64 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0070 Cardiology
The Effect of Serum Hepcidin Level on Anemia in Heart Failure
Betul BORKU UYSAL1, Feray AKBAS2, Esma ALTUNOGLU2, Gulhan IPEK DENIZ8, Duygu UYSAL2, Harun UYSAL5, Hanife USTA ATMACA2, Yasin YUKSEL3, Hale ARAL4, Guven CETIN6, M. Cem AR7, Mustafa BOZ2, Fusun ERDENEN2
Lutfiye Nuri Burat State Hospital, Turkey1, Istanbul Education and Research Hospital, Turkey2, Istanbul Educa- tion and Research Hospital, Turkey3, Istanbul Education and Research Hospital, Turkey4, Bezmialem University Faculty of Medicine, Turkey5, Bezmialem University Faculty of Medicine, Turkey6, Istanbul University Cerrahpasa Faculty of Medicine, Turkey7, Istanbul University Cerrahpasa Faculty of Medicine, Turkey8
Background: Anemia is an accelerating problem among patients with heart failure. In this study, we investigated whether anemia in heart failure was related to hepcidin level.
Methods: Totally 70 patients; 50 patients with heart failure and 20 otherwise healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verifi ed by echocardiography in each subject and patients were defi ned as ones with reduced ejection fraction (HFrEF) if EF
= 40% and with preserved ejection fraction (HFpEF) if EF 40-50%. Exclusion criteria included presence of kidney failure (serum creatinine level>1.4), history of hemorrhage (gastrointestinal or severe menstrual bleeding), chronic liver disease (ALT>2 folds), hematologic disease, iron replacement therapy or blood transfusion in the past six months, hypothyroidism, autoimmune disease and manifest infection.
Results: There was no correlation between hepcidin concentration and age, weight, creatinine, iron, vitamin B12, folate, white blood cell (WBC), platetelet, mean corpus- cular volume, ESR, ejection fraction (EF) (p > 0,05). There was a positive correlation between hepcidin level and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (p
< 0,05). Hepcidin levels of anemic heart failure patients were signifi cantly lower than the non-anemic heart failure patients (p < 0,05).
Conclusions: We found that serum hepcidin level in anemic patients with heart failure was lower than in heart failure patients without anemia. Previously, progression of heart failure was found to be associated with decline in circulating hepcidin and the development of iron defi ciency and low hepcidin level was related to unfavorable out come. We believe that iron defi ency occurs as a result of infl ammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed.
PS 0071 Cardiology
Prognosis of Chronic Heart Failure - Possible Role of Gut Microbiota
Nadezda BYLOVA1, Gregory ARUTYUNOV1, Anna SIMBIRTSEVA1, Anna KULINKOVICH1 Pirogov Russian National Research Medical University, Russia1
Background: It is well known that with chronic heart failure associated with high levels of endotoxin and proinfl ammatory cytokines. One of hypotheses porpoise, that a possible cause of these changes is – microbiota of gut. Aim: to analyze prognostic value of microbiota changes in patients with CHF.
Methods: Study included 121 patients with CHF III-IV NYHA of ischemic genesis hos- pitalized in City Clinical Hospital #4 from 01.2010 to 01.2011. All patients underwent faecal plating on growth media, colonoscopy with large intestine biopsy and sample plating on growth media. We follow up petients for 2 yers.
Results: 75 patients were male, 46 – female. All patients had ejection fraction be- low 30%. By microbiological analysis of feacal samples we see signifi cant (p<0.05) increase in total number of enterobacteria (1010 CFU/g). The pool of enterobacteria grew primarily due to growth of E. сoli (109.6 CFU/g) (Lac+/hem- and isolated hem+), Klebsiella pneumoniae (108 CFU/g), citrate-assimilating enterobacteria (1010 CFU/
g), Citrobacter freundii (108 CFU/g), Clostridia populations (lecithinase- and hydrogen sulfi de-positive strains) (107 CFU/g), Bacteroides (109 CFU/g). E.coli and Klebsiella were at higher level in 41 (33,9%) of patients, Clostridial microbiota – in 26 (21,49%) of patients. Comparison of the cavity and parietal microfl ora did not reveal signifi cant differences. By 6 month of follow-up 39 (95,12%) of patients with prevalence of Clostridial microbiota die, and other 2 (4,88%) patients die in next 3 month, in fi rst 6 month only 3 (11,54%) of patients with prevalence of E.coli and Klebsiella die, but at the end of fi rst year of follow up all patients from this group die.
Conclusions: in patients with III-IV FC CHF bacteriological changes of gut microbiota may be a useful prognostic value, especially in case of using express test-systems for clostridial toxin in feacal.
PS 0072 Cardiology
Adipose Tissue in Patients with Chronic Heart Failure Ii- Iii FC Nyha – One Year of Follow Up
Nadezda BYLOVA1
Pirogov Russian National Research Medical University, Russia1
Background: Chronic heart failure (CHF) one of the most frequent causes of car- dio-vascular death. Adipose tissue in case of CHF obtain new qualities,so that we propose,that adipose begins to be a key point of systemic infl ammation in patient with CHF. Aim: to evaluate weight, BMI, levels of leptin in blood, lean mass, % of adipose tissue in patients with CHF II-III FC NYHA for a year and to try to fi nd any prognostic markers.
Methods: 138 patients with CHF of ischemic genesis: 78–II function class(FC), 60 III- FC. Height, weight, BMI, lean mass,% of adipose tissue (Durnin methodic), ejection fraction(EF) and leptin in plasma was evaluated every three month for a year. Also we collect information about re-hospitalizations, mortality, cardiac complications, cardiac surgery prosedges.
Results: 110 patient were male, 28 female, main cause of heart failure – myocardial infarction, mean age 65±3,6; mean time from fi rst clinics of heart failure 1,2±0,9 year, in all cases EF was low then 30%. All patients receive standard medications. We fi nd out, then lowering of lean mass more then 3% for 6 month associated with high level of re-hospitalizations (more then in 2 times) and mortality in nearest 6 month. Such lowering of lean mass we fi nd out in 18 of our patients and 15 of them died in next 6 month, it is necessary to mention that we didn’t fi nd any fall of EF. Also leptin eleva- tion more then to 10 ng/ml in 3 month associated with higher risk of cardio-vascular events: from 38 patients with leptin elevation 10 myocardial infarctions, 5 strokes, 12 surgery prosedges on coronary vessels.
Conclusions: dynamic of lean mass and leptin level may be a prediction factors in patients with CHF of ischemic genesis.
PS 0073 Cardiology
Education of Patients with Chronic Heart Failure (CHF) - Key Points
Nadezda BYLOVA1
Pirogov Russian National Research Medical University, Russia1
Background: New medications, new methods, new recommendations – but no real effect. What can we do? One of possible ways to solve this problem – education of patients and their relatives. Aim: to analyze usefulness of education program to patients with CHF and their relatives in different groups divided by: education, social level, living with relatives, occupancy.
Methods: Study included 135 patients with CHF II-III NYHA of ischemic genesis edu- cated for CHF education program for patients and their relatives in City Clinical Hos- pital #4 from 01.2012 to 01.2013. All patients had pre-test on problem of heart failure (to evaluate a level of knowledge and compliance to recommendations of doctors) 2 of 2 hours lessons, post-test, follow up for a year (monthly telephone contacts), and at the end of the year one more test and 2 of 2 hours lessons. In all cases we ask pa- tients to visit our lessons with relatives (in case they have any relatives).
Results: 90 patients were male, 45 – female. Mean age was 67±5,2. 120 of our pa- tient had high education, 35 of them were still occupied, social level in all cases was not very high. Results of pre-test show, that our patients poor information. Compli- ance at the beginning was low then 80% in most of cases. Pos-test was at most of cases well done. One-year follow up shows, that compliance was at very high level and we have no re-hospitalizations in 32 of our patients, all of them had high edu- cation, were still occupied, have well-motivated relatives. 3 more patients with such characteristic were re-hospitalized: 1 – myocardial infarction, 1 – pneumonia, 1 – trauma.
Conclusions: well educated patients with chronic heart failure have best compliance, best motivation in following education and best prognosis.
