ヤマグチ　ジユンイチ   YAMAGUCHI Jiyun'ichi   山口　淳一    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
言語種別	英語
発表タイトル	Serum Bilirubin/Alanine Aminotransferase Ratio Predict Response to Tolvaptan in Hospitalized Heart Failure Patients
会議名	The 79th Annual Scientific Meeting of the Japanese Circulation Society
主催者	Japanese Circulation Society
学会区分	全国規模の学会
発表形式	口頭
講演区分	一般
発表者・共同発表者	◎OKAYAMA Dai, MINAMI Yuichiro, SUZUKI Tsuyoshi, SHIGA Tsuyoshi, HARUKI Shintaro, NAKAO Masashi, JUJO Kentaro, ARASHI Hiroyuki, SASHIDA Yukiko, MIZUNO Masayuki, YAMAGUCHI Junichi, HAGIWARA Nobuhisa
発表年月日	2015/04/24
開催地 （都市, 国名）	Osaka, JAPAN
学会抄録	PROGRAM JCS 2015 181
概要	Background: Liver has high metabolic activity that requires a quarter of cardiac output at rest. Increased central venous pressure leads to passive hepatic congestion so called cholestasis and causes elevation of serum bilirubin (Bil). On the other hand, decreased cardiac output with impaired organ perfusion results in hepatocellular damage and causes elevation of serum alanine aminotransferase (ALT). Tolvaptan, vasopressin type2 receptor antagonist, is used for therapy for heart failure. However it is uncertain that volume overloads and preserved organ perfusion are necessary conditions for response to Tolvaptan, and high Bil/ALT ratio may be a surrogate marker for those conditions. The aim of this study is to investigate the association between Bil/ALT ratio and response to Tolvaptan in hospitalized heart failure(HHF) patients. Methods and Results: We evaluated consecutive 55 HHF patients with Tolvaptan between December 2010 and April 2014.We defined responder to Tolvaptan as 30% increase in urine volume at day2.Receiver operating characteristic (ROC) curve analysis was applied to assess its prognostic value for responder, and Bil/ALT ratio showed favorable performance. The area under the ROC curve was 0.702 (optimal cutoff point >0.057; sensitivity 69.2%; specificity 65.5%). After adjusting for blood pressure and eGFR, high Bil/ALT ratio was an independent predictor for responder (OR:3.66, p=0.02).Conclusions: High Bil/ALT ratio could be a predictive factor for response to Tolvaptan in patients with HHF.