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The Case of Tuberculous Myocarditis Manifested by Extensive Myocardial Calcification
S170 Journal of Cardiac Failure Vol. 21 No. 10S October 2015 blood pressure and subsequent improvement of heart failure. One day 19, she underwent MIBG scintigraphy, which showed no tracer uptake in the heart, again compatible with TCM. On day 33, follow up echocardiography showed normalization of LV wall motion. We experienced a case of heart failure associated with recurrent pheochromocytoma, compatible with TCM. We consider that elevated levels of circulating catecholamines may play important role to develop TCM in this case.
OP10-4 A Case of Takotsubo Cardiomyopathy Complicated by Transient Cataplectic Attack of Upper Limb JOH AKAMA, ATSUSHI KOBAYASHI, YUSUKE KIMISHIMA, TAKASHI KANESHIRO, NOBUO SAKAMOTO, KOICHI SUGIMOTO, HITOSHI SUZUKI, SHU-ICHI SAITOH, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan A 60 year-old women realized chest pain during an argument. Next day, she visited a clinic, and was transferred to our hospital due to suspected acute coronary syndrome with ECG T-wave changes. Because coronary angiogram showed no significant stenosis, whereas left ventriculography demonstrated akinesis in the apical and midventricular region and hyperkinesis in the basal area, we diagnosed as Takotsubo cardiomyopathy. Anticoagulation therapy was started as soon as possible because left ventricle (LV) apical wall motion was severely reduced. Nevertheless, she suffered a bout of cataplectic attack of upper limb at the day of admission. Head MRI demonstrated high intensity area located near right lateral cerebroventricle. At the same time, echocardiography also demonstrated improvement of LV apical and mid-ventricular wall motion. After that, intensification of anticoagulation therapy and start of rehabilitation were performed. She was discharged without paralysis after ten days of hospitalization. In this case, it took comparatively a long time for her to be diagnosed as Takotsubo cardiomyopathy from chest pain. Therefore, it seemed more likely that small thrombus was formed in LV apex. Because LV wall motion improved earlier than usual, free thrombus from LV wall caused cerebral embolism. This case suggested that intensification of anticoagulation therapy was needed when it took a long time to be diagnosed as Takotsubo cardiomyopathy from onset.
OP10-5 The Case of Tuberculous Myocarditis Manifested by Extensive Myocardial Calcification TATSURO HITSUMOTO, SYUNTARO IKEDA, SIGEHIRO MIYAZAKI, HISAKI KADOTA, HIDEAKI SHIMIZU, KIYOTAKA OSHIMA, MAREOMI HAMADA Department of Cardiology, Uwajima City Hospital 81-years-old woman was referred to our hospital because of shortness of breath on exertion. Chest X-ray revealed massive right pleural effusion, pulmonary congestion, and cardiomegary. An echocardiogram showed left ventricular hypertrophy with aggregated hyper-echoic mass. Cardiac CT image revealed massive left ventricular myocardial calcifications. The calcifications are distributed spirally from cardiac apex to base (Figure A). Hemodynamic data obtained by catheterization demonstrated restrictive pattern. On the basis of these data, diagnosis of diastolic heart failure with preserved ejection fraction due to extensive myocardial calcification. Eight months later after prior admission, she died of recurrence of heart failure. Postmortem autopsy revealed systemic miliary tuberculosis involving almost entire organ. In the heart, tuberculous granuloma and acid-fast bacterium are found around myocardial calcification (Figure D). We experienced the rare case of tuberculous myocarditis.
OP11-1 Impact of Obstructive Sleep Apnea on Cardiac Sympathetic Drive in Patients with Congestive Heart Failure TARO ADACHI, SHINJI KOBA, SHIGETO TSUKAMOTO, NORIKAZU WATANABE, YOSHINO MINOURA, MITSUHARU KAWAMURA, TAKU ASANO, HIROYUKI KAYANO, YOUICHI KOBAYASHI Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan Background: Sudden cardiac death is more likely to occur during sleep in patients with obstructive sleep apnea (OSA). We hypothesized that the presence of OSA is associated with increased cardiac sympathetic drive at night and morning in patients with congestive heart failure (CHF). Methods: We conducted a cross-sectional study of patients with CHF. The presence of OSA (apnea-hypopnea index S 15) was determined by polysomnography and patients were divided according to the presence (OSA, n513) or absence of OSA (no-OSA, n59). Spectral analysis of the R-R interval from the electrocardiogram was performed at 9PM and at 7AM. The Low frequency (LF)/high frequency (HF) ratio was calculated to reflect sympathovagal balance. Results: Age (6469 vs.63615 years), ejection fraction (33.568.5 vs.30.7611.1%), and the incidence of b-blocker users (80.0 vs. 83.3%) did not differ between the two groups. The LF/HF ratio was higher in OSA at 7AM (7.968.1 vs. 2.161.2, p50.04) and at 9PM (4.162.3 vs. 1.961.3, p50.01), and the former was significantly higher than the latter (p50.03). Conclusion: OSA is accompanied by an altered cardiac sympathovagal balance favoring heightened sympathetic drive at night and morning in patients with CHF. This might contribute to the increased risk of sudden cardiac death during sleep in patients with OSA, and may be associated with poorer prognosis in this patient population.
OP11-2 The Evaluation of Cardiac Function on SAS Patient SHU SUZUKI, OSAMU KITAMUKAI Department of Cardiology Tohoku Kosai Hospital, Sendai, Japan Objectives: Although it is well-known that sleep-disordered breathing may contribute to the progression of heart failure, the precise mechanism is still unclear. To elucidate it we examined the relation between apnea/hypopnea index and cardiac function by conventional, tissue Doppler and speckle tracking echocardiography. Methods: 69 patients who underwent polysomnography (PSG) were divided into two groups by their AHI (mild group: AHI!30, severe group: AHIO30). Results: There were no significant differences in the indicator of diastolic function, but systolic function (LVEF) was significantly (p!0.05) reduced in severe group (59.467.0) than mild group (64.266.2). MPI was significantly (p!0.05) higher in severe group (0.560.1) than mild group (0.460.1). Conclusion: Systolic function of severe sleepapnea patients are significantly reduced, but diastolic function are preserved. Table 1.
AHI!30 AHI (times/h) Age (yrs.) Height (cm) Weights(kg) BMI HR (bpm) Echocardiography data LVDd (mm) LVDs (mm) IVST (mm) PWT (mm) LVMI (gm/m2) EF (%) E/e0 GLS (%) MPI LAVI E/A
AHIO30
18.0 65.7 163.8 67.2 25.0 64.2
6 6 6 6 6 6
6.0 11.0 8.5 12.2 3.7 12.2
49.1 59.1 169.9 77.0 26.7 67.3
6 6 6 6 6 6
16.5* 10.2* 8.0* 12.7* 4.2 12.7
48.4 28.7 9.9 9.8 87.3 64.2 9.0 18.1 0.4 32.1 0.8
6 6 6 6 6 6 6 6 6 6 6
4.8 45 1.5 1.3 19.6 6.2 2.0 3.7 0.1 10.1 0.3
48.4 29.8 9.9 10.3 84.8 59.4 8.8 16.8 0.5 28.6 0.9
6 6 6 6 6 6 6 6 6 6 6
3.9 4.3 2.1 1.6 17.9 7.0* 3.0 2.8 0.1* 114.9 04
*p!0.05 v.s. mild group
OP11-3 Association of Insomnia with Exercise Capacity in Heart Failure Patients YUKI KANNO, AKIOMI YOSHIHISA, TAKESHI SHIMIZU, MAI TAKIGUCHI, HIROYUKI YAMAUCHI, TAKAMASA SATO, SATOSHI SUZUKI, MASAYOSHI OIKAWA, ATSUSHI KOBAYASHI, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
Figure.
Background: Insomnia is associated with incident heart failure (HF). However, clinical significance and impacts of insomnia on exercise capacity in HF remain unclear.
OP10-4 A Case of Takotsubo Cardiomyopathy Complicated by Transient Cataplectic Attack of Upper Limb JOH AKAMA, ATSUSHI KOBAYASHI, YUSUKE KIMISHIMA, TAKASHI KANESHIRO, NOBUO SAKAMOTO, KOICHI SUGIMOTO, HITOSHI SUZUKI, SHU-ICHI SAITOH, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan A 60 year-old women realized chest pain during an argument. Next day, she visited a clinic, and was transferred to our hospital due to suspected acute coronary syndrome with ECG T-wave changes. Because coronary angiogram showed no significant stenosis, whereas left ventriculography demonstrated akinesis in the apical and midventricular region and hyperkinesis in the basal area, we diagnosed as Takotsubo cardiomyopathy. Anticoagulation therapy was started as soon as possible because left ventricle (LV) apical wall motion was severely reduced. Nevertheless, she suffered a bout of cataplectic attack of upper limb at the day of admission. Head MRI demonstrated high intensity area located near right lateral cerebroventricle. At the same time, echocardiography also demonstrated improvement of LV apical and mid-ventricular wall motion. After that, intensification of anticoagulation therapy and start of rehabilitation were performed. She was discharged without paralysis after ten days of hospitalization. In this case, it took comparatively a long time for her to be diagnosed as Takotsubo cardiomyopathy from chest pain. Therefore, it seemed more likely that small thrombus was formed in LV apex. Because LV wall motion improved earlier than usual, free thrombus from LV wall caused cerebral embolism. This case suggested that intensification of anticoagulation therapy was needed when it took a long time to be diagnosed as Takotsubo cardiomyopathy from onset.
OP10-5 The Case of Tuberculous Myocarditis Manifested by Extensive Myocardial Calcification TATSURO HITSUMOTO, SYUNTARO IKEDA, SIGEHIRO MIYAZAKI, HISAKI KADOTA, HIDEAKI SHIMIZU, KIYOTAKA OSHIMA, MAREOMI HAMADA Department of Cardiology, Uwajima City Hospital 81-years-old woman was referred to our hospital because of shortness of breath on exertion. Chest X-ray revealed massive right pleural effusion, pulmonary congestion, and cardiomegary. An echocardiogram showed left ventricular hypertrophy with aggregated hyper-echoic mass. Cardiac CT image revealed massive left ventricular myocardial calcifications. The calcifications are distributed spirally from cardiac apex to base (Figure A). Hemodynamic data obtained by catheterization demonstrated restrictive pattern. On the basis of these data, diagnosis of diastolic heart failure with preserved ejection fraction due to extensive myocardial calcification. Eight months later after prior admission, she died of recurrence of heart failure. Postmortem autopsy revealed systemic miliary tuberculosis involving almost entire organ. In the heart, tuberculous granuloma and acid-fast bacterium are found around myocardial calcification (Figure D). We experienced the rare case of tuberculous myocarditis.
OP11-1 Impact of Obstructive Sleep Apnea on Cardiac Sympathetic Drive in Patients with Congestive Heart Failure TARO ADACHI, SHINJI KOBA, SHIGETO TSUKAMOTO, NORIKAZU WATANABE, YOSHINO MINOURA, MITSUHARU KAWAMURA, TAKU ASANO, HIROYUKI KAYANO, YOUICHI KOBAYASHI Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan Background: Sudden cardiac death is more likely to occur during sleep in patients with obstructive sleep apnea (OSA). We hypothesized that the presence of OSA is associated with increased cardiac sympathetic drive at night and morning in patients with congestive heart failure (CHF). Methods: We conducted a cross-sectional study of patients with CHF. The presence of OSA (apnea-hypopnea index S 15) was determined by polysomnography and patients were divided according to the presence (OSA, n513) or absence of OSA (no-OSA, n59). Spectral analysis of the R-R interval from the electrocardiogram was performed at 9PM and at 7AM. The Low frequency (LF)/high frequency (HF) ratio was calculated to reflect sympathovagal balance. Results: Age (6469 vs.63615 years), ejection fraction (33.568.5 vs.30.7611.1%), and the incidence of b-blocker users (80.0 vs. 83.3%) did not differ between the two groups. The LF/HF ratio was higher in OSA at 7AM (7.968.1 vs. 2.161.2, p50.04) and at 9PM (4.162.3 vs. 1.961.3, p50.01), and the former was significantly higher than the latter (p50.03). Conclusion: OSA is accompanied by an altered cardiac sympathovagal balance favoring heightened sympathetic drive at night and morning in patients with CHF. This might contribute to the increased risk of sudden cardiac death during sleep in patients with OSA, and may be associated with poorer prognosis in this patient population.
OP11-2 The Evaluation of Cardiac Function on SAS Patient SHU SUZUKI, OSAMU KITAMUKAI Department of Cardiology Tohoku Kosai Hospital, Sendai, Japan Objectives: Although it is well-known that sleep-disordered breathing may contribute to the progression of heart failure, the precise mechanism is still unclear. To elucidate it we examined the relation between apnea/hypopnea index and cardiac function by conventional, tissue Doppler and speckle tracking echocardiography. Methods: 69 patients who underwent polysomnography (PSG) were divided into two groups by their AHI (mild group: AHI!30, severe group: AHIO30). Results: There were no significant differences in the indicator of diastolic function, but systolic function (LVEF) was significantly (p!0.05) reduced in severe group (59.467.0) than mild group (64.266.2). MPI was significantly (p!0.05) higher in severe group (0.560.1) than mild group (0.460.1). Conclusion: Systolic function of severe sleepapnea patients are significantly reduced, but diastolic function are preserved. Table 1.
AHI!30 AHI (times/h) Age (yrs.) Height (cm) Weights(kg) BMI HR (bpm) Echocardiography data LVDd (mm) LVDs (mm) IVST (mm) PWT (mm) LVMI (gm/m2) EF (%) E/e0 GLS (%) MPI LAVI E/A
AHIO30
18.0 65.7 163.8 67.2 25.0 64.2
6 6 6 6 6 6
6.0 11.0 8.5 12.2 3.7 12.2
49.1 59.1 169.9 77.0 26.7 67.3
6 6 6 6 6 6
16.5* 10.2* 8.0* 12.7* 4.2 12.7
48.4 28.7 9.9 9.8 87.3 64.2 9.0 18.1 0.4 32.1 0.8
6 6 6 6 6 6 6 6 6 6 6
4.8 45 1.5 1.3 19.6 6.2 2.0 3.7 0.1 10.1 0.3
48.4 29.8 9.9 10.3 84.8 59.4 8.8 16.8 0.5 28.6 0.9
6 6 6 6 6 6 6 6 6 6 6
3.9 4.3 2.1 1.6 17.9 7.0* 3.0 2.8 0.1* 114.9 04
*p!0.05 v.s. mild group
OP11-3 Association of Insomnia with Exercise Capacity in Heart Failure Patients YUKI KANNO, AKIOMI YOSHIHISA, TAKESHI SHIMIZU, MAI TAKIGUCHI, HIROYUKI YAMAUCHI, TAKAMASA SATO, SATOSHI SUZUKI, MASAYOSHI OIKAWA, ATSUSHI KOBAYASHI, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
Figure.
Background: Insomnia is associated with incident heart failure (HF). However, clinical significance and impacts of insomnia on exercise capacity in HF remain unclear.