Prognostic Impact of De-novo Atrial Fibrillation in Patients with Chronic Heart Failure - A Report from the CHART-2 Study

Prognostic Impact of De-novo Atrial Fibrillation in Patients with Chronic Heart Failure - A Report from the CHART-2 Study

S172 Journal of Cardiac Failure Vol. 21 No. 10S October 2015 OP15-2 The Modified R2CHADS2 Score Predicts Poor Clinical Outcome Among Chronic Heart Fai...

207KB Sizes 1 Downloads 53 Views

S172 Journal of Cardiac Failure Vol. 21 No. 10S October 2015 OP15-2 The Modified R2CHADS2 Score Predicts Poor Clinical Outcome Among Chronic Heart Failure Patients TAKUMI KONDO, TAKAHISA YAMADA, TAKASHI MORITA, SHUNSUKE TAMAKI, MASATAKE FUKUNAMI Division of Cardiology, Osaka General Medical Center, Osaka We investigated whether the modified R2CHADS2 score had predictive value for the risk of poor clinical outcome in CHF pts. We prospectively enrolled 153 CHF patients (LVEF!40%). During the follow-up period of 6.164.5 yrs, 49 pts hospitalized for worsening heart failure (WHF) (30 of 68 pts with high [S 4] modified R2CHADS2 score and 19 of 85 with low [& 3] modified R2CHADS2 score). Kaplan-Meier analysis revealed that pts with high modified R2CHADS2 score had a greater risk of hospitalization of WHF than pts with low modified R2CHADS2 score (p50.0008, adjusted HR 2.2 [95% CI 1.1-4.2]). Cox multivariate analysis revealed that high modified R2CHADS2 score was independently significantly associated with hospitalization of WHF (p50.02). Modified R2CHADS2 score could have predictive value for the risk of hospitalization of worsening heart failure in CHF patients.

Figure.

OP15-3

examined the effect of ARBs on HRV. In this study, we evaluated the effects of ARBs on HRV and cardiac sympathetic nervous activities (CSNA) in HF patients. Methods: 92 patients with HF were enrolled. We measured Coefficient of variation in the R-R intervals (CVRR) by ECG. Next, we enrolled 20 HF patients already treated with normal dose ACE-I/ARB. We changed dose to maximum dose Olmesartan (40 mg/day), and evaluated CVRR and plasma norepinephrine before and 6 months after treatment. Results: There was no significant difference in CVRR between patients with and without beta-blocker (2.8761.36 vs 2.7861.91, p5ns). Whereas, CVRR in patients with ACE-I/ ARB was significantly higher than without ACE-I/ARB (2.9961.28 vs 2.4061.11, p! 0.05). After 6 months treatment, CVRR tended to be improved (2.3160.54 to 2.9061.27, p50.082), and plasma norepinephrine was significantly decreased (770.06277.6 to 503.96212.1, P!0.01). Conclusions: These findings suggest ARB might inhibit CSNA in HF patients dose dependently. Improvement of HRV might be associated with better prognosis in HF patients.

OP15-5 Chronic Heart Failure Markedly Attenuates the Low Pressure Baroreflex in Regulating Sympathetic Function in Rats YASUHIRO OGA1, TAKUYA KISHI2, KEITA SAKU3, AKIKO NISHIZAKI1, TAKAHIRO ARIMURA1, KANA FUJII1, TAKESHI TOHYAMA1, TAKUYA NISHIKAWA1, TOMOMI IDE1, KENJI SUNAGAWA3 1 Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan; 2Collaborative Research Institute of Innovative Therapeutics for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan; 3Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan Background: We previously reported that the activation of low-pressure baroreflex (LBARO) by volume infusion biphasically altered sympathetic nerve activity (SNA). We examined whether chronic heart failure (CHF) changed LBARO. Methods: In 14 anesthetized Sprague-Dawley rats, we created CHF by myocardial infarction. We isolated carotid sinuses to abolish the arterial baroreflex. We infused blood stepwise to activate LBARO, and recorded SNA and hemodynamics. Result: In the normal group (n56), volume loading increased both central venous pressure (CVP) and left ventricular end-diastolic pressure (LVEDP) and biphasically changed SNA with a maximal response of 48621%. In contrast, CHF (n58) markedly reduced the maximum response (1567%, p!0.05) and abolished the biphasic change of SNA (Figure). Conclusions: CHF induces the L-BARO failure. How the LBARO failure impacts the pathophysiology of CHF remains to be investigated.

Prognostic Impact of De-novo Atrial Fibrillation in Patients with Chronic Heart Failure - A Report from the CHART-2 Study TAKESHI YAMAUCHI1, YASUHIKO SAKATA1, MASANOBU MIURA2, SOICHIRO TADAKI1, RYOICHI USHIGOME1, KENJIRO SATO1, TAKEO ONOSE1, KANAKO TSUJI1, SATOSHI MIYATA2, HIROAKI SHIMOKAWA1,2 1 Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; 2Department of Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan Background: We aimed to elucidate the prognostic impacts of atrial fibrillation (AF) in patients with chronic heart failure (CHF). Methods and Results: We examined 4,818 consecutive patients with Stage C/D CHF registered in our CHART-2 Study (N510,219). Among them, 1,859 (38.6%) had AF at enrollment. As compared with the remaining 2,953 patients with sinus rhythm at enrollment, patients with AF were characterized by higher age (71 vs. 68 yrs.), lower estimated glomerular filtration rate (58.9 vs. 61.9 ml/min/1.73m2), higher brain natriuretic peptide (BNP) levels (152 vs. 74.5 pg/ml), comparable LVEF (56.8 vs 56.5%) and similar prescription rate of beta-blocker (48.1 vs. 50.6%) and reninangiotensin system (RAS) inhibitor (72.9 vs. 71.6%). Among the patients with sinus rhythm at enrollment, 106 (3.6%) developed de-novo AF (dnAF) during the median follow-up for 3.2 years, which was associated with an increased mortality (adjusted hazard ratio (HR) 1.72, P50.013). In contrast, neither paroxysmal AF (pAF) nor chronic AF (cAF) at enrollment was associated with mortality (pAF, adjusted HR 1.10, P50.491; cAF, adjusted HR 1.00, P 50.992). IPTW analysis revealed that neither beta-blockers nor RAS inhibitors was associated with reduced mortality in AF patients, regardless of pAF or cAF. Conclusions: These results indicate that development of dnAF, but not pAF or cAF at enrollment, was associated with increased mortality in CHF patients.

OP15-4 Effect of Angiotensin II Receptor Blocker on Cardiac Autonomic Activity in Patients with Chronic Heart Failure SHOHEI ISHIKAWA, TAKAHISA NOMA, KEIJI MATSUNAGA, KAORU MANTANI, WATARU TAKABATAKE, MAKOTO ISHIZAWA, KAORI ISHIKAWA, KAZUSHI MURAKAMI, KOJI OHMORI, MASAKAZU KOHNO Department of Cardiorenal Cerebrovascular Medicine, Faculty of Medicine, Kagawa University Background: In heart failure (HF) patients, reduced heart rate variability (HRV) is associated with increase in cardiovascular events. Angiotensin II receptor blockers (ARBs) improve the cardiovascular mortality in HF patients. However, there are few studies that

Figure.

OP16-1 Prothrombin Time as a Novel Marker for Congestion in Patients with Acute Decompensated Heart Failure Not Taking Anticoagulants ATSUSHI OKADA, YASUO SUGANO, TOSHIYUKI NAGAI, SATOSHI HONDA, YASUHIDE ASAUMI, TERUO NOGUCHI, KENGO KUSANO, HISAO OGAWA, SATOSHI YASUDA, TOSHIHISA ANZAI Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan Background: Prothrombin time is a classical marker of liver damage. However, the clinical significance of prothrombin time in heart failure patients not taking