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Sodium Restriction Is Associated With Low Caloric Intake in Patients Hospitalized With Acute Decompensated Heart Failure
S226 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 P15-4 D-HCM Patient With Left Ventricular Assistance Device Who Was Uncontrolled in Medical Medical Treatment Mitsuhiro Kunimoto1, Shuta Tsuboi1, Manabu Ogita1, Eriko Aoki1, Kenichi Kitamura1, Takashi Iso 1 , Hideki Ebina 1 , Taketo Sonoda 1 , Kikuo Isoda 2 , Hiroyuki Daida 2 ; 1 Cardiovascular Internal Medicine, Juntendo university, Shizuoka, Japan; 2Cardiovascular Internal Medicine, Juntendo university, Tokyo, Japan The patient was 52-year-old man. During the initial hospitalization to another hospital due to heart failure in October 2008, LV wall motion exhibited globally severe hypokinesis with LV ejection fraction (LVEF) of 18.2% on echocardiography at admission. He was diagnosed as dilated phase of hypertrophic cardiomyopathy (DHCM) by myocardial biopsy. Amiodarone had been started for non-sustained ventricular tachycardia (NSVT) since January 2011. In 2014 amiodarone-induced thyrotoxicosis type 2 occuered and heart failure had worsened. After we altered amiodarone to sotalol, ICD implantation was performed because of reappearance of NSVT. However, even after optimal medical treatment, NYHA functional class was 3 to 4 and levels of BNP were more than 1500 pg/mL. We decided to start intravenous dobutamine during hospitalization. Although dobutamine infusion improved dyspnea, repeat re-hospitalization was not avoided. Finally he had depended on dobutamine. In January 2016, he was transferred to the University of Tokyo for the purpose of implantation of left ventricular assist device (LVAD). LVAD implant surgery was successfully performed. Now he is waiting for a heart transplantation at home with NYHA class 2–3. We experienced the case of D-HCM who underwent LVAD implantation.
P15-6 A Case of Implantable Left Ventricular Assist Device Requiring Emergent but Uncomplicated Pump Exchange After Severe Driveline Damage Makiko Nakamura 1 , Osahiko Sunagawa 1 , Tadao Kugai 2 , Koichiro Kinugawa 3 ; 1 Department of Cardiology, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Okinawa, Japan; 2Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Okinawa, Japan; 3 The Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan A 43-year-old man with de novo heart failure was admitted to our hospital. Echocardiography showed markedly dilated left ventricle (LVDd 72 mm) with depressed systolic function (LVEF 24%). At the time of admission, BNP level was 2113 pg/ mL. He was diagnosed as familial dilated cardiomyopathy. Every effort titrating guidelinedirected medical therapy had been failed. He remained dependent on dobutamine, and after listed for heart transplantation he received implantable left ventricular assist device (LVAD, HeartMate II). LVAD implantation enabled us to up-titrate carvedilol to 30 mg/ day, and significant reverse remodeling was observed 6 months later (LVDd 55 mm, LVEF 42%, BNP 45.3 pg/mL). He was uneventful on the outpatient basis for a year. However, 1 year after LVAD implantation, severe driveline injury caused sudden pump stoppage requiring emergent hospitalization. We replaced his pump on the next day of injury. Thanks to the sufficient recovery of his native heart function, he had no organ damage during pump failure. This case reminds us the importance of up-titration of beta-blocker targeting recovery after LVAD implantation, especially in patients with short history of heart failure.
is supposed to play a key role to practice palliative care in patients with end-stage heart failure.
P20-6 Association Between the Patient Activity Log of CRT/ICD Device and Clinical Outcomes Masashi Kato, Shun Hojyo, Akihiro Kushiyama, Kazuhisa Kaneda, Takafumi Yokomatsu, Tetsu Mizoguchi, Shinji Miki; Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan Recently, implantable devices have various monitoring function and such parameters help us to understand the severity of illness and ADL status of the patients. We investigated the association between the patient activity log and clinical outcomes. From November 2005 to March 2015, 65 consecutive patients who received CRT/ICD device implantation in our hospital were included in this study. Average age 65.9, ischemic heart disease 35.4%, mean EF 41.2%, average follow up period 1533 days. Patients were divided into 3 groups according to the activity log at 6 months after device implantation, Low activity (L group: activity 0–1.9 hours/day, N = 29), Moderate activity (M group: activity 2–3.9 hours/day, N = 20) and High activity (H group: 4.0 hours or more/days, N = 16). During follow up periods, 21 patients (72.4%)in L group, 8 patients (40.0%) in M group, 1 patients (6.3%) in H group were hospitalized for heart failure (P < .05). 14 patients (48.3%)in L group, 5 patients (25.0%) in M group, no patients (0%) in H group were died during follow up periods (P < .05). Patient activity log was easy-to-use and quite effective index to predict clinical outcomes.
P21-2 Estimation of Urinary Sodium Excretion in Heart Failure Patients Yuichiro Iida1, Takayuki Inomata2, Toyoji Kaida1, Teppei Fujita1, Yuki Ikeda1, Takeru Nabeta 1 , Shunsuke Ishii 1 , Toshimi Koitabashi 1 , Jyunya Ako 1 ; 1 Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan; 2 Kitasato University Kitasato Institute Hospital, Shirokane, Minato-ku, Tokyo, Japan Background: Urinary sodium excretion has been measured to estimate the degree of dietary salt restriction in hypertensive patients. However, there are few reports on the measurement of urinary sodium excretion in chronic heart failure (CHF) patients. Methods & Results: We collected early-morning urine samples from 20 CHF patients for estimating the 24-hour urinary sodium excretion. The subjects consumed 5 g or 10 g of salt in the diet for 4 consecutive days and the urinary sodium excretion was measured. There was little difference in the 24-hour urinary sodium excretion between the 5 g-salt intake and 10 g-salt intake group as estimated from the early-morning urine samples (9.0 ± 1.8 g/day vs 7.4 ± 2.6 g/day; P = .04). Furthermore, we also measured the urinary sodium excretion in 24-hour urine collections in 25 CHF patients who took 6 g of salt in the diet for 7 days prior to discharge from the hospital. The urinary sodium excretion was found to be inversely associated with age. (β = −0.45; 95% CI −0.1 to −0.01; P = .01). Conclusion: Estimation of dietary salt intake based on the 24-hour urinary sodium excretion is affected by age. Therefore, it is difficult to precisely estimate the appropriate dietary salt intake from the 24-hour urinary sodium excretion in CHF patients.
P21-3 P16-6 Oxycodone May Be Effective for Medical Refractory Dyspnea in End-Stage Heart Failure Patients With Chronic Kidney Disease, a Case Report Hirofumi Maeba1, Masayuki Tanaka2, Takeshi Senoh1, Jyunji Iwasaka1, Aki Ohkita3, Ichiro Shiojima1; 1Department of Medicine II, Kansai Medical University, Osaka, Japan; 2 Department of Pharmacy, Kansai Medical University, Osaka, Japan; 3Nursing Deparment, Kansai Medical University, Osaka, Japan A 67-year-old male with dilated cardiomyopathy and chronic kidney disease (CKD) was admitted to our hospital because of worsening heart failure. Diuretics combined with phosphodiesterase inhibitor III inhibitor was effective on admission, and the respiratory condition improved from modified Borg Scale (mBS) 10 to mBS 8. On the 5th day of hospitalization, his hemodynamics and respiratory condition deteriorated suddenly after the onset of paroximal atrial fibrillation. Especially, the dyspnea was medical refractory and the most unbearable symptom for the patient. Because the patient did not agree with indication of mechanical ventilation, oxicodone was administrated with the aim of palliative care according to multi-disciplinary conference on the 5th day of hospitalization. After initiation of oxicodone, his respiratory condition improved from mBS 10 to mBS 3 without reduction of stroke volume and estimated glomerular filtration rate. It has been reported that there is little concern about respiratory depression in patients with chronic kidney disease because of small amount of active metabolite produced by oxycodone. To a greater or lesser extent, most patients with end-stage heart failure have complication of CKD, therefore the role of oxicodone
Sodium Restriction Is Associated With Low Caloric Intake in Patients Hospitalized With Acute Decompensated Heart Failure Yasutaka Inuzuka, Takefumi Kisimori, Takesi Inoue, Junya Seki, Sinsaku Takeda, Masaharu Okada, Kunihiko Kosuga, Shigeru Ikeguchi; Department of Cardiology, Shiga Medical Center for Adults, Japan Backgrounds: The influence of salt restriction on nutritional status in Japanese patients hospitalized for acute decompensated heart failure (ADHF) is unclear. Methods and Results: We retrospectively studied 207 consecutive patients hospitalized for ADHF (median age, 79 years; New York Heart Association class, II-IV; median brain natriuretic peptide level, 856 pg/mL) between January 2011 and December 2012. One hundred forty-five patients received low-salt diet (maximum dietary salt intake, 6 g/day): saltrestricted group, and 45 patients received a standard diet (dietary salt intake, 10 g/day): control group. The groups were homogeneous in terms of baseline characteristics including CONUT score at admission (4.6 ± 2.3 vs 4.1 ± −2.6, P = .2). CONUT score at discharge was not different between groups (4.8 vs 5.0, P = .7). In patients >80 years, CONUT score at discharge was higher in salt-restricted group than control group (5.3 ± −2.5 vs 4.3 ± 2.2, P = .04). Caloric intake represented as a percentage of estimated daily requirements was less in salt-restricted group (96 ± 25% vs 112 ± 29%, P < .01). The incidence of low caloric intakes (caloric intakes less than 20 kcal/kg per day) was higher in salt-restricted group (53% vs 15%, P = .02). In multivariate analysis, low caloric intakes was associated with salt-restriction and serum creatinine at discharge. Conclusion: Salt restriction is associated with low caloric intake and malnutrition especially in aged patients.
P15-6 A Case of Implantable Left Ventricular Assist Device Requiring Emergent but Uncomplicated Pump Exchange After Severe Driveline Damage Makiko Nakamura 1 , Osahiko Sunagawa 1 , Tadao Kugai 2 , Koichiro Kinugawa 3 ; 1 Department of Cardiology, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Okinawa, Japan; 2Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Okinawa, Japan; 3 The Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan A 43-year-old man with de novo heart failure was admitted to our hospital. Echocardiography showed markedly dilated left ventricle (LVDd 72 mm) with depressed systolic function (LVEF 24%). At the time of admission, BNP level was 2113 pg/ mL. He was diagnosed as familial dilated cardiomyopathy. Every effort titrating guidelinedirected medical therapy had been failed. He remained dependent on dobutamine, and after listed for heart transplantation he received implantable left ventricular assist device (LVAD, HeartMate II). LVAD implantation enabled us to up-titrate carvedilol to 30 mg/ day, and significant reverse remodeling was observed 6 months later (LVDd 55 mm, LVEF 42%, BNP 45.3 pg/mL). He was uneventful on the outpatient basis for a year. However, 1 year after LVAD implantation, severe driveline injury caused sudden pump stoppage requiring emergent hospitalization. We replaced his pump on the next day of injury. Thanks to the sufficient recovery of his native heart function, he had no organ damage during pump failure. This case reminds us the importance of up-titration of beta-blocker targeting recovery after LVAD implantation, especially in patients with short history of heart failure.
is supposed to play a key role to practice palliative care in patients with end-stage heart failure.
P20-6 Association Between the Patient Activity Log of CRT/ICD Device and Clinical Outcomes Masashi Kato, Shun Hojyo, Akihiro Kushiyama, Kazuhisa Kaneda, Takafumi Yokomatsu, Tetsu Mizoguchi, Shinji Miki; Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan Recently, implantable devices have various monitoring function and such parameters help us to understand the severity of illness and ADL status of the patients. We investigated the association between the patient activity log and clinical outcomes. From November 2005 to March 2015, 65 consecutive patients who received CRT/ICD device implantation in our hospital were included in this study. Average age 65.9, ischemic heart disease 35.4%, mean EF 41.2%, average follow up period 1533 days. Patients were divided into 3 groups according to the activity log at 6 months after device implantation, Low activity (L group: activity 0–1.9 hours/day, N = 29), Moderate activity (M group: activity 2–3.9 hours/day, N = 20) and High activity (H group: 4.0 hours or more/days, N = 16). During follow up periods, 21 patients (72.4%)in L group, 8 patients (40.0%) in M group, 1 patients (6.3%) in H group were hospitalized for heart failure (P < .05). 14 patients (48.3%)in L group, 5 patients (25.0%) in M group, no patients (0%) in H group were died during follow up periods (P < .05). Patient activity log was easy-to-use and quite effective index to predict clinical outcomes.
P21-2 Estimation of Urinary Sodium Excretion in Heart Failure Patients Yuichiro Iida1, Takayuki Inomata2, Toyoji Kaida1, Teppei Fujita1, Yuki Ikeda1, Takeru Nabeta 1 , Shunsuke Ishii 1 , Toshimi Koitabashi 1 , Jyunya Ako 1 ; 1 Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan; 2 Kitasato University Kitasato Institute Hospital, Shirokane, Minato-ku, Tokyo, Japan Background: Urinary sodium excretion has been measured to estimate the degree of dietary salt restriction in hypertensive patients. However, there are few reports on the measurement of urinary sodium excretion in chronic heart failure (CHF) patients. Methods & Results: We collected early-morning urine samples from 20 CHF patients for estimating the 24-hour urinary sodium excretion. The subjects consumed 5 g or 10 g of salt in the diet for 4 consecutive days and the urinary sodium excretion was measured. There was little difference in the 24-hour urinary sodium excretion between the 5 g-salt intake and 10 g-salt intake group as estimated from the early-morning urine samples (9.0 ± 1.8 g/day vs 7.4 ± 2.6 g/day; P = .04). Furthermore, we also measured the urinary sodium excretion in 24-hour urine collections in 25 CHF patients who took 6 g of salt in the diet for 7 days prior to discharge from the hospital. The urinary sodium excretion was found to be inversely associated with age. (β = −0.45; 95% CI −0.1 to −0.01; P = .01). Conclusion: Estimation of dietary salt intake based on the 24-hour urinary sodium excretion is affected by age. Therefore, it is difficult to precisely estimate the appropriate dietary salt intake from the 24-hour urinary sodium excretion in CHF patients.
P21-3 P16-6 Oxycodone May Be Effective for Medical Refractory Dyspnea in End-Stage Heart Failure Patients With Chronic Kidney Disease, a Case Report Hirofumi Maeba1, Masayuki Tanaka2, Takeshi Senoh1, Jyunji Iwasaka1, Aki Ohkita3, Ichiro Shiojima1; 1Department of Medicine II, Kansai Medical University, Osaka, Japan; 2 Department of Pharmacy, Kansai Medical University, Osaka, Japan; 3Nursing Deparment, Kansai Medical University, Osaka, Japan A 67-year-old male with dilated cardiomyopathy and chronic kidney disease (CKD) was admitted to our hospital because of worsening heart failure. Diuretics combined with phosphodiesterase inhibitor III inhibitor was effective on admission, and the respiratory condition improved from modified Borg Scale (mBS) 10 to mBS 8. On the 5th day of hospitalization, his hemodynamics and respiratory condition deteriorated suddenly after the onset of paroximal atrial fibrillation. Especially, the dyspnea was medical refractory and the most unbearable symptom for the patient. Because the patient did not agree with indication of mechanical ventilation, oxicodone was administrated with the aim of palliative care according to multi-disciplinary conference on the 5th day of hospitalization. After initiation of oxicodone, his respiratory condition improved from mBS 10 to mBS 3 without reduction of stroke volume and estimated glomerular filtration rate. It has been reported that there is little concern about respiratory depression in patients with chronic kidney disease because of small amount of active metabolite produced by oxycodone. To a greater or lesser extent, most patients with end-stage heart failure have complication of CKD, therefore the role of oxicodone
Sodium Restriction Is Associated With Low Caloric Intake in Patients Hospitalized With Acute Decompensated Heart Failure Yasutaka Inuzuka, Takefumi Kisimori, Takesi Inoue, Junya Seki, Sinsaku Takeda, Masaharu Okada, Kunihiko Kosuga, Shigeru Ikeguchi; Department of Cardiology, Shiga Medical Center for Adults, Japan Backgrounds: The influence of salt restriction on nutritional status in Japanese patients hospitalized for acute decompensated heart failure (ADHF) is unclear. Methods and Results: We retrospectively studied 207 consecutive patients hospitalized for ADHF (median age, 79 years; New York Heart Association class, II-IV; median brain natriuretic peptide level, 856 pg/mL) between January 2011 and December 2012. One hundred forty-five patients received low-salt diet (maximum dietary salt intake, 6 g/day): saltrestricted group, and 45 patients received a standard diet (dietary salt intake, 10 g/day): control group. The groups were homogeneous in terms of baseline characteristics including CONUT score at admission (4.6 ± 2.3 vs 4.1 ± −2.6, P = .2). CONUT score at discharge was not different between groups (4.8 vs 5.0, P = .7). In patients >80 years, CONUT score at discharge was higher in salt-restricted group than control group (5.3 ± −2.5 vs 4.3 ± 2.2, P = .04). Caloric intake represented as a percentage of estimated daily requirements was less in salt-restricted group (96 ± 25% vs 112 ± 29%, P < .01). The incidence of low caloric intakes (caloric intakes less than 20 kcal/kg per day) was higher in salt-restricted group (53% vs 15%, P = .02). In multivariate analysis, low caloric intakes was associated with salt-restriction and serum creatinine at discharge. Conclusion: Salt restriction is associated with low caloric intake and malnutrition especially in aged patients.