Scintigraphical Systolic Function and Increased Right Ventricular Uptake may be Predictive Factors for Major Adverse Cardiac Event in Takotsubo Cardiomyopathy

S174 Journal of Cardiac Failure Vol. 19 No. 10S October 2013 ventricular uptake (P50.006). Conclusion: Scintigraphical systolic function and increased right ventricular uptake may be predictive factors for major adverse cardiac event in TTC.

P-119 Isolated Pulmonary Ttakayasu’s aArteritis: Report of Two Cases SOU OHTSUKI Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences

Prevalence of Non-Compliant Pattern of Jugular Pulse

P-117 Potential Involvement of Functional Tricuspid Regurgitation in the Diagnostic Error to Assess Pulmonary Arterial Pressure by Doppler Echocardiography SAORI YAMAMOTO, YASUHARU MATSUMOTO, YOSHIHIRO FUKUMOTO, KOTARO NOCHIOKA, MASANOBU MIURA, SHUNSUKE TETEBE, KOICHIRO SUGIMURA, TOMOYUKI SUZUKI, HIROAKI SHIMOKAWA Cardiovascular Medicine, Tohoku University Graduate School of Medicine Background: We tested our hypothesis that functional tricuspid regurgitation (TR) with geometric alterations caused by right ventricular dilatation is involved in the diagnostic error of echocardiography for the assessment of pulmonary hypertension (PH). Methods: We conducted a retrospective cohort study of consecutive 127 patients (male, n558 (46%), mean age of 55y) who received both echocardiography and right heart catheterization (RHC) during the 2-year period. We defined “accurate estimated echocardiographic value” when it remained within 10mmHg of the invasive measurement. Results: A total of 75 patients (59%) were diagnosed to have PH by RHC. When the patients were divided into 3 groups; accurate (n552), over-estimate (n563) and under-estimate groups (n512), the diagnosis of PH by RHC was 42% in accurate, 68% in over-estimate, and 83% in under-estimate groups (P50.004). In echocardiography, right ventricular dimension was significantly larger in over-estimate group (accurate, 30.065.7mm; over-estimate, 35.368.6mm; underestimate, 32.865.2mm, P50.002). Conclusions: These results indicate that the accuracy of DE is not enough for pulmonary arterial pressure (PAP) evaluation, particularly in patients with PH associated with increased TR grading and enlarged right heart dimension. The present study provides the first insight that functional TR or tricuspid valve tethering as a consequence of geometric remodeling caused by right heart dilatation may be involved in the major diagnostic error of DE for the assessment of PAP.

P-118 Scintigraphical Systolic Function and Increased Right Ventricular Uptake may be Predictive Factors for Major Adverse Cardiac Event in Takotsubo Cardiomyopathy HIROFUMI MAEBA Kansai Medical University, Department of Medicine II Background: While Takotsubo Cardiomyopathy (TTC) rarely causes major adverse cardiac event (MACE), predictive factors for MACE are still unclear. We investigated which factors can predict MACE in TTC by using scintigraphical and echocardiographical evaluation. Method: Enrolled 15 patients were divided into 2 groups [Group M: patients with MACE (n54), Group N: patients without MACE (n511)]. MACE consisted of 1 patient with acute decompensated heart failure and 3 patients with ventricular fibrillation. Acute phase rest SPECT with 99mTc-tetrofosmin and echocardiography were performed on all patients. Scintigraphical evaluation consisted of visual semiquantitative myocardial perfusion, quantitative gated SPECT (QGS), and visual increased right ventricular uptake. Results: Patient background was identical between two groups except for renal function (CRTN: Group M vs. Group N: 4.265.6 vs. 1.361.3, P50.02). Echocardiographical and scintigraphical analyses of the left ventricular myocardial perfusion were identical between two groups. Conversely, systolic function evaluated by QGS was significantly lower in Group M than in Group N (ejection fraction: 30611 vs. 52612, P50.005; end systolic volume: 67623 vs. 38616, P50.01; respectively). Moreover, Group M showed significantly more increased right

Case 1: A 40-year-old female, with progressive exertional dyspnea presented to our emergency room. Chest computed tomography (CT) revealed severe stenosis of the bilateral main pulmonary arteries. Catheterization and angiography confirmed the stenoses and marked pulmonary hypertension (85mmHg). The C-reactive protein (CRP) was 2.17mg/dl. Human leucocyte antigens (HLA) were B52 and B39. We diagnosed the patient as having Takayasu’s arteritis (TA) based on her age, sex, laboratory findings, and the isolated pulmonary artery lesions. Treatment was started with glucocorticoid initially 40mg per day. Pulmonary artery pressure estimated by echocardiography decreased from 85mmHg to 35mmHg. During 2-year follow-up period, her functional status was improved to WHO class 1 and no signs of exacerbation were observed. Case 2: A 31-year-old female was referred due to a heart murmur and persistent low-grade fever. Pulmonary artery pressure by echocardiography was 80mmHg, and CT demonstrated severe narrowing of the bilateral main pulmonary arteries. The HLA was B39. A diagnosis of TA was secured and immunosuppressive therapy with glucocorticoid initially 30mg per day was administered. However, after the initiation of the treatment, her functional status remained poor (WHO class 3) and catheterization showed that the systolic main pulmonary artery pressure was 104mmHg. Isolated pulmonary TA is very uncommon. We describe and discuss our successful and unsuccessful experiences in treatment of this rare clinical condition.

P-120 Rare Case of Systemic Lupus Erythematosus-Associated Pulmonary Arterial Hypertension with Acute Myocarditis NOZOMI NOMOTO, NORIAKI TAKAMA, KUNIKO MASUDA, HIROKAZU SANO, MASAHIKO KURABAYASHI Cardiology, Gunma University We report a case of 28-year-old-woman with pulmonary arterial hypertension (PAH) associated with systemic lupus erythematosus (SLE). Since she was teenager, she took medicine (prednisolone 40mg per day), but discontinued drug treatment by her own judgment. She felt palpitation and dyspnea for several months. These symptoms were rapidly progressive. On admission, she diagnosed as NYHA Class IV, and had poor prognostic factors (brain natriuretic peptide; 605 pg/ml, 6-minute walk distance; 50 m, mean pulmonary arterial pressure; 59 mmHg; cardiac index; 1.09 L/min/ m2) with normal wedge pressure and left ventricular end-diastolic pressure. Magnetic resonance imaging showed acute myocardial edema. Therefore, left ventricular muscle biopsy was performed, and its examination indicated acute myocarditis. According to standard PAH therapy with oral agents (ambrisentantadalafilberaprost sodium), oxygen, and warfarin, symptoms related to PAH were slightly improved (mean pulmonary arterial pressure; 50 mmHg). After initiating epoprostenol treatment, symptoms and previous poor prognostic factors were significantly improved. SLE is a disease that is characterized by periodic episodes of inflammation of organs including the heart (especially Libman-Sacks endocarditis) and lungs. We experienced rare case which was diagnosed with SLE-associated PAH and acute myocarditis around the same time.

P-121 Sleep-disordered Breathing on Familial Dilated Cardiomyopathy REIKO FUKUDA, TAKUO ARIKAWA, SHIGERU TOYODA, NAOYUKI OTANI, SHU INAMI, YU NISHI, HIROHISA AMANO, TERUO INOUE Cardiovascular Medicine, Dokkyo Medical University Recent studies have focused on sleep-disordered breathing (SDB) as a complication of heart failure, since SDB, including both obstructive sleep apnea (OSA) and central sleep apnea (CSA) is a common symptom in patients with heart failure. We experienced rare case of a family, to which 4 patients with familial dilated cardiomyopathy, complicated with OSA or CSA, belong. The 4 patients included mother (82-yr), her elder daughter (66-yr), her son (64-yr) and her younger daughter (61-yr). Five years ago, they suffered from heart failure symptom (NYHA III, II, III and II, respectively). All of 4 patients complicated with SDB, i.e., CSA, OSA, CSA, and OSA, respectively. AHI was 21.0, 40.1, 42.8 and 47.4, respectively. Their heart failure status was demonstrated by ejection fraction (30, 33, 28 and 34%), E/A ratio (0.74, 0.8, 1.2 and 0.9), E wave deceleration time (277, 244, 156 and 202 msec.), E/E0 ratio