326Role of Worsening Renal Function in Patients Hospitalised for Acute HeartFailureBenedetta Fontanella1, Marco Metra1, Savina Nodari1, Giovanni Parrinello2, TaniaBordonali1, Giulia Verzura1, Carlo Lombardi1, Patrizia Milani1, Silvia Bugatti1,Livio Dei Cas1; 1Section of Cardiovascular Diseases, Dept. Exp and Appl.Medicine, University of Brescia, Brescia, Italy; 2Section of Medical Statistics,University of Brescia, Brescia, Italy

Background: Renal failure is a common finding in the patients with heart failure(HF) and it is a powerful independent prognostic factor. Hospitalisations for acuteHF may be associated with further worsening of renal function (WRF) and thismay have prognostic impact. Previous studies assessing the prognostic role ofWRF were mainly based on retrospective analyses of data collected in different cen-tres with limited follow-up duration and few assessed the role of medical treatment.Aim of the study: To assess the clinical and prognostic significance of WRF in aconsecutive series of patients admitted at our institute for acute HF. Methods: Weincluded 318 consecutive patients admitted for AHF. WRF was defined by the occur-rence of either a $0.3 mg/dL (WRF-Abs) or a $25% (WRF-%) increase in serumcreatinine (s-Cr) from admission, or both (WRF-Both). Results: Patients were fol-lowed for 480 6 363 days (median 388). During follow-up, 53 patients (17%)died and 132 (41%) were rehospitalised for HF. WRF-%, WRF-abs and WRF-Both occurred in 110 (35%), 134 (42%) and 107 (34%) patients, respectively. Atmultivariable analysis, WRF-% was an independent predictor of death or HF rehospi-talization (HR, 1.46; 95%CI, 1.04e2.05; p 5 0.029). WRF-Both had a slightly lowersignificance (p 5 0.03) and WRF-abs did not reach statistical significance. The inde-pendent predictors of WRF-% were NYHA class (p 5 0.005) and LV ejection frac-tion (p 5 0.026) on admission, the daily furosemide dose before admission (p 5

0.004) and the daily furosemide dose on the first day of hospitalization (p 5

0.049). In addition to WRF-%, the other variables associated with death or HF hos-pitalization at multivariable Cox analysis, were systolic BP at discharge (p ! 0.001),BUN at discharge (p 5 0.007), change in body weight during hospitalization (p 5

0.008), persistence of restrictive LV filling pattern at Doppler-echocardiography(p 5 0.008) and diabetes (p 5 0.009). Conclusions: WRF is a frequent finding inpatients hospitalized for AHF and it is independently associated with a poor progno-sis. Severity of HF and daily furosemide doses are the most important predictors of itsoccurrence during hospitalization.

327Ventricular Remodeling in Heart Failure with Preserved Ejection Fraction eImpact of an Aldosterone AntagonistAlan B. Miller, Norbert Wilke, Chris Klassen, Binu Jacob, Robert F. Percy;1Cardiology, University of Florida & Shands, Jacksonville, FL

Heart failure with preserved ejection fraction (HFPEF) is usually characterized by ab-normalities in left ventricular (LV) relaxation. This may be secondary to increasedfilling pressures and/or ventricular stiffness. We postulated that aldosterone mayplay a role in LV function in patients with HFPEF and sought to investigate the ef-fects of an aldosterone antagonist on LV size, function and mass determined by serialcardiac magnetic resonance imaging (C-MRI). Methods: Patients with a hospitaliza-tion for decompensated heart failure with an ejection fraction greater than 45%, mea-sured within 3-5 days of the decompensation episode qualified for the study. At thetime of the decompensation episode, patients had to have documented pulmonarycongestion on x-ray and had to be treated with intravenous diuretics. All patientssigned informed consent and the study was approved by the IRB. Eight patients,all women, mean age 66, qualified for the study and underwent a baseline C-MRI.Patients were then treated with eplerenone 25 mg (per day) added to their baselinetherapy. Cardiac MRI and clinical assessment were repeated at four months. Results:Cardiac MRI’s were read in our MRI core lab by a single reader who was blinded (seeTable 1). Baseline end-diastolic and end-systolic volumes were normal as was ejec-tion fraction. Left atrial size was slightly increased. Left ventricular mass was alsonormal at baseline. At the end of four months, ejection fraction, volumes, and leftatrial size did not change. LV mass decreased over the four month study periodbut this change was not statistically significant (p 5 NS). Conclusion: In a cohortof elderly women with HFPEF defined with clinical parameters, left ventricular vol-umes and mass are normal when measured by C-MRI. Left atrial sizes were slightlyincreased at baseline. Treatment with an aldosterone antagonist over a four month pe-riod did not change left ventricular systolic or diastolic volumes, left atrial size, orejection fraction. Left ventricular mass decreases but this change is not statisticallysignificant. It appears that modest remodeling of the left ventricle can occur in pa-tients with HFPEF treated with an aldosterone antagonist.

Table 1.

EDV (ml) ESV (ml) EF (%) LA (cm) LV mass (gm)

Baseline Visit 114 þ 32.4 33.5 þ 19.4 67.7 þ 8.7 4.8 þ 0.5 104.2 þ 34.2Follow-up 118 þ 22.7 36 þ 11.5 68.6 þ 7.6 4.6 þ 0.5 98.2 þ 31.6

EDV 5 end diastolic volume, ESV 5 end systolic volume, EF 5 ejection fraction,LA 5 left atrium, LV 5 left ventricle.

S168 Journal of Cardiac Failure Vol. 13 No. 6 Suppl. 2007

328Does It Matter Which Beta-Blocker Is Prescribed in Patients with Systolic HeartFailureBinu Jacob, Bharat Gummadi, Mario Pulido, Robert F. Percy, Alan B. Miller;1Cardiology, University of Florida & Shands, Jacksonville, FL

Two B-blockers, metoprolol succinate and carvedilol, have demonstrated improvedsurvival and are indicated for heart failure patients based on randomized clinical tri-als. There has never been a prospective ‘‘head-to-head’’ comparison of these twodrugs on heart failure patients. We compared the hospitalization rates and mortalitybetween patients on metoprolol succinate versus carvedilol in our outpatient heartfailure population. Methods: In a stable outpatient heart failure population, we ana-lyzed data from our Clinical Information Manager for Heart Failure (CIM-HF) data-base of 304 patients from November 2004 until December 2006. Clinicalexaminations, co-morbidities, and medication logs were all performed at the UF &Shands Cardiology Clinics. Hospitalizations were obtained from the UF & Shandsmedical records database from 2005 to 2006. Mortality data was obtained by the so-cial security death index. Logistic regression (LR) was performed to determine sig-nificant clinical predictors for the outcomes. Results: From our database of 304patients, 84 (28%) were prescribed metoprolol succinate compared to 116 (38%) pre-scribed carvedilol. Both groups of heart failure patients received similar therapy withACE-I’s/ARB’s, diuretics, nitrates, digoxin, statins, except the carvedilol group wasmore frequently on aldosterone antagonists. There were no differences in age or cre-atinine clearance. Carvedilol-treated patients exhibited higher heart rates (76 bpm vs.71 bpm, p 5 0.02), lower EF (24.9% vs. 33%, p 5 0.001), higher pro-BNP levels(4911.9 vs. 3774.9, p 5 0.001), and NYHA class (2.78 vs. 2.71, p 5 NS). When an-alyzing congestive heart failure hospitalizations for the past year, rates were 59 ad-mits for the carvedilol group (51%) vs. 34 admits for the metoprolol succinategroup (40%), p 5 NS. All-cause mortality was 20% in carvedilol-treated patientsvs. 8% in metoprolol succinate-treated patients (p 5 0.03). Further analysis withLR showed that the lower EF in the carvedilol group accounted for the large mortalitydifference. Conclusion: In our outpatient heart failure clinic, carvedilol-treated pa-tients received similar therapy compared to patients receiving metoprolol succinate.The carvedilol-treated group of patients appears to have more severe heart failuregiven their worse NYHA class, pro-BNP and EF. This may have contributed to theirmore frequent heart failure hospitalizations. The lower ejection fraction accountedfor the greater mortality rate in the carvedilol-treated group of patients.

329The Predictive Value of Left Atrial Volume in Patients Referred for TransplantEvaluationAndreas Kalogeropoulos, Grigorios Giamouzis, Vasiliki Georgiopoulou, Andrew L.Smith, Randolph P. Martin, Javed Butler; 1Emory University, Atlanta, GA;2Onassis Cardiac Surgery Center, Athens, Greece

Background: LA volume (LAV) has been shown to entail powerful independentprognostic information in diverse heart failure settings. However, the value of LAVfor event prediction has not been assessed in a pre-transplant population yet, neitheralone nor in context with validated prognostic markers. Methods: To assess the pre-dictive value of LAV, we collected data on 51 patients (51 6 13 years, 69% male,71% white) referred for evaluation for cardiac transplantation from 5/2003 to 4/2005. LAV was calculated offline by the biplane area-length method. We also eval-uated the prognostic value of LAV in the context of the Seattle Heart Failure Model(SHFM), a multi-marker model which incorporates the effects of medical therapy andcardiac devices. Event was defined as death or cardiac transplantation. The discrim-inatory power of the prediction models was assessed by calculating the respective c-statistics. Results: Mean follow up was 31 6 11 months. Baseline ejection fractionwas 0.18% (25%e75%: 0.13e0.28), VO2max was 15.6 6 5.1 ml/kg/min, and LAVwas 110 6 41 ml. Of the 51 patients, 4 (7.8%) died and 8 (15.7%) underwent trans-plantation. LAV was significantly higher in patients with an endpoint compared toevent-free patients, 137 6 42 vs. 102 6 37 ml, p 5 0.018 (Figure). In univariateCox regression models LAV alone emerged as a significant prognostic factor (p 5

0.003), reaching a c-statistic of 0.746, while the SHFM alone reached a c-statisticof 0.724. The inclusion of LAV in the SHFM model conferred significant additionalprognostic information (multivariate p for LAV 5 0.014), leading to an overall im-provement of the c-statistic to 0.781. The addition of maximal oxygen consumptionin this combined model did not increase its predictive power. Of note, ejection frac-tion by itself did not demonstrate any discriminatory value. Conclusion: Left atrialvolume appears to maintain its powerful predictive value even in this highly selectedsetting. Importantly, LAV improved the performance of the SHFM for event predic-tion in this small pre-transplant population. These findings need validation in largerprospective studies.