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The Use of Tolvaptan in a Case of Severe Heart Failure with Drug-induced Cardiomyopathy
S208 Journal of Cardiac Failure Vol. 20 No. 10S October 2014 Median irisin levels in each group were 45.77ng/ml and 64.72ng/ml, respectively. Low irisin group revealed significantly higher high sensitive troponin T levels than high irisin group (median 0.024, interquartile range [0.012-0.042] vs. 0.014, [0.008-0.023] ng/ml, p50.006). Right heart catheterization demonstrated that pulmonary capillary wedge pressure is higher in the low than the high irisin group (15.967.0 vs. 12.365.8 mmHg, p50.013). Kaplan Meier curve revealed that the event-free rate was decreased in the low irisin group (log-rank test p50.042). In receiver operating characteristic analysis, irisin achieved an area under the curve of 0.67 for the identification of event free 1year survival (p50.031). Conclusions: Irisin could be a useful biomarker for evaluating disease severity and providing prognostic information in patients with HFrEF.
man was admitted with fatigue and fever. Severe mitral regurgitation due to infective endocarditis was diagnosed and he also had CHF with pulmonary hypertension and low cardiac output. We performed urgent mitral valve replacement. The early postoperative course was relatively smooth, and oral furosemide was initiated after extubation on day 3. However, CHF symptoms secondary to volume overload appeared on day 6. The chest X-ray film showed bilateral pleural effusions and an enlarged CTR. Echocardiography revealed impaired LV contraction and pulmonary hypertension. Oral tolvaptan (7.5 mg) was administered in addition to low-dose dobutamine. His body weight decreased by 8.2 kg after one week and CHF improved rapidly. Electrolyte imbalance did not occur and hemodynamics did not deteriorate in both patients. In conclusion, tolvaptan is effective for refractory CHF after cardiac surgery.
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Utility of Neutrophil to Lymphocyte Ratio for Predicting Sudden Cardiac Death in Patients With Ischemic and Non-ischemic Chronic Heart Failure TAKAHISA YAMADA, TAKASHI MORITA, SHUNSUKE TAMAKI, MASATAKE FUKUNAMI D Division of Cardiology, Osaka Medical Center
The Use of Tolvaptan in a Case of Severe Heart Failure with Drug-induced Cardiomyopathy TAICHI OKONOGI The Department of Cardiovascular Medicine, Heart Center, New Yukuhashi Hospital, Yukuhashi, Japan
The neutrophil to lymphocyte ratio (NLR) has been associated with poor outcome in patients with acute coronary syndrome. To investigate the prognostic significance of NLR for predicting sudden cardiac death (SCD) in patients with chronic heart failure (CHF), relating to the etiology (ischemic or non-ischemic), we studied 153 CHF outpatients (ischemic; 51%) with LVEF!40% in our prospective cohort study. These patients underwent complete blood counts with automated differential counts, which included total white blood cell count, neutrophils, lymphocytes, red cell distribution width (RDW) and platelet cell distribution width (PDW), at baseline. During a follow up period of 7.664.3 yrs, 28 patients had SCD. At multivariate Cox analysis, only NLR was independently and significantly associated with SCD in both ischemic and non-ischemic groups, although percent neurophil, percent lymphocyte, RDW or PDW showed a significant association with SCD at univariate analysis. SCD was significantly observed in patients with high NLR (above the highest quartile) than low NLR, in ischemic (43% vs 14%, p50.002) and non-ischemic groups (38% vs 8%, p50.003). The adjusted hazard ratios of high NLR for predicting SCD in ischemic and non-ischemic groups were 3.46 (95%CI 1.04-11.49) and 3.72 (95%CI 1.05-13.20), respectively. Thus, NLR has the long-term prognostic value for the prediction of SCD in CHF patients, irrespective of the etiology.
Tolvaptan is an oral vasopressin V2 receptor antagonist. Recently, many papers report the efficacy and safety of tolvaptan for patients with congestive heart failure. However, there is little information about clinical experience of the use of tolvaptan for a patient with drug-induced cardiomyopathy. A 52-year-old female with relapse breast cancer, invasive ductal carcinoma, treated by the CEF therapy (cyclophosphamide 800mg/day, epirubicin 100mg/day, 5-fluorouracil 800mg/day). After she underwent her 15th cycle of the therapy, she was admitted to our hospital with dyspnea. The chest X-ray showed cardiomegaly with pulmonary congestion and pleural effusion. The transthoracic echocardiogram showed a left ventricular dysfunction with an ejection fraction of 35%. Her physical examination failed to indicate the cause of the heart failure. After analyzing some of her examination, we diagnosed epirubicininduced cardiomyopathy. Treatments with furosemide, carperitide, low-dose dopamine and dobutamine are not useful in this case. Because the patient had a retention of fluid repeatedly, we administered a low-dose tolvaptan (7.5mg/day). As a result, her edema and body weight were reduced remarkably without worsening renal dysfunction, allowing her discharge from our hospital. It is possible that the use of tolvaptan enabled us to improve heart failure safety for patients with drug-induced cardiomyopathy.
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Circulating Invariant Natural Killer T Cells are Decreased in Patients With Chronic Heart Failure AKIMICHI SAITO, NAOKI ISHIMORI, MIKITO NISHIKAWA, SHINTARO KINUGAWA, HIROYUKI TSUTSUI Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Tolvaptan was Effective in Patient with Heart Failure due to Subclavian Arteriovenous Malformation ATSUKO HIRAMINE, TAKURO KUBOZONO, SHIN KAWASOE, KUNITSUGU TAKASAKI, AKIRA KISANUKI, MASAAKI MIYATA, MITSURU OHISHI Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
Objective: Inflammation plays a crucial role in the development of chronic heart failure (HF). We have demonstrated that invariant natural killer T (iNKT) cells, a unique subset of T lymphocytes, have a protective role against left ventricular (LV) remodeling after myocardial infarction in mice. However, little is known about the changes in iNKT cells in patients with HF. Methods and Results: Nine patients with HF (NYHA II or III, LV ejection fraction 26.363.0%) and 8 healthy controls were studied. The number of circulating Va24+ iNKT cells in peripheral blood by flowcytometric analysis. The causes of HF were idiopathic dilated cardiomyopathy in 3, ischemic in 2, and others in 4 patients. Plasma BNP was significantly higher in HF (739.46207.2 vs. 19.866.5 pg/mL, P!0.01). The number of circulating iNKT cells and the ratio of the iNKT cell number to the total lymphocyte number were significantly lower in HF (747685 vs. 10586271 counts/mL and 0.11160.004 vs. 0.14660.035%, respectively, both P!0.01). Plasma interleukin-6 and hs-CRP were significantly higher in HF (3.9960.86 vs. 0.7860.14 pg/mL and 0.2860.10 vs. 0.0660.02 mg/dL, respectively, both P!0.01). LV ejection fraction (r50.72, P!0.05) and plasma logBNP (r5-0.70, P!0.05) were significantly correlated to iNKT cell ratio among HF patients. Conclusion: Circulating iNKT cells were decreased in patients with HF, indicating that they may be involved in this disease.
The patients with heart failure due to subclavian arteriovenous malformation are rare, and its treatment is difficult. Here, we report a 74-year-old male patient. In 1998, he was diagnosed with heart failure due to subclavian arteriovenous malformation and received medical treatment. Heart failure progressed, and he was treated with the coil embolism in 2009. However, the coil embolism was not effective to reduce the shunt flow and his symptom progressed slowly. He admitted because of general malaise and appetite loss, the edema was observed in his whole body, and the shunt flow was heard at his neck. The cardiomegaly and the pleural effusion were shown in a chest X-ray. The echocardiography demonstrated the dilatation of right atrium and ventricle and the severe tricuspid valve regurgitation with the cusp separation. He have been already treated with the high dose of diuretics including furosemide (80 mg/day), eplerenone (50 mg/day) and trichlormethiazide (2 mg/day). It is not improved with low-salt diet and rest, and tolvapvtan (7.5 mg/day) was added. The urine volume increased after the administration of tolvaptan, and the body weight decreased by 7 kg in a week. His symptom of general fatigue improved and appetite also increased. In this case, tolvaptan was effective in the patient with heart failure due to subclavian arteriovenous malformation.
P-132 Tolvaptan for Perioperative Heart Failure in Patients with Preoperative Pulmonary Congestion: Two Case Reports AKI KITAMURA, KEITARO NAKAGIRI The Department of Cardio-vascular Surgery, Ako City Hospital, Hyogo, Japan We report two cases of postoperative congestive heart failure (CHF) successfully treated with tolvaptan. Case 1: A 65-year-old man was admitted with chest pain and dyspnea. We diagnosed acute coronary syndrome (LMT) and CHF, so emergency CABG was performed. His P/F ratio was 110 because of pulmonary edema. According to Swan-Ganz data, he also had intravascular hypovolemia. Tolvaptan (15 mg) was administered and urine output was 4200 ml after 24 hours. His P/F ratio improved to 270, and extubation was possible on day 2. Case 2: A 26-year-old
P-135 Effects of Tolvaptan on Congestion and Neurohumoral Factors: A Case of Right Heart Failure Caused by Severe Tricuspid Regurgitation YODO TAMAKI, YUKIKO HAYAMA, NAOAKI ONISHI, SOICHIRO ENOMOTO, MAKOTO MIYAKE, TOSHIHIRO TAMURA, HIROKAZU KONDO, KAZUAKI KAITANI, CHISATO IZUMI, YOSHIHISA NAKAGAWA Department of Cardiology, Tenri Hospital, Tenri, Japan We report a case of 74 year-old man with right heart failure caused by severe tricuspid regurgitation requiring frequent hospitalizations. The patient was admitted because of abdominal distension one month after discharge, gaining weight by 6kg. In the previous hospitalization just before discharge, cardiac index was 1.87 L/min/ square meter and right atrial pressure was 19 mmHg in right heart catheterization. He declined surgery and was discharged on medical treatment. On admission, physical
man was admitted with fatigue and fever. Severe mitral regurgitation due to infective endocarditis was diagnosed and he also had CHF with pulmonary hypertension and low cardiac output. We performed urgent mitral valve replacement. The early postoperative course was relatively smooth, and oral furosemide was initiated after extubation on day 3. However, CHF symptoms secondary to volume overload appeared on day 6. The chest X-ray film showed bilateral pleural effusions and an enlarged CTR. Echocardiography revealed impaired LV contraction and pulmonary hypertension. Oral tolvaptan (7.5 mg) was administered in addition to low-dose dobutamine. His body weight decreased by 8.2 kg after one week and CHF improved rapidly. Electrolyte imbalance did not occur and hemodynamics did not deteriorate in both patients. In conclusion, tolvaptan is effective for refractory CHF after cardiac surgery.
P-130
P-133
Utility of Neutrophil to Lymphocyte Ratio for Predicting Sudden Cardiac Death in Patients With Ischemic and Non-ischemic Chronic Heart Failure TAKAHISA YAMADA, TAKASHI MORITA, SHUNSUKE TAMAKI, MASATAKE FUKUNAMI D Division of Cardiology, Osaka Medical Center
The Use of Tolvaptan in a Case of Severe Heart Failure with Drug-induced Cardiomyopathy TAICHI OKONOGI The Department of Cardiovascular Medicine, Heart Center, New Yukuhashi Hospital, Yukuhashi, Japan
The neutrophil to lymphocyte ratio (NLR) has been associated with poor outcome in patients with acute coronary syndrome. To investigate the prognostic significance of NLR for predicting sudden cardiac death (SCD) in patients with chronic heart failure (CHF), relating to the etiology (ischemic or non-ischemic), we studied 153 CHF outpatients (ischemic; 51%) with LVEF!40% in our prospective cohort study. These patients underwent complete blood counts with automated differential counts, which included total white blood cell count, neutrophils, lymphocytes, red cell distribution width (RDW) and platelet cell distribution width (PDW), at baseline. During a follow up period of 7.664.3 yrs, 28 patients had SCD. At multivariate Cox analysis, only NLR was independently and significantly associated with SCD in both ischemic and non-ischemic groups, although percent neurophil, percent lymphocyte, RDW or PDW showed a significant association with SCD at univariate analysis. SCD was significantly observed in patients with high NLR (above the highest quartile) than low NLR, in ischemic (43% vs 14%, p50.002) and non-ischemic groups (38% vs 8%, p50.003). The adjusted hazard ratios of high NLR for predicting SCD in ischemic and non-ischemic groups were 3.46 (95%CI 1.04-11.49) and 3.72 (95%CI 1.05-13.20), respectively. Thus, NLR has the long-term prognostic value for the prediction of SCD in CHF patients, irrespective of the etiology.
Tolvaptan is an oral vasopressin V2 receptor antagonist. Recently, many papers report the efficacy and safety of tolvaptan for patients with congestive heart failure. However, there is little information about clinical experience of the use of tolvaptan for a patient with drug-induced cardiomyopathy. A 52-year-old female with relapse breast cancer, invasive ductal carcinoma, treated by the CEF therapy (cyclophosphamide 800mg/day, epirubicin 100mg/day, 5-fluorouracil 800mg/day). After she underwent her 15th cycle of the therapy, she was admitted to our hospital with dyspnea. The chest X-ray showed cardiomegaly with pulmonary congestion and pleural effusion. The transthoracic echocardiogram showed a left ventricular dysfunction with an ejection fraction of 35%. Her physical examination failed to indicate the cause of the heart failure. After analyzing some of her examination, we diagnosed epirubicininduced cardiomyopathy. Treatments with furosemide, carperitide, low-dose dopamine and dobutamine are not useful in this case. Because the patient had a retention of fluid repeatedly, we administered a low-dose tolvaptan (7.5mg/day). As a result, her edema and body weight were reduced remarkably without worsening renal dysfunction, allowing her discharge from our hospital. It is possible that the use of tolvaptan enabled us to improve heart failure safety for patients with drug-induced cardiomyopathy.
P-131
P-134
Circulating Invariant Natural Killer T Cells are Decreased in Patients With Chronic Heart Failure AKIMICHI SAITO, NAOKI ISHIMORI, MIKITO NISHIKAWA, SHINTARO KINUGAWA, HIROYUKI TSUTSUI Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Tolvaptan was Effective in Patient with Heart Failure due to Subclavian Arteriovenous Malformation ATSUKO HIRAMINE, TAKURO KUBOZONO, SHIN KAWASOE, KUNITSUGU TAKASAKI, AKIRA KISANUKI, MASAAKI MIYATA, MITSURU OHISHI Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
Objective: Inflammation plays a crucial role in the development of chronic heart failure (HF). We have demonstrated that invariant natural killer T (iNKT) cells, a unique subset of T lymphocytes, have a protective role against left ventricular (LV) remodeling after myocardial infarction in mice. However, little is known about the changes in iNKT cells in patients with HF. Methods and Results: Nine patients with HF (NYHA II or III, LV ejection fraction 26.363.0%) and 8 healthy controls were studied. The number of circulating Va24+ iNKT cells in peripheral blood by flowcytometric analysis. The causes of HF were idiopathic dilated cardiomyopathy in 3, ischemic in 2, and others in 4 patients. Plasma BNP was significantly higher in HF (739.46207.2 vs. 19.866.5 pg/mL, P!0.01). The number of circulating iNKT cells and the ratio of the iNKT cell number to the total lymphocyte number were significantly lower in HF (747685 vs. 10586271 counts/mL and 0.11160.004 vs. 0.14660.035%, respectively, both P!0.01). Plasma interleukin-6 and hs-CRP were significantly higher in HF (3.9960.86 vs. 0.7860.14 pg/mL and 0.2860.10 vs. 0.0660.02 mg/dL, respectively, both P!0.01). LV ejection fraction (r50.72, P!0.05) and plasma logBNP (r5-0.70, P!0.05) were significantly correlated to iNKT cell ratio among HF patients. Conclusion: Circulating iNKT cells were decreased in patients with HF, indicating that they may be involved in this disease.
The patients with heart failure due to subclavian arteriovenous malformation are rare, and its treatment is difficult. Here, we report a 74-year-old male patient. In 1998, he was diagnosed with heart failure due to subclavian arteriovenous malformation and received medical treatment. Heart failure progressed, and he was treated with the coil embolism in 2009. However, the coil embolism was not effective to reduce the shunt flow and his symptom progressed slowly. He admitted because of general malaise and appetite loss, the edema was observed in his whole body, and the shunt flow was heard at his neck. The cardiomegaly and the pleural effusion were shown in a chest X-ray. The echocardiography demonstrated the dilatation of right atrium and ventricle and the severe tricuspid valve regurgitation with the cusp separation. He have been already treated with the high dose of diuretics including furosemide (80 mg/day), eplerenone (50 mg/day) and trichlormethiazide (2 mg/day). It is not improved with low-salt diet and rest, and tolvapvtan (7.5 mg/day) was added. The urine volume increased after the administration of tolvaptan, and the body weight decreased by 7 kg in a week. His symptom of general fatigue improved and appetite also increased. In this case, tolvaptan was effective in the patient with heart failure due to subclavian arteriovenous malformation.
P-132 Tolvaptan for Perioperative Heart Failure in Patients with Preoperative Pulmonary Congestion: Two Case Reports AKI KITAMURA, KEITARO NAKAGIRI The Department of Cardio-vascular Surgery, Ako City Hospital, Hyogo, Japan We report two cases of postoperative congestive heart failure (CHF) successfully treated with tolvaptan. Case 1: A 65-year-old man was admitted with chest pain and dyspnea. We diagnosed acute coronary syndrome (LMT) and CHF, so emergency CABG was performed. His P/F ratio was 110 because of pulmonary edema. According to Swan-Ganz data, he also had intravascular hypovolemia. Tolvaptan (15 mg) was administered and urine output was 4200 ml after 24 hours. His P/F ratio improved to 270, and extubation was possible on day 2. Case 2: A 26-year-old
P-135 Effects of Tolvaptan on Congestion and Neurohumoral Factors: A Case of Right Heart Failure Caused by Severe Tricuspid Regurgitation YODO TAMAKI, YUKIKO HAYAMA, NAOAKI ONISHI, SOICHIRO ENOMOTO, MAKOTO MIYAKE, TOSHIHIRO TAMURA, HIROKAZU KONDO, KAZUAKI KAITANI, CHISATO IZUMI, YOSHIHISA NAKAGAWA Department of Cardiology, Tenri Hospital, Tenri, Japan We report a case of 74 year-old man with right heart failure caused by severe tricuspid regurgitation requiring frequent hospitalizations. The patient was admitted because of abdominal distension one month after discharge, gaining weight by 6kg. In the previous hospitalization just before discharge, cardiac index was 1.87 L/min/ square meter and right atrial pressure was 19 mmHg in right heart catheterization. He declined surgery and was discharged on medical treatment. On admission, physical