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P-43 Outcome of Acute Decompensated Heart Failure and Acute Kidney Injury (Rifle Criteria)
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Abstracts of the 17th Asian Pacific Congress of Cardiology
years. The prevalence of elderly patients, diabetes mellitus, hypertension and ischemic cardiomyopathy were high. The 3-year mortality rate was 47.2%. The 3-year death or readmission for any cause rate was 88.2%. Risk factors for 3-year mortality included age 65 years and index admission AMI (41.8% v 25.5%, p = 0.05, and 55.6% v 27.1%, p = 0.001 respectively). DHF conferred lower 3-year mortality risk (22% v 40.8%, p = 0.05). Deceased patients at 3 years had higher mean age, serum creatinine, and random blood sugar level, and lower mean LVEF. Conclusions: With strict methodology, HF is truly a disease of the elderly, with significant 3-year mortality and morbidity outcomes. Prognostic features are reviewed. P-41 Serum Cortisol as a Cardiac Event Predictor of Patients with Chronic Heart Failure Comparison with Aldosterone and ACTH Masayuki Yamaji, Takayoshi Tsutamoto, Chiho Kawahara, Keizo Nishiyama, Takashi Yamamoto, Masanori Fujii, Minoru Horie. Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan Background: In patients with chronic heart failure (CHF), high plasma aldosterone (ALD) levels are associated with poor prognosis and mineralocorticoid receptor blockade improves survival in these patients. The cardiac event (CE) prediction value of cortisol that may also bind and activate the mineralocorticoid receptor remains unclear. Methods: We measured the plasma levels of biomarkers such as brain natriuretic peptide (BNP), ALD, adrenocorticotropic hormone (ACTH) and serum cortisol in 311 consecutive symptomatic CHF patients and then we prospectively followed up for a mean period of 33 months. Results: During a mean follow-up period of 33 months, 21 patients had CE (death or hospitalization). Plasma levels of BNP, ALD, ACTH and serum cortisol (18.9±2.2 vs. 12.4±0.3 mg/dL, p = 0.001) were significantly higher in patients with CE than without CE. High levels of BNP, ALD, ACTH and cortisol were significant predictors of CE in univariate analyses and on stepwise multivariable analyses, high levels of BNP (p = 0.006), and cortisol (p = 0.03) were independent predictors of CE, but not ALD and ACTH levels. Compared with patients with low levels of both BNP and cortisol, patients with high levels of both variables had a 24.1-fold higher CE risk (p = 0.002). Conclusions: These findings indicate that serum cortisol levels were complementary and incremental CE risk predictor in the combination with BNP in patients with CHF. P-42 Arterial Baroreflex Control of Single-Unit Muscle Sympathetic Nerve Activity in Chronic Heart Failure with Atrial Fibrillation Tatsunori Ikeda, Masayuki Takamura, Hisayoshi Murai, Jyunichirou Inomata, Daisuke Kobayashi, Keisuke Ohtani, Shinichirou Takashima, Takeshi Katou, Hiroshi Furushou, Masaki Okajima, Shuichi Kaneko. Department of Disease Control and Homeostasis, Kanazawa University, Japan Prognosis of rate-control therapy in congestive heart failure (CHF) with atrial fibrillation has been shown to be similar to that of rhythm-control therapy. Blood pressure changes induced by AF demonstrated major determinations of sympathetic nerve activity via arterial baroreflex. We hypothesized irregular R-R interval accompanying AF might not activate sympathetic nerve activity in CHF. In this study, we measured single-unit and multiunit muscle sympathetic activity (MSNA) in 6 CHF with AF patients (ACHF)
compared to, 10 CHF patients. Mean arterial pressure and heart rate were not differing between groups. Multiunit MSNA in CHF was significantly greater than ACHF. However, single-unit MSNA in ACHF was significantly greater than that in CHF (61.6±12.3 vs 54.6±14.5, p < 0.01, respectively). Incidences of multiple firing of single-unit MSNA within one cardiac interval in ACHF augmented compred to CHF (p < 0.05). Furthermore, significant positive relationship was shown between single-unit MSNA and diastolic pressure in ACHF, not in CHF. The firing characteristics of sympathetic activation were different between CHF with and without AF. Arterial baroreflex control of single-unit MSNA would preserve in ACHF. These results indicate that therapy for AF in CHF would be need to prevent sympathetic augmentation. P-43 Outcome of Acute Decompensated Heart Failure and Acute Kidney Injury (Rifle Criteria) Noritake Hata, Shinya Yokoyama, Takuro Shinada, Nobuaki Kobayashi, Kazunori Tomita, Yasuhiro Takahashi, Koichi Akutsu, Akihiro Shirakabe. Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Japan Clinical course including outcomes of acute decompensated heart failure (ADHF) is correlated with renal dysfunction, but the evaluation of renal function has not been standardized. RIFLE criteria for acute kidney injury (AKI) was reported as a useful method for evaluating renal function in critically ill patients. The aim of this study was to investigate the relationship between prognosis of ADHF and AKI by using RIFLE criteria. Methods: Subjects were 376 patients with ADHF admitted to ICU from April 2000 to June 2008. Mean age was 71.6 years old and 238 were males. Basic cardiovascular diseases were ischemic heart disease in 124, hypertensive heart disease in 70, cardiomyopathy in 60, valvular diseases in 107, and others in 15. AKI was defined by using RIFLE criteria, and the severest RIFLE classifications in hospitalization were adopted. Patients who readmitted during research period or received hemodyalysis before admission were excluded from this study. Results: In-hospital mortality was significantly higher in AKI patients (29 of 271; 10.7%) than in non-AKI patients (1 of 105; 1.0%, p < 0.001), and both ICU stay and hospital stay were longer in AKI patients (8.9±15.5 days and 49.1±47.8 days) than non-AKI (5.0±2.7 days and 25.5±16.6 days, p < 0.05 and p < 0.001). Conclusion: AKI based on RIFLE criteria was well related with prognosis of ADHF. P-44 Comparison and Contrast of Findings Among Acute Decompensated Heart Failure Syndromes Registries Preliminary Data from ATTEND Registry Naoki Sato1 , Katsuya Kajimoto2 , Michitaka Nagashima3 , Kuniya Asai4 , Masaaki Mizuno3 , Yuichiro Minami3 , Koji Murai1 , Ryo Munakata1 , Kyoichi Mizuno4 , Keiji Tanaka1 , Nobuhisa Hagiwara3 , Hiroshi Kasanuki3 , Teruo Takano4 . 1 Intensive and Cardiac Care Unit, Nippon Medical School, Japan, 2 Department of Cardiology, Shonan Dai-ichi Hospital, Japan, 3 Department of Cardiology, Tokyo Women’s Medical University, Japan, 4 Department of Internal Medicine, Divisions of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Nippon Medical School, Japan Background: With the world’s aging populations, the prevalence of acute heart failure syndromes (AHFS) is likely
Abstracts of the 17th Asian Pacific Congress of Cardiology
years. The prevalence of elderly patients, diabetes mellitus, hypertension and ischemic cardiomyopathy were high. The 3-year mortality rate was 47.2%. The 3-year death or readmission for any cause rate was 88.2%. Risk factors for 3-year mortality included age 65 years and index admission AMI (41.8% v 25.5%, p = 0.05, and 55.6% v 27.1%, p = 0.001 respectively). DHF conferred lower 3-year mortality risk (22% v 40.8%, p = 0.05). Deceased patients at 3 years had higher mean age, serum creatinine, and random blood sugar level, and lower mean LVEF. Conclusions: With strict methodology, HF is truly a disease of the elderly, with significant 3-year mortality and morbidity outcomes. Prognostic features are reviewed. P-41 Serum Cortisol as a Cardiac Event Predictor of Patients with Chronic Heart Failure Comparison with Aldosterone and ACTH Masayuki Yamaji, Takayoshi Tsutamoto, Chiho Kawahara, Keizo Nishiyama, Takashi Yamamoto, Masanori Fujii, Minoru Horie. Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan Background: In patients with chronic heart failure (CHF), high plasma aldosterone (ALD) levels are associated with poor prognosis and mineralocorticoid receptor blockade improves survival in these patients. The cardiac event (CE) prediction value of cortisol that may also bind and activate the mineralocorticoid receptor remains unclear. Methods: We measured the plasma levels of biomarkers such as brain natriuretic peptide (BNP), ALD, adrenocorticotropic hormone (ACTH) and serum cortisol in 311 consecutive symptomatic CHF patients and then we prospectively followed up for a mean period of 33 months. Results: During a mean follow-up period of 33 months, 21 patients had CE (death or hospitalization). Plasma levels of BNP, ALD, ACTH and serum cortisol (18.9±2.2 vs. 12.4±0.3 mg/dL, p = 0.001) were significantly higher in patients with CE than without CE. High levels of BNP, ALD, ACTH and cortisol were significant predictors of CE in univariate analyses and on stepwise multivariable analyses, high levels of BNP (p = 0.006), and cortisol (p = 0.03) were independent predictors of CE, but not ALD and ACTH levels. Compared with patients with low levels of both BNP and cortisol, patients with high levels of both variables had a 24.1-fold higher CE risk (p = 0.002). Conclusions: These findings indicate that serum cortisol levels were complementary and incremental CE risk predictor in the combination with BNP in patients with CHF. P-42 Arterial Baroreflex Control of Single-Unit Muscle Sympathetic Nerve Activity in Chronic Heart Failure with Atrial Fibrillation Tatsunori Ikeda, Masayuki Takamura, Hisayoshi Murai, Jyunichirou Inomata, Daisuke Kobayashi, Keisuke Ohtani, Shinichirou Takashima, Takeshi Katou, Hiroshi Furushou, Masaki Okajima, Shuichi Kaneko. Department of Disease Control and Homeostasis, Kanazawa University, Japan Prognosis of rate-control therapy in congestive heart failure (CHF) with atrial fibrillation has been shown to be similar to that of rhythm-control therapy. Blood pressure changes induced by AF demonstrated major determinations of sympathetic nerve activity via arterial baroreflex. We hypothesized irregular R-R interval accompanying AF might not activate sympathetic nerve activity in CHF. In this study, we measured single-unit and multiunit muscle sympathetic activity (MSNA) in 6 CHF with AF patients (ACHF)
compared to, 10 CHF patients. Mean arterial pressure and heart rate were not differing between groups. Multiunit MSNA in CHF was significantly greater than ACHF. However, single-unit MSNA in ACHF was significantly greater than that in CHF (61.6±12.3 vs 54.6±14.5, p < 0.01, respectively). Incidences of multiple firing of single-unit MSNA within one cardiac interval in ACHF augmented compred to CHF (p < 0.05). Furthermore, significant positive relationship was shown between single-unit MSNA and diastolic pressure in ACHF, not in CHF. The firing characteristics of sympathetic activation were different between CHF with and without AF. Arterial baroreflex control of single-unit MSNA would preserve in ACHF. These results indicate that therapy for AF in CHF would be need to prevent sympathetic augmentation. P-43 Outcome of Acute Decompensated Heart Failure and Acute Kidney Injury (Rifle Criteria) Noritake Hata, Shinya Yokoyama, Takuro Shinada, Nobuaki Kobayashi, Kazunori Tomita, Yasuhiro Takahashi, Koichi Akutsu, Akihiro Shirakabe. Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Japan Clinical course including outcomes of acute decompensated heart failure (ADHF) is correlated with renal dysfunction, but the evaluation of renal function has not been standardized. RIFLE criteria for acute kidney injury (AKI) was reported as a useful method for evaluating renal function in critically ill patients. The aim of this study was to investigate the relationship between prognosis of ADHF and AKI by using RIFLE criteria. Methods: Subjects were 376 patients with ADHF admitted to ICU from April 2000 to June 2008. Mean age was 71.6 years old and 238 were males. Basic cardiovascular diseases were ischemic heart disease in 124, hypertensive heart disease in 70, cardiomyopathy in 60, valvular diseases in 107, and others in 15. AKI was defined by using RIFLE criteria, and the severest RIFLE classifications in hospitalization were adopted. Patients who readmitted during research period or received hemodyalysis before admission were excluded from this study. Results: In-hospital mortality was significantly higher in AKI patients (29 of 271; 10.7%) than in non-AKI patients (1 of 105; 1.0%, p < 0.001), and both ICU stay and hospital stay were longer in AKI patients (8.9±15.5 days and 49.1±47.8 days) than non-AKI (5.0±2.7 days and 25.5±16.6 days, p < 0.05 and p < 0.001). Conclusion: AKI based on RIFLE criteria was well related with prognosis of ADHF. P-44 Comparison and Contrast of Findings Among Acute Decompensated Heart Failure Syndromes Registries Preliminary Data from ATTEND Registry Naoki Sato1 , Katsuya Kajimoto2 , Michitaka Nagashima3 , Kuniya Asai4 , Masaaki Mizuno3 , Yuichiro Minami3 , Koji Murai1 , Ryo Munakata1 , Kyoichi Mizuno4 , Keiji Tanaka1 , Nobuhisa Hagiwara3 , Hiroshi Kasanuki3 , Teruo Takano4 . 1 Intensive and Cardiac Care Unit, Nippon Medical School, Japan, 2 Department of Cardiology, Shonan Dai-ichi Hospital, Japan, 3 Department of Cardiology, Tokyo Women’s Medical University, Japan, 4 Department of Internal Medicine, Divisions of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Nippon Medical School, Japan Background: With the world’s aging populations, the prevalence of acute heart failure syndromes (AHFS) is likely