ポスター1（P01）心肥大・心リモデリング

第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター１（P01）心肥大・心リモデリング
P-001
Myocardial Afadin Contributes to Cardiac
Remodeling During Chronic Pressure
Overload
Dimitar ZANKOV、Hisakazu OGITA
Department of Biochemistry and Molecular Biology, Shiga University of
MedicalScience
一般演題
︵ポスター︶
Adaptor protein afadin and transmembrane protein nectin form
cell-cell adhesion system that is essential for the embryonic
development, tissue physiology, and behavior of some malignancies.
In the heart afadin（paired with nectin）is located in the intercalated
disks of cardiomyocytes but its function there is still unclear.
We generated conditional knockout mice deficient in myocardial
afadin（m-afa-/- mice）to explore the consequences of afadin loss.
There was no detectable change in phenotype of m-afa-/- mice
compared to littermate controls. In vivo monitoring of blood
pressure, cardiac function and dimensions（echography）has not
revealed signiﬁcant diﬀerences. In a similar manner, heart weight,
morphology, histology（HE staining）, intercalated disks structure
（confocal images）were indistinguishable between the two groups.
Involvement of afadin in cardiac pathophysiology is evaluated in the
hearts confronting pressure overload for 4 weeks by subcutaneous
infusion of angiotensin II（ang）. Ang treated control mice developed
hypertension and cardiac hypertrophy; Massons s trichrome stained
histological preparations demonstrated collagen deposits around the
arterial vessels in ventricles and in some areas between myocytes.
There was no deterioration of cardiac function. Hearts of ang
treated m-afa-/- mice remodeled in a similar way except for the
signiﬁcantly less degree of ﬁbrosis. Our data suggest involvement
of myocardial afadin in cardiac remodeling during chronic pressure
overload, and now underlying mechanisms are investigated.
P-002
Unexpected Localization of AMPK at the
Intercalated Disc
Yasunori SHINTANI、Shohei YASHIROGI、Issei YAZAWA、
Seiji TAKASHIMA
Medical Biochemistry, Osaka University Graduate School of Medicine,
Suita,Japan
AMP-activated protein kinase（AMPK）is a central player of
cellular energy homeostasis. AMPK activation is triggered
by energy deprivation, increased ratio of AMP/ATP.
AMPK has been reported to be involved in cellular polarity,
proliferation and migration, however, its substrates and
downstream signalling on these cellular aspects has been
unclear. We have recently established infrared confocal
microscopy which enabled us to eliminate background
signals from tissue section so that we can sensitively
detect relatively weak signals even from phosphorylated
kinase in immunohistology. Here we found an unexpected
subcellular localization of AMPK at the intercalated disc
in the heart by using the infrared confocal microscopy. By
screening unknown substrates of AMPK at the junction
fraction from the heart, we identiﬁed a couple of molecules
which also localized at the intercalated disc. We conﬁrmed
these substrates were phosphorylated by AMPK in vitro
and identiﬁed phosphorylation sites within them. By using
phosphorylation specific antibodies, we found they were
also phosphorylated at the intercalated disc by AMPK
in vivo.These data propose a novel biological function of
AMPK at the intercalated disc. Further investigation will be
warranted.
258
P-003
Activation of PPAR Alpha During Heart
Failure Maintained Myocardial Function
and Energetics in Mice Transverse Aortic
Constriction（TAC）Model
Satoshi KAIMOTO、Atsushi HOSHINO、Yoshifumi OKAWA、
Makoto ARIYOSHI、Kuniyoshi FUKAI、Motoki UCHIHASHI、
Kazunori ONO、Shuhei TATEISHI、Eri IWAI-KANAI、Satoaki MATOBA
Department of Cardiovascular Medicine, Graduate School of Medical
ScienceKyotoPrefecturalUniversityofMedicineKyoto,Japan
Background: Failing heart loses its metabolic ﬂexibility and relies
more on glucose as its preferential substrate. A key regulator of
this substrate shift is peroxisome proliferator-activated receptorα
（PPARα）. However the role PPARα and the eﬀect of modulating
fatty acid oxidation（FAO）are still unclear in heart failure.
Method and Results: After eight weeks of transverse aortic
constriction（TAC）, left ventricular function was decreased with
the reduction of PPARα expression. TAC-operated mice were
randomly allocated into two groups : a HF group of untreated
mice with heart failure, and a WY-HF group of mice with heart
failure receiving WY14643（speciﬁc PPARα agonist）. Eight weeks
after TAC, LV construction was preserved significantly in the
WY-HF group with reduction in ﬁbrosis relative to HF-group. The
levels of PPARα targeted genes involved in fatty acid metabolism
were signiﬁcantly increased and BNP was signiﬁcantly reduced in
the WY-HF group in comparison with the HF group. Myocardial
high energy phosphates i.e., ATP measured by HPLC were
signiﬁcantly preserved in the WY-HF group.Conclusions: These
data suggest that activation of PPARα during heart failure
improved myocardial function and energetics. Modulation of FAO
will be a new therapeutic strategy for heart failure.
P-004
RyR2 Stabilization by Inhibition of CaMKIIMediated Aberrant Ca2+ Release Suppress
Arrhythmogenesis in Cardiac Troponin
T-Related Hypertrophic Cardiomyopathy
Shinichi OKUDA、Masakazu FUKUDA、Takayoshi KATO、
Tetsuro ODA、Shigeki KOBAYASHI、Takeshi YAMAMOTO、
Masafumi YANO
Department of Medicine and Clinical Science, Division of Cardiology,
YamaguchiUniversityGraduateSchoolofMedicine,Japan
Cardiac troponin T（cTnT）mutations that increase myoﬁlament Ca2+ sensitivity
cause Familial Hypertrophic Cardiomyopathy（FHC）, which leads to sudden
cardiac death. However, the underlying mechanism by which the cTnT mutations
lead to lethal arrhythmia remains elusive. Here, we investigated the pathogenic
role of phosphorylation-mediated aberrant Ca2+ release via cardiac ryanodine
receptor（RyR2）and therapeutic eﬀects of dantrolene, which was found to correct
inter-domain interactions of RyR2, in transgenic mouse（TG）model with FHCrelated cTnT mutation（TNT-delta160E）. In 6-months-old´s TG, there was no
appreciable diﬀerence in the structural features of hearts, compared with non-TG.
In response to isoproterenol（ISO; 10nmol/L）, the Ca2+ spark frequency（SpF:s-1m1
）was much higher in TG cardiomyocytes（ISO-TG: 7.9±0.6; p<0.01）than in nonTG cardiomyocytes（3.6±0.4）. It was largely reversed by CaMKII inhibitor {KN93（1μM）, 5.0±0.4; p<0.05}, but not by PKA inhibitor{H-89（1μM）, 7.6±0.3;n.s.}. ISOTG（but not ISO-treated non-TG）showed spontaneous Ca2+ transient（sCaT）after
5Hz pacing, whereas it was attenuated only by KN-93. Moreover, dantrolene（1
μM）attenuated ISO-induced SpF（5.2±0.3; p<0.05 vs ISO-TG）, time from peak
to 70% decline of Ca2+ transient and sCaT in TG cardiomyocytes. In FHC-linked
cTnT-mutated hearts, aberrant Ca2+ release through defective RyR2 was induced
by beta-adrenergic stimulation, and subsequent CaMKII activation. Inhibition
of CaMKII-mediated aberrant Ca2+ release by stabilizing RyR2 might be a new
therapeutic target for preventing the development of arrhythmias in FHC.
プログラム・抄録集
ポスター２（P02）心不全と他臓器連関を考える
P-005
Dahl食塩感受性高血圧ラットにおける鉄欠乏は
貧血の原因か？
佐々木尚子 1）、真鍋恵理 2）、志方敏幸 1）、増山理 2）、野健 1）
兵庫医療大学　薬学部　医療薬学科、2）兵庫医科大学循環器内科
1）
Altered Hypercapnic Chemosensitivity
in Conscious Nephrectomized Rats with
Myocardial Infarction
Tadakazu HIRAI1）、Satoshi NUMA1）、Takashi OHORI1）、
Shuji JOHO1）、Hidetsugu ASANOI2）、Hiroshi INOUE1）
1）
The Second Department of Internal Medicine, University of Toyama,
Japan、2）ImizuCityHospital
Background: Chronic kidney disease（CKD）is an important risk factor
for poor outcomes in patients with heart failure（ HF）. Although
exaggerated sympathetic activation could lead to adverse outcome in
cardiorenal syndrome, precise mechanism of enhanced sympathetic
activation remains unclear. This study was designed to evaluate
circadian variations of hypercapnic chemosensitivity and sympathetic
tone in nephrectomized rats with HF. Methods: Rats underwent
subtotal nephrectomy and surgically induced myocardial infarction
（MI）. After acclimatization to a 12h light-dark cycle, blood pressure
（BP）and heart rate were continuously recorded in conscious rats with
CKD and MI by using radiotelemetry pressure transducer. To evaluate
hypercapnic chemosensitivity rats were intermittently exposed to 5-min
hypercapnic conditions（13%CO2+20%O2）every one hour. Sympathetic
tone was assessed by low-frequency components（0.15-0.79Hz）of diastolic
BP variability（LFdp）. Results: Serum creatinine was increased in CKD
rats than those in Sham rats（1.0± 0.3 mg/dl vs 0.5± 0.1 mg/dl, p < 0.05）.
A transient increase in LFdp was observed during the awaking period
in rats with MI+CKD（n=7）when compared to those in SHAM（n=7）
（883
±165 vs 541±165（SE）mmHg2, p<0.05）. In rats with MI and CKD,
CO2 chemoreﬂex gain during the awaking period was more enhanced
than those of sham rats（p<0.05）. Conclusion: In rats with CKD and
HF, transient augmentation of chemoreﬂex gain during the awakening
periods could contribute to enhanced sympathetic tone.
P-006
Altered Renal Gene Expression in Mice with
Heart Failure Induced by Pressure Overload
Kazuhiro SHINDO、Masanori ASAKURA、Kyung-Duk MIN、
Miki IMAZU、Hiroki FUKUDA、Masafumi KITAKAZE
C l i n i c a l R e s e a r c h a n d D e v e l o p m e n t , N a t i o n a l C e r e b r a l a n d
CardiovascularCenter,Osaka,Japan
B A C K G R O U N D C a r d i o - r e n a l i n t e r a c t i o n（ C R I ）a f f e c t s
pathophysiology of heart failure（HF）through various mechanisms.
However, the impact of renal gene expression on both acute and
chronic HF has not been fully unveiled.
AIM We aimed to search the genes responsible for CRI using
murine pressure overloaded HF model induced by transverse aortic
constriction（TAC）.
METHODS We created TAC and sham mice and conducted
echocardiogram followed by sacrifice at 3 days or 8 weeks after
operation. RNA samples were corrected from mid-portion of
the kidneys and gene expression levels were analyzed by DNA
microarray. Obtained data were further analyzed using Ingenuity
Pathway Analysis（IPA）.
RESULTS We compared TAC mice with shams at 3 days（4 TACs
vs 2 shams）or 8 weeks（4 TACs vs 4 shams）.From 45101 probe sets
on the chip, we identiﬁed 64（3 days）and 26（8 weeks）up-regulated
probe sets with fold-change >1.5. IPA gave us the information about
the location and functions of each molecule and we found that these
up-regulated genes included secretory proteins and receptors which
might be contributed to organ-organ interaction via circulating
blood ﬂow, namely PRLR, ADIPOQ, GREM, IGFBP and PSAP.
CONCLUSION We identified up-regulation of several genes
cording secretory proteins and receptors in kidneys under HF by
comprehensible gene expression analysis. They might contribute to
the pathophysiology of HF.
P-008
VEGF Signaling of the Diabetic Heart
by Endothelin Antagonism: Endothelin-A
Antagonism and Endothelin-A/-B Antagonism
Yumi MIYAUCHI1）、Jesmin SUBRINA1,3）、Satoshi SAKAI2）、
Nobutake SHIMOJO1,3）、Hidekazu MARUYAMA1,2）、Taizo KIMURA2）、
Yoshihiro SEO2）、Satoshi HOMMA2）、Kazutaka AONUMA2）、Takashi MIYAUCHI1,2）
Life Science Center for Tsukuba Advanced Research Alliance,
University of Tsukuba、2）Division of Cardiology, University of Tsukuba,
Tsukuba, Japan、 3）Division of Emergency Medicine, University of
Tsukuba,Tsukuba,Japan
1）
To study the differences in effectiveness by two types of endothelin
（ET）receptor antagonists（selective ET-A or dual ET-A/B antagonists）on
the streptozotocin（STZ）-induced rat diabetic hearts（type I diabetes）at
functional and biochemical/molecular levels, citrate saline（vehicle）or STZ
were injected to rats. The ET-A/B dual receptor antagonist（SB209670）and
the ET-A receptor antagonist（TA-0201）were applied to these rats. One week
after injection, animals were separated into those receiving SB209670, TA0201or vehicle by 4-week osmotic mini-pump. The VEGF level and percent
fractional shortening in the diabetic heart was signiﬁcantly decreased than
in the non-diabetic heart, whereas SB209670 and TA-0201 treatments greatly
and comparably prevented this decrease. SB209670 treatment was more
effective in reversing decreased expressions of KDR and phosphorylated
AKT, downstreams of VEGF angiogenic signaling, than TA-0201 treatment.
（Conclusions and Discussion）The present study showed that TA-0201 or
SB209670 improved % fractional shortening and VEGF levels of the diabetic
hearts in a similar extent, suggesting that ET-A blockade and dual ETA/-B blockade are similarly eﬀective in improving cardiac dysfunction of the
diabetic rats. In addition to this ﬁnding, the data of improvement in KDR
mRNA and pAKT levels by SB209670, but not TA-0201, also suggests that
dual ET-A/-B blockade may be eﬀective in improving intracellular signaling
systems by these components in the diabetic（type I）rat heart.
259
一般演題
︵ポスター︶
【目的】慢性心不全患者の貧血には鉄欠乏が合併するが、それ
が貧血の原因かどうかは不明である。慢性心不全のモデル動
物である Dahl 食塩感受性高血圧（DS）ラットは鉄欠乏を伴う
正球性正色素性貧血を発症する。我々は DS ラットの貧血が
鉄補充で改善するかどうかを検討した。【方法】雄性 DS ラッ
トをコントロール群（con 群）、高食塩食群（HS 群）、高食塩
食＋鉄静注群（HS+Fe 群）の 3 群に分けた。HS 群、HS+Fe 群
には 6 週より 8%NaCl 食を負荷し、貧血が出現し始める 10 週
齢から、HS+Fe 群には含糖酸化鉄注射液 0.2mL
（鉄 4mg に相
当）を、HS 群には生理的食塩水を週 1 回尾静脈から注射した。
14 週齢にてサンプリングを行った。【結果】血圧、左心室重量、
血清クレアチニン値は HS 群において上昇し、体重、ヘモグ
ロビン値、血清鉄は減少した。これらの指標の鉄補充による
改善は見られなかった。脾臓において、HS 群では貯蔵鉄が
枯渇しており鉄剤静注により con 群と同等に回復しても血清
鉄は上昇しなかった。【結論】DS ラットの貧血に対して、静
注による鉄補充は無効であり、鉄欠乏は貧血の主な原因では
なく、鉄の利用障害が存在していることが示された。
P-007
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター３（P03）心不全の基礎研究における話題
P-009
P-010
Survivin Mediates Protective Eﬀect of Insulin
Against Doxorubicin-Induced Cardiotoxicity
Via Akt/mTOR/p70S6K/sp1 Pathway
Role of O-linked N-acetyl Glucosamine
Posttranslational Modiﬁcation in Intermittent
Hypoxia-Induced Cardiac Remodeling
Beom Seob LEE1,3）、Jaewon OH2,3）、Seok-Min KANG2,3）
Mizuho SASAKI1）、Takatoshi NAKAGAWA2）、Atsuo NOMURA1）、
Ryuji KATO1）、Yoshio IJIRI1）、Takehiro YAMAGUCHI3）、Yasukatsu IZUMI4）、
Minoru YOSHIYAMA3）、Michio ASAHI2）、Tetsuya HAYASHI1）
1）
GraduatePrograminScienceforAging,YonseiUniversity、2）Cardiology
Division, Yonsei University College of Medicine、 3）Cardiovascular
ResearchInstitute,SeveranceCadiovascularHospital,Seoul,Republicof
Korea
一般演題
︵ポスター︶
Background and Objective: Insulin inhibits ischemia-reperfused induced
myocardial apoptosis through the PI3K/Akt/mTOR/survivin pathway.
Survivin has an anti-apoptotic effect against Doxorubicin（DOX）induced
cardiotoxicity. However, whether survivin mediates the protective eﬀect of
insulin against DOX injury remains undetermined. This study is aimed to
investigate whether survivin plays a role in the anti-apoptotic eﬀect of insulin
against the DOX injury in the cardiomyocytes and further to determine the
signaling mechanism involved.
Methods and Results: We observed that insulin had anti-apoptotic effect
against DOX injury by demonstrating reduced caspase-3 activity（from 4.1±
0.3 to 2.8±0.3, p<0.05）and apoptosis index（from 4.1±0.04 to 1.9±0.03, p<0.05）,
concomitantly increased cell viability（ 55.2±7.6% vs. 84.5±0.8%, p<0.05）.
Transcript and protein levels of survivin were signiﬁcantly reduced by DOX,
which were recovered by insulin through the activation of Akt/mTOR/p70s6k
and protein level of Sp1. Pretreatment with rapamycin, a specific mTOR
inhibitor or p70s6k inhibitor blocked insulin-induced recovery of sp1 protein
expression level against DOX injury. To further ascertain the role of survivin
in insulin-induced protective eﬀect, cardiac myocytes were transfected with
siRNA of sp1 or survivin. The Sp1 or survivin siRNA signiﬁcantly blunted the
anti-apoptotic eﬀect of insulin against the DOX injury.
Conclusions: Our results suggest that survivin mediates protective effect
of insulin against DOX-induced cardiotoxicity via Akt/mTOR/p70S6K/Sp1
pathway.
LaboratoryofCardiovascularPharmacotherapyandToxicology,Osaka
University of Pharmaceutical Sciences, Takatsuki, Japan、2）Department
of Pharmacology and Osaka Medical College,Takatsuki, Japan、
3）
DepartmentofCardiovascularMedicine,OsakaCityUniversityGraduate
School of Medicine, Osaka, Japan、 4）Department of Pharmacology,
OsakaCityUniversityGraduateSchoolofMedicine,Osaka,Japan
1）
Background: Intermittent hypoxia, a major phenomenon in the sleep apnea syndrome
（SAS）, is relevant to cardiovascular events, especially in patients with diabetes mellitus
（DM）. The aim of this study was to evaluate the role of O-Linked N-Acetyl Glucosamine
（O-GlcNAc）posttranslational modification in cardiomyocytes exposed to intermittent
hypoxia, using DM and O-N-acetylglucosamine transferase transgenic（OGT-Tg）mice.
Methods: Male db/db, OGT-Tg, and wild type mice were exposed to intermittent hypoxia
（IH; 1 minute of 5% oxygen followed by 5 minutes of 21% oxygen）for 14 days. HEK
（Human Embryonic Kidney）293 cells were kept under sustained hypoxia（3-4 %）for 4,
24, 48 hours. Heart was excised and O-GlcNAc modified proteins, OGT, microtubuleassociated protein 1 light chain 3（LC3）were detected by Western blotting.Results:
Although fibroblast proliferation in HEK cells under hypoxia was suppressed by
O-GlcNAc, IH increased myocardial degeneration and interstitial ﬁbrosis in DM mice,
associated with signiﬁcant increase of O-GlcNAc modiﬁed proteins. On the other hand, the
LC3-II/LC3-I ratio was signiﬁcantly increased by IH in OGT-Tg mice, and cardiomyocyte
hypertrophy, mitochondrial destruction, and autophagosomes were observed.Conclusion:
IH significantly increased oxidative stress and histological degeneration, especially in
DM mice with increased O-GlcNAcylation. On the contrary, OGT-Tg mice showed
acceleration of autophagy and IH-induced cardiac remodeling. Thus, O-GlcNAc might
play a crucial role in cardiac remodeling caused by intermittent hypoxia.
P-011
In Failing Cardiomyocytes, Calmodulin
Dissociation from Ryr2 and Defective Domain
Interaction Leads to Channel Destabilization
Tetsuro ODA1）、Takeshi YAMAMOTO2）、
Shigehiko NISHIMURA2）、Takayoshi KATO2）、Sinichi OKUDA2）、
Shigeki KOBAYASHI2）、Donald M BERS3）、Masafumi YANO2）
1）
Advanced Medical Emergency and Critical Care Center, University of
Yamaguchi,Ube,Japan、2）DepartmentofMedicineandClinicalScience,
Division of Cardiology, Yamaguchi University Graduate School of
Medicine, ube, Japan、 3）Department of Pharmacology, University of
CaliforniaDavis,DavisCA,USA
Calmodulin（CaM）binding to RyR2 inhibits diastolic channel activity, indicating
that CaM stabilizes the RyR2. In conditions where CaM dissociates from RyR2, like
heart failure（HF）, RyR2 exhibits destabilized gating and increased activity. Those
characteristics make CaM a critical regulator of RyR2 and potential therapeutic
target for HF. Another leading mechanism for the RyR2 dysfunction in HF is
defective domain interaction between N-terminal and central domains. However,
the relationship between CaM-RyR2 binding and defective domain interaction in
HF is unclear, especially in cardiomyocytes. Here, in cardiomyocytes from HF rat,
we use FRET between ﬂuorescent FKBP12.6 and CaM to detect RyR2-bound CaM
and measure the RyR2-CaM binding aﬃnity. The Kd for CaM-RyR2 binding in HF
myocytes is ∼ 3 fold increased vs. normal myocytes. By measuring the binding
kinetics of ﬂuorescent domain peptide DPc10（F-DPc10）, we can detect defective
interaction between N-terminal and central domains in myocytes. In HF myocytes,
the F-DPc10-RyR2 association rate was significantly accelerated vs. normal
myocytes, indicating a destabilized domain interaction（unzipping）.However, in HF
myocytes, saturating RyR2 with high [CaM] dramatically reduced F-DPc10 binding
to RyR2 and greatly slowed the association rate. We conclude that in HF myocytes,
reduced CaM-RyR2 binding aﬃnity leads to defective domain interaction, shifting
the channel to an "unzipped" state. Promoting CaM-RyR2 reassociation can restore
the defective domain interaction and stabilize the channel.
260
プログラム・抄録集
ポスター４（P04）心不全の慢性期管理をどうする
P-012
Newly Identiﬁcation of Antibodies Against
Severe Heart Failure Patients
Takaharu HAYASHI1）、Yoshihiro ASANO1）、Yasushi SAKATA1）、
Seiji TAKASHIMA2）
TheDepartmentofCardiology,UniversityofOsaka,Osaka,Japan、2）The
DepartmentofMedicalBiochemistry,UniversityofOsaka,Osaka,Japan、
3）
Clinical Research and Development, National Cerebral and
CardiovascularCenterResearchInstitute,Osaka,Japan
1）
P-013
心不全を発症した壮年期独居者における生活支援
稲谷怜、松村さゆり
厚生連　滑川病院　看護部
【背景目的】近年、壮年期における心不全予備軍が増加して
おり、早期からの生活指導・是正が重要である。今回、家
族・社会的支援が困難であった壮年期の患者に看護介入した
事例を報告する。【症例】K 氏、40 代男性、心不全で入院。無
職、独居。母・妹との交流はない。【経過】入院 2 ヶ月前に胸
痛出現する。全身浮腫がみられ入院 1 週間前から座位で過ご
す。入院前日に自殺企図し入院となる。入院時 NYHA IV 度、
BNP 6751 pg/ml、両下肢、腹部より浸出液がみられた。入院
時より病態説明や生活指導、入院前の生活について看護師と
面談し、振り返りを行う。経済的問題は多職種と協働し話し
合いの上退院となる。
【考察】今回の事例では K 氏が独居、家
族と疎遠状態であるため、今後の生活や、K 氏のセルフモニ
タリング能力が問題となった。K 氏は入院前の下肢浮腫・浸
出液を
「汗」
と捉えるなど、セルフモニタリングにおける知識・
技術・関心が低いといえたが、心不全症状が軽減していく過
程で症状や状態・治療に合わせ、生活指導を受けたことで、
身体への興味・関心が高まったと思われる。
P-015
The Eﬀect of Left Ventricular Hypertrophy and Associated
Diastolic Dysfunction on Left Ventricular Remodeling and
Exercise Capacity in a Murine Model of Mitral Regurgitation
再入院を繰り返す肺気腫合併肺線維症を併せ持っ
た慢性心不全患者への継続看護と地域連携に対す
る一考
Kyung-Hee KIM1）、Yong-Jin KIM2）、Seung-Pyo LEE2）、
Hyung-Kwan KIM2）、Dae-Won SOHN2）
岩尾雅子
DivisionofCardiology,DepartmentofInternalMedicine,SejongGeneral
Hospital & Sejong Heart Institute、2）Department of Internal Medicine,
Cardiovascular Center, Seoul National University College of Medicine,
SeoulNationalUniversityHospitalSeoul,Korea
高齢化が急速に進み家族の在りようも変化する中、地域包括
ケアの構築が重要視されている。看護の対象が変化する中に
おいて、患者と医療者の問題認識の相違が退院後の生活に支
障をきたした慢性心不全に肺気腫合併肺線維症を併せ持つ患
者の退院調整に関わる機会を得たので報告する。看護師は問
題を妻と死別し独居生活、活動制限の必要はあるが生活維持
のために動かざるを得ない状況である事、労作性呼吸困難に
より退職し生活保護、介護申請適応年齢外、経済力介護力と
もに不足している事と捉えていた。患者は、心筋塞は完治
し呼吸器疾患は継続との認識で退院したが、再入院後は今
通りの生活が難しいと考えるようになった。同時に社会的な
援助を希望され、
退院前カンファレンスにてケアマネージャー
と身体精神的状況と問題点を共有することで、掃除や買い物
などヘルパーを週 3 回、疾病管理や精神的支援のため訪問看
護を週 2 回配置する計画が立案された。家庭復帰初期の再入
院しやすい時期に在宅支援者のケアマネージャーや訪問看護
師と地域連携し外的統制を行うことが再入院の延長に繋がっ
たと考える。
1）
Introduction: Degenerative mitral regurgitation（MR）is often accompanied by left ventricular
hypertrophy（LVH）and diastolic dysfunction.
Objectives: This study determined the contribution of LVH and associated diastolic dysfunction
on LV remodeling and exercise capacity in rats with signiﬁcant MR.
Method: LVH and diastolic dysfunction were created by suprarenal aortic constriction（SAC）in
SD rats. Serial echocardiographic studies and exercise were performed at 2-week intervals
and invasive hemodynamic examination by a pressure-volume catheter system was done at
14 weeks after SAC. To test the eﬀect of LVH and diastolic dysfunction on LV remodeling
and exercise capacity, the rats were divided into 3 groups [SAC+MR =SAC followed by MR
operation, MR=laparotomy followed by MR operation, Control]. MR was created by introducing
a needle through LV apex under the guidance of TEE and making a hole on anterior mitral
leaﬂet. MR was considered signiﬁcant if a regurgitant jet area occupied more than 45% of the
left atrium. SAC was done at 2 weeks before MR formation in SAC+MR group.
Results: During the LVH and diastolic dysfunction experiment, LV wall thickness increased
in LVH group compared to control group whereas LV ejection fraction（EF）and E/E' did
not change. In hemodynamic analysis, LV end diastolic pressure and the EDPVR slope were
greater in LVH group than in control group. Next, when we compared LV remodeling and
exercise capacity between above 3 groups, LV dilatation and exercise intolerance were
developed ﬁrst in SAC+MR group. However, MR group showed a catch-up of remodeling and
exercise intolerance at 10 weeks after MR formation（LV ESD at 10 weeks after MR formation,
4.33±0.26 vs. 6.50±0.40 vs. 6.59±1.38 mm for control vs. MR vs. SAC+MR, P<0.05; LV EDD,
7.68±0.15 vs. 10.48±0.46 vs. 10.20±1.26 mm, P<0.05; exercise duration, 765.3±130.1 vs. 487.8±
49.0 vs. 434.0±80.3 seconds, P<0.05; no statistical differences between SAC+MR and MR）.
In neurohormonal activity, the level of BNP was not diﬀerent between 3 groups. However
interstitial ﬁbrosis is greater in SAC+MR compared with MR and control.
Conclusion: We successfully set up two small animal models of LVH accompanied with diastolic
dysfunction and signiﬁcant MR. LVH and associated diastolic dysfunction did not aﬀect LV
remodeling and exercise capacity over time in rats with signiﬁcant MR.
獨協医科大学越谷病院
261
一般演題
︵ポスター︶
<Background>The ventricular assist device（VAD）is poweful
in the course of the treatment for heart transplantation. But
it is difficult to decide when to perform VAD implantation.
Sometimes biopsy samples of heart tissue from severe heart
failure patients revealed the inavasion of many lymphocytes,
despite the absence of myocarditis.<Purpose>We
hypothesized there might be concerned with autoimmune
responce, therefore evaluated relationship between
autoimmunity and severe heart hailure.<Methods and
Results>We collected blood serum from 37 heart failure
patients and 10 VAD patients along with 100 healthy normal
subjects. Using homogenated normal human heart lysate, we
performed western blot analysis by their serum. We could ﬁnd
several speciﬁc auto-antigens and to identify the protein, we
next made puriﬁcation of these proteins by an anion exchange
and reverse phase HPLC. We ﬁnally identiﬁed 4 proteins as
auto-antigen candidates by MS analysis. For example, one out
of antigen X were detected against the serum from 4 out of
10 VAD implantation patients, which could ﬁnd only one out
of a hundred healthy normal subjects（P<0.01）.<Conclusion>
In this study, we identified specific auto-antigens in severe
heart failuer patients. It will be a marker of severe heart
failure and useful for us to decide VAD implantation.
P-014
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
P-016
P-018
心不全患者に関する生活指導プロトコールを作成して
心不全患者のセルフモニタリングに関する現状
小林希望、原田友香、前田京子
竹之内恵、肥後あかね、木本直子、田上さとみ
特定医療法人明石医療センター
独立行政法人国立病院機構鹿児島医療センター
一般演題
︵ポスター︶
【目的】平成 24 年に、セルフケア能力を査定する質問紙（SelfCare Agency Questionnaire, 以下、SCAQ）を用いて心不全患
者の弱みを抽出し生活指導を行った結果、セルフケア能力の
向上を認めた。しかし、SCAQ の活用には時間を要し、研究
メンバーのみが情報整理を行った。そのため、他スタッフは
SCAQ の使用方法を理解出来ておらず、活用できていない。
そこで、心不全患者の弱みへの支援を、病棟全体で行えるよ
うにすることを目的とした。【方法】SCAQ の活用とカンファ
レンスを含めた、指導プロトコールの作成を行った。プ
ロトコールは、カンファレンスと実践を繰り返し作成し、患
者・看護師ともにわかりやすくした。
【結果と結語】スタッフ
が指導を行った結果、8 人の初回心不全患者の SCAQ 値は、
Wilcoxon の符号順位和検定、X2 による分析で、指導前より
有意な向上を認めた。カンファレンスも開催でき、個別性に
応じた指導へとつながったと考える。また、初回入院でない
慢性心不全患者はすでに自己管理法を持っていることが多く、
今回のプロトコールを用いた指導は不向きであることもわ
かった。
目的
心不全患者の入院時・退院後のセルフモニタリングの状況を
把握し、現在の療養生活指導の効果を明らかにする。
結果および考察
心不全の診断で入院となった患者を対象に心不全患者のセル
フモニタリング評価尺度を使用し調査を行った。入院 1 週間
以内のセルフモニタリングの状況について初回入院患者と再
入院患者を比較した結果、「水分貯留に対する解釈」のみ有意
差を認めた。パンフレットを使用した一般的な指導では、患
者が自らセルフモニタリングを行えるような行動変容に繋が
らなかったと考えられる。また追跡調査を行い、入院 1 週間
以内と退院 1 ヶ月後のセルフモニタリングの状況について比
較した結果、「体調を定期的に測っている」「測定結果が気に
なる」
「水分の量を気にしている」
「動きに伴う身体の調子を
気にしている」
「体調管理の状況と症状に対する解釈」
「脈の
悪化に対する解釈」「水分貯留に対する解釈」について有意差
を認めた。現在の療養指導では
「自覚」
「測定」
について効果が
あるが、「解釈」については効果が乏しく、どのように
「解釈」
しているか具体的に確認を行うことが心不全患者の療養生活
指導において重要であることが明らかとなった。
P-017
P-019
高度血圧上昇による急性心不全例の特徴と生活支
援の必要性についての検討
心不全多職種チームと在宅部門との協働で目指す
包括的疾病管理についての一考察
白倉透規 1）、布施公一 2）、相澤義房 3）
平野美樹 1）、佐々木真弓 1）、飯塚裕美 1）、末永祐哉 2）、鈴木誠 2）
立川メディカルセンター　立川綜合病院　看護部、立川メディカルセン
ター　立川綜合病院　循環器内科、3）立川メディカルセンター　研究開発部
1）
2）
【背景と目的】疫学調査からみた急性心不全の背景に高血圧が
大きく関わっており、高血圧を基礎疾患とする例が 50-70%、
急性心不全の直接の原因となる例が 20% 前後とされる。血圧
上昇が誘因として発症する中には、高度血圧上昇をきたす例
がある。そのような症例の患者背景と生活支援方法について
検討する。【対象と方法】2011 年 4 月 1 日∼ 2014 年 3 月 31 日に
収縮期血圧が 190mmHg 以上を呈して入院となった急性心不
全症例を対象に、臨床像、入院前の生活背景を分析した。
【成
績】年齢は平均79.5歳で、血圧は平均213/101 mmHg であった。
いずれも血圧の急激な上昇を機に緊急入院となったもので全
例初回入院であった。基礎疾患に高血圧を 14 例で認め、血圧
上昇の原因として服薬管理・塩分水分管理・セルフモニタリ
ングの不足があった。入院前に心不全症状が認められており、
処置の遅れも指摘できた。【考察】症例は殆どが高齢者であり、
治療アドヒアランスやセルフケアが低いため、高度な血圧上
昇による急性心不全をきたしたと考えられた。外来での多職
種支援体制構築と入院中の継続した支援が再発予防に重要と
考えられた。
262
亀田総合病院看護部、2）亀田総合病院循環器内科
1）
【背景】心不全増悪に伴う再入院を回避するためには、多職種
による包括的な疾病管理が効果的であると報告されている。
当院も多職種チームで疾病管理における包括的介入を開始し
たが施設完結型で、
再入院を防ぐためには在宅とのネットワー
ク構築の必要性が求められていた。【目的】多職種による包括
的疾病管理に訪問看護の積極的導入を試みることで、再入
院率の減少につなげられるか検討する。【方法】2013 年 3 月∼
2014 年 2 月までに入院した心不全患者 279 名に対して、再入
院のリスクが高いと判断した患者に訪問看護の導入を検討し
た。【結果】14 名が高リスクと判断され 2 名は拒否し 12 名に訪
問看護を導入。患者の転帰は 12 名中、再入院 6 名、死亡 1 名で、
導入者の生活背景は 12 名中、独居 3 名、高齢者世帯 4 名、そ
の他 5 名であった。【考察】訪問看護師が加わり在宅療養への
円滑な移行が実現し、再入院を繰り返していた患者において、
心不全増悪を回避することができた。再入院に至った症例も、
入院中から退院後の患者情報を共有でき、薬剤調整や早期外
来受診の調整等、重症化する前に入院となった。今後は、近
隣の地域とも連携を図り、地域完結型の疾病管理へと発展さ
せていきたい。
プログラム・抄録集
ポスター５（P05）栄養・生活習慣と心不全
P-020
Relationships Between Nutritional Status
and Markers of Congestion in Patients with
Pulmonary Arterial Hypertension
Akira KAWAMOTO1,3）、Takao KATO2）、Yoshiaki OKANO3）、
Tetsuo SHIOI3）、Takeshi KIMURA3）
Hamamatsu Rosai Hospital、 2）Cardiovascular Center, the Tazuke
Kofukai Medical Research Institute, Kitano Hospital、3）Department of
CardiovascularMedicine,GraduateSchoolofMedicine,KyotoUniversity
1）
P-021
The Fischer Ratio in Patients with Chronic
Heart Failure
Shuhei TSUJI、Yukihito SATOU
HyogoPrefectualAmagasakiHospital,Hyogo,Japan
Background: Cachexia is a common complication in severe
chronic heart failure（HF）. Patients with HF complicated
with cachexia showed increased mortality, but its
pathophysiology is not fully understood. Hence, this study
aimed at identifying malnutrition in HF patients from the
viewpoint of amino acid concentration.Methods: To clarify
the relationship between amino acids and HF, we collected
blood samples from 113 HF patients（male, 61（54%）; mean
age, 73.9±8.8 years; mean ejection fraction, 53±16%; median
serum B-type natriuretic peptide（ BNP）concentration,
2 2 9 . 6 p g / m l ）, a n d m e a s u r e d t h e s e r u m a m i n o a c i d
composition.Result: The median Fischer ratio（the molar ratio
of branched chain amino acids to aromatic amino acids）was
2.7. Patients with higher Fischer ratio were younger
（P<0.001）, and had higher body mass index（P<0.001）,
hemoglobin（P<0.001）,and albumin（P<0.001）,and lower high
density lipoprotein（HDL）cholesterol（P=0.003）, and BNP
（P<0.001）. In the multivariable analysis, the Fischer ratio
was positively correlated with albumin（correlation coeﬃcient
（CC）=0.489; 95% confidence interval（CI）, 0.183 ∼ 0.795;
P=0.002）, and negatively correlated with HDL cholesterol
（CC=-0.025; 95% CI, -0.008 ∼ -0.025; P<0.001）, and BNP（CC=0.695; 95% CI, -1.111 ∼ -0.277; P=0.001）.Conclusion: In the
patients with HF, the Fischer ratio was paralleled with poor
control of HF represented as a high BNP concentration.
Thus, HF patients may have poor nutritional status.
P-023
Changes of Metabolomic Proﬁling are
Associated with Reduced Exercise Capacity in
Patients with Heart Failure
Prognostic Impact of Preexisting
Hypertension in Hospitalized Patient with
Established Systolic Heart Failure
Masaya TSUDA、Shintaro KINUGAWA、Arata FUKUSHIMA、
Takashi YOKOTA、Shoji MATSUSHIMA、Takaaki FURIHATA、
Shingo TAKADA、Masato KUDO、Junichi MATSUMOTO、Hiroyuki TSUTSUI
Byung-Su YOO1）、Seok-Min KANG2）、Eun-Seok JEON3）、
Dong-Ju CHOI4）、Myeong-Chan CHO5）、Kyu-Hyung RYU6）
Department of Cardiovascular Medicine, Hokkaido University Graduate
SchoolofMedicine,Sapporo,Japan
Background: Exercise intolerance is a major clinical manifestation, and closely
related to poor prognosis in heart failure（HF）patients. Metabolic derangements
have been shown to be involved in this phenomenon. We thus investigated
the metabolites associated with exercise capacity by using global metabolomic
analysis of plasma samples in HF patients.
Methods and Results: Ten consecutive HF patients with reduced ejection
fraction（57 ± 12 years, NYHA class II-III）and 5 age-matched healthy subjects as
controls（56 ± 3 years）were studied. Charged metabolites in plasma samples were
measured by capillary electrophoresis mass spectrometry. Peak oxygen uptake
（peak VO2）, anaerobic threshold（AT）, and VE/VCO2 slope were measured
by cardiopulmonary exercise test. A total of 233 charged metabolites were
identiﬁed. Signiﬁcant increases in arginine methylation, phospholipid metabolites,
and urea cycle metabolites were observed in HF patients compared to controls.
Methylarginine including asymmetric dimethylarginine（ ADMA）（r=-0.77,
P<0.001）and symmetric dimethylarginine（SDMA）（r=-0.65, P=0.040）levels,
and phospholipid metabolites including choline（ r=-0.63, P=0.049）and N,N dimethylglycine（r=-0.75, P=0.011）levels were negatively correlated to both peak
VO2 and AT in HF patients. N,N -dimethylglycine（r=0.72, P=0.026）and Urea
（r=0.82, P=0.006）levels were positively correlated to VE/VCO2 slope.
Conclusions: Increases in metabolites of arginine methylation, phospholipid
metabolism, and urea cycle are associated with exercise intolerance in HF. These
results provide mechanistic insights into exercise intolerance associated with HF.
1）
Division of Cardiology, Wonju College of Medicine, Yonsei University,
Wonju, Korea、2）Division of Cardiology, Yonsei University Severance
Hospital, Seoul, Korea、 3） Division of Cardiology, Sungkyunkwan
University Samsung Medical Center, Seoul, Korea、 4） Division of
Cardiology, Seoul National University Bundang Hospital, Seongnam,
Korea、5）Chungbuk National University College of Medicine, Cheongju,
Korea、6）DivisionofCardiology,HallymUniversityMedicalCenter,Korea
Background: Hypertension is the most common risk factor and co-morbidity for heart failure. However the prognostic
value of the hypertension in established heart failure has not been well evaluated. The aim of present study was to
investigate the prognostic impact of preexisting hypertension in patients hospitalized with systolic heart failure.
Method: We performed a pooled analysis of data from three multi-center, observational studies [KorHF, the Korean
Heart Failure Registry; SUGAR, SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real
World; COAST, Clinical Outcomes in Relation with Serum Sodium Level in Asian Patients Hospitalized for Systolic
Heart Failure] across Korea. We selected the patients with systolic heart failure（Ejection fraction（EF）<45%）and > 18
years old. Then we divided the subjects into 2 groups by presence of preexisting hypertension history: Hypertension
group and No hypertension group. Study endpoints included all cause mortality and rehospitalization within 1 year.
Results: Total 3877 patients were enrolled. Mean EF was 29.6 ± 8.7 %. The prevalence of preexisting hypertension
was 51.5%. Patients with hypertension presented more often diabetes（44.4% vs. 23.3%, P<0.001）,previous MI（15.5% vs.
12.2%, p<0.001）, Stroke（16.3% vs.8.4%, p<0.001）and chronic kidney disease（14.7% vs. 6.1%, p<0.001）. At 1 year followup, patient with hypertension had a higher rehospitalization rate（31.5 % vs. 26.6%, p=0.001）but, mortality rate was not
signiﬁcant diﬀerence between 2 groups（14.1% vs. 14.7%, p=0.624）. After adjusting for baseline clinical variables（age,
sex, diabetes, prior MI, atrial ﬁbrillation, ejection fraction, LBBB, serum creatinine etc）, the presence of hypertension
was independently associated with lower 1 year mortality rate（OR 0.73 95% CI 0.548 - 0.966）and higher prescription of
medications（ACE inhibitor or ARB OR 1.389 95%CI 1.118 - 1.724, beta blocker OR 1.517 95% CI 1.260 - 1.827）.
Conclusions: Preexisting hypertension was independently associated with lower 1 year mortality rates and higher
prescription of medications in systolic heart failure.
263
一般演題
︵ポスター︶
Purpose: Right ventricular（RV）dysfunction and cachexia often coexist;
however, there are few studies investigating pulmonary arterial
hypertension（PAH）and nutritional status. This study sought to examine
the relationships among nutritional status, markers of congestion, and
echocardiographic parameters in patients with stable PAH.Methods:
In this prospective study, subjects with stable PAH（n=8）underwent
the subjective global assessment（SGA）for nutritional status, blood
tests, and comprehensive echocardiography. Results: Estimated systolic
pulmonary artery pressure（ePAP）and BNP levels were 82.7±15.7（mean
±SD）mmHg and 176±146 ng/L, respectively. Left ventricular diastolic
diameter（LVDd）was negatively correlated with ePAP（r=-0.70, p=0.04）,
implying a dilated RV and compressed left ventricle（LV）. Blood urea
nitrogen, a marker of protein catabolism, was positively correlated with
SGA scores（r=0.81, p<0.01）and BNP（r=0.68, p=0.04）and negatively
with LV diameter（r=-0.87, p<0.01）.Serum pre-albumin, a rapid turnover
hepatic protein, was positively correlated with ePAP（r=0.70, p=0.01）and
negatively with serum sodium concentrations（ r=-0.56, p=0.02）. In
multiple regression analyses, BMI was determined by WBC count, ePAP,
serum sodium and AST concentrations, and IVC diameter.Conclusion:
There were strong correlations between markers of nutritional status,
markers of congestion, and PAH severity. These results suggest that
poor nutritional status and cachexia may be surrogate markers for PAH
severity and potential therapeutic targets for PAH.
P-022
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター６（P06）心不全と腎機能の連関
P-024
A Case of Using Pedometer for Severe Heart
Failure Patients
Daiki GYOTOKU、Yuka KUSAKAWA、Hidekuni KIRIGAYA、
Nao YAMADA、Naoki IINUMA、Yuko MIKI、Tastuya NAKACHI、
Kazuki FUKUI
Cardiology,KanagawaCardiovascularandRespiratoryCenter
一般演題
︵ポスター︶
W e r e p o r t a c a s e t h a t t h e p e d o m e t e r（ L i f e c o r d e r
PLUS;SUZUKEN）was effective for prevention of heart
failure exacerbation. A 80-year-old man with a chronic
heart failure due to ischemic cardiomyopathy hospitalized
30 times. He had anterior myocardial infarction in 2005, and
performed percutaneous coronay intervention in our hospital.
Echocardiography showed LVEF was 30%, and a cavity of
left ventricular was extremely dilated. We treated him with
fully optimized medication, and introduced adaptive serve
ventilations（ASV）.However, he was hospitalized 3-4 times/
year due to acute heart failure. Since Nov 2013, he was
hospitalized every month. Frequency of the hospitalization
increased. We suspected that hyperactivity participated in
heart failure aggravation, we started to grasp of his daily
steps using pedometer. It started from Apr 2014, and period
of observation was 4 weeks. Average steps was 801 steps/
day（max 1803 steps/day, min 146 steps/day）. His condition
was stable after introduction with a pedometer. In this case,
low physical activity contribute to prevent heart failure
exacerbation.
P-026
Acute Kidney Injury Predicts Heart Failure
and Mortality in Patients with ST-segment
Elevation Acute Coronary Syndrome
Shinichi OKINO、Atsushi IKEDA、Shigeru FUKUZAWA、
Masayuki INAGAKI
DivisionofCardiology,HeartandVascularInstitute,FunabashiMunicipal
MedicalCenter
Aim
The aim of this study is to investigate the impact of acute
kidney injury（AKI）on prognosis in patients with STsegment elevation acute coronary syndrome
（STE-ACS）.
Methods
The population consisted of 423 STE-ACS patients
undergoing primary PCI. AKI was deﬁned as an increase in
serum creatinine level of 0.3 mg/dL or more from baseline
within 48 hours. Mean follow-up period was 33.7±18.9
months. Clinical event
（CE）
was deﬁned as re-admission due
to heart failure or death.
Results
There were 78 AKI patients. AKI had more chronic kidney
disease（ CKD）and cardiogenic shock.
AKI patients had higher incidence of
CE than non-AKI patients regardless
of CKD. Multivaritate analysis showed
AKI, maximum CK-MB and cardiogenic
shock were independent predictors of
CE.
Conclusion
AKI was a predictor of CE.
P-025
P-027
Is There a Gender Diﬀerence of Obesity
Paradox in Systolic Heart Failure?
Gender Diﬀerence of Obesity Paradox.
Clinical Response of Tolvaptan in Patients
with Heart Failure Who Had End-Stage Renal
Function
Byung-Su YOO1）、Seok-Min KANG2）、Eun-Seok JEON3）、
Dong-Ju CHOI4）、Myeong-Chan CHO5）、Sang Hong BAEK6）、
Shung Chull CHAE7）、Hyun-Young PARK8）、Byung-Hee OH9）
Shinsuke HARASAWA1）、Kiyoshi IIDA1）、Tadashi ASHIDA1）、Daisuke KISO1）、
Masakazu MATSUZAKI1）、Takehiko WASHIO1）、Katsuaki OOKUBO1）、
Hirofumi KAWAMATA1）、Naoya MATSUMOTO1）、Atsushi HIRAYAMA2）
1）
Division of Cardiology, Wonju College of Medicine, Yonsei University,
Wonju, Korea、2）Division of Cardiology, Yonsei University Severance
Hospital, Seoul, Korea、 3） Division of Cardiology, Sungkyunkwan
University Samsung Medical Center, Seoul, Korea、 4） Division of
Cardiology, Seoul National University Bundang Hospital, Seongnam,
Korea、5）Chungbuk National University College of Medicine, Cheongju,
Korea、6）The Catholic University of Korea, Seoul, Korea、7）Kyungpook
National University College of Medicine, Daegu, Korea、 8）National
Institute of Health (NIH), Osong, Korea、 9）Department of Internal
Medicine,SeoulNationalUniversityHospital,Seoul,Korea
1）
Purpose: The aim of the present study was to investigate the prognostic value of the
obesity in patients hospitalized with acute heart failure syndrome. Method: The Korean
acute heart failure registry（KorAHF）is an on-going prospective multicenter cohort study
for acute HF. As of November 2013, interim analysis of 4184 patients was performed.
We categorized the study population into 4 groups by BMI value（kg/m2）; BMI<18.5,
18.5 BMI<25, 25 BMI<30 and 30 BMI. Study endpoint included all cause death and
rehospitalization. Results: Of total 3618 patients, 549（28.3%）and 489（29.1%）reached study
endpoints in men and women, respectively. After adjusting, the male patients with BMI
30 showed the lowest risk（Hazard ratio [HR]: 0.472, 95% CI: 0.267-0.836, p=0.010）compared to
those with BMI<18.5. This correlation between BMI and study endpoint was not remarkable
in women. In male, patients with HF with reduced ejection fraction（EF<40%）,patients with
BMI 30 showed the lowest risk（HR: 0.323, 95% CI: 0.138-0.755, p=0.009）for study endpoint
compared to those with BMI<18.5. However this correlation was not noted in patients with
preserved ejection fraction in male. Conclusions: In KorAHF registry, there was a gender
diﬀerence of obesity paradox in patients with AHF. BMI was the independent risk factor for
adverse cardiac events in men who have HF with reduced ejection fraction.
264
DepartmentofCardiology,NihonUniversitySurugadaiHospital,Tokyo,
Japan、 2） Division of Cardiology, Department of Medicine, Nihon
UniversitySchoolofMedicine,Tokyo,Japan
Background: A newly-developed vasopressin-2 receptor
antagonist, Tolvaptan（TLV）, has been shown to improve volume
overload through free water excretion, however, the eﬀect of TLV
on renal function is still unclear.
Purpose and methods: This study aimed to investigate whether
TLV has a clinical eﬃcacy in patients with heart failure who had
renal dysfunction. We classified 67 patients who received TLV
according to the renal function and examined the response of
TLV using urine volume as well as short-term prognosis.
Results: Urine volume increase with dose dependence fashion was
observed in preserved eGFR group（>30）, but did not observed in
low eGFR group（<30）. The higher in baseline serum creatinine
level, the more frequent the occurrence of worsening renal
function（WRF）
（deﬁned by absolute increase >0.3mg/dl in serum
creatinine level from baseline to follow up）. All-cause mortality
and renal death（fall into dialysis）were significantly higher in
patients who complicated with WRF as compared without WRF.
Eﬃcacy of TLV and short-term prognosis were especially poor in
end-stage renal disease patients who had the nephrotic syndrome.
Conclusions: The clinical efficacy of TLV in patients with endstage renal disease was modest, and especially in patients with
nephrotic syndrome.
プログラム・抄録集
P-028
Renal Function Improvement in Chronic
Heart Failure is Associated with Less Risk of
Pump Failure Death but Not Sudden Death
Satoshi TAKAHASHI、Takashi MORITA、Shunsuke TAMAKI、
Masatake FUKUNAMI、Takahisa YAMADA
DivisionofCardiology,OsakaGeneralMedicalCenter
P-029
Chronic Kidney Disease in Hospitalized
Patients with Heart Failure
Satoko NAKAMURA1）、Toshihisa ANZAI2）、Yuhei KAWANO1）
1）
Division of Hypertension and Nephrology, National Cerebral and
Cardiovascular Center, Suita, Japan、2）Department of Cardiovascular
Medicine,NationalCerebralandCardiovascularCenter,Suita,Japan
Background: Chronic kidney disease（CKD）and cardiovascular
diseases（ CVD）are related to the development of kidney
impairment. However, the prevalence of CKD or kidney
impairment and its consequences in hospitalized patients
with CVD are not well clariﬁed.
Methods: We performed a prospective study, in which 74
consecutive patients with heart failure were enrolled. Blood
and urine samples are collected at the time of hospitalization,
interventions and discharge. Estimated glomerular ﬁltration
rate（eGFR）was calculated from serum creatinine and age
using Japanese equation. CKD was deﬁned by eGFR less than
60（ml/min/1.73m2）and/or the presence of proteinuria.
Results: Patients were divided into the groups with CKD
（n=30, 41%）and without CKD（n=44, 59%）. The age was 72
±10 and 57±15（years old）, and eGFR was 42±4 and 79±16
（ml/min/1.73m2）, respectively. The presence of traditional
CVD risk factors was more evident in the patients with
CKD compared to those without CKD. Serum albumin and
HDL cholesterol were lower, and uric acid, fasting glucose
and BNP were higher in the patients with CKD. eGFR was
signiﬁcantly related to age and several traditional risk factors.
Conclusions: In patients with heart failure, kidney function
was frequently deteriorated at admission. Aging and
traditional CVD risk factors as well as impaired cardiac
function may contribute to CKD in heart failure.
P-031
The Impact of Kidney Dysfunction on HypoAlbuminemia and Cardiac Prognosis in
Patients with Chronic Heart Failure
Eﬀectiveness of Carperitide for Preventing
Worsening Renal Function（WRF）in Patients
with Heart Failure
Yoichiro OTAKI、Tetsu WATANABE、Akira FUNAYAMA、
Hiroki TAKAHASHI、Takanori ARIMOTO、Tetsuro SHISHIDO、
Takuya MIYAMOTO、Isao KUBOTA
Taro SASAOKA、Mie SEYA、Shunji YOSHIKAWA、
Yasuhiro MAEJIMA、Masahiko GOYA、Takashi ASHIKAGA、
Kenzo HIRAO、Mitsuaki ISOBE
YamagataUniversitySchoolofMedicine,Yamagata,Japan
Department of Cardiovascular Medicine, Tokyo Medical and Dental
University,Tokyo,Japan
Background Hypo-albuminemia is closely associated with poor prognosis
in patients with chronic heart failure（CHF）. Although kidney plays a
pivotal role in excretion and reabsorption of albumin and amino acid,
it remains to be fully elucidated the impact of kidney dysfunction on
hypo-albuminemia in patients with CHF. The aim of the present study
was to reveal the impact of kidney dysfunction on hypo-albuminemia
and cardiac prognosis in patients with CHF.Methods and Results We
included consecutive 296 patients with CHF. Albuminuria and renal
tubular damage（RTD）were deﬁned as a urinary albumin to creatinine
ratio（UCAR）>30mg/g and urinaryβ2-microglobulin to creatinine ratio
（UBCR）>300 μg/g, respectively. There was a modest correlation
between kidney dysfunction and serum albumin（UACR, r=0.300,
P<0.0001; and UBCR, r=0.434, P<0.0001）. Multivariate logistic analysis
showed that RTD was significantly related to hypo-albuminemia in
patients with CHF after adjustment for confounding factors. During
a median period of 1060 days, there were 87 cardiac events. Net
reclassification index and C index were significantly improved by
addition of RTD to basic risk factors. All patients were divided into 3
groups: hypo-albuminemia+RTD group, hypo-albuminaemia or RTD
group, and control group. Kaplan-Meier analysis demonstrated that
hypo-albuminemia+RTD group had the greatest risk among 3 groups.
Conclusion Kidney dysfunction, in particular RTD, is closely associated
with hypo-albuminemia and could identify patients at high risk.
Background: WRF is an important matter in heart failure. Some
studies have demonstrated Carperitide might have a favorable eﬀect
in cardiorenal syndrome; however, the detail of its eﬀect was not fully
investigated.Method: A total of 66 non-hemodialysis patients admitted
to our hospital for acute decompensated heart failure（ADHF）in 2010
and followed at 1 year were retrospectively reviewed. They were
divided in 2 groups according to the Carperitide usage, Carperitide
group（n=41）, and non-Carperitide group（n=25）. WRF was deﬁned
as the occurrence of both 25% increase and 0.3 mg/dL increase in
serum creatinine levels during hospitalization. Result: Average dose
of Carperitide was 0.026γ. Left ventricular function and BNP levels
at admission were not different. WRF was significantly lower in
Carperitide Group（12/41, 29%）than non-Craperitide group（13/25,
52%, p<0.05）. Survical rate at 1 year is tended to be lower in nonCarperitide group（85% vs 68%）, but not significantly different. In
Carperitide group, estimated glomerular ﬁltration rate（eGFR）levels
at admission, discharge, and 1year（45.5, 48.4, and 49.0ml/min/1.73m2,
n.s.）were not signiﬁcantly diﬀerent. On the other hand, eGFR levels
were signiﬁcantly decreased at 1 year compared with admission in
non-Carperitide group（62.7, 52.3, and 37.4 ml/min/1.73m2, p<0.05）.
Conclusion: In this study, Carperitide was eﬀective to prevent WRF.
Also, it had a favorable long-term renal protective eﬀect.
265
一般演題
︵ポスター︶
To investigate the prognostic significance of the renal
function improvement in patients with chronic heart failure
（CHF）, from a viewpoint of mode of death（sudden cardiac
death（SCD）and pump failure death（PFD）, we studied
123 CHF outpatients with LVEF<40%. Forty-nine pts had
an improvement in eGFR（58±15 to 64±17 ml/min/1.73m2,
p<0.01）at 1 year after the entry, while the remaining 74
pts had an eGFR decline（ 66±21 to 59±20ml/min/1.73m 2,
p<0.01）. During a follow-up period of 7.4±4.4 years, PFD
was signiﬁcantly less frequently observed in pts with than
without eGFR improvement, while there was no signiﬁcant
diﬀerence in SCD incidence between the two groups. Thus,
CHF pts with eGFR improvement had less risk for PFD,
while they are still at risk of SCD.
P-030
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター７（P07）心不全における様々な薬物療法
P-032
Eﬀects of Intensive Versus Mild Lipid
Lowering with Statins in Congestive Heart
Failure with Ischemic Origin
Hae-Young LEE1）、Hyun-Jai CHO1）、Hee-Yul KIM2）、
Hee-Kyung JEON3）、Joon Han SHIN4）、Suk-Min KANG5）、
Sang Hong BAEK6）
Seoul National University Hospital、2）The Catholic University of Korea
Bucheon St.Mary’s Hospital、 3）The Catholic University of Korea
Uijeongbu St. Mary's Hospital、 4）Ajou University Hospital、 5）Yonsei
UniversitySeveranceHospital、6）TheCatholicUniversityofKoreaSeoul
St.Mary'sHospital
1）
一般演題
︵ポスター︶
Background and Aim. As the role of statins in congestive heart
failure（CHF）are still unclear, this study was designed to evaluate the
dose-eﬀect relationship of statins in ischemic CHF patients.
Methods. The South koreAn Pitavastatin Heart FaIluRE Study
（SAPHIRE）was designed to randomize ischemic CHF patients in
pravastatin 10mg or in pitavastatin 4mg daily group.
Results. 1）The LDL cholesterol level was reduced by 30 %
significantly greater in the pitavastatin 4mg group compared with
12% in the pravastatin 10 mg group 2）The left ventricular systolic
dimensions were signiﬁcantly reduced by 9% in the pitavastatin group
and by 5% in the pravastatin group. The left ventricular ejections
were significantly improved from 37% to 42% in the pitavastatin
group and from 35% to 39% in the pravastatin group. Although the
extent of the EF change was greater in the pitavastatin group（+16%
vs + 11%）,there was no statistical signiﬁcance between two groups（p
= 0.3862）. 3）The exercise capacity evaluated by 6-minute walk test
was improved signiﬁcantly in the pravastatin 10mg group（p = 0.0002）,
however, there was no changes in the pitavastatin group（p = 0.3707）.
Conclusions: In CHF patients with ischemic origin, too much
lowering of cholesterol might not be beneﬁcial to CHF patients.
P-033
Diabetes Mellitus is a Poor Prognostic
Risk but Has a Therapeutic Potential for
Functional Reversibility in Nonischemic
Systolic Heart Failure
Yuki IKEDA、Takayuki INOMATA、Teppei FUJITA、Yuichiro IIDA、
Takeru NABETA、Shunsuke ISHII、Takashi NARUKE、
Hisahito SHINAGAWA、Toshimi KOITABASHI、Junya AKO
Department of Cardiovascular Medicine, Kitasato University School of
Medicine
Purpose: To identify the association between diabetes mellitus
（DM）and clinical outcome in patients with nonischemic heart
failure with reduced ejection fraction（NI-HFrEF）. Methods: We
evaluated 248 patients with NI-HFrEF at baseline, 6 months, and 1
year, then observed for cardiac events（CEs）such as heart failure
worsening or cardiac deaths. Results: Seventy-ﬁve（30%）patients
had DM. Kaplan-Meier analysis revealed DM was related to
higher incidence of CEs（Figure A）. However, patients with DM
and improved hemoglobin（Hb）A1c during 6 months showed
lower incidence of CEs（Figure B）, and higher HbA1c at baseline
was independently related to normalization of left ventricular EF
a t 1 y e a r（ T a b l e ）.
Conclusion: Although
concomitant DM
is related to poor
outcome in patients
with NI-HFrEF,
appropriate glycemic
control might improve
cardiac function and
their prognosis.
266
P-034
Azilsartan Improves Diastolic Function in
Patients with Chronic Heart Failure
Mari SAKAMOTO、Takahiro OHARA、Akira FUNADA、Makoto AMAKI、
Takuya HASEGAWA、Yasuo SUGANO、Hideaki KANZAKI、
Masanori ASAKURA、Toshihisa ANZAI、Masafumi KITAKAZE
Department of Cardiovascular Medicine, National Cerebral and
CardiovascularCenter,Osaka,Japan
Background: Angiotensin receptor blocker（ ARB）is
reported to improve the prognosis of patients with chronic
heart failure（CHF）. It is not known that the effect is a
class effect or not.Methods: We retrospectively assessed
echocardiographic and clinical parameters in CHF patients,
to whom azilsartan（Azilsartans, n=15）or candesartan
（Candesartans, n=15）were newly prescribed. Results: At
baseline, there were no significant differences between
both groups in clinical, echocardiographic parameters, and
BNP levels. At 3 months, blood pressure decreased to the
similar levels in both groups. Whereas E/Ea significantly
decreased in Azilsartans（13.0±4.2 vs. 10.9±3.2, p=0.03）, that
of Candesartans did not（12.0±3.6 vs. 12.5±5.0, p=0.58）（p
for interaction=0.04,
Figure）. Conclusions:
Azilsartan improves
diastolic function in
the patients with
CHF. Azilsartan may
be more preferable
in patients with CHF
than other ARBs.
P-035
Eﬀect of Telmisartan on Heart Failure in
Patient with Hypertensive Cardiomyopathy
Megumi SHIMADA、Akiyasu BABA、Rie KOSUGI、
Makoto AKAISHI
DepartmentofCardiology,KitasatoInstituteHospital,KitasatoUniversity,
Tokyo,Japan
A 58-year-old man was referred to our hospital because
of acute heart failure. He was diagnosed as hypertensive
cardiomyopathy, and started treatment of heart failure and
hypertension. After 6 months of combination therapy, we
modiﬁed the treatment, and started telmisartan, then, followup examination of standard ECG-gated SPECT imaging
was done. The SPECT data were reanalyzed by using new
software, heart function view（Medi-Physics Co.）,automatically.
LVEF were used as markers of systolic function, and Peak
phase, systolic phase standard deviation（Phase SD）and
histogram bandwidth（Bandwidth）were used as markers of
dyssynchrony. We also tested BNP concentration as a marker
of heart failure. As shown in ﬁgure, telmisartan may have had
favourable eﬀects on heart failure in this case.
プログラム・抄録集
ポスター８（P08）心不全を症例報告から考える
P-036
The Eﬃcacy and Safety of Febuxostat for
Hyperuricemia in Hypertensive Patients with
Chronic Heart Failure and Chronic Kidney
Disease
Toshio NAKA1）、Tomotaka ANDOU2）、Tohru MASUYAMA2）
DepartmentofInternalMedicine,KaizukaCityHospital,Kaizuka,Japan、
2）
Cardiovascular Division, Department of Internal Medicine, Hyogo
CollegeofMedicine,Nishinomiya,Japan
1）
P-037
Eﬀect of Inhibitors of Renin-Angiotensin
System on ST-segment Elevation Myocardial
Infarction in Patient with Left Ventricular
Ejection Fraction More Than 40%
Woong JEON1）、Sang-Ho PARK1）、Seung-Woon RHA2）、Jin-Soo BYUN1）、
Dong Kyu JIN1）、Byoung Geol CHOI2）、Cheol Ung CHOI2）、
Chang Gyu PARK2）、Hong Seog SEO2）、Dong Joo OH2）
CardiologyDepartment,SoonchunhyangUniversityCheonanHospital,
Cheonan, Korea、 2）Cardiovascular Center, Korea University Guro
Hospital,Seoul,Korea
1）
Background; It has been known that the inhibitors of renin-anigotensin system（RAS）is eﬀective on
long-term survival after primary percutaneous coronary intervention（PCI）in ST-segment elevation
acute myocardial infarction（STEMI）with left ventricular ejection fraction<40%. However, the beneﬁt
on clinical outcomes in STEMI with LVEF 40% has been not evaluated.
Methods; We investigated the 316 patients（pts）that was presented with STEMI with LVEF 40% in
Korea University Guro Hospital PCI registry database from september 2004 to june 2011. We compared
2-year clinical outcomes of pts treated with（n=229）and without（n=87）RAS inhibitor at discharge.
Results; There was no statistic signiﬁcance except in the incidence of total mortality（6.0% vs 12.%,
p=0.037）and cardiac death（6.0% vs 0.6%, p=0.010）. In multivariate logistic regression analysis, the
non-use of RAS inhibitor was predictor for cardiac death（OR, 9.859; 95% CI, 1.047-92.834; p=0.045）. In
Kaplan-Meyer Curve, the incidence of
cardiac death was higher in the nonuse group of the RAS inhibitor（ﬁgure）.
Conclusions; In our study, the inhibitor
of RAS may be effective on cardiac
death up to 2-year clinical outcome
after PCI in pts with STEMI and
LVEF 40%.
Alterations in Ventricular Contractile
Mechanisms in Heart Failure with Atrial
Fibrillation
Shin-Ichi USHIRODA
UshirodaMedicalClinic,Fukushima,Japan
Objective: The aim of this case study was to show the
alterations in the ventricular contractile mechanisms in a
patient with heart failure（HF）and atrial ﬁbrillation（AF）during
the course of treatment, which remained largely unknown.
Methods and Results: A new ventricular function curve was
created by applying（dZ/dt）min, which represents the peak
value of the ﬁrst derivative of the heart-synchronous thoracic
impedance changes, obtained using impedance cardiography.
Ventricular beats involved in postextrasystolic potentiation
（PESP）were defined by preceding RR interval（RR1）/
pre-preceding RR interval（RR2）> 1 [VP（+）]. Ventricular
beats not involved in PESP（Frank-Starling mechanism and
mechanical restitution: FSM+MR）were deﬁned by RR1/RR2
< 1 [VP（-）]. The ventricular function curve was divided into
two regression curves of VP（-）and VP（+）based on this RR1/
RR2 ratio. The degree of PESP was represented by the slope
of the regression line between the RR1/RR2 ratio（ where
RR1/RR2 > 1）and（dZ/dt）min of VP（+）.Use of this method in
a 76-year-old man with deterioration of HF with AF showed
that（ 1）the ventricular function curve and the regression
curve of VP（-）gradually shifted upward,（2）the slope of the
regression line representing the degree of PESP gradually
decreased as HF with AF improved. Conclusion: In this case,
contributions of FSM+MR increased, whereas the contribution
of PESP decreased as HF with AF improved.
P-039
The Usefulness of Ambulatory Blood
Pressure Monitoring in Heart Failure Due to
Nocturnal Hypertension
Yusuke UEDA、Shinsuke MIKAMI、Hitoshi SUSAWA、
Kengo KOBAYASHI、Haruki TANAKA、Kouichi TANAKA
DepartmentofCardiology,MiyoshiCentralHospital,Hiroshima,Japan
Nocturnal hypertension is a risk factor for heart failure
exacerbation.A case was 91 year-old male. He was
transferred to our hospital because of sudden dyspnea.
His past history were hypertension, chronic heart failure,
arteriosclerosis obliterans, chronic kidney disease and left
below knee amputation. Systolic blood pressure exceeded
more than 200 mmHg. Chest X-ray showed pleural eﬀusion
and pulmonary congestion. We diagnosed clinical scenario
one heart failure. Then, we used nicardipine hydrochloride
in order to lower the blood pressure. But antihypertensive
drugs were not sufficient to improve heart failure.
Ambulatory blood pressure monitoring（ABPM）showed
riser type blood-pressure transition. After that we shifted
hypotensive drugs and diuretics from after breakfast to
before sleep, pleural eﬀusion was decreased. Blood-pressure
type in ABPM changed from riser to non-dipper pattern,
and heart failure was improved. We experienced that
ABPM was usefull to control heart failure due to nocturnal
hypertension.
267
一般演題
︵ポスター︶
（Background）Febuxostat, a non-purine xanthine oxidase inhibitor,
has been reported to have a stronger effect and more safety on
hyperuricemia than allopurinol. However, there is not available on the
eﬀect of febuxostat in hypertensive patients with chronic heart failure
（CHF）and chronic kidney disease（CKD）
（Methods）
.
The aim of this
study is to examine the eﬃcacy and safety of febuxostat in hypertensive
patients with CHF and CKD for treating hyperuricemia. Twenty
hyperuricemic patients with hypertension（HT）, CHF and CKD were
enrolled and treated with febuxostat（10-20mg/day）. Serum uric acid
concentrations and serum estimated GFR levels in the 3 months
before and after the start of febuxostat treatment were collected for
HT, CHF and CKD patients switched from allopurinol after failing to
achieve serum uric acid concentrations <6.0mg/dl.（Results）Evaluable
data were available for 20 patients, 20% of whom had advanced
CKD（eGFR<30ml/min/1.73m2）. Mean dose of febuxostat was 11（±
3.7）mg/day. By using febuxostat, mean serum uric acid concentration
decreased from 7.6（±1.2）mg/dl at baseline to 6.2（±0.9）&mg/dL at
3 months（p<0.001）; 35% of patients achieved a level <6.0mg/dL. No
serious adverse reactions were noted with febuxostat, and there were
no signiﬁcant changes in blood pressure, heart rate, total cholesterol,
triglyceride, hemoglobin A1c, and hepatic and renal function.
（Conclusions）Febuxostat was eﬀective for hyperuricemia in patients
with HT, CHF and CKD without severe side eﬀects.
P-038
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
P-040
P-042
What is the Best Treatment for Severe
Tricuspid Valve Regurgitation ?
Right-Sided Infectious Endocarditis
Complicated with Atrial Septal Defect
Naoko IKEDA1）、Mio EBATO2）、Miki TSUJIUCHI2）、
Takuya MIZUKAMI2）、Ayaka NOGI2）、Hideyuki MAEZAWA2）、
Hiroshi SUZUKI2）、Kaoru TANNO1）
Mai SHIMBO、Hiroyuki WATANABE、Tatsumi ABE、
Teruki SATO、Takashi KOYAMA、Hiroshi ITO
Cardiovasculerdivision,Kototoyosuhospital,Showauniversity,Tokyo,
Japan、2）Cardiovasculer division, Fujigaoka hospital, Showa university,
Tokyo,Japan
1）
一般演題
︵ポスター︶
Patients with severe tricuspid valve regurgitation are increasing and
we have to choose the best treatment for each patients. We evaluated
whether the tricuspid valve dimension will change by various treatment.
The study sample consisted of 8 chronic heart failure patients with
severe tricuspid valve regurgitation and they were evaluated with
echocardiography several times during hospital course. 75±9.4years old,
male 25%,leg edema 75% ,pacemaker, ICDimplanted 50%,chronic atria
fibrillation 87.5% admission times for heart failure 1.25±1.7/min, cases
with completely unattached valve leaflets 50%,NYHA2.6±0.9,BMI 23±
6.5kg/m2,systolic blood pressure 105±11mmHg, diastolic blood pressure
60±10mmHg, heart rate 66±4.5bpm, BNP 730±770 pg/ml, eGFR 35.5
±19ml/min/1.73m2, LVEF=67.3±2.5% We turned attention to 4 cases
who have completely unattached valve leaflets and compared some
echocardiac parameters before and after treatment. There were a
signiﬁcant correlation between reduction of RA area and reduction of
tricuspid valve regurgitant area. And there were a signiﬁcant correlation
between reduction of RV area and tricuspid valve regurgitant area.
However, there were no signiﬁcant correlation between tricuspid valve
dimension and reduction of tricuspid valve regurgitant area. There is
little correlation between tricuspid valve dimension and the reduction of
tricuspid valve regurgitation among patients with completely unattached
valve leaﬂets. This might be the reason they are getting worse CHF.
Surgical treatment would be needed to control tricuspid regurgitation.
P-041
Department of Cardiovascular Medicine, Akita University Graduate
SchoolofMedicine,Akita,Japan
A 55-year-old female was referred to our hospital due to dyspnea
and persistent fever resistant to antibiotics. Echocardiography
showed secundum atrial septal defect（ASD）measuring 2 cm
in diameter and moderate tricuspid regurgitation（TR）with
right ventricular and right atrial enlargement. Moreover, we
detected a mobile vegetation measuring 15x10 mm attached to
the anterior leaflet of tricuspid valve. Chest CT showed the
multiple nodules in bilateral lung parenchyma, suggestive of the
septic pulmonary embolism. Blood cultures grew Gram negative
bacillus. We have a strong suspicion of right-sided infectious
endocarditis（RSIE）.
Although brain MRI showed evidences
of neither stroke nor intracranial aneurysm, given the risk of
paradoxical embolism, an urgent surgical treatment consisting
of the removal of vegetation, tricuspid valve replacement and
ASD patch-closure was performed successfully. Microscopically,
friable vegetation consisted of fibrin and platelets mixed
with leukocytes and bacterial colonies. A diagnosis of RSIE
complicated with ASD was made. She had an uneventful
postoperative course. ASD is considered to be a negligible
risk for IE because of the slow shunt ﬂow, so that RSIE with
ASD is extremely rare. However, TR secondary to right
ventricular overload has a potential cause of IE, once it occurs,
the paradoxical embolism might lead to fetal complication. We
emphasize that, unlike other RSIE, RSIE with ASD needs early
surgical treatment to avoid fetal complication.
P-043
A Case of Myocardial Calciﬁcation with the
Latent Risk of Congestive Heart Failure
Two Cases of Pulmonary Hypertension
Associated with Portosystemic Shunt
Shimpei ITO1）、Akihiro ENDO1）、Taiji OKADA1）、Taku NAKAMURA1）、
Tomoko ADACHI1）、Ryuma NAKASHIMA1）、Takashi SUGAMORI1）、
Nobuyuki TAKAHASHI1）、Hiroyuki YOSHITOMI2）、Kazuaki TANABE1）
Haruka SATO、Tatsuo AOKI、Masanobu MIURA、Nobuhiro YAOITA、
Saori YAMAMOTO、Syunsuke TATEBE、Kotaro NOCHIOKA、
Kimio SATOH、Koichiro SUGIMURA、Hiroaki SHIMOKAWA
The Forth Department of Internal Medicine, University of Shimane,
Shimane,Japan、2）DepartmentofClinicalLaboratory,ShimaneUniversity
Hospital,Shimane,Japan
Department of Cardiovascular Medicine, Tohoku University Graduate
SchoolofMedicine,Sendai,Japan.
1）
An 88-year-old man was referred to our hospital because of
cardiac evaluation before cholecystectomy. He had a history
of rheumatic fever at 30 years old and tuberculosis at 86
years old. Electrocardiogram showed abnormal Q waves
in I and aVL and negative T waves in V3-6. The results of
blood test were almost within normal range. Transthoracic
echocardiography demonstrated left ventricular
（LV）
ejection
fraction was 46% and LV wall motion abnormality
was detected in the posterolateral wall and apex with
hyperechoic calcified mass. A CT scan confirmed the
myocardial calcification at the same region. A coronary
angiogram showed normal coronary arteries. Right heart
catheterization revealed normal pulmonary artery pressure.
However stress echocardiography revealed pulmonary
hypertension during exercise. Reports of myocardial
calcification are limited mainly to case reports and most
reported cases have been identiﬁed postmortem. Pathologic
myocardial calcification occurs by two mechanisms
dystrophic and metastatic. We report an interesting case of
myocardial calciﬁcation. We consider etiology of calciﬁcation
was due to rheumatic fever because of his past history. His
LV myocardial calcification may cause elevated LV filling
pressure during exercise.
268
<Case 1> In October 2013, a 57 year-old woman admitted to a hospital
for dyspnea and hypoxia. Since echocardiography showed elevated
tricuspid regurgitation pressure gradient, she was transferred to
our hospital. Computed tomography showed portal-hepatic vein
shunt and partial anomalous pulmonary venous return. Right heart
catheterization showed that she had pulmonary hypertension（PH）with
elevated mean pulmonary arterial pressure（ mPAP, 29 mmHg）.
Furthermore, micro-bubble test showed intrapulmonary shunt. Finally,
she was diagnosed as having hepatopulmonary syndrome associated
with portal-hepatic vein shunt. For further treatment, transcatheter
embolization for portosystemic shunt is scheduled.<Case 2> In August
2013, a 25 year-old woman was referred to our hospital for examination
of abnormal ﬁndings on chest X-ray with dilated pulmonary arteries.
At age 9, she underwent partial splenic embolization for extrahepahc
portal hypertension and at age of 11, surgical superior mesenteric vein
and inferior vena cava shunting. Right heart catheterization showed
elevated mPAP（72 mmHg）and high cardiac output（CO 7.3 l/ml, CI
3.2 L/min/m2）. Finally, she was diagnosed as having pulmonary
hypertension associated with portosystemic shunt based on her past
history and hemodynamic ﬁndings. Subsequent therapy with tadalaﬁl
for 2 months decreased mPAP to 48 mmHg. We hereby report
2 cases of pulmonary hypertension associated with congenital or
acquired portosystemic shunt.
プログラム・抄録集
ポスター９（P09）バイオマーカーの新たな展開
P-044
Mismatch Between Brain Natriuretic Peptide
and Body Fluid Status Assessed by Multifrequency Bioimpedance in Patients with
Acute Decompensated Heart Failure
Fumie OTOMO1）、Mitsuaki ENDO2）、Eiichi AKIYAMA3）、
Yasushi MATSUZAWA3）、Masaaki KONISHI3）、Hideo HIMENO2）、
Satoshi UMEMURA4）、Kazuo KIMURA3）
Background: The natriuretic peptides have proven useful as an adjunct tool for
optimizing ﬂuid management of heart failure patients. However, in the setting of acute
decompensated heart failure（ADHF）, there are some cases where brain natriuretic
peptide（BNP）paradoxically increases despite resolution of signs and symptoms of
congestion. Therefore, we investigated the association between BNP and body fluid
status assessed by multi-frequency bioimpedance（MFBIA）.Methods: Consecutive twentyfour patients（81±8 years; 46% men）admitted for ADHF underwent serial BNP and
edema index（EI）measurement at admission, on days 2, 5, and at discharge. EI represents
a ratio of extracellular water to whole-body water on MFBIA.Results: From admission
to discharge, BNP and EI signiﬁcantly decreased（from 1175.2±1147.2 to 381.3±381.4pg/
ml, and from 0.415±0.011 to 0.401±0.011, respectively, both p<0.01）, and changes in BNP
correlated with those in EI（r=0.53, P=0.007）. Nevertheless, there are no correlations
between changes in BNP and EI on day 2（r=0.13, P=0.52）and day 5（r=0.26, p=0.21）. A
mismatch between changes in BNP and EI on day 2 was noted in 7（29%）patients, who
had signiﬁcantly lower tricuspid annular plane systolic excursion on echocardiography
（13.2±2.5 vs. 17.4±3.6mm, p=0.008）compared to those without a mismatch.Conclusions: In
patients with ADHF with right ventricular dysfunction, serial changes in BNP during the
acute phase of hospitalization might not aid clinical assessments of congestion.
P-045
Hyponatraemia is Associated with Elevated
Pulmonary Capillary Wedge Pressure and
Mortality in Patients with Chronic Heart
Failure
Tetsuji MORISHITA、Hiroyasu UZUI、Ken-ichiro ARAKAWA、
Naoki AMAYA、Kenichi KASENO、Kentaro ISHIDA、Takehiko SATO、
Yoshitomo FUKUOKA、Jong-Dae LEE、Hiroshi TADA
DepartmentofCardiovascularMedicine,UniversityofFukui,Fukui,Japan
PURPOSE: The aim of this study was to estimate the prognostic relevance of hyponatraemia
and
the associations with neurohormonal factors, including interleukin-6（IL-6）,matrix
metalloproteinase（MMP）-9 and tissue inhibitor of MMP（TIMP）-1 in patients with heart failure.
METHODS: Serum sodium level, circulating levels of IL-6, MMP-9 and TIMP-1 were measured
in 118
heart failure patients. Invasive hemodynamic study with dual heart catheterization was
performed to measure pulmonary capillary wedge pressure（PCWP）and left ventricular enddiastolic pressure（EDP）.Cardiac death and all-cause mortality were assessed during the
follow-up period（average of 85±49 months）.All patients were divided into four groups
based on the serum sodium level; <135, 135 to 139.9, 140 to 144.9 and > 145 mmol/L.
RESULTS: Hyponatraemia was found in 58.4% of the patients. A U-shaped associations of serum
sodium level with PCWP and EDP were found, with lowest values in patients group with
normonatraemia（P<0.05）. IL-6 and MMP-9/TIMP-1 ratio increased with decreasing serum
sodium
level（P for trend < 0.05 and = 0.083, respectively）.Kaplan-Meier analysis demonstrated a
higher probability of cardiac death and all-cause death in patients group with hyponatraemia
（<140 mmol/L）（P<0.05）.
CONCLUSIONS: Hyponatraemia indicate an increasing mortality risk in patients with heart
failure. Our results suggest IL-6 and the disparity between MMP-9 and TIMP-1 contribute to
the
worsening hemodynamics of failing hearts with hyponatraemia.
ACE2 and Ang（1-7）Concentration for
Patients Urgently Hospitalized Due to
Cardiovascular Disease
Shinji HISATAKE、Takayuki KABUKI、Shunsuke KIUCHI、
Takashi OKA、Junichi YAMAZAKI、Takanori IKEDA
Division of Cardiovascular Medicine, Department Internal Medicine, the
FacultyofMedicine,TohoUniversity
Background;Recently the existence of the ACE2/Ang-（1-7）/Masreceptor-axis in the RAS and the organ-protective-eﬀect by activating
this axis have been revealed. There are as yet not many reports about
the transition of the ACE2/Ang-（1-7）/Mas-receptor-axis under various
clinical conditions.Aim; To compare the blood concentration of ACE2
under various pathological conditions to the healthy volunteers.Methods;
Among patients who were hospitalized for AHF, AMI, and acute aortic
dissection between November-2012 to August-2013, 15 patients who gave
their consent became the subjects of this study. At the acute stage of
each disease, ACE2 and ACE, Ang-（1-7）concentration, activation of renin,
AngII and aldosterone concentration were measured, and then compared
and examined against a group of 10 healthy volunteers. Results; There
were no signiﬁcant diﬀerences in age and SBP between disease patient
group（D）and healthy volunteer group（H）. ACE2 concentration was
signiﬁcantly higher in group D compared to group H（10.52±6.12 ng/ml
vs 4.83±1.91 ng/ml, p=0.004）. Ang-（1-7）concentration was signiﬁcantly
lower in groupD than in groupH（2.35±1.50 ng/ml vs 3.66±1.29 ng/ml,
p=0.035）. PRA was signiﬁcantly higher in groupD compared to groupH
（4.23±4.68 ng/ml/h vs 1.54±0.99 ng/ml/h, p=0.047）. There were no
differences in ACE, Ang II, and aldosterone concentrations between
the two groups.Conclusion;The patients urgently hospitalized for
cardiovascular disease had higher concentration of ACE2, but lower
concentration of Ang-（1-7）compared to the healthy volunteers.
P-047
Surrogate Marker of Warfarin Control in
Patients with Atrial Fiblliration
Tatsuya KOYAMA1）、Shingo SEKI1）、Ritsu YOSHIDA1）、
Jyun HASEGAWA1）、Yoshitsugu OHKI1）、Seiko TSUNODA1）、
Tomoyuki TAKEMOTO1）、Koji YAMAZAKI1）、Michihiro YOSIMURA2）
1）
Department of Cardiology, Katsushika Medical Center, The Jikei
University School of Medicine, Tokyo, Japan、 2） Department of
Cardiology,TheJikeiUniversitySchoolofMedicine,Tokyo,Japan
Background:Atrial fibrillation is a known risk factor for
thromboembolism.D-dimer levels reﬂect a pro-thrombogenic
state and thus might serve as another marker of warfarin
control. Aim:This study investigated the correlation of
warfarin control marker;PT-INR and pro-thromboembolic
marker;D-dimer in patients with atrial fiblliration during
oral anticoagulant therapy. Method:This was a single
center,retrospective study.Patients with atrial fibrillation
treated with
（57 males,17 females,mean age 71.8±8.7 years ）
warfarin（target PT-INR: 1.5 to 3.0）were included in this
investigation based on the medical chart.D-dimer levels
and PT-INR were measured,and followed up to June 2014.
Result:The correlation of PT-INR and D-dimer in all patients
statistically was found.Espacially the negative relationship
between PT-INR and D-dimer in subgroup patients,elderly
patients
（over 75 years）
; 28,hypertension patients; 57,patients
were statistically found. Conclusion:The correlation of PTINR and D-dimer in patients of atrial ﬁbrillation was found
and thus D-dimer also can serve as surrogate marker of
warfarin control.
269
一般演題
︵ポスター︶
1）
Department of Cardiology, International Goodwill Hospital, Yokohama,
Japan、2）Department of Cardiology, Fujisawa City Hospital, Fujisawa,
Japan、 3）Division of Cardiology, Yokohama City University Medical
Center, Yokohama, Japan、 4）Department of Medical Science and
Cardiorenal Medicine, Yokohama City University Graduate School of
Medicine,Yokohama,Japan
P-046
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター１０（P10）肥大型心筋症の臨床
P-048
Atrioventricular Node Reentrant Tachycardia
as a Cause of Recurrent Syncope in a
Patient with Non-Obstructive Hypertrophic
Cardiomyopathy
Mariko YAGI、Tetsuo KONNO、Youji NAGATA、
Noboru FHJINO、Kenshi HAYASHI、Masayoshi KAWAJIRI、
Masakazu YAMAGISHI
Departmentofcardiology,KanazawaUniversityHospital
一般演題
︵ポスター︶
A 60-year-old male patient was admitted to our hospital for recurrent
syncope. On arrival at our hospital, the patient was totally oriented. Blood
pressure was 180/104mmHg, with a heart rate of 100bpm. ECG showed
high voltage of precordial leads and minor ST-segment depression in
lateral leads. Echocardiography demonstrated preserved left ventricular
（LV）systolic function and asymmetrical ventricular wall hypertrophy. LV
outflow obstruction was undetectable. Cardiac MRI demonstrated late
gadolinium enhancement in the hypertrophied anteroseptal wall. Together,
the patient was diagnosed as non-obstructive hypertrophic cardiomyopathy
（HCM）. During the hospital stay, 24-h Holter monitoring was conducted,
demonstrating no pauses and no ventricular tachy-arrhythmias. Both head-uptilt test and head MRI showed no abnormal ﬁndings. On electrophysiological
studies, ventricular tachycardia was not induced by extra-stimuli and basic
drives from the right ventricle. However, atrioventricular node reentrant
tachycardia（AVNRT）was induced by extra-stimuli of the right atrium,
which resulted in sudden decrease of systolic blood pressure from 120mmHg
to 50mmHg and presyncope. Subsequently, catheter ablation to the slow
pathway was successfully performed, after which the patient have not
suﬀered from syncope. HCM patients with one or more recent episodes of
unexplained syncope meet indications for ICD（class IIa）. Unnecessary ICD
implantation in this patient was avoided by a prompt diagnosis of AVNRT,
which is an uncommon cause of syncope in non-obstructive HCM.
P-049
Clinical Characteristics and Prognosis in
Patients with Hypertrophic Cardiomyopathy
with Apical Aneurysm
Seiji TAKASHIO1,2）、Megumi YAMAMURO2）、Hisao OGAWA1,2）
Depertment of Cardiovascular Medicine, National Cerebaral and
Cardiovascular Center, Osaka, Japan、2）Department of Cardiovascular
Medicine, Graduate School of Medical Sciences, Kumamoto University,
Kumamoto,Japan
1）
Background: Hypertrophic cardiomyopathy（HCM）with apical
aneurysm is a rare and unique form of this disease. Although
there have been several reports until now, clinical characteristics
and its prognosis are not fully understood.Methods and result:
Between July 1996 and September 2013, consecutive 25 HCM
patients with apical aneurysm（mean age 56±16 years at diagnosis,
male 20）were enrolled from two referral hospitals in Kumamoto
and analyzed retrospectively. Their ﬁrst clinical manifestation was
sustained ventricular tachycardia（Sus-VT）in 8 patients. Implantable
cardioverter defibrillators（ ICD）were implanted in 17 patients,
including 8 patients for primary prevention. Over the follow-up period
of 62±43 months（range 6-142 months）, 15 patients（60%）experienced
adverse clinical events（ event rate: 40 %/5 years）. Appropriate
ICD shock and Sus-VT were occurred in 8 patients and 1 patient,
respectively. Heart failure（HF）to need hospitalization was occurred
6 patients. Thrombi in the aneurysm were recognized in 5 patients.
Among them, those were refractory to anticoagulant therapy in 3
patients. Thromboembolism was occurred in 1 patient. Four patients
died due to electrical storm with end-stage HF, end-stage HF, and
hepatic failure, respectively.Conclusion: HCM with apical aneurysm
was at high risk of fatal ventricular arrhythmias, HF and apical
thrombi. HCM with apical aneurysm could be a powerful predictor to
consider ICD implantation and the strict anticoagulant therapy.
270
P-050
Impact of Right Ventricular Hypertrophy
on Severity of Clinical Phenotypes in
Hypertrophic Cardiomyopathy
Yoji NAGATA、Tetsuo KONNO、Noboru FUJINO、
Akihiko HODATSU、Akihiro NOMURA、Kenshi HAYASHI、
Masa-Aki KAWASHIRI、Masakazu YAMAGISHI
Department of cardiology, Kanazawa university hospital, Kanazawa,
Japan
Although left ventricular（LV）morphology and function have been
well studied in hypertrophic cardiomyopathy（HCM）, few data exist
regarding right ventricular（RV）ones. We examined 59 HCM patients
（36 men, age 60.5±15.0 years）who underwent cardiac magnetic
resonance（CMR）exhibiting maximal LV thickness > 13 mm. RV
hypertrophy（RVH）, defined as RV maximal wall thickness > 5mm,
was observed in 17 of 59 patients（RVH group）. The RVH group
showed higher brain natriuretic peptide levels（ 387.7 ± 287.4 vs.
226.1 ± 217.3pg/ml, p=0.02）than those in the non-RVH group. The
RVH group showed reduced RV end diastolic volume index（48.7
± 16.0 ml/m2 vs. 64.4 ± 13.9 ml/m2, p=0.001）in accordance with
greater LV mass index（110.4 ± 21.6 vs. 75.6 ± 21.4 g/m2, p < 0.0001）.
Interestingly, the RVH group was highly associated with RV-late
gadolinium enhancement in comparison with the non-RVH group（29.4%
vs. 0%）.During follow up period, the RVH group had higher incidence
of cardiovascular events such as heart failure admission, ventricular
tachyarrhythmia/fibrillation, stroke and sudden cardiac death than
that in the non-RVH group（log-rank p = 0.02）. Multivariable analysis
revealed that only RV maximal wall thickness was independent
predictor of cardiovascular events（p = 0.03）. In Conclusion, HCM
with RVH determined by CMR can be associated with the higher
incidence of cardiovascular events than non-RVH patients.
P-051
Intravenous Cibenzoline Shifts Force-frequency
Relationship Downwards and Decreases Intraventricular
Pressure Gradient During Tachycardia in Patients with
Hypertrophic Obstructive Cardiomyopathy
Tohru WATANABE、Takeshi KASHIMURA、
Hiromi KAYAMORI、Koumei TANAKA、Hiroaki OBATA、
Tohru MINAMINO
Department of Cardiovascular Biology and Medicine, Niigata University
GraduateSchoolofMedicalandDentalSciences,Niigata,Japan
[Background] Heart rate- dependent change of left ventricular
contractile force is known as the force-frequency relationship（FFR）.
FFR in patient with hypertrophic obstructive cardiomyopathy
（HOCM）and eﬀects of class I anti-arrhythmic agents on it are still to
be elucidated. [Methods] In 4 patients with HOCM（left ventricular
outﬂow tract obstruction in 3, mid-ventricular obstruction in 1）, FFR
was assessed by the initial peak of left ventricular dP/dt during right
atrial or ventricular incremental pacing before and after intravenous
cibenzoline（cibenzoline succinate 1.4mg/kg）. [Results] Two of the
four patients showed FFR of a progressive rise during incremental
pacing and their intraventricular pressure gradient remained high. One
showed FFR of a progressive decrease and a concomitant decrease of
intraventricular pressure gradient. The other showed biphasic FFR of
initial rise and subsequent drop with sustained high intraventricular
pressure gradient. Intravenous cibenzoline shifted FFR downwards and
nearly abolished intraventriculr pressure gradient in 3 patients, even
though the other patient with a biphasic FFR did not show apparent
shift of FFR, nor did intraventricular pressure gradient. [Conclusions]
Patterns of FFR vary among patients with HOCM. Cibenzoline can
shift FFR downwards and diminish intraventricular pressure gradient
even during tachycardia, although the eﬀects also vary among patients.
プログラム・抄録集
ポスター１１（P11）虚血による心不全のメカニズムを解明する
P-052
Tenascin-C Enhances Inﬂammaoty Response
During the Ventricular Remodeling after
Myocardial Infarction in Mice Model
Taizo KIMURA1）、Akira SATO1）、Kazuko TAJIRI1）、
Zeng WANG1）、Toshimichi YOSHIDA2）、Michiaki HIROE3）、
Kyoko IMANAKA2）、Kazutaka AONUMA1）
1）
Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba,
Japan、2）Department of Pathology and Matrix Biology, Mie University
Graduate School of Medicine, Tsu, Japan、3）National Center for Global
HealthandMedicine,Tokyo,Japan
Prevention of Myocardial IschemiaReperfusion Injury in Cardiac-Speciﬁc SOCS3
Knockout Mice by Enhanced Activation of
Cardioprotective Signaling Pathways
Takanobu NAGATA、Hideo YASUKAWA、
Toyoharu OBA、Kazutoshi MAWATARI、Sachiko KYOGOKU、Hideki OHSHIMA、
Tomoko MINAMI、Shouichirou NOHARA、Yuusuke SUGI、Yoshihiro FUKUMOTO
DepartmentofInternalMedicine,KurumeUniversitySchoolofMedicine,
Fukuoka,Japan
BACKGROUND: Although JAK-STAT signaling activating cytokines
have been shown to prevent myocardial ischemia-reperfusion（IR）injury,
little is known about the negative regulatior of the JAK-STAT pathway
in the development of IR injury. We previously showed that（SOCS3）is
an intrinsic negative regulaton of cytokine-induced STAT3 activation. In
this study, we investigated the role of myocardial SOCS3 during IR injury.
METHODS AND RESULTS: Myocardial IR injury was induced by ligation
（1-hr）of LAD, followed by different reperfusion time in cardiac-specific
SOCS3 knockout mice（SOCS3-CKO）and controls. Evans blue and 1% TTC
staining after a 24-hr reperfusion showed a 33% reduction in myocardial
infarct size in SOCS3-CKO compared to controls（p<0.05）. TUNEL staining
revealed that, after 6-hr of reperfusion, apoptotic cells were signiﬁcantly
decreased in SOCS3-CKO. STAT3 phosphorylation was faint at 1-hr after
ischemia, marked at 20-min after reperfusion, and suppressed at 3-hr after
reperfusion. In contrast, STAT3, AKT, and ERK1/2 phosphorylation after
reperfusion was significantly greater in SOCS3-CKO than in controls.
To investigate the mechanism underlying the prevention of myocardial
IR injury in SOCS3-CKO, we examined expression of anti-apoptotic Bcl2 family member myeloid cell leukemia-1（Mcl-1）.CONCLUSION: These
results suggested that myocardial IR injury may have been prevented in
SOCS3-CKO by enhanced activation of cardioprotective signaling pathways.
P-053
P-055
Dipeptidyl- Peptidase 4 Inhibitor Alogliptin
Attenuates Myocardial Ischemia/ Reperfusion
Injury Via an Adenosine- Dependent
Mechanism
Evaluation of Mitochondrial ATP Levels
in Vivo Identiﬁes G0/G1 Switch Gene 2 as
a Therapeutic Target of Ischemic Heart
Failure
Madoka IHARA1）、Satoru YAMAZAKI2）、Hiroshi ASANUMA3）、
Masafumi KITAKAZE4）
Hisakazu KATO1）、Hidetaka KIOKA1,2）、Yoshihiro ASANO1,2）、
Seiji TAKASHIMA1,2）
Department of Cell Biology, National Cerebral and Cardiovascular
Center, Osaka, Japan、2）Department of Cell Biology, National Cerebral
a n d C a r d i o v a s c u l a r C e n t e r, O s a k a , J a p a n 、 3 ） D e p a r t m e n t o f
Cardiovascular Science and Technology, Kyoto Prefectural University
School of Medicine, Kyoto, Japan、4）Department of Cardiovascular
Medicine,NationalCerebralandCardiovascularCenter,Osaka,Japan
1）
1）
Incretin therapy diﬀers from previous DM therapies which are
often limited by adverse effects such as weight gain, edema,
or hypoglycemia and incretin therapy can help preserve
pancreatic β-cell function. In addition to glucose control, incretin
mimetics have multiple effects including cardioprotection. In
DM patients, coronary artery disease is the leading cause of
cardiovascular death, accounting for half of the deaths but
it remains controversial whether dpp4 inhibitor can reduce
the infarct size after myocardial ischemic/reperfusion injury.
Therefore, we tested the involvement of dpp4 inhibitor in the
infarct size-limiting eﬀect using larger mammals and focused on
the mechanism related to adenosine, which is thought to be a key
player in preconditioning. In anesthetized dogs, the left anterior
descending coronary artery was occluded for 90 minutes, followed
by reperfusion for 6hours. Alogliptin reduced the infarct size（17.1
± 5.0 % versus 43.1 ± 2.5 %）, and this eﬀect was completely
reversed by a nonselective adenosine receptor. Alogliptin shows a
cardioprotective eﬀect against ischemia/reperfusion injury, which
might arise from an adenosine -related mechanism.
DepartmentofMedicalBiochemistry,OsakaUniversityGraduateSchool
of Medicine, Osaka, Japan、 2） Department of Cardiology, Osaka
UniversityGraduateSchoolofMedicine,Osaka,Japan
<Background>
Heart tissue consumes more energy than other organs to maintain cell viability and cardiac pump
function. Imbalances between energy demand and supply in an ischemic myocardium fall into the
mechanical failure of heart. Therefore understanding the mechanism to maintain ATP production in
heart would be therapeutic strategy for ischemic heart failure. We recently identiﬁed G0/G1 switch
gene 2（G0s2）as an active regulator for ATP-producing enzyme, FoF1-ATP synthase in cultured
cardiomyocytes. However, whether G0s2 play roles in regulating ATP production in vivo is still
unknown.
<Hypothesis>
In this study, we aimed to clarify whether G0s2 actually aﬀects mitochondrial ATP production using a
zebraﬁsh model to accurately measure mitochondrial ATP concentration in vivo.
<Methods and Results>
To assess mitochondrial ATP production in vivo heart, we created transgenic zebrafish model
that specifically expresses mitochondria-targeted FRET-based ATP biosensor（Mit-ATeam）in
cardiomyocytes. Using Mit-ATeam zebraﬁsh, we observed a decline in mitochondrial ATP concentration
in the beating hearts during hypoxia and its recovery by sequential re-oxygenation. Furthermore,
we expressed G0s2 in Mit-ATeam zebraﬁsh heart and G0s2-overexpressing cardiomyocytes showed
enhanced contractility with increased intra-mitochondrial ATP concentration in hypoxic condition.
<Conclusion>
These results suggest that G0s2 functions as a guardian of hypoxic tissue via enhancing ATP
production and could become a therapeutic target for ischemic heart failure.
271
一般演題
︵ポスター︶
Tenascin-C（TN-C）, an extracellular matrix glycoprotein, transiently
appeared in myocardial tissue after acute myocardial infarction（AMI）.
However, the biological function of TN-C in ventricular remodeling
after myocardial infarction reminas to be elucidated. The aim of this
study was to investigated the eﬀects of TN-C on LV remodeling after
myocardial infarction. The 8 to 10 weeks old male wild type（WT）and
TN-C knock-out（KO）mice were divided into 4 groups of WT+Sham,
KO+Sham, WT+myocardial infarction（ MI）and KO+MI. In chronic
pahse, 12 weeks post-MI, the survival rate of both WT+MI（48.3%,14
of 29 mice）and KO +MI（55.6%,15 of 27 mice）groups had no signiﬁcant
difference. TN-C KO group had the better cardiac function than WT
had（LVEF, 19.02±6.31% vs 10.63±4.43%; p<0.001）. Interstitial ﬁbrosis at
border area was signiﬁcantly increased in the WT+MI group. At acute
phase, ﬂuorescence activated cell sorting（FACS）analysis showed that
ratio of CD45+, F4/80+, CD206+, M2 macrophage were significantly
increased in KO+MI compared with WT+MI group 7 days after MI. RTPCR analysis showed that the expression of IL-10, an anti-inﬂammatory
cytokine, was significantly higher in KO+MI than WT+MI at acute
phase. In conclusion, TN-C aggravates the deterioration of LV function
in chronic phase after MI partly through accerelation of inﬂammation
via suppression of the anti-inﬂammatory M2 macrophage at acute phase.
P-054
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター１２（P12）心不全に対する新たな薬物療法の可能性
P-056
P-058
Post-Infarct Treatment with microRNA145
Protects the Heart Against Myocardial
Ischemia-reperfusion Injury through
Acceleration of Myocyte Autophagy
1）
1）
Eﬀects of a Selective Acetylcholine-activated
Potassium Channel Blocker on the Regulation
of Heart Rate
4）
Kenshi HIGASHI 、Yoshihisa YAMADA 、Takuma AOYAMA 、
Shinya BABA1）、Shingo MINATOGUCHI1）、Kazuhiko NISHIGAKI1）、
Genzo TAKEMURA3）、Yukihiro AKAO2）、Shinya MINATOGUCHI1）
Gifu University Graduate School Of Medicine, Gifu, Japan、 United
Graduate School of Drug Discovery and Medical information Science,
Gifu University, Gifu, Japan、3）Asahi University, Gifu, Japan、4）Kizawa
memorialhospital,Gifu,Japan
1）
2）
一般演題
︵ポスター︶
Background: We previously reported that microRNA145（miRNA145）signiﬁcantly
reduced the myocardial infarct size and improved the function of left ventricle.
It has been reported that autophagy is activated in cardiomyocytes in ischemic
heart disease. We investigated whether miRNA145 reduces the myocardial
infarct size through acceleration of autophagy.Objective: We aimed to investigate
whether administration of miRNA145 would affect myocyte autophagy in a
rabbit model of myocardial infarction.Methods: Male Japanese white rabbits
underwent 30 min of coronary occlusion followed by 14 days of reperfusion, then
received intravenous injection of saline or miRNA145（0.035 mg/kg）immediately
after reperfusion. At 14 days after reperfusion, rabbits were sacriﬁced and the
hearts were removed. Heart tissues were sampled and devided them into three
area; remote area, borderline area and infarct area. The morphological changes
were investigated by electron microscopy, and the expressions of LC3B were
assessed by western blot analysis. Results: Electron microscopy ﬁndings showed
that cardiomyocyte autophagy was observed in both control and miRNA145
groups. Western blot analysis showed that transition from LC3B-1to LC3B2 were stronger in miRNA145 group than in the control group.Conclusions: It
is suggested that post-infarct treatment with miRNA145 attenuated ischemiareperfusion injury through acceleration of myocyte autophagy. This was
conﬁrmed by western blotting analysis of LC3B.
P-057
Noriaki YAMADA1）、Yoshihiro ASANO1）、
Satoru YAMAZAKI2）、Tetsuo MINAMINO1）、Yasushi SAKATA1）、
Masafumi KITAKAZE2）、Seiji TAKASHIMA1）
1）
Department of Cardiovascular Medicine, Osaka University Graduate
School of Medicine、 2）National Cerebral and Cardiovascular Center
ResearchInstitute
Sinus bradycardia causes a decreased cardiac output resulting in a variety
of clinical symptoms. From a pedigree of familial sinus bradycardia,
we previously identified a novel missense mutation in the KCNJ3
gene. KCNJ3 is a member of heterotetrameric acetylcholine-activated
potassium channel（KACh channel）in the sinus node, atrioventricular
node, and atrial myocardium. The mutation is located in the M1 helix
of KCNJ3, which forms the transmembrane pore of the KACh channel.
Electrophysiological analyses demonstrated that the KCNJ3 mutation
increased the basal current amplitude, and the increased current flow
through KACh channels leads to sinus bradycardia. This result suggests
that a pharmacological approach to the KACh channel would modulate
the heart rate in vivo . We hypothesized that a novel selective KACh
channel blocker is a hopeful candidate for the up-regulation of heart rate.
We investigated the electrophysiological eﬀects of this drug on the KACh
channel activity by two-electrode voltage clamp analysis using Xenopus
oocytes. This drug eﬃciently blocked the potassium current mediated by
the KACh channel in the mutant as well as wild type. Furthermore, we
generated transgenic zebraﬁsh bearing atrium speciﬁc expression of the
human KCNJ3 mutant for pharmacological intervention. The transgenic
zebraﬁsh showed marked bradycardia. In conclusion, functionally-altered
KACh channels cause the pathogenesis of sinus bradycardia, and the
KACh channel might be a therapeutic target of heart rate regulation.
P-059
Angiotensin II Vaccination Suppresses
Cardiac Remodeling after Myocardial
Infarction
Tranilast, Orally Active TRPV2 Antagonist,
Ameliorates End-Stage Heart Failure in Mice
with Dilated Cardiomyopathy
Ryo WATANABE、Mitsuaki ISOBE
Kazuo KOMAMURA、Yuko IWATA
Department of Cardiovascular Medicine, Tokyo Medical and Dental
University
Research Institute, National Cerebral and Cardiovascular Center, Suita,
Japan
A growing body of evidence suggests that angiotensin II
（AngII）plays a crucial role in the pathogenesis of cardiac
remodeling after myocardial infarction（MI）, which in turn leads
to heart failure. We here examined whether a vaccination against
AngII can be eﬀective strategy to prevent cardiac remodeling after
MI. Male Sprague-Dawley rats were injected subcutaneously with
saline（n=7）or AngII vaccine, a conjugate of AngII and keyhole
limpet hemocyanin（5µg/rat, n=11）, on day 0, 14 and 21. On day
28, these rats were subjected to permanent left anterior descending
coronary artery ligation. Then, hearts of these rats were harvested
on day 56. The anti-AngII antibody titer was increased in the
AngII vaccine-injected group [half-maximum binding titer（OD50）:
AngII vaccine=2595±788 vs. saline=N.D.]. Although no signiﬁcant
diﬀerences of blood pressure or infarct size were observed between
two experimental groups, left ventricular（LV）dysfunction and
infiltration of macrophages in myocardium were milder in the
AngII vaccine injected-group than in the saline-injected group [LV
ejection fraction: AngII vaccine=41.3±2.8% vs. saline=30.7±2.6%,
p<0.05; inﬁltration of macrophages: AngII vaccine=65±18 cells/ﬁeld
vs. saline=119±9 cells/ﬁeld, p<0.05]. Furthermore, AngII vaccination
did not cause any detrimental changes in cardiac function and
myocardium in sham-operated rats. These results suggest that the
AngII vaccine may provide a novel promising therapeutic strategy
to prevent cardiac remodeling after MI.
Background
Expression of transient receptor potential vanilloid 2（ TRPV2）, a
calcium-permeable cation channel, increased in the sarcolemma of
animal and human myocardium with dilated cardiomyopathy（DCM）.
We assessed whether a TRPV2 antagonist, tranilast, ameliorated heart
failure of DCM mice.
Methods and Results
We used 4C30 mice, which has abnormal myocardial calcium handling,
as a model of DCM. Sixteen 4C30 mice of 25 weeks old with end-stage
heart failure were given no drug（control）or 20 mg/kg/day of carvediol
（group C）or 400 mg/kg/day of tranilast（group T）or both of them（group
B）for 2 weeks. Blood pressure and heart rate were similar among the
4 groups. Echocardiography demonstrated tranilast improved fractional
shortening（in %）. Control: 6.2±2.5; Group C: 14.2±5.6, NS; Group T:
16.6±2.3, p<0.05; Group B: 17.2±3.2, p<0.05. Tranilast also improved
cardiac hypertrophy measured with heart-to-body weight ratio（in mg/
g）. Control: 12.4±2.5; Group C: 11.5±3.4, NS; Group T: 8.6±0.9, p<0.05;
Group B: 5.9±1.1, p<0.01. Sarcolemmal expression of TRPV2 measured
with immunostaing in 4C30 mice increased twice as much as syngeneic
C57BL/6J. Tranilast, not carvedilol, halved the expression of TRPV2,
corresponding to reduction in [Ca2+]i of isolated cardiomyocytes.
Conclusion
Tranilast ameliorated heart failure in 4C30 mice, possibly due to the
inhibition of Ca2+ inﬂux through TRPV2.
272
プログラム・抄録集
ポスター１３（P13）重症心不全から心不全終末期への対応
P-060
P-062
Nifedipine Attenuates Cardiac Hypertrophy
by Inhibiting Nox4-induced Oxidation of
HDAC4
1）
1,2）
Junichi MATSUMOTO 、Shouji MATSUSHIMA 、
Shintaro KINUGAWA1）、Hiroyuki TSUTSUI1）、
Junichi SADOSHIMA2）
1）
Depertment of Cardiovascular Medicine, Hokkaido University Gradiate
School of Medicine, Sapporo, Japan、2）Rutgers New Jersery Medical
School,Newark,USA
P-061
Role of FOXO Transcription Factors in the
Protective Mechanism by Resveratrol Against
Cardiomyopathy in the Dystrophin-deﬁcient
Mdx Mouse
Atsushi KUNO、Rio SEBORI、Yoshiyuki HORIO、Tetsuji MIURA
Department of Pharmacology, Sapporo Medical University, School of
Medicine, Sapporo, Japan、2）Department of Cardiovascular, Renal and
MetabolicMedicine,Sapporo,Japan
1）
[Purpose] We previously reported that treatment with resveratrol, an activator
of the NAD+-dependent protein deacetylase SIRT1, ameliorates cardiomyopathy
in the dystrophin-deficient mdx mouse. Since SIRT1 is known to activate
FOXO transcription factors under stress conditions, we hypothesized that
FOXO play roles in protection by resveratrol in the mdx heart.
[Methods and Results] Mdx mice were divided into untreated（RSV0）and
resveratrol-treated（400 mg/kg chow, RSV400）groups. Resveratrol
administration was started at 8-week-old, and mice were sacriﬁced at 65-weekold. Echocardiography at 62-week-old demonstrated that left ventricular
（LV）fractional shortening was higher（38±2% vs. 34±1%, P<0.05）,IVS thickness
was thinner, and end-diastolic LV dimension was smaller in RSV400 than those
in RSV0. Compared with untreated mdx, resveratrol treatment signiﬁcantly
up-regulated cardiac mRNA levels of genes known as FOXO's targets including
anti-oxidant catalase（+2.0-fold）, SOD1（+2.8-fold）and autophagy-related LC3b
（+2.5-fold）, Bnip3（+4.1-fold）. Dihydroethidium staining for analysis of cardiac
reactive oxygen species revealed that ﬂuorescence intensity was signiﬁcantly
decreased by 45% by resveratrol treatment. Immunoblot showed that total
myocardial LC3 protein level was rather decreased in RSV400, suggesting
promotion of autophagic ﬂux by resveratrol. Nuclear FOXO3a level assessed
by immunostaining was increased in RSV400 compared with RSV0.
[Conclusion] Resveratrol ameliorated cardiomyopathy in mdx mice probably by
attenuation of oxidative stress and induction of autophagy via FOXO activation.
楠川翠里 1）、角田あゆみ 1）、平田理利佳 1）、岡本佳子 1）、佐藤琢磨 2）、
瀬口理 2）、簗瀬正伸 2）、中谷武嗣 2）
1）
国立循環器病研究センター　看護部　重症心不全・移植病棟、2）国立循環器
病研究センター　移植部
植込型左心補助人工心臓
（以下植込型 LVAS）
の管理において、
ドライブライン貫通部の管理は特に重要であり、貫通部が感
染症を引き起こし重篤化すると生命の危機に直結する。当病
棟では、創傷治癒過程及び ADL に応じた固定方法を検討し
ているが、
固定方法が継続できないという現状がある。
そこで、
重症心不全移植病棟に勤務する看護師 13 名に、植込型 LVAS
ドライブラインの固定についてどのように考え、実践してい
るのか、質問紙を用いてアンケート調査を行った。その結果、
「患者の状態に応じた固定を継続できている」の質問に対し、
「はい」は 38％であった。それに対し、
「いいえ」は 62% で、個
別性があり複雑で分かりにくいという意見があった。植込型
LVAS は機種により、また同じ機種でも患者により固定方法
が違うという難しさがある。患者の状態にあった固定方法が
検討・継続するためには、アセスメントや注意点も含め、記
録に残すことも有効だと考える。
P-063
介護老人保健施設で行う慢性心不全患者に対する
認知症アプローチ
村井達彦
介護老人保健施設プランタンおおまま
【はじめに】高齢化とともに認知症を合併する心不全患者が増
加している . 特に介護老人保健施設（以下老健）では , 心不全患
者のほとんどが認知症と診断されている【目的】
.
老健に入所し
ている慢性心不全患者に対して認知症予防を含めた有酸素運
.
対象は平成
動プログラムを行い , その効果を検証した【方法】
24 年 10 月から平成 25 年 1 月までの間に当施設に入所していた
93 名のうち認知症を合併する慢性心不全患者 10 名を対象とし
た . 介入は施設長の許可得て行われ , 利用者から文書で同意を
得た . プログラムは週1回の認知活動と有酸素運動を行った . 介
入は 3 人の小集団で行ない , 効果検証には Mann-Whitney 検
定を用いた . 評価指標には MMSE, Barthel index, Vitality
.
介入前後の比較では
index, DBD, ISWT,FBS, を用いた【結果】
Vitality index が介入前に比べて有意に改善していた
（p<0.05）.
【考察】日本の高齢化が進行するに伴い認知症を合併する慢性
心不全患者は増加傾向にある . 認知症患者にとって意欲低下
は更なる認知症上の悪化につながるため , 本研究のプログラ
ムは慢性心不全患者の認知症予防の一手段として活用できる
可能性がある .
273
一般演題
︵ポスター︶
<Rationale> NADPH oxidase 4（Nox4）is a major source of ROS in the
heart and induces cardiac hypertrophy through oxidation and nuclear
exit of HDAC4.<Hypothesis> We hypothesized that nifedipine, an
L-type Ca2+ channel blocker, inhibits Nox4-induced oxidation of HDAC4,
thereby attenuating pathological hypertrophy.<Methods and Results>
A subpressor dose of phenylaphrine（PE; 20 mg/kg/day）or saline alone
was continuously infused into mice with or without nifedipine（10 mg/kg/
day）via osmotic mini-pumps. After 14 days, aortic pressure was similar
among the four groups. Left ventricular weight/tibial length（5.6±0.2 vs.
6.1±0.2 mg/mm; p<0.05）and cardiomyocyte cross-sectional area（223±12
vs. 268±18 μm2; p<0.05）were significantly smaller in the PE+nifedipine
group than in the PE+saline group. Nifedipine caused a significant
decrease in PE-induced upregulation of Nox4 in the heart, accompanied
by suppression of phosphorylation of NF-κB, a transcriptional factor that
upregulates Nox4. Nifedipine inhibited PE-induced upregulation of Nox4
and nuclear ROS production（Lucigenin chemiluminescence assay: 3982
±941 vs. 7218±1945 relative light unit; p<0.05）in cardiomyocytes. PEinduced nuclear exit of HDAC4 and HDAC4 oxidation, as evaluated with
biotinylated iodoacetamide assays, were also attenuated in cardiomyocytes
treated with nifedipine.<Conclusion> Nifedipine inhibits pathological
hypertrophy in the heart by inhibiting upregulation of Nox4 and oxidation
of HDAC4, a critical redox signaling pathway in pathological hypertrophy.
植込型左心補助人工心臓のドライブライン固定方
法についての看護師の意識調査
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
P-064
P-066
介護老人保健施設に入所する認知症を合併する高
齢慢性心不全療養者の対応困難な状況と看護支援
心不全終末期患者のスピリチュアルペインの分析
∼心不全終末期患者のインタビューを通して∼
大津美香
小田真澄、夏迫里奈、木本直子
弘前大学大学院　保健学研究科
独立行政法人国立病院機構鹿児島医療センター
一般演題
︵ポスター︶
1 研究目的 : 認知症を合併する高齢慢性心不全療養者の心不全
の疾病管理の支援に際して、看護職員は対応に困難を感じて
いるといわれている。再入院を繰り返す居宅以外の生活場所
として、介護老人保健施設が上位に挙げられ、対応困難によ
り支援が円滑に行われていない可能性が推察された。そこで
本研究では、介護老人保健施設に入所する認知症を合併する
高齢慢性心不全療養者の対応が困難な状況と看護支援につい
て明らかにする。2 研究方法 : 全国の介護老人保健施設 1,000
件の看護職員各 1 名を対象に、無記名の自記式質問紙調査を
郵送にて実施した。研究者の所属する大学の倫理委員会にお
いて承認を得て実施した。3 結果 : 看護職員 106 名から有効回
答を得た。認知症を合併する高齢慢性心不全療養者では自覚
症状に乏しいうえ、心不全の客観的な症状の把握が難しいこ
とから、心不全の症状および悪化症状のモニタリングに困難
を抱いていたが、悪化の予防や水分過剰摂取への対応に向け
ては、医師へ報告及び相談をしていた。4 考察 : 介護老人保健
施設では常勤医師が配置されていることから、医師の協力を
得られやすい環境にあり、悪化の早期発見へとつながるもの
と考えられた。
P-065
有効な終末期の支援ができた慢性心不全患者の一症例
神保美里 1）、林亜希子 1）、松田美紗子 1）、成毛崇 2）、猪又孝元 2）、
松野時子 1）、阿古潤哉 2）
北里大学病院　看護部、2）北里大学　医学部　循環器内科学
1）
背景：心不全は増悪と寛解を繰り返しながら重篤化していく
ため、予後の予測が困難であり、終末期のケアにおいてジレ
ンマを抱えるケースが多い。今回、緩和ケアが積極的に提供
できた症例を通し、介入の有効性を検討したので報告する。
患者紹介：70 歳男性。慢性心不全で入退院を繰り返し、低心
拍出症状を呈し緊急入院となったが、徐々に治療への抵抗性
が見られるようになった。看護の実際 : 医療チームで患者が
終末期にあることを共通認識したうえで、患者・家族に現状
が伝えられた。緩和ケアチームの介入を得て、身体的苦痛の
軽減を図った。また、患者家族との話し合いの場を十分にもち、
その人らしい生活に近づけるケアを提供した。患者は愛犬と
の面会を希望し、医師・家族の協力を得て、外来玄関での愛
犬との面会を実施した。傾眠傾向ではあったが、面会の際に
はしっかりと開眼し、生きている実感が得られていた。
その後、
残された時間を家族とともに穏やかに過ごされ、永眠となっ
た。考察：終末期である事実を医療者・患者家族が共通認識
すること、残された時間を患者がその人らしく過ごせるよう
支援できたことで、患者家族にとって有効な緩和ケアが提供
できたと考える。
274
【背景】非がん領域での終末期医療では具体的方向性の支援が
認識されていない現状があり、先行研究でも看護の方向性に
ついては明らかにされていない。【目的】心不全終末期患者の
疾患や予後に関する思いの傾向と看護の方向性を明らかにす
る。
【対象・方法】
DNAR の方針を受容した患者を対象として、
疾患の受け止め方を
「緩和ケアマニュアル」
（第 5 版）を参考に
カテゴリー化し、村田理論を用いて看護の方向性を分析した。
【結果・考察】「回復への期待」「退院後の生活への不安」「進
行している心不全への驚き」
「回復するか分からないことへの
藤」
が新たなスピリチュアルペインとして存在した。また今
後の看護の方向性については、
村田理論の自立存在、関係存在、
時間存在の中でも、心不全終末期患者には時間存在を意味す
るスピリチュアルペインが少なかった。予後の予測が難しい
ことから、心不全終末期患者の経過、特徴をよく理解し、患
者自身が疾患を抱えたうえで、今後どうしたいか、どう生き
たいかの意思決定を早期から行えるような支援が重要である。
プログラム・抄録集
ポスター１４（P14）心不全患者の心臓リハビリテーション
P-067
P-069
複数の心臓リハビリテーション進行阻害要因を有
するCABG/CRT-D埋め込み後重症心不全の一例
鈴木裕二 1）、山本壱弥 1）、福井教之 1）、小西治美 1）、熊坂礼音 1,2）、
荒川鉄雄 1,2）、大原貴裕 1,2）、中西道郎 1,2）、後藤葉一 1,2）
1）
国立循環器病研究センター　心血管リハビリテーション科、2）国立循環器病
研究センター　心臓血管内科
金子奈央 1,2）、高橋仁美 3）、山嵜継敬 4）
1）
川崎幸病院　リハビリテーション科、2）弘前大学大学院　保健学研究科、3）市
立秋田総合病院　リハビリテーション科、4）川崎幸病院　循環器科
【目的】急性心不全患者に対する早期リハビリ介入が在院日数
に与える影響を調べるため，在院日数と座位，立位，歩行の
それぞれの開始日との関連性について検討した．【対象と方
法】対象は，2012 年 6 月 1 日∼ 2013 年 10 月 31 日の間に当院循
環器科にて急性心不全
（CS 分類 1 ∼ 2）と診断された入院患者
230 名である．CS1 群と CS2 群に分け，在院日数と座位，立位，
および歩行の開始日を調べ，
これらの相関を検定した．
【結果】
CS2 群は CS1 群に比べ，在院日数が有意に長く，座位，立位，
歩行のそれぞれの開始日が有意に遅かった．在院日数との相
関分析では，CS1 群は座位，立位，歩行のいずれの開始日と
も相関関係を認めなかったが，CS2 群は座位，立位，歩行の
いずれの開始日とも中等度の有意な正の相関を認めた．
【考察】
心不全患者の高齢化が進んでおり，長期臥床による廃用症候
群を防ぐためにも安全な早期離床が重要になると考える．急
性心不全の病態や治療上，積極的なリハビリが実施できない
状況にあっても，座位などの早期リハビリ介入は在院日数を
短縮させる可能性があると考えられる．
P-068
P-070
強心薬持続投与下で心臓リハビリテーションを実
施した重症心不全の一例
高齢心不全患者の入院期ADLとリハビリテー
ションの検討
安川悠仁 1）、小林聖典 1）、清水美帆 1）、土川洋平 1）、澤村昭典 2）、
深谷兼次 2）、奥村貴裕 2）、室原豊明 2）
大浦啓輔 1）、越智裕介 1）、高橋実希 1）、後藤賢治 2）
名古屋大学医学部附属病院　リハビリテーション部、名古屋大学大学院医
学系研究科　循環器内科学
1）
2）
【背景】強心薬持続投与下の重症心不全患者における心臓リハ
ビリテーション（心リハ）の有効性・安全性は確立されていな
い。今回重症心不全患者に対し強心薬持続投与下で心リハを
行い、自宅退院に至った症例を経験したので報告する。【症
例】
57 歳男性、基礎疾患は薬剤性心筋症。心不全で入院後、
6 病日より心リハを開始した（開始時 LVEF22%、E/e 19.6、
BNP1513pg/ml、膝伸展筋力 60.8kgf/kg）。30 病日に VT が
出現し心リハを中止した。38 病日、ICD 植込み術施行後より
心リハを再開した。強心薬持続投与下での心リハプログラム
は、下肢筋力強化中心の身体機能維持、心不全疾病管理、栄
養・運動指導を継続した。心不全症状の増悪に注意しなが
ら、強心薬の漸減とともに心リハプログラムを拡大した。リ
ハ再開時、膝伸展筋力は 48.6kgf/kg に低下していたが、116
病日、心機能・身体機能の改善を認め自宅退院に至った（退院
時 LVEF34%、E/e 8.4、BNP153pg/ml、膝伸展筋力 71.5kgf/
kg）
。運動中の VT、血圧低下等の有害事象発生はなかった。
【考
察】
重症心不全患者に対し、強心薬持続投与下においても下肢
筋力を保つことで、退院時は良好な身体機能まで改善できる
可能性が示唆された。
福山循環器病院　リハビリテーション課、2）福山循環器病院　循環器内科
1）
【はじめに】高齢心不全患者は増加傾向であり、病態が安定し
ても ADL 低下が問題となる。ADL 低下にはリハビリテー
ションが重要であり、本研究では高齢心不全患者の ADL と
リハビリテーションについて検討した。【方法】対象は、当院
にて 2014 年 3 月∼ 5 月の間に心不全急性増悪で入院しリハビ
リテーションを施行した患者 68 例
（年齢 77±10 歳、男性 41 例）。
80 歳以上（O 群）と未満（C 群）の 2 群に分け調査した。
【結果】
O 群は 35 例
（51％）
認めた。O 群は有意に女性が多く、BMI が
低値であった
（p<0.01）
。ADL は barthel index が入院時 O 群
86±17 点、C 群 96±12 点と O 群が有意に高値であり（p<0.01）、
退院時 O 群 85±19 点、C 群 96±11 点と変化を認めなかった。
ADL が入院中に低下した症例は O 群 2 例（6 ％）、C 群 1 例
（3％）
と両群に有意差を認めなかった。リハビリテーション開
始時期は O 群 3±2 日、C 群 4±3 日であり、歩行開始までの日
【考察】
数は O 群 4±3 日、C 群 4±3 日と有意差を認めなかった。
高齢心不全患者は入院前より ADL 低下を認めるが、リハビ
リテーションを 80 歳未満の患者と同様に実施することにより
入院中の更なる低下を予防できる可能性が示唆された。
275
一般演題
︵ポスター︶
【はじめに】心不全・陳旧性心筋塞・重症不整脈・CABG 術後・
CRT-D 埋込・高度デコンディショニングなど複数の心臓リハ
ビリテーション
（心リハ）進行阻害要因を有する症例を経験し
た。
【症例】67 歳男性。今回、意識消失・VT 発症後第 7 病日に当
院転院。CAG にて 3 枝病変、低心機能（EF 26%）を認め、緊
急 CABG 施行。術後、治療抵抗性心不全に対し IABP 管理、
第 20 病日に IABP 抜去、第 26 病日に病棟リハビリ開始。術後
も VT・VF が出現し、第 45 病日に CRT-D 埋込術、第 53 病
日に心リハ室にて運動療法開始となった。
【方法・結果】心リハ初日、歩行負荷試験後に血圧低下し（BP
60/mmHg）、ストレッチャーで帰室。第 2 日、降圧薬減量
にもかかわらずリハ来室時 BP 70/48mmHg。座位レジス
タンストレーニング施行。以後、徐々に運動メニューを増
量、CRT-D 埋込例につき上限心拍数は 140bpm とした。第
61 病日に退院。心リハ 3 ヶ月終了時、膝伸展筋力が +16%、
PeakVO2 が +32% 増加した。
【結語】複数の心リハ進行阻害要因に対し適切に対処して心リ
ハを行った結果、筋力・運動耐容能の良好な改善を認めた。
急性心不全患者の在院日数と離床との関係
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター１５（P15）急性心不全の臨床
P-071
P-073
心不全患者に対する外来リハビリテーションの有用性
1）
1）
1）
1）
1）
渡邊暢、清川憲孝、佐藤清佳、高橋仁美、柏倉剛、
藤原敏弥 2）、柴原徹 2）、池田研 2）、中川正康 2）
市立秋田総合病院　リハビリテーション科、2）私立秋田総合病院　循環器内科
1）
一般演題
︵ポスター︶
【目的】入院中心臓リハビリテーション（リハ）を施行した後，
外来でリハを継続する効果について検討した．【対象】入院中
にリハを施行した心不全患者 17 名を対象とし，外来でリハを
継続した 11 名（リハ継続群）と，退院後は在宅での運動のみ指
導した 6 名
（自主トレ群）の 2 群に分け，比較検討した．【方
法】2 群とも入院中のリハは同様に行い，退院後のリハは個別
に設定，指導した．リハ継続群は週 1 回通院し，他の日は自
宅で運動を行った．自主トレ群は自宅での運動のみ行った．
2 群の 6 分間歩行距離（6MWD），握力，下肢筋力 ,BMI, 血液
生化学検査をリハ開始時と 3 カ月後に評価し，比較した．ま
た，自宅での運動時間も聞き取りにより調査した．【結果】リ
ハ継続群は 6MWD が 427.3 → 466.1m，下肢筋力（体重比）が
49.3 → 58.7% と有意な改善があり，自主トレ群に有意な変化
はなかった． 1 週間の運動時間は自主トレ群の 46 分に対し，
リハ継続群が 205 分と有意に多かった．【まとめ】外来でリハ
を継続した患者は 3 ヵ月後の運動機能に改善がみられ，外来
リハの有用性が示唆された．
P-072
外来心臓リハビリテーション参加継続の動機付け
支援に対するCNSの役割
藤井利江 1）、高橋敬子 2）
兵庫医科大学病院　看護部、2）兵庫医科大学医学教育センター
1）
【目的】外来心臓リハビリテーション（CR）参加には，動機付
けが重要である．患者が CR を心疾患の治療として捉えてい
ないこと，医療者側も CR 参加への動機付け支援が十分でな
い現状がある．当院は CR チームに心疾患をサブスペシャリ
ティとする慢性疾患看護専門看護師（CNS）を加え，包括的外
来 CR を実施している．今回，治療中断のリスクが高く，行
動変容の意思がない患者に，CNS が行った動機付け支援から
役割を考察する．
【事例】拡張型心筋症の 40 歳代男性．無職，独居，高度肥満が
あり，医療者とのコミュニケーションや内服アドヒアランス
が悪く，入退院を繰り返した．
【方法】診療録から動機付け支援の内容を抽出し分析した．倫
理的配慮は，対象に研究目的，協力は自由意思，匿名性の保
持を説明し同意を得た．
【結果】
CNS が毎週電話による問診と生活指導を繰り返したと
ころ，コミュニケーションが得られ，患者の CR 参加を促し，
運動習慣の萌芽と再入院の回避をもたらした．
【考察】CNS は，個々の患者に適確な助言を与えることができ，
患者自身のヘルスリテラシーの向上や外来 CR 参加継続の動
機付けを得る可能性があり，心不全チーム医療において CNS
の役割は重要である．
276
A Case of Heart Failure Due to Tachycardiainduced Cardiomyopathy
Kenji TAKEDA
Departmentofcardiology,OkayamaSaiseikaiGeneralHospital
A 55 years old man with dyspnea visited our hospital.
Chest X-ray showed cardiac enlargement and pulmonary
congestion. The ECG showed atrial ﬁbrillation of heart rate
160 bpm. The echocardiography showed diffuse severe
hypokinesis of left ventricular
（LV）
.LV ejection fraction was
16.9%. We started intravenous administration of landiolol
for heart rate control. Also, we treated with vasodilator
and a diuretic. Cardiac rehabilitation started after heart
failure improvement. Late Gadolinium enhancement was
observed at intramural segment of interventricular septum
in the cardiac MRI. There is no signiﬁcant stenosis by the
coronary arteriography. Myocardial biopsy showed mild
hypertrophy, mild fibrosis and no disarray. The systolic
function was improved in the echocardiography at the 44th
day of illness. The abnormality of the fatty acid metabolism
was not found in the BMIPP scintigraphy after the systric
function improvement. We reported a case of heart failure
due to tachycardia-induced cardiomyopathy.
P-074
Neuroleptic Malignant Syndrome Presennting
Severe Acute Heart Failure: as an Initial
Manifestation Autopsy Case
Minoru WAKASA、Hirohumi AOKI、Kouji KAJINAMI
TheDepartmentofCardiology,KanazawaMedicalUniversity,Uchinada,
Japan
A-20-year-old man was admitted to our hospital because
of dyspnea. He had a 6-year history of depression
treated with psychotropic drug. One week prior to
admission, he developed nocturnal dyspnea. At admission,
echocardiography showed diffuse severe hypokinesis of
left ventricle, which was confirmed by left ventricular
angiography without any coronary artery stenosis.
Furthermore endcardial biopsy revealed no histopathlogical
findings suggesting cardiomyopathy and carditis. Initial
treatment with diuretics and inotropic agent did not improve
cardiac function, resulting in endtracheal intubation.Two
（39.0°
C）
in association
days after admission, he became febrile
with CK increased
（482 to 4860IU/l）
.We diagnosed as having
neuroleptic malignant syndrome and started dantrolene
administration.Level of CK decreased, however he continued
to have a high fever sustained and ultimately he died at six
days after admission. Taken together with autopsy ﬁndings,
potential mechanism of cardiac dysfunction in the present
case will be discussed.
プログラム・抄録集
P-075
P-077
Thrombus Detected in Right Atrium
and Inferior Vena Cava in Patient with
Tachycardia Induced Cardiomyopathy
Eﬀect of Non-invasive Positive Pressure
Ventilation on Outcome in Patients with Acute
Heart Failure
Takuya MIZUAKAMI1）、Naoko IKEDA2）、Hideyuki MAEZAWA1）、
Miki TSUJIUCHI1）、Ayaka NOGI1）、Mio EBATO1）、
Hiroshi SUZUKI1）
Mitsutoshi ASAI1,2）、Kazunori KASHIWASE1）、Akio HIRATA1）、
Takayoshi NEMOTO1）、Koshi MATSUO1）、Masato OKADA1）
Department of Cardiology, Showa University Fujigaoka Hospital,
Kanagawa, Japan、2）Department of Cardiology, Showa University Koto
ToyosuHospital,Tokyo,Japan
1）
P-076
The Factors Associated with Successful
Treatment with Non-invasive Positive
Pressure Ventilation for the Patients with
Acute Heart Failure
2）
Background; Non-invasive positive pressure ventilation
（NPPV）has been established for patients with acute
heart failure（ AHF）. However, many patients cannot be
discharged home after treatment, although NPPV can avoid
endotracheal intubation（ETI）.Objective; We examined
the factors that influenced whether or not the patients
could be discharged home among the patients with AHF
treated with NPPV.Methods and results; We analyzed
784 patients with AHF who admitted to Osaka Police
Hospital between January 2010 and December 2012. The
patients（ n=110）treated with NPPV without ETI were
divided into those who were discharged home（H group;
n=82）and those who died during hospitalization or those
who were transferred to other hospital for a longer chronic
treatment（ DC group; n=28）. The blood pressure, heart
rate, respiratory rate, LVDd, and LVEF on admission were
not different between the groups. On the other hand, the
patients treated with continuous sedation（21% vs. 5%,
p=0.01）and those who suffered pneumonia（55% vs. 21%,
p=0.07）were more frequent in DC group than in H group.
Conclusions; The use of continuous sedation and suffering
pneumonia were negatively associated with the outcome
among the patients with AHF treated with NPPV.
P-078
演題取り下げ
Mitsutoshi ASAI1,2）、Kazunori KASHIWASE1）、Akio HIRATA1）、
Takayoshi NEMOTO1）、Koshi MATSUO1）、Masato OKADA1）、
Yasunori UEDA1）
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan、
Cardiovascular Division, Higashiosaka City General Hospital, Osaka,
Japan
1）
2）
Background; Non-invasive positive pressure ventilation（NPPV）has
been established for patients with acute heart failure（AHF）. Under
the expanding indication of NPPV use, we sometimes experience the
cases in which NPPV treatment is not successful and endotracheal
intubation（ETI）is required.Objective; We examined the factors
associated with successful NPPV treatment among the patients
with AHF.Methods and results; We analyzed 784 patients with AHF
who admitted to Osaka Police Hospital between January 2010 and
December 2012. Initially, 640 patients of them were treated with
standard oxygen therapy, 121 patients with NPPV, and 23 patients
with ETI. Among 121 patients initially treated with NPPV, the
treatment was not successful in 11（9%）patients who required ETI（F
group）while the treatment was successful in the rest of the patients
（S group）.The blood pressure, heart rate, respiratory rate, LVDd, and
LVEF on admission were not diﬀerent between the groups. On the
other hand, PCO2 was signiﬁcantly higher（60.4±30.6mmHg vs. 47.1±
17.1mmHg, p=0.03）and the patients who suﬀered pneumonia was more
frequent（55% vs. 28%, p=0.07）in F group than in S group. Conclusions;
A high PCO2 value and suffering pneumonia were associated with
unsuccessful NPPV treatment of the patients with AHF.
277
一般演題
︵ポスター︶
Patients with atrial ﬁbrillation（AF）and heart failure are at
high risk for left atrial thrombus formation, though thrombi
in right atrium are rare. The 62-years-old man was admitted
with acute decompensated heart failure（ ADHF）caused
by AF with rapid ventricular response（ 180beats/min）.
He underwent pulmonary vein isolation（PVI）at 48-yearsold after four episodes of heart failure admission with AF.
After PVI, he developed no clinically documented AF. On
admission, left ventricular wall motion was disturbed with
ejection fraction of 30% and left ventricular was enlarged.
He was treated with furosemide, carperitide and intravenous
heparin under countinuous positive airway pressure.
Intravenous amiodarone was used for the rate control as HR
was resistant to digitalis. On the third hospital day, a 3 × 4
cm mobile thrombus was found in right atrium on follow-up
echocardiography. Contrast enhanced CT showed multiple
pulmonary embolism. Emergency operation was performed
to remove the thrombi in pulmonary artery and right
atrium. Long thrombus from right atrium to inferior vena
cava over 10cm was found and successfully removed. He
discharged on the 23th hospital day with good postoperative
course.
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan、
Cardiovascular Division, Higashiosaka City General Hospital, Osaka,
Japan
1）
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター１６（P16）虚血性心疾患による心不全
P-079
P-081
A Case of Heart Failure and Coronary Spasm
1）
1）
1）
Hiroki TERAGAWA 、Yuichi FUJII 、Tomohiro UEDA 、
Shuichi NOMURA2）
DepartmentofCardiovascularMedicine,HiroshimaGeneralHospitalof
West Japan Railway Company、 2）Department of General Physician,
HiroshimaGeneralHospitalofWestJapanRailwayCompany
1）
一般演題
︵ポスター︶
As the cause of heart failure, there are several cardiac
disorders. Coronary spasm, which causes vasoconstriction of
epicardial coronary arteries, leading to myocardial ischemia.
Recently, it has been reported that coronary spam causes
heart failure. We also experienced a case of heart failure
and coronary spasm. A 69-year-old woman was admitted for
further examination and treatment of chest pain. Emergency
cardiac catheterization showed no significant stenosis on
coronary angiograms, but on a left ventriculogram, diﬀuse
wall hypokinesis was observed. After treating heart failure,
cardiac catheterization was performed again. A spasm
provocation test showed coronary spasm of the right
and left coronary arteries. Under taking vasodilators and
standard treatment for heart failure, she had experienced no
readmission. Coronary spasm should be considered as one of
causes of heart failure.
Impact of Infarct Location on Development
of Ischemic Mitral Regurgitation in Patients
with Acute Myocardial Infarction
Kitae KIM、Shuichiro KAJI、Takeshi KITAI、Tomoko TANI、
Makoto KINOSHITA、Natsuhiko EHARA、Atsushi KOBORI、
Yasuhiro SASAKI、Toru KITA、Yutaka FURUKAWA
Department of Cardiovascular Medicine, Kobe City Medical Center
GeneralHospital
Background: It has been reported that patients with inferior
myocardial infarction（MI）have higher incidence of ischemic mitral
regurgitation（IMR）compared with patients with anterior MI. However,
the impact of infarct location on development of IMR after acute MI
during long-term follow-up period has not been fully investigated.
Methods and Results: We studied 652 consecutive patients with acute
MI from 2000 to 2008 who underwent emergent coronary angiography
and transthoracic echocardiography during index hospitalization. The
mean age was 65±11 years and 509 patients（78%）were men. A total of
44 patients had combined anterior and infero-posterior（Ant+IP）infarct
locations（Ant+IP-MI group）including prior MI（n=37）or second MI
during follow-up（ n=7）. The remaining 610 patients had isolated
anterior（n=271; Ant-MI group）or infero-posterior MI（n=337; IP-MI
group）location. At late follow-up echocardiography, the incidence
of significant IMR（moderate or severe）was significantly higher in
Ant+IP-MI group, compared to Ant-MI group and IP-MI group
（36% vs. 6% vs. 10%, P<0.001）. Cox proportional model revealed that
combined Ant+IP infarct locations was associated with a signiﬁcant
increase in the risk of heart failure independent of age, gender, and
baseline IMR.Conclusions: Combined Ant+IP infarct location, which
was associated with increased risk of heart failure, was an independent
predictor of late IMR development in patients after acute MI.
P-080
P-082
Endothelial Function is Associated with
Ventilatory Eﬃciency Rather Than Exercise
Tolerance in Patients after Acute Myocardial
Infarction
Eﬀect of Left Ventricular Ejection Fraction on 2-Year
Clinical Cutcomes in Patients with Acute Myocardial
Infarction Undergoing Primary Percutaneous
Coronary Intervention with Drug-Eluting Stents
Etsushi KYUNO1）、Yoshitaka ISO2）、Naoko IKEDA1）、
Chisato SATO2）、Hideyuki MAEZAWA1）、Hiroshi SUZUKI2）
Woong JEON1）、Sang-Ho PARK1）、Seung-Woon RHA2）、Kanhaiya L. PODDAR2）、
Meera KUMARI2）、Yun Kyung KIM2）、Jin Oh NA2）、Cheol Ung CHOI2）、Hong Euy LIM2）、
Jin Won KIM2）、Eung Ju KIM2）、Chang Gyu PARK2）、Hong Seog SEO2）、Dong Joo OH2）
Division of Cardiology, Showa University Fujigaoka Rehabilitation
Hospital、2）DivisionofCardiology,ShowaUniversityFujigaokaHospital
1）
Ventilatory efficiency assessed by cardiopulmonary exercise
testing（CPX）predicts prognosis of heart failure patients. Aim
of this study was to investigate the cross-sectional association
between exercise capacity, ventilatory eﬃciency and endothelial
function determined by ﬂow-mediated dilation（FMD）in patients
with lower exercise capacity after acute myocardial infarction
（MI）.Methods and Results: We studied 20 acute-MI patients with
low exercise capacity（peak oxygen consumption（VO2）<16 ml/
min/kg）. FMD and CPX were performed in sub-acute phase of
the MI. The %FMD were inversely and signiﬁcantly correlated
with the VE/VCO2 slope（r= − 0.44, p<0.05）but not associated
with the VO2 levels at anaerobic threshold and peak. The
patients were divided by VE/VCO2 slope value at 35（>35, n=7;
<35, n= 13）. %FMD was signiﬁcantly lower in the patients with
VE/VCO2 slope >35 than in the patients with<35, whereas
there were no significant differences between the two groups
in peak VO2 levels, plasma BNP concentration, ejection fraction
documented by echocardiography and the clinical characteristics.
Conclusion: Results of the present study demonstrated that FMD
was associated with ventilatory eﬃciency rather than exercise
tolerance in acute MI patients. FMD may reﬂect and stratify the
severity in in the lower exercise capacity patients after acute MI.
278
Cardiology Department, Soonchunhyang university cheonan hospital,
cheonan, Korea、 2）Cardiovascular Center, Korea University Guro
Hospital,Seoul,Korea
1）
Background: The purpose of this study is to evaluate the
effect of left ventricular ejection fraction（LVEF）on clinical
outcomes in patients with acute myocardial infarction（AMI）
Methods: A total of 464 patients with AMI undergoing
primary percutaneous coronary intervention between 2004
to 2009 were enrolled. They were divided into two group;
LVEF 40%（n=279）and LVEF<40%（n=185）. The clinical
follow-up end-point was total major adverse cardiac event
（MACE）including death, AMI, TVR, Non-TVR
Results: At 2-year（follow-up, 89.2%）, major clinical outcomes
was similar to two groups except total
MACE and cardiac death. However,
when in-hospital mortality was excluded,
total MACE and cardiac death were also
similar to two groups（table, ﬁgure）.
Conclusions: LVEF is associated with inhospital cardiac death and total MACE.
However, LVEF doesn t seem to be
independent predictor for a major clinical
outcomes except in-hospital period.
プログラム・抄録集
ポスター１７（P17）様々な角度から心不全を考える
P-083
P-085
Design Challenges for Heart Failure
Prevention Clinical Trials: Adaptive Design
Approach
Hae-Young LEE、Wook-Jin CHUNG、Hui-Kyung JEON、
Hong-Seog SEO、Dong-Ju CHOI、Eun-Seok JEON、Jae-Joong KIM、
Joon Han SHIN、Seok-Min KANG、Sung Cil LIM、Sang-Hong BAEK
Toshimitsu HAMASAKI1,2）、
Atsushi NAKANO3）、Kanae TAKAHASHI1）、Hideaki KANZAKI4）、
Masanori ASAKURA3）、Masafumi KITAKAZE3）
Seoul National University Hospital、2）Gachon University Gill Hospital、
CatholicUniversityUijeongbuSt.Mary'sHospital、4）KoreaUniversityGuro
Hospital、5）SeoulNationalUniversityBundanghospital、6）SamsungMedical
Center、7）Asan Medical Center、8）Ajou University Hospital、9）Severance
hospital of Yonsei University、10）Catholic College of Pharmacy, Catholic
UniversityofKorea、11）CatholicUniversitySeoulSt.Mary'sHospital
1）
Objectives. The association between the coding region variations of adrenergic receptor
signaling genes and therapeutic eﬀect were investigated in heart failure patients.
Methods. Genotypic analysis was carried out in 83 patients of chronic heart failure
patients（NYHA class II-III）with reduced left ventricular ejection fraction（LVEF）<
45%. Enrolled patients started bisoprolol 1.25mg once daily, up-titrated to the maximally
tolerable dose, then maintained until 1 year of treatment.
Results.
1）At position 389 of the beta-1 adrenergic receptor（ADRB1）, the observed minor Gly
allele frequency was 21% and no deviation from Hardy-Weinberg equilibrium was seen
in the genotypic distribution of Arg389Gly（p=0.75）.
2）There was no significant difference in the final heart rate across the genotypes.
However, Arg389Arg genotype group required signiﬁcantly larger amount of bisoprolol
compared with Gly389X（Gly389Arg+Gly389Gly）group in order to achieve the same
level of heart rate reduction（5.26±2.62 mg vs 3.96±2.05mg, p=0.022）.
3）There were no significant differences either in LVEF or in left ventricular enddiastolic volume between Arg389Arg genotype group and Gly389X group. There was
also no signiﬁcant diﬀerence in exercise capacity or B-natriuretic peptide level change
between two groups.
4）However, interestingly, there was two-fold higher rate of readmission（21.2% vs 10.0%,
p=0.162）and one heart-failure related death in Arg389Arg group.
Conclusion: In heart failure patients, ABRB1 Gly389X genotype showed greater response
to bisoprolol than Arg389Arg genotype. ABRB1 Gly389X genotype was also suggested
to have better prognosis than Arg389Arg genotype. The ﬁndings of this study implicate
the potential of individually tailoring of beta-blocker therapy according to genotypes.
Cardiovascular prevention clinical trials generally require a large number of
subjects and long-term follow-up period to observe events of interest to evaluate
the risk and beneﬁt of a test intervention compared with any control intervention.
These may increase difficulties in conducting and managing clinical trials with
respect to resources such as time and cost.One recent major advance in clinical
trial methodology is adaptive designs. Adaptive designs allow for smaller, shorter
trials while ensuring scienti¬ﬁc rigor and integrity of results. Adaptive designs
offer the opportunities of saving resources and preventing subjects from being
exposed to an ineﬀective intervention unnecessarily. However, along with these
benefits, adaptive designs introduce additional challenges: decision complexity,
statistical expertise and operational demands. Accumulated experiences are
required for a practical use of adaptive designs for clinical trials, especially for
cardiovascular prevention clinical trials.In this presentation, we will share our
lessons learned in planning and designing "linical Study of the Eﬀect of Teneligliptin
on the Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes
Mellitus"（TOPLEVEL Study）. As adaptive features, the study design allows to
assess either futility or efficacy of the test intervention, and to recalculate the
sample size based on the observed eﬀect at the interim. We discuss the advantages
and disadvantages of adaptive designs in heart failure prevention clinical trials.
1）
3）
Department of Advanced Medical Technology Development, National
CerebralandCardiovascularCenter、2）DepartmentofInnovativeClinical
TrialsandDataScience,OsakaUniversityGraduateSchoolofMedicine、
3）
Department of Clinical Medicine and Development, National Cerebral
and Cardiovascular Center、4）Department of Cardiovascular Medicine,
NationalCerebralandCardiovascularCenter
P-084
Webメールを用いた登録割付システムの適用
高橋佳苗、濱崎俊光
国立循環器病研究センター　先進医療・治験推進部
臨床試験において，確率化操作は，患者特性に関わる偏りが
治療効果の比較に及ぼす影響をできるだけ小さくし，治療の
比較可能性を高めるための唯一で最良の方法である．実地に
おいては，妥当な方法と手段をもって，適切な体制のもとで
確率化操作を実行することが必須であるが，予算の限られた
医師主導臨床試験では，これらのすべてを満たす環境を準備
することが困難な場合がある．国立循環器病研究センターで
は，Web メールを介して被験者登録・割付が行えるシステム
を開発し，研究実施者が比較的容易に，被験者登録と確率化
操作が実行できる環境を整備した．本システムは，オペレー
タなどの人を介さず Web メールにて被験者登録・割付を 24
時間，提供するものである．各試験の情報、割付登録票・結
果票を Microsoft Excel と Adobe Acrobat を用いて定義する
のみでよく，システムの試験毎の仕様変更は必要としない．
本発表では，今回開発した登録割付システムを，循環器疾患
を対象とした実際の臨床試験に適用した事例を紹介し，適用
から得られた経験や知識を共有することを目的とする．
P-086
Long-Term Prognosis in Patients Treated
with Cardiac Resynchronization Therapy
Reisuke YOSHIZAWA1）、Tomonori ITOH1）、Yoshihiro SATOH2）、
Satoshi NAKAJIMA1）、Mahito OZAWA2）、Fusanori KUNUGITA2）、
Takashi KOMATSU2）、Motoyuki NAKAMURA2）、Yoshihiro MORINO1）
DivisionofCardiology,DepartmentofInternalMedicine,IwateMedical
University School of Medicine, Morioka, Japan、 2） Division of
Cardioangiology,NephrologyandEndocrinology,DepartmentofInternal
Medicine,IwateMedicalUniversitySchoolofMedicine,Morioka,Japan
1）
Background: The effect of cardiac resynchronization therapy（CRT）is
controversial for long-term prognosis in patients with severe heart failure
in the previous study.
Objectives: To clarify long-term prognosis in patients treated with CRT.
Methods: The subjects were 24 consecutive CRT patients admitted to our
institute from 2006 to 2014（21 males and 3 females）. We retrospectively
evaluated patient characteristics and electrocardiogram just before
and after CRT implanted. Cardiac events were defined as heart failure
requiring hospitalization/death from cardiovascular events.
Results: Average age at CRT implantation was 60±14 years in the study
patients. Basal heart disease were as follows: dilated cardiomyopathy 15,
ischemic heart disease 3, and the others 6. Average BNP level before CRT
implantation decreased to after CRT implantation（820±676 pg/ml to 587
±771 pg/ml; p=0.206）. However, QRS widths just before and after CRT
implantation were 150±27 and 146±22 msec respectively（p=0.601）.2 cases
required intra-aortic balloon pump just before CRT implantation.Long-term
prognosis of an average observation period of 35 months yielded: death 10
cases,（7 cardiac and 3 non-cardiac deaths;mortality rate 42%）.Readmission
rate caused by heart failure after CRT implantation was 58%（14 cases）.
Conclusion: Readmission rate after CRT implantation was high and longterm prognosis was low. Not only CRT implantation but also fundamental
and polite care in patients with severe heart failure is needed.
279
一般演題
︵ポスター︶
Impact of the Beta-1 Adrenergic Receptor
Polymorphism on Tolerability and Eﬃcacy of
Bisoprolol Therapy in Heart Failure Patients
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター１８（P18）様々な心筋症を診る
P-087
P-089
A Novel Hemodynamic Subsets in the
Predicting of Need for Inotropic Support in
Heart Failure
A Case of Woman with Fabry Disease Whose
Myocardial Hypertrophy May Become Worse
by Changing Enzyme Replacement Therapy
Muneyoshi TANIMURA1）、Kaoru DOHI1）、Naoki FUJIMOTO2）、
Tetsusiro TAKEUCHI1）、Yuichi SATO1）、Naoto KUMAGAI1）、Shiro NAKAMORI1）、
Norikazu YAMADA1）、Mashio NAKAMURA3）、Masaaki ITO1）
Yasuhiro MORITA、Hideyuki TSUBOI、Itsurou MORISHIMA、
Michitaka UESUGI、Yousuke INOUE、Ruka YOSHIDA
Department of Cardiology and Nephrology, Mie University Graduate
School of Medicine、 2） Department of Molecular and Laboratory
Medicine,MieUniversityGraduateSchoolofMedicine、3）Departmentof
Clinical Cardiovascular Research, Mie University Graduate School of
Medicine
Fabry disease is an X-linked lysosomal storage disorder
caused by a deficiency of the enzyme α-galactosidase.
A 56 years old woman was referred to our hospital
with respiratory discomfort at April 2005. She was
already diagnosed with Fabry disease in our hospital.
Echocardiogram showed a thickening of the interventricular
septum（23mm）, and BNP was raised（363.9pg/dl）. We
started enzyme replacement therapy by using agalsidaseβ. 6 months later, her symptom was vanished and IVST
was decreased significantly（13mm）. In September 2011,
we switched enzyme to agalsidase-α, because of shortage
of agalsidase-β. 1 year later, echocardiogram showed a
thickening of the interventricular septum again（18mm）and
increase in brightness. MRI showed late enhancement
in septum. We switched enzyme from agalsidase-α to
agalsidase-β again. Agalsidase-β and α considered to be
almost equal. But in this case, enzyme eﬃcacy may not be
equal.
1）
一般演題
︵ポスター︶
PurposeWe aimed to elucidate the best hemodynamic parameter to predict
need for inotropic support in patients with heart failure（HF）.MethodsWe
retrospectively evaluated 177 HF patients（65±16 years old, 125 males,
NYHA classes I/II/II/IV were 27/78/55/17）who underwent right heart
catheterization（RHC）on hospital admission.ResultsFifteen（8.5%）patients
required inotropic support during hospitalization. Among various
hemodynamic variables, the combination of left ventricular stroke work
index（LVSWI: cutoﬀ value of 32.2g/m2/beat）and mean right atrial pressure
（mRAP: cutoﬀ value of 12mmHg）had the greatest ability for predicting need
for inotropic support
with sensitivity of 93%
and specificity of 91%
（Figure）.ConclusionThe
novel hemodynamic
subsets based on
combined RHC-derived
LVSWI and mRAP
have the greatest utility
in predicting need for
inotropic support in HF.
P-088
An Assessment of the Current Status on the
Palliative Care in Patients with End-of-life
Stage Heart Failure
Machiko ASAKA、Norihiko KOTOOKA、Koichi NODE
DepartmentofCardiovascularMedicine,SagaUniversity,Saga,Japan
According to the recommendations and guidelines for
palliative care in end-stage heart failure, the health-care
professionals should inform patients and their family about
prognosis, life-prolonging procedures and the role of the
palliative care and the hospice program. However, very
few patients have discussed about their wishes for medical
care at the end-of-life in advance. There still remain a lot
of issues to be resolved about palliative care in end-stage
heart failure.Of the 1044 patients with heart failure who
admitted in our hospital between April 2010 to July 2013, 68
patients died. We investigated the medical records of these
68 deceased patients retrospectively. Of the 68 patients,
36 patients were hospitalized due to acute heart failure
that includes acute myocardial infarction, and 32 patients
were due to acute exacerbation of chronic heart failure.
Of the 32 patients with chronic heart failure, 19 patients
were readmission.The only one patient was informed his
prognosis and confirmed his willingness of future medical
treatment at the end-of-life in advance, and 4 patients were
received palliative care including continuous subcutaneous
infusion of morphine in collaboration with palliative care
team.We need to consider questions about palliative care
for patients with end-stage heart failure, including optimal
timing of initiation, preferable team, opioid administration,
willingness of life prolonging therapy, and resuscitation.
280
DepartmentofCardiology,OgakiMunicipalHospital
P-090
A Case of Dilated Cardiomyopathy with
Functional Recovery along with The
Disappearmnace of Electrical Dyssynchrony
on Response to Pharmacotherapy
Yuichiro IIDA、Takayuki INOMATA、Teppei FUJITA、
Yuki IKEDA、Takeru NABETA、Shunsuke ISHI、Takashi NARUKE、
Hisahito SHINAGAWA、Toshimi KOITABASHI、Jyunya AKO
The Department of Cardiovasucular Medicine, University of Kitasato,
Kanagawa,Japan
A 70-year-old male was diagnosed and treated as non-ischemic
dilated cardiomyopathy（DCM）with complete left bundle
branch block（CLBBB）.We observed him during 5 years after
administration of anti-neurohumoral agents such as carvedilol
and enalapril. There was no significant improvement in
LVEF or changes in QRS formation during the ﬁrst 3 years.
He had stably mild heart failure（HF）complaints of NYHA
class II and no re-hospitalization. However, CLBBB improved
to normally narrow QRS at 3 years later and subsequent
LVEF at 4 years later was improved to a normal rage of
LVEF 66 %. We evaluated his electrocardiographic ﬁndings.
There is no signiﬁcant change in PQ interval, QRS duration,
and other clinical data, whereas only QTc interval was
gradually shortened prior to the recovery to normal QRS
formation. There are few reports concerning time course
of electrocardiographic findings in DCM. From this case
we experienced an electrical normalization from CLBBB
after only medical treatments. Moreover, shortening of QTc
interval was the earliest ﬁnding among electrocardiographic
parameters. QTc interval may be a surrogate marker of the
electrical reverse remodeling, then predict prognosis of DCM.
プログラム・抄録集
P-091
P-093
A Case of Human Immunodeﬁciency VirusRelated Heart Failure Accompanied with
High Cardiac-output
A Case of Refractory Anthracycline
Induced Cardiomyopathy Worsened by Septic
Embolism Due to Extremely Rare Mycosis
Megumi YAMAMURO、Noriaki TABATA、Seigo SUGIYAMA、
Koichi KAIKITA、Seiji HOKIMOTO、Hisao OGAWA
Takahide KODAMA、Yasuhiro TOMITA、Minoru OONO
Departments of Cardiovascular Medicine, Graduate School of Medical
Sciences,KumamotoUniversity
A 29-year-old woman with very rare Ewing sarcoma originating
from liver developed heart failure due to chemotherapy including
anthracycline antibiotics. The ﬁrst symptom was dyspnea（NYHA
class 3）and screening tests revealed severe pleural eﬀusion and
deteriorated ejection fraction（19%）with dilated left-ventricularend-diastolic diameter（59mm）. Moreover her mental state was
depressive and she rejected invasive monitoring and central
venous catheter（CV）insertion. First of all 3 microgram/kg/min
of dobutamine and 0.0125 microgram/kg/min of hANP were
administered, however, her symptoms worsened. Additional
diuretic agents, ﬂosemide and tolvaptan, and inotrope, milrinone,
were administered through CV and the heart failure was
managed. Through introduction of carvedirol（up to 5mg）,
she claimed malaise, low-grade fever and bloody phlegm and
the decompensated heart failure relapsed. A chest plane CT
was carried out and it revealed multiple nodules in bilateral
lung ﬁeld. The diagnosis was septic embolism or metastasis of
malignant tumor. We believed the diagnosis of septic embolism
because there was long-term detained CV catheter in her right
jugular vein. Therefore, we performed blood culture from 3
diﬀerent accessible site and all of the 3 blood cultures showed
extremely rare mycosis, Paecilomyces lilacinus infection. In
accordance with the result of the blood culture, we administered
200mg of voriconazole for her and her symptoms were gradually
getting better and reduced dobutamine intravenous infusion.
P-092
Heart Failure without Subjective Skeletal
Muscle Weakness in Becker Muscular
Dystrophy Patient: A Case Report
Toshiyuki OHYA1）、Mahoto KATO1）、Kazuhito TOHYAMA1）、Yasuo OKUMURA1）、
Tadateru TAKAYAMA1）、Ichiro WATANABE1）、Takafumi HIRO1）、
Tsutomu YAMADA3）、Tomoko YAMAMOTO2）、Atsushi HIRAYAMA1）
1）
Division of Cardiology, Department of Internal Medicine, Nihon
UniversitySchoolofMedicine,Tokyo,Japan、2）DepartmentofPathology,
Tokyo Women's Medical Univerisity, Tokyo, Japan、 3） Division of
Pathology, Department of Pathology, Nihon University School of
Medicine,Tokyo,Japan
We describe a case of Becker Mascular Dystrophy（BMD）in a 42
year-old man without subjective skeletal muscle weakness showed
lower left ventricular systolic function in echocardiography. He visited
our outpatient clinic with slight fatigue in legs. His serum creatine
kinase level was elevated（2000 to 5000 IU/l）.Psuedohypertrophy was
obserbed in both crural muscles but Manual Muscle Testing showed
normal skeletal muscle powers in Legs. Echocardiography data
showed reduced ejection fraction（40%）and dilated left ventricular
diastolic diameter（56mm）. Magnetic resonance imaging showed a
liner Late Gadolinium Enhancement image in the middle myocardial
layer in left ventricle lateral wall. Coronary angiography showed
normal coronary arteries. Endomyocardial biopsy was performed
and pathological data is not a typical BMD pattern including antiDystophin staining of immunohistochemistry. Genetic testing
（Multiplex ligation-dependent probe ampliﬁcation）was demonstrated.
The deletion of only 4th Exon of Dystrophin gene was detected. We
diagnosed his heart failure caused by insuﬃcient dystophin function
due to BMD. We suggested only one exon skipping may produce
specific myocardial dysfunction without crural muscle dysfunction
and typical change in immunohistochemistry of dystrophin staining.
281
一般演題
︵ポスター︶
Heart failure associated with human immunodeficiency
virus（ HIV）has been recognized early in the epidemic.
HIV-associated myocarditis, nutrition-deficiencies
including selenium, drugs-cardiotoxicity, and inflammatory
cytokinemia have been suggested as possible causes;
however, the precise etiology remains unresolved. We here
report on a man of heart failure with HIV infection. He did
not have any of the causes above; but did have high cardiacoutput despite low systolic function. After anti-retroviral
therapy, his systolic function was improved, interestingly
with an inverse reduction and normalization of cardiacoutput. Our case indicated that high cardiac-output might
be involved in pathogenic mechanisms of HIV-related heart
failure.
CardiovascularCenter,ToranomonHospital
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター１９（P19）補助循環を用いた心不全治療
P-094
P-096
A Case of Cardiogenic Shock Treated with
Paracorporeal Left Ventricular Assisted
Device Caused by Acute Myocardial
Infarction
Impact of MELD Score on Outcome in
Patients with Percutaneous Extracorporeal
Membrane Oxygenation Followed by
Ventricular Assist Device Implantation
Kensuke HIRASAWA1）、Yu HATANO1）、Taro SASAOKA1）、
Toshiharu YOSHIKAWA1）、Yasuhiro MAESHIMA1）、Masahiko GOYA1）、
Takashi ASHIKAGA1）、Kenzo HIRAO1）、Hirokuni ARAI2）、Mitsuaki ISOBE1）
Osamu SEGUCHI1）、Tomoyuki FUJITA2）、Takuma SATO1）、
Haruki SUNAMI1）、Masanobu YANASE1）、Hiroki HATA2）、
Takeshi NAKATANI1）
DepartmentofCardiology,TokyoMedicalAndDentalUniversity,Tokyo,
Japan、2）Department of Cardiovascular Surgery, Tokyo Medical And
DentalUniversity,Tokyo,Japan
Department of Transplantation, National Cerebral and Cardiovascular
Center,Osaka,Japan、2）DepartmentofAdultCardiacSurgery,National
CerebralandCardiovascularCenter,Osaka,Japan
1）
一般演題
︵ポスター︶
Case: A 42-years-old man was suﬀered from chest pain and transferred to
our hospital with cardiogenic shock. Under intraaortic balloon pumping
（IABP）support, emergency coronary angiography was performed. Left
anterior descending（LAD）and left circumﬂex branch（LCX）were chronic
total occlusion, and right coronary artery（RCA）was total thrombotic
occlusion. Percutaneous coronary intervention（ PCI）was performed
on RCA. However, cardiogenic shock was sustained and incessant
ventricular tachycardia was occurred. Percutaneous cardiopulmonary
support（PCPS）and mechanical ventilation were performed. After PCI,
left ventricular function was severely impaired and aortic valve was
continuously closed under PCPS. It is difficult to remove mechanical
support, coronary artery bypass grafting and paracorporeal left
ventricular assist device were performed for bridge to candidacy the
next day after the onset. After registration of heart transplantation,
implantable left ventricular assisted device was implanted 30 days after
the onset.In Japan, implantable left ventricular assisted device is adopted
to patients with severe heart failure waiting for heart transplantation.
This case suggests that using paracorporeal left ventricular assist device
for bridge to candidacy might be eﬀective to severe acute heart failure
caused by acute myocardial infarction depending on mechanical support.
P-095
Purpose Recently, models for end-stage liver disease（ MELD）score hase
reported to be a prognostic factor in patients with heart failure. In this study,
we aimed to elucidate the prognostic values of MELD score in patients with
severe hemodynamic instability supported by percutaneousextracorporeal
membrane oxygenation（p-ECMO）, who underwent sequential ventricular
assist device（VAD）implantation as bridge to bridge therapy. Methods We
retrospectively reviewed consecutive 131 patients who underwent VAD
implantation between 2001 and 2013. Thirteen patients（mean age 32.6±11.1
years, 20 males）who received p-ECMO insertion prior to VAD implantation
were analyzed in more detail from their clinical characteristics and they were
stratefied according to their MELD-exclude INR（MELD-XI）score that were
calculated just before VAD implantation. Results All 30 patients survived at
least 2 weeks after VAD implantation. The mean MELD-XI score was 18.8±7.1.
Univariate cox proportional hazard model demonstrated that increasing MELDXI score significantly predicts poor prognosis during VAD support period
（hazard ratio, 1.08; 95% confidence interval, 1.01-1.16; p=0.02）. Kaplan-Meier
analysis revealed that a MELD-XI score>17 was a strong predictor of mortality
during VAD support period（p=0.008, log-rank test）. Conclusion End-organ
function assessed by MELD-XI score has potential to predict the prognosis in
patients with p-ECMO who are scheduled to receive VAD implantation.
P-097
Importance of Aortic Valve Opening
under Percutaneous Cardiopulmonary
Support（PCPS）in Patients with Fulminant
Myocarditis; from the 2 Distinctive Cases
1）
2）
2）
Masao YAMAGUCHI 、Taro SASAOKA 、Kensuke HIRASAWA 、
Mie SEYA2）、Syunji YOSHIKAWA2）、Yasuhiro MAEJIMA2）、
Masahiko GOYA2）、Takashi ASHIKAGA2）、Kenzo HIRAO2）、Mitsuaki ISOBE2）
Soka Municipal Hospital、 2）Tokyo Medical and Dental University
DepartmentofCardiovascularMedicine
1）
Case 1: A 48-year-old male, who was diagnosed as fulminant
myocarditis was transferred to the intensive-care unit in our hospital.
Echocardiography showed progressive decline of left ventricular
function after admission. The 2nd day, intraaortic balloon pumping
（IABP）and PCPS were introduced due to cardiogenic shock. Under
cardiopulmonary support, we paid careful attention to keeping aortic
valve open in systole to prevent thromboembolic complications. After
10 days of cardiopulmonary support, his cardiac function improved
gradually and he weaned from IABP and PCPS. He discharged on foot
without major complications. Case 2: A 44-year-old female with fulminant
myocarditis under PCPS was transferred to our hospital in consideration
of left ventricular assist device（LVAD）. Her echocardiography showed
continuous closure of the aortic valve and spontaneous echo contrast
in left ventricle. At the time of arrival at our hospital, major cerebral
hemorrhagic infarction was found on brain CT. Lack of opening aortic
valve under PCPS might induce thromboembolic complication. She
died due to cerebral hernia 10 days later.Discussion: These cases imply
that evaluation and retention of the aortic valve opening are important
to avoid thromboembolic complications in patients with fulminant
myocarditis. LVAD implantation could be beneﬁcial in those cases who
could not keep aortic valve open in systole under PCPS.
282
1）
Impact of Implantable Ventricular Assist
Devices on Long-Term Prognosis of Patients
with Advanced Heart Failure
Tatsuo AOKI1）、Koichiro SUGIMURA1）、Kotaro NOCHIOKA1）、
Shunsuke TATEBE1）、Saori YAMAMOTO1）、Masanobu MIURA1）、Kimio SATO1）、
Masatoshi AKIYAMA2）、Yoshikatsu SAIKI2）、Hiroaki SHIMOKAWA1）
1）
Department of Cardiovascular Medicine, Tohoku University Graduate
School of Medicine、2）Department of Cardiovascular Surgery, Tohoku
UniversityGraduateSchoolofMedicine
Backgrounds: Implantable ventricular assist devices
（VADs）became available in 2011 and may have changed
the prognosis of advanced heart failure（ HF）patients in
Japan. Methods and Results: We retrospectively identiﬁed
40 adult patients with advanced HF（mean age, 43.6 years;
male, 30（74 %））with the VADs indication in our hospital
from 2004 to 2013. We categorized them into 4 groups
according to the INTERMACS proﬁle（proﬁle 1 or not）and
hospitalization date（before or after April 2011）. KaplanMeier survival curves showed that the patients with proﬁle
1 after 2011 tended to have a lower mortality compared
with those before 2011
（ P = 0 . 1 3 ）（ F i g u r e ）.
Conclusions: Implantable
VADs tended to improve
long-term prognosis even
in advanced HF patients
with INTERMACS profile
1, although further studies
with a larger number of
patients are needed.
プログラム・抄録集
ポスター２０（P20）心リモデリングを抑制する
P-098
Hemodynamic Diﬀerences Between Axial and
Centrifugal-Flow Pumps: Which Type of Left
Ventricular Assist Device Should be Selected
for Each Patient?
Seiko NAKAJIMA1）、Osamu SEGUCHI1）、Haruki SUNAMI1）、
Takuma SATO1）、Yoshihiro MURATA1）、Hiroki HATA2）、
Tomoyuki FUJITA2）、Masanobu YANASE1）、Takeshi NAKATANI1）
P-099
Ketone Body Metabolism Attenuates
Oxidative Stress and Cardiac Remodeling in
Pressure Overload Heart Failure
Motoki UCHIHASHI、Atsushi HOSHINO、Makoto ARIYOSHI、
Shuhei TATEISHI、Kazunori ONO、Satoshi KAIMOTO、
Kuniyoshi FUKAI、Eri KANAI、Satoaki MATOBA
Department of Cardiovascular Medicine, Kyoto Prefectural University of
Medicine,Kyoto,Japan
Background Two types of implantable continuous-ﬂow left ventricular assist
device（LVAD）, axial and centrifugal-flow LVAD, have been available for
advanced heart failure patients and they have different pump physiology.
However, detail hemodynamic characteristics of both pumps in human are not
well elucidated. Methods & Results We retrospectively reviewed consecutive
29 patients（ mean age 41.0 ± 11.5）who received continuous-flow LVAD
implantation between 2011 and 2014（20 patients with HeartMateII, A group and
14 patients with EvaHeart, C group）. Clinical measurements and hemodynamic
parameters after LVAD implantation were compared between 2 groups.
Although there was no signiﬁcant diﬀerence in cardiac index, left ventricular
diastolic dimension, right atrial pressure, pulmonary arterial pressure,
pulmonary capillary wedge pressure, and right ventricular stroke work index
were signiﬁcantly lower in A group（54.3±13.3 vs 69.2±12.4 mm: p=0.013, 3.7±2.9
vs 5.8±2.5 mmHg: p=0.039, 13.6±3.3 vs 19.3±5.0 mmHg: p=0.0034, 3.2±2.4 vs 8.2±
3.6 mmHg: p<0.001, 4.3±1.9 vs 6.4±1.8 g/m2: p=0.011, respectively）. Clinically, no
patient has developed persistent right heart failure（RHF）or other hemodynamic
deterioration.Conclusion Patients with axial-flow pump showed significantly
smaller LV size and lower intracardiac pressure early after implantation. They
might get through RHF in the early phase, but impact on late phase RVF and
appropriate pump selection are the subjects of future investigation.
Background: The shift of energy substrate from fatty acid to glucose
accompanied by myocardial energy compromise is the hallmark of metabolic
remodeling in pathological cardiac hypertrophy. However, it has not been
investigated the pathogenic contribution of ketone body metabolism in heart
failure. Methods and results: Pressure overload heart failure was introduced
with the transverse aortic constriction（TAC）. Microarray and mitochondrial
iTRAQ proteomics revealed that the expression of Bdh1, an enzyme that
catalyzes the NAD+/NADH coupled interconversion of acetoacetate and betahydroxybutyrate（betaOHB）, was increased 2.5-fold in TAC-operated heart.
Ketone body oxidation determined by measuring 14CO2 released from [1-14C]
betaOHB in the isolated perfused hearts was upregulated 1.8-fold in TACoperated heart. To investigate the functional significance of increased ketone
body oxidation we generated heart-specific Bdh1 Tg mice which had 1.7-fold
increase of ketone body oxidation in the heart. When subjected to TAC operation
Bdh1 Tg mice were resistant to cardiac hypertrophy, contractile dysfunction,
and ﬁbrosis. Immunochemical detection of carbonylated proteins demonstrated
that protein oxidative damage was ameliorated in Bdh1 Tg mice. In vitro
study with rat neonatal cardiomyocytes revealed that the adenovirus-mediated
Bdh1 overexpression decreased ROS production and apoptosis. Conclusions:
The present study demonstrates that ketone body oxidation is promoted in
hypertrophied hearts. Increased ketone body utilization reduces oxidative stress
and protects against heart failure progression after chronic pressure overload.
Department of Transplantation, National Cerebral and Cardiovascular
Center, Suita, Japan、2）Department of Adult Cardiac Surgery, National
CerebralandCardiovascularCenter,Suita,Japan
P-100
Identiﬁcation of Novel Spliced Genes in
Failing Heart Using Exon Array and RNASeq
Shin ITO、Masanori ASAKURA、Kyung-Duk MIN、Miki IMAZU、
Kazuhiro SHINDO、Hiroki FUKUDA、Masafumi KITAKAZE
C l i n i c a l R e s e a r c h a n d D e v e l o p m e n t , N a t i o n a l C e r e b r a l a n d
CardiovascularCenter,Osaka,Japan
The role of alternative splicing in heart diseases has not
been completely elucidated. W aimed to perform a genomewide splicing analysis and develop a profiling of spliced
genes in failing heart. We performed a comprehensive
analysis of splicing genes, using both exon array and RNASeq. We constructed murine heart failure model induced
by transverse aortic constriction for 8 weeks. We then
extracted RNA from the hearts and analyzed it using the
Mouse Exon 1.0 ST and Miseq V3 kit. Of 17,705 genes, exon
array analysis identiﬁed 46 genes with signiﬁcantly changes
in the splicing pattern, but not in the gene expression level;
85 genes with changes in the splicing pattern and gene
expression level（fold change >2, P<0.05）. Furthermore,
we confirmed the splicing events by RNA-Seq analysis: 5
genes（Mtus1, Arhgap25, Sfpi1, etc.）with changes only in
the splicing pattern, and 19 genes（Rcan1, Rtn2, Synpo2l,
etc.）with changes both in the splicing pattern and gene
expression level. Of these 24 spliced genes, twenty-two
genes have not been reported previously in heart diseases.
Combined analysis using exon array and RNA-Seq is
powerful tool to identify novel spliced genes in failing heart.
Further study of the spliced genes identiﬁed in this study
may reveal the pathophysiology of heart failure.
283
一般演題
︵ポスター︶
1）
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
P-101
P-103
一般演題
︵ポスター︶
The Transition from Compensated Cardiac
Hypertrophy to Failure Created by
Transverse Aortic Constriction in Mice
VEGF Overexpression and Right Ventricular
Remodeling in Rats Exposed to Chronic
Hypoxia
Takaaki FURIHATA、Shintaro KINUGAWA、Arata FUKUSHIMA、
Tsuneaki HOMMA、Yoshihiro MASAKI、Shingo TAKADA、Tomoyasu KADOGUCHI、
Shouji MATSUSHIMA、Takashi YOKOTA、Hiroyuki TSUTSUI
Mika MATSUI1）、Eiki WOO2）、Takahiro KATSUMATA2）、
Takehiro YAMAGUCHI3）、Minoru YOSHIYAMA3）、Yasukatsu IZUMI4）、
Atsuo NOMURA1）、Yuji FUJIWARA1）、Ryuji KATO1）、Tetsuya HAYASHI1）
Department of Cardiovascular Medicine, Hokkaido University Graduate
SchoolofMedicine,Sapporo,Japan
LaboratoryofCardiovascularPharmacotherapyandToxicology,Osaka
University of Pharmaceutical Sciences, Takatsuki, Japan、2）Department
of Thoracic and Cardiovascular Surgery, Osaka Medical College,
Takatsuki,Japan、3）DepartmentofCardiovascularMedicine,OsakaCity
UniversityGraduateSchoolofMedicine,Osaka,Japan、4）Departmentof
Pharmacology, Osaka City University Graduate School of Medicine,
Osaka,Japan
Background: Transverse aortic constriction（TAC）operation is used as
an experimental model of left ventricular（LV）hypertrophy and failure in
mice. The severity of LV remodeling or failure may depend on the degree
of TAC, but is variable among operated animals. Therefore, we tried to
identify the optimal diameter of TAC to create this model with ease and
high reproducibility.Methods and Results: To produce TAC in C57BL/6J
mice（7-9 weeks, body weight 19-25g, n=110）, a 7-0 nylon suture ligature
was tightly tied around the transverse aorta against needles with 3
diﬀerent diameters（mm）. LV wall thickness, end-diastolic dimension and
fractional shortening were measured by echocardiography.Conclusion:
TAC with the diameter of 0.385mm can induce the transition from LV
hypertrophy to failure in mice with relatively preserved survival.
1）
Objective: Our previous study has shown that chronic hypoxia combined with
vascular endothelial growth factor（VEGF）receptor blocker induces right ventricular
（RV）remodeling in rats. The aim of this study was to examine the hypoxiainduced histological changes chronologically and evaluate the role of VEGF in the
development of pulmonary arterial hypertension（PAH）. Method: Male SpragueDawley rats were exposed to hypoxia（10% O 2）for 2 or 3 weeks, after a single
subcutaneous injection of VEGF receptor blocker（Sugen 5416, 20 mg/kg, SU+Hypo
group）or solution（V+Hypo group）. They were then returned to normoxia for
additional 10 weeks. After echocardiography, heart was examined by light and
electron microscopy, immunohistochemistry, and RT-PCR. Results: After 2 weeks of
hypoxia, tricuspid annular plane systolic excursion（TAPSE）and acceleration time/
ejection time（E/A）were decreased in SU+Hypo compared with those in V+Hypo
（TAPSE, 2.25±0.26 vs. 3.03±0.04 mm; E/A, 0.22±0.07 vs. 0.32±0.03）. Histologically,
perivascular ﬁbrosis and hypertrophy of cardiomyocytes and vascular smooth muscle
cells were accelerated 10 weeks after the reoxygenation in SU+Hypo. Furthermore,
delayed peak with overexpression of VEGF mRNA in RV myocardium was observed
during hypoxia in SU+Hypo. Conclusion: Overexpression of VEGF at the timing of
reoxygenation might be relevant to RV remodeling in the development of PAH.
P-102
Intermittent Hypoxia Relevant to Sleep Apnea
Increases Oxidative Stress and Accelerates
Cardiac Remodeling in Cardiomyopathic
Hamster
Misaki MUROYA1）、Atsuo NOMURA1）、Ryuji KATO1）、Yoshio IJIRI1）、
Aiji SAKAMOTO2）、Takehiro YAMAGUCHI3）、Yasukatsu IZUMI4）、
Minoru YOSHIYAMA3）、Kazuhiko TANAKA2）、Tetsuya HAYASHI1）
LaboratoryofCardiovascularPharmacotherapyandToxicology,Osaka
University of Pharmaceutical Sciences, Takatsuki、 2）Laboratory of
Vascular Biology, National Cerebral and Cardiovascular Center, Suita、
3）
DepartmentofCardiovascularMedicine,OsakaCityUniversityGraduate
School of Medicine, Osaka, Japan、 4）Department of Pharmacology,
OsakaCityUniversityGraduateSchoolofMedicine,Osaka,Japan
1）
Background: High prevalence rates of sleep apnea have been reported
in patients with heart failure. The aim of this study was to investigate
the eﬀect of intermittent hypoxia on left ventricular（LV）myocardium
and cardiac function in failing heart. Methods: Male Syrian（normal）and
Bio14.6 cardiomyopathic hamsters（CM）at 20 to 24 weeks of age were
exposed to intermittent hypoxia（IH: 5 minutes of 5% O2 followed by 5
min of 21% O2, repetitive for 8 h/day during daytime）or normoxia for
14 days. After evaluation of cardiac function by echocardiography, heart
was examined by light and electron microscopy, immunohistochemistry,
and RT-PCR. Results: In normal, IH tended to increase E/e'（26.6 vs.
17.6）, but had no effect on LV ejection fraction（EF）. In CM, IH also
tended to increase E/e'（28.1 vs. 22.3）,but decreased EF（34.2 vs. 44.5%）.
Histologically, IH increased cardiomyocyte diameter（19.9 vs. 17.4 μ
m）and interstitial ﬁbrosis（29.9 vs. 9.6%）in CM, compared with those of
normal. Furthermore, IH increased oxidative stress such as 4-hydroxy-2nonenal proteins and c-fos mRNA expression. Conclusion: IH accelerated
degeneration of cardiomyocytes and systolic dysfunction in CM, which
might account for the poor prognosis of HF patients with sleep apnea.
284
P-104
The Role of Exosomes on Cardiac
Hypertrophy
Takehiro YAMAGUCHI1）、Yasukatsu IZUMI2）、
Takanori YAMAZAKI3）、Minoru YOSHIYAMA1）
DepartmentofCardiovascularMedicine,OsakaCityUniversityMedical
School, Osaka, Japan、 2）Department of Pharmacology, Osaka City
University Medical School, Osaka, Japan、3）Department of Cardiology,
AsakayamaGeneralHospital,Sakai,Japan
1）
Objective: Sustained hypertension induces chronic inflammation, which
causes cardiac remodeling and dysfunction. Exosomes are thought to
contribute to intercellular communication. Here, we investigated the role
of exosomes in experimental hypertensive models. Methods and Results:
（1）Continuous infusion of angiotensin II（Ang II, 200 μg/kg/min）or a nitric
oxide synthase inhibitor（N ω -nitro-L-arginine methyl ester; L-NAME, 1 mg/
mL in drinking water）induced hypertension and left ventricular hypertrophy.
An amount of proteins in exosomes purified by ultracentrifugation from
serum was increased in both hypertensive rats compared with that in
normotensive rats. Addition of serum exosomes from hypertensive rats
activated some signal transduction pathways such as JNK, p38MAPK, and
Akt in human coronary arterial endothelial cells（HCAECs）. Interestingly,
the proteins in HCAECs were positive for CD68 antibody（a speciﬁc marker
of macrophages）
（2）
. Human THP-1-derived macrophages were stimulated
by Ang II（100 nM）or hypoxia, and purified exsosomes in culture media
were treated to HCAECs. Activated macrophages increased an amount
of exsosomal proteins and changed the constitutive proteins in medium
exosomes. Medium exosomes collected in Ang II- and hypoxia-stimulated
macrophages activated the same signal transduction pathways as the serum
exosomes. These stimulations increased ICAM-1 in HCAECs, suggesting that
stimulated THP-1-derived exosomes may induce proinﬂammatory eﬀects and
damage the endothelial cells.Conclusions: Endothelial damage by hypertension
may be partially associated with activated macrophages-derived exosomes.
プログラム・抄録集
ポスター２１（P21）心不全再入院を減らすための試み
P-105
P-107
再入院予防につながる心不全サポートチーム
（HST）介入の一考察∼HST介入後再入院なく経
過している一例から∼
1）
2）
3）
3）
中原さちこ、掛川ちさと、松川龍一、久保田徹、岡部眞典
3）
1）
済生会福岡総合病院　看護部、2）済生会福岡総合病院　栄養部、3）済生会福
岡総合病院　循環器内科
P-106
妹尾美和 1）、道城綾 1）、多木香織 1）、田頭千賀子 1）、大坪美保 1）、
萩原敏恵 1）、萩倉新 2）、後藤賢治 2）
福山循環器病院　看護部、2）福山循環器病院　循環器内科
1）
はじめに近年チーム医療による患者教育の取り組みが行われ
ている。当院では心不全パンフレットを用いた指導を実施し
ていたが、セルフモニタリング不足による再入院となる患者
が多く、多職種協働による心不全チームの発足を機に従来の
指導内容・介入時期の変更を行った。今回、新たな介入方法
が心不全再入院や心不全死の抑制に有効であるか検討する。
方法チームによる介入が開始された 2012 年 3 月前後 1 年の心
不全加療を要し生存退院が可能であった連続 317 名で検討。
既存介入群 199 例、新たな介入開始後のチーム介入群 118 例と
し、それぞれの群での半年の心不全再入院や心不全死
（以下 ;
心イベント）発生率の比較・評価を行った。結果・考察半年
までの心イベントは既存介入群で 17％、チーム介入群で 20%
に生じ Kaplan-Meier 曲線は有意差を認めなかった
（logrank
p=0.47）
。心不全手帳を用いたチーム介入には成功したものの
患者自身の危険予知能力向上には結びつかなかったと考えら
れた。今後の課題として
「ヨーロッパ心不全セルフケア行動尺
度」
を用い行動変容を客観的に評価して心イベントの原因精査
と個々に応じた指導が必要である。
P-108
看護師による電話フォローアップは心不全の再入
院を予測できるか
重症心不全患者の再入院予防にむけた病棟−外来
の連携強化への取り組み
飯塚裕美 1）、末永祐哉 2）、高梨久美 1）、平野美樹 3）、斉藤洋 4）、
鈴木誠 2）、松村昭彦 2）、橋本裕二 2）
会田絵理子 1）、篠原佐和 1）、上村敬子 1）、今村光成 1）、増田容子 1）、
岩崎朋之 1）、大谷朋仁 2）、坂田泰史 2）
1）
亀田総合病院　CCU、2）亀田総合病院　循環器内科、3）亀田総合病院　HCU、4）亀田総合病院　リハビリテーション室
1）
大阪大学医学部附属病院　循環器内科病棟、CCU、2）大阪大学大学院　医学
系研究科　循環器内科学
【背景】退院後の看護師による電話インタビュー内容が心不全
の再入院を予測できるかは明らかにされていない。【目的】電
話インタビューで 90 日間の心不全患者の再入院を予測できる
か明らかにする【方法】
2013.4 ∼ 2014.3 の期間に入院した心不
全患者を対象に、退院後30日以内に看護師による電話フォロー
アップを行った。ESC ガイドラインで推奨されているセルフ
ケアについてインタビューを行い、得られた回答をスコア化
し、90 日以内再入院群と非再入院群に分け比較した。【結果】
92 人
（76.3±12.7 歳、男性 48.9%）に、電話フォローアップを実
施。退院日から電話介入日までは11.9（7-16）日で、フォローアッ
プ期間中に、医師へ報告 23 人（25%）、9 人（10%）が早期受診し、
14 人
（15.2％）が心不全で再入院した。しかし、各スコアは再
入院群と非再入院群間で有意差は得られず、また、電話イン
タビューで得られたスコアは、90日間の再入院を予測しなかっ
た
（AUC:0.52 95% 信頼区間 :0.38-0.66）。【考察】心不全患者に
対して、いつ、どのように電話フォローアップをすべきか検
討していく必要がある。
【はじめに】
重症心不全患者の再入院率は約 20％と高く、再入院の予防に
は病棟−外来看護師の連携が重要である。今回、この取り組
みにより再入院を予防できていると考えられる症例について
報告する。
【症例】
食事と塩分の摂取過多、過労、感冒を契機に年間 2 ∼ 3 回の
入院を 5 年間繰り返していた重症心不全の高齢女性。患者は
独居でキーパーソンは近所に在住の甥。
【看護の実際】
病棟看護師は、入院の契機となった増悪因子のアセスメント
結果に基づき計画的に介入を行ったが、退院後に実践出来て
いるかを把握することは困難であった。
アドヒアランスの向上を目指した患者中心の看護という観点
から、外来看護師との連携強化として看護サマリでの情報共
有に加え、定例ミーティングで問題抽出を行い、対策として
新たに個別面談を導入した。導入前は、退院後短期間での入
院を繰り返すことが多く、入院期間も長期に及んだが、導入
後は 10 ヶ月以上再入院なく経過出来ている。
【結語】
病棟−外来看護師間で、看護目標ならびに計画を中心とした
情報共有やコミュニケーションの充実を図る事は、重症心不
全患者における再入院予防の一助になり得る可能性が示唆さ
れた。
285
一般演題
︵ポスター︶
【目的】入退院を繰り返していた慢性心不全患者が心不全サ
ポートチーム（以下 HST）介入後、再入院することなく経過し
ている。この事例を振り返り有効であった HST の介入を考
察する。
【事例紹介】70 歳代、男性、無職。診断名 : 慢性心不全（EF19%、
AHA/ACC Stage 分類 C）、陳旧性心筋塞、慢性腎臓病（Stage
G4）
、糖尿病。20XX 年、慢性心不全増悪による入退院を繰り
返すようになり 6 ヶ月間で 4 回入院した。
【倫理的配慮】本研究について対象者へ説明を行い書面にて同
意を得た。
【介入の実際】20XX 年 4 回目の入院時から HST が介入。介入
の過程で体重増加・早期受診行動・塩分制限への認識と療養
行動に変化を認めた。また、HST メンバー以外のスタッフと
も連携し抑うつ傾向や内服忘れに早期に対処した。最終入院
から 6 ヶ月後現在、心不全増悪による再入院なく経過してい
る。
【考察】
HST の継続した介入により療養行動に変化を認めた。
また HST メンバー以外のスタッフとの連携もとれ、その結果、
心不全増悪因子となり得る事柄に早期に対処できた。これら
が再入院予防に繋がっていると考える。今回は一例のみの考
察であり今後はデータを収集し HST 介入のアウトカムを明
確にすることが課題である。
心不全患者の再入院率軽減をめざして∼患者の行
動変容に向けての取り組み∼
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター２２（P22）心不全の様々なエビデンス
P-109
尼崎病院における慢性心不全看護認定看護師によ
る心不全看護外来の役割と課題
鷲田幸一、佐藤幸人
兵庫県立尼崎病院　看護部　慢性心不全看護認定看護師
一般演題
︵ポスター︶
【背景】心不全患者のセルフケアを長期に支援していく目的で
心不全看護外来を立ち上げた。【目的】尼崎病院における慢性
心不全看護認定看護師による心不全看護外来の特徴を分析し、
役割と課題を明確にする。【方法】後方的調査研究。カルテか
ら心不全看護外来の介入を調査しその特徴を分析する。
【結果】
尼崎病院での心不全看護外来の特徴は以下。1. 患者面談の中で、
患者の語りから心不全知識の確認・心不全増悪因子の探索を
行う。2. 専門職種による患者教育後、断片的になっている患者
の知識を面談の中で整理・統合する。3. 心臓リハビリと連携を
取り、運動時の循環応答と身体負荷の関連性を患者と共有し、
自身の心臓を含めた身体への関心を高める。4. 患者面談により
得られた患者の認識や生活情報を病棟に伝達し、入院中の患
者教育の方向性を調整する。5. ソーシャルワーカー・退院調整
看護師と連携し退院調整を行う。【考察】尼崎病院における心
不全看護外来は、多職種と連携を図り、患者が心不全につい
て考える機会を継続して提供することで、心不全のセルフケ
アを支援する役割を果たしている。院内との多職種連携だけ
でなく、今後は地域との連携強化が課題である。
P-110
心不全患者の早期再入院予防に向けた効果的な生
活指導の検討
大田奈々、大工真人、松田直子、松田麻未、熊本紗千、殿谷智子
富山県立中央病院
心不全患者は生活習慣病の増加や高齢化に伴い、さらなる
増加が予想されている。当病院の平成 25 年度における心不全
増悪に伴う年間の入院患者数は約 800 例前後、退院後 1 年以内
の再入院率は 41.6％となっており、看護師は心不全の一次予
防の必要性を理解し患者・家族に対して食生活や運動習慣、
アルコールや喫煙などの危険因子の是正に向けた教育を行う
役割がある。当病院においても、再入院予防が急務である。
また、当院の心不全加療退院後の次回再入院までの平均日数
は、平成 25 年度では、2 月が最短で 24.4 日であり、冬に退院
した患者が短期間で再入院している結果であった。石坂は、
「循
環器病の季節変動」において " 心不全増悪による入院が冬に多
くなる " ことを述べており、再入院が多い月（時期・気候等）
を
見据えた指導を行うことで患者の QOL が向上し早期再入院
予防につながると考えた。そこで、ガイドラインを元に患者
の病期を把握し、心不全患者の早期再入院予防につなげるた
めに、退院指導内容の見直しを行い指導にいかした。その結
果を、ここに報告する。
286
P-111
心房中隔欠損によるEisenmenger症候群を背景
とし、感染を契機に急性心不全を呈した一症例の
理学療法経験
川村雄介 1）、松井彩乃 1）、沼田玄理 2）、齊藤哲也 2）、田中茂博 2）
公立昭和病院　リハビリテーション科、2）公立昭和病院　循環器内科
1）
成人先天性心疾患患者は高齢化に伴い心不全等の合併症を生
じる。今回，心房中隔欠損
（以下 ASD）による Eisenmenger
症候群
（以下 ES）
を既往に持つ高齢患者が，感染を契機に急性
心不全
（以下 AHF）
となった症例の理学療法を経験したので報
告する。
症例は 70 歳代男性。20 歳で ASD を指摘され外科治療を望ま
ず，その後 ES を合併し NYHAII で経過。消化器感染を契機
に AHF となり入院。
理学療法は第 9 病日目より開始。Speciﬁc Activity Scale（以下
SAS）は 1Met 以下であった。運動時は SpO2 75％以上が許容
範囲とされ，深呼吸練習，息こらえの防止，頻繁に休憩をと
り症状悪化防止に努めた。最終的に 50m 歩行と階段 5 段昇降
は自覚症状なく SpO2 80％前半で推移。それ以上の負荷は低
酸素血症悪化を招く為運動を制限した。SAS は 3Mets に改善
し第 30 病日目に退院した。
心不全と肺高血圧を考慮した理学療法は心肺機能維持だけで
なく多臓器保護の観点からも重要である。本症例は医師と連
携して両方向性短絡による状態変化に注意し，過度な安静を
避けて運動許容範囲を明確にした介入が一助となり軽快した
と考える。本症例を通して疾患特性を考慮した運動方法と生
活指導の重要性を学んだ。
P-112
当院CICUにおけるNPPV使用患者の調査
手塚友加里 1）、高橋亜由美 1）、谷本周三 2）、青野ひろみ 3）、田邉健吾 2）、
安部崇子 1）
1）
三井記念病院　CICU、2）三井記念病院　循環器内科、3）三井記念病院　呼吸
器内科
【目的】急性心不全
（AHF）の呼吸管理として非侵襲的陽圧換
気療法
（NPPV）が推奨されている。当院においても AHF に
て入院した患者へ積極的に NPPV を使用しているが、中に
は NPPV から気管内挿管へ移行する例もみられる。そのた
め当院における AHF 患者への NPPV 使用が適切であるか調
査する。
【方法】
2012 年 4 月から 2013 年 12 月に AHF と診断さ
れ NPPV を装着した症例に関し調査を実施。患者背景、治
療経過はカルテベースで市情報収集した。
【結果】全 287 例中
NPPV 装着症例は 89 例、入院時に気管内挿管された症例は 11
例であった。NPPV 装着症例のうち気管内挿管へ移行した症
例（移行群）は 4 例あったが心原性ショック症例は含まれてい
なかった。【結論】AHF 症例に対する NPPV 使用は適切であ
ると考える。
プログラム・抄録集
P-113
P-115
ペースメーカー、ICD植込み患者の運動耐容能
1）
2）
近藤和夫、吉田泉、櫻井正之
2）
社会医療法人社団カレスサッポロ　北光記念病院　心臓リハビリテーション
室、2）社会医療法人社団カレスサッポロ　北光記念病院　循環器科
1）
茅本洋平 1）、宮本欣倫 2）
1）
脳神経センター　大田記念病院　リハビリテーション課、2）脳神経センター
大田記念病院　循環器内科
【背景】近年、75 歳以上の高齢者の増加に伴い脳卒中（CVA）者
であっても多臓器との重複疾患が問題となっている。CVA 者
の予後予測には身体機能を中心とした報告は散見するも内部
障害との関係を示した報告は少ない。【目的】当院に入院した
心原性脳塞栓症（CE）者のうち入院時の内部障害が予後に影響
するか明らかにすること。【対象】H24 年 4 月∼ H25 年 12 月に
当院に入院した 75 歳以上の初発 CE 者で、入院時の心・腎機
能が明確かつ発症前に歩行が可能であった 135 例【方法】
mRS
の 0 ∼ 2 を良好群、3 ∼ 6 を不良群と定義した。パラメーター
は年齢、性別、BNP、EF、E/E 、eGFR である。心・腎機
能障害として心不全を BNP ≧ 100。収縮障害
（SHF）を EF ＜
50。拡張障害
（DHF）を E/E ＞ 15 とし、慢性腎臓病
（CKD）を
eGFR ＜ 60 とした。これらを後方視的に調査した。【結果と
考察】転機不良群において女性、心不全罹患、SHF、DHF が
高率であった
（それぞれ P=0.031、0.06、0.06、P=0.048）。CE
者における予後予測に入院時の性別や心機能障害も考慮する
必要性が示唆された
P-114
心不全患者における低栄養状態は呼吸筋力を低下
させる
曽田武史 1）、衣笠良治 2）、片桐茜 1）、山田健作 2）、杉原志伸 2）、
加藤雅彦 2）、萩野浩 1）、山本一博 2）
1）
鳥取大学医学部附属病院　リハビリテーション部、2）鳥取大学医学部附属病
院　循環器内科
【目的】慢性心不全患者における栄養状態の悪化は四肢の骨
格筋力を低下させることが知られているが，呼吸筋力に及
ぼす影響については明らかにされていない。【方法】歩行が
可能な慢性心不全患者 40 名（年齢 75.0±12.7 歳 , 男性 55％）を
対象に、心不全患者の栄養評価の指標として提唱されてい
る Geriatric nutritional risk index（GNRI）を算出し，92 未満
（低栄養群）と 92 以上
（正常群）に分け，握力，膝伸展筋力，呼
吸筋力（Maximum inspiratory pressure: MIP，Maximum
expiratory pressure: MEP）6 分間歩行距離（6MWD）を 2 群で
比較した．
【結果】低栄養群は，正常群と比較して、高齢で、
握力，膝伸展筋力，MIP，MEP が有意に低値であった
（P <
0.05）
。また、6MWD は低栄養群で低い傾向にあった（p ＝
0.054）
。
【結語】低栄養状態にある慢性心不全患者は四肢筋力
だけでなく、呼吸筋力の低下も認められ、骨格筋ならびに呼
吸筋のレジスタンストレーニングを併用した包括的な栄養・
リハビリ介入が必要と考えられる。
287
一般演題
︵ポスター︶
【目的】ペースメーカー（以下、PM）等植込みの身体障害者手
帳認定基準が、身体活動能力に応じた等級となった。そこで、
当院の PM 等植込み患者の運動耐容能（peak VO2）について
調査を行なった。
【対象と方法】CPX を実施した連続症例か
らペースメーカー等植込み後に実施した症例の peak VO2 を
カルテより調査した。心臓血管外科術後に植込みを行なった
症例を除外し、PM60 名（男性 39 名女性 21 名、平均 70.6 歳）
、
ICD46 名（男性 40 名女性 7 名、平均 66.3 歳）、CRT-P6 名
（男
性 2 名女性 4 名、平均 69.7 歳）、CRT-D25 名（男性 22 名女性 3
名、平均 68.3 歳）であった。【結果】peak VO2 平均値（ml/kg/
min）は、PM 群 12.4、ICD 群 12.3、CRT-P 群 11.4、CRT-D 群
12.4 であり、群間の差はなかった。2 メッツ未満の 1 級に該当
する症例は 8 名（PM 群 5 名、ICD 群 3 名）全体の 5.8％であり、
うち女性が 5 名であった。メッツは 3.5ml/kg/min を 1 メット
とした。【考察】デバイスの種類に関係なく、運動耐容能は平
均 3.5 メッツであった。心機能の影響も大きいが、運動遂行困
難な原因は下肢疲労であることが多く、適切な生活、運動指
導によって今後改善することも考えられる。
高齢の心原性脳塞栓症者の予後についての調査
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター２３（P23）HFpEF の様々な話題
P-116
Cessation of Taking βBlocker Ameliorates
Oscillatory Ventilation During Exercise
Yuko KATO1）、Tomoko HIMI2）、Osamu NAGAYAMA1）、
Etsuko HAYAMA1）、Kaori ISHII1）、Kouji SAKURADA1）、
Takeshi YAMASHITA1）
The Cardiovascular Institute Hospital、2）Kawaguchi Kogyo General
Hospital
1）
一般演題
︵ポスター︶
61 year-old woman was admitted to our hospital because of
acute decompensated heart failure（HF）（clinical scenario
classiﬁcation 1, HFpEF）. She was treated with decreasing
blood pressure and administrating diuretics. After improved
HF, she performed cardiopulmonary exercise testing
（CPET）. At the time of the first CPET, she was taking
8mg of candesartan and 1.25mg of bisoprolol. The first
CPET showed obvious oscillatory ventilation through whole
exercise testing. After the ﬁrst CPET, she stopped taking
bisoprolol because it has been thought to deteriorate her
HF via increasing diastolic ﬁlling pressure due to shortening
the duration of diastole. One week later, the second CPET
showed an improving exercise capacity and an abatement of
oscillatory ventilation
（Figure）. Heart rate
apparently increased
after cessation, which
may ameliorate
hemodynamics and
improve every CPET
variables.
P-117
Arterial Stiﬀness is Signiﬁcantly Associated
with Left Ventricular Diastolic Dysfunction in
Patients with Clinical Cardiovascular Disease
P-118
Sex Diﬀerence in Mortality in Heart Failure
with Preserved Ejection Fraction -A Report
from the CHART-2 StudyKanako TSUJI、Yasuhiko SAKATA、Masanobu MIURA、Satoshi MIYATA、
Kotaro NOCHIOKA、Tsuyoshi TAKADA、Soichiro TADAKI、
Ryoichi USHIGOME、Takeshi YAMAUCHI、Hiroaki SHIMOKAWA
Department of Cardiovascular Medicine and Department of EvidenceBased Cardiovascular Medicine, Tohoku University Graduate School of
Medicine,Sendai,Japan
Background: Sex diﬀerence remains to be fully examined in patients with heart failure with
preserved ejection fraction（HFpEF）.
Methods : We examined sex diﬀerence in 3,124 consecutive HFpEF patients（EF>50%, mean
69.4years, 34.7% female）registered in the CHART-2 Study（n=10,219）.
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, P=0.11）,
the adjusted mortality risk was signiﬁcantly low in females（HR 0.72, P=0.009）. 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.
P-119
Pathogenesis and Prognostic Factors Involved
in the HFpEF
Takayuki NAMBA、Nobuyuki MASAKI、Hirotaka YADA、
Daihiko HAKUNO、Kouji MIYAZAKI、Takeshi ADACHI
Yoshiaki KUBOTA、Kuniya ASAI、Daigo CHINEN、Aya YOSHINAGA、
Keisuke INUI、Shyunichi NAKAMURA、Kouji MURAI、
Masatomo YOSHIKAWA、Kouji KATOU、Wataru SHIMIZU
The Department of Cardiology, National Defense Medical College,
Tokorozawa,Japan
DepartmentofCardiovascularMedicine,NipponMedicalSchoolHospital,
Tokyo,Japan
Backgroud: The cardio-ankle vascular index（CAVI）has been
developed as a parameter of arterial stiﬀness. There are some
previous reports about the association of arterial stiffness
and left ventricular（LV）diastolic dysfunction in patients with
subclinical atherosclerosis. However, there are few reports
about this relationship in clinical cardiovascular disease.
Methods: We measured parameters of arterial stiﬀness and LV
systolic and diastolic function（LV ejection fraction, left atrial
diameter, E/e' etc）by using CAVI and echocardiography in 80
patients of clinical cardiovascular disease. We also measured
plasma BNP levels at the time of measurement of CAVI.
Patients were divided into two groups, the higher CAVI group
（CAVI>9）and the lower CAVI group（CAVI<9）. Patients with
atrial ﬁbrillation, peripheral arterial disease, signiﬁcant valvular
disease were excluded. Results: In multivariate analysis, E/e'
was signiﬁcantly higher in patients of the higher CAVI group
than the lower CAVI group（16.5± 7.7 and 13.4± 4.9, p=0.033）.
There were not significant relationship between CAVI and
LV ejection fraction, left atrial diameter, or plasma BNP levels.
Conclusion: A higher CAVI was independently associated with
LV diastolic dysfunction in patients with clinical cardiovascular
disease. The results suggested that aortic stiﬀness contributed
to the development of LV diastolic heart failure.
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 75.6±11.4 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 all-cause 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.
288
プログラム・抄録集
ポスター２４（P24）心筋疾患の臨床
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）
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
SchoolofMedicine,Sendai,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 63±12 years;
79 male）who underwent cardiopulmonary testing were enrolled and divided
into two groups; AF group（n=21）and non-AF group（n=75）.
Results: VO2peak was lower and VE/VCO2 slope was higher in AF group
than non-AF group（VO2peak; 17.0±4.3 vs. 22.0±4.9 ml/min/kg, p<0.001, VE/
VCO2 slope; 33.0±6.5 vs. 28.3±5.8, p=0.006）. In multiple linear regression
analysis, age（β=-0.309, p=0.001）, hemoglobin（β=0.342, p<0.001）, and AF（β
=-0.249, p=0.004）were selected as independent variables on VO2peak. When
compared AF patients with age- and sex-matched non AF patients（n=21）,
VO2peak was signiﬁcantly lower and VE/VCO2 slope was signiﬁcantly higher
in AF patients（VO2peak; 17.0±4.3 vs. 20.6±5.5 ml/min/kg, VE/VCO2 slope;
33.0±6.5 vs. 28.7±6.0）.
Conclusion: The ﬁndings of this study suggest that intensive care of AF may
be a possible option for better prognosis in HFpEF patients.
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.
DepartmentofCardiology,NagoyaEkisaikaiHospital,Nagoya,Japan、
2）
NagoyaUniversityGraduateSchoolofMedicine,Nagoya,Japan
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
Cardiovasculardepartment,UniversityofOkayama,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.
289
一般演題
︵ポスター︶
1）
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
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
一般演題
︵ポスター︶
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 congestive heart 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 ± 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（EF>50%）. VT were observed in 13 patients
（38%）, and they had signiﬁcantly lower LVEF compared to
no-VT patients.（43 ± 14% vs. 58 ± 10% p=0.02）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.
P-124
Diagnosis and Treatment of Isolated Cardiac
Sarcoidosis
Daisuke TEZUKA、Taro SASAOKA、Mitsuaki ISOBE
Department of Cardiovascular Medicine, Tokyo Medical and Dental
University
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-fluoro2-deoxyglucose positron emission tomography/computed
tomography.
Results Baseline of brain natriuretic peptide（ BNP）were
not different between sCS（n=17）and iCS（n=7）. After
prednisolone treatment, BNP decreased significantly in
both groups（ sCS: before, 157.3±130.3 pg/ml; after, 108.8
±93.7, p=0.01; iCS: before, 317.8±331.2; after, 138.6±161.6,
p=0.043）. The prognosis demonstrated by Kaplan-Meier
curve（ 40±51.1 months）was not different between sCS
（n=30）and iCS（n=11）. CS cases not treated by prednisolone
showed poorer prognosis（p=0.0069）. The patients with LV
dysfunction which was not treated by prednisolone had the
worst outcome among the all groups
（p=0.0011）.
Conclusion iCS cases with LV dysfunction initially those
suspected with the noninvasive imaging modalities,
prednisolone treatment should be considered.
290
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
UniversityGraduateSchoolofMedicalSciences,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（0.59±0.10 vs 0.78±0.10 mL/min/g, p=0.0003;
6.9±1.9 vs 8.8±2.0 %/min, p=0.02, respectively）. CV of both MBF
and HED-RI were signiﬁcantly higher in patients with DCM than
in healthy subjects（24.7±7.9 vs 17.5±4.1 %, p=0.004; 16.4±5.4 vs
10.3±2.2 %, p=0.0004, respectively）. The CVs of HED-RI were
signiﬁcantly correlated with logBNP（r=0.65, p=0.0001）. 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.
プログラム・抄録集
ポスター２５（P25）心不全におけるバイオマーカー
P-126
P-128
Impact of Parathyroid Hormone on Future
Occurrence of Heart Failure in Patients
without History of Cardiovascular Disease
Serum Brain-Derived Neurotrophic Factor
Level Predicts Adverse Clinical Outcomes in
Patients with Heart Failure
Satoru SAKURAGI、Keiji YAMADA
Masato KUDO、Shintaro KINUGAWA、Arata FUKUSHIMA、Takashi YOKOTA、
Shouji MATSUSHIMA、Takaaki FURIHATA、Masaya TSUDA、
Junichi MATSUMOTO、Shingo TAKADA、Hiroyuki TSUTSUI
Departmentofcardiology,iwakuniClinicalCenter
P-127
Department of Cardiovascular Medicine, Hokkaido University Graduate
SchoolofMedicine,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（59.2±13.7 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, P=0.008）. 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（P=0.001）. 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
Relationship Between Indoxyl Sulfate and
Fibroblast Growth Factor 23 in Heart Failure
Patients with Preserved Renal Function
Serum Irisin Levels Provide Prognostic
Information in Patients with Heart Failure
with Reduced Ejection Fraction
Miki IMAZU1）、Masanori ASAKURA1）、Hiroyuki TAKAHAMA1）、Hiroshi ASANUMA2）、
Akira FUNADA1）、Yasuo SUGANO1）、Takahiro OHARA1）、Takuya HASEGAWA1）、
Hideaki KANZAKI1）、Toshihisa ANZAI1）、Masafumi KITAKAZE1）
Shinsuke HANATANI、Yasuhiro IZUMIYA、Yuichi KIMURA、
Yoshiro ONOUE、Satoshi ARAKI、Hisao OGAWA
National Cerebral and Cardiovascular Center, Osaka, Japan、2）Kyoto
PrefecturalUniversitySchoolofMedicine
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. Median irisin levels in
each group were 45.77ng/ml and 64.72ng/ml, respectively. Low
irisin group revealed signiﬁcantly higher high sensitive troponin
T levels than high irisin group（median 0.024, interquartile range
[0.012-0.042] vs. 0.014, [0.008-0.023] ng/ml, p=0.006）. Right heart
catheterization demonstrated that pulmonary capillary wedge
pressure is higher in the low than the high irisin group（15.9±7.0
vs. 12.3±5.8 mmHg, p=0.013）. Kaplan Meier curve revealed that
the event-free rate was decreased in the low irisin group（log-rank
test p=0.042）. In receiver operating characteristic analysis, irisin
achieved an area under the curve of 0.67 for the identiﬁcation of
event free 1year survival（p=0.031）.Conclusions: Irisin could be a
useful biomarker for evaluating disease severity and providing
prognostic information in patients with HFrEF.
1）
Relationship between Indoxyl Sulfate and Fibroblast Growth Factor 23 in Heart
Failure Patients with Preserved Renal Function
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（r=0.35,
p=0.002）, but not in Control group（r=0.07, p=0.521）, 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
CardiovascularMedicine,KumamotoUniversity,Kumamoto,Japan
291
一般演題
︵ポスター︶
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 results174 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
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. ConclusionParathyroid hormone is associated with
future heart failure. Our results suggest that treatment to
reduced PTH level is helpful to prevent future cardiac event.
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター２６（P26）トルバプタンを用いた心不全治療
P-130
Utility of Neutrophil to Lymphocyte Ratio for
Predicting Sudden Cardiac Death in Patients
with Ischemic and Non-Ischemic Chronic
Heart Failure
Takahisa YAMADA、Takashi MORITA、Shunsuke TAMAKI、
Masatake FUKUNAMI
DivisionofCardiology,OsakaGeneralMedicalCenter
一般演題
︵ポスター︶
The neutrophil to lymphocyte ratio（NLR）has been associated
with poor outcome in patients with acute coronary syndrome.
To investigate the prognostic signiﬁcance of NLR for predicting
sudden cardiac death（SCD）in patients with chronic heart failure
（CHF）, relating to the etiology（ischemic or non-ischemic）, we
studied 153 CHF outpatients（ischemic;51%）with LVEF<40% in
our prospective cohort study. These patients underwent complete
blood counts with automated diﬀerential counts, which included
total white blood cell count, neutrophils, lymphocytes, red cell
distribution width（RDW）and platelet cell distribution width
（PDW）, at baseline. During a follow up period of 7.6±4.3 yrs, 28
patients had SCD. At multivariate Cox analysis, only NLR was
independently and significantly associated with SCD in both
ischemic and non-ischemic groups, although percent neurophil,
percent lymphocyte, RDW or PDW showed a significant
association with SCD at univariate analysis. SCD was signiﬁcantly
observed in patients with high NLR（above the highest
quartile）than low NLR, in ischemic（43% vs 14%, p=0.002）and nonischemic groups（38% vs 8%, p=0.003）. The adjusted hazard ratios
of high NLR for predicting SCD in ischemic and non-ischemic
groups were 3.46（95%CI 1.04-11.49）and 3.72（95%CI 1.05-13.20）,
respectively. Thus, NLR has the long-term prognostic value for
the prediction of SCD in CHF patients, irrespective of the etiology.
P-131
P-132
Tolvaptan for Perioperative Heart Failure
in Patients with Preoperative Pulmonary
Congestion: Two Case Reports
Aki KITAMURA、Keitaro NAKAGIRI
The Department of Cardio-vascular Surgery, Ako City Hospital, Hyogo,
Japan
We report two cases of postoperative congestive heart failure
（CHF）successfully treated with tolvaptan. Case 1. A 65-year-old
man was admitted with chest pain and dyspnea.We diagnosed
acute coronary syndrome（LMT）and CHF, so emergency CABG
was performed. His P/F ratio was 110 because of pulmonary
edema. According to Swan-Ganz data, he also had intravascular
hypovolemia. Tolvaptan（15 mg）was administered and urine
output was 4200 ml after 24 hours. His P/F ratio improved to
270, and extubation was possible on day 2.Case 2. A 26-yearold man was admitted with fatigue and fever.Severe mitral
regurgitation due to infective endocarditis was diagnosed and
he also had CHF with pulmonary hypertension and low cardiac
output. We performed urgent mitral valve replacement. The
early postoperative course was relatively smooth, and oral
furosemide was initiated after extubation on day 3.However,
CHF symptoms secondary to volume overload appeared on
day 6. The chest X-ray ﬁlm showed bilateral pleural eﬀusions
and an enlarged CTR. Echocardiography revealed impaired
LV contraction and pulmonary hypertension. Oral tolvaptan
（7.5 mg）was administered in addition to low-dose dobutamine.
His body weight decreased by 8.2 kg after one week and CHF
improved rapidly.Electrolyte imbalance did not occur and
hemodynamics did not deteriorate in both patients.In conclusion,
tolvaptan is eﬀective for refractory CHF after cardiac surgery.
P-133
Circulating Invariant Natural Killer T Cells
are Decreased in Patients with Chronic Heart
Failure
The Use of Tolvaptan in a Case of
Severe Heart Failure with Drug-Induced
Cardiomyopathy
Akimichi SAITO、Naoki ISHIMORI、Mikito NISHIKAWA、
Shintaro KINUGAWA、Hiroyuki TSUTSUI
Taichi OKONOGI
Department of Cardiovascular Medicine, Hokkaido University Graduate
SchoolofMedicine,Sapporo,Japan
Objective: Inﬂammation plays a crucial role in the development of
chronic heart failure（HF）. We have demonstrated that invariant
natural killer T（iNKT）cells, a unique subset of T lymphocytes,
have a protective role against left ventricular（LV）remodeling
after myocardial infarction in mice. However, little is known
about the changes in iNKT cells in patients with HF. Methods
and Results: Nine patients with HF
（NYHA II or III, LV ejection
fraction 26.3±3.0%）and 8 healthy controls were studied. The
number of circulating Vα24+ iNKT cells in peripheral blood by
ﬂow-cytometric analysis. The causes of HF were idiopathic dilated
cardiomyopathy in 3, ischemic in 2, and others in 4 patients.
Plasma BNP was signiﬁcantly higher in HF（739.4±207.2 vs. 19.8±
6.5 pg/mL, P <0.01）.The number of circulating iNKT cells and the
ratio of the iNKT cell number to the total lymphocyte number
were significantly lower in HF（747±85 vs. 1058±271 counts/
mL and 0.111±0.004 vs. 0.146±0.035%, respectively, both P <0.01）.
Plasma interleukin-6 and hs-CRP were significantly higher in
HF（3.99±0.86 vs. 0.78±0.14 pg/mL and 0.28±0.10 vs. 0.06±0.02
mg/dL, respectively, both P <0.01）. LV ejection fraction（r =0.72,
P <0.05）and plasma logBNP（r =-0.70, P <0.05）were significantly
correlated to iNKT cell ratio among HF patients. Conclusion:
Circulating iNKT cells were decreased in patients with HF,
indicating that they may be involved in this disease.
292
The Department of Cardiovascular Medicine, Heart Center, New
YukuhashiHospital,Yukuhashi,Japan
Tolvaptan is an oral vasopressin V2 receptor antagonist.
Recently, many papers report the efficacy and safety of
tolvaptan for patients with congestive heart failure. However,
there is little information about clinical experience of the use of
tolvaptan for a patient with drug-induced cardiomyopathy. A
52-year-old female with relapse breast cancer, invasive ductal
carcinoma, treated by the CEF therapy（cyclophosphamide
800mg/day, epirubicin 100mg/day, 5-fluorouracil 800mg/
day）. After she underwent her 15th cycle of the therapy,
she was admitted to our hospital with dyspnea. The chest
X-ray showed cardiomegaly with pulmonary congestion and
pleural eﬀusion. The transthoracic echocardiogram showed a
left ventricular dysfunction with an ejection fraction of 35%.
Her physical examination failed to indicate the cause of the
heart failure. After analyzing some of her examination, we
diagnosed epirubicin-induced cardiomyopathy. Treatments
with furosemide, carperitide, low-dose dopamine and
dobutamine are not useful in this case. Because the patient
had a retention of fluid repeatedly, we administered a lowdose tolvaptan（7.5mg/day）. As a result, her edema and body
weight were reduced remarkably without worsening renal
dysfunction, allowing her discharge from our hospital. It is
possible that the use of tolvaptan enabled us to improve heart
failure safety for patients with drug-induced cardiomyopathy.
プログラム・抄録集
P-134
Tolvaptan was Eﬀective in Patient with Heart
Failure Due to Subclavian Arteriovenous
Malformation
Atsuko HIRAMINE、Takuro KUBOZONO、Shin KAWASOE、
Kunitsugu TAKASAKI、Akira KISANUKI、Masaaki MIYATA、
Mitsuru OHISHI
Department of Cardiovascular Medicine and Hypertension, Graduate
school of Medical and Dental Sciences, Kagoshima University,
Kagoshima,Japan
Eﬃcacy and Safety of Tolvaptan Therapy
for Acute Decompensated Heart Failure
Toshijirou AOKI、Ryo YAMAGUCHI、Hideo OISHI、Yusuke MIKI、
Toshiki KAWAMIYA、Hitoshi ICHIMIYA、Yasuhiro UCHIDA、
Junji WATANABE、Masaaki KANASHIRO、Satoshi ICHIMIYA
DepartmentofCardiology,YokkaichiMunicipalHospital,Mie,Japan
Background: Diuretic use for acute decompensated heart
failure（ADHF）is associated with electrolyte abnormalities
and worsening renal function. The vasopressin antagonist
tolvaptan may increase net volume loss without adversely
affecting electrolytes and renal function. However, data on
tolvaptan use for ADHF are limited even now. Method:
Between March 2011 and February 2014, we enrolled 36
patients with ADHF who received tolvaptan in addition to
standard medication therapy including diuretics. Patients
were divided into two gropes; survival to hospital discharge
（n = 30）and cardiac death in hospital（n = 6）. We compared
their clinical features, and assessed the efficacy and safety
of tolvaptan therapy. Result: There was no side effect of
tolvaptan such as acute elevation of serum sodium level,
hypotension and deterioration of renal function. The baseline
characteristics were almost similar between the two groups.
But systolic blood pressure and estimated glomerular ﬁltration
rate（eGFR）on admission were lower in cardiac death group
（125.8±32.5 mmHg vs 108.8±15.1 mmHg; p = 0.064 and 31.9
±20.0 ml/min/1.73m2 vs 22.4±7.0 ml/min/1.73m2; p = 0.053,
respectively）.There was a positive correlation between eGFR
and gain of the urine volume after starting tolvaptan（r = 0.58,
p = 0.002）. Conclusion: Tolvaptan therapy for ADHF is safe,
but may not be eﬀective for patients with renal dysfunction.
P-135
Eﬀects of Tolvaptan on Congestion and
Neurohumoral Factors: A Case of Right
Heart Failure Caused by Severe Tricuspid
Regurgitation.
Yodo TAMAKI、Yukiko HAYAMA、Naoaki ONISHI、Soichiro ENOMOTO、
Makoto MIYAKE、Toshihiro TAMURA、Hirokazu KONDO、
Kazuaki KAITANI、Chisato IZUMI、Yoshihisa NAKAGAWA
DepartmentofCardiology,TenriHospital,Tenri,Japan
We report a case of 74 year-old man with right heart failure
caused by severe tricuspid regurgitation requiring frequent
hospitalizations. The patient was admitted because of abdominal
distension one month after discharge, gaining weight by 6kg. In
the previous hospitalization just before discharge, cardiac index
was 1.87 L/min/square meter and right atrial pressure was 19
mmHg in right heart catheterization. He declined surgery and
was discharged on medical treatment. On admission, physical
examination revealed massive ascites and cheat X-ray showed
right dominant pleural eﬀusion. Since he was already taking 80mg
of furosemide, 16 mg of torasemide and 50mg of spironolactone,
tolvaptan 7.5mg was added. Tolvaptan increased urinary output
and decreased pleural eﬀusion, ascites and body weight. He was
discharged on 17th hospital day continuing to take tolvaptan.
Plasma BNP decreased from 602.1 pg/ml to 260.4pg/ml. However,
aldosterone increased from 116 pg/ml to 338 pg/ml and
noradrenaline from 585 pg/ml to 1487 pg/ml. He is now visiting
outpatient clinic, keeping his weight with no sign of congestion
and has not been hospitalized for 1 year. In this case, tolvaptan
was eﬀective in preventing heart failure hospitalizations at the
cost of neurohumoral activation. Further studies are needed to
determine eﬀects of long-term administration of tolvaptan.
P-137
Clinical Eﬃcacy and Safety of Tolvaptan
in Very Elderly Patients with Acute Heart
Failure
Hiroki NIIKURA1）、Hitoshi ANNZAI1）、Hiroki TAKENAKA1）、Ryo FUKUI1）、
Norihiro KOUGAME1）、Junn KURIBARA1）、Naohiko NEMOTO1）、
Nobuyuki KOBAYASHI1）、Masato NAKAMURA2）、Kaoru SUGI2）
Department of Cardiology, Ohta memorial hospital, Gunnma, Japan、
Division of Cardiovascular Medicine, Toho University Ohashi Medical
Center
1）
2）
Objective: We aim to assess the eﬃcacy and safety of Tolvaptan（TLV）in very
elderly patients（VEP）with acute heart failure（AHF）. Patients and methods:
We treated consecutive 77 AHF patients with TLV from March 2013 through
March 2014. TLV was administered within 24 hours after admission. Patients
with hypernatremia（over 145 mEq/L）, acute coronary syndrome and dialysis
were excluded in this study. Patients were divided into 2 groups（VEP; 85
yrs-old >/=, non VEP; <85 yrs-old）and were compared between 2 groups
regarding in-hospital outcomes. Results: Two groups were identical in terms
of patient backgrounds, concomitant treatment. Dose and duration of TLV.
Conclusion: This study showed TLV was safely administered to VEP with
AHF and provided the same clinical eﬃcacy as those with non VEP.
293
一般演題
︵ポスター︶
The patients with heart failure due to subclavian arteriovenous
malformation are rare, and its treatment is difficult. Here, we
report a 74-year-old male patient. In 1998, he was diagnosed with
heart failure due to subclavian arteriovenous malformation and
received medical treatment. Heart failure progressed, and he
was treated with the coil embolism in 2009. However, the coil
embolism was not effective to reduce the shunt flow and his
symptom progressed slowly. He admitted because of general
malaise and appetite loss, the edema was observed in his whole
body, and the shunt ﬂow was heard at his neck. The cardiomegaly
and the pleural effusion were shown in a chest X-ray. The
echocardiography demonstrated the dilatation of right atrium and
ventricle and the severe tricuspid valve regurgitation with the
cusp separation. He have been already treated with the high dose
of diuretics including furosemide（80 mg/day）,eplerenone（50 mg/
day）and trichlormethiazide（2 mg/day）. It is not improved with
low-salt diet and rest, and tolvapvtan（7.5 mg/day）was added. The
urine volume increased after the administration of tolvaptan, and
the body weight decreased by 7 kg in a week. His symptom of
general fatigue improved and appetite also increased. In this case,
tolvaptan was effective in the patient with heart failure due to
subclavian arteriovenous malformation.
P-136
第18回日本心不全学会学術集会
The 18th Annual Scientific Meeting of the Japanese Heart Failure Society
ポスター２７（P27）慢性心不全の睡眠時呼吸管理をどうするか？
P-138
Change in Type of Sleep-Disordered Breathing
from Predominant Central to Obstructive
Sleep Apnea Following Coronary Artery
Bypass Grafting
Shoichiro YATSU1）、Takatoshi KASAI1,2）、Azusa MURATA1）、
Takao KATO1）、Shoko SUDA1,2）、Masaru HIKI1）、Eriko MATSUNAGA1）、
Tetsuro MIYAZAKI1）、Atsutoshi TAKAGI1）、Hiroyuki DAIDA1）
Department of Cardiology, Juntendo University School of Medicine,
Tokyo,Japan、2）Cardio-RespiratorySleepMedicine,Tokyo,Japan
1）
一般演題
︵ポスター︶
Patients with heart failure（ HF）frequently have central sleep apnea
（CSA）due to hyperventilation associated with pulmonary congestion and
increased chemosensitivity. On the other hand, CSA in HF patients may
be improved by the initiation of speciﬁc therapy for failing heart. Several
reports have shown that resolution of CSA or conversion of CSA to
obstructive sleep apnea（OSA）was observed following surgical approaches
for HF including mitral repair or cardiac transplant. We report the case of
a 67-year-old overweight（body mass index, 26 kg/m2）man with reduced
left ventricular ejection fraction（LVEF）due to myocardial infarction. He
was initiated into implantable cardioverter deﬁbrillator（ICD）therapy for
frequent episodes of ventricular tachyarrhythmia and adaptive-servo
ventilation for severe CSA. Since he had several episodes of appropriate
ICD therapies, coronary angiogram was performed and three vessel
disease with chronic total occlusion in left anterior descending was found.
Then, he underwent coronary artery bypass grafting（CABG）. After
CABG, his LVEF increased slightly（from 38 to 42%）and B-type natriuretic
level decreased（from 560 to 330 pg/ml）. Although apnea-hypopnea index
did not change（49.4 /h before CABG versus 55.1 /h after CABG）,his CSA
converted to predominant OSA accompanied by shortening of lung-toﬁnger circulation time（from 43 to 29 sec）2 weeks after CABG, which was
completely suppressed with continuous positive airway pressure.
P-139
A Case of Congestive Heart Failure Who
Exhibited a Marked Improvement of
Persistent Nocturnal Dyspnea Despite of
Cardiac Resynchronization Therapy
Takehiro TAMAKI、Yuuki IZUMI、Tsutomu YOSHIKAWA、
Jun UMEMURA、Tetsuya SUMIYOSHI、Hitonobu TOMOIKE
D e p a r t m e n t o f C a r d i o l o g y S a k a k i b a r a H e a r t I n s t i t u t e J a p a n
CardiovascularResearchPromotorSociety,Tokyo,Japan
Adaptive servo-ventilation（ASV）has been originally
applied to Cheyne-Stokes respiration which is seen in
patients with advanced heart failure. This type of therapy
directly alleviates sympatho-excitation and ameliorates
hemodynamics, as well as improvement of oxygenation
and respiration. It directly reduces both preload and
afterload, resulting in reduction of total cardiac workload.
Alternatively, it directly inhibits cardiac sympathetic
outflow, especially in patients with heart failure. These
effects altogether contribute to afterload reduction via
reducing peripheral vascular resistance in acute phase. In
addition, these effects elicit reverse remodeling of the left
ventricle in patients with heart failure over the long-term
observation. Here, we report a case who exhibited marked
improvement of hemodynamics after introduction of ASV in
advanced heart failure despite of cardiac resynchronization
therapy.
294
P-140
Inﬂuence of Sleep Disordered Breathing on
Heart Rate Turbulence in Heart Failure
Patients
Takeshi SHIMIZU、Akiomi YOSHIHISA、Minoru NODERA、
Yuichi NAKAMURA、Satoshi ABE、Satoshi SUZUKI、Kazuhiko NAKAZATO、
Hitoshi SUZUKI、Shu-Ichi SAITOH、Yasuchika TAKEISHI
Department of Cardiology and Hematology, Fukushima Medical
University,Fukushima,Japan
Background: Sleep-disordered breathing（SDB）is associated
with adverse outcomes in patients with heart failure（HF）,
while heart rate turbulence（HRT）assessed by Holter ECG
has been used in order to predict sudden cardiac death.
However, little is known about the relationship between
SDB and HRT in HF patients. Methods and Results: 75
patients with HF and SDB were enrolled in this study. We
simultaneously performed Holter ECG during 24-hr period
and polysomnography in night time, and examined apnea
hypopnea index（AHI）and HRT（turbulence onset and
turbulence slope（ TS））during 24-hr period. Patients were
divided into two groups based on the presence of severe SDB:
group A（AHI > 30, n = 17）and group B（AHI < 30, n = 58）.
TS was signiﬁcantly lower in group A than in group B across
the 24-hr period（nighttime: 3.6 ± 1.1 vs. 6.9 ± 1.3; daytime:
3.7 ± 0.8 vs. 7.0 ± 1.1; all-day: 3.5 ± 0.7 vs. 6.7 ± 0.9% ms/RR,
P < 0.05, respectively）. Furthermore, there was a signiﬁcant
negative correlation between all-day TS and AHI（R = -0.257,
P = 0.027）.Conclusions: Blunted TS was observed across a 24hour in patients with severe SDB. These results suggest that
SDB may induce autonomic nervous modulation associated
with poor prognosis across a 24-hour period in CHF patients.
P-141
Time Course of Adaptive Servo-Ventilation
Eﬀects on Central Sleep Apnea in Patients
with Chronic Heart Failure
Takashi AKABANE、Shuji JOHO、Ryuichi USHIJIMA、
Yoshitaka ODA、Hiroshi INOUE
The Second Department of Internal Medicine, University of Toyama,
Toyama,Japan
Background: Central sleep apnea（CSA）is prevalent in patients
with heart failure（HF）. Although adaptive servo-ventilation
（ASV）suppresses CSA, it remains unknown whether long-term
ASV leads to alleviation of CSA. Methods: Cardiorespiratory
polygraphy and echocardiography were performed at baseline
and 3.5 ± 0.8 months（mean ± SD）of follow-up in 28 patients
with HF（NYHA II and III; left ventricular ejection fraction
（LVEF）< 45%）and CSA（apnea-hypopnea index（AHI） 15/
h）. Of these, 17 patients consented and 11 patients declined to
undergo ASV treatment. Eﬀect of ASV on AHI was conﬁrmed
with polygraphy and device integral counters. Result: Onenight ASV reduced AHI from 27 ± 15/h to 3 ± 3/h（p < 0.0001）.
AHI on ASV using device counters were similar with AHI
measured by polygraphy. Long-term ASV alleviated AHI from
27 ± 15/h to 11 ± 7/h（p < 0.001）. Diﬀerence between AHI at
baseline and AHI on ASV was closely correlated with change
in AHI between baseline and follow-up（R = 0.81, p<0.001）.
Change in LVEF was also correlated with the change in
AHI. However, bivariate analysis revealed that the diﬀerence
between AHI at baseline and AHI on ASV was an independent
predictor of change in AHI. Conclusions: More suppression
of CSA by ASV may relate to greater improvement of CSA
irrespective of change of cardiac function.
プログラム・抄録集
P-142
Acute Hemodynamic Eﬀects of Adaptive
Servo Ventilation in a Patient with Atrial
Septal Defect
Shinya FUJIKI1,2）、Hiroaki OBATA1）、Takeshi KASHIMURA1）、
Ritsuo WATANABE2）、Osamu OGAWA2）、Haruo HANAWA1）、
Tohru MINAMINO1）
Department of cardiovascular biology and medicine, Niigata university
graduate school of medical and dental sciences, Niigata, Japan、
Departmentofcardiology,NiigataPrefecturalCentralHospital,Niigata,
Japan.
1）
2）
一般演題
︵ポスター︶
Acute beneﬁcial hemodynamic eﬀects of adaptive servo ventilation
（ASV）has been reported in patients with left-sided heart failure.
However, little is known about its eﬀects in patients with atrial
septal defect（ASD）.A 76 years-old female with ASD was admitted
to our hospital for right-sided heart failure. After congestion was
controlled, cardiac catheterization was performed. Her mean
pulmonary artery pressure（ mPAP）was 23mmHg with high
pulmonary blood ﬂow and normal pulmonary vascular resistance
（Qp 10.95 l/min, Qs 6.01 l/min, Qp/Qs 1.83, PVR 138.8 dyne-seccm-5）. ASV（EPAP 5, PS 3-10 cmH20, for 30min）decreased PVR
by 44%（PVR: 89.4 dyne-sec-cm-5）, although mPAP did not change
with increased pulmonary blood ﬂow（mPAP 23mmHg, Qp 14.32
l/min, Qs 6.55 l/min, Qp/Qs 2.19）. These hemodynamic changes
were observed with little diﬀerence in arterial oxygen saturation
（SaO2: 93.3% in control and 94.7% under BiPAP, respectively）,
even though the changes were similar to those observed in this
patient under oxygen inhalation（10 l/min, SaO2 99.8%, mPAP
23mmHg, Qp 16.5 l/min, Qs 6.94 l/min, Qp/Qs 2.39, PVR 77.3
dyne-sec-cm-5）. This case shows that ASV can decrease PVR,
even though its beneficial effect is offset by increased Qp. The
mechanism underling the decrease of PVR is still to be elucidated.
295

ポスター1（P01）心肥大・心リモデリング

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