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The Clinical Determinant of Recovery Time from Left Ventricular Systolic Dysfunction and its Impact of the Prognosis in Takotsubo Cardiomyopathy
S202 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 EP5-1 Restrictive Left Ventricular Filling Pattern and Sudden Death Risk in Japanese Patients with Hypertrophic Cardiomyopathy Keigo Kanbayashi, Shintaro Haruki, Yuichiro Minami, Ryozo Maeda, Ryosuke Itani, Kentaro Jujo, Atsushi Suzuki, Tsuyoshi Suzuki, Tsuyoshi Shiga, Nobuhisa Hagiwara; Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan Background: The Doppler echocardiographic pattern of restrictive left ventricular (LV) filling has proved to be an important predictor of prognosis in various cardiac disease. However, the relation between restrictive LV filling and sudden death has not been systematically investigated in Japanese hypertrophic cardiomyopathy (HCM) patients. We evaluated the impact of restrictive LV filling on sudden death risk in a tertiary referral HCM cohort in Japan. Methods and Results: This study included 272 HCM patients in whom Doppler measurements of LV filling had been recorded at initial evaluation. Patients were assigned to one of two groups based on LV filling: a restrictive group (33 patients), with an E/A ratio >2 or E/A between 1 and 2 and deceleration time of the peak E velocity <140 ms; and a non-restrictive group (239 patients). Seven of 33 patients (21.2%) with restrictive group suffered from the combined endpoint of sudden death and potentially lethal arrhythmic events during the follow-up period of 10.7 ± 9.1 years. In contrast, 14 of 239 patients (5.9%) with non-restrictive group suffered from the combined endpoint during the 10.5 ± 7.4 years. In multivariate analysis adjusted for established risk markers related to HCM, restrictive LV filling was independently associated with sudden death risk (hazard ratio 2.87; P = .029). Conclusions: The restrictive LV filling could help sudden death risk stratification in Japanese patients with HCM.
EP5-2 Impact of the Selvester QRS Score on Prognosis and Myocardial Fibrosis in Non-Ischemic Dilated Cardiomyopathy Hiroaki Hiraiwa, Takahiro Okumura, Toru Kondo, Naoaki Kano, Naoki Watanabe, Kenji Fukaya, Akinori Sawamura, Ryota Morimoto, Yasuko Bando, Toyoaki Murohara; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan Background: The Selvester QRS score is a QRS-scoring system using twelve-lead ECG. It is known to have association with myocardial scar and prognostic value in patients with myocardial infarction. However, its availability in patients with non-ischemic dilated cardiomyopathy (NIDCM) is unknown. Purpose: We investigated the prognostic value of Selvester QRS score in patients with NIDCM. Methods and Results: We enrolled 72 NIDCM patients (50 male, 53 years). The patients with any cardiac devices were excluded. The mean of ejection fraction, plasma BNP level, and the Selvester QRS score were 31.5%, 199.6 pg/mL, and 4.3 points, respectively. All the patients were divided into 2 groups based on QRS score cut-off value of 6 points for prediction of cardiac events; high-score group (≥6 points, n = 25) and low-score group (<6 points, n = 47). The cardiac events were defined as a composite of cardiac death, readmission for heart failure, and lethal arrhythmia. During the mean of 2.8 years follow up periods, 16 cardiac events were observed. In survival analyses, high-score group had a significantly highercardiac events rate than low-score group (Log-rank, P = .041). Cox proportional hazard analyses revealed the Selvester QRS score as an independent determinant of cardiac events (hazard ratio = 1.195, P = .049). Conclusion: The Selvester QRS score had prognostic value in patients with NIDCM, because high QRS score would reflect severe myocardial fibrosis.
EP5-3 Fibrosis Area Semiquantitatively Measured with Endomyocardial Biopsy Specimen Predicts Poor Long-Term Outcome of Dilated Phase Hypertrophic Cardiomyopathy Yasuteru Nakashima1, Yasuo Sugano1, Hideaki Kanzaki1, Junko Nakashima2, Keiko Ogo2, Yoshihiko Ikeda2, Hastsue Ueda2, Toshihisa Anzai1; 1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center; 2Department of Clinical Pathology, National Cerebral and Cardiovascular Center Background: Dilated phase hypertrophic cardiomyopathy (d-HCM) is a rare subtype of hypertrophic cardiomyopathy. Although d-HCM is reported to have poor prognosis with decreased LV systolic function, predictor of long-term outcome of d-HCM has not yet established. Purpose: We investigated the relationship between fibrosis area of endomyocardial biopsy sections and long-term outcome in d-HCM. Method: We studied consecutive 41patients of d-HCM (11 female, mean 55 ± 14 years) between 2000 and 2014. All patients underwent cardiac catheterization including right ventricular endomyocardial biopsy. Demographic, laboratory, and echocardiographic data were collected from the patients’ medical records. Fibrosis area was semiquantatively measured as the ratio of blue-colored area to the whole myocardial area in biopsy sections. Result: Fibrosis area of this study population was 6–32% (mean 15.6 ± 7.5%). Patients were divided into two groups based on ROC analysis of fibrosis area: severe fibrosis group (Fibrosis area ≥24%) and less severe fibrosis group (Fibrosis area <24%). There were no significant differences in basic characteristics between two groups. Despite of comparable LVEF (36 ± 5 vs. 38 ± 7%, P = .56), survival analysis
revealed that patients with severe fibrosis had worse outcome determined by death, LVAS implantation, and appropriate ICD discharge compared to those with less severe fibrosis (P = .002). Conclusions: Fibrosis area determined by semiquantitative analysis with endomyocardial biopsy could be a predictor of poor outcome in patients with d-HCM.
EP5-4 The Clinical Determinant of Recovery Time from Left Ventricular Systolic Dysfunction and its Impact of the Prognosis in Takotsubo Cardiomyopathy Yuko Soyama, Toshiaki Mano, Mitsuru Masaki, Akiko Goda, Akiyo Eguchi, Kumiko Masai, Aika Matsumoto, Tohru Masuyama; Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan Takotsubo cardiomyopathy (TC) is characterized as reversible left ventricular systolic dysfunction (LVSD) and the prognosis is favorable in general. Recovery speed of LVSD varies among patients and is unclear whether it affects the prognosis of TTC. We aimed to determine the clinical parameters related with delayed recovery (DR) from LVSD in TTC patients. A 12-lead ECG, echocardiography and blood samples were examined within 24 hours after the admission. We diagnosed 47 patients as TTC according to the Mayo Criteria. The mean recovery period was 10 ± 13 days and we defined DR as sustained LVSD > 10 days. Serum creatinine, BNP and CRP levels, BMI, use of beta blockade and no use of Ca blocker were associated with DR. In the echo parameters, LVEF, TRPG, LVDd and LAVI at acute phase were associated with DR (P = .0001, 0.03, 0.046, 0.013 respectively). Mutiple logistic regression analysisy among these echo parameters showed LVEF and LAVI were the indipendent predictors of DR (P = .046, 0.015 respectively). There were more patients with heart failure, lethal arrhythmia or all cause death in DR group than no DR group (P = .039). LVEF and LAVI might have the information of the recovery speed of of LV systolic dysfunction. The delayed recovery from LV systolic dysfunction might affect the prognosis of patients with TTC.
EP5-5 What a Predictive Factor of Decreased Cardiac Contractility with Hematological Malignancy after Bone Marrow Transplantation? Yoshiyuki Orihara1, Shinichi Hirotani1, Tomotaka Ando1,2, Toshiaki Mano1, Masaharu Ishihara2, Tohru Masuyama1; 1Cardiovascular Division, Department of Internal Medicine Hyogo College of Medicine; 2Division of Coronary Heart Disease hyogo College of Medicine Background: Patients with hematological malignancy often exhibit decrease in cardiac contractility after bone marrow transplantation. However, it is not yet clear that factors associated with decrease in cardiac contractility after bone marrow transplantation. Method: Consecutive 53 patients with hematological malignancy (age:41 ± 14 years old) underwent bone marrow transplantation from January 2014 to December 2014 in the College Hospital were enrolled. All patients underwent echocardiography before transplantation. After transplantation, patients were underwent echocardiography within two months. Decrease in cardiac contractility was defined as decrease of ejection fraction (EF) down to less than 50% after bone marrow transplantation. A multiregression analysis was performed to assess for factors independently associated with decrease in cardiac contractility. Result: Eight patients (14%) exhibited decreased in EF. The triggers of decreased in EF were mainly infection and graft versus host disease. The baseline EF of the patients who exhibited decrease in cardiac contractility was significantly lower than that of the patients who did not (62 ± 8% vs. 67 ± 6%, P = .04). Multiregression analysis revealed that baseline EF was the only independent association factor for decrease in cardiac contractility. The cut-off value for decrease in cardiac contractility was 62.0% (sensitivity 82.0%, specificity 62.5%). Conclusion: In patients who received bone marrow transplants, EF < 62% was associated with decrease in cardiac contractility.
EP5-6 Primary Prevention of Subclinical Cardiotoxicity in Breast Cancer Patients Treated with Doxorubicin Woo-Baek Chung1, Sang Hyun Ihm1, Ho-Joong Youn1, Byung Joo Chae2, Byung-Joo Song2; 1Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea; 2Department of Surgery, The Catholic University of Korea 110 patients from prospective registry (Pros) for prediction and prevention of chemotherapy induced cardiotoxicity in breast cancer were selected. All patients were administered candesartan or carvedilol concomitantly with doxorubicin contained chemotherapy. 85 patients from retrospective registry (Retros) of breast cancer of our institution were selected for control. Transthoracic echocardiography was performed before, during and after the chemotherapy. LVEF of Pros showed no change during follow up period, however, LVEF of Retros showed gradual decrement (Table 1). Incidence of subclinical carditoxicity (SC) was higher in Retros. Number of SC with LVEF <55% was higher in Retros. 3 out of 6 patients in Pros recovered from SC at 2nd follow up and 2 out of 5 patients recovered in Retros. Concomitant administration of candesartan or carvedilol can reduce incidence of SC.
EP5-2 Impact of the Selvester QRS Score on Prognosis and Myocardial Fibrosis in Non-Ischemic Dilated Cardiomyopathy Hiroaki Hiraiwa, Takahiro Okumura, Toru Kondo, Naoaki Kano, Naoki Watanabe, Kenji Fukaya, Akinori Sawamura, Ryota Morimoto, Yasuko Bando, Toyoaki Murohara; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan Background: The Selvester QRS score is a QRS-scoring system using twelve-lead ECG. It is known to have association with myocardial scar and prognostic value in patients with myocardial infarction. However, its availability in patients with non-ischemic dilated cardiomyopathy (NIDCM) is unknown. Purpose: We investigated the prognostic value of Selvester QRS score in patients with NIDCM. Methods and Results: We enrolled 72 NIDCM patients (50 male, 53 years). The patients with any cardiac devices were excluded. The mean of ejection fraction, plasma BNP level, and the Selvester QRS score were 31.5%, 199.6 pg/mL, and 4.3 points, respectively. All the patients were divided into 2 groups based on QRS score cut-off value of 6 points for prediction of cardiac events; high-score group (≥6 points, n = 25) and low-score group (<6 points, n = 47). The cardiac events were defined as a composite of cardiac death, readmission for heart failure, and lethal arrhythmia. During the mean of 2.8 years follow up periods, 16 cardiac events were observed. In survival analyses, high-score group had a significantly highercardiac events rate than low-score group (Log-rank, P = .041). Cox proportional hazard analyses revealed the Selvester QRS score as an independent determinant of cardiac events (hazard ratio = 1.195, P = .049). Conclusion: The Selvester QRS score had prognostic value in patients with NIDCM, because high QRS score would reflect severe myocardial fibrosis.
EP5-3 Fibrosis Area Semiquantitatively Measured with Endomyocardial Biopsy Specimen Predicts Poor Long-Term Outcome of Dilated Phase Hypertrophic Cardiomyopathy Yasuteru Nakashima1, Yasuo Sugano1, Hideaki Kanzaki1, Junko Nakashima2, Keiko Ogo2, Yoshihiko Ikeda2, Hastsue Ueda2, Toshihisa Anzai1; 1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center; 2Department of Clinical Pathology, National Cerebral and Cardiovascular Center Background: Dilated phase hypertrophic cardiomyopathy (d-HCM) is a rare subtype of hypertrophic cardiomyopathy. Although d-HCM is reported to have poor prognosis with decreased LV systolic function, predictor of long-term outcome of d-HCM has not yet established. Purpose: We investigated the relationship between fibrosis area of endomyocardial biopsy sections and long-term outcome in d-HCM. Method: We studied consecutive 41patients of d-HCM (11 female, mean 55 ± 14 years) between 2000 and 2014. All patients underwent cardiac catheterization including right ventricular endomyocardial biopsy. Demographic, laboratory, and echocardiographic data were collected from the patients’ medical records. Fibrosis area was semiquantatively measured as the ratio of blue-colored area to the whole myocardial area in biopsy sections. Result: Fibrosis area of this study population was 6–32% (mean 15.6 ± 7.5%). Patients were divided into two groups based on ROC analysis of fibrosis area: severe fibrosis group (Fibrosis area ≥24%) and less severe fibrosis group (Fibrosis area <24%). There were no significant differences in basic characteristics between two groups. Despite of comparable LVEF (36 ± 5 vs. 38 ± 7%, P = .56), survival analysis
revealed that patients with severe fibrosis had worse outcome determined by death, LVAS implantation, and appropriate ICD discharge compared to those with less severe fibrosis (P = .002). Conclusions: Fibrosis area determined by semiquantitative analysis with endomyocardial biopsy could be a predictor of poor outcome in patients with d-HCM.
EP5-4 The Clinical Determinant of Recovery Time from Left Ventricular Systolic Dysfunction and its Impact of the Prognosis in Takotsubo Cardiomyopathy Yuko Soyama, Toshiaki Mano, Mitsuru Masaki, Akiko Goda, Akiyo Eguchi, Kumiko Masai, Aika Matsumoto, Tohru Masuyama; Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan Takotsubo cardiomyopathy (TC) is characterized as reversible left ventricular systolic dysfunction (LVSD) and the prognosis is favorable in general. Recovery speed of LVSD varies among patients and is unclear whether it affects the prognosis of TTC. We aimed to determine the clinical parameters related with delayed recovery (DR) from LVSD in TTC patients. A 12-lead ECG, echocardiography and blood samples were examined within 24 hours after the admission. We diagnosed 47 patients as TTC according to the Mayo Criteria. The mean recovery period was 10 ± 13 days and we defined DR as sustained LVSD > 10 days. Serum creatinine, BNP and CRP levels, BMI, use of beta blockade and no use of Ca blocker were associated with DR. In the echo parameters, LVEF, TRPG, LVDd and LAVI at acute phase were associated with DR (P = .0001, 0.03, 0.046, 0.013 respectively). Mutiple logistic regression analysisy among these echo parameters showed LVEF and LAVI were the indipendent predictors of DR (P = .046, 0.015 respectively). There were more patients with heart failure, lethal arrhythmia or all cause death in DR group than no DR group (P = .039). LVEF and LAVI might have the information of the recovery speed of of LV systolic dysfunction. The delayed recovery from LV systolic dysfunction might affect the prognosis of patients with TTC.
EP5-5 What a Predictive Factor of Decreased Cardiac Contractility with Hematological Malignancy after Bone Marrow Transplantation? Yoshiyuki Orihara1, Shinichi Hirotani1, Tomotaka Ando1,2, Toshiaki Mano1, Masaharu Ishihara2, Tohru Masuyama1; 1Cardiovascular Division, Department of Internal Medicine Hyogo College of Medicine; 2Division of Coronary Heart Disease hyogo College of Medicine Background: Patients with hematological malignancy often exhibit decrease in cardiac contractility after bone marrow transplantation. However, it is not yet clear that factors associated with decrease in cardiac contractility after bone marrow transplantation. Method: Consecutive 53 patients with hematological malignancy (age:41 ± 14 years old) underwent bone marrow transplantation from January 2014 to December 2014 in the College Hospital were enrolled. All patients underwent echocardiography before transplantation. After transplantation, patients were underwent echocardiography within two months. Decrease in cardiac contractility was defined as decrease of ejection fraction (EF) down to less than 50% after bone marrow transplantation. A multiregression analysis was performed to assess for factors independently associated with decrease in cardiac contractility. Result: Eight patients (14%) exhibited decreased in EF. The triggers of decreased in EF were mainly infection and graft versus host disease. The baseline EF of the patients who exhibited decrease in cardiac contractility was significantly lower than that of the patients who did not (62 ± 8% vs. 67 ± 6%, P = .04). Multiregression analysis revealed that baseline EF was the only independent association factor for decrease in cardiac contractility. The cut-off value for decrease in cardiac contractility was 62.0% (sensitivity 82.0%, specificity 62.5%). Conclusion: In patients who received bone marrow transplants, EF < 62% was associated with decrease in cardiac contractility.
EP5-6 Primary Prevention of Subclinical Cardiotoxicity in Breast Cancer Patients Treated with Doxorubicin Woo-Baek Chung1, Sang Hyun Ihm1, Ho-Joong Youn1, Byung Joo Chae2, Byung-Joo Song2; 1Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea; 2Department of Surgery, The Catholic University of Korea 110 patients from prospective registry (Pros) for prediction and prevention of chemotherapy induced cardiotoxicity in breast cancer were selected. All patients were administered candesartan or carvedilol concomitantly with doxorubicin contained chemotherapy. 85 patients from retrospective registry (Retros) of breast cancer of our institution were selected for control. Transthoracic echocardiography was performed before, during and after the chemotherapy. LVEF of Pros showed no change during follow up period, however, LVEF of Retros showed gradual decrement (Table 1). Incidence of subclinical carditoxicity (SC) was higher in Retros. Number of SC with LVEF <55% was higher in Retros. 3 out of 6 patients in Pros recovered from SC at 2nd follow up and 2 out of 5 patients recovered in Retros. Concomitant administration of candesartan or carvedilol can reduce incidence of SC.