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Things Necessary for Certification of Management Institute of Implantable LVAD
S20 Journal of Cardiac Failure Vol. 23 No. 10S October 2017
Panel Discussion PD3-2 Extracorporeal Circulatory Support as a Bridge to Decision for Acute Cardiogenic Shock With Impending Organ Failure Masatoshi Akiyama, Satoshi Kawatsu, Naoya Terao, Yusuke Suzuki, Yukihiro Hayatsu, Ichiro Yoshioka, Kiichiro Kumagai, Osamu Adachi, Yoshikatsu Saiki; Division of Cardiovascular Surgery, Tohoku University, Sendai, Japan In the unstable patient with impending organ failure, implantation a temporary ventricular assist device (VAD) is associated with a high morbidity and mortality. The use of temporary VADs in acute cardiogenic shock produces a low survival rate. We retrospectively reviewed 46 patients underwent temporary VAD since 2002 at Tohoku University Hospital. Mean age was 39.4. 29 were male (61%). The etiology of heart disease included 41 (87%) patients with primary and secondary cardiomyopathies and 6 (13%) with fulminant myocarditis. 6 patients underwent heart transplantation, 4 weaned from temporary VAD following cardiac recovery, and 10 underwent conversion to durable VAD. In the overall cohort, there were 26 deaths. The patients who died after device implantation were older (P = .002) and supported with BVAD (P = .001). The causes of death were stroke (11), MOF (10), bleeding (3), ARDS (1), and mediastinitis (1). The survival rates were 89%, 72%, 51%, and 47% at 1 month, 3 month, 6 month and 1 year after device implantation. The optimal use of temporary VAD has not been completely elucidated. Alternative strategy is necessary for patients with cardiogenic shock especially biventricular failure.
PD3-4 Things Necessary for Certification of Management Institute of Implantable LVAD Koichiro Kinugawa; The 2nd Department of Internal Medicine, University of Toyama, Toyama, Japan Certification of management institute of implantable LVAD has now begun, and so far a couple of hospitals have been certified. The concept of this certification is based on hub-and-spork network to establish shred care for LVAD patients. This system is indispensable when destination therapy is approved. DT patients do not want to move away from their home just because of implanting devices. In this session, I will discuss what things need to establish shared care for LVAD patients.
the rate increasing to around 70% over the course of hospitalization. Our findings further suggested that the presence of AKI on admission, especially the exacerbation of AKI at admission, was associated with a poor prognosis. We devised the biomarker strategy to detect the AKI on admission and predict the AKI during acute phase. In these reports, the serum HFABP level can detect the AKI on admission and the urinary LFABP level was useful for the prediction of AKI during the acute phase of AHF in CKD patients. AKI on admission was reported to be caused by venous congestion, and subsequent worsening of AKI during treatment has been suggested to be due to renal proximal tubular injury. Based on the different mechanism of AKI, we can detect the AKI on admission and predict the exacerbation of AKI in AHF by these biomarkers.
PD4-3 Highly Sensitive Cardiac Troponin T and N-Terminal Pro-BNP Between Bisoprolol and Carvedilol in Patients With Chronic Heart Failure Shigeru Toyoda, Akiko Haruyama, Shu Inami, Hirohisa Amano, Takuo Arikawa, Teruo Inoue; Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan The effects of beta blockers on long-term morbidity and mortality have been established in patients with chronic heart failure with reduced left ventricular function. Among various beta blockers, only carvedilol and bisoprolol are approved by Japanese guidelines for treatment of patients with chronic heart failure. Bisoprolol is highly selectivity for the beta-1 receptor, while carvedilol is a non-selective beta blocker with simultaneous alpha receptor antagonist effects. BNP and NT-proBNP are established biomarkers used in the diagnosis and prognosis of chronic heart failure. Recently, hsTnT, which is released by injured myocardial tissue, has also been investigated as a marker of heart failure. Although several reports have compared bisoprolol and carvedilol in patients with chronic heart failure in Japan as well as in western countries, these reports did not focus on hsTnT levels. We thus designed the “Bisoprolol Improvement Group for chronic heart failure treatment study in Dokkyo Medical University” (BRIGHT-D) to directly compare drug tolerability, heart failure symptoms, biomarkers and cardiac function between bisoprolol and carvedilol in patients with chronic heart failure with reduced ejection fraction. As a result, bisoprolol might have some potential advantage over carvedilol in terms of protection against myocardial injury. In this session, we would like to present and discuss our data.
PD4-4 PD3-5 Ventricular Assist Device Treatment for Pediatric Patients Minoru Ono, Yasutaka Hirata; Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan Continuous-flow ventricular assist devices (CF-VAD) have been widely used in endstage heart failure in adult patients for both bridge to transplantation and destination therapy. Technology improvement has enabled miniaturization of the CF-VAD, which may greatly benefit the pediatric patients with sufficient body size in advanced heart failure. There are still, however, challenging situations for CF-VAD implantation, such as in single ventricle physiology, anatomically abnormal heart, small children and infants. Limited number of reports of CF-VAD for systemic ventricular failure of Fontan circulation were published. There is, so far, no agreed consensus as for the timing of CFVAD implantation in such a situation. Successful CF-VAD experiences in (congenitally corrected) transposition of great arteries have been also reported. Berlin Heart EXCOR pediatric is an only device which is suitable for small children and infants. There are more than 1800 implantations reported worldwide. One year overall survival rate is 73%. Dilated cardiomyopathy is the major cause of its use, comprising 53%, and 21% for congenital heart disease. EXCOR pediatric was approved in 2015 in Japan. 28 implants were performed including trial cases. Fifteen patients underwent heart transplantation, 3 weaned from the VAD and 10 on-going support, which means there is no death. Clinical trial of pediatric Jarvik is just about being started with great expectations.
PD4-2
Interaction Between Mineralocorticoid Receptor Antagonist and Soluble ST2 in Heart Failure with Preserved Ejection Fraction Akinori Sugano1, Yoshihiro Seo2, Tomoko Ishizu2, Masayoshi Yamamoto2, Yoshie Hamada2, Isao Nishi2, Kazutaka Aonuma2, Akihiko Nogami2, Yoshito Iesaka1; 1 Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan; 2Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan Background: Soluble ST2 (sST2) is a novel biomarker reflecting myocardial stress and fibrosis. Mineralocorticoid receptor antagonist (MRA) has a potential to improve clinical outcomes in heart failure with preserved ejection fraction (HFpEF), since MRA inhibits progression of myocardial hypertrophy and fibrosis. Aim: To investigate the relationship between sST2 and outcome, and interaction between the effect of MRA and the sST2 level in HFpEF. Methods: 191 patients with acute decompensated HF and EF >50% were prospectively enrolled. The endpoint was major adverse cardiovascular event. Results: During follow-up (421 ± 258 days), 53 patients (27.7%) met endpoints. In multivariable analysis, the use of MRA and sST2 were significantly associated with the endpoint (HR 0.48, 95%CI 0.26–0.86, P = .01, HR 1.02, 1.01–1.03, P = .01). Patients were divided into 4 groups according to use of MRA and a cutoff value of sST2 determined by ROC analysis. In multivariable analysis, MRA was not associated with outcome in high sST2 group(HR0.62, 0.28–1.30, P = .21), whereas MRA was significantly associated with improved outcome in low sST2 group (HR0.37, 0.13– 0.91, P = .03). Conclusion: In HFpEF patients, higher ST-2 level was significantly associated with poor prognosis. The present study indicated that effect of MRA might be different depending on the levels of sST2 in HFpEF.
PD4-5
Biomarker Strategy for the Detection and Prediction of Acute Kidney Injury in Patients With Acute Heart Failure Akihiro Shirakabe1, Noritake Hata1, Nobuaki Kobayashi1, Hirotake Okazaki1, Masato Matsushita1, Yusaku Shibata1, Suguru Nishigoori1, Saori Uchiyama1, Kuniya Asai2, Wataru Shimizu2; 1Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan; 2Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
Serum Brain-Derived Neurotrophic Factor Level at Discharge Predicts the Prognosis in Patients with Heart Failure Atsushi Shibata1, Akihisa Hanatani1, Ryoko Kitada1, Shinichi Iwata1, Yasukatsu Izumi2, Minoru Yoshiyama1; 1Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan; 2Department of Internal Medicine, Takaishikamo Hospital, Osaka, Japan
Since the proposal of cardio-renal syndrome, which describes diseases that involve both heart failure (HF) and acute or chronic kidney disease (CKD), kidney damage has become a topic of discussion in patients with acute HF (AHF). However, the mechanisms and pathophysiology of acute kidney injury (AKI) in AHF patients are multi-factorial and still poorly understood. We first reported AKI on admission in patients with AHF. AKI was found to be already involved in approximately 30% of patients with AHF, with
Background: Skeletal muscle has recently been identified as an organ that produces and releases cytokines, named “myokines”. Brain derived neurotropic factor (BDNF), a neurotrophic factor family, is one of myokines and plays a key role in regulating survival, growth and maintenance of neurons. We investigated whether serum BDNF level at discharge could predict the prognosis in patients with heart failure (HF). Methods: We prospectively enrolled 94 patients who were hospitalized for worsening HF and
Panel Discussion PD3-2 Extracorporeal Circulatory Support as a Bridge to Decision for Acute Cardiogenic Shock With Impending Organ Failure Masatoshi Akiyama, Satoshi Kawatsu, Naoya Terao, Yusuke Suzuki, Yukihiro Hayatsu, Ichiro Yoshioka, Kiichiro Kumagai, Osamu Adachi, Yoshikatsu Saiki; Division of Cardiovascular Surgery, Tohoku University, Sendai, Japan In the unstable patient with impending organ failure, implantation a temporary ventricular assist device (VAD) is associated with a high morbidity and mortality. The use of temporary VADs in acute cardiogenic shock produces a low survival rate. We retrospectively reviewed 46 patients underwent temporary VAD since 2002 at Tohoku University Hospital. Mean age was 39.4. 29 were male (61%). The etiology of heart disease included 41 (87%) patients with primary and secondary cardiomyopathies and 6 (13%) with fulminant myocarditis. 6 patients underwent heart transplantation, 4 weaned from temporary VAD following cardiac recovery, and 10 underwent conversion to durable VAD. In the overall cohort, there were 26 deaths. The patients who died after device implantation were older (P = .002) and supported with BVAD (P = .001). The causes of death were stroke (11), MOF (10), bleeding (3), ARDS (1), and mediastinitis (1). The survival rates were 89%, 72%, 51%, and 47% at 1 month, 3 month, 6 month and 1 year after device implantation. The optimal use of temporary VAD has not been completely elucidated. Alternative strategy is necessary for patients with cardiogenic shock especially biventricular failure.
PD3-4 Things Necessary for Certification of Management Institute of Implantable LVAD Koichiro Kinugawa; The 2nd Department of Internal Medicine, University of Toyama, Toyama, Japan Certification of management institute of implantable LVAD has now begun, and so far a couple of hospitals have been certified. The concept of this certification is based on hub-and-spork network to establish shred care for LVAD patients. This system is indispensable when destination therapy is approved. DT patients do not want to move away from their home just because of implanting devices. In this session, I will discuss what things need to establish shared care for LVAD patients.
the rate increasing to around 70% over the course of hospitalization. Our findings further suggested that the presence of AKI on admission, especially the exacerbation of AKI at admission, was associated with a poor prognosis. We devised the biomarker strategy to detect the AKI on admission and predict the AKI during acute phase. In these reports, the serum HFABP level can detect the AKI on admission and the urinary LFABP level was useful for the prediction of AKI during the acute phase of AHF in CKD patients. AKI on admission was reported to be caused by venous congestion, and subsequent worsening of AKI during treatment has been suggested to be due to renal proximal tubular injury. Based on the different mechanism of AKI, we can detect the AKI on admission and predict the exacerbation of AKI in AHF by these biomarkers.
PD4-3 Highly Sensitive Cardiac Troponin T and N-Terminal Pro-BNP Between Bisoprolol and Carvedilol in Patients With Chronic Heart Failure Shigeru Toyoda, Akiko Haruyama, Shu Inami, Hirohisa Amano, Takuo Arikawa, Teruo Inoue; Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan The effects of beta blockers on long-term morbidity and mortality have been established in patients with chronic heart failure with reduced left ventricular function. Among various beta blockers, only carvedilol and bisoprolol are approved by Japanese guidelines for treatment of patients with chronic heart failure. Bisoprolol is highly selectivity for the beta-1 receptor, while carvedilol is a non-selective beta blocker with simultaneous alpha receptor antagonist effects. BNP and NT-proBNP are established biomarkers used in the diagnosis and prognosis of chronic heart failure. Recently, hsTnT, which is released by injured myocardial tissue, has also been investigated as a marker of heart failure. Although several reports have compared bisoprolol and carvedilol in patients with chronic heart failure in Japan as well as in western countries, these reports did not focus on hsTnT levels. We thus designed the “Bisoprolol Improvement Group for chronic heart failure treatment study in Dokkyo Medical University” (BRIGHT-D) to directly compare drug tolerability, heart failure symptoms, biomarkers and cardiac function between bisoprolol and carvedilol in patients with chronic heart failure with reduced ejection fraction. As a result, bisoprolol might have some potential advantage over carvedilol in terms of protection against myocardial injury. In this session, we would like to present and discuss our data.
PD4-4 PD3-5 Ventricular Assist Device Treatment for Pediatric Patients Minoru Ono, Yasutaka Hirata; Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan Continuous-flow ventricular assist devices (CF-VAD) have been widely used in endstage heart failure in adult patients for both bridge to transplantation and destination therapy. Technology improvement has enabled miniaturization of the CF-VAD, which may greatly benefit the pediatric patients with sufficient body size in advanced heart failure. There are still, however, challenging situations for CF-VAD implantation, such as in single ventricle physiology, anatomically abnormal heart, small children and infants. Limited number of reports of CF-VAD for systemic ventricular failure of Fontan circulation were published. There is, so far, no agreed consensus as for the timing of CFVAD implantation in such a situation. Successful CF-VAD experiences in (congenitally corrected) transposition of great arteries have been also reported. Berlin Heart EXCOR pediatric is an only device which is suitable for small children and infants. There are more than 1800 implantations reported worldwide. One year overall survival rate is 73%. Dilated cardiomyopathy is the major cause of its use, comprising 53%, and 21% for congenital heart disease. EXCOR pediatric was approved in 2015 in Japan. 28 implants were performed including trial cases. Fifteen patients underwent heart transplantation, 3 weaned from the VAD and 10 on-going support, which means there is no death. Clinical trial of pediatric Jarvik is just about being started with great expectations.
PD4-2
Interaction Between Mineralocorticoid Receptor Antagonist and Soluble ST2 in Heart Failure with Preserved Ejection Fraction Akinori Sugano1, Yoshihiro Seo2, Tomoko Ishizu2, Masayoshi Yamamoto2, Yoshie Hamada2, Isao Nishi2, Kazutaka Aonuma2, Akihiko Nogami2, Yoshito Iesaka1; 1 Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan; 2Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan Background: Soluble ST2 (sST2) is a novel biomarker reflecting myocardial stress and fibrosis. Mineralocorticoid receptor antagonist (MRA) has a potential to improve clinical outcomes in heart failure with preserved ejection fraction (HFpEF), since MRA inhibits progression of myocardial hypertrophy and fibrosis. Aim: To investigate the relationship between sST2 and outcome, and interaction between the effect of MRA and the sST2 level in HFpEF. Methods: 191 patients with acute decompensated HF and EF >50% were prospectively enrolled. The endpoint was major adverse cardiovascular event. Results: During follow-up (421 ± 258 days), 53 patients (27.7%) met endpoints. In multivariable analysis, the use of MRA and sST2 were significantly associated with the endpoint (HR 0.48, 95%CI 0.26–0.86, P = .01, HR 1.02, 1.01–1.03, P = .01). Patients were divided into 4 groups according to use of MRA and a cutoff value of sST2 determined by ROC analysis. In multivariable analysis, MRA was not associated with outcome in high sST2 group(HR0.62, 0.28–1.30, P = .21), whereas MRA was significantly associated with improved outcome in low sST2 group (HR0.37, 0.13– 0.91, P = .03). Conclusion: In HFpEF patients, higher ST-2 level was significantly associated with poor prognosis. The present study indicated that effect of MRA might be different depending on the levels of sST2 in HFpEF.
PD4-5
Biomarker Strategy for the Detection and Prediction of Acute Kidney Injury in Patients With Acute Heart Failure Akihiro Shirakabe1, Noritake Hata1, Nobuaki Kobayashi1, Hirotake Okazaki1, Masato Matsushita1, Yusaku Shibata1, Suguru Nishigoori1, Saori Uchiyama1, Kuniya Asai2, Wataru Shimizu2; 1Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan; 2Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
Serum Brain-Derived Neurotrophic Factor Level at Discharge Predicts the Prognosis in Patients with Heart Failure Atsushi Shibata1, Akihisa Hanatani1, Ryoko Kitada1, Shinichi Iwata1, Yasukatsu Izumi2, Minoru Yoshiyama1; 1Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan; 2Department of Internal Medicine, Takaishikamo Hospital, Osaka, Japan
Since the proposal of cardio-renal syndrome, which describes diseases that involve both heart failure (HF) and acute or chronic kidney disease (CKD), kidney damage has become a topic of discussion in patients with acute HF (AHF). However, the mechanisms and pathophysiology of acute kidney injury (AKI) in AHF patients are multi-factorial and still poorly understood. We first reported AKI on admission in patients with AHF. AKI was found to be already involved in approximately 30% of patients with AHF, with
Background: Skeletal muscle has recently been identified as an organ that produces and releases cytokines, named “myokines”. Brain derived neurotropic factor (BDNF), a neurotrophic factor family, is one of myokines and plays a key role in regulating survival, growth and maintenance of neurons. We investigated whether serum BDNF level at discharge could predict the prognosis in patients with heart failure (HF). Methods: We prospectively enrolled 94 patients who were hospitalized for worsening HF and