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Withdraw
The 21st Annual Scientific Meeting
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JHFS
S79
P18-5
P19-2
A Highly Sensitive Regulatory System of Plasma B-Type Natriuretic Peptide to Ischemic Heart Disease Determined by Intracoronary Pressure Measurement Ryosuke Itakura, Yasunori Inoue, Makoto Kawai, Michihiro Yoshimura; Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
Liver Fibrosis Predicts Mortality in Heart Failure Patients With Preserved Ejection Fraction Yu Sato, Akiomi Yoshihisa, Yuki Kanno, Makiko Tatsumi, Satoshi Abe, Takamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Atsushi Kobayashi, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
Background: B-type natriuretic peptide (BNP) is a biomarker of heart failure, however, the response of BNP to cardiac ischemia is still unclear. Therefore the myocardial ischemic effect on BNP by intracoronary pressure measurement in patients with suspected cardiac ischemia was investigated. Methods: The baseline distal-to-aortic pressure ratio (Pd/Pa) and fractional flow reserve (FFR) were examined in 167 patients with the intermediate coronary stenosis. Results: A significant inverse correlation between Pd/ Pa and LogBNP became clear only in the patients with FFR ≤ 0.80 but not in those with FFR > 0.08. To examine a causative contribution of Pd/Pa to LogBNP in patients with FFR ≤ 0.08, the covariance structure analysis were performed. The Pd/Pa causatively affected LVEF (standard regression coefficient: β = −0.458, P < .001) and LogBNP (β = 0.394, P = .002). In order to examine a causative role of BNP to coronary vasodilation, another path model by using a value dividing FFR by Pd/Pa (FFR/ Pd/Pa) as an index of hyperemia response was performed. A significant contribution of LogBNP to FFR/Pd/Pa (β = 0.353, P = .045) and also significant positive correlation between these factors were showed that, as the LogBNP increased, the value of FFR/Pd/Pa approached toward 1.0 but fell short of 1.0, suggesting an insufficient secretion of BNP for full coronary vasodilation. Conclusion: This study showed that BNP finely responded to the degree of cardiac ischemia, which should work to alleviate increased coronary arterial tonus.
Background: Heart failure with preserved ejection fraction (HFpEF) has several pathophysiological aspects including stiffness of multiple organs. According to recent research, liver stiffness assessed by transient elastography predicts adverse prognosis in heart failure patients. Liver fibrosis can be assessed by nonalcoholic fatty liver disease (NAFLD) fibrosis score (−1.675 + 0.037 × age [years] + 0.094 × body mass index + 1.13 × diabetes mellitus [if presence, given 1] + 0.95 × AST [IU/L]/ALT [IU/L] − 0.013 × platelet count [10−9/L] − 0.66 × albumin [g/dL]) in patients with NAFLD. We aimed to investigate the impact of NAFLD fibrosis score (NFS) on prognosis of HFpEF patients. Methods and Results: We analyzed consecutive 492 patients with HFpEF who admitted to our hospital without chronic liver disease. These patients were divided into 4 groups based on the NFS: 1st (NFS < −1.12, n = 123), 2nd (−1.13 < NFS < 0.19, n = 123), 3rd (0.20 < NFS < 1.55, n = 123) and 4th (1.56 < NFS, n = 123) quartiles. In the follow-up period (mean 1107 days), 93 deaths (33 cardiac and 60 non-cardiac deaths) occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from 1st to 2nd, 3rd and 4th groups (8.1%, 12.2%, 23.6% and 31.7%, log rank P < .001). In the Cox proportional hazard analysis, after adjusting for potential confounding factors, NFS was an independent predictor of all-cause mortality in HFpEF patients (hazard ratio 1.98, 95% confidence interval 1.43–3.19, P < .001). Conclusion: NAFLD fibrosis score, a marker of liver fibrosis, can identify high risk patients with HFpEF.
P18-6
P19-3 Withdraw
Persistent Coronary Intervention Overcame Heart Failure Due to Severely Complicated Acute Coronary Syndrome Koichi Narita, Takahide Kodama, Haruo Mitani; Cardiovascular Center, Toranomon Hospital, Tokyo, Japan A 57-year-old male with heart failure due to acute coronary syndrome consulted our outpatient and admitted emergently. Three days before the admission, he had been aware of chest pain and dyspnea, and at the admission, the electrocardiogram revealed STelevation at the precordial leads of V1–3. Emergent CAG was performed and it showed 3 vessels disease including total occlusion of proximal LAD and obtuse marginal branch, a 90% stenosis of mid LCx and diffuse distal RCA lesions. PCI was carried out to the proximal LAD and obtuse marginal branch, but the guide wire did not pass easily. The operator could not identify the real culprit lesion and stopped the procedure. Then IABP and Swan-Gantz catheter was employed. The HF was managed with furosemide and dobutamine. On the day 4, PCI for LCA was tried again. In this time, obtuse marginal branch was spontaneously re-canalized, and we realized it was the real culprit. We successfully performed PCI for LCx and also tried PCI for the CTO lesion of proximal LAD to stabilize his hemodynamics. Although the procedure was successfully performed, refractory Torsades de Pointes (TdP) occurred. Because medical treatment failed, PCI for RCA distal lesions was performed on the day 18. After the third procedure, the arrhythmia disappeared and the hemodynamics stabilized completely.
P19-4 Withdraw
P19-1 A Possible Mechanisms of Cardio-Renal Syndrome in Elderly Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction Daisuke Harada, Takahisa Noto, Junya Takagawa; The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan Introduction: Congestive kidney failure provoked by increased central venous pressure is clinically important in patients with heart failure and preserved ejection fraction (HFpEF), however, the underlying mechanisms of increase in central venous pressure remains unclear. The present study aimed to examine the relationship between right ventricular distensibility and estimated glomerular filtration rate (eGFR) in patients with HFpEF. Material and Methods: Retrospective and cross-sectional study was performed based on echocardiographic database of our hospital between 2012 and 2014, and 45 of 138 elderly patients with HFpEF had reduced eGFR (<60 mL/min). We identified 45 patients with preserved eGFR matched to the reduced eGFR population for age and sex. Using signal processing techniques, the prominent Y descent of jugular pulse waveform was detected as a hemodynamic sign of less-distensible right ventricle (RV). Results: Patients with reduced eGFR had larger left atrial diameters and higher right ventricular systolic pressure as compared to those with preserved eGFR (42 ± 8 mm vs 39 ± 7 mm, P = .04; 38 ± 10 mmHg vs 33 ± 8 mmHg, P = .02, respectively). Lessdistensible RV was more prevalent in patients with reduced eGFR than those with preserved eGFR (47% vs 16%, P = .003). Multivariate conditional logistic regression analysis revealed that less-distensible RV was an independent risk factor for reduced eGFR (odds ratio = 5.9, P = .02). Conclusion: Less-distensible RV is a possible mechanism of cardio-renal syndrome in elderly patients with HFpEF.
P20-1 Geriatric Nutritional Risk Index Might Predict All-Cause Deaths in Elderly Patients With Heart Failure With Preserved Ejection Fraction Requiring Hospitalization Isao Nishi1, Yoshihiro Seo2, Yoshie Hamada2, Kimi Sato2, Seika Sai2, Masayoshi Yamamoto2, Tomoko Ishizu3, Akinori Sugano2, Kenichi Obara4, Kazutaka Aonuma2; 1 Tsuchiura Clinical Education and Training Center, University of Tsukuba Hospital, Tsuchiura, Japan; 2Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; 3Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; 4Division of Cardiology, Ryugasaki Saiseikai General Hospital, Ryugasaki, Japan To clarify whether geriatric nutritional risk index (GNRI) is useful for predicting the prognosis of patients hospitalized with preserved ejection fraction (HFpEF). A total of 117 HFpEF elderly patients (more than or equal 65 years) from the Ibaraki Cardiovascular Assessment Study-HF (N = 838) were enrolled. All-cause mortality was compared between 2 groups: low GNRI (<92) with moderate or severe nutritional risk; and high GNRI (more than or equal 92) with no or low nutritional risk. A KaplanMeier analysis revealed that all-cause deaths occurred more frequently in HFpEF patients with low GNRI (n = 19 [40.4%]) than in those with high GNRI (n = 8 [11.4%]; logrank P < .01) (Fig. 1). This study suggests that nutritional screening using GNRI is helpful in predicting the prognosis of elderly patients hospitalized with HFpEF in a multicenter registry setting.
•
JHFS
S79
P18-5
P19-2
A Highly Sensitive Regulatory System of Plasma B-Type Natriuretic Peptide to Ischemic Heart Disease Determined by Intracoronary Pressure Measurement Ryosuke Itakura, Yasunori Inoue, Makoto Kawai, Michihiro Yoshimura; Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
Liver Fibrosis Predicts Mortality in Heart Failure Patients With Preserved Ejection Fraction Yu Sato, Akiomi Yoshihisa, Yuki Kanno, Makiko Tatsumi, Satoshi Abe, Takamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Atsushi Kobayashi, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
Background: B-type natriuretic peptide (BNP) is a biomarker of heart failure, however, the response of BNP to cardiac ischemia is still unclear. Therefore the myocardial ischemic effect on BNP by intracoronary pressure measurement in patients with suspected cardiac ischemia was investigated. Methods: The baseline distal-to-aortic pressure ratio (Pd/Pa) and fractional flow reserve (FFR) were examined in 167 patients with the intermediate coronary stenosis. Results: A significant inverse correlation between Pd/ Pa and LogBNP became clear only in the patients with FFR ≤ 0.80 but not in those with FFR > 0.08. To examine a causative contribution of Pd/Pa to LogBNP in patients with FFR ≤ 0.08, the covariance structure analysis were performed. The Pd/Pa causatively affected LVEF (standard regression coefficient: β = −0.458, P < .001) and LogBNP (β = 0.394, P = .002). In order to examine a causative role of BNP to coronary vasodilation, another path model by using a value dividing FFR by Pd/Pa (FFR/ Pd/Pa) as an index of hyperemia response was performed. A significant contribution of LogBNP to FFR/Pd/Pa (β = 0.353, P = .045) and also significant positive correlation between these factors were showed that, as the LogBNP increased, the value of FFR/Pd/Pa approached toward 1.0 but fell short of 1.0, suggesting an insufficient secretion of BNP for full coronary vasodilation. Conclusion: This study showed that BNP finely responded to the degree of cardiac ischemia, which should work to alleviate increased coronary arterial tonus.
Background: Heart failure with preserved ejection fraction (HFpEF) has several pathophysiological aspects including stiffness of multiple organs. According to recent research, liver stiffness assessed by transient elastography predicts adverse prognosis in heart failure patients. Liver fibrosis can be assessed by nonalcoholic fatty liver disease (NAFLD) fibrosis score (−1.675 + 0.037 × age [years] + 0.094 × body mass index + 1.13 × diabetes mellitus [if presence, given 1] + 0.95 × AST [IU/L]/ALT [IU/L] − 0.013 × platelet count [10−9/L] − 0.66 × albumin [g/dL]) in patients with NAFLD. We aimed to investigate the impact of NAFLD fibrosis score (NFS) on prognosis of HFpEF patients. Methods and Results: We analyzed consecutive 492 patients with HFpEF who admitted to our hospital without chronic liver disease. These patients were divided into 4 groups based on the NFS: 1st (NFS < −1.12, n = 123), 2nd (−1.13 < NFS < 0.19, n = 123), 3rd (0.20 < NFS < 1.55, n = 123) and 4th (1.56 < NFS, n = 123) quartiles. In the follow-up period (mean 1107 days), 93 deaths (33 cardiac and 60 non-cardiac deaths) occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from 1st to 2nd, 3rd and 4th groups (8.1%, 12.2%, 23.6% and 31.7%, log rank P < .001). In the Cox proportional hazard analysis, after adjusting for potential confounding factors, NFS was an independent predictor of all-cause mortality in HFpEF patients (hazard ratio 1.98, 95% confidence interval 1.43–3.19, P < .001). Conclusion: NAFLD fibrosis score, a marker of liver fibrosis, can identify high risk patients with HFpEF.
P18-6
P19-3 Withdraw
Persistent Coronary Intervention Overcame Heart Failure Due to Severely Complicated Acute Coronary Syndrome Koichi Narita, Takahide Kodama, Haruo Mitani; Cardiovascular Center, Toranomon Hospital, Tokyo, Japan A 57-year-old male with heart failure due to acute coronary syndrome consulted our outpatient and admitted emergently. Three days before the admission, he had been aware of chest pain and dyspnea, and at the admission, the electrocardiogram revealed STelevation at the precordial leads of V1–3. Emergent CAG was performed and it showed 3 vessels disease including total occlusion of proximal LAD and obtuse marginal branch, a 90% stenosis of mid LCx and diffuse distal RCA lesions. PCI was carried out to the proximal LAD and obtuse marginal branch, but the guide wire did not pass easily. The operator could not identify the real culprit lesion and stopped the procedure. Then IABP and Swan-Gantz catheter was employed. The HF was managed with furosemide and dobutamine. On the day 4, PCI for LCA was tried again. In this time, obtuse marginal branch was spontaneously re-canalized, and we realized it was the real culprit. We successfully performed PCI for LCx and also tried PCI for the CTO lesion of proximal LAD to stabilize his hemodynamics. Although the procedure was successfully performed, refractory Torsades de Pointes (TdP) occurred. Because medical treatment failed, PCI for RCA distal lesions was performed on the day 18. After the third procedure, the arrhythmia disappeared and the hemodynamics stabilized completely.
P19-4 Withdraw
P19-1 A Possible Mechanisms of Cardio-Renal Syndrome in Elderly Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction Daisuke Harada, Takahisa Noto, Junya Takagawa; The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan Introduction: Congestive kidney failure provoked by increased central venous pressure is clinically important in patients with heart failure and preserved ejection fraction (HFpEF), however, the underlying mechanisms of increase in central venous pressure remains unclear. The present study aimed to examine the relationship between right ventricular distensibility and estimated glomerular filtration rate (eGFR) in patients with HFpEF. Material and Methods: Retrospective and cross-sectional study was performed based on echocardiographic database of our hospital between 2012 and 2014, and 45 of 138 elderly patients with HFpEF had reduced eGFR (<60 mL/min). We identified 45 patients with preserved eGFR matched to the reduced eGFR population for age and sex. Using signal processing techniques, the prominent Y descent of jugular pulse waveform was detected as a hemodynamic sign of less-distensible right ventricle (RV). Results: Patients with reduced eGFR had larger left atrial diameters and higher right ventricular systolic pressure as compared to those with preserved eGFR (42 ± 8 mm vs 39 ± 7 mm, P = .04; 38 ± 10 mmHg vs 33 ± 8 mmHg, P = .02, respectively). Lessdistensible RV was more prevalent in patients with reduced eGFR than those with preserved eGFR (47% vs 16%, P = .003). Multivariate conditional logistic regression analysis revealed that less-distensible RV was an independent risk factor for reduced eGFR (odds ratio = 5.9, P = .02). Conclusion: Less-distensible RV is a possible mechanism of cardio-renal syndrome in elderly patients with HFpEF.
P20-1 Geriatric Nutritional Risk Index Might Predict All-Cause Deaths in Elderly Patients With Heart Failure With Preserved Ejection Fraction Requiring Hospitalization Isao Nishi1, Yoshihiro Seo2, Yoshie Hamada2, Kimi Sato2, Seika Sai2, Masayoshi Yamamoto2, Tomoko Ishizu3, Akinori Sugano2, Kenichi Obara4, Kazutaka Aonuma2; 1 Tsuchiura Clinical Education and Training Center, University of Tsukuba Hospital, Tsuchiura, Japan; 2Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; 3Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; 4Division of Cardiology, Ryugasaki Saiseikai General Hospital, Ryugasaki, Japan To clarify whether geriatric nutritional risk index (GNRI) is useful for predicting the prognosis of patients hospitalized with preserved ejection fraction (HFpEF). A total of 117 HFpEF elderly patients (more than or equal 65 years) from the Ibaraki Cardiovascular Assessment Study-HF (N = 838) were enrolled. All-cause mortality was compared between 2 groups: low GNRI (<92) with moderate or severe nutritional risk; and high GNRI (more than or equal 92) with no or low nutritional risk. A KaplanMeier analysis revealed that all-cause deaths occurred more frequently in HFpEF patients with low GNRI (n = 19 [40.4%]) than in those with high GNRI (n = 8 [11.4%]; logrank P < .01) (Fig. 1). This study suggests that nutritional screening using GNRI is helpful in predicting the prognosis of elderly patients hospitalized with HFpEF in a multicenter registry setting.