leading to an increase in ischemic injury during surgical repair. Lysine acetylation is an important post-translational modification that enhances fatty acid oxidation. We investigated the effect of cardiac hypertrophy on the acetylation control of maturational changes in cardiac energy metabolism. Methods and Results: 145 right ventricular biopsy samples were collected from CHD patients and were stratified according to age (0–20, 21–100, and 101–200 days), as well as the absence (N = 83) or presence (N = 62) of hypertrophy. There was a maturational increase in overall myocardial protein acetylation following age only in non-hypertrophied hearts, accompanied by decreased SIRT3 and increased mitochondrial acetyltransferase GCN5L1. Acetylation in fatty acid oxidation enzymes, long chain acyl CoA dehydrogenase and β-hydroxyacyl CoA dehydrogenase, increased with age in non-hypertrophied hearts, along with increased LCAD activities, whereas acetylation of these enzymes declined in hypertrophied hearts. Acetylation of PGC-1α decreased with age only in
(see Table). By multivariate analysis, only new onset infection was the significant independent factor (Odds ratio: 16.5, 95%CI: 2.9–138.8, P = .001). Conclusion: New onset infection during hospital stay is the strong factor to hinder home discharge in super-elderly patients admitted with ADHF.
P26-3 A Case of Elderly Heart Failure Patient With Cardiac Cachexia; How Should We Improve Malnutrition? Akito Kuwano, Daisuke Nagatomo, Yurie Higashi, Norihiko Kotooka, Kouichi Node; The Department of Cardiovascular Medicine, Japan A 78 year-old-man who was received aortic valve replacement for aortic regurgitation 36 years ago had attended our hospital for management of heart failure (HF) with reduced ejection fraction. He had suffered from decompensation of HF many times and repeated hospitalization, and dietary intake, body weight, and activity gradually decreased, which indicate progression of cardiac cachexia. He also suffered from the chronic obstructive pulmonary disease, and showed marasmus type of malnutrition. Although the status of HF has compensated in the past few years, we asked him to hospitalize for control of malnutrition and cardiac rehabilitation. After 10-days of hospitalization, dietary intake improved with the slight increase of body weight. On the other hand, his cognitive function mildly impaired by the changes of environment due to hospitalization. On the next day of discharge, he was transported to our emergency unit for acute decompensation of heart failure. Cognitive decline progressed and he died in spite of the intensive treatment 2 weeks after readmission. Cardiac cachexia is frequently observed among progressively increasing HF patients in the aging society, and are the prognostic factors. However, the consensus has not been reached on how to improve cachexia. In the present case, nutrition intervention for cachexia was supposed to be an exacerbating factor of HF, which shows us many clinical implications for management of cardiac cachexia.
P26-4 Nutritional Characteristics of Patients With Worsening Heart Failure Over 75 Years of Age Yasuhiro Ikeda, Toru Ueda, Takahiro Shinohara, Takamasa Oda, Masashi Kanemoto, Fumiaki Nakao, Takashi Fujii; Department of Cardiology, Yamaguchi Grand Medical Center, Japan We investigated whether patients with heart failure over 75 years of age has different characteristics in their nutritional status than those under 75 years. From January 2013 to May 2015, 425 patients with acute or acute-on-chronic heart failure admitted to our prefectural critical care medical center were recruited (male/female = 235/190). All patients with nimble discharge (n = 304) were retrospectively analyzed; number of patients under 75/over 75 = 108/196. The body mass indexes of patients with heart failure over 75 and under 75 years were 22.8 ± 5 vs 21 ± 4, respectively. The percentage of LV systolic dysfunction in over 75 years of age was significantly smaller than those under 75 years (67% vs 42%, P < .01). HF patients over 75 years showed significantly higher frequency of delirium, dysphagia and accompanying pneumonia after admission. Serum albumin levels were similar on admission between these two groups, but that over 75 years of age was significantly decreased at discharge compared to those under 75 years. In conclusion, elderly patients with heart failure showed a higher frequency of malnutrition and frailty that was associated with eating disorder. These data suggest that nutritional management is essential in the elderly patients with heart failure.
P26-5 New Onset Infection Is the Risk Facor to Hinder Home Discharge in Super-Elderly Patients With Acute Decompensated Heart Failure Sakura Nagumo, Miki Tsujiuchi, Takuya Mizukami, Ayaka Nogi, Hideyuki Maezawa, Mio Ebato; Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan Background: The factors to hamper home discharge in super-elderly patients admitted with acute decompensated heart failure (ADHF) have not fully studied. Methods and Results: Forty-seven consecutive super-elderly (≥85 yo) patients admitted with ADHF from home were enrolled from prospective ADHF registry of Showa University Fujigaoka Hospital in 2015 (n = 270). Thirty-four patients (72%) went back to home and 13 patients moved to other hospitals/facilities after discharge. Duration of hospital stay, new onset infections in hospital, presence of dementia, LVEF and E/e,+ at admission were factors associated with discharge to transfer/facility other than home
P27-1 An Adult Case of Cor Triatriatum Causing Congestive Heart Failure Shunsuke Kimura, Katsuhito Seki, Mai Shinbo, Yuuta Sutou, Kenji Iino, Hiroyuki Watanabe, Hiroshi Itou; Department of Internal Medcine, Division of Cardiovascular and Respiratory Medcine, Akita University School of Medicine, Japan A 68-year-old man was admitted to our hospital for congestive heart failure. The patient had been healthy until 2 months prior, when dyspnea on exertion developed. On chest radiograph, a mild enlargement of the cardiac silhouette and bilateral pulmonary congestion were noticed. An ECG showed an atrial fibrillation. Transthoracic echocardiography showed preserved LV contractile function and normal valvular function, but revealed a membrane-like, echo-dense structure in left atrium (LA), which divided the LA into posterior-superior (accessory) and anterior-inferior (true) chambers. Color Doppler showed an open communication in the flow between both chambers, which was charaterized by a jet flow with 1.6 m/s of peak velocity. Transesophageal echocardiography and contrast CT confirmed the intraatrial septum and segmented LA chamber. Based on those findings, we made a diagnosis of cor triatriatum. On cardiac catheterization, the mean pressure gradient between pulmonary capillary and diastolic LV chamber was 12 mmHg which was similar to the hemodynamic characteristics of mitral stenosis. Surgical resection was performed successfully. Cor triatriatum is a rare congenital cardiac malformation. In almost all cases, it is diagnosed in childhood, whereas adult cases including this patient are extremely rare. He had an uneventfulpostoperative course.
P27-2 Cardiac Hypertrophy in Neonates With Congenital Heart Disease Delays Maturational Alterations in Cardiac Energy Metabolism by Modifying Myocardial Acetylation Control Arata Fukushima1,2, Alda Huqi2, Liyan Zhang2, Victoria H. Lam2, Tariq Altamimi2, Shintaro Kinugawa1, Hiroyuki Tsutsui1, Ivan M. Rebeyka2, Paul F. Kantor2, Gary D. Lopaschuk2; 1Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan; 2Cardiovascular Translational Science Institute, University of Alberta, Canada Background: Maturational changes in cardiac energy metabolism are characterized by a rapid increase in fatty acid oxidation following birth. However, cardiac hypertrophy secondary to congenital heart diseases (CHDs) delays this normal maturation of fatty acid oxidation, leading to an increase in ischemic injury during surgical repair. Lysine acetylation is an important post-translational modification that enhances fatty acid oxidation. We investigated the effect of cardiac hypertrophy on the acetylation control of maturational changes in cardiac energy metabolism. Methods and Results: 145 right ventricular biopsy samples were collected from CHD patients and were stratified according to age (0–20, 21–100, and 101–200 days), as well as the absence (N = 83) or presence (N = 62) of hypertrophy. There was a maturational increase in overall myocardial protein acetylation following age only in non-hypertrophied hearts, accompanied by decreased SIRT3 and increased mitochondrial acetyltransferase GCN5L1. Acetylation in fatty acid oxidation enzymes, long chain acyl CoA dehydrogenase and β-hydroxyacyl CoA dehydrogenase, increased with age in non-hypertrophied hearts, along with increased LCAD activities, whereas acetylation of these enzymes declined in hypertrophied hearts. Acetylation of PGC-1α decreased with age only in