due to severe sepsis. All patients however did have decreasing lactic acid level which points to resolving sepsis. Prospective studies with larger sample size may clarify the effect of larger volume of fluid in CHF patients with severe sepsis and septic shock. 141 Nemaline Rods: A Rare Case of Restrictive Cardiomyopathy Mohamed B. Elamin 1 , Amber L. Patton 2 , William T. Gunning III 1 , Samer J. Khouri 1 ; 1 University of Toledo, Toledo, Ohio; 2 Lima Pathology Associates, Inc., Lima, Ohio Introduction: Nemaline Myopathy is typically a skeletal muscle disorder defined by the presence of cytoplasmic inclusions called nemaline rods in myocytes that results in generalized muscle weakness. Case Presentation: This report is an unusual presentation of a 51-year-old female with symptoms of increasing dyspnea and lower extremity edema for a year. Her medical history included concentric left ventricular hypertrophy, severe restrictive cardiomyopathy, and pulmonary hypertension. Micro- scopic examination of an endomyocardial biopsy revealed individual cardiomyocyte hypertrophy with non-specific degenerative changes. Electron microscopy revealed mild interstitial fibrosis and cardiomyocytes with multiple crystalloid inclusions synonymous with nemaline bodies seen in nemaline myopathy. Discussion: Nemaline rods associated with myopathy are typically seen only in skeletal muscle. However, a few cases of nemaline rods associated with cardiomyopathy have been reported, but most have been associated with dilated cardiomyopathy. This is a novel case of restrictive cardiomyopathy with nemaline body inclusions. 142 Right Ventricular Endo-Diastolic Pressure is a Key to the Changes in Cardiac Output During Adaptive Servo-Ventilation Support in Patients with Heart Failure—Clinical Relevance of Transmural Left Ventricular Filling Pressure Teruhiko Imamura 1 , Koichiro Kinugawa 2 ; 1 Graduate School of Medicine, University of Tokyo, Tokyo, Japan; 2 Toyama University, Toyama, Japan Objective: Adaptive servo-ventilation (ASV) is a recently developed, noninvasive ther- apeutic tool for the treatment of congestive heart failure, and has been proven to improve patients’ clinical course. However, precise hemodynamic response during ASV support remained uncertain. Methods: A total of 69 patients with heart failure assigned to New York Heart Association class II-IV (53 years old and 179 pg/mL of plasma B-type na- triuretic peptide level on average) received 10-min ASV support testing along with hemodynamic studies before and after ASV. Intracavitary left ventricular endo- diastolic pressure (LVEDP) was alternated by pulmonary capillary wedge pressure. Findings: Of all, 21 patients (30%) achieved the acute response, which was defined as any increase in cardiac index (CI) during ASV support. Δintracavitary LVEDP did not correlate with ΔCI, whereas Δtransmural LVEDP, which was calculated by sub- tracting right ventricular endo-diastolic pressure (RVEDP) from intracavitary LVEDP, and ΔCI were positively correlated (P = .009, r = 0.311). Among baseline data, higher RVEDP and higher LVEDP were demonstrated to be significant predictors of acute response by logistic regression analyses (P < .05 for both). RVEDP had significantly higher area under curve over LVEDP in the receiver operating characteristics analy- ses (0.846 vs. 0.673, P = .028). Higher baseline RVEDP was significantly associated with more decrease in RVEDP during ASV (P < .001, r =−0.604). Conclusion: ASV increases cardiac output through decrease in RVEDPand increase in transmural LVEDP according to the Frank-Starling’s law in heart failure patients, when they had el- evated baseline RVEDP. 144 Prospective, Randomised and Blinded Clinical Study Testing Two Levels of Dietary Sodium Intake in Patients with Acute Decompensated Heart Failure Camila G. Fabrício, Jaqueline R.S. Gentil, Cristiana A.F. Amato, Fabiana Marques, Pedro V. Schwartzmann, Marcus V. Simões; Medical School of Ribeirão Preto—University of Sao Paulo, Ribeirão Preto, Brazil Introduction: Current guidelines endorse the use of low dietary sodium intake for the treatment of acute decompensated heart failure (ADHF). However, this recom- mendation is not based on scientific evidence. Purpose: This study aimed at assessing the effect of two levels of dietary sodium intake in hospitalized patients with ADHF. We hypothesize that a normal sodium diet is associated with more preserved levels of serum sodium during the hospitalization. Methods: We investi- gated prospectively 44 patients hospitalized for ADHF, randomized to 2 groups: LS (low sodium diet), receiving 3g/day of dietary NaCl (n = 22, 59.5 ± 11.9 y.o., 50% male, LVEF = 30.0 ± 13.6%); and NS (normal sodium diet), receiving 7g/day of dietary NaCl (n = 22, 56.4 ± 10.3 y.o., 68% male; LVEF =27.8 ± 11.7%). Both groups were submitted to a limit of fluid intake of 1000 ml/day. The primary endpoint was the serum sodium level at day 7. The NT-Pro-BNP levels were measured at baseline and at day 7. Daily monitoring included: analogic visual scale of dyspnea, body weight, accumulated fluid balance, diuretic dose, mean blood pressure (BP); and serum levels of sodium, ureic nitrogen, and creatinine. Results: LS and NS groups presented, respectively, similar amount of accumulated fluid balance (-1118.6 ± 1362.6 ml vs -1581.3 ± 5169.0 ml, P = .7), percent body weight reduction (5.4 ± 4,7% vs 4.6 ± 5,2%, p = 0,6), cumulative furosemide dose (6.9 ± 4.1 mg/ kg vs 6.2 ± 3.1 mg/kg, P = .5), percent reduction of NT-Pro-BNP levels (15.2 ± 40.4% vs 22.8 ± 55.5%, P = .6), improvement in visual analogic scale of dyspnea (3.4 ± 2.1 e 3.0 ± 1.9, P = .6). Additionally, at day 7, the LS group presented lower levels of serum sodium (135.3 ± 3.7 mg/dl) in comparison to the NS (137.7 ± 1.9 mg/dl; P = .03). During hospitalization, 4 cases of hyponatremia were observed, all in the LSD group (22%). The NS group exhibited more preserved values of BP (79.4 ± 2.4 mmHg), as compared to the LS group (75.5 ± 3.0 mmHg), P = .03. The renal function tests presented no significant difference between groups. Conclusions: In patients with ADHF, the use of low dietary sodium intake is not associated to additional benefits when compared to a normal sodium diet in regard to reduction of congestive manifestations, symptoms resolution and decrease of the neurohumoral activation. In addition, the normal sodium diet was associated to preservation of serum sodium and blood pressure levels. These results suggest that a low sodium diet should not be routinely used for ADHF treatment. 145 An Assessment of Knowledge of Sleep Apnea in a Heart Failure Population Lauren Tiberio, Sara Naseer, Penny Cyr, Richard Soucier; Saint Francis Hospital and Medical Center, Hartford, Connecticut Introduction: Sleep apnea, defined as interrupted or complete cessation of breathing during sleep, is diagnosed by assessing the number of apneic and/or hypopneic during overnight plethysmography. Of the two distinct etiologies of this syndrome, obstructive (OSA) and central sleep apnea (CSA), OSA is generally easier to diagnose and is characterized by intermittent upper airway obstruction resulting in airflow cessation. Risk factors for OSA include increased body mass index, smoking, hypertension and diabetes. CSA can be more difficult to diagnose, as it is less frequently characterized by a standard phenotypical profile. Risk factors for CSA include acute serious illness, severe neurologic disease, opioid use, and renal disease, as well as advanced cardiac diseases, notably heart failure (HF). The prevalence of both is high in patients with both chronic systolic dysfunction (HFrEF) and in patients with HF with a preserved ejection fraction (HFpEF). This association occurs in up to 50% of HF patients. The coexistence of these two disease states portends a poor prognosis and the presence of sleep apnea is under recognized. Methods: We sought to evaluate how frequently sleep apnea is considered in a group of heart failure patients admitted for acute decompensation. Using data we currently collect on all inpatients admitted to the heart failure unit at our institution from July through September 2015 through American Heart Association’s Get with the Guidelines database, we attempted to evaluate how often OSA, CSA, or both were considered as a concomitant diagnosis by evaluating whether or not patients had any documented reference to the presence of or evaluation for sleep apnea. We also evaluated which clinical variables were associated with whether or not sleep apnea was considered. Results: Two hundred fourteen consecutive patients admitted to the heart failure unit for acute HF were reviewed. Of these, 97 patients (45.3%) had HFrEF and 117 (54.7%) had HFpEF. The mean age of this cohort was 74.5 years. One hundred nine were female (50.9%). Overall, only seventy two patients (34%) either had a diagnosis of sleep apnea or had a reference to its presence. Of the patients with the diagnosis of OSA or CSA or who were considered for these diseases, only a BMI > 30 seem to be associated (Table). Discussion: The diagnosis of sleep apnea, especially CSA, is difficult in patients with chronic HF even within a HF program with specially trained practitioners. When OSA is suspected, the diagnosis is considered, leaving many patients with unrecognized CSA. Based on these results, routine screening should be considered for all hospitalized heart failure patients. The 20 th Annual Scientific Meeting • HFSA S55