388Cardiac Screening for Late-Onset Cardiomyopathy in Recipients of CardiotoxicChemotherapy: Pilot Data from a Prospective StudyShahid Wazir1, G. Thomas Budd2, Mikkael A. Sekeres2, W.H. Wilson Tang1;1Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; 2Oncology/Hematology, Cleveland Clinic, Cleveland, OH

Background: Biomarker and echocardiographic evaluation of early-onset cardiotox-icity related to chemotherapeutic agents have been well described. However, the fre-quency and diagnostic utility of these measures to identify late-onset (O 2 years)cardiomyopathy in recipients of cardiotoxic chemotherapy has not been reported.Methods: We prospectively evaluated 132 consecutive cancer survivor who were re-cipients of cardiotoxic chemotherapy for O 2 years in remission, and without knownhistory of heart failure or cardiac dysfunction. Clinical histories, limited echocardi-ography performed by a designated trained individual using MicroMaxx (SonositeInc), and biochemical evaluation of cardiac biomarkers including plasma N-terminalpro B-type natriuretic peptides (NT-proBNP, Roche Diagnostics), serum cardiac tro-ponin T (cTnT, Roche Diagnostics) and serum myeloperoxidase (MPO, PrognostiXInc) were performed. Results: In our study cohort (mean age 55 6 11years, 96%breast cancer survivor, 70% with radiation, 31% hypertensive, 6% diabetic, 35%with lipid disorders, 52% with family history of coronary artery disease), all patientshad preserved LV ejection fraction (LVEF $ 50%), one patient had LV dilatation, and14 patients had left ventricular hypertrophy. In contrast, the mean plasma NT-proBNP level was 135 6 119 pg/mL (range 50-786 pg/mL, with 36% of subjectsabove the upper limit of normal at 125 pg/mL). The mean MPO level was 1,0706 752 pmol/L (range 206-3,876 pmol/L, with 69% of patients above the upper limitof normal at 640 pmol/L). Patients with cardiac pathology identified by echocardio-gram did not demonstrate statistically significant differences in biomarker levels thanthose with no apparent abnormalities. No subject presented with a clinical diagnosisof congestive heart failure or an elevated serum cTnT level (all ! 0.01 ng/mL). Con-clusion: Our pilot data of prospective screening for late-onset cardiomyopathy in re-cipients of cardiotoxic chemotherapy did not reveal any subject with asymptomaticleft ventricular dysfunction. However, the clinical significance regarding the substan-tial population with elevated cardiac biomarker levels (NT-proBNP and MPO) war-rants further evaluation and follow-up analysis.

390Prevalence of Complex Sleep-Disordered Breathing in CHF PatientsUndergoing Cardiac Resynchronization TherapyLarry Chinitz1, Yachuan Pu6, Kevin Ferrick2, Anthony Magnano3, Arjun Gururaj4,Erik Sirulnick4, Stuart Winston5, Lisa Stahl6, Jane Smyth-Melsky1, Joan Whelan-Schwartz6, Edward Burkhardt6, Geng Zhang6, Ross Sample6, David Rapoport1;1New York University Medical Center, New York; 2Montefiore Medical Center,New Work; 3St. Vincent’s Medical Center, Jacksonville, FL; 4Sunrise Hospital &Medical Center, Las Vegas, NV; 5St. Joseph Mercy Hospital, Ann Arbor, MI;6Boston Scientific Coporation, St. Paul, MN

Introduction: CHF Patients often have sleep-disordered breathing (SDB), particularlycentral sleep apnea and Cheyne-Stokes respiration (CSR) related to poor cardiac func-tion. Obstructive sleep apnea is commonly linked to obesity. Increasingly, a categorydescribed as ‘‘complex SDB’’ is being recognized, representing an overlap of obstruc-tive and central apnea and may often prevent diagnosing patients by those distinct phe-notypes. As part of the APNEA-CHF trial evaluating effects of CRTon SDB, this studydescribes complex SDB in CRT recipients. Methods: CRT indicated patients were en-rolled consecutively at 6 sites in the US. After implantation, patients were screened byfull polysomnography (PSG) and manually scored by a core lab using nasal cannula,thorax & abdomen effort, and EEG to classify apneas as obstructive or central. Apneahypopnea indices (AHI) were calculated separately for obstructive (oAHI) and central(cAHI) events. cAHI% and oAHI% were calculated as a percentage of the total AHI.Results: Of 50 patients screened by PSG; 37 (74%) had AHI $ 15. CAHI% ranged con-tinuously from 0 to 90% in these 37 patients (see figure). All patients were NYHA classIII, with baseline characteristics: age 5 62 6 11Yr, BMI 5 32 6 6kg/m2, LVEF 5 22 6

6%, AHI 5 43 6 21/Hr, cAHI 5 12 6 14/Hr, oAHI 5 30 6 21/Hr, F/M 5 3/34, Ische-mic/Non-Ischemic 5 15/22, QRS width 5 154 6 26s. Conclusions: SDB was verycommon in CRT patients. Much of this is neither pure obstructive nor central but com-plex, requiring detailed diagnosis. Concomitant obesity and poor cardiac function mayhave contributed to complexity of SDB. Further study is required to ascertain the impli-cations of complex SDB within a HF population.

391Safe and Cost Effective Utilization of Standard Telemetry Units for Patientswith Invasive Swan-Ganz MonitoringRobert L. Scott1, David E. Steidley1, Gale M. Hess1, Nancy S. Cisar1, Eva M.Caruso1, Jenifer M. Spadafore1, Sergei G. Shatillo1; 1Division of Cardiology,Mayo Clinic Arizona, Phoenix, AZ

Background: The utilization of Swan-Ganz monitoring catheters are necessary forthe diagnosis of pulmonary hypertension as well as the assessment of pulmonary ar-tery reactivity among patients evaluated for cardiac transplantation. Traditionally,such devices are restricted to Intensive Care Units thereby increasing the cost of hos-pitalization. Methods: In our investigation we evaluated a total of 60 patients admit-ted to a standard telemetry unit staffed by nurses with enhanced training in the care

LVEF groups & respective SphygmoCor indices (Mean 6 SD)

Group 1A (n 5 20) Group 1B (n 5 69) GROUP II (n 5 36)

EF 60 6 4 60 6 5 36 6 13VI 154 6 30 139 6 28** 167 6 37Radial EDI 35 6 5* 36 6 6** 41 6 6Central EDI 35 6 5 34 6 4** 38 6 6

[* p ! 0.05 1A vs II ] [**p ! 0.05 1B vs II].

S186 Journal of Cardiac Failure Vol. 13 No. 6 Suppl. 2007

389Prevalence of Sleep Disordered Breathing in Congestive Heart FailureKevin Jiang1, Nancy J. Gardetto2, Jennifer A. Tolen1, Susan I. Liu1, Alan S. Maisel2;1Research, VA San Diego Healthcare System, San Diego, CA; 2Cardiology, VA SanDiego Healthcare System, San Diego, CA

Background: Sleep Disordered Breathing (SDB) is very common in patients withcongestive heart failure (CHF), with some studies reporting an incidence of 50%. In-creased sympathetic activity, caused by frequent arousals (increased Apnea-Hypo-pnea Index [AHI]) during the night has been implicated as a contributing factor ina four-fold increase in mortality for CHF patients. Many patients are undiagnosedfor SDB due to lack of awareness of the disorder and access to an easy, reliablescreening test. The purpose of this study is to evaluate the prevalence of SDB in pa-tients with CHF in the inpatient and outpatient settings using the ApneaLink (AL)(ResMed Corp, San Diego, CA) screening device. Methods: 86 patients with CHFfrom the VA San Diego Healthcare System were enrolled. Eligible patients are thosewith diagnosis of CHF, treatment naive for SDB, and symptomatic for obstructivesleep apnea (OSA) per SDB questionnaire. The mean age was 66 years, and themean BMI was 32 kg/m2. SDB was defined using an AHI result of $ 5 events/hour. The prevalence of OSA was determined from the Apnea-Hypopnea Index(AHI) data recorded by the AL. Patients were included in the analysis if they hada minimum of 4 hours evaluation time (ET). Determination for the presence ofCheyne-Stokes respiration (CSR) was performed by evaluation of the flow signaldata. Results: 70% (60/86) of the patients met the enrollment criteria. The overallprevalence of OSA was 85% (51/60 subjects). CSR was detected in 32% (19/60 sub-jects). For the 44 subjects that completed the study in the outpatient setting, the prev-alence of OSA and CSR were 84% and 25%, respectively. In the inpatient setting, 16patients with an admission diagnosis of CHF completed the study with a prevalenceof 88% and 50% for OSA and CSR, respectively. The mean AHI was 23 6 21.8events/hour. A correlation was present between BMI and AHI. The mean BMI of pa-tients with high AHI ($ 5 events/hour) was 32.8, while mean BMI of those with lowAHI was 27.1 (p ! 0.05). Conclusions: SDB appears to be relatively common in the

CHF population, regardless of age. Preliminary results provide supportive evidencefor the clinical need to identify, diagnose and treat the CHF patient with SDB. TheAL is a relatively simple test to administer to patients and easy to use by patientsin the home setting. A larger sample size of hospital patients using the device is re-quired to evaluate utility in the inpatient setting.