New Therapeutic Strategy for Severe Heart Failure Patients with Functional Mitral Regurgitation

New Therapeutic Strategy for Severe Heart Failure Patients with Functional Mitral Regurgitation

The 18th Annual Scientific Meeting volumetric image data of multi-slice CT can be converted into plastic models that enhance our spatial perception of...

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The 18th Annual Scientific Meeting volumetric image data of multi-slice CT can be converted into plastic models that enhance our spatial perception of real-life anatomy and pathology. Followed by a new vacuum casting method, rubbery models with real anatomy of the heart can be precisely manufactured. We made a variety of replicas of congenital heart disease (CHD) including VSD, ASD, TOF, DORV, SRV, TAPVR, and ccTGA, etc. This combination of the techniques enabled us to reproduce replicas with similar texture and structure of the heart. This technique also allowed the surgeon to cut and suture, facilitating the simulation of the surgical operation, and would be helpful for rescuing the children with complicated CHD.

O-208 New Therapeutic Strategy for Severe Heart Failure Patients with Functional Mitral Regurgitation SHIGERU MIYAGAWA, KOICHI TODA, TERUYA NAKAMURA, YASUSHI YOSHIKAWA, SATSUKI FUKUSHIMA, DAISUKE YOSHIOKA, TETSUYA SAITO, TAKAYOSHI UENO, TORU KURATANI, YOSHIKI SAWA Department of Cardiovascular Surgery, Osaka University, Osaka, Japan



between the two groups. In the follow-up period (mean 776 days), there were 64 cardiac deaths and 51 non-cardiac deaths. The event-free survival (cardiac death, non-cardiac death and all-cause death) was significantly higher in Group L than in Group H. In the multivariate Cox proportional hazard analysis, a high hs-TnT was an independent predictor of cardiac death (P!0.001), non-cardiac death (P!0.001) and all-cause mortality (P!0.001) in HF patients after adjusting for other known risk factors. Regarding echocardiographic paremeters, left ventricular wall thickness was higher (P!0.001), and left ventricular ejection fraction was lower (P50.011) in Group H than in Group L. Conclusions: Hs-TnT is an independent predictor not only of cardiac mortality, but also non-cardiac mortality in HF patients.

O-211 Positive hs-TnI at Emergency Department is an Independent Predictor for Inhospital Mortality in Acute Heart Failure Syndrome Patients YUJI MASTUDA1, YUYA MATSUE1, NOBUYUKI KAGIYAMA3, TERUYOSHI KUME2, HIROYUKI OKURA2, MAKOTO SUZUKI1, AKIHIKO MATSUMURA1, KIYOSHI YOSHIDA2, YUJI HASHIMOTO1 1 Department of Cardiology, Kameda Medical Center, Kamogawa, Japan, 2The Sakakibara Heart Institute of Okayama, Okayama, Japan, 3Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan

Although effective surgical treatments for sever heart failure such as implantable Left ventricular assist device (LVAD) or Heart transplantation have already been introduced to clinical situation, these established treatment could not be applied to all patients because of donor shortage. In this situation, alternative surgical strategy which can improve survival rate and symptoms should be developed. In this report we want to report new surgical strategy using combination of beating Mitral valve replacement (MVR) and cell sheet therapy for severe heart failure. Candidates were 6 Dilated cardiomyopathy (DCM) patients. On the first stage, beating MVR was performed with bioprosthetic valve About 4 months after MVR, cell sheets were made of cultured myoblasts on temperature responsive dishes in 4 patients and implanted on recipient myocardium through left lateral thoracotomy. After operation US analysis showed that LV volume was preserved and systolic function gradually increased. Moreover some patients who showed pulmonary hypertension demonstrated normalization of pulmonary pressure and improvement of NYHA classification (3.25 vs 2.5vs 1.75 vs 1.75). Survival rate was better compared with estimated survival rate calculated by Seattle Heart failure model This combination therapy might be feasible and safe and promising results in functional recovery warrant further clinical investigation to prove the therapeutic efficacy of this treatment for DCM patients with severe heart failure.

Background: High-sensitivity troponin I (hs-TnI) can detect minor myocardial injury in acute heart failure syndrome (AHFS) patients. However, the prognostic utility of hsTnI in AHFS is not well elucidated. Methods: We retrospectively enrolled 494 AHFS patients who were admitted from emergency department (ED) with hs-TnI measurement in ED. Dialysis patients were excluded. We determined hs-TnI was positive if hs-TnI concentration was above 99th percentile cut-off value. Endpoint was in-hospital mortality. Results: In this cohort (median 82.0 years old, 48.2% male), hs-TnI was positive in 309 patients (62.6%). Median and Interquartile range of hs-TnI were 0.064 and 0.03-0.189 ng/ml). During hospitalization, 32 patients (6.5%) had died. When hsTnI was divided into tertile (T1: -0.036 ng/ml, T2: 0.036-0.121 ng/ml, T3: 0.121- ng/ ml), in hospital mortality was increased significantly as hsTnI increased (T1: 2.5%, T2: 6.1%, and T2 10.7%, P50.010). Both in univariate and multivariate analysis, positive hs-TnI at admission was an independent predictor for in-hospital mortality in AHFS patients (HR: 3.45, 95% CI: 1.30-9.11, P50.013, and HR 3.58, 95% CI: 1.24-10.3, P50.018, respectively). Conclusion: In AHFS patients, positive hs-TnI is an independent predictor for in-hospital mortality.



Importance of Peak Uric Acid in Patients with Acute Heart Failure Syndromes KOJI MURAI1, KUNIYA ASAI1, EICHIRO OKA1, YOSHIAKI KUBOTA1, SYUNICHI NAKAMURA1, KEISUKE INUI1, MASATOMO YOSHIKAWA1, YAYOI TSUKADA1, NAOKI SATO2, WATARU SHIMIZU1 1 Nippon Medical School, Tokyo, Cardiology, 2Nippon Medical School Musashikosugi Hospital, Kanagawa, Cardiology

Low Serum Vitamin D Levels are Associated with Patients with Acute Decompensated Heart Failure TETSURO MIYAZAKI, SHOKO SUDA, TAKATOSHI KASAI, TAKAO KATO, MASARU HIKI, RIE MATSUMORI, MAKOTO HIKI, ATSUTOSI TAKAGI, KATSUMI MIYAUCHI, HIROYUKI DAIDA Department of Cardiovascular Disease, Juntendo University School of Medicine, Tokyo, Japan

Backgrounds: It is known that high value of uric acid (UA) at discharge is the independent factor of mortality in patients with acute heart failure syndromes (AHFS), and UA is closely related to renal function. It is not well investigated whether peak UA value is correlated to the in-hospital mortality in patients with AHFS. Methods: We retrospectively analyzed the data of continuous 105 patients of AHFS (average 73.4 years old, 63 male patients) admitted directly to cardiac care unit from 2005 June to 2008 January. Patients with acute coronary syndromes and patients with severely reduced renal function (value of serum creatinine O3.0 mg/ dl at admission) were excluded. Results: Peak UA (8.762.3 mg/dl in survival patients (N598) vs 12.162.3 mg/dl in patients with in-hospital death (N57), P50.002), peak BUN (P50.004), and peak creatinine (P50.002) were significantly higher in patients with in-hospital death compared with survival patients. The value of area under curve were 0.887 (peak UA and peak creatinine) and 0.878 (peak BUN) in ROC curve with in-hospital mortality. Conclusions: The value of peak UA is powerful predictor of in-hospital mortality as well as that of peak BUN.

O-210 Impact of Cardiac Troponin T on Non-cardiac Mortality in Hospitalized Heart Failure Patients YUICHI NAKAMURA, AKIOMI YOSHIHISA, TAKESHI SHIMIZU, HIROYUKI YAMAUCHI, MAKIKO MIYATA, SATOSHI SUZUKI, KAZUHIKO NAKAZATO, HITOSHI SUZUKI, SHU-ICHI SAITOH, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical University Background: Cardiac troponins are independent predictors of cardiac mortality in patients with heart failure (HF). Recently, elevation of troponins has been described in non-cardiac diseases. However, it still remains unclear whether high-sensitive troponin T (hs-TnT) predicts non-cardiac mortality in HF patients. Methods and Results: Consecutive 444 HF patients admitted to our hospital for the treatment of decompensated HF were divided into 2 groups based on median hs-TnT: Group L (!0.028 ng/ml, n5220) and Group H (O0.028 ng/ml, n5224). We compared all-cause mortality and echocardiographic findings

Objective: Vitamin D deficiency is a risk factor for cardiovascular disease, including congestive heart failure, coronary heart disease, and peripheral arterial disease. However, clinical significance of Vitamin D in the pathogenesis of acute decompesated heart failure (ADHF) remains unclear. Method: We enrolled consecutive 198 patients admitted to coronary care unit in Juntendo University Hospital. Serum 25-hydroxy vitamin D (25 (OH)D) levels on admission were measured by ELISA. Results: In 198 patients, 83 patients with ADHF (NYHA classification III or IV) showed significantly lower 25 (OH)D levels than others (14.3 6 7.2 vs. 19.3 6 7.9 ng/ ml, P! 0.0001). There were no significant associations of 25 (OH)D levels with age and BMI, while 25 (OH)D levels were positively associated with systolic blood pressure, and total, HDL and LDL cholesterol levels, and negatively associated with serum creatinine, IL-6, TNF-a and CRP levels. In addition, 25 (OH)D levels were negatively associated with BNP and NT-pro BNP levels (r 5 -0.27, P 5 0.0002, and r 5 -0.33, P! 0.0001, respectively) and positively with ejection fraction (r 5 0.18, P 5 0.02). Multivariate analysis demonstrated 25 (OH)D levels were an independent predictor for the presence of ADHF. Conclusion: Low serum vitamin D levels in patients with ADHF correlated with inflammation, BNP and NT-pro BNP levels, and ejection fraction, suggesting an important role of vitamin D in the pathogenesis of ADHF.

O-213 Transtubular Potassium Gradient (TTKG) as a Surrogate for Monitoring Aldosterone Bioactivity in Patients with Acute Decompensated Heart Failure TAIKI SAKAGUCHI1, KAZUYA SHINOUCHI1, HIROYUKI MIURA1, KOICHI MIYAZAKI1, MASAO KOIDE1, HARUHIKO ABE2, KEIJI HIROOKA1, YUKIHIRO KORETSUNE2, HIDEO KUSUOKA1, YOSHIO YASUMURA1 1 Division of Cardiology, National Hospital Organization Osaka National Hospital, Osaka, Japan, 2Institute for Clinical Research, National Hospital Organization Osaka National Hospital, Osaka, Japan Backgrounds: The renin-angiotensin-aldosterone system (RAAS) is deeply involved in the pathophysiology of acute decompensated heart failure (ADHF), and RAAS