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Outcome of Severe Ischemic Heart Failure Patients Treated With Amiodarone
S84 Journal of Cardiac Failure Vol. 23 No. 10S October 2017 P24-4 Cardiac Arrest Caused by Isolated Right Ventricular Takotsubo Cardiomyopathy Hirofumi Maeba, Takeshi Senoh, Yoshinobu Suwa, Yoko Miyasaka, Ichiro Shiojima; Department of Medicine II, Division of Cardiology, Kansai Medical University, Osaka, Japan A 72 year old male patient with diabetus, hypertension, and COPD was admitted to our hospital due to cardiac arrest. Electrocardiography revealed ST elevation wave in leads II, III, aVF, V1, V2, and V3, and echocardiography revealed right ventricular apical ballooning with hyperkinetic left ventricle. Emergent coronary angiography showed intact coronary. Echocardiography revealed completely normalized right ventricle a week later after admission. We diagnosed isolated right ventricular takotsubo cardiomyopathy induced by a physical stress of worsening COPD because the patient showed CO2 narcosis on admission. Isolated right ventricular takotsubo cardiomypathy is quite rare compared with left ventricular or biventricular takotsubo cardiomyopathy. Moreover, cardiac arrest caused by isolated right ventricular takotsubo cardiomyopathy has not been reported.
P24-5 A Case of Possible Isolated Cardiac Sarcoidosis Takayuki Suzuki, Kentaro Ohnishi, Masahiko Nakao, Takamori Matoba, Emiko Nakashima, Gou Ishimaru, Hiroyuki Okada, Hiroshi Inagaki, Nobuo Toshida, Toshihiko Takamoto; Cardiovascular Medicine, Soka Municipal Hospital, Saitama, Japan This case report illustrates challenging aspects of diagnosis of isolated cardiac sarcoidosis. Here, we present a 69-year-old female who had been diagnosed as dilated cardiomyopathy before was admitted to our hospital for congestive heart failure. Coronary angiography showed no significant abnormalities. Left ventriculography revealed left ventricular aneurysm. The endomyocardial biopsy specimens showed no significant findings. Cardiac MRI showed late enhancement at the lateral wall of the left ventricle, this finding suggested the presence of cardiac sarcoidosis. However, Ga citrate scintigraphy and examination of eyes showed no signs of extracardiac sarcoidosis and pulmonary sarcoidosis was excluded by chest CT. Therefore, she did not fulfill the diagnostic criteria for cardiac sarcoidosis. Since then her symptoms gradually worsened and she was readmitted to our hospital for recurrent heart failure in April 2017. During hospitalization, she developed monomorphic sustained ventricular tachycardia. Thus, she met the diagnostic criteria for possible isolated cardiac sarcoidosis. Steroid immunosuppressive therapy was started at this time. Catheter radiofrequency ablation was performed on the 21st hospital day and cardiac resynchronization therapy defibrillator was implanted at a later date. We report a case of possible isolated cardiac sarcoidosis presenting difficulty in diagnosis, mimicking idiopathic dilated cardiomyopathy.
age 65 ± 8 yrs) who underwent CAfor non-paroxysmalAF. Transthoracic echocardiography (TTE) was performed during sinus rhythm at the next day after CA. LA functions were calculated using the following formula: (1) Reservoir function = {[maximum LA volume (LAVmax) − minimum LA volume (LAVmin)]/LAVmin} × 100, (2) Booster function = {[Pre-Avolume (LAVpre-A) − LAVmin]/LAVpre-A} × 100, LAVpre-Awas defined as LA volume at the onset of the P-wave on electrocardiogram. (3) Conduit function = [(LAVmax − LAVpre-A)/LAVmax] × 100. Results: Recurrent AF was detected in 24/64 (38%) during the follow-up period (11.5 ± 7.0 month). Univariate analysis revealed lower reservoir function, decreased booster function, larger LA diameter, and elevated E wave as significant variables. On multivariate analysis, booster function was only independently associated with recurrent AF (P = .0279, OR 1.140 for each 1% decrease in LA booster function, 95%CI 1.024–1.301). Moreover, patients with decreased LA booster function (<10.6%) had a higher risk of recurrent AF (log-rank P = .0009). Conclusion: LA booster dysfunction immediately after the CA might predict a recurrence after CA for non-paroxysmal AF.
P25-2 A Case of Atrial Fibrillation With Severe Left Ventricular Dysfunction Treated With Catheter Ablation Shiori Eguchi, Kenji Koura, Toru Misawa, Emiko Nakashima, Kentarou Ohnishi, Gou Ishimaru, Hiroyuki Okada, Hiroshi Inagaki, Nobuo Toshida, Toshihiko Takamoto; Cardiovascular Medicine, Soka Municipal Hospital, Saitama, Japan A 61-year-old man who had a past medical history of hypertension and atrial fibrillation (AF) was referred to our hospital with orthopnea and edema in the lower extremities. Electrocardiography showed AF with a heart rate of 142 bpm. Chest radiography demonstrated cardiomegaly and bilateral pleural effusion. Transthoracic echocardiography revealed a severely reduced left ventricular (LV) systolic function (ejection fraction of 28%). He was diagnosed as acute heart failure and assessed as New York Heart Association functional class IV. Pharmacotherapy with intravenous administration of landiolol and diuretics was initiated. It was switched to oral administration of bisoprolol and diuretics after the pleural effusion diminished. The dose of bisoprolol was carefully increased over two weeks. Even after acute heart failure was compensated, his hemodynamics corresponded to Forrester subset IV. Coronary angiography was normal and the etiology of acute heart failure was considered to be hypertensive heart disease and tachycardia-induced cardiomyopathy caused by persistent AF with a rapid ventricular response from the pathological findings. Thereafter, we performed catheter ablation for the recurrent AF one month after electric shock conversion to a sinus rhythm. Some studies have reported that maintenance of a sinus rhythm benefits AF patients with severe LV dysfunction. Intensive therapy including catheter ablation might be needed for treatment of heart failure.
P25-3 P24-6 Reduced Right Ventricular Peak Circumferential Strain Measured by MRI Predicts Wild-Type Transthyretin Amyloidosis in Patients With Ventricular Hypertrophy Yasuhiro Izumiya, Toshifumi Ishida, Satoru Yamamura, Seiji Takashio, Kenichi Tsujita; Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan
Association Between Discharge Heart Rate and Composite Outcomes in Patients With Heart Failure and Atrial Fibrillation Athanasius Wrin Hudoyo, Hiroki Fukuda, Miki Imazu, Kazuhiro Shindo, Haiying Fu, Yuko Iwata, Shin Ito, Masafumi Kitakaze; Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
Background: Wild-type transthyretin amyloidosis (ATTRwt) is often overlooked in elderly patients with left ventricular hypertrophy (LVH). Cardiac magnetic resonance (CMR)-tagging is established technique to evaluate LV local intra-myocardial motion, however usefulness to assess RV function by CMR is unknown. We assessed the hypothesis that the peak RV strain by CMR can distinguish ATTRwt. Methods: We analyzed 11 ATTRwt and 7 non-ATTRwt consecutive patients. We excluded patients younger than 50 years old, less than left ventricular ejectionfraction (LVEF) 50%, without LVH, old myocardial infarction, and with other types ofcardiac amyloidosis. To evaluate circumferential strain (CS), CMR-tagging images were analyzed on a post-processing workstation. The peak CS (%) and peak CS time (msec) of each segment were recorded. Results: LVEF was significantly lower in ATTRwt than non-ATTRwt (59.1 ± 4.0 vs66.2 ± 5.0, P = .004). The average of RV peak CS was significantly lower in ATTRwt than non-ATTRwt (−8.46 ± 2.32 vs −11.7 ± 2.86, P = .017). Univariate logistic regression analysis identified LVEF (odds ratio [OR]: 0.67, 95% confidence interval [95%CI]: 0.47–0.97, P = .49) and average of RV peak CS (OR: 1.74, 95%CI: 1.00–3.02, P = .49) were correlated with ATTRwt. In receiver operating characteristic analysis, the area under the curve for average of RV peak CS in discrimination between ATTRwt and non-ATTRwt were 0.83 (P = .02). Conclusion: Reduced RV peak CS predicts the presence of ATTRwt in elderly patients with LVH.
Background: Recent reports show that heart rate is a prognostic factor in patients with heart failure (HF). However, there are few reports on the association between discharge heart rate (HR) and outcome in patients with HF and atrial fibrillation (Af). Method: We enrolled 202 patients with heart failure admitted to our hospital from 2005 to 2008. The patients were divided into sinus rhythm (SR) (n = 111) and Af groups (n = 91) with or without beta-blocker treatment. Furthermore, these groups were devided into tertiles according to HR (<60, 61–70, >71). The primary endpoint was a composite of all cause mortality and heart failure rehospitalization. Cox proportional hazard models were used to assess the relationship between discharge HR and primary endpoint. Result: The median follow-up was 1.9 years (IQR: 0.5 to 5.5 years) in patients with Af and 2.5 years (IQR: 0.7 to 6.3 years) in patients with SR. After adjustment, lowest tertiles was associated with increased risk of the events in Af patients with betablocker treatment (hazard ratio: 2.66, 95% confidence interval (CI): 1.03–6.9), compared to middle tertile in Af patient with beta-blocker. Whereas, we did not observe any association between beta-blocker use and risk of the events in SR patients. Conclusion: In patients with HF and Af receiving beta-blocker treatment, our data suggets that lower heart rate may associate with increased risk of cardiovascular event.
P25-1
Outcome of Severe Ischemic Heart Failure Patients Treated With Amiodarone Atsushi Suzuki, Tsuyoshi Shiga, Kotaro Arai, Nobuhisa Hagiwara; Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
Left Atrial Function: A Predictor of Poor Outcome After Catheter Ablation for Atrial Fibrillation Kumiko Masai, Akiko Goda, Miho Fukui, Yuko Soyama, Aika Daimon, Masanori Asakura, Tohru Masuyama; Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan Background: Left atrium (LA) have reservoir, booster and conduit function. We investigated which LA function play the most important role for atrial fibrillation (AF) recurrence after catheter ablation (CA). Methods: We studied 64 patients (39 males,
P26-1
Severe heart failure patients with reduced left ventricular ejection fraction (LVEF) still have poor outcomes. The outcome of amiodarone treatment for severe ischemic HF patients is still unknown. We studied 65 patients (67 ± 12 years old, 54 men) with severe HF (New York Heart Association [NYHA] functional class 3 or 4) due to ischemic heart disease treated by amiodarone. During 24 months of follow-up, 44 patients (81%) were died (Fig. 1). 89% of patients were treated with beta-blockers and/or angiotensinconverting-enzyme inhibitors or angiotensin-receptor blockers. After amiodarone
The 21st Annual Scientific Meeting treatment, NYHA functional class was significantly improved, and heart rate was significantly decreased than before (Table 1). However, LVEF was not improved. Alternative treatment for severe heart failure patients is needed.
•
JHFS
S85
mission and divided into 2 groups (febuxostat, n = 61; allopurinol, n = 90). After 12 months of follow-up, the cardiac event-free rate in the febuxostat group was significantly higher than that in the allopurinol group (55.7% vs 41.1%; P < .05). Although the baseline characteristics such as the level of brain natriuretic peptide (BNP) and the left ventricular ejection fraction were similar between the 2 groups prior to the introduction of the antihyperuricemics, the percent changes of serum creatinine and BNP levels improved significantly in the febuxostat group than in the allopurinol group. Conclusion: Our data suggest that febuxostat prevents worsening renal function and shows favorable effects in patients with severe HF.
P26-5 The Effectiveness of Continuous Intravenous Administration of Landiolol for Supraventricular Tachycardia Shunsuke Kiuchi, Shinji Hisatake, Ippei Watabnabe, Takayuki Kabuki, Takashi Oka, Shintaro Dobashi, Takahiro Fujii, Takanori Ikeda; Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan Background: Continuous intravenous administration of landiolol has been performed in supraventricular tachycardia (SVT) patients for heart rate (HR) control. SVT includes atrial fibrillation (af) and atrial flutter (AFL), though effectiveness of landiolol on these different arrhythmias are still unclear. Methods: We enrolled 98 consecutive patients with SVT who received landiolol from January 2012 to December 2016. Successful HR control was defined as >20% reduction in baseline HR or with HR < 110 bpm at 2 hours after starting landiolol. We divided the subjects into group A (af, n = 88) and F (AFL, n = 10). HR control level, conversion of normal sinus rhythm (NSR), merger rate of heart failure (HF), laboratory and echocardiographic findings were compared. These findings were also compared to HF patients. Results: The mean HR at baseline were 136.7 ± 21.4 bpm and 142.2 ± 19.7 bpm in group A and F, respectivilty. HR was successfully controlled in 69.3% and 20.0% in group A and F (P < .001). NSR was achieved in 19 patients of group A, and none in group F. Merger rate of HF were 83% and 60% respectively (P = .042). In laboratory and echocardiographic findings, only BNP in group A was significantly higher than group F (727.1 ± 504.5 pg/mL and 390.8 ± 279.4 pg/mL, P = .021). The results were similar in patients with HF. Conclusion: It is important to give thoughts to the type of arrhythmia when administrating landiolol for SVT. Fig. 1. Kaplan-Meier analysis for all-cause mortality after aniodarone treatment.
P27-1 Table 1. Changes Before and During Aniodarone Treatment
Efficacy of Tolvaptan for the Initial Hospitalized Patients With Acute Decompensated Heart Failure (ADHF) Yoriyasu Suzuki, Suguru Murase, Akira Murata, Yusuke Ochiumi, Satoshi Tsujimoto, Ai Kagase, Tatsuya Ito; Division of Cardiovascular Medicine, Nagoya Heart Center, Aichi, Japan Aim: The purpose of this study is to evaluate the efficacy of TLV for the initially hospitalized patients with ADHF. Methods: From 2011 to 2013, consecutive 124 patients initially hospitalized with a diagnosis of ADHF (clinical scenario 2/5) at Nagoya Heart Center. They were treated with or without TLV (TLV (−); n = 81, TLV (+); n = 43). We retrospectively analyzed the clinical outcome of these patients. Results: The results are shown in the Table 1 and Fig. 1. 39.5% of cases were re-hospitalized. In the rehospitalized cases, the incidence of WRF was significantly higher. Conclusion: the treatment with tolvaptan could shortened the duration of bed-rest and prevent WRF and re-hospitalization. The results of this study suggest tolvaptan initiated for acute treatment of patients initially hospitalized with ADHF had effect outcome in daily clinical practice.
P26-2 Comparative Effects of Febuxostat Vs Allopurinol for Severe Congestive Heart Failure Masanori Konishi1, Yasuhiro Maejima1, Yusuke Ito1, Takanobu Yamamoto1, Kenzo Hirao1, Mitsuaki Isobe1,2; 1Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan; 2Sakakibara Heart Institute, Okayama, Japan Background: Although both of febuxostat and allopurinol are effective medicine for the treatment of patients with hyperuricemia, only a few reports have compared for hyperuricemic patients with heart failure (HF). This study was designed to compare the effect of them in patients with severe HF. Methods and Results: A total of 479 consecutive patients with categorized as New York Heart Association class 3 or 4 were retrospectively investigated. Of these patients, 202 were hyperuricemic at admission [8.0 mg/dL < uric acid (UA)] and 151 were administered antihyperuricemics after ad-
P27-2 Factors Associated With Worsening Renal Function in Patients With Acute Decompensated Heart Failure Treated With Tolvaptan Hidetada Fukuoka, Tetsuya Watanabe, Yukinori Shinoda, Kuniyasu Ikeoka, Tomoko Minamisaka, Hirooki Inui, Keisuke Ueno, Soki Inoue, Kentaro Mine, Shiro Hoshida; Department of Cardiovascular Medicine, Yao Municipal Hospital, Osaka, Japan Background: Tolvaptan, a selective V2 receptor antagonist, can increase net volume loss in acute decompensated heart failure (ADHF) with compromised renal function.
P24-5 A Case of Possible Isolated Cardiac Sarcoidosis Takayuki Suzuki, Kentaro Ohnishi, Masahiko Nakao, Takamori Matoba, Emiko Nakashima, Gou Ishimaru, Hiroyuki Okada, Hiroshi Inagaki, Nobuo Toshida, Toshihiko Takamoto; Cardiovascular Medicine, Soka Municipal Hospital, Saitama, Japan This case report illustrates challenging aspects of diagnosis of isolated cardiac sarcoidosis. Here, we present a 69-year-old female who had been diagnosed as dilated cardiomyopathy before was admitted to our hospital for congestive heart failure. Coronary angiography showed no significant abnormalities. Left ventriculography revealed left ventricular aneurysm. The endomyocardial biopsy specimens showed no significant findings. Cardiac MRI showed late enhancement at the lateral wall of the left ventricle, this finding suggested the presence of cardiac sarcoidosis. However, Ga citrate scintigraphy and examination of eyes showed no signs of extracardiac sarcoidosis and pulmonary sarcoidosis was excluded by chest CT. Therefore, she did not fulfill the diagnostic criteria for cardiac sarcoidosis. Since then her symptoms gradually worsened and she was readmitted to our hospital for recurrent heart failure in April 2017. During hospitalization, she developed monomorphic sustained ventricular tachycardia. Thus, she met the diagnostic criteria for possible isolated cardiac sarcoidosis. Steroid immunosuppressive therapy was started at this time. Catheter radiofrequency ablation was performed on the 21st hospital day and cardiac resynchronization therapy defibrillator was implanted at a later date. We report a case of possible isolated cardiac sarcoidosis presenting difficulty in diagnosis, mimicking idiopathic dilated cardiomyopathy.
age 65 ± 8 yrs) who underwent CAfor non-paroxysmalAF. Transthoracic echocardiography (TTE) was performed during sinus rhythm at the next day after CA. LA functions were calculated using the following formula: (1) Reservoir function = {[maximum LA volume (LAVmax) − minimum LA volume (LAVmin)]/LAVmin} × 100, (2) Booster function = {[Pre-Avolume (LAVpre-A) − LAVmin]/LAVpre-A} × 100, LAVpre-Awas defined as LA volume at the onset of the P-wave on electrocardiogram. (3) Conduit function = [(LAVmax − LAVpre-A)/LAVmax] × 100. Results: Recurrent AF was detected in 24/64 (38%) during the follow-up period (11.5 ± 7.0 month). Univariate analysis revealed lower reservoir function, decreased booster function, larger LA diameter, and elevated E wave as significant variables. On multivariate analysis, booster function was only independently associated with recurrent AF (P = .0279, OR 1.140 for each 1% decrease in LA booster function, 95%CI 1.024–1.301). Moreover, patients with decreased LA booster function (<10.6%) had a higher risk of recurrent AF (log-rank P = .0009). Conclusion: LA booster dysfunction immediately after the CA might predict a recurrence after CA for non-paroxysmal AF.
P25-2 A Case of Atrial Fibrillation With Severe Left Ventricular Dysfunction Treated With Catheter Ablation Shiori Eguchi, Kenji Koura, Toru Misawa, Emiko Nakashima, Kentarou Ohnishi, Gou Ishimaru, Hiroyuki Okada, Hiroshi Inagaki, Nobuo Toshida, Toshihiko Takamoto; Cardiovascular Medicine, Soka Municipal Hospital, Saitama, Japan A 61-year-old man who had a past medical history of hypertension and atrial fibrillation (AF) was referred to our hospital with orthopnea and edema in the lower extremities. Electrocardiography showed AF with a heart rate of 142 bpm. Chest radiography demonstrated cardiomegaly and bilateral pleural effusion. Transthoracic echocardiography revealed a severely reduced left ventricular (LV) systolic function (ejection fraction of 28%). He was diagnosed as acute heart failure and assessed as New York Heart Association functional class IV. Pharmacotherapy with intravenous administration of landiolol and diuretics was initiated. It was switched to oral administration of bisoprolol and diuretics after the pleural effusion diminished. The dose of bisoprolol was carefully increased over two weeks. Even after acute heart failure was compensated, his hemodynamics corresponded to Forrester subset IV. Coronary angiography was normal and the etiology of acute heart failure was considered to be hypertensive heart disease and tachycardia-induced cardiomyopathy caused by persistent AF with a rapid ventricular response from the pathological findings. Thereafter, we performed catheter ablation for the recurrent AF one month after electric shock conversion to a sinus rhythm. Some studies have reported that maintenance of a sinus rhythm benefits AF patients with severe LV dysfunction. Intensive therapy including catheter ablation might be needed for treatment of heart failure.
P25-3 P24-6 Reduced Right Ventricular Peak Circumferential Strain Measured by MRI Predicts Wild-Type Transthyretin Amyloidosis in Patients With Ventricular Hypertrophy Yasuhiro Izumiya, Toshifumi Ishida, Satoru Yamamura, Seiji Takashio, Kenichi Tsujita; Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan
Association Between Discharge Heart Rate and Composite Outcomes in Patients With Heart Failure and Atrial Fibrillation Athanasius Wrin Hudoyo, Hiroki Fukuda, Miki Imazu, Kazuhiro Shindo, Haiying Fu, Yuko Iwata, Shin Ito, Masafumi Kitakaze; Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
Background: Wild-type transthyretin amyloidosis (ATTRwt) is often overlooked in elderly patients with left ventricular hypertrophy (LVH). Cardiac magnetic resonance (CMR)-tagging is established technique to evaluate LV local intra-myocardial motion, however usefulness to assess RV function by CMR is unknown. We assessed the hypothesis that the peak RV strain by CMR can distinguish ATTRwt. Methods: We analyzed 11 ATTRwt and 7 non-ATTRwt consecutive patients. We excluded patients younger than 50 years old, less than left ventricular ejectionfraction (LVEF) 50%, without LVH, old myocardial infarction, and with other types ofcardiac amyloidosis. To evaluate circumferential strain (CS), CMR-tagging images were analyzed on a post-processing workstation. The peak CS (%) and peak CS time (msec) of each segment were recorded. Results: LVEF was significantly lower in ATTRwt than non-ATTRwt (59.1 ± 4.0 vs66.2 ± 5.0, P = .004). The average of RV peak CS was significantly lower in ATTRwt than non-ATTRwt (−8.46 ± 2.32 vs −11.7 ± 2.86, P = .017). Univariate logistic regression analysis identified LVEF (odds ratio [OR]: 0.67, 95% confidence interval [95%CI]: 0.47–0.97, P = .49) and average of RV peak CS (OR: 1.74, 95%CI: 1.00–3.02, P = .49) were correlated with ATTRwt. In receiver operating characteristic analysis, the area under the curve for average of RV peak CS in discrimination between ATTRwt and non-ATTRwt were 0.83 (P = .02). Conclusion: Reduced RV peak CS predicts the presence of ATTRwt in elderly patients with LVH.
Background: Recent reports show that heart rate is a prognostic factor in patients with heart failure (HF). However, there are few reports on the association between discharge heart rate (HR) and outcome in patients with HF and atrial fibrillation (Af). Method: We enrolled 202 patients with heart failure admitted to our hospital from 2005 to 2008. The patients were divided into sinus rhythm (SR) (n = 111) and Af groups (n = 91) with or without beta-blocker treatment. Furthermore, these groups were devided into tertiles according to HR (<60, 61–70, >71). The primary endpoint was a composite of all cause mortality and heart failure rehospitalization. Cox proportional hazard models were used to assess the relationship between discharge HR and primary endpoint. Result: The median follow-up was 1.9 years (IQR: 0.5 to 5.5 years) in patients with Af and 2.5 years (IQR: 0.7 to 6.3 years) in patients with SR. After adjustment, lowest tertiles was associated with increased risk of the events in Af patients with betablocker treatment (hazard ratio: 2.66, 95% confidence interval (CI): 1.03–6.9), compared to middle tertile in Af patient with beta-blocker. Whereas, we did not observe any association between beta-blocker use and risk of the events in SR patients. Conclusion: In patients with HF and Af receiving beta-blocker treatment, our data suggets that lower heart rate may associate with increased risk of cardiovascular event.
P25-1
Outcome of Severe Ischemic Heart Failure Patients Treated With Amiodarone Atsushi Suzuki, Tsuyoshi Shiga, Kotaro Arai, Nobuhisa Hagiwara; Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
Left Atrial Function: A Predictor of Poor Outcome After Catheter Ablation for Atrial Fibrillation Kumiko Masai, Akiko Goda, Miho Fukui, Yuko Soyama, Aika Daimon, Masanori Asakura, Tohru Masuyama; Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan Background: Left atrium (LA) have reservoir, booster and conduit function. We investigated which LA function play the most important role for atrial fibrillation (AF) recurrence after catheter ablation (CA). Methods: We studied 64 patients (39 males,
P26-1
Severe heart failure patients with reduced left ventricular ejection fraction (LVEF) still have poor outcomes. The outcome of amiodarone treatment for severe ischemic HF patients is still unknown. We studied 65 patients (67 ± 12 years old, 54 men) with severe HF (New York Heart Association [NYHA] functional class 3 or 4) due to ischemic heart disease treated by amiodarone. During 24 months of follow-up, 44 patients (81%) were died (Fig. 1). 89% of patients were treated with beta-blockers and/or angiotensinconverting-enzyme inhibitors or angiotensin-receptor blockers. After amiodarone
The 21st Annual Scientific Meeting treatment, NYHA functional class was significantly improved, and heart rate was significantly decreased than before (Table 1). However, LVEF was not improved. Alternative treatment for severe heart failure patients is needed.
•
JHFS
S85
mission and divided into 2 groups (febuxostat, n = 61; allopurinol, n = 90). After 12 months of follow-up, the cardiac event-free rate in the febuxostat group was significantly higher than that in the allopurinol group (55.7% vs 41.1%; P < .05). Although the baseline characteristics such as the level of brain natriuretic peptide (BNP) and the left ventricular ejection fraction were similar between the 2 groups prior to the introduction of the antihyperuricemics, the percent changes of serum creatinine and BNP levels improved significantly in the febuxostat group than in the allopurinol group. Conclusion: Our data suggest that febuxostat prevents worsening renal function and shows favorable effects in patients with severe HF.
P26-5 The Effectiveness of Continuous Intravenous Administration of Landiolol for Supraventricular Tachycardia Shunsuke Kiuchi, Shinji Hisatake, Ippei Watabnabe, Takayuki Kabuki, Takashi Oka, Shintaro Dobashi, Takahiro Fujii, Takanori Ikeda; Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan Background: Continuous intravenous administration of landiolol has been performed in supraventricular tachycardia (SVT) patients for heart rate (HR) control. SVT includes atrial fibrillation (af) and atrial flutter (AFL), though effectiveness of landiolol on these different arrhythmias are still unclear. Methods: We enrolled 98 consecutive patients with SVT who received landiolol from January 2012 to December 2016. Successful HR control was defined as >20% reduction in baseline HR or with HR < 110 bpm at 2 hours after starting landiolol. We divided the subjects into group A (af, n = 88) and F (AFL, n = 10). HR control level, conversion of normal sinus rhythm (NSR), merger rate of heart failure (HF), laboratory and echocardiographic findings were compared. These findings were also compared to HF patients. Results: The mean HR at baseline were 136.7 ± 21.4 bpm and 142.2 ± 19.7 bpm in group A and F, respectivilty. HR was successfully controlled in 69.3% and 20.0% in group A and F (P < .001). NSR was achieved in 19 patients of group A, and none in group F. Merger rate of HF were 83% and 60% respectively (P = .042). In laboratory and echocardiographic findings, only BNP in group A was significantly higher than group F (727.1 ± 504.5 pg/mL and 390.8 ± 279.4 pg/mL, P = .021). The results were similar in patients with HF. Conclusion: It is important to give thoughts to the type of arrhythmia when administrating landiolol for SVT. Fig. 1. Kaplan-Meier analysis for all-cause mortality after aniodarone treatment.
P27-1 Table 1. Changes Before and During Aniodarone Treatment
Efficacy of Tolvaptan for the Initial Hospitalized Patients With Acute Decompensated Heart Failure (ADHF) Yoriyasu Suzuki, Suguru Murase, Akira Murata, Yusuke Ochiumi, Satoshi Tsujimoto, Ai Kagase, Tatsuya Ito; Division of Cardiovascular Medicine, Nagoya Heart Center, Aichi, Japan Aim: The purpose of this study is to evaluate the efficacy of TLV for the initially hospitalized patients with ADHF. Methods: From 2011 to 2013, consecutive 124 patients initially hospitalized with a diagnosis of ADHF (clinical scenario 2/5) at Nagoya Heart Center. They were treated with or without TLV (TLV (−); n = 81, TLV (+); n = 43). We retrospectively analyzed the clinical outcome of these patients. Results: The results are shown in the Table 1 and Fig. 1. 39.5% of cases were re-hospitalized. In the rehospitalized cases, the incidence of WRF was significantly higher. Conclusion: the treatment with tolvaptan could shortened the duration of bed-rest and prevent WRF and re-hospitalization. The results of this study suggest tolvaptan initiated for acute treatment of patients initially hospitalized with ADHF had effect outcome in daily clinical practice.
P26-2 Comparative Effects of Febuxostat Vs Allopurinol for Severe Congestive Heart Failure Masanori Konishi1, Yasuhiro Maejima1, Yusuke Ito1, Takanobu Yamamoto1, Kenzo Hirao1, Mitsuaki Isobe1,2; 1Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan; 2Sakakibara Heart Institute, Okayama, Japan Background: Although both of febuxostat and allopurinol are effective medicine for the treatment of patients with hyperuricemia, only a few reports have compared for hyperuricemic patients with heart failure (HF). This study was designed to compare the effect of them in patients with severe HF. Methods and Results: A total of 479 consecutive patients with categorized as New York Heart Association class 3 or 4 were retrospectively investigated. Of these patients, 202 were hyperuricemic at admission [8.0 mg/dL < uric acid (UA)] and 151 were administered antihyperuricemics after ad-
P27-2 Factors Associated With Worsening Renal Function in Patients With Acute Decompensated Heart Failure Treated With Tolvaptan Hidetada Fukuoka, Tetsuya Watanabe, Yukinori Shinoda, Kuniyasu Ikeoka, Tomoko Minamisaka, Hirooki Inui, Keisuke Ueno, Soki Inoue, Kentaro Mine, Shiro Hoshida; Department of Cardiovascular Medicine, Yao Municipal Hospital, Osaka, Japan Background: Tolvaptan, a selective V2 receptor antagonist, can increase net volume loss in acute decompensated heart failure (ADHF) with compromised renal function.