crude mortality was comparable between genders (hazard ratio (HR) 1.18, P50.11), the adjusted ... Brain natriuretic peptide. (pg/mL). 106. 729 !0.001. HF, heartfailure; NYHA, New York Heart Association; LVEF, left ventricular ejec- tion fraction ...
S206 Journal of Cardiac Failure Vol. 20 No. 10S October 2014 registered in the CHART-2 Study (n510,219). Results: Female patients were characterized by higher age, higher NYHA class and higher BNP levels than males (Table). During the median 3.2-year follow-up, 392 patients (12.5%) died. Although the crude mortality was comparable between genders (hazard ratio (HR) 1.18, P50.11), the adjusted mortality risk was significantly low in females (HR 0.72, P50.009). Female patients died due to cardiovascular causes more frequently than males (53.7% vs. 39.2%, P!0.01). Conclusions: Although female HFpEF patients had comparable all-cause mortality with males, they had severer HF and higher cardiovascular mortality than males. Table. Sex difference in baseline characteristics in patients with HF pEF
Age (yrs) Ischemic heart disease (%) NYHA class 3 and 4 (%) Systolic blood pressure (mmHg) Heart rate (beat/min) LVEF (%) Hemoglobin (g/dL) Brain natriuretic peptide (pg/mL)
Female (n51,083)
Male (n52,041)
P value
71.6 6 12.4 30.8 14.1 128.0 6 19.4
68.3 6 12.0 53.4 7.0 128.6 6 18.2
!0.001 !0.001 !0.001 0.46
73.8 6 15.6 67.2 6 9.3 12.3 6 2.0 106
73.5 6 11.6 64.5 67.0 13.6 6 2.0 729
!0.001 !0.001 !0.001 !0.001
HF, heartfailure; NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; Numerical data are shown as mean6 standard deviation BNP is shown as median
P-119 Pathogenesis and Prognostic Factors Involved in the HFpEF YOSHIAKI KUBOTA, KUNIYA ASAI, DAIGO CHINEN, AYA YOSHINAGA, KEISUKE INUI, SHYUNICHI NAKAMURA, KOUJI MURAI, MASATOMO YOSHIKAWA, KOUJI KATOU, WATARU SHIMIZU Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan Background: Factors involved in the pathogenesis of heart failure with preserved ejection fraction (HFpEF) include hypertension (HTN), anemia, diabetes, obesity, and chronic obstructive pulmonary disease (COPD). On the other hand, few studies have examined the influence of these non-heart-associated concomitant diseases on the prognosis of patients with HFpEF. Subjects and Methods: We retrospectively analyzed 69 HTN patients who were admitted to our hospital with a diagnosis of HFpEF between January 2008 and March 2012 and could be followed-up for 2 years, excluding those with acute coronary syndrome, those undergoing dialysis and those with severe valvular disease. We evaluated the factors involved in all-cause mortality and rehospitalization due to HF. Results: The mean age of the subjects was 75.6611.4 years, males accounted for 66.7%. The COPD was identified as a factor involved in all-cause mortality (HR: 2.71 (1.01-7.23), P!0.05). On the other hand, chronic kidney disease and anemia was identified as a factor involved in rehospitalization due to HF (HR: 3.01 (1.06-8.57), P!0.05, HR 2.65 (1.06-6.59) P!0.05, respectively). Conclusion: In HFpEF patients with HTN, factors involved in allcause mortality may differ from those involved in rehospitalization due to HF. Not only HF treatment but also active management for individual concomitant diseases may be necessary to improve the prognosis. Treatment for COPD may also improve the prognosis.
P-120 Intensive Treatment of Atrial Fibrillation in Heart Failure with Preserved Ejection Fraction may be a Possible Option for Clinical Management HIROAKI HIRAIWA1, SUMIO YAMADA2, SAYANO KONDO1, TORU KONDO1, YASUNORI KANZAKI1, DAISUKE TANIMURA1, TOSHIAKI KATOH1, HIROAKI SANO1, YOSHIFUMI AWAJI1, RINYA KATOH1 1 Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan, 2Nagoya University Graduate School of Medicine, Nagoya, Japan Background and Aims: Several hemodynamic factors contribute to decreased peak oxygen uptake (VO2peak) in heart failure with preserved ejection fraction (HFpEF). Atrial fibrillation (AF), frequent comorbidity with heart failure, can affect exercise hemodynamics by the loss of atrial kick. However, the influence of AF on VO2peak in HFpEF has not been fully investigated in Japanese patients. Therefore, we aimed to investigate the impact of AF on VO2peak and VE/VCO2 slope in Japanese patients with HFpEF (LVEF$50%). Methods: A total of ninety six patients with HFpEF (mean age 63612 years; 79 male) who underwent cardiopulmonary testing were enrolled and divided into two groups; AF group (n521) and non-AF group (n575). Results: VO2peak was lower and VE/VCO2 slope was higher in AF group than non-AF group (VO2peak; 17.064.3 vs. 22.064.9 ml/min/kg, p!0.001, VE/VCO2 slope; 33.066.5 vs. 28.365.8, p50.006). In multiple linear regression analysis, age (b5-0.309, p50.001), hemoglobin (b50.342, p!0.001), and AF
(b5-0.249, p50.004) were selected as independent variables on VO2peak. When compared AF patients with age- and sex-matched non AF patients (n521), VO2peak was significantly lower and VE/VCO2 slope was significantly higher in AF patients (VO2peak; 17.064.3 vs. 20.665.5 ml/min/kg, VE/VCO2 slope; 33.066.5 vs. 28.766.0). Conclusion: The findings of this study suggest that intensive care of AF may be a possible option for better prognosis in HFpEF patients.
P-121 A Case Report of Successful Immunosuppressive Therapy for Chronic Myocarditis HARUKA SATO, TATSUO AOKI, KOICHIRO SUGIMURA, KOTARO NOCHIOKA, SHUNSUKE TATEBE, SAORI YAMAMOTO, MASANOBU MIURA, NOBUHIRO YAOITA, KIMIO SATOH, HIROAKI SHIMOKAWA Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan In February 2013, a 61-year-old woman admitted to a hospital for dyspnea. She was diagnosed as having heart failure (HF) due to dilated cardiomyopathy and medical therapies were started. However, she had repeated episodes of acute exacerbation of HF and admission to the hospital. In December 2013, she was transferred to our hospital for the treatment of her refractory HF. On admission, she had symptoms of NYHA III and elevated BNP level (1188 pg/ml). Cardiac MRI showed reduced left ventricular ejection fraction (LVEF, 22%) and delayed enhancement in the apex. Right heart catheterization showed low cardiac index (CI, 2.03 L/min/m2), and endomyocardial biopsy revealed lymphocytic infiltration, indicating chronic myocarditis. Chest X-ray and chest computed tomography showed multiple consolidations on both lungs, and transbronchial lung biopsy showed the presence of organizing pneumonia. Although tuberculin skin test was negative, FDG-PET, laboratory tests and endomyocardial and lung biopsies showed no other findings suggestive of cardiac sarcoidosis. Despite optimal treatments for HF, LVEF was not improved. In February 2014, we started immunosuppressive therapy with prednisolone (40 mg/day) and azathioprine (50 mg/day) with resultant improvement of LVEF (LVEF 41%, CI 2.61 L/min/m2) in 2 weeks. Furthermore, endomyocardial biopsy after the immunosuppression therapy showed disappearance of lymphocytic infiltration in the myocardium. Thus, immunosuppressive therapy dramatically improved LV dysfunction in this case of chronic myocarditis.
P-122 A Case of Cardiac Sarcoidosis with Acute Heart Failure Successfully Treated with Steroid Pulse Therapy TOMONARI KIMURA, KAZUFUMI NAKAMURA, KOJI TOKIOKA, TOSHIHIRO SARASHINA, HIRONOBU TODA, YOKO NODA, HIROSHI ITO Cardiovascular department, University of Okayama, Okayama, Japan We report a case of cardiac sarcoidosis (CS) with acute heart failure, and successfully treated with steroid pulse therapy. A 64 year-old woman with left ventricular (LV) dysfunction was referred to our hospital because of acute heart failure and hypotension. Laboratory findings showed significant increase of serum high sensitive troponin T (hsTNT) level. Coronary artery angiography showed no coronary artery disease. Echocardiography showed decrease of mid to apex inferior wall motion. Cardiac magnetic resonance imaging showed late enhancement at several region of LV wall. 67Ga scintigraphy showed uptake by diffuse LV wall. Non-caseated epithilioid cell granulomas were observed in myocardial tissue, and diagnosed CS. The patient was treated with steroid pulse therapy (methyl prednisolone 500mg/day for 3days), the serum hsTNT decrease (from 1.41 to 0.300 ng/mL) and the worsening of LV wall motion stopped. Steroid pulse therapy was effective for CS with acute inflammation and acute heart failure.
P-123 Cardiac Sarcoidosis with Ventricular Tachycardia And Echocardiography MIE SEYA, TARO SASAOKA, KENSUKE HIRASAWA, SHUNJI YOSHIKAWA, YASUHIRO MAEJIMA, MIHOKO KAWABATA, MASAHIKO GOYA, TAKASHI ASHIKAGA, KENZO HIRAO, MITSUAKI ISOBE Department of Cardiovascular Medicine, Tokyo Medical and Dental University Background: Sarcoidosis is a multisystem disease, and cardiac sarcoidosis may be present in as many as 25% of the patients with systemic sarcoidosis. Cardiac sarcoidosis affects patient’s prognosis because of congestiveheart failure and ventricular arrhythmias, however the details are remained to be elucidated. This study aimed to reveal the predictors of prognosis in patients with cardiac sarcoidosis. Methods and Results: We retrospectively analyzed consecutive 34 patients diagnosed cardiac sarcoidosis in our institution. Mean age of the patients were 62 6 14 years old, and 24 patients (71%) were female. Solitary cardiac sarcoidosis was found in 10 patients (29%). 12 patients had decreased left ventricular ejection fraction (LVEF) (!50%) and 4 patients (12%) had the thinning of LV wall, 4 patients (12%) had no abnormal change of the echocardiography. VT (ventricular tachycardia) was tend to be occurred in patients with low EF (EF!50%) than with preserved EF (EFO50%).
The 18th Annual Scientific Meeting
JHFS
S207
VT were observed in 13 patients (38%), and they had significantly lower LVEF compared to no-VT patients. (43 6 14% vs. 58 6 10% p50.02) We found an optimal cut off value of 44% in ROC analysis, this value identified 7 of 13 patients with VT, resulting in sensitivity and specificity levels of 0.54 and 0.91. Conclusion: In this study, lower LVEF was associated with VT in cardiac sarcoidosis.
with occurrence of heart failure (p ! 0.05). This association was still significant after adjustment for age, gender, incidence of hypertension, diabetes mellitus and kidney function. Conclusion: Parathyroid hormone is associated with future heart failure. Our results suggest that treatment to reduced PTH level is helpful to prevent future cardiac event.
P-124
P-127
Diagnosis and Treatment of Isolated Cardiac Sarcoidosis DAISUKE TEZUKA, TARO SASAOKA, MITSUAKI ISOBE Department of Cardiovascular Medicine, Tokyo Medical and Dental University
Relationship between Indoxyl Sulfate and Fibroblast Growth Factor 23 in Heart Failure Patients with Preserved Renal Function MIKI IMAZU1, MASANORI ASAKURA1, HIROYUKI TAKAHAMA1, HIROSHI ASANUMA2, AKIRA FUNADA1, YASUO SUGANO1, TAKAHIRO OHARA1, TAKUYA HASEGAWA1, HIDEAKI KANZAKI1, TOSHIHISA ANZAI1, MASAFUMI KITAKAZE1 1 National Cerebral and Cardiovascular Center, Osaka, Japan, 2Kyoto Prefectural University School of Medicine
Background: Long term survival data and the therapeutic significance of prednisolone for isolated cardiac sarcoidosis (iCS) has not been established, particularly in the cases with left ventricular (LV) dysfunction (EF ! 50%). Moreover, it is difficult to diagnose iCS patients without histological evidence of granulomas. The aim of this study was to assess therapeutic effect and prognosis of iCS. Methods: According to clinical criteria, sarcoidosis with CS (sCS) and iCS were diagnosed. iCS cases were examined using cardiac magnetic resonance imaging or 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography. Results: Baseline of brain natriuretic peptide (BNP) were not different between sCS (n517) and iCS (n57). After prednisolone treatment, BNP decreased significantly in both groups (sCS: before, 157.36130.3 pg/ml; after, 108.8693.7, p50.01; iCS: before, 317.86331.2; after, 138.66161.6, p50.043). The prognosis demonstrated by Kaplan -Meier curve (40651.1 months) was not different between sCS (n530) and iCS (n511). CS cases not treated by prednisolone showed poorer prognosis (p50.0069). The patients with LV dysfunction which was not treated by prednisolone had the worst outcome among the all groups (p50.0011). Conclusion: iCS cases with LV dysfunction initially those suspected with the noninvasive imaging modalities, prednisolone treatment should be considered.
P-125 Heterogeneity of Sympathetic Nervous Density in the Left Ventricular Wall in Dilated Cardiomyopathy SHOHEI KIKUCHI, SHUICHI KITADA, NOBUYUKI OHTE Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Purpose: We assessed presynaptic sympathetic nervous function in patients with dilated cardiomyopathy (DCM) using positron emission tomography (PET) with Carbon-11 hydroxyephedrine (HED). Methods: In 15 patients with DCM in stable conditions and 15 healthy controls, left ventricular (LV) myocardial global blood flow (MBF) was measured using N-13 ammonia PET and then global HED retention index (HED-RI) was determined as myocardial tracer activity between 30-40 minutes divided by the integral of the activity input function. The polar maps of the tracers were divided into 17 segments, and each segmental tracer activity of MBF and HED-RI were normalized to the highest values in each patients. Coefficients of variation (CV) were calculated to assess heterogeneity of MBF and HED-RI in the LV wall. Results: MBF and HED-RI were significantly lower in patients with DCM than in healthy subjects (0.5960.10 vs 0.7860.10 mL/min/g, p50.0003; 6.961.9 vs 8.862.0 %/min, p50.02, respectively). CV of both MBF and HED-RI were significantly higher in patients with DCM than in healthy subjects (24.767.9 vs 17.564.1 %, p50.004; 16.465.4 vs 10.362.2%, p50.0004, respectively). The CVs of HED-RI were significantly correlated with logBNP (r50.65, p50.0001). Conclusion: In addition to the global reduction of cardiac sympathetic activity, heterogeneous sympathetic presynaptic tracer uptake in the LV wall was demonstrated in patients with DCM. The degree of heterogeneity was correlated to severity of heart failure.
P-126 Impact of Parathyroid Hormone on Future Occurrence of Heart Failure in Patients without History of Cardiovascular Disease SATORU SAKURAGI, KEIJI YAMADA Department of Cardiology, Iwakuni Clinical Center Parathyroid hormone (PTH) plays an important role in bone metabolism. High PTH level increases intracellular calcium in arterial wall, which causes hypertension and left ventricular hypertrophy. However, information on the association of PTH level with cardiovascular event in general population is still lacking. Methods and Results: 174 subjects (84male, 68years) without history of cardiovascular disease were enrolled from September 2012 to April 2013. At baseline, parathyroid function was assessed with intact PTH (iPTH). Subjects were classified into tertiles of intact PTH and clinical characteristics were compared. Association of intact PTH with future cardiovascular event was also evaluated. Subjects with highest tertile of iPTH was older, and had higher ratio of female and prevalence of hypertension (p ! 0.05 for all). In blood test, markers of kidney function such as creatinine and cystatin C were increaed in subjects with highest tertile of iPTH. NT-proBNP increased with iPTH (p ! 0.01). During the follow-up period of 115days, 7 subjects developed congestive heart failure. Serum intact iPTH was significantly associated
Backgrounds: Both indoxyl sulfate (IS) known as one of a uremic toxin and fibroblast growth factor 23 (FGF23) which is one of a phosphate-regulating hormone are known to be prognostic markers with chronic kidney disease. Recently it was reported that IS suppressed Klotho expression which need to FGF23 signaling in kidney, but it is less known the relationship between IS and FGF23. We aimed to determine the relationship in heart failure patients without advanced renal dysfunction. Methods: We investigated 726 subjects from a community population, and prospectively enrolled 79 patients who have history of heart failure with more than 60 ml/min/1.73 m2 of eGFR and without albuminuria (HF group). We matched community population with gender and eGFR of HF patients (Control group). The plasma IS levels and the serum FGF23 levels were measured at the same time. Results: IS levels significantly correlated with FGF23 levels in HF group (r50.35, p50.002), but not in Control group (r50.07, p50.521), and IS did not correlate with phosphorous and intact parathyroid hormone which relate to FGF23 in these groups. IS and FGF23 levels of HF group were significantly higher than of Control group, and BNP levels, too. Conclusion: IS related to FGF23 in HF patients without obvious renal dysfunction. IS might influence regulating the serum FGF23 levels.
P-128 Serum Brain-derived Neurotrophic Factor Level Predicts Adverse Clinical Outcomes in Patients with Heart Failure MASATO KUDO, SHINTARO KINUGAWA, ARATA FUKUSHIMA, TAKASHI YOKOTA, SHOUJI MATSUSHIMA, TAKAAKI FURIHATA, MASAYA TSUDA, JUNICHI MATSUMOTO, SHINGO TAKADA, HIROYUKI TSUTSUI Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan Aims: Exercise intolerance as well as depressive symptoms are prevalent and associated with adverse outcomes in patients with heart failure (HF). Brain-derived neurotrophic factor (BDNF) is involved in cardiovascular diseases as well as skeletal muscle energy metabolism and depression. We recently reported that serum BDNF level was decreased in HF patients and was closely related to their exercise capacity. We thus investigated whether serum BDNF level was associated with their outcomes. Methods and Results: We measured serum BDNF level in 58 HF patients (59.2613.7 years, NYHA I-III) at baseline and adverse events including all cause death and HF rehospitalization were registered during the mean follow-up of 18.2 months. The multivariate analysis demonstrated that serum BDNF level was an independent prognostic factor of adverse events (hazard ratio 2.32, 95% confidence interval 1.20-4.47, P50.008). Cutoff value of serum BDNF determined by receiver operating characteristic curve analysis predicted adverse events with sensitivity, specificity, and positive and negative predictive values of 75%, 79%, 60%, and 85%, respectively. Kaplan-Meier analysis demonstrated that low level of BDNF was associated with higher rates of adverse events than high level of BDNF (P50.001). Conclusion: Decreased serum BDNF levels were significantly associated with adverse outcomes in HF patients, suggesting that they can be a useful prognostic biomarker.
P-129 Serum Irisin Levels Provide Prognostic Information in Patients with Heart Failure with Reduced Ejection Fraction SHINSUKE HANATANI, YASUHIRO IZUMIYA, YUICHI KIMURA, YOSHIRO ONOUE, SATOSHI ARAKI, HISAO OGAWA Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan Introduction: Irisin is a newly identified myokine found in human serum. The gene expression of irisin precursor in skeletal muscle is associated with exercise tolerance in heart failure patients. Hypothesis: In patients with heart failure with reduced ejection fraction (HFrEF), irisin could be a useful biomarker to predict future cardiovascular events. Methods and Results: We measured serum irisin levels in 84 patients with HFrEF. Serum irisin concentrations were measured by an ELISA. The endpoint was a composite of total mortality, cardiovascular hospitalization and coronary revascularization. These patients were divided into 2 groups according to irisin levels.
