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Prognostic Factor of In-hospital Death in Very Elderly Patients with Acute Decompensated Heart Failure
The 18th Annual Scientific Meeting
O-093 Relationship between Muscle Volume and Serum Myostatin Level in Patients with Heart Failure TSUYOSHI SUZUKI, TSUYOSHI SHIGA, NOBUHISA HAGIWARA Tokyo Womens Medical University, Tokyo, Japan Backgrounds: Muscle wasting is a problem in cardiac heart failure, also in other chronic disease Imbalance of anabolic and catabolic state is important in these patients, myokines or myostatin are known as cofounder in muscle metabolism. Aim To investigate the relationship serum myostatin level and muscle volume in patients cardiac heart failure. Methods: We prospectively examined pilot 11patients (female 4) who admitted to our hospital. To evaluate muscle volume, we examined DEXA method. Serum blood was collected from antecubital vein, serum sample was analyzed using myostatin ELISA kit. Results: There was no relationship between serum myostatin level and muscle volume by DEXA method. Conclusions: Serum myostatin known as growth and differentiation factor in skeletal muscle. The reason that no relationship between serum myostatin and mass volume is no cachexia patients in our study.
O-094 Less Body Fat and Skeletal Muscle Mass Correlate with the Severity of Acute Decompensated Heart Failure EIICHI AKIYAMA, MASAAKI KONISHI, NORIAKI IWAHASHI, TOSHIAKI EBINA, KAZUO KIMURA Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan Background: Recent studies demonstrated that both less body fat (BF) and skeletal muscle mass could predict the future events in chronic heart failure (HF) patients. We investigated body composition in patients with acute decompensated HF (ADHF). Methods: We assessed BF and appendicular skeletal muscle mass by dual energy X-ray absorptiometry in 60 patients with ADHF (age 71610, 67% male, left ventricular ejection fraction 38616%, B-type natriuretic peptide (BNP) levels on admission 597 [294-1271] pg/ml). Patients were divided into low- or high-BF group by the cut-off value of 18% in male and 28% in female (median). Sarcopenia was defined as the appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height2) 2 standard deviations below the mean of young healthy Japanese subjects (!6.87 kg/m2 in male, !5.46 kg/m2 in female). Results: Both BF and ASMI significantly correlated with BNP levels. ADHF patients with low-BF had higher NYHA-class and higher BNP levels than those with high-BF. ADHF patients with sarcopenia (n531) had higher NYHA-class, higher BNP levels and higher rate of clinical scenario 2-3 (45% versus 17%, p50.02) than those without sarcopenia. Stepwise multivariate logistic regression analysis demonstrated that low-BF (odds ratio: 9.3, 95%-confidence interval: 2.4-36.0, P50.001) independently correlated with higher BNP levels (above median) in ADHF patients. Conclusions: Less body fat and skeletal muscle mass correlated with the severity of ADHF.
O-095 The Impact of Early Cardiac Rehabilitation by using Classification of the Status on Admission for Patients with Congestive Heart Failure YASUSHI TANAKA, DAISUKE MATSUMOTO, NAO OHIRA, MAKIKO OGIKU, MAKITO OZAWA, TOSHIYA KATAOKA, NAOTO YONEDA, HIROSHI TAKAISHI Cardivascular Internal Medicine, Ydogawa Christian Hospital, Osaka, Japan
JHFS
S161
MAEKAWA1, MOTOAKI SANO1, TSUTOMU YOSHIKAWA2, KEIICHI FUKUDA1 1 Keio University School of Medicine, Division of Cardiology, Tokyo, Japan, 2 Sakakibara Heart Institute, Tokyo, Japan Background: Heart failure is the leading cause of hospitalization among the elderly. Here, we investigated the clinical characteristics and prognosis between octogenarians and younger patients hospitalized for acute decompensated heart failure (ADHF). Methods and Results: We analyzed the data of 504 consecutive ADHF patients admitted to Keio university hospital (mean age 656 15 years). Octogenarians represented 27% of total enrolls, and has a higher rate of ischemic heart disease as etiology of heart failure (p!0.05). Female gender, atrial fibrillation, anemia, and HFpEF were more common in the elderly (all p!0.05). Risk factors such as dyslipidemia and smoking were more frequent in younger group (all p!0.05). Blood pressure and BNP level on admission was higher in octogenarians (all p!0.05). Mortality rate during hospital stay was significantly higher in octogenarians (p!0.05). Serum troponin T level at discharge was higher in octogenarians. In patients with a LVEF!40%, the use of ACE-inhibitor, beta-blocker, and spironolactone at discharge was lower in octogenarians (all p!0.05). We also evaluated long-term prognosis, and the rate of all cause death or rehopitalization for heart failure was higher in octogenarians than younger patients (p!0.0001). Conclusions: Octogenarians had a worse short- and long-term prognosis than younger patients in ADHF. Our data suggested that the current management of very elderly patients with HF remains suboptimal.
O-097 In-hospital Clinical Outcomes of the Oldest-old Patients Over 90 Years Old with Acute Heart Failure TETSUO YAMAGUCHI1, NORIKO WATANABE3, TAKAMICHI MIYAMOTO1, TORU OBAYASHI1, MITSUAKI ISOBE2 1 Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan, 2 Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan, 3 Department of Nursing, Musashino Red Cross Hospital, Tokyo, Japan Methods: A total of 720 consecutive patients with acute heart failure (AHF) admitted to our intensive care unit between January 2009 and June 2013 were enrolled. The in-hospital mortality was compared between the oldest-old group (group-A: O90 years old, 84 patients, 11.7%, 93.5 6 3.5 years) and the younger group (group-B: 70.3 6 12.4 years). Results: There were no differences about the rate of intravascular diuretics use (97.6 vs 99.1 %, P 5 0.24) and mechanical ventilation (44.0 vs 42.5 %, P 5 0.78) between group A and B. The overall in-hospital mortality was significantly higher in the group A than B (17.9 vs 7.9 %, P 5 0.007). However, when compared by systolic blood pressure (SBP) on admission (High; SBP O 140 mmHg, Middle; SBP 5 100-140 mmHg, Low; SBP ! 100 mmHg), the in-hospital mortality was similar between group A and B (High; 5.0 vs. 3.2%, P 5 0.37, Middle; 11.8 vs. 14.4 %, P 5 0.29, Low; 40.7 vs. 23.8 %, P 5 0.22). The proportion of low SBP on admission was significantly higher in the group-A (32.1 vs. 6.6 %, P ! 0.001). Conclusions: In oldest-old patients with AHF, the in-hospital mortality was not inferior to the younger patients when compared by the same SBP on admission. A high rate of lower SBP on admission worsened the overall prognosis.
O-098 Background: Cardiac rehabilitation is an important adjunct to medical therapy in patients with congestive heart failure (CHF). However, there is no indicator to progress cardiac rehabilitation in patients with CHF. The purpose of this study is to evaluate the impact of early cardiac rehabilitation by using classification of the status of the patients with CHF on admission. Methods: 80 patients of intervention cardiac rehabilitation group (I group) and 69 patients of control cardiac rehabilitation group (C group) were enrolled. Patients in I group were scored by respiratory status (0:Oxygen !3L/min, 1: Oxygen O3L/min, 2: treatment with NPPV or Endotracheal intubation), Activity of Daily Living (0: Independence, 1:outside activity with support, 2:limited activity only inside), and BNP (0:!500pg/ml, 1:500-1999pg/ml, 2:O2000pg/ml), and were classified into four groups by total score (mild:0, moderate:1-3, severe:4-5, most severe:6). Then according to this score, cardiac rehabilitation was started immediately. We compared the duration in hospitalization between two groups, and evaluated the safety. Results: There were no significant differences between two groups on admission. Duration in hospitalization in I group could be shorter (I group; 21.0610.9 days vs C group; 25.9612.3 days, p!0.05). Conclusion: Cardiac rehabilitation by using this classification could be performed without serious accident. We considered that early mobilization prevent the Activity of Daily Living from lowering and lead to early discharge.
O-096 Clinical Features and Outcome in Octogenarians Hospitalized for Acute Heart Failure KEITARO AKITA1, TAKASHI KOHNO1, SHUN KOHSAKA1, YASUYUKI SHIRAISHI1, MITSUAKI SAWANO1, TAKU INOHARA1, YUICHIRO
Prognostic Factor of In-hospital Death in Very Elderly Patients with Acute Decompensated Heart Failure SHIN KAWASOE1, TAKURO KUBOZONO1, HIROYUKI TORII2, TSUYOSHI YAMAGUCHI2, MASAAKI MIYATA1, MITSURU OHISHI1 1 Cardiovascular Medicine and Hypertension, Kagoshima University, Kagoshima, Japan, 2Kagoshima Medical Association Hospital, Kagoshima, Japan Purpose: To investigate the prognostic factor of in-hospital death in very elderly patients with acute decompensated heart failure (ADHF). Methods: The consecutive 157 ADHF patients over 80 years old, who admitted at Kagoshima Medical Association Hospital, were divided into the in-hospital death group (N525) and the discharge group (N5132). The vital signs and blood samples were obtained, echocardiography was performed at hospitalization, and the prognostic factor of in-hospital death was evaluated. Results: The mean age was 86.364.4 years old (69 men). The mean systolic blood pressure, pulse rate, left ventricular ejection fraction and B-type natriuretic peptide (BNP) were 133.5629.1mmHg, 85.7630.0 beats/min, 54.1616.0% and 7876743 pg/ml, respectively. Compared to discharge group, inhospital death group had higher BNP level (113361253 vs 7276603 pg/ml, p50.023), higher white blood cell count (868063115 vs 719063231/mL, p50.036), lower concentration of hemoglobin (10.162.3 vs 11.262.0 g/dL, p50.014), higher serum creatinine level (1.6060.92 vs 1.1760.49 mg/dL, p50.001) and lower serum albumin level (3.0960.60 vs 3.4960.45 g/dL, p50.002). The logistic regression analysis revealed only serum creatinine level could identify in-hospital death (p50.021). Conclusion: The serum creatinine level was the significant prognostic factor of in-hospital death in very elderly patients with ADHF.
O-093 Relationship between Muscle Volume and Serum Myostatin Level in Patients with Heart Failure TSUYOSHI SUZUKI, TSUYOSHI SHIGA, NOBUHISA HAGIWARA Tokyo Womens Medical University, Tokyo, Japan Backgrounds: Muscle wasting is a problem in cardiac heart failure, also in other chronic disease Imbalance of anabolic and catabolic state is important in these patients, myokines or myostatin are known as cofounder in muscle metabolism. Aim To investigate the relationship serum myostatin level and muscle volume in patients cardiac heart failure. Methods: We prospectively examined pilot 11patients (female 4) who admitted to our hospital. To evaluate muscle volume, we examined DEXA method. Serum blood was collected from antecubital vein, serum sample was analyzed using myostatin ELISA kit. Results: There was no relationship between serum myostatin level and muscle volume by DEXA method. Conclusions: Serum myostatin known as growth and differentiation factor in skeletal muscle. The reason that no relationship between serum myostatin and mass volume is no cachexia patients in our study.
O-094 Less Body Fat and Skeletal Muscle Mass Correlate with the Severity of Acute Decompensated Heart Failure EIICHI AKIYAMA, MASAAKI KONISHI, NORIAKI IWAHASHI, TOSHIAKI EBINA, KAZUO KIMURA Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan Background: Recent studies demonstrated that both less body fat (BF) and skeletal muscle mass could predict the future events in chronic heart failure (HF) patients. We investigated body composition in patients with acute decompensated HF (ADHF). Methods: We assessed BF and appendicular skeletal muscle mass by dual energy X-ray absorptiometry in 60 patients with ADHF (age 71610, 67% male, left ventricular ejection fraction 38616%, B-type natriuretic peptide (BNP) levels on admission 597 [294-1271] pg/ml). Patients were divided into low- or high-BF group by the cut-off value of 18% in male and 28% in female (median). Sarcopenia was defined as the appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height2) 2 standard deviations below the mean of young healthy Japanese subjects (!6.87 kg/m2 in male, !5.46 kg/m2 in female). Results: Both BF and ASMI significantly correlated with BNP levels. ADHF patients with low-BF had higher NYHA-class and higher BNP levels than those with high-BF. ADHF patients with sarcopenia (n531) had higher NYHA-class, higher BNP levels and higher rate of clinical scenario 2-3 (45% versus 17%, p50.02) than those without sarcopenia. Stepwise multivariate logistic regression analysis demonstrated that low-BF (odds ratio: 9.3, 95%-confidence interval: 2.4-36.0, P50.001) independently correlated with higher BNP levels (above median) in ADHF patients. Conclusions: Less body fat and skeletal muscle mass correlated with the severity of ADHF.
O-095 The Impact of Early Cardiac Rehabilitation by using Classification of the Status on Admission for Patients with Congestive Heart Failure YASUSHI TANAKA, DAISUKE MATSUMOTO, NAO OHIRA, MAKIKO OGIKU, MAKITO OZAWA, TOSHIYA KATAOKA, NAOTO YONEDA, HIROSHI TAKAISHI Cardivascular Internal Medicine, Ydogawa Christian Hospital, Osaka, Japan
JHFS
S161
MAEKAWA1, MOTOAKI SANO1, TSUTOMU YOSHIKAWA2, KEIICHI FUKUDA1 1 Keio University School of Medicine, Division of Cardiology, Tokyo, Japan, 2 Sakakibara Heart Institute, Tokyo, Japan Background: Heart failure is the leading cause of hospitalization among the elderly. Here, we investigated the clinical characteristics and prognosis between octogenarians and younger patients hospitalized for acute decompensated heart failure (ADHF). Methods and Results: We analyzed the data of 504 consecutive ADHF patients admitted to Keio university hospital (mean age 656 15 years). Octogenarians represented 27% of total enrolls, and has a higher rate of ischemic heart disease as etiology of heart failure (p!0.05). Female gender, atrial fibrillation, anemia, and HFpEF were more common in the elderly (all p!0.05). Risk factors such as dyslipidemia and smoking were more frequent in younger group (all p!0.05). Blood pressure and BNP level on admission was higher in octogenarians (all p!0.05). Mortality rate during hospital stay was significantly higher in octogenarians (p!0.05). Serum troponin T level at discharge was higher in octogenarians. In patients with a LVEF!40%, the use of ACE-inhibitor, beta-blocker, and spironolactone at discharge was lower in octogenarians (all p!0.05). We also evaluated long-term prognosis, and the rate of all cause death or rehopitalization for heart failure was higher in octogenarians than younger patients (p!0.0001). Conclusions: Octogenarians had a worse short- and long-term prognosis than younger patients in ADHF. Our data suggested that the current management of very elderly patients with HF remains suboptimal.
O-097 In-hospital Clinical Outcomes of the Oldest-old Patients Over 90 Years Old with Acute Heart Failure TETSUO YAMAGUCHI1, NORIKO WATANABE3, TAKAMICHI MIYAMOTO1, TORU OBAYASHI1, MITSUAKI ISOBE2 1 Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan, 2 Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan, 3 Department of Nursing, Musashino Red Cross Hospital, Tokyo, Japan Methods: A total of 720 consecutive patients with acute heart failure (AHF) admitted to our intensive care unit between January 2009 and June 2013 were enrolled. The in-hospital mortality was compared between the oldest-old group (group-A: O90 years old, 84 patients, 11.7%, 93.5 6 3.5 years) and the younger group (group-B: 70.3 6 12.4 years). Results: There were no differences about the rate of intravascular diuretics use (97.6 vs 99.1 %, P 5 0.24) and mechanical ventilation (44.0 vs 42.5 %, P 5 0.78) between group A and B. The overall in-hospital mortality was significantly higher in the group A than B (17.9 vs 7.9 %, P 5 0.007). However, when compared by systolic blood pressure (SBP) on admission (High; SBP O 140 mmHg, Middle; SBP 5 100-140 mmHg, Low; SBP ! 100 mmHg), the in-hospital mortality was similar between group A and B (High; 5.0 vs. 3.2%, P 5 0.37, Middle; 11.8 vs. 14.4 %, P 5 0.29, Low; 40.7 vs. 23.8 %, P 5 0.22). The proportion of low SBP on admission was significantly higher in the group-A (32.1 vs. 6.6 %, P ! 0.001). Conclusions: In oldest-old patients with AHF, the in-hospital mortality was not inferior to the younger patients when compared by the same SBP on admission. A high rate of lower SBP on admission worsened the overall prognosis.
O-098 Background: Cardiac rehabilitation is an important adjunct to medical therapy in patients with congestive heart failure (CHF). However, there is no indicator to progress cardiac rehabilitation in patients with CHF. The purpose of this study is to evaluate the impact of early cardiac rehabilitation by using classification of the status of the patients with CHF on admission. Methods: 80 patients of intervention cardiac rehabilitation group (I group) and 69 patients of control cardiac rehabilitation group (C group) were enrolled. Patients in I group were scored by respiratory status (0:Oxygen !3L/min, 1: Oxygen O3L/min, 2: treatment with NPPV or Endotracheal intubation), Activity of Daily Living (0: Independence, 1:outside activity with support, 2:limited activity only inside), and BNP (0:!500pg/ml, 1:500-1999pg/ml, 2:O2000pg/ml), and were classified into four groups by total score (mild:0, moderate:1-3, severe:4-5, most severe:6). Then according to this score, cardiac rehabilitation was started immediately. We compared the duration in hospitalization between two groups, and evaluated the safety. Results: There were no significant differences between two groups on admission. Duration in hospitalization in I group could be shorter (I group; 21.0610.9 days vs C group; 25.9612.3 days, p!0.05). Conclusion: Cardiac rehabilitation by using this classification could be performed without serious accident. We considered that early mobilization prevent the Activity of Daily Living from lowering and lead to early discharge.
O-096 Clinical Features and Outcome in Octogenarians Hospitalized for Acute Heart Failure KEITARO AKITA1, TAKASHI KOHNO1, SHUN KOHSAKA1, YASUYUKI SHIRAISHI1, MITSUAKI SAWANO1, TAKU INOHARA1, YUICHIRO
Prognostic Factor of In-hospital Death in Very Elderly Patients with Acute Decompensated Heart Failure SHIN KAWASOE1, TAKURO KUBOZONO1, HIROYUKI TORII2, TSUYOSHI YAMAGUCHI2, MASAAKI MIYATA1, MITSURU OHISHI1 1 Cardiovascular Medicine and Hypertension, Kagoshima University, Kagoshima, Japan, 2Kagoshima Medical Association Hospital, Kagoshima, Japan Purpose: To investigate the prognostic factor of in-hospital death in very elderly patients with acute decompensated heart failure (ADHF). Methods: The consecutive 157 ADHF patients over 80 years old, who admitted at Kagoshima Medical Association Hospital, were divided into the in-hospital death group (N525) and the discharge group (N5132). The vital signs and blood samples were obtained, echocardiography was performed at hospitalization, and the prognostic factor of in-hospital death was evaluated. Results: The mean age was 86.364.4 years old (69 men). The mean systolic blood pressure, pulse rate, left ventricular ejection fraction and B-type natriuretic peptide (BNP) were 133.5629.1mmHg, 85.7630.0 beats/min, 54.1616.0% and 7876743 pg/ml, respectively. Compared to discharge group, inhospital death group had higher BNP level (113361253 vs 7276603 pg/ml, p50.023), higher white blood cell count (868063115 vs 719063231/mL, p50.036), lower concentration of hemoglobin (10.162.3 vs 11.262.0 g/dL, p50.014), higher serum creatinine level (1.6060.92 vs 1.1760.49 mg/dL, p50.001) and lower serum albumin level (3.0960.60 vs 3.4960.45 g/dL, p50.002). The logistic regression analysis revealed only serum creatinine level could identify in-hospital death (p50.021). Conclusion: The serum creatinine level was the significant prognostic factor of in-hospital death in very elderly patients with ADHF.