The 18th Annual Scientific Meeting � JHFS S165
(n516 [14%], July to September) and other seasons admission group (n565 [56%],March to June, October to November). HFpEF showed the trend of more prevalent inother seasons than winter season (n531 [48%] vs. 10 [29%], p50.06, Figure).Compared with patient admitted in winter, other seasons had significantly lowerdiuretic use (22% vs. 49%, p50.006) and higher prevalence of hypertensive heart dis-ease (25% vs. 6%, p50.01). Conclusion: Onsets of HFpEF might be related withvulnerability of blood pressure in the change of the season.
O-115Abnormal Circadian Blood Pressure Rhythm is Associated with Heart Failurewith Preserved Ejection FractionTAKAHIRO KOMORI, KAZUO EGUCHI, YOSHIOKI NISHIMURA, MASARUICHIDA, SATOSHI HOSHIDE, KAZUOMI KARIODivision of Cardiovascular Medicine, Department of Medicine, Jichi MedicalUniversity School of Medicine, Tochigi, Japan
Riser pattern, defined by higher nocturnal BP than awake BP, has been reported to beassociated with adverse cardiovascular prognosis. However the significance of ambu-latory blood pressure (ABP) in heart failure with preserved ejection fraction (HFpEF)has never been reported.We aimed to clarify the hypothesis that abnormal circadian BPrhythm is associated with HFpEF. HFpEF was defined as EF gt;45%. We enrolled 508patients with hospitalizedHF (age, 68613 years; male sex, 62%). Therewere 232 casesof HFpEF and 276 case of heart failurewith reduced ejection fraction (HFrEF). Patientswith HFpEF were older, higher rate of female and higher ambulatory BP levels. Theriser pattern was more frequent in patients with HFpEF (28.9%) than in HFrEF(19.9%). In multivariable logistic regression analysis, riser pattern was associatedwith HFpEF (odds ratio 1.73, 95% confidence interval (CI) 1.02-2.91, p50.041) inde-pendent of other covariates. In conclusion, riser pattern was associated with HFpEF.Uncontrolled nocturnal BP could be one of the major risk factors of HFpEF.
O-116Impact of Coronary Artery Calcification on the Development of Future HeartFailure in Patients with Preserved Left Ventricular Ejection FractionKEIJI YAMADA, SATORU SAKURAGI, KEISHI ICHIKAWA, MASAFUMITANIMOTO, TAKASHI MIKI, HIROAKI OTSUKA, KAZUHIKO YAMAMOTO,KENJI KAWAMOTO, MACHIKO TANAKAYA, YUSUKE KATAYAMADepartment of cardiology, Iwakuni Clinical Center, Iwakuni, Japan
Background: Coronary artery calcium score (CACS) is a predictor of coronary eventin patients with subclinical atherosclerosis; however, the association of coronary ar-tery calcification with heart failure has not been elucidated. In this study, we exam-ined the impact of CACS on cardiac function and occurrence of future heart failure inpatients with preserved left ventricular ejection fraction (LVEF). Methods and re-sults: 578 subjects with preserved LVEF and without history of coronary artery dis-ease (CAD) were enrolled. Subjects underwent CACS determination by MDCT.CACS was calculated using the Agaston criteria. Subjects were classified into fourgroups according to CACS: normal (!10, n5256), mild (11 to 100, n5104), mod-erate (101 to 400, n5105), severe (401!, n5113). Cardiac function was evaluatedwith echocardiography. Associations of CACS with cardiac function and future car-diovascular events were evaluated. There was no difference in LV systolic functionamong groups; however, diastolic dysfunction assessed by E/e was associated withCACS (p50.009). In univariable analysis, CACS was significantly associated withfuture occurrence of heart failure (r50.113, p50.007). In multivariable analysis,the association of CACS with the onset of heart failure was still significant even afteradjustment for age, gender, kidney function, LVEF, prevalence of hypertension, dia-betes mellitus and coronary artery disease. Conclusions: Coronary artery calcifica-tion was associated with the onset of heart failure in patients with preserved LVEF.
O-117Association between Peripheral Endothelial Function and Left VentricularDiastolic Function in Patients with Ischemic Heart DiseaseTETSUARI ONISHI, SHOKO TAKEDA, TAKAHIRO SAWADA, HARUMI UEDA,HIDEMI YASUGI, MASATO TSURU, HIROYA KAWAIHimeji Cardiovascular Center
Background: Endothelial dysfunction is associated with adverse outcomes in pa-tients with ischemic heart disease (IHD). However, it is not clear whether endothelialdysfunction is associated with the progression of left ventricular (LV) diastolicdysfunction and left atrial (LA) overload in IHD patients. Methods: We studied107 consecutive patients with IHD (age 67610 years, 21 females) using echocardi-ography and reactive hyperemia peripheral arterial tonometry (RH-PAT). LV diastolicfunction by the ratio of transmitral peak E-wave velocity to peak A-wave velocity(E/A) and the deceleration time of E-wave (DT), LA overload by LA volume, andestimated LA pressure (eLAP) derived from the velocity of pulmonary valve regur-gitation and LV systolic function by LV ejection fraction (EF) were assessed usingechocardiography. Peripheral endothelial function was assessed by RH-PAT indexas the ratio of the digital pulse volume during reactive hyperemia divided by thatat baseline using RH-PAT. Results: RH-PAT index significantly correlated with
DT, LA volume, and e-LAP, and EF (all p!0.05) but it did not with E/A. Multivar-iate analysis showed DT (p50.004) and LAvolume (p50.009) were independent fac-tors associated with RH-PAT index. Conclusions: Our results showed that theendothelial dysfunction was associated with the progression of LV diastolic dysfunc-tion with LA overload. Therapeutic strategy for improving endothelial dysfunctionmay play an important role for management in patients with heart failure and IHD.
O-118Left Ventricular Diastolic Dysfunction and Exercise Intolerance in Type 2Diabetes Patients with Endothelial DysfunctionTADAFUMI SUGIMOTO1, MOTOKI OTSUJI2, KAZUKI MORI1, MASAHIDEHORIGUCHI1, TAKESHI TAKAMURA1, SHIGETOSHI SAKABE1, DAISUKEIZUMI1, TETSUYA SEKO1, KATSUNORI BETTOU2, ATSUNOBU KASAI11Department of Cardiology, Ise Red Cross Hospital, Mie, Japan, 2Department ofClinical Laboratory, Ise Red Cross Hospita
Purpose: Endothelial dysfunction plays a central role in the pathogenesis of diabeticvascular disease. Although resultant left ventricular diastolic dysfunction (LVDF) ishypothesized to reduce exercise capacity, limited data exist on the relation betweenendothelial function, LVDF and exercise capacity in patients with type 2 diabetes.Methods: We recruited 231 subjects with type 2 diabetes, a preserved ejection frac-tion, a negative stress test and a sodium-restricted diet. All subjects underwent abrachial artery flow-mediated dilation (FMD) measurement, a transthoracic echocar-diography and a standard Bruce protocol treadmill exercise test. Results: ImpairedFMD and impaired LVDF were found in 193 subjects and 174 subjects, respectively,of which 11 had diastolic dysfunction. Mean E/E’ by quartile (Q) were: Q1 6.9, Q28.9, Q3 10.4, and Q4 14.0. E/E’ was inversely correlated with %FMD (2.964.3%,r 5 -0.19, p 5 0.003) and exercise duration (4606150 sec, r 5 -0.30, p !0.001).Compared with subjects in Q4, those in Q1, Q2 and Q3 had longer exercise duration(Q1 5006150 sec, Q2 5106140 sec, Q3 4606140 sec and Q4 3906140 sec, p !0.001). After adjustment for potential confounders, %FMD and exercise durationwere significantly associated with E/E’ (b 5 -0.1 and -0.003, p 5 0.006 and0.014) in all subjects. Conclusions: Diabetes patients with impaired endothelial func-tion have impaired LVDF potentially leading to exercise intolerance.
O-119Respiratory Muscle Weakness is Associated with Exercise Intolerance inPatients with Heart Failure with Preserved Ejection FractionKENSAKU YAMADA, YOSHIHARU KINUGASA, SHINOBU SUGIHARA,MASAHIKO KATO, KAZUHIRO YAMAMOTOThe Department of Molecular Medicine and Therapeutics, Tottori University,Yonago, Japan
Background: The relationship between respiratory muscle strength and exercisetolerance in patients with heart failure with preserved ejection fraction(HFpEF)re-mains undefined. Methods: The present study enrolled a total of 39 patients withHFpEF (EFO45%)who were hospitalized with worsening HF in author’s institution.Respiratory muscle strength as assessed by maximum inspiratory pressure(PImax)and 6-minute walk distance (6MWD)were evaluated before hospital discharge. Res-piratory muscle weakness was defined as PImax!70% of predicted normal values.Results: Respiratory muscle weakness was prevalent in 41% of patients. PImaxwas positively correlated with vital capacity (VC), forced expiratory volume inone second (FEV 1.0), grip strength, weight bearing index(WBI), and limb musclemass(VC:R50.677, FEV 1.0:R50.577, grip strength: R50.791, WBI: R50.459,limb muscle mass: R50492, all p!0.05). 6MWD was significantly decreased in pa-tients with respiratory muscle weakness compared with those with normal respiratorymuscle strength (2476132m vs. 3366134m, p!0.05). Conclusions: Respiratorymuscle weakness is common, and associated with exercise intolerance in patientswith HFpEF. Respiratory muscle training is a potential rehabilitation strategy forthese patients.
O-120Low Serum Concentrations of N-3 Polyunsaturated Fatty Acids Promote LeftAtrial Remodeling Following Onset of Acute Myocardial InfarctionNORIHIRO OKADA, KUNIO YUFU, YUKI EBATA, REIKA AYABE, TETSUJISHINOHARA, YASUSHI TESHIMA, MIKIKO NAKAGAWA, NAOHIKOTAKAHASHIDepartment of Cardiology anf Clinical Examination, University of Oita, Oita, Japan
Objectives: N-3 polyunsaturated fatty acids (N-3 PUFA) have been associated with areduced incidence of adverse cardiovascular events. The aim of the present study is toevaluate the relationship between serum N-3 PUFA concentrations and echocardio-graphic parameters in patients with acute myocardial infarction (AMI). Methodsand Result: Twenty patientswithAMI (3 female and 17male,mean age 71612 years),who admitted to our hospital, were enrolled. Echocardiographic study was evaluated atbaseline and 6 months after the onset of AMI in all the patients. The serum concentra-tions of N-3 PUFA (eicosapentaenoic acid; EPA and arachidonic acid; AA) weremeasured at baseline period in all the patients. The association between the baseline
