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The Influence of Skeletal Muscle Pump Function and Strength on Exercise Capacity in Patients with Chronic Heart Failure
S160 Journal of Cardiac Failure Vol. 20 No. 10S October 2014 ventricular systolic pressure (RVSP) was 55 mmHg. Thus, she was diagnosed as PH with OHS. During the hospital course, the estimated RVSP reduced to 39 mmHg in association with reductions in BMI to 30.6 kg/m2 and daytime PaCO2 to 54.5 Torr with nocturnal NPPV. This case reminds us that OHS may cause PH but weight loss and nocturnal NPPV can be effective strategies to treat PH in OHS patients.
O-088 Paradoxical Emboli Might Occur in Patients with Pulmonary Hypertension without a Right-to-left Shunt SHINGO WATANABE1, KAZUYA MURATA1, TAE ISHIKAWA1, KEITA HANDA1, KAORU SAKURAI1, KOJI AZEGAMI1, MITSUAKI ISOBE2 1 Department of Cardiovascular Medicine, Shinyurigaoka General Hospital, Kanagawa, Japan, 2Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo A 41-year-old woman was admitted to our hospital to undergo ovarian cystectomy. Echocardiography before the surgery showed pulmonary hypertension (TR max PG557.9mmHg). After induction of anesthesia, she went into shock which was recovered by immediate use of Dobutamine. Contrast CT was performed. Her blood pressure had been maintained before the contrast CT, but after contrast media injection, she went into shock again immediately. Electrocardiogram showed ST elevation in leads II and III and aVf. She recovered from the shock in about 10 minutes. ST elevation in the electrocardiogram was also improved. The contrast CT showed air in the left ventricle. It was thought that the air in the venous line migrated into the left ventricle, and caused the right coronary artery embolism. No right-to-left shunt was found in the transoesophageal echocardiography and right heart catheterization. She was diagnosed with chronic thromboembolic pulmonary hypertension by the lung perfusion scintigraphy performed at a later date. When right atrial pressure is high, paradoxical emboli might occur in the patients even without a right-to-left shunt.
O-089 Let-7 Family microRNAs Expression in Subcutaneous Skin Negatively Correlate with Severity of Pulmonary Hypertension in Patients with Systemic Scleroderma YASUHIRO IZUMIYA, YUICHI KIMURA, YOSHIRO ONOUE, SHINSUKE HANATANI, SATOSHI ARAKI, HISAO OGAWA Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan Introduction: Recent evidence indicate that miRNAs are involved in various cardiovascular diseases. However, its roles in connective tissue disease-associated pulmonary hypertension (PH) are not clear. Methods and Results: We examined miRNA expression profile in subcutaneous skin samples obtained from 16 systemic scleroderma (SSc) patients. To determine which miRNAs are involved in SSc-associated PH, a mixture of equal amount of miRNAs from PH or non-PH were prepared. We performed miRNA PCR array analysis, and the miRNA expression was comprehensively compared. We found that 591 miRNAs were upregulated, and 57 miRNAs were downregulated in PH group. Among them, only miRNAs which showed a Ct value less than 30 were considered for further analysis. When a 1.5-fold difference was considered meaningful, 32 miRNAs were upregulated, and 14 miRNAs were down regulated in PH group. Interestingly, 5 out of 14 downregulated miRNAs belongs to let-7 family. We confirmed the array results by quantitative real-time PCR with specific primer for each miRNAs individually and found that 4 let-7 family members were significantly downregulated in 6 PH compared with those in 10 non-PH skin. The expression level of let-7d was negatively correlated with pulmonary arterial pressure measured by echocardiography. Conclusions: Downregulation of let-7 family miRNA in subcutaneous tissue could be used as a marker to identify the presence of PH in patients with SSc.
O-090 Predictors of Smaller Oxygen Uptake Reserve Above Anaerobic Threshold in Patients with Cardiovascular Diseases NAOKI FUJIMOTO1, KAORU DOHI2, NAOTO KUMAGAI2, MUNEYOSHI TANIMURA2, YUICHI SATO2, EMIYO SUGIURA2, SHIRO NAKAMORI2, NORIKAZU YAMADA2, MASIO NAKAMURA3, MASAAKI ITO2 1 Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan, 2Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan, 3Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu, Japan Background: Aerobic exercise up to 70 % of peak oxygen uptake (VO2peak) or below anaerobic threshold (VO2AT) is recommended in patients with cardiovascular diseases. However, a VO2AT/VO2peak ratio greater than 0.70 is often observed in such patients at maximal exercise testing. Methods: Fifty two cardiovascular patients (60614 years, m/f 44/8) with their peak respiratory exchange ratio (RER) O1.10
at cardiopulmonary exercise test, indicative of maximal effort, were stratified into 2 groups: VO2AT/VO2peakO0.70 (n533) and VO2AT/VO2peak!0.70 (n522). Clinical variables including echocardiographic data were compared, and predictors of VO2AT/ VO2peak were evaluated. Result: VO2AT/VO2peak ratio and age were higher in VO2AT/ VO2peakO0.70 than VO2AT/VO2peak!0.70 (0.7760.08 vs. 0.6260.06, and 64610 vs. 56616 years, p!0.01). No differences were observed in gender, current medication, underling diseases, or RER at anaerobic threshold and peak exercise (1.2460.11 vs. 1.2660.09, p50.51). At peak exercise, VO2AT/VO2peakO0.70 had smaller peak heart rates (p50.02), VO2peak (19.965.9 vs. 22.8654.0 ml/kg/min, p!0.01), minutes ventilation (p!0.01), and work rates (86628 vs. 106624 watt, p!0.01). Echocardiography showed higher E wave, slower peak early diastolic mitral annular velocity, and lower ejection fraction in VO2AT/VO2peakO0.70. Multivariate analysis showed that age was positively and left ventricular ejection fraction and VO2peak were negatively associated with VO2AT/VO2peak ratio. Conclusion: Cardiovascular patients with higher age and lower ejection fraction may have smaller oxygen uptake reserve above anaerobic threshold.
O-091 The Influence of Skeletal Muscle Pump Function and Strength on Exercise Capacity in Patients with Chronic Heart Failure TORU KONDO1, SUMIO YAMADA2, CHIKAKO ASAI3, TATSUYA MATSUOKA4, DAISUKE TANIMURA5, YOSHIHUMI AWAJI5, RINYA KATO5 1 Konan Kosei Hospital, Department of Cardiology, Aichi, Japan, 2Nagoya University Graduate School of Medicine, Rehabilitation of Medical Science, Aichi, Japan, 3 Japanese Red Cross Nagoya Daini Hospital, Department of Rehabilitation, Aichi, Japan, 4Nagoya Ekisaikai Hospital, Department of Rehabilitation, Aichi, Japan, 5 Nagoya Ekisaikai Hospital, Department of Cardiology, Aichi, Japan Background: Decreased skeletal muscle strength in heart failure (HF) has been reported to well relate to the reduced peak oxygen consumption (VO2). However, the underlying mechanism of this relationship has not been fully investigated. This study aimed to examine the relationship between skeletal muscle function (pump function and strength) and the cardiopulmonary exercise testing parameters. Methods: We enrolled 69 HF patients without atrial fibrillation. Venous volume (VV) and ejected volume (EV) of lower leg were measured by strain-gauge plethysmography and leg ejection fraction (LEF) was computed (LEF5EV100/VV) as the index of preload. Isokinetic strength was measured by Strength Ergo240. Results: LEF significantly correlated with peak O2 pulse (r50.43) and peakVO2 (r50.22). Multiple linear regression analysis revealed that hemoglobin (b50.353), left ventricular ejection fraction (LVEF) (b50.321), and LEF (b50.279) were selected as significant determinants of peak O2 pulse. LEF was strongly correlated with peak O2 pulse (r50.62, p! 0.001) in HF with reduced ejection fraction (HFrEF) (LVEF#40%), but not in HF with preserved ejection fraction (EF$50%) (r50.24, p50.21). Otherwise, muscle strength was more strongly correlated with peak HR (r50.56). Conclusions: The skeletal muscle pump and strength have different manner in contribution to exercise capacity, the pump function achieves stroke volume especially in HFrEF and muscle strength leads to higher peak VO2 by accelerating HR during exercise.
O-092 Characteristics of Sarcopenia in Patients with Heart Failure HIROAKI OBATA1, TORU IZUMI2, WATARU MITSUMA3, ASAKO TOMII5, KATSUYUKI SAKAI4, AKIFUMI UEHARA2, TOHRU WATANABE1, TAKESHI KASHIMURA1, HARUO HANAWA1, TOHRU MINAMINO1 1 Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan, 2Department of Internal Medicine, Niigata Minami Hospital, Niigata, Japan, 3Department of Cardiology, Shinrakuen Hospital, Niigata, Japan, 4Department of Cardiology, Saiseikai Niigata Daini Hospital, Niigata, Japan, 5Department of cardiology, Niigata Medical center, Niigata, Japan Background: The loss of skeletal muscle mass (sarcopenia) is a major determinant of strength loss in aging. This study aimed to determine the relationship between skeletal muscle mass and function in patients with heart failure. Methods and Results: Appendicular skeletal muscle mass was measured by dual x-ray absorptiometry in 28 patients with heart failure aged 43-91 years, who underwent phase 2 cardiac rehabilitation. We defined sarcopenia as appendicular skeletal muscle mass/height2 (skeletal muscle mass index: SMI) less than 2 standard deviations below the mean for young, healthy Japanese reference populations. There were 16 (57.1%) patients with sarcopenia. SMI was inversely correlated with age (r5-0.45; p50.016), and correlated with grasping power (r50.77; p!0.001), knee extension strength (r50.66; p50.001), and walking speed (r50.41; p50.029). However, SMI was not correlated with left ventricular ejection fraction (LVEF) and BNP. Interestingly, 5 (45.5%) patients had sarcopenia among 11 non-elderly patients (!65 years). When compared to elderly patients with sarcopenia, muscle strength and balance function were not decreased; however, LVEF tended to be lower in non-elderly patients with sarcopenia. Conclusions: In patients with heart failure, sarcopenia was a determinant of muscle strength and ambulatory function. The prevalence of sarcopenia may be high; a pathogenesis different from aging is suggested in non-elderly patients with severe heart failure.
O-088 Paradoxical Emboli Might Occur in Patients with Pulmonary Hypertension without a Right-to-left Shunt SHINGO WATANABE1, KAZUYA MURATA1, TAE ISHIKAWA1, KEITA HANDA1, KAORU SAKURAI1, KOJI AZEGAMI1, MITSUAKI ISOBE2 1 Department of Cardiovascular Medicine, Shinyurigaoka General Hospital, Kanagawa, Japan, 2Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo A 41-year-old woman was admitted to our hospital to undergo ovarian cystectomy. Echocardiography before the surgery showed pulmonary hypertension (TR max PG557.9mmHg). After induction of anesthesia, she went into shock which was recovered by immediate use of Dobutamine. Contrast CT was performed. Her blood pressure had been maintained before the contrast CT, but after contrast media injection, she went into shock again immediately. Electrocardiogram showed ST elevation in leads II and III and aVf. She recovered from the shock in about 10 minutes. ST elevation in the electrocardiogram was also improved. The contrast CT showed air in the left ventricle. It was thought that the air in the venous line migrated into the left ventricle, and caused the right coronary artery embolism. No right-to-left shunt was found in the transoesophageal echocardiography and right heart catheterization. She was diagnosed with chronic thromboembolic pulmonary hypertension by the lung perfusion scintigraphy performed at a later date. When right atrial pressure is high, paradoxical emboli might occur in the patients even without a right-to-left shunt.
O-089 Let-7 Family microRNAs Expression in Subcutaneous Skin Negatively Correlate with Severity of Pulmonary Hypertension in Patients with Systemic Scleroderma YASUHIRO IZUMIYA, YUICHI KIMURA, YOSHIRO ONOUE, SHINSUKE HANATANI, SATOSHI ARAKI, HISAO OGAWA Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan Introduction: Recent evidence indicate that miRNAs are involved in various cardiovascular diseases. However, its roles in connective tissue disease-associated pulmonary hypertension (PH) are not clear. Methods and Results: We examined miRNA expression profile in subcutaneous skin samples obtained from 16 systemic scleroderma (SSc) patients. To determine which miRNAs are involved in SSc-associated PH, a mixture of equal amount of miRNAs from PH or non-PH were prepared. We performed miRNA PCR array analysis, and the miRNA expression was comprehensively compared. We found that 591 miRNAs were upregulated, and 57 miRNAs were downregulated in PH group. Among them, only miRNAs which showed a Ct value less than 30 were considered for further analysis. When a 1.5-fold difference was considered meaningful, 32 miRNAs were upregulated, and 14 miRNAs were down regulated in PH group. Interestingly, 5 out of 14 downregulated miRNAs belongs to let-7 family. We confirmed the array results by quantitative real-time PCR with specific primer for each miRNAs individually and found that 4 let-7 family members were significantly downregulated in 6 PH compared with those in 10 non-PH skin. The expression level of let-7d was negatively correlated with pulmonary arterial pressure measured by echocardiography. Conclusions: Downregulation of let-7 family miRNA in subcutaneous tissue could be used as a marker to identify the presence of PH in patients with SSc.
O-090 Predictors of Smaller Oxygen Uptake Reserve Above Anaerobic Threshold in Patients with Cardiovascular Diseases NAOKI FUJIMOTO1, KAORU DOHI2, NAOTO KUMAGAI2, MUNEYOSHI TANIMURA2, YUICHI SATO2, EMIYO SUGIURA2, SHIRO NAKAMORI2, NORIKAZU YAMADA2, MASIO NAKAMURA3, MASAAKI ITO2 1 Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan, 2Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan, 3Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu, Japan Background: Aerobic exercise up to 70 % of peak oxygen uptake (VO2peak) or below anaerobic threshold (VO2AT) is recommended in patients with cardiovascular diseases. However, a VO2AT/VO2peak ratio greater than 0.70 is often observed in such patients at maximal exercise testing. Methods: Fifty two cardiovascular patients (60614 years, m/f 44/8) with their peak respiratory exchange ratio (RER) O1.10
at cardiopulmonary exercise test, indicative of maximal effort, were stratified into 2 groups: VO2AT/VO2peakO0.70 (n533) and VO2AT/VO2peak!0.70 (n522). Clinical variables including echocardiographic data were compared, and predictors of VO2AT/ VO2peak were evaluated. Result: VO2AT/VO2peak ratio and age were higher in VO2AT/ VO2peakO0.70 than VO2AT/VO2peak!0.70 (0.7760.08 vs. 0.6260.06, and 64610 vs. 56616 years, p!0.01). No differences were observed in gender, current medication, underling diseases, or RER at anaerobic threshold and peak exercise (1.2460.11 vs. 1.2660.09, p50.51). At peak exercise, VO2AT/VO2peakO0.70 had smaller peak heart rates (p50.02), VO2peak (19.965.9 vs. 22.8654.0 ml/kg/min, p!0.01), minutes ventilation (p!0.01), and work rates (86628 vs. 106624 watt, p!0.01). Echocardiography showed higher E wave, slower peak early diastolic mitral annular velocity, and lower ejection fraction in VO2AT/VO2peakO0.70. Multivariate analysis showed that age was positively and left ventricular ejection fraction and VO2peak were negatively associated with VO2AT/VO2peak ratio. Conclusion: Cardiovascular patients with higher age and lower ejection fraction may have smaller oxygen uptake reserve above anaerobic threshold.
O-091 The Influence of Skeletal Muscle Pump Function and Strength on Exercise Capacity in Patients with Chronic Heart Failure TORU KONDO1, SUMIO YAMADA2, CHIKAKO ASAI3, TATSUYA MATSUOKA4, DAISUKE TANIMURA5, YOSHIHUMI AWAJI5, RINYA KATO5 1 Konan Kosei Hospital, Department of Cardiology, Aichi, Japan, 2Nagoya University Graduate School of Medicine, Rehabilitation of Medical Science, Aichi, Japan, 3 Japanese Red Cross Nagoya Daini Hospital, Department of Rehabilitation, Aichi, Japan, 4Nagoya Ekisaikai Hospital, Department of Rehabilitation, Aichi, Japan, 5 Nagoya Ekisaikai Hospital, Department of Cardiology, Aichi, Japan Background: Decreased skeletal muscle strength in heart failure (HF) has been reported to well relate to the reduced peak oxygen consumption (VO2). However, the underlying mechanism of this relationship has not been fully investigated. This study aimed to examine the relationship between skeletal muscle function (pump function and strength) and the cardiopulmonary exercise testing parameters. Methods: We enrolled 69 HF patients without atrial fibrillation. Venous volume (VV) and ejected volume (EV) of lower leg were measured by strain-gauge plethysmography and leg ejection fraction (LEF) was computed (LEF5EV100/VV) as the index of preload. Isokinetic strength was measured by Strength Ergo240. Results: LEF significantly correlated with peak O2 pulse (r50.43) and peakVO2 (r50.22). Multiple linear regression analysis revealed that hemoglobin (b50.353), left ventricular ejection fraction (LVEF) (b50.321), and LEF (b50.279) were selected as significant determinants of peak O2 pulse. LEF was strongly correlated with peak O2 pulse (r50.62, p! 0.001) in HF with reduced ejection fraction (HFrEF) (LVEF#40%), but not in HF with preserved ejection fraction (EF$50%) (r50.24, p50.21). Otherwise, muscle strength was more strongly correlated with peak HR (r50.56). Conclusions: The skeletal muscle pump and strength have different manner in contribution to exercise capacity, the pump function achieves stroke volume especially in HFrEF and muscle strength leads to higher peak VO2 by accelerating HR during exercise.
O-092 Characteristics of Sarcopenia in Patients with Heart Failure HIROAKI OBATA1, TORU IZUMI2, WATARU MITSUMA3, ASAKO TOMII5, KATSUYUKI SAKAI4, AKIFUMI UEHARA2, TOHRU WATANABE1, TAKESHI KASHIMURA1, HARUO HANAWA1, TOHRU MINAMINO1 1 Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan, 2Department of Internal Medicine, Niigata Minami Hospital, Niigata, Japan, 3Department of Cardiology, Shinrakuen Hospital, Niigata, Japan, 4Department of Cardiology, Saiseikai Niigata Daini Hospital, Niigata, Japan, 5Department of cardiology, Niigata Medical center, Niigata, Japan Background: The loss of skeletal muscle mass (sarcopenia) is a major determinant of strength loss in aging. This study aimed to determine the relationship between skeletal muscle mass and function in patients with heart failure. Methods and Results: Appendicular skeletal muscle mass was measured by dual x-ray absorptiometry in 28 patients with heart failure aged 43-91 years, who underwent phase 2 cardiac rehabilitation. We defined sarcopenia as appendicular skeletal muscle mass/height2 (skeletal muscle mass index: SMI) less than 2 standard deviations below the mean for young, healthy Japanese reference populations. There were 16 (57.1%) patients with sarcopenia. SMI was inversely correlated with age (r5-0.45; p50.016), and correlated with grasping power (r50.77; p!0.001), knee extension strength (r50.66; p50.001), and walking speed (r50.41; p50.029). However, SMI was not correlated with left ventricular ejection fraction (LVEF) and BNP. Interestingly, 5 (45.5%) patients had sarcopenia among 11 non-elderly patients (!65 years). When compared to elderly patients with sarcopenia, muscle strength and balance function were not decreased; however, LVEF tended to be lower in non-elderly patients with sarcopenia. Conclusions: In patients with heart failure, sarcopenia was a determinant of muscle strength and ambulatory function. The prevalence of sarcopenia may be high; a pathogenesis different from aging is suggested in non-elderly patients with severe heart failure.