Prognostic Impact of Sleep Disordered Breathing in Patients with Acute Decompensate Heart Failure

The 21st Annual Scientific Meeting

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JHFS

S53

O41-4

O42-3

Comparison of Nutritional Status in Elderly Patients with Low-pressure Gradient and High-pressure Gradient Severe Aortic Stenosis Nobuhiko Haruki, Yoshiharu Kinugasa, Koichi Matsubara, Kiyotaka Yanagihara, Masayuki Hirai, Masahiko Kato, Kazuhiro Yamamoto; Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan

Prevalence and Risk Factors of Obstructive and Central Sleep Apnea in Patients Hospitalized Following Acute Decompensated Heart Failure Shoko Suda1,2, Takatoshi Kasai1,2, Shoichiro Yatsu1, Azusa Murata1, Hiroki Matsumoto1,2, Takao Kato1, Masaru Hiki1, Chiang Shuo-Ju1,3, Sakiko Miyazaki1, Hiroyuki Daida1; 1 Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan; 2Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; 3Division of Cardiology, Department of Internal Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan

Background: Assessment of nutrition status is important among elderly patients with severe aortic stenosis (SAS) when considering treatment or its prognosis. Although low pressure gradient (PG) SAS with preserved ejection fraction (EF) have been recently identified, it remains unclear whether the nutritional status is different between patients with high-PG SAS and low-PG SAS. Methods: We retrospectively enrolled 200 consecutive patients (mean age 81 ± 8 years) with SAS (aortic valve area <1.0 cm2) and preserved EF (≥50%). Patients were divided into paradoxical low-PG (mean PG <40 mmHg) and high-PG (mean PG ≥40 mmHg) SAS. Geriatric nutritional risk index (GNRI) as a marker of nutrition status was calculated as follows; 14.89 × serum albumin (g/dl) + 41.7 × body mass index (BMI)/22. Results: Compared with high-PG SAS, low-PG SAS patients were older (86 ± 7 vs. 80 ± 7 years, P < .001), lower BMI (1.41 ± 0.15 vs. 1.48 ± 0.15 kg/m2, P < .05), and smaller LV end-diastolic volume index (43 ± 12 vs. 47 ± 12 ml/m2, P < .05) and stroke volume index (33 ± 13 vs. 38 ± 13 ml/ m2, P < .01). Serum albumin was significantly lower in low-PG SAS patients than highPG SAS patients, resulting in lower GNRI (91.8 ± 9.7 vs. 97.6 ± 9.0, P < .01). Multivariate analysis identified an age (Odds ratio 1.08, 95% CI 1.024–1.158, P = .0045) and GNRI (Odds ratio 0.95, 95% CI 0.911–0.995, P = .03) were independent predictor for lowPG SAS. Conclusions: Low-PG SAS patients presents a lower nutrition status assessed by the GNRI.

O42-1 Prognostic Impact of Sleep Disordered Breathing in Patients with Acute Decompensate Heart Failure Hirokazu Kondo, Masashi Amano, Jiro Sakamoto, Yodo Tamaki, Soichiro Enomoto, Makoto Miyake, Toshihiro Tamura, Chisato Izumi, Yoshihisa Nakagawa; Cardiology, Tenri Hospital, Tenri, Japan Background: It has been reported that heart failure is frequently concomitant with sleep disordered breathing (SDB) and hypoxia is a worsening factor of heart failure. The purpose of this study it to evaluate prognostic impact of SDB in patients with acute decompensate heart failure (ADHF). Methods: Consecutive 213 patients (76.3 ± 12.0 years, males, 49.8%) with ADHF emergently admitted to our hospital from September 2015 to March 2017 were enrolled and performed overnight oximetry with PULSOXMe300 before discharge. We examined and calculated 3% oxygen desaturated index (ODI), and mean SpO2, and defined SDB positive as 3%ODI>15, and low SpO2 as mean SpO2 <95, and investigated prognosis as re-admission of heart failure. Results: 3%ODI was 16.4 ± 12.6 and SDB positive were 96 patients. Median of mean SpO2 was 95.1% (93.8–96.3) and low SpO2 were 106 patients. 44 patients were readmitted for heart failure, and Kaplan-Meier analysis revealed that low SpO2 group had worse prognosis than normal SpO2 group, on the other hand, SDB positive was not significant (log-rank P = .011 and P = .738, respectively). Conclusions: Low mean SpO2 was associated with increasing risk for re-admission in patients with ADHF.

O42-2 Prognostic Implications of Concomitant Pneumonia in Acute Heart Failure Patients Who Underwent Noninvasive Positive Pressure Ventilation Yuko Matsui, Shintaro Haruki, Yuichiro Minami, Hiromu Kadowaki, Madoka Akashi, Kentaro Jujo, Issei Ishida, Keiko Mizobuchi, Tsuyoshi Shiga, Nobuhisa Hagiwara; Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan

Background: Data regarding the presence of obstructive and central sleep apnea (OSA and CSA, respectively) in hospitalized patients with left ventricular (LV) systolic dysfunction following acute decompensated heart failure (ADHF) are limited. Methods: Data from consecutive patients with an LV ejection fraction (LVEF) <50% who were hospitalized with ADHF from May 2012 to September 2013 were assessed. Polysomnography was performed after the initial improvement of ADHF acute signs and symptoms. Patients with an apnea-hypopnea index (AHI) <15 were defined as mild to no sleep apnea (M-NSA), while those with an AHI ≥15 were further classified into OSA and CSA. Echocardiography and blood sampling for various parameters, such as B-type natriuretic peptide level, were performed systematically. Results: Data of 60 patients were assessed. Among them, 40 (67%) had sleep apnea (SA), including 15 with OSA (25%) and 25 with CSA (42%). Multivariate polynomial logistic regression analysis of SA type showed that greater BMI (odds ratio [OR], 1.30; P = .017) and E/e’ (OR, 1.19; P = .025) were the significant correlates for OSA and that greater BMI (OR, 1.24; P = .033) and E/e’ (OR, 1.21; P = .008) were the significant correlates for CSA. Conclusions: OSA and CSA were common in hospitalized patients with LV systolic dysfunction following ADHF. Greater BMI and E/e’ levels assessed using echocardiography can be clinical correlates of OSA or CSA.

O42-4 Effects of 3-month Astaxanthin Supplementation on Sleepiness, Physical Activity and Health Related Quality-of-life in Heart Failure Patients with Sleep-disordered Breathing Takao Kato1, Takatoshi Kasai1,2, Shoichiro Yatsu1, Hiroki Matsumoto1,2, Azusa Murata1, Shoko Suda1, Masaru Hiki1, Hiroyuki Daida1; 1Department of Cardiovascular Medicine; 2 Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine Background: Sleep disordered breathing (SDB) was observed in 50% of patients with heart failure (HF), and reportedly worsens clinical outcome possibly through increased oxidative stress. Astaxanthin which consist of the natural products is one of the carotenoid and antioxidative products. We planned a prospective pilot study in HF patients with SDB to investigate improvements of sleepiness, physical activity, health related quality of life (QoL) in addition to the reduction of oxidative stress level by 3-month astaxanthin supplementation. Methods: We investigated changes in their oxidative stress levels by diacron reactive oxygen metabolite (dROM) test, sleepiness by Epworth sleepiness scale (ESS), physical activity by specific activity scale, and QoL by SF-8 before and after 3-month astaxanthin supplementation. Results: Nineteen patients with HF were enrolled (mean age, 67.3 years; 16 men; mean ejection fraction, 33.6%). The dROM test reduced from 390.4 ± 82.4 U to 348.7 ± 55.8 U (P = .041). In addition, subjective sleepiness (ESS score, from 5.2 ± 5.7 to 2.0 ± 2.7, P = .008), physical activity (specific activity scale from 4.8 ± 1.2 to 6.1 ± 1.1, P = .009) and QoL (physical component summary score, from 46.1 ± 9.5 to, 50.1 ± 6.6, P = .009; and mental component summary score, from 48.5 ± 9.2 to 53.8 ± 4.8, P = .031) improved significantly. Conclusion: In this pilot study, three-month astxanthin supplementation alleviated subjective sleepiness, and improved physical activity and QoL in addition to the reduction of oxidative stress levels in HF patients with SDB.

O42-5 Background: Heart failure may increase risk of pneumonia due to alveoli flooding and reduced microbial clearance. Conversely, pneumonia may induce or worsen heart failure as cardiac output fails to meet the needs during infection. Although noninvasive positive pressure ventilation (NPPV) reduces mortality of patients with acute pulmonary edema, the relationship between concomitant pneumonia and outcome of acute heart failure (AHF) patients treated with NPPV is poorly understood. Hence, we investigated the association between concomitant pneumonia and outcome in hospitalized AHF patients who underwent NPPV. Methods and Results: In 174 consecutive AHF patients treated with NPPV (enrolled from July 2013 to June 2016), 34 (19.5%) had concomitant pneumonia on admission. Patients with pneumonia was older, had higher left ventricular ejection fraction, and had lower B-type natriuretic peptide level than those without. However, there were no significant differences with respect to initial NPPV setting between the groups. In multivariable analysis, concomitant pneumonia was independently associated with higher in-hospital mortality (adjusted odds ratio 3.01; P = .028). Additionally, the 6-month mortality among patients with pneumonia was also significantly higher than that among those without (32.4% vs. 15.7%; Log-rank P = .008). Conclusions: Concomitant pneumonia on admission was associated with not only inhospital short-term outcome, but also 6-month medium-term prognosis in AHF patients who underwent NPPV. Careful observation during NPPV might be needed in AHF patients with pneumonia.

Cardiac Resynchronization Therapy Altered the Severity and Pattern of Sleep Disordered Breathing in Case of Heart Failure with Systolic Dysfunction Hiroki Matsumoto1, Takatoshi Kasai1,2, Hidemori Hayashi1, Haruna Tabuchi1, Gaku Sekita1, Takashi Tokano3, Masataka Sumiyoshi4, Yuji Nakazato3, Hiroyuki Daida1; 1 Department of Cardiology, Juntendo University Graduate School of Medicine; 2 Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine; 3Juntendo University Urayasu Hospital; 4Juntendo University Nerima Hospital 69-year-old men with heart failure (HF) due to dilated cardiomyopathy (DCM) was referred for cardiac resynchronization therapy (CRT). He has frequent episodes of hospitalizations for acute decompensated heart failure (ADHF), requiring catecholamineadministration. He has functional class III-IV symptoms, AF with complete left bundle branch block (CLBBB) in electrocardiogram, and left ventricular ejection fraction (LVEF) of 20% in echocardiography. Considering previous history of ventricular tachycardia (VT), CRT with defibrillator (CRT-D) was implanted. After implantation, dyssynchrony ameliorated with an improvement of functional class (to II-III) and a reduction of BNP levels (from 3,000 to 800 pg/ml). Besides, apnea-hypopnea index in polysomnography reduced from 82.0/hr to 18.7/hr with an alteration of type of sleep disordered breathing (SDB) from predominant central sleep apnea (CSA) which required adaptive