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Serum Heme Oxygenase-1 Level is Increased in Cardiac Patients with Elevated Serum Uric Acid and Decreased Renal Function
S164 Journal of Cardiac Failure Vol. 20 No. 10S October 2014 elderly patient would have potential renal dysfunction, anemia, dementia, and low activity of daily living. Purpose: To clarify the risks of long-term hospitalization for elderly patient. Methods: One hundred seventy patients older than 80 with cardiovascular disease had been admitted to our hospital, classified into Long-term hospitalization (LTH) group (N528) and Short-term hospitalization (STH) group (N5142) according to whether the patients needed hospitalization for longer than 20 days or not. Patient characteristics, clinical outcome, blood examination, echocardiographic parameters, and Certification of Needed Long-Term Care or Support Condition were compared between the two groups. Results: Patient characteristics were not significant difference between the two groups. The left ventricle diastolic dimension, ejection fraction, serum creatinine, and hemoglobin level were not significant difference too. But the serum BNP level was significantly higher in LTH group (P!0.05). The ratio of the patient was issued a certification of Needed Long-Term Care or Support Condition was significantly higher in LTH group (P!0.05). In hospital death by any reason was significantly higher in LTH group (p!0.05). Conclusions: High BNP level and certification of Needed Long-Term Care or Support Condition was correlated with long-term hospitalization, and showed the possibility of early intervention.
O-110 Serum Acylcarnitine Concentration is Elevated in Patients with Acute Decompensated Heart Failure TAKEO FUJINO1, KOICHIRO KINUGAWA2, MASARU HATANO1, DAISUKE NITTA1, TERUHIKO IMAMURA2, HISATAKA MAKI1, EISUKE AMIYA1, ISSEI KOMURO1 1 Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan, 2 Department of Therapeutic Strategy for Heart Failure, the Unviersity of Tokyo, Tokyo, Japan Background: Impaired b-oxidation of fatty acid is observed in failing myocardium, but little is known about the mechanism. Carnitine plays a key role in b-oxidation, but alterations in carnitine homeostasis in heart failure (HF) remains unknown. Methods: We measured serum concentrations of free carnitine and acylcarnitine in hospitalized patients with acute decompensated HF (ADHF) or stable HF as well as those without HF. Results: Consecutive 29 ADHF, 27 stable HF and 26 non-HF patients were enrolled. Serum acylcarnitine was significantly increased in ADHF patients (18.269.2 mM) compared with stable HF (12.564.1 mM) and non-HF (11.663.0 mM) patients, while free carnitine was comparable. In stable HF and non-HF patients, serum acylcarnitine concentration was correlated with serum creatinine (r50.589 and 0.458, respectively). In contrast, among ADHF patients the elevation of serum acylcarnitine was independent of renal function (r50.017), and was significantly lowered at the time of their discharge (21.5610.2 mM to 13.065.2 mM, P!0.05). Conclusion: In stable HF and non-HF patients, serum acylcarnitine may be accumulated as a consequence of impaired glomerular filtration. However, in ADHF patients serum acylcarnitine is elevated, which is not associated with renal function but with the change of hemodynamics. Intravenous supplementation of free carnitine may not only give some clues to clarify the disorder of carnitine metabolism but also be beneficial in ADHF patients.
O-112 Predictors of Serum Cholinesterase Levels in Chronic Heart Failure TAKAMASA SATO, HIROYUKI YAMAUCHI, AKIOMI YOSHIHISA, YASUCHIKA TAKEISHI Department of Cardiology and Hematology Background: We have reported that serum cholinesterase (ChE) is a strong prognostic factor in chronic heart failure (CHF). Purpose: The purpose of this study was to determine the predictors of low ChE levels in CHF. Methods and Results: A total of 465 consecutive patients with CHF (376 males, 62614 years) were enrolled. Out of 465 patients, 173 patients were in low ChE group (ChE!240 U/L) and 292 patients in high ChE group (ChE $240 U/L). Patients in low ChE group had significantly higher cardiac event rates than in high ChE group (P!0.001). Patients with low ChE group were significantly older and more frequently given diuretics than those in high ChE group. Patients in low ChE group had significantly lower body mass index, lower serum albumin, higher log BNP, worse renal function, higher estimated right ventricular pressure, larger inferior vena cava (IVC) diameter and lower exercise capacity. However, left ventricular ejection fraction was similar between two groups. The independent factors to predict low ChE levels analyzed by multivariate logistic regression were body mass index (P50.005), IVC diameter (P50.009) and serum albumin level (P50.001). Conclusions: Low ChE is associated with unfavorable clinical outcomes, and venous congestion and malnutrition relates to low ChE level in CHF.
O-113 Association Between Right Ventricular Pressure and Serum Levels of Uric Acid and FGF23 Among Cardiac Patients without Pulmonary Arterial Hypertension KAZUSHI SAKANE, SHUICHI FUJITA, HIDEAKI MORITA, MASAAKI HOSHIGA, NOBUKAZU ISHIZAKA The Department of Cardiology, Osaka Medical College, Osaka, Japan Background: Fibroblast growth factor-23 (FGF23) plays a crucial role in phosphate metabolism via suppressing renal tubular phosphate re-absorption. Recent studies showed that patients with higher serum FGF23 more likely to have cardiac hypertrophy, which is independent of renal function, and blood pressure. Purpose: We have investigated whether serum UA levels are associated with estimated right ventricular systolic pressure (eRVSP) among cardiac patients without pulmonary arterial hypertension. Methods and Results: Among enrolled 394 cardiac patients, association between serum UA and FGF23 and eRVSP was investigated. Median eRVSP was 29 mmHg (interquartile range, 24-35 mmHg). UA was correlated with left ventricular ejection fraction (LVEF, R5-0.18, P!0.001), left ventricular mass index (LVMI, R50.15, P50.002), BNP (R50.24, P!0.001), and eRVSP (R50.16, P50.001). In addition, log(FGF23) showed significant association with LVEF (R5-0.20, P! 0.001), LVMI (R50.28, P!0.001), and BNP (R50.23, P!0.001), but association between log(FGF23) and eRVSP was borderline significant (R50.10, P50.056). By multivariate linear regression analysis using eRVSP as independent variable and entering age, gender, LVEF, LVMI, serum UA and log (FGF23) as dependent variable, UA was selected as significant predictor for eRVSP (standardized correlation coefficient50.14, P50.009), but log(FGF23) was not selected as a predictor. Conclusions: Elevation of serum UA, but not that of FGF23, may be associated with higher eRVSP independent of left ventricular function and left ventricular mass.
O-111 Serum Heme Oxygenase-1 Level is Increased in Cardiac Patients with Elevated Serum Uric Acid and Decreased Renal Function SHUICHI FUJITA, SHUN KIZAKA, HIDEAKI MORITA, TAKAHIDE ITO, KAZUSHI SAKANE, KOICHI SOHMIYA, MASAAKI HOSHIGA The Department of Cardiology, Osaka Medical College, Osaka, Japan Background and Purpose: Heme oxygenase-1 (HO-1) is induced by various types of oxidative stress. We have investigated, among cardiac patients, whether serum HO-1 concentration was incresaed in patients with high serum uric acid (UA) and low renal function, conditions that are thought to be associated with increased oxidative stress. Methods and Results: Serum HO-1 was measured using ELISA system. Serum HO-1 levels were found to be correlated with serum UA (R50.61, P50.017, Figure) and estimated GFR (eGFR) (R50.55, P50.026, by Spearman’s test). On the other hand, serum HO-1 did not, although UA did, have significant association with left ventricular ejection fraction (Figure). Conclusions: Serum HO-1 level was elevated in patients with high UA and low eGFR. Circulating HO-1 may represent a useful biomarker for in vivo oxidative stress among cardiac patients.
Figure. Correlation between serum uric acid, HO-1, and left ventricular ejection fraction.
O-114 Prevalence of Seasonal Variation in Patients with Heart Failure with Preserved Ejection Fraction KIMI SATO1,2, YOSHIHIRO SEO2, TOMOKO ISHIZU2, HIDEKAZU TSUNEOKA1, YUTAKA EKI1, KAZUTAKA AONUMA2 1 Division of Cardiology, Hitachi General Hospital, Hitachi, Japan, 2Division of Cardiovascular, University of Tsukuba Aim: To assess the relationship between the seasonal variation and clinical profile of heart failure with preserved ejection fraction (HFpEF). Methods and results: We enrolled 116 patients who admitted with acute heart failure. Patients were divided into winter admission (n535 [30%], December to February), summer admission
O-110 Serum Acylcarnitine Concentration is Elevated in Patients with Acute Decompensated Heart Failure TAKEO FUJINO1, KOICHIRO KINUGAWA2, MASARU HATANO1, DAISUKE NITTA1, TERUHIKO IMAMURA2, HISATAKA MAKI1, EISUKE AMIYA1, ISSEI KOMURO1 1 Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan, 2 Department of Therapeutic Strategy for Heart Failure, the Unviersity of Tokyo, Tokyo, Japan Background: Impaired b-oxidation of fatty acid is observed in failing myocardium, but little is known about the mechanism. Carnitine plays a key role in b-oxidation, but alterations in carnitine homeostasis in heart failure (HF) remains unknown. Methods: We measured serum concentrations of free carnitine and acylcarnitine in hospitalized patients with acute decompensated HF (ADHF) or stable HF as well as those without HF. Results: Consecutive 29 ADHF, 27 stable HF and 26 non-HF patients were enrolled. Serum acylcarnitine was significantly increased in ADHF patients (18.269.2 mM) compared with stable HF (12.564.1 mM) and non-HF (11.663.0 mM) patients, while free carnitine was comparable. In stable HF and non-HF patients, serum acylcarnitine concentration was correlated with serum creatinine (r50.589 and 0.458, respectively). In contrast, among ADHF patients the elevation of serum acylcarnitine was independent of renal function (r50.017), and was significantly lowered at the time of their discharge (21.5610.2 mM to 13.065.2 mM, P!0.05). Conclusion: In stable HF and non-HF patients, serum acylcarnitine may be accumulated as a consequence of impaired glomerular filtration. However, in ADHF patients serum acylcarnitine is elevated, which is not associated with renal function but with the change of hemodynamics. Intravenous supplementation of free carnitine may not only give some clues to clarify the disorder of carnitine metabolism but also be beneficial in ADHF patients.
O-112 Predictors of Serum Cholinesterase Levels in Chronic Heart Failure TAKAMASA SATO, HIROYUKI YAMAUCHI, AKIOMI YOSHIHISA, YASUCHIKA TAKEISHI Department of Cardiology and Hematology Background: We have reported that serum cholinesterase (ChE) is a strong prognostic factor in chronic heart failure (CHF). Purpose: The purpose of this study was to determine the predictors of low ChE levels in CHF. Methods and Results: A total of 465 consecutive patients with CHF (376 males, 62614 years) were enrolled. Out of 465 patients, 173 patients were in low ChE group (ChE!240 U/L) and 292 patients in high ChE group (ChE $240 U/L). Patients in low ChE group had significantly higher cardiac event rates than in high ChE group (P!0.001). Patients with low ChE group were significantly older and more frequently given diuretics than those in high ChE group. Patients in low ChE group had significantly lower body mass index, lower serum albumin, higher log BNP, worse renal function, higher estimated right ventricular pressure, larger inferior vena cava (IVC) diameter and lower exercise capacity. However, left ventricular ejection fraction was similar between two groups. The independent factors to predict low ChE levels analyzed by multivariate logistic regression were body mass index (P50.005), IVC diameter (P50.009) and serum albumin level (P50.001). Conclusions: Low ChE is associated with unfavorable clinical outcomes, and venous congestion and malnutrition relates to low ChE level in CHF.
O-113 Association Between Right Ventricular Pressure and Serum Levels of Uric Acid and FGF23 Among Cardiac Patients without Pulmonary Arterial Hypertension KAZUSHI SAKANE, SHUICHI FUJITA, HIDEAKI MORITA, MASAAKI HOSHIGA, NOBUKAZU ISHIZAKA The Department of Cardiology, Osaka Medical College, Osaka, Japan Background: Fibroblast growth factor-23 (FGF23) plays a crucial role in phosphate metabolism via suppressing renal tubular phosphate re-absorption. Recent studies showed that patients with higher serum FGF23 more likely to have cardiac hypertrophy, which is independent of renal function, and blood pressure. Purpose: We have investigated whether serum UA levels are associated with estimated right ventricular systolic pressure (eRVSP) among cardiac patients without pulmonary arterial hypertension. Methods and Results: Among enrolled 394 cardiac patients, association between serum UA and FGF23 and eRVSP was investigated. Median eRVSP was 29 mmHg (interquartile range, 24-35 mmHg). UA was correlated with left ventricular ejection fraction (LVEF, R5-0.18, P!0.001), left ventricular mass index (LVMI, R50.15, P50.002), BNP (R50.24, P!0.001), and eRVSP (R50.16, P50.001). In addition, log(FGF23) showed significant association with LVEF (R5-0.20, P! 0.001), LVMI (R50.28, P!0.001), and BNP (R50.23, P!0.001), but association between log(FGF23) and eRVSP was borderline significant (R50.10, P50.056). By multivariate linear regression analysis using eRVSP as independent variable and entering age, gender, LVEF, LVMI, serum UA and log (FGF23) as dependent variable, UA was selected as significant predictor for eRVSP (standardized correlation coefficient50.14, P50.009), but log(FGF23) was not selected as a predictor. Conclusions: Elevation of serum UA, but not that of FGF23, may be associated with higher eRVSP independent of left ventricular function and left ventricular mass.
O-111 Serum Heme Oxygenase-1 Level is Increased in Cardiac Patients with Elevated Serum Uric Acid and Decreased Renal Function SHUICHI FUJITA, SHUN KIZAKA, HIDEAKI MORITA, TAKAHIDE ITO, KAZUSHI SAKANE, KOICHI SOHMIYA, MASAAKI HOSHIGA The Department of Cardiology, Osaka Medical College, Osaka, Japan Background and Purpose: Heme oxygenase-1 (HO-1) is induced by various types of oxidative stress. We have investigated, among cardiac patients, whether serum HO-1 concentration was incresaed in patients with high serum uric acid (UA) and low renal function, conditions that are thought to be associated with increased oxidative stress. Methods and Results: Serum HO-1 was measured using ELISA system. Serum HO-1 levels were found to be correlated with serum UA (R50.61, P50.017, Figure) and estimated GFR (eGFR) (R50.55, P50.026, by Spearman’s test). On the other hand, serum HO-1 did not, although UA did, have significant association with left ventricular ejection fraction (Figure). Conclusions: Serum HO-1 level was elevated in patients with high UA and low eGFR. Circulating HO-1 may represent a useful biomarker for in vivo oxidative stress among cardiac patients.
Figure. Correlation between serum uric acid, HO-1, and left ventricular ejection fraction.
O-114 Prevalence of Seasonal Variation in Patients with Heart Failure with Preserved Ejection Fraction KIMI SATO1,2, YOSHIHIRO SEO2, TOMOKO ISHIZU2, HIDEKAZU TSUNEOKA1, YUTAKA EKI1, KAZUTAKA AONUMA2 1 Division of Cardiology, Hitachi General Hospital, Hitachi, Japan, 2Division of Cardiovascular, University of Tsukuba Aim: To assess the relationship between the seasonal variation and clinical profile of heart failure with preserved ejection fraction (HFpEF). Methods and results: We enrolled 116 patients who admitted with acute heart failure. Patients were divided into winter admission (n535 [30%], December to February), summer admission