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Prognostic Factors of Heart Failure Patients with Atrial Fibrillation
The 21st Annual Scientific Meeting thoracic echocardiography. LA appendage (LAA) area, LAA wall motion velocity, and presence of spontaneous echo contrast (SEC) were examined using transesophageal echocardiography. Results: NLR of patients with cerebral embolism was significantly greater than in patients without the disorder. A cut-off point of 2.5 for NLR had a sensitivity of 71% and a specificity of 74% in predicting cerebral embolism. The patients with NLR > 2.5 had greater LA volume index or LAA area compared to the patients with NLR < 2.5. NLR was an independent risk factor for SEC. NLR was significantly correlated with LAA wall motion velocity in 153 patients without SEC and with LAA wall motion velocity and LAA area, in 30 patients with SEC, but not with LA volume index, A, or mitral annular motion velocity in both groups. Conclusion: In PAF patients, high NLR indicates thrombogenesis with a high degree of certainty and is associated with reduced LAA contraction rather than with LA body function.
O20-4 A Case of Acute Decompensated Heart Failure Caused by Premature Ventricular Contractions induced Mitral Regurgitation and LV Dysfunction Hiroki Mochizuki, Yosuke Nishihata, Takayoshi Kanie, Yoshimitsu Takaoka, Masafumi Ono, Satoshi Aita, Akira Kimata, Yasuhiro Yokoyama, Nobuyuki Komiyama; Cardiology Department, St.Luke’s International Hospital, Tokyo, Japan A 75-year-old woman who was told that she had premature ventricular contractions (PVC) in a medical examination was transferred to our hospital with orthopnea and diagnosed as acute decompensated heart failure. Electrocardiogram showed sinus tachycardia and frequent PVC and echocardiogram showed severely reduced left ventricular (LV) ejection fraction (17.8%) with dilated LV and severe mitral regurgitation (MR). We started furosemide, spironolactone and tolvaptan for volume overload. She also had high blood pressure, so nitroglycerin and ACE-inhibitor was started. Ambulatory electrocardiogram revealed that PVC were 35,389 beats per day, and which were over 30% of total heart beats. In coronary angiography, there was no significant stenosis, and cardiac magnetic resonance imaging showed no late gadolinium enhancement of myocardium. Myocardial biopsy showed nonspecific changes, so it was considered that LV dysfunction resulted from both frequent PVC and severe MR. MR apparently deteriorated on PVC. We started beta-blocker and amiodarone for PVC. However, PVC didn’t decrease after medical treatment and we also couldn’t help stopping amiodarone because of liver dysfunction. We performed radiofrequency catheter ablation for PVC. After procedure, MR significantly improved as PVC decreased, and LV dysfunction was gradually improved. It is important to understand mechanisms of mitral regurgitation and hemodynamic deterioration caused by frequent PVC. We report this case with some literature reviews.
O20-5 Prognostic Factors of Heart Failure Patients with Atrial Fibrillation Masaki Fujita, Hiroshi Ohira, Takehiko Keida, Tatsuo Kikuchi, Takashi Nakasone, Kazunobu Iidaka, Masaya Nakata, Tatsuya Shiraishi; Depertment of Cardiology, Edogawa hospital, Tokyo, Japan Introduction: Atrial fibrillation is associated with an increased mortality of patients in heart failure, however the impact of rhythm control by medical therapy or catheter ablation for these patients has been unknown. Method: This study was a retrospective casecontrol study of 109 patients who were hospitalized for heart failure with atrial fibrillation from February 2010 to March 2013. Primary endpoints are composite events (all cause death, cardiac death and hospitalization for heart failure) after 3 years. Result: Composite events were occurred in 35 cases (32. 1%) (all cause death: 22 cases (20.2%), cardiac death: 13 cases (12.0%) and hospitalization for heart failure:13 cases (12.0%)). The mean age (80.2±10.8 vs.72.3±10.3: P < .001), creatinine level (1.36±0.85 vs. 1.05±0.43: P = .43) and BNP level after 1 year (475.7±404.8 vs. 194.1±226.3: P < .001) were significantly higher in event (+) group. In univariate analysis for composite events, 65 years or older (OR = 4.95: P = .041) and CKD (OR = 2.38: P = .042) were significant predictors of occurrence of composite events, and catheter ablation (OR = 0.11: P = .034) was associated with a significantly lower risk of composite events. In multivariate analysis, only patients treated by catheter ablation had a significantly lower risk of composite events (OR = 0.12: P = .045). Conclusion: Our study suggests that the catheter ablation atrial fibrillation in patients with heart failure might reduce the cardiac events.
O21-1 Difference in Prognostic Value of Left Atrial Longitudinal and Circumferential Strain Miki Tsujiuchi, Mio Ebato, Sakura Nagumo, Takuya Mizukami, Hideyuki Maezawa, Hiroshi Suzuki; Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan Background: Left ventricular longitudinal strain (LVLS), Left atrial (LA) volume and functional indices measured by two dimensional echocardiography (2DE) have significant prognostic value for major cardiovascular events (MACE: cardiac death, stroke, nonfatal myocardial infarction and hospitalization for heart failure). Prognostic values of left atrial longitudinal and circumferential strain measured by three-dimensional speckle tracking analysis (3DSTA) were evaluated. Method: Two hundred eight patients (Male 61%, 65 ± 15yo) with various kind of cardiovascular diseases underwent standard 2DE and 3DSTA of left atrium. Maximum and minimum left atrial volume (LAVImax and LAVImin), left atrial emptying fraction (LAEmpF), peak global LA area strain (LAAS),
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circumferential strain (LACS) and longitudinal strain (LALS) were measured using 3DSTA. Serial changes of LACS and LALS were also recorded in 14 patietns hospitalized with heart failure. Results: During a mean follow-up of 611 ± 371 days, MACE developed in 23 patients. By multivariate analysis, CAD, CKD, 2DLVLS, 2DLAVImax, 2DLAmin and all LA indices were significant independent factors predicting MACE. The model added LALS or LAEmpF by 3DSTA had higher prognostic value (LALS <10.4%, AUC; 0.88, HR;7.45 CI:2.62–24.34, LAEmpF <2.7%: AUC; 0.88, HR:9.05, CI:2.93–37.53) than LACS. In patients with HF, LACS showed more rapid and greater change after therapy than LALS (rate of change: 108% vs 64%, P < .01). Conclusion: LALS is more robst predictor of future MACE than LACS.
O21-2 A Case of Cardiac Amyloidosis with Reduced Longitudinal Strain in All Cardiac Chambers Kaito Koshino1, Shimpei Ito1, Kazuto Yamaguchi2, Taiji Okada1, Takeshi Ouchi1, Hirotomo Sato1, Nobuhide Watanabe1, Akihiro Endo1, Hiroyuki Yoshitomi2, Kazuaki Tanabe1; 1The Fourth Department of Inter Medicine, University of Shimane, Shimane, Japan; 2The Inspection Department, Shimane University Hospital, Shimane, Japan A 83-year-old man with a history of hypertension and cardiac amyloidosis was admitted to our hospital due to progressive dyspnea on effort. His electrocardiogram showed intraventricular conduction delay and poor R wave progression in the pericardial leads. 99mTcPYP SPECT showed diffuse uptake throughout the myocardium of 4 chambers, indicating amyloid deposition into the both ventricles as well as both atrial myocardium. Echocardiography revealed diffuse biventricular thickening, and decreased left ventricular (LV) ejection fraction of 40%. Two-dimensional speckletracking echocardiography showed a typical bull’s-eye pattern with progressively reduced segmental longitudinal strain (LS) gradient from the base to the apex of the LV. LS values in each cardiac chambers were decreased: LV LS 6.9%, left atrial LS 3.8%, right ventricular LS 8.2%, right atrial LS 10.6% compared with those of two years ago. These results suggest that cardiac amyloidosis involved all chambers as well as 99mTcPYP SPECT and high risk of worsening heart failure. Previous studies reported that the LV LS is the independent predictor of adverse outcome in cardiac amyloidosis. Identification of patients at high risk for cardiac events would be helpful to initiate proper therapy, which may produce better outcome. We reported an interesting case of cardiac amyloidosis with all cardiac chambers are involved. When we perform echocardiography for cardiac amyloidosis, adding a four chamber LS will give us useful information.
O21-3 Good Predictor of Right Atrial Pressure in the Inferior Vena Cava Parameters by 2-Dimensional Echocardiogrphy Akiko Idemoto, Haruhiko Abe, Kaori Yasumura, Hiroki Nishida, Taishi Kato, Kazuya Shinouchi, Motoo Date, Yasunori Ueda, Masaaki Uematsu, Yukihiro Koretsune; Cardiovascular Division, Osaka National Hospital Background: Our purpose was to find the useful predictive factor for right atrial pressure (RAP), in several parameters of inferior vena cava (IVC) in 2-dimensional echocardiography. Methods: Thirty two patients who underwent right heart catheterization and echocardiography were enrolled. Maximum and minimum diameters in longaxis images, and short diameter, long diameter, area, and sphericity index in short-axis were measured. We evaluated the association between RAP and each index. Results: Among several indices, sphericity index of IVC showed the largest area under the ROC to detect RAP > 8 mmHg (AUC = 0.738). When a cutoff value of 0.54 for sphericity index of IVC was used, the sensitivity and specificity were 78% and 79% (Figure). Conclusion: Sphericity index could be a useful parameter to predict high RAP in several IVC parameters.
O20-4 A Case of Acute Decompensated Heart Failure Caused by Premature Ventricular Contractions induced Mitral Regurgitation and LV Dysfunction Hiroki Mochizuki, Yosuke Nishihata, Takayoshi Kanie, Yoshimitsu Takaoka, Masafumi Ono, Satoshi Aita, Akira Kimata, Yasuhiro Yokoyama, Nobuyuki Komiyama; Cardiology Department, St.Luke’s International Hospital, Tokyo, Japan A 75-year-old woman who was told that she had premature ventricular contractions (PVC) in a medical examination was transferred to our hospital with orthopnea and diagnosed as acute decompensated heart failure. Electrocardiogram showed sinus tachycardia and frequent PVC and echocardiogram showed severely reduced left ventricular (LV) ejection fraction (17.8%) with dilated LV and severe mitral regurgitation (MR). We started furosemide, spironolactone and tolvaptan for volume overload. She also had high blood pressure, so nitroglycerin and ACE-inhibitor was started. Ambulatory electrocardiogram revealed that PVC were 35,389 beats per day, and which were over 30% of total heart beats. In coronary angiography, there was no significant stenosis, and cardiac magnetic resonance imaging showed no late gadolinium enhancement of myocardium. Myocardial biopsy showed nonspecific changes, so it was considered that LV dysfunction resulted from both frequent PVC and severe MR. MR apparently deteriorated on PVC. We started beta-blocker and amiodarone for PVC. However, PVC didn’t decrease after medical treatment and we also couldn’t help stopping amiodarone because of liver dysfunction. We performed radiofrequency catheter ablation for PVC. After procedure, MR significantly improved as PVC decreased, and LV dysfunction was gradually improved. It is important to understand mechanisms of mitral regurgitation and hemodynamic deterioration caused by frequent PVC. We report this case with some literature reviews.
O20-5 Prognostic Factors of Heart Failure Patients with Atrial Fibrillation Masaki Fujita, Hiroshi Ohira, Takehiko Keida, Tatsuo Kikuchi, Takashi Nakasone, Kazunobu Iidaka, Masaya Nakata, Tatsuya Shiraishi; Depertment of Cardiology, Edogawa hospital, Tokyo, Japan Introduction: Atrial fibrillation is associated with an increased mortality of patients in heart failure, however the impact of rhythm control by medical therapy or catheter ablation for these patients has been unknown. Method: This study was a retrospective casecontrol study of 109 patients who were hospitalized for heart failure with atrial fibrillation from February 2010 to March 2013. Primary endpoints are composite events (all cause death, cardiac death and hospitalization for heart failure) after 3 years. Result: Composite events were occurred in 35 cases (32. 1%) (all cause death: 22 cases (20.2%), cardiac death: 13 cases (12.0%) and hospitalization for heart failure:13 cases (12.0%)). The mean age (80.2±10.8 vs.72.3±10.3: P < .001), creatinine level (1.36±0.85 vs. 1.05±0.43: P = .43) and BNP level after 1 year (475.7±404.8 vs. 194.1±226.3: P < .001) were significantly higher in event (+) group. In univariate analysis for composite events, 65 years or older (OR = 4.95: P = .041) and CKD (OR = 2.38: P = .042) were significant predictors of occurrence of composite events, and catheter ablation (OR = 0.11: P = .034) was associated with a significantly lower risk of composite events. In multivariate analysis, only patients treated by catheter ablation had a significantly lower risk of composite events (OR = 0.12: P = .045). Conclusion: Our study suggests that the catheter ablation atrial fibrillation in patients with heart failure might reduce the cardiac events.
O21-1 Difference in Prognostic Value of Left Atrial Longitudinal and Circumferential Strain Miki Tsujiuchi, Mio Ebato, Sakura Nagumo, Takuya Mizukami, Hideyuki Maezawa, Hiroshi Suzuki; Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan Background: Left ventricular longitudinal strain (LVLS), Left atrial (LA) volume and functional indices measured by two dimensional echocardiography (2DE) have significant prognostic value for major cardiovascular events (MACE: cardiac death, stroke, nonfatal myocardial infarction and hospitalization for heart failure). Prognostic values of left atrial longitudinal and circumferential strain measured by three-dimensional speckle tracking analysis (3DSTA) were evaluated. Method: Two hundred eight patients (Male 61%, 65 ± 15yo) with various kind of cardiovascular diseases underwent standard 2DE and 3DSTA of left atrium. Maximum and minimum left atrial volume (LAVImax and LAVImin), left atrial emptying fraction (LAEmpF), peak global LA area strain (LAAS),
•
JHFS
S39
circumferential strain (LACS) and longitudinal strain (LALS) were measured using 3DSTA. Serial changes of LACS and LALS were also recorded in 14 patietns hospitalized with heart failure. Results: During a mean follow-up of 611 ± 371 days, MACE developed in 23 patients. By multivariate analysis, CAD, CKD, 2DLVLS, 2DLAVImax, 2DLAmin and all LA indices were significant independent factors predicting MACE. The model added LALS or LAEmpF by 3DSTA had higher prognostic value (LALS <10.4%, AUC; 0.88, HR;7.45 CI:2.62–24.34, LAEmpF <2.7%: AUC; 0.88, HR:9.05, CI:2.93–37.53) than LACS. In patients with HF, LACS showed more rapid and greater change after therapy than LALS (rate of change: 108% vs 64%, P < .01). Conclusion: LALS is more robst predictor of future MACE than LACS.
O21-2 A Case of Cardiac Amyloidosis with Reduced Longitudinal Strain in All Cardiac Chambers Kaito Koshino1, Shimpei Ito1, Kazuto Yamaguchi2, Taiji Okada1, Takeshi Ouchi1, Hirotomo Sato1, Nobuhide Watanabe1, Akihiro Endo1, Hiroyuki Yoshitomi2, Kazuaki Tanabe1; 1The Fourth Department of Inter Medicine, University of Shimane, Shimane, Japan; 2The Inspection Department, Shimane University Hospital, Shimane, Japan A 83-year-old man with a history of hypertension and cardiac amyloidosis was admitted to our hospital due to progressive dyspnea on effort. His electrocardiogram showed intraventricular conduction delay and poor R wave progression in the pericardial leads. 99mTcPYP SPECT showed diffuse uptake throughout the myocardium of 4 chambers, indicating amyloid deposition into the both ventricles as well as both atrial myocardium. Echocardiography revealed diffuse biventricular thickening, and decreased left ventricular (LV) ejection fraction of 40%. Two-dimensional speckletracking echocardiography showed a typical bull’s-eye pattern with progressively reduced segmental longitudinal strain (LS) gradient from the base to the apex of the LV. LS values in each cardiac chambers were decreased: LV LS 6.9%, left atrial LS 3.8%, right ventricular LS 8.2%, right atrial LS 10.6% compared with those of two years ago. These results suggest that cardiac amyloidosis involved all chambers as well as 99mTcPYP SPECT and high risk of worsening heart failure. Previous studies reported that the LV LS is the independent predictor of adverse outcome in cardiac amyloidosis. Identification of patients at high risk for cardiac events would be helpful to initiate proper therapy, which may produce better outcome. We reported an interesting case of cardiac amyloidosis with all cardiac chambers are involved. When we perform echocardiography for cardiac amyloidosis, adding a four chamber LS will give us useful information.
O21-3 Good Predictor of Right Atrial Pressure in the Inferior Vena Cava Parameters by 2-Dimensional Echocardiogrphy Akiko Idemoto, Haruhiko Abe, Kaori Yasumura, Hiroki Nishida, Taishi Kato, Kazuya Shinouchi, Motoo Date, Yasunori Ueda, Masaaki Uematsu, Yukihiro Koretsune; Cardiovascular Division, Osaka National Hospital Background: Our purpose was to find the useful predictive factor for right atrial pressure (RAP), in several parameters of inferior vena cava (IVC) in 2-dimensional echocardiography. Methods: Thirty two patients who underwent right heart catheterization and echocardiography were enrolled. Maximum and minimum diameters in longaxis images, and short diameter, long diameter, area, and sphericity index in short-axis were measured. We evaluated the association between RAP and each index. Results: Among several indices, sphericity index of IVC showed the largest area under the ROC to detect RAP > 8 mmHg (AUC = 0.738). When a cutoff value of 0.54 for sphericity index of IVC was used, the sensitivity and specificity were 78% and 79% (Figure). Conclusion: Sphericity index could be a useful parameter to predict high RAP in several IVC parameters.