Masahiro Seo

Tolvaptan Reduces the Risk of Worsening Renal Function in Patients With Acute Decompensated Heart Failure and Preserved Left Ventricular Ejection Fraction - Prospective Randomized Controlled Study.

BACKGROUND Although the mainstay of treatment for acute decompensated heart failure (ADHF) is decongestion by diuretic therapy, it is often associated with worsening renal function (WRF). The effect of tolvaptan, a selective V2 receptor antagonist, on WRF in ADHF patients with preserved left ventricular ejection fraction (LVEF) is unknown.Methods and Results:We enrolled 50 consecutive ADHF patients whose LVEF on admission was ≥45%. Patients were randomly assigned to either tolvaptan add-on (n=26) or conventional diuretic therapy (n=24). The primary endpoint was the incidence of WRF, defined as an increase in serum creatinine (Cr) ≥0.3 mg/dL or 50% above baseline within 48 h of randomization. There was no significant difference between the 2 groups in the change in body weight or the total urine volume during 48 h. However, the change in Cr (∆Cr) at 24 and 48 h after randomization and the incidence of WRF (12% vs. 42%, P=0.0236) were significantly lower, and the fractional excretion of urea (FEUN) at 24 and 48 h after randomization was significantly higher in the tolvaptan group. There was an inverse correlation between ∆Cr and FEUN at 48 h after randomization. CONCLUSIONS Tolvaptan can alleviate congestion with a significantly lower risk of WRF in ADHF patients with preserved LVEF, presumably through maintenance of renal perfusion.

Risk stratification of patients with chronic heart failure using cardiac iodine-123 metaiodobenzylguanidine imaging: incremental prognostic value over right ventricular ejection fraction

Right ventricular (RV) systolic dysfunction has been shown to be an independent predictor of clinical outcome in patients with chronic heart failure (CHF), and cardiac metaiodobenzylguanidine (MIBG) imaging also provides prognostic information. We aimed to evaluate the long‐term predictive value of combining RV systolic dysfunction and abnormal findings of cardiac MIBG imaging on outcome in CHF patients.

Continuous Renal Replacement Therapy for Pheochromocytoma Crisis With Multiple Organ Failure

Pheochromocytoma crisis is a feared and potentially lethal complication associated with excess release of catecholamine from the tumor, which might lead to multiple organ failure (MOF). The definitive treatment for pheochromocytoma is surgical resection. To safely proceed with surgery, hemodynamic stabilization in the acute phase is indispensable, but it might be extremely challenging in case of pheochromocytoma crisis with MOF even if the sufficient pharmacological drugs would be administered. Catecholamine is a dialyzable substance and is removed by renal replacement therapy. In this report, we described 2 cases of pheochromocytoma crisis with MOF, in which we succeeded in controlling acute unstable hemodynamics by means of catecholamine removal with continuous renal replacement therapy. These cases suggest that continuous renal replacement therapy may be effective to manage unstable hemodynamics because of massive catecholamine excretion in patients with pheochromocytoma crisis and MOF.

Serial Change in Serum Chloride During Hospitalization Could Predict Heart Failure Death in Acute Decompensated Heart Failure Patients

BACKGROUND Although hyponatremia predicts morbidity and mortality in acute decompensated heart failure (ADHF), hypochloremia is also independently associated with poor prognosis in ADHF. Little is known, however, about the prognostic value of serial change in serum chloride during hospitalization in ADHF patients.Methods and Results:We prospectively studied 208 ADHF survivors after discharge and divided them into 4 groups according to serum chloride on admission and at discharge: (1) persistent hypochloremia group (n=12), hypochloremia both on admission and at discharge; (2) progressive hypochloremia group (n=42), development of hypochloremia after admission; (3) improved hypochloremia group (n=14), hypochloremia only on admission; and (4) no hypochloremia group, no hypochloremia during hospitalization (n=140). During a mean follow-up period of 1.86±0.76 years, 20 of 208 patients had heart failure death (HFD). In a model adjusted for hyponatremia, hypochloremia both on admission and at discharge was still significantly associated with HFD. Hyponatremia, however, was not significantly associated with HFD after adjustment for hypochloremia. Patients with persistent hypochloremia (HR, 9.13; 95% CI: 2.56-32.55) and with progressive hypochloremia (HR, 4.65; 95% CI: 1.61-13.4) had a significantly greater risk of HFD than those without hypochloremia during hospitalization. CONCLUSIONS Both persistent hypochloremia and progressive hypochloremia during hospitalization are associated with HFD in ADHF patients.

CHADS2 SCORE PREDICTS ISCHEMIC STROKE AMONG CHRONIC HEART FAILURE PATIENTS WITH SINUS RHYTHM IRRESPECTIVE OF THE LEVEL OF RED CELL DISTRIBUTION WIDTH

The CHADS2 score is useful to stratify the risk of ischemic stroke or transient ischemic attack (TIA) in patients with non-valvular atrial fibrillation (AF). It has also been reported that red cell distribution width (RDW) is associated with the incidence of ischemic stroke. However, no information

THE CHADS2 SCORE PREDICTS ISCHEMIC STROKE IN CHRONIC HEART FAILURE PATIENTS WITHOUT ATRIAL FIBRILLATION: COMPARISON TO OTHER STROKE RISK SCORES

The CHADS2 score is useful in stratifying the risk of ischemic stroke or transient ischemic attack (TIA) in patients with non-valvular atrial fibrillation (AF). However, it remains unclear whether the CHADS2 score could predict stroke or TIA in chronic heart failure (CHF) patients without AF. Recently, the new stroke risk score was proposed from 2 contemporary heart failure trials. We evaluated the prognostic power of the CHADS2 score for stroke or TIA in CHF patients without AF in comparison to the “stroke risk score”. We retrospectively studied 127 CHF patients [left ventricular ejection fraction (LVEF) <40 %] without AF, who had been enrolled in our previous prospective cohort study. The primary endpoint was the incidence of stroke or TIA. The mean baseline CHADS2 score was 2.1 ± 1.0. During the follow-up period of 8.4 ± 5.1 years, stroke or TIA occurred in 21 of 127 patients. At multivariate Cox analysis, CHADS2 score (C-index 0.794), but not “stroke risk score” (C-index 0.625), was significantly and independently associated with stroke or TIA. The incidence of stroke or TIA appeared to increase in relation to the CHADS2 score [low (=1), 0 per 100 person-years; intermediate (=2), 1.6 per 100 person-years; high (≥3), 4.7 per 100 person-years; p = 0.04]. CHADS2 score could stratify the risk of ischemic stroke in CHF patients with the absence of AF, with greater prognostic power than the “stroke risk score”.

MODEL OF END-STAGE LIVER DISEASE EXCLUDING INR (MELD-XI) SCORING SYSTEM PROVIDES THE ADDITIONAL LONG-TERM PROGNOSTIC INFORMATION TO ADHERE RISK LEVEL IN PATIENTS ADMITTED WITH ACUTE DECOMPENSATED HEART FAILURE

The Acute Decompensated Heart Failure National Registry (AHDERE) risk levels are a validated tool to assess the risk of in-hospital mortality in patients (pts) with acute decompensated heart failure (ADHF). Liver dysfunction has a prognostic impact on the outcome of pts with advanced heart failure.

PROGRESSIVE HYPONATREMIA DURING HEART FAILURE TREATMENT PROVIDES THE LONG-TERM PROGNOSTIC INFORMATION IN PATIENTS ADMITTED WITH ACUTE DECOMPENSATED HEART FAILURE, REGARDLESS OF REDUCED OR PRESERVED LEFT VENTRICULAR EJECTION FRACTION

Progressive hyponatremia during hospitalization are reported to be associated with poor outcome in patients (pts) with acute decompensated heart failure(ADHF). However, there is little information available on the long-term prognostic significance of progressive hyponatremia during hospitalization

USEFULNESS OF ADMIRE-HF RISK SCORE FOR THE PREDICTION OF SUDDEN CARDIAC DEATH IN PATIENTS WITH CHRONIC HEART FAILURE

AdreView Myocardial Imaging for Risk Evaluation in Heart Failure (ADMIRE-HF) risk score is a novel risk score that combines clinical characteristics and imaging variables to provide individualized estimates of serious arrhythmic risk in patients (pts) with chronic heart failure (CHF). However, there

NUTRITIONAL ASSESSMENT BY PROGNOSTIC NUTRITIONAL INDEX PROVIDES THE ADDITIONAL LONG-TERM PROGNOSTIC INFORMATION TO BODY MASS INDEX IN PATIENTS ADMITTED WITH ACUTE DECOMPENSATED HEART FAILURE

Obesity Paradox is well recognized in patients (pts) with heart failure. Malnutrition is associated with increased mortality risk in pts with heart failure. However, there is little information available on the long-term prognostic significance of nutritional assessment in patients admitted with