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1

Heart Failure  

MedlinePLUS

... version of this page please turn Javascript on. Heart Failure What is Heart Failure? In heart failure, the heart cannot pump ... the lungs, where it picks up oxygen. The Heart's Pumping Action In normal hearts, blood vessels called ...

2

Heart Failure  

MedlinePLUS

Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped ... Tiredness and shortness of breath Common causes of heart failure are coronary artery disease, high blood pressure and ...

3

Heart Failure  

MedlinePLUS

... failure" simply means that your heart isn't pumping blood as well as it should. Heart failure does not mean ... your heart. The pictures show your doctor how well your heart is pumping. Radionuclide ventriculography involves injecting a very small amount ...

4

[Heart failure].  

PubMed

It seems that the causes of the insomnia are dyspnea and an orthopnea in the heart failure patient. But, only such a fit is not the cause of the insomnia because it complains about the insomnia even if heart failure is slight. An obstructive sleep apnea (OSA) is the risk of the heart failure. A heart failure patient often complicates a central sleep apnea (CSA) and a Cheyne-Stokes respiration (CSR), and has much sleep fragmentation and difficulty maintaining sleep. And sleep disorders are sometimes started by the medications such as the cardiovascular system agent thing; beta blocker and the statins. Sleep disorders represent a major challenge in terms of differential diagnosis in heart failure patients. This is particularly relevant to insomnia and sleep disordered breathing (SDB) such as OSA, CSA and CSR. Thus, expending the knowledge on both insomnia and SDB may contribute to improve medical quality among physician. PMID:19768933

Sasanabe, Ryujiro; Shiomi, Toshiaki

2009-08-01

5

Heart Failure Overview  

MedlinePLUS

CHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failure - Cor pulmonale; Cardiomyopathy - heart failure ... Heart failure is often a long-term (chronic) condition, but it may come on suddenly. It can ...

6

Types of Heart Failure  

MedlinePLUS

Types of Heart Failure Updated:Sep 9,2014 Left-sided heart failure The heart's pumping action moves oxygen-rich blood as it ... during their journey. Visit our Support Network today . Heart Failure Questions to Ask Your Doctor Use these questions ...

7

Classes of Heart Failure  

MedlinePLUS

Classes of Heart Failure Updated:Sep 29,2014 Doctors usually classify patients' heart failure according to the severity of their symptoms. The ... is classified: Functional Capacity IV, Objective Assessment A Heart Failure Questions to Ask Your Doctor Use these questions ...

8

Managing Feelings about Heart Failure  

MedlinePLUS

... About Heart Failure Module 6: Managing Feelings About Heart Failure Download Module Order Hardcopy Heart failure can cause ... professional help for emotional problems. Common Feelings About Heart Failure It is common for people to feel depressed ...

9

Biomarkers in heart failure.  

PubMed

Appropriate use of biomarkers is clinically important for identifying heart failure in its early stage, optimizing risk stratification, and managing patients. This article describes established and traditional biomarkers as well as novel biomarkers reflective of myocardial stress, myocardial damage, extracellular matrix, oxidative stress, inflammation, renal function, micro RNAs, and heart failure with preserved left ventricular ejection fraction. This review focuses on the recent advances in cardiac and non-cardiac biomarkers of heart failure and their appropriate use in clinical practice. PMID:25341366

Takeishi, Yasuchika

2014-11-13

10

Heart failure - surgeries and devices  

MedlinePLUS

... Suggested procedures may include: Angioplasty and stent placement Heart bypass surgery ... cause heart failure or make heart failure worse. Heart valve surgery may be needed to repair or replace one ...

11

Warning Signs of Heart Failure  

MedlinePLUS

Warning Signs of Heart Failure Updated:Jul 18,2014 By themselves, any one sign of heart failure may not be cause for alarm. But ... content was last reviewed on 08/20/2012." Heart Failure • Home • About Heart Failure • Warning Signs of Heart ...

12

Advanced Heart Failure  

MedlinePLUS

... doctors, making good decisions requires teamwork. Through shared decision making, doctors and patients consider both the options and ... care you want to receive. What is shared decision making? When heart failure progresses to an advanced stage, ...

13

Congestive Heart Failure  

MedlinePLUS Videos and Cool Tools

... the main medicines for treating heart failure: • Diuretics (water or fluid pills) help reduce fluid buildup in ... the body to get rid of salt and water through urine, which lowers the volume of blood ...

14

Apoptosis, Heart Failure, Ischemic Heart Disease  

Microsoft Academic Search

Cardiomyocytes die by apoptosis in addition to necrosis under a variety of pathological conditions including heart failure, cardiomyopathy, and ischemia\\/reperfusion. This review summarizes current status of the literature demonstrating evidence of apoptotic cell death in heart failure and ischemic heart disease. Apoptotic cells have been detected in failing hearts of human and dog. Ischemia up to 2 hr does not

Nilanjana Maulik; Dipak K. Das

1999-01-01

15

Sleep in heart failure.  

PubMed

Sleep plays a large role in patients with heart failure. In normal subjects, sleep is usually in a supine position with reduced sympathetic drive, elevated vagal tone and as such a relatively lower cardiac output and minute ventilation, allowing for recuperation. Patients with heart failure may not experience the same degree of autonomic activity change and the supine position may place a large strain on the pulmonary system. More than half of all heart failure patients have one of two types of sleep apnea: either obstructive or central sleep apnea. Some patients have both types. Obstructive sleep apnea is likely to be a cause of heart failure due to large negative intrathoracic pressures, apnea related hypoxemia and hypercapnia, terminated by an arousal and surge in systemic blood pressure associated with endothelial damage and resultant premature atherosclerosis. Reversal of obstructive sleep apnea improves blood pressure, systolic contraction and autonomic dysfunction however mortality studies are lacking. Central sleep apnea with Cheyne Stokes pattern of respiration (CSA-CSR) occurs as a result of increased central controller (brainstem driving ventilation) and plant (ventilation driving CO2) gain in the setting of a delayed feed back (i.e., low cardiac output). It is thought this type of apnea is a result of moderately to severely impaired cardiac function and is possibly indicative of high mortality. Treatment of CSA-CSR is best undertaken by treating the underlying cardiac condition which may include with medications, pacemakers, transplantation or continuous positive airway pressure (CPAP). In such patients CPAP exerts unique effects to assist cardiac function and reduce pulmonary edema. Whether CPAP improves survival in this heart failure population remains to be determined. PMID:19110135

Naughton, Matthew T; Lorenzi-Filho, Geraldo

2009-01-01

16

Heart failure induced by itraconazole  

PubMed Central

Itraconazole is a broad-spectrum antifungal agent. It rarely leads to adverse the cardiovascular effects, especially heart failure. We present here a case of a 60-year-old female patient with itraconazole induced heart failure. PMID:24130392

Okuyan, H?z?r; Alt?n, Cihan

2013-01-01

17

Heart failure induced by itraconazole.  

PubMed

Itraconazole is a broad-spectrum antifungal agent. It rarely leads to adverse the cardiovascular effects, especially heart failure. We present here a case of a 60-year-old female patient with itraconazole induced heart failure. PMID:24130392

Okuyan, H?z?r; Alt?n, Cihan

2013-01-01

18

Ejection Fraction Heart Failure Measurement  

MedlinePLUS

Ejection Fraction Heart Failure Measurement Updated:Aug 4,2014 The ejection fraction (EF) is an important measurement in determining how well ... content was last reviewed on 07/09/2013. Heart Failure News Read the latest heart failure related ...

19

Primary Prevention of Heart Failure  

PubMed Central

Most heart failure research and quality improvement efforts are targeted at treatment and secondary prevention of patients with manifest heart failure. This is distinct from coronary disease where primary prevention has been a focus for over three decades. Given the current importance and the projected worsening of heart failure epidemiology, a more focused effort on prevention is urgently needed. PMID:22957272

Butler, Javed

2012-01-01

20

Beta blockers in heart failure  

Microsoft Academic Search

The rationale for beta blockade in heart failure is now well established. Heart failure mortality, which is predicted by neurohormonal activation, remains high despite modern treatment, including angiotensin-converting enzyme (ACE) inhibition, and additional neurohormonal blockade has further therapeutic potential. Previous clinical trial experience in heart failure, most of which has been in patients with idiopathic cardiomyopathy, indicates consistent improvement in

Norman Sharpe

1996-01-01

21

CONGESTIVE HEART FAILURE Congestive Heart Failure: Condition in which the heart muscle can not pump enough  

E-print Network

, and increased heart rate are the clinical markers of disease progression as the heart attempts to compensate disease (HTN, Diabetes, Cardiomyopathy, Heart Valve Disease, etc.) ultimately may lead to heart failureCONGESTIVE HEART FAILURE Congestive Heart Failure: Condition in which the heart muscle can not pump

22

Heart failure - fluids and diuretics  

MedlinePLUS

When you have heart failure, your heart does not pump out enough blood. This causes fluids to build up in your body. If you ... the amount of fluids you drink: When your heart failure is not very bad, you may not have ...

23

Predicting survival in heart failure  

Microsoft Academic Search

Despite advances in the therapy of cardiovascular disorders, heart failure remains a challenging disease with a dismal prognosis.\\u000a A plethora of variables have been shown to be related to survival in patients with heart failure. These include heart failure\\u000a etiology, clinical presentation, ventricular performance, exercise capacity, neurohormones and, more recently, inflammatory\\u000a and necrosis markers. In this review we briefly list

Viorel G. Florea; Inder S. Anand

2007-01-01

24

Acute Heart Failure Treatment  

PubMed Central

Dyspnea is the predominant symptom for patients with acute heart failure and initial treatment is largely directed towards the alleviation of this. Contrary to conventional belief, not all patients present with fluid overload and the approach to management is rapidly evolving from a solitary focus on diuresis to one that more accurately reflects the complex interplay of underlying cardiac dysfunction and acute precipitant. Effective treatment thus requires an understanding of divergent patient profiles and an appreciation of various therapeutic options for targeted patient stabilization. The key principle within this paradigm is directed management that aims to diminish the work of breathing through situation appropriate ventillatory support, volume reduction and hemodynamic improvement. With such an approach, clinicians can more efficiently address respiratory discomfort while reducing the likelihood of avoidable harm. PMID:24223323

Bellou, Abdel

2013-01-01

25

Surgical alternatives for heart failure  

Microsoft Academic Search

Heart failure is one of the leading causes of hospitalization in the United States. Congestive heart failure is a chronic, progressive disease and its central element is remodeling of the cardiac chamber associated with ventricular dilation. Secondary mitral regurgitation is a complication of end-stage cardiomyopathy and is associated with poor prognosis. Historically, these patients were not considered operative candidates because

Steven F Bolling; Iva A Smolens; Francis D Pagani

2001-01-01

26

Congestive heart failure. New frontiers.  

PubMed Central

Congestive heart failure is a common syndrome with high mortality in its advanced stages. Current therapy includes the use of vasodilator drugs, which have been shown to prolong life. Despite current therapy, mortality remains high in patients with severe heart failure. Potent new inotropic vasodilators have improved ventricular performance but have not prolonged life in patients with end-stage heart failure. Serious arrhythmias are implicated in the sudden deaths of 30% to 40% of patients with severe heart failure, but the benefits of antiarrhythmic therapy have not been established. Upcoming trials will address this question. Ventricular remodeling and progressive dilatation after myocardial infarction commonly lead to congestive heart failure; early unloading of the ventricle with an angiotensin-converting enzyme inhibitor may attenuate these events. These findings support the concept that angiotensin-converting enzyme inhibitors may be useful in managing heart failure of all degrees of severity, including left ventricular dysfunction and end-stage heart failure. Part of the damage that may occur with acute myocardial infarction, particularly in this era of thrombolysis therapy, is reperfusion injury, which may be mediated by oxygen-derived free radicals. Better knowledge of the mechanisms and treatment of myocardial infarction, the leading cause of congestive heart failure, may help prevent or attenuate the development of this syndrome. PMID:1678903

Parmley, W. W.; Chatterjee, K.; Francis, G. S.; Firth, B. G.; Kloner, R. A.

1991-01-01

27

Heart failure in North America.  

PubMed

Heart failure is a major health problem that affects patients and healthcare systems worldwide. Within the continent of North America, differences in economic development, genetic susceptibility, cultural practices, and trends in risk factors and treatment all contribute to both inter-continental and within-continent differences in heart failure. The United States and Canada represent industrialized countries with similar culture, geography, and advanced economies and infrastructure. During the epidemiologic transition from rural to industrial in countries such as the United States and Canada, nutritional deficiencies and infectious diseases made way for degenerative diseases such as cardiovascular diseases, cancer, overweight/obesity, and diabetes. This in turn has resulted in an increase in heart failure incidence in these countries, especially as overall life expectancy increases. Mexico, on the other hand, has a less developed economy and infrastructure, and has a wide distribution in the level of urbanization as it becomes more industrialized. Mexico is under a period of epidemiologic transition and the etiology and incidence of heart failure is rapidly changing. Ethnic differences within the populations of the United States and Canada highlight the changing demographics of each country as well as potential disparities in heart failure care. Heart failure with preserved ejection fraction makes up approximately half of all hospital admissions throughout North America; however, important differences in demographics and etiology exist between countries. Similarly, acute heart failure etiology, severity, and management differ between countries in North America. The overall economic burden of heart failure continues to be large and growing worldwide, with each country managing this burden differently. Understanding the inter-and within-continental differences may help improve understanding of the heart failure epidemic, and may aid healthcare systems in delivering better heart failure prevention and treatment. PMID:23597296

Blair, John E A; Huffman, Mark; Shah, Sanjiv J

2013-05-01

28

Heart Failure in North America  

PubMed Central

Heart failure is a major health problem that affects patients and healthcare systems worldwide. Within the continent of North America, differences in economic development, genetic susceptibility, cultural practices, and trends in risk factors and treatment all contribute to both inter-continental and within-continent differences in heart failure. The United States and Canada represent industrialized countries with similar culture, geography, and advanced economies and infrastructure. During the epidemiologic transition from rural to industrial in countries such as the United States and Canada, nutritional deficiencies and infectious diseases made way for degenerative diseases such as cardiovascular diseases, cancer, overweight/obesity, and diabetes. This in turn has resulted in an increase in heart failure incidence in these countries, especially as overall life expectancy increases. Mexico, on the other hand, has a less developed economy and infrastructure, and has a wide distribution in the level of urbanization as it becomes more industrialized. Mexico is under a period of epidemiologic transition and the etiology and incidence of heart failure is rapidly changing. Ethnic differences within the populations of the United States and Canada highlight the changing demographics of each country as well as potential disparities in heart failure care. Heart failure with preserved ejection fraction makes up approximately half of all hospital admissions throughout North America; however, important differences in demographics and etiology exist between countries. Similarly, acute heart failure etiology, severity, and management differ between countries in North America. The overall economic burden of heart failure continues to be large and growing worldwide, with each country managing this burden differently. Understanding the inter-and within-continental differences may help improve understanding of the heart failure epidemic, and may aid healthcare systems in delivering better heart failure prevention and treatment. PMID:23597296

Blair, John E. A; Huffman, Mark; Shah, Sanjiv J

2013-01-01

29

Heart Failure: Unique to Older Adults  

MedlinePLUS

Heart Failure Unique to Older Adults This section provides information to help older adults and their caregivers ... or maintain quality of life. Urinary Incontinence and Heart Failure If you have heart failure, you may ...

30

Heart Failure Questions to Ask Your Doctor  

MedlinePLUS

... Pressure High Blood Pressure Tools & Resources Stroke More Heart Failure Questions to Ask Your Doctor Updated:Apr 2, ... content was last reviewed on 08/20/2012." Heart Failure News Read the latest heart failure related news. ...

31

[Metabolic therapy for heart failure].  

PubMed

Heart failure may promote metabolic changes such as insulin resistance, in part through neurohumoral activation, and determining an increased utilization of non-carbohydrate substrates for energy production. In fact, fasting blood ketone bodies as well as fat oxidation have been shown to be increased in patients with heart failure. The result is depletion of myocardial ATP, phosphocreatine and creatine kinase with decreased efficiency of mechanical work. A direct approach to manipulate cardiac energy metabolism consists in modifying substrate utilization by the failing heart. To date, the most effective metabolic treatments include several pharmacological agents that directly inhibit fatty acid oxidation. The results of current research are supporting the concept that shifting the energy substrate preference away from fatty acid metabolism and toward glucose metabolism could be an effective adjunctive treatment in patients with heart failure. Trimetazidine is the most studied drug in this context. Several small studies have evidenced the usefulness of such additional therapeutic tools for heart failure. More specifically, recent meta-analyses and a multicenter retrospective study have shown that additional use of trimetazidine in patients with heart failure, along with symptoms and cardiac function improvement, also provides a significant protective effect on all-cause mortality, cardiovascular events and hospitalization due to cardiac causes. Nevertheless, the exact role of metabolic therapy in heart failure is yet to be established, and a large multicenter randomized trial is necessary. PMID:25072544

Loiacono, Ferdinando; Alberti, Luca; Lauretta, Ludovica; Puccetti, Patrizia; Silipigni, Carmen; Margonato, Alberto; Fragasso, Gabriele

2014-01-01

32

[Therapeutic perspectives in heart failure  

PubMed

Many different diseases may lead to heart failure. Nevertheless, the symptoms and pathophysiological changes in heart failure are uniform as are the basic principles of treatment. Although significant progress has been achieved in understanding the biology of heart failure and the therapeutic options, the quality of life of heart failure patients and their survival are often poor. Since cardiac transplantation as a final therapeutic option is limited by the availability of donor organs, new strategies and technologies need to be explored to treat the failing heart effectively. Approaches to improve the medical therapy of heart failure mainly focus on strategies to escape the vicious circle of decreased contractility and neurohumoral activation. Substances with promising experimental and clinical results include neutral endopeptidase inhibitors, endothelin antagonists or cytokine inhibitors, e.g. TNF antagonists. Mechanical and electrical devices are under development such as left ventricular assist devices (LVADs), biventricular pacemakers and artificial hearts, which may become valuable alternative therapies. Gene therapy approaches aim to improve the vascularization of the heart, the Ca-homeostasis of the myocytes or the survival of cardiac cells in disease. Finally, cellular cardiomyoplasty is a relatively novel approach to replace or support the cardiomyocytes of the diseased heart by implanting new ones. Which cell type under which conditions will turn out to be the most suitable is still unknown and subject to debate. Ongoing clinical studies will only help to demonstrate the safety and feasibility of this technique but not determine its long-term efficacy. It is highly desirable that one of these new therapeutic strategies or a combination of them will have a significant impact on the future management of heart failure. Currently, our main clinical focus must be to treat as many patients as possible with drugs that are known to improve symptoms and survival, like ACE inhibitors, beta-blockers, cardiac glycosides, diuretics and spironolactone. PMID:12806818

Müller-Ehmsen, Jochen; Schwinger, Robert H

2003-04-01

33

Sleep dysfunction in heart failure  

Microsoft Academic Search

Opinion statement  Chronic congestive heart failure is a highly prevalent and progressive disorder associated with excess morbidity and mortality;\\u000a it has huge economic impact. Left heart failure may be systolic or may occur as isolated diastolic dysfunction. The diastolic\\u000a form predominates in older people. Sleep disorders are frequent in both types. Most systematic studies have been performed\\u000a in patients with systolic

Shahrokh Javaheri

2008-01-01

34

A Review of Heart Failure Treatment  

Microsoft Academic Search

Heart failure is a common and costly medical condition. Ischemic heart disease and hypertension account for most cases of heart failure in developed countries. Estimates of the one-year mortality rates for patients with New York Heart Association (NYHA) Class II, III, and IV are 10%, 20%, and 40%, respectively. Angiotensin-converting enzyme (ACE) inhibitors reduce mortality of heart failure patients by

GORDON H. GUYATT; P. J. DEVEREAUX

2004-01-01

35

Heart failure - what to ask your doctor  

MedlinePLUS

... a pump that moves blood through your body. Heart failure occurs when blood does not move well and ... often, fluid collects in your lungs and legs. Heart failure usually occurs because the muscles of your heart ...

36

Heart Failure in Children and Adolescents  

MedlinePLUS

... like a battery and internal wires. What Is Heart Failure? For a child to grow and develop, the ... a child may not function normally. The term “heart failure” describes a heart that's not functioning properly. It ...

37

Anemia in Heart Failure Patients  

PubMed Central

Heart failure is a very common disease, with severe morbidity and mortality, and a frequent reason of hospitalization. Anemia and a concurrent renal impairment are two major risk factors contributing to the severity of the outcome and consist of the cardio renal anemia syndrome. Anemia in heart failure is complex and multifactorial. Hemodilution, absolute or functional iron deficiency, activation of the inflammatory cascade, and impaired erythropoietin production and activity are some pathophysiological mechanisms involved in anemia of the heart failure. Furthermore other concomitant causes of anemia, such as myelodysplastic syndrome and chemotherapy, may worsen the outcome. Based on the pathophysiology of cardiac anemia, there are several therapeutic options that may improve hemoglobin levels, tissues' oxygenation, and probably the outcome. These include administration of iron, erythropoiesis-stimulating agents, and blood transfusions but still the evidence provided for their use remains limited. PMID:22536520

Alexandrakis, Michael G.; Tsirakis, George

2012-01-01

38

Sleep apnoea in heart failure.  

PubMed

Studies from the USA have reported that sleep apnoea is common in congestive heart failure (CHF), with Cheyne-Stokes respiration (CSR) being the most frequent type of sleep-disordered breathing (SDB) in these patients. Within the present study, the authors sought to assess the prevalence and type of SDB among CHF patients in Germany. A total of 203 CHF patients participated in this prospective multicentre study. All patients were stable in New York Heart Association classes II and III and had a left ventricular ejection fraction (LVEF)<40%. The patients were investigated by polygraphy and all data were centrally analysed. Patient enrolment was irrespective of sleep-related symptoms. The majority of patients were male with a mean age of 65 yrs and hospitalised. Of the 203 patients, 145 (71%) had an apnoea/hypopnoea index>10.h(-1), obstructive sleep apnoea (OSA) occurred in 43% (n=88) and CSR in 28% (n=57) of patients. The prevalence of sleep-disordered breathing is high in patients with stable severe congestive heart failure from a European population. As sleep-disordered breathing may have a negative impact on the prognosis of congestive heart failure, a sleep study should be performed in every patient with congestive heart failure and a left ventricular ejection fraction of <40%. This diagnostic approach should probably be adopted for all of these patients irrespective of the presence of sleep-related symptoms. PMID:17360729

Schulz, R; Blau, A; Börgel, J; Duchna, H W; Fietze, I; Koper, I; Prenzel, R; Schädlich, S; Schmitt, J; Tasci, S; Andreas, S

2007-06-01

39

Congenital heart disease in adults: management of advanced heart failure  

Microsoft Academic Search

The number of adults living with congenital heart disease grows annually. The sequelae of congenital heart disease surgery may involve the electrical conduction system, cardiac valves, prosthetic materials, the myocardium, vascular beds, and the nervous system. These sequelae may lead to heart failure. Adults with congenital heart disease develop heart failure as a consequence of: (1) chronic cyanosis, volume overload,

Stacy F. Davis; Thomas P. Graham

2003-01-01

40

Lifestyle Changes for Heart Failure  

MedlinePLUS

... Failure Updated:Oct 28,2014 Following recommendations about diet, exercise and other habits can help to alleviate symptoms, ... Eating a heart-healthy diet Eat a healthy diet that's low in saturated ... Begin an exercise program (with your healthcare provider's permission). Schedule physical ...

41

Maximum therapy for heart failure  

Microsoft Academic Search

Standard medical therapy in the treatment of heart failure is a combination of a loop diuretic, an angiotensin-converting enzyme (ACE) inhibitor and a beta- blocker. A number of other pharmacological and non-pharmacological therapies are also available, and may be highly useful in selected patients. This chapter is written to offer a practical guide to the use of these different agents

Michael Davies

42

How Can I Live with Heart Failure?  

MedlinePLUS

What medicine might I take? The goal of heart failure treatment is to help you live a longer, better-quality life. Treating the causes of heart failure with medication can lessen tiredness (fatigue), shortness of ...

43

Congestive heart failure: echocardiographic insights.  

PubMed

This study was designed to assess the role of echocardiography in the evaluation and management of patients with the congestive heart failure syndrome. Fifty consecutive patients with congestive heart failure referred for echocardiography were evaluated. Thirty patients (60 percent) had ejection fractions under 50 percent (mean +/- SD 30 +/- 9 percent), left ventricular dilatation (6.5 +/- 0.7 cm), and normal wall thicknesses (1.0 +/- 0.2 cm). The echocardiographic findings were predictable on clinical grounds in 18 of the 30 patients (60 percent) and worse than clinically expected in 12 patients (40 percent). Management changes after echocardiography were indicated in 11 of 30 patients (37 percent). The remaining 20 of the 50-patient cohort (40 percent) had ejection fractions above 50 percent (mean 70 +/- 9 percent, p less than 0.01), and, as a group, were characterized by normal left ventricular size (5.1 +/- 0.8 cm, p less than 0.01) and borderline wall thicknesses (1.1 +/- 0.2 cm, p less than 0.01). The largest subgroup of these 20 patients had hypertensive heart disease (seven patients, 35 percent) associated with the congestive heart failure syndrome presumably related to left ventricular diastolic (compliance) dysfunction. The normal ejection fraction was unexpected clinically in 18 of these 20 patients (90 percent). Recommended management after echocardiography changed in all 18 patients. Since standard clinical findings (history, physical examination, and chest roentgenography) failed to separate patients with normal and abnormal ejection fractions, or those in need of changes in management, echocardiography was a useful and, at times, essential part of the evaluation of these patients with the congestive heart failure syndrome. PMID:6638044

Echeverria, H H; Bilsker, M S; Myerburg, R J; Kessler, K M

1983-11-01

44

Cardiotonic Modulation in Heart Failure  

PubMed Central

Medicinal herbs have been used over the past centuries for restoring the body's homeostatic balance. Contemporary use of herbal supplements remains widespread in many cultures as treatment for specific ailments. Many possess cardiovascular actions, and some interact with cardiac medications. However, there is variable scientific evidence with respect to their safety and efficacy, and few have been subjected to the same rigorous evaluation processes and regulations as contemporary pharmaceuticals (1). In the field of heart failure, we have also witnessed the failure of promising naturopathic therapies like hawthorn extract in translating their potential benefits in rigorous clinical trials (2,3). PMID:23747774

Tang, W. H. Wilson; Huang, Yanming

2014-01-01

45

Medication adherence in heart failure  

Microsoft Academic Search

Non-adherence with medical regimens in heart failure is a significant challenge and serves as a major reason that favorable\\u000a outcomes associated with various therapies evaluated in clinical trials have not translated to the so-called real-world setting.\\u000a Non-adherence has complex influences and is clearly associated with poorer outcomes. The approaches that are used or have\\u000a been proposed to improve drug-taking behavior,

Paul J. Hauptman

2008-01-01

46

Heart Failure in South Asia  

PubMed Central

South Asia (SA) is both the most populous and the most densely populated geographical region in the world. The countries in this region are undergoing epidemiological transition and are facing the double burden of infectious and non-communicable diseases. Heart failure (HF) is a major and increasing burden all over the world. In this review, we discuss the epidemiology of HF in SA today and its impact in the health system of the countries in the region. There are no reliable estimates of incidence and prevalence of HF (heart failure) from this region. The prevalence of HF which is predominantly a disease of the elderly is likely to rise in this region due to the growing age of the population. Patients admitted with HF in the SA region are relatively younger than their western counterparts. The etiology of HF in this region is also different from the western world. Untreated congenital heart disease and rheumatic heart disease still contribute significantly to the burden of HF in this region. Due to epidemiological transition, the prevalence of hypertension, diabetes mellitus, obesity and smoking is on the rise in this region. This is likely to escalate the prevalence of HF in South Asia. We also discuss potential developments in the field of HF management likely to occur in the nations in South Asia. Finally, we discuss the interventions for prevention of HF in this region PMID:23597297

Sivadasan Pillai, Harikrishnan; Ganapathi, Sanjay

2013-01-01

47

Congestive Heart Failure: Experimental Model  

PubMed Central

Introduction: Surgically induced, combined volume and pressure overload has been used in rabbits to create a simplified and reproducible model of acute left ventricular (LV) failure. Materials and Methods: New Zealand white male rabbits (n?=?24, mean weight 3.1?±?0.2?kg) were randomly assigned to either the Control group (n?=?10) or to the Heart Failure group (HF, n?=?14). Animals in the Control group underwent “sham” procedures. Animals in the HF group underwent procedures to induce LV volume overload by inducing severe aortic valve regurgitation with aortic cusp disruption and pressure overload using an occlusive silver clip positioned around the pre-renal abdominal aorta. Results: Following Procedure-1 (volume overload) echocardiography confirmed severe aortic regurgitation in all animals in the HF group, with increased mean pulse pressure difference from 18?±?3 to 38?±?3?mmHg (P?heart/body weight ratio in the HF group vs. Control group (4.6?±?0.2 vs. 2.9?±?0.1?g/kg, P?heart failure, (b) provides new data on the time course of LV dilatation, hypertrophy and failure, (c) allows study of the progress and evolution of LV systolic and diastolic dysfunction in the presence of induced LV failure, (d) is suitable to study intervention or pharmacological administration to reduce the negative effects of acute LV failure. PMID:24400279

Corno, Antonio Francesco; Cai, Xue; Jones, Caroline B.; Mondani, Giuseppina; Boyett, Mark R.; Jarvis, Jonathan Charles; Hart, George

2013-01-01

48

Right heart failure: toward a common language  

PubMed Central

Abstract In this guideline, the International Right Heart Foundation Working Group moves a step forward to develop a common language to describe the development and defects that exemplify the common syndrome of right heart failure. We first propose fundamental definitions of the distinctive components of the right heart circulation and provide consensus on a universal definition of right heart failure. These definitions will form the foundation for describing a uniform nomenclature for right heart circulatory failure with a view to foster collaborative research initiatives and conjoint education in an effort to provide insight into mechanisms of disease unique to the right heart. PMID:25006413

2013-01-01

49

Understand Your Risk for Heart Failure  

MedlinePLUS

Understand Your Risk for Heart Failure Updated:Sep 20,2012 All of us lose some blood-pumping ability in our hearts as we age, but ... increases your risk. Conditions that may lead to heart failure Coronary artery disease When cholesterol and fatty ...

50

Prevalence of Stroke in Systolic Heart Failure  

Microsoft Academic Search

BackgroundHeart disease is a major independent risk factor for stroke, ranking third after age and hypertension. Heart failure (HF) patient constitutes an important subgroup of patients with stroke, because of their poor outcome and high rates of mortality and stroke recurrence. We examined the prevalence of stroke in patients with heart failure from 3 different geographic regions.

Kathy Hebert; Mohamed Kaif; Leonard Tamariz; Ilia Gogichaishvili; Nino Nozadze; Maria Carolina Delgado; Lee M. Arcement

2011-01-01

51

Mineralcorticoid antagonists in heart failure.  

PubMed

Mineralocorticoid receptor antagonists (MRAs) have become mandated therapy in patients with reduced ejection fraction (systolic) heart failure (HF) across all symptom classes. These agents should also be prescribed in the early post-myocardial infarction setting in those with reduced ejection fraction and either HF symptoms or diabetes. This article explores the pathophysiological role of aldosterone, an endogenous ligand for the mineralcorticoid receptor (MR), and summarizes the clinical data supporting guideline recommendations for these agents in systolic HF. The use of MRAs in novel areas beyond systolic HF ejection is also explored. Finally, the current status of newer agents will be examined. PMID:25217431

D'Elia, Emilia; Krum, Henry

2014-10-01

52

Hepcidin in anemia of chronic heart failure  

PubMed Central

Anemia is a common finding among patients with chronic heart failure. Although co-morbidities, such as kidney failure, might contribute to the pathogenesis of anemia, many patients with heart failure do not have any other obvious etiology for their anemia. We investigated whether anemia in heart failure is associated with an elevation in hepcidin concentration. We used time-of-flight mass spectrometry to measure hepcidin concentration in urine and serum samples of patients with heart failure and in control subjects. We found that the concentration of hepcidin was lower in urine samples of patients with heart failure compared to those of control subjects. Serum hepcidin was also reduced in heart failure but was not significantly lower than that in controls. There were no significant differences between hepcidin levels in patients with heart failure and anemia compared to patients with heart failure and normal hemoglobin. We concluded that hepcidin probably does not play a major role in pathogenesis of anemia in patients with chronic heart failure. PMID:21080339

Divakaran, Vijay; Mehta, Sachin; Yao, David; Hassan, Saamir; Simpson, Steven; Wiegerinck, Erwin; Swinkels, Dorine W.; Mann, Douglas L.; Afshar-Kharghan, Vahid

2010-01-01

53

Preceptorships: A practical approach to education in heart failure  

Microsoft Academic Search

Heart failure is increasing in incidence and prevalence and is associated with significant morbidity and mortality (1–3). The heart failure center, although well equipped to handle more complex cases of moderate to severe heart failure, cannot accommodate all heart failure cases. Because the majority of heart failure patients are, and should be, treated at the primary care level, the heart

William T. Abraham

1999-01-01

54

Acute Heart Failure Treatment and Brain Protection  

Microsoft Academic Search

Brain damage and heart failure may coexist if terminal heart failure or arrhythmias induce cerebral hypoperfusion. Another\\u000a frequent situation of heart failure-induced brain damage is represented by cardiac arrest, which remains a major public health\\u000a problem and a leading cause of death. Cardiac arrest either occurs during the course of a known cardiopathy or suddenly reveals\\u000a an unknown underlying cardiac

Nicolas Deye; Bruno Mégarbane; Frédéric J. Baud

55

Immune System Alterations in Acute Heart Failure  

Microsoft Academic Search

Acute heart failure has emerged as a major public health problem, with over 1 million hospitalizations annually, but debate\\u000a continues concerning the pathophysiology of this syndrome. Whether there are unique and important mechanisms that mediate\\u000a decompensation distinct from those operative in chronic heart failure or whether mechanisms in common to both play a more\\u000a prominent role in acute heart failure

Kirkwood F. Adams; Tien M. H. Ng

56

Disease Management Programs for Heart Failure  

Microsoft Academic Search

Opinion statement  The impact of the very significant advances in the management of heart failure over the past several decades had been limited\\u000a by a lack of appropriate infrastructure for heart failure care delivery in the community. The development of disease management\\u000a programs has brought about significant advances in ensuring improved care of the wider heart failure population, allowing\\u000a for effective

Ken McDonald

2010-01-01

57

Pharmacological Management for Chronic Heart Failure  

Microsoft Academic Search

Angiotensin-converting enzyme inhibitors (ACEI) and beta-blockers are main stream of pharmacological treatment for chronic heart failure. However, the role of angiotensin receptor blockers (ARB) as first line management for chronic heart failure is still not in consensus. Several studies such as Val-HeFT1, STRETCH2 and CHARM-overall3 trials show benefits of ARB in patients of heart failure. The benefits include improving exercise

Yi-Lwun Ho

58

Oxygen free radicals and congestive heart failure  

Microsoft Academic Search

Plasma lipid peroxides (malondialdehyde) and thiols were measured in 45 patients with congestive heart failure and 45 controls. Malondialdehyde concentrations were significantly higher in the patients with congestive heart failure (median 9.0 nmol\\/ml interquartile range (IQR) 7.9-10.2) than in the controls (median 7.7 nmol\\/ml (IQR 6.9-9.2)). Plasma thiols were significantly lower in congestive heart failure (median 420 mumol\\/l (IQR 379-480))

J J Belch; A B Bridges; N Scott; M Chopra

1991-01-01

59

Pacific Islanders' Perspectives on Heart Failure Management  

PubMed Central

Objective To identify the health beliefs, attitudes, practices and social and family relations important in heart failure treatment among Pacific Islanders. Methods Four focus groups were convened with 36 Native Hawaiians and Samoans with heart failure and their family caregivers. Thematic data analysis was used to categorize data into four domains: health beliefs and attitudes, preferred health practices, social support systems, and barriers to heart failure care. Results Common coping styles and emotional experiences of heart failure in this population included avoidance or denial of illness, hopelessness and despair, and reliance on spiritual/religious beliefs as a means of support. Among study participants, more Samoans preferred to be treated by physicians whereas more Native Hawaiians preferred traditional Hawaiian methods of healing. Two types of social support (informational and tangible-instrumental) were identified as important in heart failure care. Barriers to heart failure care included poor knowledge of heart failure, lack of trust in physicians’ care, poor physician-patient relations, finances, dietary changes, and competing demands on time. Conclusion The recruitment, retention, and adherence of Pacific Islanders to heart failure interventions are affected by an array of psychosocial and socio-cultural factors. Practice Implications Interventions might be improved by offering participants accurate and detailed information about heart failure and its treatment, engaging the extended family in providing necessary supports, and providing tools to facilitate physician-patient relationships, among others, within the context of a larger socio-cultural system. PMID:18068939

Kaholokula, Joseph Keawe'aimoku; Saito, Erin; Mau, Marjorie K.; Latimer, Renee; Seto, Todd B.

2008-01-01

60

Combination Drug Therapy in Chronic Heart Failure: Is Treatment Part of the Problem in Heart Failure?  

Microsoft Academic Search

Despite advances in medical treatment, the annual mortality associated with severe heart failure remains over 40%, and even in mild heart failure the associated mortality is 40% over 4 years. Once it has been demonstrated that the morbidity and mortality to heart failure can be adequately addressed by combinations of drug therapy, then it is logical to attempt to strip

John G. F. Cleland

1997-01-01

61

Gene therapy in heart failure.  

PubMed

The treatment of heart failure (HF) may be entering a new era with clinical trials currently assessing the value of gene therapy as a novel therapeutic strategy. If these trials demonstrate efficacy then a new avenue of potential treatments could become available to the clinicians treating HF. In principle, gene therapy allows us to directly target the underlying molecular abnormalities seen in the failing myocyte. In this review we discuss the fundamentals of gene therapy and the challenges of delivering it to patients with HF. The molecular abnormalities underlying HF are discussed along with potential targets for gene therapy, focusing on SERCA2a. We discuss the laboratory and early clinical evidence for the benefit of SERCA2a gene therapy in HF. Finally, we discuss the ongoing clinical trials of SERCA2a gene therapy and possible future directions for this treatment. (Circ J 2014; 78: 2577-2587). PMID:25327883

Hayward, Carl; Patel, Hitesh; Lyon, Alexander

2014-10-24

62

Vitamin D in heart failure.  

PubMed

Evidence linking vitamin D to cardiovascular (CV) health has accumulated in recent years: numerous epidemiologic studies report deficiency as a significant CV risk factor, and rodent models suggest that active vitamin D can modulate critical remodeling processes, including cardiac hypertrophy and extracellular matrix remodeling. The presence of vitamin D signaling machinery within the human heart implies a direct role for this hormone in cardiac physiology and may explain associations between vitamin D status and CV outcomes. Heart failure (HF) represents a growing social and economic burden worldwide. Myocardial remodeling is central to HF development, and in the context of emerging evidence supporting mechanistic involvement of vitamin D, this review provides critical appraisal of scientific literature related to the role of vitamin D in CV disease, including data from epidemiologic and supplementation studies, as well as novel findings from animal models and in vitro work. Although associative data linking vitamin D and CV outcomes and evidence supporting a role for vitamin D in relevant pathogenic processes are both substantial, there are limited mechanistic data to indicate vitamin D supplementation as a viable therapeutic adjunct for the prevention of HF development following myocardial injury. PMID:24125108

Meredith, Anna J; McManus, Bruce M

2013-10-01

63

Mitochondrial dysfunction in heart failure  

PubMed Central

Heart failure (HF) is a complex chronic clinical syndrome. Energy deficit is considered to be a key contributor to the development of both cardiac and skeletal myopathy. In HF several components of cardiac and skeletal muscle bioenergetics are altered, such as oxygen availability, substrate oxidation, mitochondrial ATP production, and ATP transfer to the contractile apparatus via the creatine kinase shuttle. This review focuses on alterations in mitochondrial biogenesis and respirasome organization, substrate oxidation coupled with ATP synthesis in the context of their contribution to the chronic energy deficit, and mechanical dysfunction of the cardiac and skeletal muscle in HF. We conclude that HF is associated with decreased mitochondrial biogenesis and function in both heart and skeletal muscle, supporting the concept of a systemic mitochondrial cytopathy. The sites of mitochondrial defects are located within the electron transport and phosphorylation apparatus, and differ with the etiology and progression of HF in the two mitochondrial populations (subsarcolemmal and interfibrillar) of cardiac and skeletal muscle. The roles of adrenergic stimulation, the renin-angiotensin system, and cytokines are evaluated as factors responsible for the systemic energy deficit. We propose a cylic AMP-mediated mechanism by which increased adrenergic stimulation contributes to the mitochondrial dysfunction. PMID:22948484

Rosca, Mariana G.; Hoppel, Charles L.

2013-01-01

64

Origin of symptoms in chronic heart failure  

Microsoft Academic Search

Skeletal muscle abnormalities are highly prevalent in chronic heart failure and are associated with an increase in the ergoreflex, a muscle reflex stimulated by work done. Stimulation of the ergoreflex results in increased ventilation and contributes to the increased sympathetic activation of the heart failure syndrome. The origin of the skeletal myopathy is related to a chronic imbalance between catabolic

A L Clark

2006-01-01

65

Molecular genetics and genomics of heart failure  

Microsoft Academic Search

Heart failure is a major disease burden worldwide, and its incidence continues to increase as premature deaths from other cardiovascular conditions decline. Although the overall molecular portrait of this multifactorial disease remains incomplete, molecular and genetic studies have implicated, in recent decades, various pathways and genes that participate in the pathophysiology of heart failure. Here, we highlight the current understanding

Choong-Chin Liew; Victor J. Dzau

2004-01-01

66

Angiotensin receptor blockers for heart failure  

PubMed Central

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the efficacy of ARBs on the survival of patients with heart failure when compared to placebo or ACEIs.To determine the efficacy of ARBs on hospitalization rates in patients with heart failure when compared to placebo or ACEIs.

Jong, Phillip; Demers, Catherine; McKelvie, Robert S; Liu, Peter

2014-01-01

67

Increased heteroscedasticity of heart rate in fatal heart failure  

NASA Astrophysics Data System (ADS)

Healthy human heart rate is known to fluctuate in a highly complex manner, displaying complexity characteristics such as those shared by physical systems at a critical state. It is, however, widely believed that chronic heart failure reduces this complexity and that heart rate data from chronic-heart-failure patients can be used for the validation of complexity measures and paradigms applicable both to heart rate and more generally to assess any system's complexity. Here, we counter the above belief, showing an increase in fluctuations and in complexity of heart rate in chronic-heart-failure patients, in particular those at risk of death. This is supported by evidence of increased non-Gaussianity and heteroscedasticity resulting from the emergence of a characteristic correlation scale in the magnitude correlation landscape.

Struzik, Z. R.; Kiyono, K.; Hayano, J.; Watanabe, E.; Yamamoto, Y.

2008-04-01

68

Effects of bisoprolol on heart rate variability in heart failure  

Microsoft Academic Search

Analysis of heart rate variability (HRV) provides a noninvasive index of autonomic nervous system activity. HRV has been shown to be reduced in heart failure. Preliminary data indicate that ? blockers improve clinical status in patients with heart failure, but HRV improvement remains to be demonstrated. Fifty-four patients from the randomized double-blind, placebo-controlled Cardiac Insufficiency Bisoprolol Study were included in

Francoise Pousset; Xavier Copie; Philippe Lechat; Patrice Jaillon; Jean-Pierre Boissel; Martin Hetzel; Frédéric Fillette; Willem Remme; Louis Guize; Jean-Yves Le Heuzey

1996-01-01

69

Genomics and the pathophysiology of heart failure  

Microsoft Academic Search

Heart failure is not a single disease entity, but a syndrome with various causes, including hypertension, ischemic and congenital\\u000a heart disease, cardiomyopathy, and myocarditis. Because of the multiple etiologies and secondary adaptations contributing\\u000a to heart failure, the study of the cellular and molecular mechanisms underlying the development and progression of this syndrome\\u000a has been rather challenging. Much has been learned

Juey-Jen Hwang; Victor J. Dzau; Choong-Chin Liew

2001-01-01

70

VT ablation in heart failure.  

PubMed

Ventricular tachycardias (VT), shocks, and clusters of shock are ominous signs in patients with implantable cardioverter-defibrillators and herald an increased risk of hospitalization and mortality. VT clusters have been associated with aggravation of heart failure (19%), acute coronary events (14%), and electrolyte imbalance (10%). Yet, any association of potential causative factors and aggravation of VT is vague. Maybe, in patients with any substrate for re-entry, progressive aggravation of ventricular dysrhythmias is to be expected. The high recurrence rate of electrical storm despite antiarrhythmic drug therapy supports this view. The optimal timing of VT ablation is unknown, but current convention is to perform VT ablation after shock clusters or incessant VT has occurred. Preemptive VT ablation before VT has occurred is rarely performed (only in 15% of active centers) and the majority of centers never perform VT ablation even after the first shock. Such practice is within guidelines that recommend VT ablation only in ICD patients with recurrent or incessant VT. However, there is strong data in support of preemptive VT ablation. PMID:22410757

Bänsch, D; Schneider, R; Akin, I; Nienaber, C A

2012-03-01

71

Heart failure and galectin 3  

PubMed Central

Innovations in medical diagnosis and treatment have led to prolongation of life of patients. Increasing the life expectancy of cardiac patients and thereby increasing the prevalence of heart failure (HF). Currently more than one million hospital admissions per year are due to HF and it has been estimated that the cost is approximately $39 billion annually in the U.S. There are two pathophysiologic myocardial mechanisms that cause HF: systolic dysfunction and diastolic dysfunction. Normal cardiac aging is characterized by morphological and structural changes that increase cardiomyocyte size, increased number of apoptosis with decreased number in myocytes, increased collagen deposition, and functional changes at cellular level. All these factors contribute to fibrotic remodeling that leads to LV diastolic stiffness, which ultimately leads to impaired diastolic function. At the same time it has been shown that galectin-3, a soluble ?-galactoside-binding protein secreted by activated macrophages, promotes cardiac fibroblast proliferation, collagen deposition, and ventricular dysfunction. In this paper we review the prognostic value of galectin-3 as an independent predictor of mortality in patients with moderate to advanced chronic HF (CHF).

Suarez, Gabriela

2014-01-01

72

Gene Therapy in Heart Failure  

PubMed Central

With increasing knowledge of basic molecular mechanisms governing the development of heart failure (HF), the possibility of specifically targeting key pathological players is evolving. Technology allowing for efficient in vivo transduction of myocardial tissue with long-term expression of a transgene enables translation of basic mechanistic knowledge into potential gene therapy approaches. Gene therapy in HF is in its infancy clinically with the predominant amount of experience being from animal models. Nevertheless, this challenging and promising field is gaining momentum as recent preclinical studies in larger animals have been carried out and, importantly, there are 2 newly initiated phase I clinical trials for HF gene therapy. To put it simply, 2 parameters are needed for achieving success with HF gene therapy: (1) clearly identified detrimental/beneficial molecular targets; and (2) the means to manipulate these targets at a molecular level in a sufficient number of cardiac cells. However, several obstacles do exist on our way to efficient and safe gene transfer to human myocardium. Some of these obstacles are discussed in this review; however, it primarily focuses on the molecular target systems that have been subjected to intense investigation over the last decade in an attempt to make gene therapy for human HF a reality. PMID:18566312

Vinge, Leif Erik; Raake, Philip W.; Koch, Walter J.

2008-01-01

73

Decongestion in acute heart failure.  

PubMed

Congestion is a major reason for hospitalization in acute heart failure (HF). Therapeutic strategies to manage congestion include diuretics, vasodilators, ultrafiltration, vasopressin antagonists, mineralocorticoid receptor antagonists, and potentially also novel therapies such as gut sequesterants and serelaxin. Uncertainty exists with respect to the appropriate decongestion strategy for an individual patient. In this review, we summarize the benefit and risk profiles for these decongestion strategies and provide guidance on selecting an appropriate approach for different patients. An evidence-based initial approach to congestion management involves high-dose i.v. diuretics with addition of vasodilators for dyspnoea relief if blood pressure allows. To enhance diuresis or overcome diuretic resistance, options include dual nephron blockade with thiazide diuretics or natriuretic doses of mineralocorticoid receptor antagonists. Vasopressin antagonists may improve aquaresis and relieve dyspnoea. If diuretic strategies are unsuccessful, then ultrafiltration may be considered. Ultrafiltration should be used with caution in the setting of worsening renal function. This review is based on discussions among scientists, clinical trialists, and regulatory representatives at the 9th Global Cardio Vascular Clinical Trialists Forum in Paris, France, from 30 November to 1 December 2012. PMID:24599738

Mentz, Robert J; Kjeldsen, Keld; Rossi, Gian Paolo; Voors, Adriaan A; Cleland, John G F; Anker, Stefan D; Gheorghiade, Mihai; Fiuzat, Mona; Rossignol, Patrick; Zannad, Faiez; Pitt, Bertram; O'Connor, Christopher; Felker, G Michael

2014-05-01

74

Hyponatremia in patients with heart failure  

PubMed Central

The present review analyses the mechanisms relating heart failure and hyponatremia, describes the association of hyponatremia with the progress of disease and morbidity/mortality in heart failure patients and presents treatment options focusing on the role of arginine vasopressin (AVP)-receptor antagonists. Hyponatremia is the most common electrolyte disorder in the clinical setting and in hospitalized patients. Patients with hyponatremia may have neurologic symptoms since low sodium concentration produces brain edema, but the rapid correction of hyponatremia is also associated with major neurologic complications. Patients with heart failure often develop hyponatremia owing to the activation of many neurohormonal systems leading to decrease of sodium levels. A large number of clinical studies have associated hyponatremia with increased morbidity and mortality in patients hospitalized for heart failure or outpatients with chronic heart failure. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. AVP-receptor antagonists increase sodium levels effectively and their use seems promising in patients with hyponatremia. However, the effects of AVP-receptor antagonists on hard outcomes in patients with heart failure and hyponatremia have not been thoroughly examined. PMID:24109495

Filippatos, Theodosios D; Elisaf, Moses S

2013-01-01

75

Ca2+ Cycling in Heart Failure  

PubMed Central

Ca2+ plays a crucial role in connecting membrane excitability with contraction in myocardium. The hallmark features of heart failure are mechanical dysfunction and arrhythmias; defective intracellular Ca2+ homeostasis is a central cause of contractile dysfunction and arrhythmias in failing myocardium. Defective Ca2+ homeostasis in heart failure can result from pathological alteration in the expression and activity of an increasingly understood collection of Ca2+ homeostatic binding proteins, ion channels and enzymes. This review focuses on the molecular mechanisms of defective Ca2+ cycling in heart failure and consider how fundamental understanding of these pathways may translate into novel and innovative therapies. PMID:23989713

Luo, Min; Anderson, Mark E.

2013-01-01

76

Adrenal adrenoceptors in heart failure  

PubMed Central

Heart failure (HF) is a chronic clinical syndrome characterized by the reduction in left ventricular (LV) function and it represents one of the most important causes of morbidity and mortality worldwide. Despite considerable advances in pharmacological treatment, HF represents a severe clinical and social burden. Sympathetic outflow, characterized by increased circulating catecholamines (CA) biosynthesis and secretion, is peculiar in HF and sympatholytic treatments (as ?-blockers) are presently being used for the treatment of this disease. Adrenal gland secretes Epinephrine (80%) and Norepinephrine (20%) in response to acetylcholine stimulation of nicotinic cholinergic receptors on the chromaffin cell membranes. This process is regulated by adrenergic receptors (ARs): ?2ARs inhibit CA release through coupling to inhibitory Gi-proteins, and ? ARs (mainly ?2ARs) stimulate CA release through coupling to stimulatory Gs-proteins. All ARs are G-protein-coupled receptors (GPCRs) and GPCR kinases (GRKs) regulate their signaling and function. Adrenal GRK2-mediated ?2AR desensitization and downregulation are increased in HF and seem to be a fundamental regulator of CA secretion from the adrenal gland. Consequently, restoration of adrenal ?2AR signaling through the inhibition of GRK2 is a fascinating sympatholytic therapeutic strategy for chronic HF. This strategy could have several significant advantages over existing HF pharmacotherapies minimizing side-effects on extra-cardiac tissues and reducing the chronic activation of the renin–angiotensin–aldosterone and endothelin systems. The role of adrenal ARs in regulation of sympathetic hyperactivity opens interesting perspectives in understanding HF pathophysiology and in the identification of new therapeutic targets. PMID:25071591

de Lucia, Claudio; Femminella, Grazia D.; Gambino, Giuseppina; Pagano, Gennaro; Allocca, Elena; Rengo, Carlo; Silvestri, Candida; Leosco, Dario; Ferrara, Nicola; Rengo, Giuseppe

2014-01-01

77

Depression, Anxiety and Heart Failure: A Review.  

National Technical Information Service (NTIS)

Although common among patients with heart failure, depression and anxiety have been relatively neglected by researchers and practitioners. Both depression and anxiety have been implicated in contributing independently to the poor outcomes seen in patients...

M. J. De Jong, V. Konstam, D. K. Moser

2005-01-01

78

Advance Care Planning with Heart Failure  

MedlinePLUS

Introduction - Advance Care Planning Heart failure is a serious chronic condition that can shorten your life. With proper management and active self-care, you can feel better, decrease your chances of being in the hospital, ...

79

Mitral valve repair in heart failure  

Microsoft Academic Search

Mitral regurgitation MR is a frequent complication of end-stage heart failure. Historically, these patients were either managed medically or with mitral valve replacement, both associated with poor outcomes. Mitral valve repair via an 'undersized' annuloplasty repair is safe and effectively corrects MR in heart-failure patients. All of the observed changes contribute to reverse remodeling and restoration of the normal left-ventricular

Iva A. Smolens; Francis D. Pagani; Steven F. BollingU

2000-01-01

80

Energy, structure, conformation, and heart failure  

Microsoft Academic Search

The problem of heart failure is analyzed from the point of view of conformation changes in submolecular cardiomyocyte structures.\\u000a The development of heart failure as a consequence of abnormal function of contractile myocardial proteins is discussed. The\\u000a properties of actin and the role of structural changes in actin molecules in the impairment of ATP energy utilization and\\u000a generation of contractile

N. V. Karsanov

1999-01-01

81

Heart failure and anemia: mechanisms and pathophysiology  

Microsoft Academic Search

Anemia is a common comorbidity in patients with heart failure and affects up to 50% of patients, depending on the definition\\u000a of anemia used and on the population studied. Presence of anemia and lower hemoglobin (Hgb) concentrations are powerful independent\\u000a predictors of adverse outcomes in heart failure. Even small reductions in Hgb are associated with worse outcomes. Correction\\u000a of anemia

Inder S. Anand

2008-01-01

82

Lung membrane diffusing capacity, heart failure, and heart transplantation  

Microsoft Academic Search

The pulmonary diffusing capacity for carbon monoxide (DLCO) is reduced in chronic heart failure and remains decreased after heart transplantation. This decrease in DLCO may depend on a permanent alteration after transplantation of one or the other of its components: diffusion of the alveolar capillary membrane or the pulmonary capillary blood volume (Vc). Therefore, we measured DLCO, the membrane conductance,

Bertrand Mettauer; Eliane Lampert; Anne Charloux; Quan Ming Zhao; Eric Epailly; Monique Oswald; Albert Frans; François Piquard; Jean Lonsdorfer

1999-01-01

83

Emergency Department Management of Patients with Acute Decompensated Heart Failure  

Microsoft Academic Search

The Acute Decompensated HEart Failure National REgistry (ADHERE®) confirms that the management of decompensated heart failure is an emergency department (ED) problem, as more than 75% of patients admitted to the hospital with heart failure arrive through the ED. This emphasizes the need for collaboration among emergency medicine, cardiology, nephrology, and hospitalists in the management of acute decompensated heart failure.

W. Franklin Peacock IV; Charles L. Emerman

2005-01-01

84

Influence of diabetes mellitus on heart failure risk and outcome  

Microsoft Academic Search

Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure. THE STUDIES LINKING DIABETES MELLITUS (DM) WITH HEART FAILURE (HF): The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in

Christophe Bauters; Nicolas Lamblin; Eugène P Mc Fadden; Eric Van Belle; Alain Millaire; Pascal de Groote

2003-01-01

85

Ankyrin-B Protein in Heart Failure  

PubMed Central

Ankyrins (ankyrin-R, -B, and -G) are adapter proteins linked with defects in metazoan physiology. Ankyrin-B (encoded by ANK2) loss-of-function mutations are directly associated with human cardiovascular phenotypes including sinus node disease, atrial fibrillation, ventricular tachycardia, and sudden cardiac death. Despite the link between ankyrin-B dysfunction and monogenic disease, there are no data linking ankyrin-B regulation with common forms of human heart failure. Here, we report that ankyrin-B levels are altered in both ischemic and non-ischemic human heart failure. Mechanistically, we demonstrate that cardiac ankyrin-B levels are tightly regulated downstream of reactive oxygen species, intracellular calcium, and the calcium-dependent protease calpain, all hallmarks of human myocardial injury and heart failure. Surprisingly, ?II-spectrin, previously thought to mediate ankyrin-dependent modulation in the nervous system and heart, is not coordinately regulated with ankyrin-B or its downstream partners. Finally, our data implicate ankyrin-B expression as required for vertebrate myocardial protection as hearts deficient in ankyrin-B show increased cardiac damage and impaired function relative to wild-type mouse hearts following ischemia reperfusion. In summary, our findings provide the data of ankyrin-B regulation in human heart failure, provide insight into candidate pathways for ankyrin-B regulation in acquired human cardiovascular disease, and surprisingly, implicate ankyrin-B as a molecular component for cardioprotection following ischemia. PMID:22778271

Kashef, Farshid; Li, Jingdong; Wright, Patrick; Snyder, Jedidiah; Suliman, Faroug; Kilic, Ahmet; Higgins, Robert S. D.; Anderson, Mark E.; Binkley, Philip F.; Hund, Thomas J.; Mohler, Peter J.

2012-01-01

86

What Are the Signs and Symptoms of Heart Failure?  

MedlinePLUS

... Twitter. What Are the Signs and Symptoms of Heart Failure? The most common signs and symptoms of heart ... in your lungs. The condition requires emergency treatment. Heart Failure Signs and Symptoms The image shows the major ...

87

A heart failure specialist’s perspective on cardiac surgery for heart failure  

Microsoft Academic Search

Aside from cardiac transplantation, ventricular assist devices, and the total artificial heart, cardiac surgery now also plays\\u000a a major role in the overall management of the heart failure patient. For patients with heart failure, cardiac surgery has\\u000a steadily moved from being a predominant rescue procedure (eg, aneursymectomy, rupture repair, transplantation) to surgical\\u000a interventions that can prevent or delay the progression

Carl V. Leier

2005-01-01

88

Increased neural activity during overt and continuous semantic verbal fluency in major depression: mainly a failure to deactivate.  

PubMed

Major depression is associated with impairments in semantic verbal fluency (VF). However, the neural correlates underlying dysfunctional cognitive processing in depressed subjects during the production of semantic category members still remain unclear. In the current study, an overt and continuous semantic VF paradigm was used to examine these mechanisms in a representative sample of 33 patients diagnosed with a current episode of unipolar depression and 33 statistically matched healthy controls. Subjects articulated words in response to semantic category cues while brain activity was measured with functional magnetic resonance imaging (fMRI). Compared to controls, patients showed poorer task performance. On the neural level, a group by condition interaction analysis, corrected for task performance, revealed a reduced task-related deactivation in patients in the right parahippocampal gyrus, the right fusiform gyrus, and the right supplementary motor area. An additional and an increased task-related activation in patients were observed in the right precentral gyrus and the left cerebellum, respectively. These results indicate that a failure to suppress potentially interfering activity from inferior temporal regions involved in default-mode network functions and visual imagery, accompanied by an enhanced recruitment of areas implicated in speech initiation and higher-order language processes, may underlie dysfunctional cognitive processing during semantic VF in depression. The finding that patients with depression demonstrated both decreased performance and aberrant brain activation during the current semantic VF task demonstrates that this paradigm is a sensitive tool for assessing brain dysfunctions in clinical populations. PMID:24557502

Backes, Heidelore; Dietsche, Bruno; Nagels, Arne; Stratmann, Mirjam; Konrad, Carsten; Kircher, Tilo; Krug, Axel

2014-10-01

89

Stem cells for heart failure in the aging heart  

Microsoft Academic Search

Despite a wide range of therapeutic interventions, the prognosis for most patients with heart failure remains poor. The identification\\u000a of stem cells with the ability to generate cardiomyocytes and vascular cells and promote local repair and survival pathways\\u000a has highlighted the ability of the heart to undergo regeneration and potentially provides a new therapeutic strategy for treatment\\u000a of the failing

Victoria L. T. Ballard

2010-01-01

90

Electrocardiography of Heart Failure: Features and Arrhythmias  

Microsoft Academic Search

While this chapter addresses the electrocardiographic (ECG) features of heart failure (HF) and physiologically significant\\u000a arrhythmias in patients with HF, neither ECG findings nor specific arrhythmias establish the diagnosis of HF, regardless of\\u000a its origin. The diagnosis of HF is established by the patient’s symptoms and physical signs, along with confirmatory evidence\\u000a of mechanical heart dysfunction (e.g., by echocardiography or

J. L. Atlee

91

Biomarkers of inflammation in heart failure  

Microsoft Academic Search

Heart failure (HF) is characterized by the elaboration of a portfolio of pro-inflammatory cytokines and inflammatory mediators\\u000a that are considered to contribute to disease progression by virtue of the deleterious effects that these molecules exert on\\u000a the heart and circulation. Recent studies have suggested that these inflammatory mediators may serve as relevant markers of\\u000a disease severity and HF prognosis. Moreover,

Biykem Bozkurt; Douglas L. Mann; Anita Deswal

2010-01-01

92

Activated Oxygen Species in Heart Failure  

Microsoft Academic Search

Congestive heart failure (CHF) is defined by inability of the heart to provide adequate blood flow, oxygen, and nutrients to tissues and organs. There is now overwhelming evidence suggesting that oxygen-derived free radicals are involved in the pathogenesis of CHF. In vitro studies suggest that the highly toxic radical species damage sub-cellular membranes leading to the disruption in excitation-contractile coupling

Rakesh C. Kukreja; Venkata R. Emani; Michael L. Hess

1999-01-01

93

Current Concepts in the Management of Heart Failure  

Microsoft Academic Search

Objective: To review current concepts in the management of patients with heart failure. Data sources: A review of articles reported on acute and chronic heart failure. Summary of review: Heart failure has been defined as that state which occurs when the heart fails to maintain the needs of the body despite a satisfactory venous return. While it has been divided

R. YOUNG; L. I. G. WORTHLEY

94

What causes the symptoms of heart failure?  

Microsoft Academic Search

hronic heart failure (CHF) is a com- mon condition with a poor prognosis. It is associated with debilitating limit- ing symptoms, even with optimal modern medical management. Foremost among these symptoms is severe exercise intolerance with pronounced fatigue and dyspnoea at low exer- cise workloads. The UK National Health Serv- ice has highlighted it as a key target for improved

Andrew J S Coats

2001-01-01

95

Oxygen free radicals and congestive heart failure.  

PubMed Central

Plasma lipid peroxides (malondialdehyde) and thiols were measured in 45 patients with congestive heart failure and 45 controls. Malondialdehyde concentrations were significantly higher in the patients with congestive heart failure (median 9.0 nmol/ml interquartile range (IQR) 7.9-10.2) than in the controls (median 7.7 nmol/ml (IQR 6.9-9.2)). Plasma thiols were significantly lower in congestive heart failure (median 420 mumol/l (IQR 379-480)) than in the controls (median 463 mumol/l (IQR 445-525)). There was a significant but weak negative correlation between malondialdehyde and left ventricular ejection fraction (r = -0.35) and a positive correlation between plasma thiols and left ventricular ejection fraction (r = 0.39). This study provides clinical support for experimental data indicating that free radicals may be important in heart failure. It also suggests that the degree of free radical production may be linked to the severity of the disease. PMID:2039668

Belch, J J; Bridges, A B; Scott, N; Chopra, M

1991-01-01

96

Combination stem cell therapy for heart failure  

Microsoft Academic Search

Patients with congestive heart failure (CHF) that are not eligible for transplantation have limited therapeutic options. Stem cell therapy such as autologous bone marrow, mobilized peripheral blood, or purified cells thereof has been used clinically since 2001. To date over 1000 patients have received cellular therapy as part of randomized trials, with the general consensus being that a moderate but

Thomas E Ichim; Fabio Solano; Fabian Lara; Jorge Paz Rodriguez; Octav Cristea; Boris Minev; Famela Ramos; Erik J Woods; Michael P Murphy; Doru T Alexandrescu; Amit N Patel; Neil H Riordan

2010-01-01

97

Electron Transport Chain Defects in Heart Failure  

Microsoft Academic Search

In recent years, the possibility that disorders of cardiac metabolism play a role in the mechanisms that lead to ventricular dilatation and dysfunction in heart failure has attracted much attention. Electron transport chain is constituted by a series of multimeric protein complexes, located in the inner mitochondrial membranes, whose genes are distributed over both nuclear and mitochondrial DNA. Its normal

Jordi Casademont; Òscar Miró

2002-01-01

98

Congestive Heart Failure Treatment: The Pacing Approach  

Microsoft Academic Search

Early reports of physiologic pacing for congestive heart failure (CHF) yielded conflicting results, and little enthusiasm was generated for pacing as a mode of therapy for CHF. Small, uncontrolled studies, which had little or no follow-up demonstrated that pacing from the left ventricle could synchronize contraction of the ventricles and improve overall ventricular performance. These encouraging reports led to a

Thomas J. Dresing; Andrea Natale

2001-01-01

99

Nurses's knowledge of heart failure education principles  

Microsoft Academic Search

Objective: The goal of this study was to determine nurses' knowledge of heart failure (HF) self-management education principles. Design: The study was exploratory and descriptive and included a convenience sample. Setting: Research took place in a large midwestern health care system that included a university-based hospital, community hospitals, and home or palliative care. Subjects: Subjects included 300 nurses who provide

Nancy M. Albert; Susan Collier; Veronica Sumodi; Sandra Wilkinson; Jeffrey P. Hammel; Linda Vopat; Cindy Willis; Barb Bittel

2002-01-01

100

Congestive Heart Failure in the Elderly (CE)  

Microsoft Academic Search

Abstract: Congestive heart failure is a complex disease that is complicated by the normal changes that accompany aging. The medical profession has learned a great deal about managing this disease in the past decade. However, the challenge remains for the nursing profession to help individuals and their families live with this chronic, debilitating disease. We must be prepared to coordinate

Mickey Stanley

1999-01-01

101

Extracorporeal Fluid Removal in Heart Failure Patients  

Microsoft Academic Search

More than one million hospitalizations occur annually in the US because of heart failure (HF) decompensation caused by fluid overload. Congestion contributes to HF progression and mortality. Apart from intrinsic renal insufficiency, venous congestion, rather than a reduced cardiac output, may be the primary hemodynamic factor driving worsening renal function in patients with acutely decompensated HF. According to data from

Maria Rosa Costanzo; Piergiuseppe Agostoni; Giancarlo Marenzi

2010-01-01

102

Kinases as therapeutic targets for heart failure  

Microsoft Academic Search

Cardiac cells respond to external stimuli by activating signal-transduction cascades involving protein and lipid kinases. These enzymes are attractive therapeutic targets as they are responsible for the direct or indirect control of most signalling pathways in cells. Existing therapies for heart failure are directed against the renin-angiotensin system and the ?-adrenoceptor, and prevent the initiation of signalling cascades. However, as

Susan A. McDowell; Angela Clerk; Chris J. Vlahos

2003-01-01

103

Heart rate variability and its relation to ventricular arrhythmias in congestive heart failure  

Microsoft Academic Search

BACKGROUND--It has been shown that heart rate variability is decreased in patients with congestive heart failure and that depressed heart rate variability is associated with a propensity to ventricular arrhythmias. Little is known, however, about heart rate variability in patients with both congestive heart failure and ventricular arrhythmias. METHODS--Spectral heart rate variability was analysed from 24 hour ambulatory electrocardiograms in

L. Fei; P. J. Keeling; J. S. Gill; Y. Bashir; D. J. Statters; J. Poloniecki; W. J. McKenna; A. J. Camm

1994-01-01

104

Remote monitoring of heart failure patients.  

PubMed

"The Teledactyl (Tele, far; Dactyl, finger--from the Greek) is a future instrument by which it will be possible for us to 'feel at a distance.' This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance...The doctor manipulates his controls, which are then manipulated at the patient's room in exactly the same manner. The doctor sees what is going on in the patient's room by means of a television screen." -Hugo Gernsback, Science and Invention Magazine, February 1925 Heart failure continues to be a major burden on our health care system. As the number of patients with heart failure increases, the cost of hospitalization alone is contributing significantly to the overall cost of this disease. Readmission rate and hospital length of stay are emerging as quality markers of heart failure care along with reimbursement policies that force hospitals to optimize these outcomes. Apart from maintaining quality assurance, the disease process of heart failure per-se requires demanding and close attention to vitals, diet, and medication compliance to prevent acute decompensation episodes. Remote patient monitoring is morphing into a key disease management strategy to optimize care for heart failure. Innovative implantable technologies to monitor intracardiac hemodynamics also are evolving, which potentially could offer better and substantial parameters to monitor. PMID:23519115

Bhimaraj, Arvind

2013-01-01

105

Effect of anemia correction on left ventricular structure and filling pressure in anemic patients without overt heart disease  

PubMed Central

Background/Aims There are few data on the effects of low hemoglobin levels on the left ventricle (LV) in patients without heart disease. The objective of this study was to document changes in the echocardiographic variables of LV structure and function after the correction of anemia without significant cardiovascular disease. Methods In total, 34 iron-deficiency anemia patients (35 ± 11 years old, 32 females) without traditional cardiovascular risk factors or cardiovascular disease and 34 age- and gender-matched controls were studied. Assessments included history, physical examination, and echocardiography. Of the 34 patients with anemia enrolled, 20 were followed and underwent echocardiography after correction of the anemia. Results There were significant differences between the anemia and control groups in LV diameter, left ventricular mass index (LVMI), left atrial volume index (LAVI), peak mitral early diastolic (E) velocity, peak mitral late diastolic (A) velocity, E/A ratio, the ratio of mitral to mitral annular early diastolic velocity (E/E'), stroke volume, and cardiac index. Twenty patients underwent follow-up echocardiography after treatment of anemia. The follow-up results showed significant decreases in the LV end-diastolic and end-systolic diameters and LVMI, compared with baseline levels. LAVI, E velocity, and E/E' also decreased, suggesting a decrease in LV filling pressure. Conclusions Low hemoglobin level was associated with larger cardiac chambers, increased LV, mass and higher LV filling pressure even in the subjects without cardiovascular risk factors or overt cardiovascular disease. Appropriate correction of anemia decreased LV mass, LA volume, and E/E'. PMID:25045292

Cho, In-Jeong; Mun, Yeung Chul; Shin, Gil Ja

2014-01-01

106

Heart Rate Variability Analysis in the Assessment of Autonomic Function in Heart Failure.  

National Technical Information Service (NTIS)

Heart rate is not static but rather changes continuously in response to physical and mental demands. In fact, an invariant heart rate is associated with disease processes such as heart failure. Heart rate variability analysis is a noninvasive technique us...

M. J. De Jong, D. C. Randall

2004-01-01

107

End-of-life care in heart failure  

Microsoft Academic Search

The clinical syndrome of heart failure is increasing in prevalence, as is the number of elderly persons with heart failure.\\u000a Increasing frailty and progression of heart failure in large numbers of patients means clinicians are increasingly challenged\\u000a to provide end-of-life care for heart failure patients. End-of-life care has been little studied, but management can be understood\\u000a from early clinical trials

Sarah J. Goodlin

2009-01-01

108

Renal dysfunction in heart failure patients: what is the evidence?  

Microsoft Academic Search

Congestive heart failure (CHF) is an increasingly common medical condition and the fastest growing cardiovascular diagnosis\\u000a in North America. Over one-third of patients with heart failure also have renal insufficiency. It has been shown that renal\\u000a insufficiency confers worsened outcomes to patients with heart failure. However, a majority of the larger and therapy-defining\\u000a heart failure medication and device trials exclude

Heath E. Saltzman; Kumar Sharma; Paul J. Mather; Sharon Rubin; Suzanne Adams; David Joshua Whellan

2007-01-01

109

Locoweed (Oxytropis sericea) poisoning and congestive heart failure in cattle.  

PubMed

Locoweed (Oxytropis sericea), when fed to calves at high elevations, increased the prevalence and severity of congestive heart failure. Forced exercise did not increase the prevalence of congestive heart failure, but it did increase severity. Calves consuming locoweed at high elevations developed signs and gross lesions of congestive heart failure and microscopic lesions of congestive heart failure and locoweed poisoning. Calves fed locoweed at low elevations developed only signs and lesions of locoweed poisoning. PMID:3793593

James, L F; Hartley, W J; Nielsen, D; Allen, S; Panter, K E

1986-12-15

110

Omega3 fatty acids and heart failure  

Microsoft Academic Search

During the past three decades, the protective role of omega (n)-3 polyunsaturated fatty acids (PUFA), mainly eicosapentaenoic\\u000a acid and docosahexaenoic acid, in patients with coronary heart disease has been widely reported. The Gruppo Italiano per lo\\u000a Studio della Sopravvivenza nell’Infarto Miocardico-Heart Failure (GISSI-HF) study, a large-scale clinical trial, recently\\u000a showed that n-3 PUFA (850–882 mg\\/d) reduced mortality and admission to

Roberto Marchioli; Maria Giuseppina Silletta; Giacomo Levantesi; Raffaella Pioggiarella

2009-01-01

111

Reversible heart failure: the role of inflammatory activation  

Microsoft Academic Search

Heart failure is increasingly common in western populations and is an inevitable consequence of the improved survival after myocardial infarction, and of an ageing population. Heart failure is usually relentlessly progressive as the maladaptive processes triggered by the physiological changes of the condition lead to further deterioration. However, in certain circumstances, heart failure is transient or potentially reversible when it

Tim Robinson; Alyson Smith; Kevin S Channer

2010-01-01

112

Palliative care needs of young people with heart failure  

Microsoft Academic Search

Earlier chapters have established that heart failure is a potentially malignant, chronic, debilitating condition suffered by a very large number of patients and their families. We have seen that the average age of patients with heart failure in the UK is 77, which is similar to the average age of patients with cancer. But just as with cancer, heart failure

Hayley Pryse-Hawkins

113

Altered Cardiac Myocyte Ca Regulation In Heart Failure  

NSDL National Science Digital Library

The article explores Myocyte Ca regulation in heart failure. The article suggests that there are alterations in how myocyte Ca is regulated which causes characteristics found during heart failure. There is a lot known about this topic and this review could help further the investigation into the cause of heart failure.

PhD Donald M. Bers (Stritch School of Medicine - Loyola University Chicago Physiology)

2006-12-01

114

Clinical profile and management of heart failure: rural community hospital vs. metropolitan heart center  

Microsoft Academic Search

Background: Knowledge on clinical characteristics and prognosis of patients with heart failure originates from studies of selected populations in clinical trials or from epidemiological observations. Reports on the large numbers of patients with heart failure treated in community hospitals are sparse. Objectie: Are there differences in patient characteristics and heart Ž. Ž . failure management between a metropolitan heart center

G. Taubert; C. Bergmeier; H. Andresenb; J. Potratz

2001-01-01

115

A personalized medicine target: heart failure in women  

PubMed Central

It is increasingly known that gender differences affect disease presentation, clinical pathways, diagnostic yield and prognosis of patients with cardiovascular disorders. There are novel insights regarding heart failure that provide a platform for personalized medicine. This is a review of the existent data about heart failure in women, a neglected topic that has gained considerable interest in the past years. Heart failure in women differs in many aspects from that of men. Part of the difference is attributable to age, ventricular function and cause of heart failure, with women being generally older at heart failure onset, more often without left ventricular systolic dysfunction and less often having heart failure due to ischaemic heart disease, in comparison with men. Elucidation of the genetic and pathophysiological basis of sex differences, together with clinical trials designed to study the impact of treatments in women, could lead to sex based heart failure management. PMID:22567052

Botezatu, CD; Serban, M; Jurcu?, R

2011-01-01

116

Heart failure in the diabetic population - pathophysiology, diagnosis and management  

PubMed Central

Evidence from clinical trials repeatedly confirms the association of diabetes with heart failure, independent of hypertension, atherosclerosis, coronary artery disease and valvular heart disease. However, the importance of coexistence of diabetes and heart failure is not universally recognized, despite the fact that it may significantly contribute to morbidity and mortality of the diabetic population. It seems that prevention of heart failure, early diagnosis, and appropriate management could improve the outcome. Unfortunately, the etiology of heart failure in diabetic patients is still to be elucidated. It is multifactorial in nature and several cellular, molecular and metabolic factors are implicated. Additionally, there are still no definite guidelines on either the diagnosis and treatment of heart failure in diabetic patients or on the therapy of diabetes in subjects with heart failure. This review focuses on the pathophysiology, diagnosis, and prevention of heart failure in the diabetic population as well as management of both comorbidities. PMID:25097587

Drzewoski, Jozef

2014-01-01

117

Salbutamol in treatment of heart failure  

Microsoft Academic Search

The haemodynamic effects of oral and intravenous salbutamol were investigated in 22 patients with chronic heart failure. Intravenous salbutamol (13 micrograms\\/min) increased cardiac index by 53 per cent from 1.5 +\\/- 0.13 1\\/min per m2 to 2.3 +\\/- 0.23 1\\/min per m2 and decreased systemic vascular resistance by 28 per cent from 29.4 +\\/- 3.9 units to 21.2 +\\/- 2.5

P D Bourdillon; J R Dawson; R A Foale; A D Timmis; P A Poole-Wilson; G C Sutton

1980-01-01

118

Epidemiology and risk profile of heart failure  

Microsoft Academic Search

Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that

Anh L. Bui; Tamara B. Horwich; Gregg C. Fonarow

2010-01-01

119

Acute Heart Failure Syndromes and Drug Intoxication  

Microsoft Academic Search

Cardiovascular drugs are responsible for life-threatening poisonings with increasing incidence. Acute heart failure is a potential\\u000a complication following accidental or intentional overdose with various classes of drugs. The most frequent ones are beta-blockers,\\u000a calcium-channel antagonists, sodium-channel blocker agents, and cardioglycosides. However, in medical toxicology, the term\\u000a cardiotoxic drug is not limited to the cardiovascular drugs but also include various other

Bruno Mégarbane; Nicolas Deye; Frédéric J. Baud

120

Cardiorenal syndrome in children with heart failure  

Microsoft Academic Search

Concomitant cardiac and renal dysfunction has been termed the cardiorenal syndrome (CRS). This clinical condition usually\\u000a manifests as heart failure with worsening renal function and occurs frequently in the acute care setting. A consistent definition\\u000a of CRS has not been universally agreed upon, although a recent classification of CRS describes several subtypes depending\\u000a on the primary organ injured and the

Jack F. Price; Stuart L. Goldstein

2009-01-01

121

Diuretic use in heart failure and outcomes.  

PubMed

Diuretics are frequently administered to relieve congestive symptoms in patients with heart failure (HF). Despite their widespread use, prospective data on the potential of diuretics to modulate HF-related morbidity and mortality are scarce. Diuretic efficacy may be limited by adverse neurohormonal activation and by "congestion-like" symptoms that may occur in the absence of fluid overload. Herein, we review the current knowledge on diuretic use and outcomes in HF. PMID:23852396

von Lueder, T G; Atar, D; Krum, H

2013-10-01

122

Haemodynamic monitoring in acute heart failure  

Microsoft Academic Search

Acute Heart Failure is a major cause of hospitalisation, with a rate of death and complications. New guidelines have been\\u000a developed in order to diagnose and treat this disease. Despite these efforts pathophysiology and treatments options are still\\u000a limited. There is agreement among the experts that increasing the cardiac output and the stroke volume without fluid overloading\\u000a the patient should

Maurizio Cecconi; Toby E. Reynolds; Nawaf Al-Subaie; Andrew Rhodes

2007-01-01

123

Hospitalization of patients with heart failure  

Microsoft Academic Search

Aims To describe the clinical course of heart failure in a population-based sample of incident cases, and to identify factors predicting hospitalization and mortality. Methods and Results Three hundred and thirty-two incident cases were identified over 15 months; 208 in- patients and 124 outpatients. Thirty-eight inpatients died during the first hospital admission (case fatality 18%) leaving 294 at risk of

M. R. Cowie; K. F. Fox; D. A. Wood; C. Metcalfe; S. G. Thompson; A. J. S. Coats; P. A. Poole-Wilson; G. C. Sutton

2002-01-01

124

Energy metabolism in heart failure and remodelling  

PubMed Central

Myocytes of the failing heart undergo impressive metabolic remodelling. The time line for changes in the pathways for ATP synthesis in compensated hypertrophy is: flux through the creatine kinase (CK) reaction falls as both creatine concentration ([Cr]) and CK activity fall; increases in [ADP] and [AMP] lead to increases in glucose uptake and utilization; fatty acid oxidation either remains the same or decreases. In uncompensated hypertrophy and in other forms of heart failure, CK flux and fatty acid oxidation are both lower; any increases in glucose uptake and utilization are not sufficient to compensate for overall decreases in the capacity for ATP supply and [ATP] falls. Metabolic remodelling is under transcriptional and post-transcriptional control. The lower metabolic reserve of the failing heart contributes to impaired contractile reserve. PMID:18987051

Ingwall, Joanne S.

2009-01-01

125

Chronic Heart Failure: Contemporary Diagnosis and Management  

PubMed Central

Chronic heart failure (CHF) remains the only cardiovascular disease with an increasing hospitalization burden and an ongoing drain on health care expenditures. The prevalence of CHF increases with advancing life span, with diastolic heart failure predominating in the elderly population. Primary prevention of coronary artery disease and risk factor management via aggressive blood pressure control are central in preventing new occurrences of left ventricular dysfunction. Optimal therapy for CHF involves identification and correction of potentially reversible precipitants, target-dose titration of medical therapy, and management of hospitalizations for decompensation. The etiological phenotype, absolute decrease in left ventricular ejection fraction and a widening of QRS duration on electrocardiography, is commonly used to identify patients at increased risk of progression of heart failure and sudden death who may benefit from prophylactic implantable cardioverter-defibrillator placement with or without cardiac resynchronization therapy. Patients who transition to advanced stages of disease despite optimal traditional medical and device therapy may be candidates for hemodynamically directed approaches such as a left ventricular assist device; in selected cases, listing for cardiac transplant may be warranted. PMID:20118395

Ramani, Gautam V.; Uber, Patricia A.; Mehra, Mandeep R.

2010-01-01

126

Salbutamol in treatment of heart failure.  

PubMed Central

The haemodynamic effects of oral and intravenous salbutamol were investigated in 22 patients with chronic heart failure. Intravenous salbutamol (13 micrograms/min) increased cardiac index by 53 per cent from 1.5 +/- 0.13 1/min per m2 to 2.3 +/- 0.23 1/min per m2 and decreased systemic vascular resistance by 28 per cent from 29.4 +/- 3.9 units to 21.2 +/- 2.5 units. Heart rate rose by 10 per cent from 101 +/- 3.5 beats per minute to 111 +/- 3.2 beats per minute and pulmonary artery end-diastolic pressure fell by 13 per cent from 26.3 +/- 1.8 mmHg to 22.8 +/- 2.1 mmHg. Similar results were obtained after oral salbutamol (8 mg). Cardiac index rose by 40 per cent and systemic vascular resistance fell by 30 per cent. There was a small rise in heart rate and a variable and not significant change in pulmonary artery end-diastolic pressure. Experiments on isolated rabbit papillary muscle showed that salbutamol, at the concentration which exists in patients, had no detectable positive inotropic effect. It is probable that the increase in cardiac output in patients is primarily the result of reduced afterload caused by vasodilatation. Salbutamol is a useful drug in the treatment of chronic heart failure. PMID:7362714

Bourdillon, P D; Dawson, J R; Foale, R A; Timmis, A D; Poole-Wilson, P A; Sutton, G C

1980-01-01

127

Heart Failure Associated Hospitalizations in the United States  

PubMed Central

Objective We sought to characterize temporal trends in hospitalizations with heart failure as a primary or secondary diagnosis. Background Heart failure patients are frequently admitted for both heart failure and other causes. Methods Using the Nationwide Inpatient Sample (NIS), we evaluated trends in heart failure hospitalizations between 2001 and 2009. Hospitalizations were categorized as either primary or secondary heart failure hospitalizations based the location of heart failure in the discharge diagnosis. National estimates were calculated using the sampling weights of the NIS. Age- and gender-standardized hospitalization rates were determined by dividing the number of hospitalizations by the United States population in a given year and using direct standardization. Results The number of primary heart failure hospitalizations in the United States decreased from 1,137,944 in 2001 to 1,086,685 in 2009, while secondary heart failure hospitalizations increased from 2,753,793 to 3,158,179 over the same period. Age- and gender-adjusted rates of primary heart failure hospitalizations decreased steadily over 2001–2009, from 566 to 468 per 100,000 people. Rates of secondary heart failure hospitalizations initially increased, from 1370 to 1476 per 100,000 from 2001–2006, then decreased to 1359 per 100,000 in 2009. Common primary diagnoses for secondary heart failure hospitalizations included pulmonary disease, renal failure, and infections. Conclusions Although primary heart failure hospitalizations declined, rates of hospitalizations with a secondary diagnosis of heart failure were stable in the past decade. Strategies to reduce the high burden of hospitalizations of heart failure patients should include consideration of both cardiac disease and non-cardiac conditions. PMID:23500328

Blecker, Saul; Paul, Margaret; Taksler, Glen; Ogedegbe, Gbenga; Katz, Stuart

2013-01-01

128

Right ventricular failure in congenital heart disease.  

PubMed

Despite developments in surgical techniques and other interventions, right ventricular (RV) failure remains an important clinical problem in several congenital heart diseases (CHD). RV function is one of the most important predictors of mortality and morbidity in patients with CHD. RV failure is a progressive disorder that begins with myocardial injury or stress, neurohormonal activation, cytokine activation, altered gene expression, and ventricular remodeling. Pressure-overload RV failure caused by RV outflow tract obstruction after total correction of tetralogy of Fallot, pulmonary stenosis, atrial switch operation for transposition of the great arteries, congenitally corrected transposition of the great arteries, and systemic RV failure after the Fontan operation. Volume-overload RV failure may be caused by atrial septal defect, pulmonary regurgitation, or tricuspid regurgitation. Although the measurement of RV function is difficult because of many reasons, the right ventricle can be evaluated using both imaging and functional modalities. In clinical practice, echocardiography is the primary mode for the evaluation of RV structure and function. Cardiac magnetic resonance imaging is increasingly used for evaluating RV structure and function. A comprehensive evaluation of RV function may lead to early and optimal management of RV failure in patients with CHD. PMID:23559970

Cho, Young Kuk; Ma, Jae Sook

2013-03-01

129

New diagnostic and therapeutic possibilities for diastolic heart failure  

PubMed Central

Despite the fact that up to half of all heart failure occurs in patients without evidence of systolic cardiac dysfunction, there are no universally accepted diagnostic markers and no approved therapies for heart failure with preserved ejection fraction (HFpEF). HFpEF, otherwise known as diastolic heart failure, has nearly the same grim prognosis as systolic heart failure, and diastolic heart failure is increasing in incidence and prevalence. Major trials have shown that many of the treatments that are salutary in systolic heart failure have no beneficial effects in diastolic heart failure, suggesting different underlying mechanisms for these two disorders. Even criteria for diagnosis of HFpEF are still debated, and there is still no gold standard marker to detect diastolic dysfunction. Here, we will review some promising new insights into the pathogenesis of diastolic dysfunction that may lead to new diagnostic and therapeutic tools. PMID:24494212

Jeong, Euy-Myoung; Dudley, Samuel C.

2014-01-01

130

Short-stepping gait in severe heart failure  

PubMed Central

Background—Patients with severe chronic heart failure seem to take shorter steps than healthy controls when walking on a treadmill and when walking freely along a corridor. In healthy individuals the pattern of walking affects the oxygen cost of exercise, and so this observation might be relevant to the limitation of exercise in heart failure. Method—Length of stride was analysed as stride/stature index in 15 controls, 10 patients with moderate heart failure, 10 patients with severe heart failure, and 10 patients with angina, walking at a constant speed/stature index. Results—The stride/stature index was 0·64 in the controls in patients with New York Heart Association (NYHA) class II heart failure, and in patients with angina. It was 0·49 in patients with NYHA class III heart failure. In the patients with heart failure the stride/stature index correlated with exercise capacity determined as peak oxygen consumption Vo2max (R = +0·62, p < 0·005). When healthy controls walked in time to a metronome adjusted to decrease their stride/stature index to approximately that seen in severe heart failure steady-state oxygen consumption increased by a mean of 15%. Conclusions—The length of stride is reduced in severe heart failure, and when healthy controls adopt this gait the oxygen cost of walking is increased. A short-stepping gait may contribute to the limitation of exercise capacity in heart failure. PMID:1467030

Davies, S W; Greig, C A; Jordan, S L; Grieve, D W; Lipkin, D P

1992-01-01

131

Mechano-signaling in heart failure.  

PubMed

Mechanosensation and mechanotransduction are fundamental aspects of biology, but the link between physical stimuli and biological responses remains not well understood. The perception of mechanical stimuli, their conversion into biochemical signals, and the transmission of these signals are particularly important for dynamic organs such as the heart. Various concepts have been introduced to explain mechanosensation at the molecular level, including effects on signalosomes, tensegrity, or direct activation (or inactivation) of enzymes. Striated muscles, including cardiac myocytes, differ from other cells in that they contain sarcomeres which are essential for the generation of forces and which play additional roles in mechanosensation. The majority of cardiomyopathy causing candidate genes encode structural proteins among which titin probably is the most important one. Due to its elastic elements, titin is a length sensor and also plays a role as a tension sensor (i.e., stress sensation). The recent discovery of titin mutations being a major cause of dilated cardiomyopathy (DCM) also underpins the importance of mechanosensation and mechanotransduction in the pathogenesis of heart failure. Here, we focus on sarcomere-related mechanisms, discuss recent findings, and provide a link to cardiomyopathy and associated heart failure. PMID:24531746

Buyandelger, Byambajav; Mansfield, Catherine; Knöll, Ralph

2014-06-01

132

Heart failure: TNM-like classification.  

PubMed

Staging of heart failure represents a major issue in clinical practice. In this setting, the MOGE(S) classification was designed to be similar to the TNM classification used in oncology. Nevertheless, MOGE(S) nosology differs greatly from the key elements of the TNM classification, as well as its simplicity and clinical applicability. In fact, MOGE(S) acronym stands for morphofunctional characteristics (M), organ involvement (O), genetic or familial inheritance pattern (G), etiological information (E), and functional status (S). Recently, a new TNM-like classification for heart failure was proposed. This classification, named HLM, refers to heart damage arising from an initial stage of impaired systolic or diastolic function, without structural injury, to an advanced stage of biventricular dysfunction (H), different stages of lung involvement (L), and malfunction of peripheral organs such as the kidney, liver, and brain (M). HLM classification was influenced by the key elements of TNM staging: simplicity, clinical usefulness, efficacy for planning a therapeutic strategy, and ability to determine patient prognosis. HLM classification seems to be easily applied in the real world and valuable for balancing economic resources with the clinical complexity of patients. PMID:24657683

Fedele, Francesco; Severino, Paolo; Calcagno, Simone; Mancone, Massimo

2014-05-20

133

Beta-blockers for heart failure  

PubMed Central

This is the protocol for a review and there is no abstract. The objectives are as follows: Our objective is to appraise the effectiveness of beta blockers in patients with heart failure. Our protocol defined main outcome is all cause mortality. The specific a priori defined aims are to examine: the effectiveness of beta blockers in all trials of patients with heart failure, and examine the importance of the presence or absence of ischaemic cardiomyopathy in patients included in trials and vasodilator properties of beta blocking agents used. We will also examine the predictive value of left ventricular function, age, use of angiotensin converting enzyme inhibitors and New York Heart Association Class (NYHA), and the rate of discontinuation of therapy due to treatment. There are a number of important ongoing trials for which data will become available in the next few years. Thus a systematic review which may be updated regularly is required to provide an up to date synthesis of the available data in this increasingly important area.

Cleland, John GF; Freemantle, Nick; Eastaugh, Joanne; Young, Phillip J; Harrison, Jane

2014-01-01

134

Highlights from the British Society for Heart Failure 16(th) Annual Autumn Meeting: 'Making sense of acute heart failure'.  

PubMed

16th Annual Autumn Meeting of the British Society of Heart Failure: 'Making sense of acute heart failure', London, UK, 28-29 November 2013 The 16th Annual Autumn Meeting of the British Society of Heart Failure entitled 'Making sense of acute heart failure' took place on the 28-29 November 2013 at the Queen Elizabeth II Conference Centre in London. This year saw the 1000th member join the British Society of Heart Failure and over 700 delegates from the UK, Europe and North America attended this year's meeting. Professionals from a range of backgrounds were present including physicians, nurses, scientists, trainees and representatives from industry. The symposium, which is accredited by the Royal College of Physicians and the Royal College of Nursing, highlighted that although we have recently seen substantial progress in the management and outcomes of patients with chronic heart failure, acute heart failure management and outcomes have not changed significantly over almost a generation. PMID:24762243

Cannon, Jane A; Dalzell, Jonathan R

2014-03-01

135

Current strategies for preventing renal dysfunction in patients with heart failure: a heart failure stage approach  

PubMed Central

Renal dysfunction is common during episodes of acute decompensated heart failure, and historical data indicate that the mean creatinine level at admission has risen in recent decades. Different mechanisms underlying this change over time have been proposed, such as demographic changes, hemodynamic and neurohumoral derangements and medical interventions. In this setting, various strategies have been proposed for the prevention of renal dysfunction with heterogeneous results. In the present article, we review and discuss the main aspects of renal dysfunction prevention according to the different stages of heart failure. PMID:23644863

Issa, Victor Sarli; Andrade, Lucia; Bocchi, Edimar Alcides

2013-01-01

136

Modulating fatty acid oxidation in heart failure  

PubMed Central

In the advanced stages of heart failure, many key enzymes involved in myocardial energy substrate metabolism display various degrees of down-regulation. The net effect of the altered metabolic phenotype consists of reduced cardiac fatty oxidation, increased glycolysis and glucose oxidation, and rigidity of the metabolic response to changes in workload. Is this metabolic shift an adaptive mechanism that protects the heart or a maladaptive process that accelerates structural and functional derangement? The question remains open; however, the metabolic remodelling of the failing heart has induced a number of investigators to test the hypothesis that pharmacological modulation of myocardial substrate utilization might prove therapeutically advantageous. The present review addresses the effects of indirect and direct modulators of fatty acid (FA) oxidation, which are the best pharmacological agents available to date for ‘metabolic therapy’ of failing hearts. Evidence for the efficacy of therapeutic strategies based on modulators of FA metabolism is mixed, pointing to the possibility that the molecular/biochemical alterations induced by these pharmacological agents are more complex than originally thought. Much remains to be understood; however, the beneficial effects of molecules such as perhexiline and trimetazidine in small clinical trials indicate that this promising therapeutic strategy is worthy of further pursuit. PMID:21289012

Lionetti, Vincenzo; Stanley, William C.; Recchia, Fabio A.

2011-01-01

137

Cost-effectiveness of heart failure therapies.  

PubMed

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Management of HF involves accurate diagnosis and implementation of evidence-based treatment strategies. Costs related to the care of patients with HF have increased substantially over the past 2 decades, partly owing to new medications and diagnostic tests, increased rates of hospitalization, implantation of costly novel devices and, as the disease progresses, consideration for heart transplantation, mechanical circulatory support, and end-of-life care. Not surprisingly, HF places a huge burden on health-care systems, and widespread implementation of all potentially beneficial therapies for HF could prove unrealistic for many, if not all, nations. Cost-effectiveness analyses can help to quantify the relationship between clinical outcomes and the economic implications of available therapies. This Review is a critical overview of cost-effectiveness studies on key areas of HF management, involving pharmacological and nonpharmacological clinical therapies, including device-based and surgical therapeutic strategies. PMID:23609174

Rohde, Luis E; Bertoldi, Eduardo G; Goldraich, Livia; Polanczyk, Carísi A

2013-06-01

138

Prepare Cells to Repair the Heart: Mesenchymal Stem Cells for the Treatment of Heart Failure  

Microsoft Academic Search

Heart failure is one of the most important cardiovascular diseases, with high mortality, and invasive treatment such as mechanical circulatory support and cardiac transplantation is sometimes required for severe heart failure. Therefore, the development of less invasive and more effective therapeutic strategies is desired. Cell therapy is attracting growing interest as a new approach for the treatment of heart failure.

Shunsuke Ohnishi; Noritoshi Nagaya

2007-01-01

139

ESPVR, ejection fraction and heart failure.  

PubMed

The problem of heart failure with preserved ejection fraction (HFpEF) has recently received much attention. In this study we discuss some relations that connect ejection fraction EF to the parameters describing the end-systolic pressure-volume relation (ESPVR). It is shown that the study of the relation between EF and ESPVR can give some understanding of the problem of HFpEF. An important feature of the present approach is the introduction of the active force of the myocardium (also called isovolumic pressure) in the formalism describing the ESPVR. PMID:21082250

Shoucri, Rachad M

2010-12-01

140

Positive airway pressure therapy for heart failure  

PubMed Central

Heart failure (HF) is a life-threatening disease and is a growing public health concern. Despite recent advances in pharmacological management for HF, the morbidity and mortality from HF remain high. Therefore, non-pharmacological approaches for HF are being developed. However, most non-pharmacological approaches are invasive, have limited indication and are considered only for advanced HF. Accordingly, the development of less invasive, non-pharmacological approaches that improve outcomes for patients with HF is important. One such approach may include positive airway pressure (PAP) therapy. In this review, the role of PAP therapy applied through mask interfaces in the wide spectrum of HF care is discussed.

Kato, Takao; Suda, Shoko; Kasai, Takatoshi

2014-01-01

141

Anemia in heart failure: an overview of current concepts.  

PubMed

Chronic heart failure is a substantial public health problem. Anemia is an important comorbidity frequently observed in patients with the disease and, in heart failure, anemia has only recently started to attract systematic epidemiological and therapeutical research endeavor. This article describes the many aspects of anemia in chronic heart failure, starting with the ongoing discussion of how to define anemia, which has important consequences for the estimation of its prevalence and incidence. Further, we discuss prognostic implications of anemia in patients with chronic or acute heart failure, the etiology of anemia in heart failure and treatment possibilities. Such therapeutic avenues embrace intravenous iron preparations and subcutaneous administration of erythropoietin and its derivatives, all of which have been extensively studied over the last several years. Finally, this article describes the potential costs incurred by treating anemic patients with heart failure. PMID:21174515

von Haehling, Stephan; Jankowska, Ewa A; Ponikowski, Piotr; Anker, Stefan D

2011-01-01

142

Prospective memory and chronic heart failure  

PubMed Central

Background Patients with chronic heart failure (CHF) experience a number of debilitating symptoms, which impact on activities of daily living and result in poor quality of life. Prospective memory, which is defined as memory to carry out future intentions, has not been investigated in this group. However, emerging evidence suggests CHF patients have difficulties with cognitive processes related to prospective memory. Self-care, which partly relies on prospective memory, is essential in symptom management and preventing acute clinical deterioration. This study aims to measure prospective memory in CHF patients, and examine the relationship between prospective memory and CHF self-care. Methods/Design A comprehensive neuropsychological assessment will be conducted to assess a range of cognitive functions and psychopathology. The primary focus will be an assessment of prospective memory using a well-established behavioral measure; Virtual Week. Thirty CHF patients attending a nurse-led management program will be recruited from three hospital sites in Melbourne, Australia and their self-care behaviors will be assessed using the Self-care Chronic Heart Failure Index (SCHFI), a validated self-report tool. An additional 30 healthy controls, matched on age, gender, and IQ will be recruited from the general community. Discussion This is a group comparison study that will provide an evaluation of the prospective memory abilities of CHF patients. The findings of this research will provide insight into whether prospective memory may be hindering patients’ ability to perform adequate self-care. PMID:23984757

2013-01-01

143

Sleep apnea in congestive heart failure.  

PubMed

Sleep-related breathing disorders, including obstructive sleep apnea (OSA) and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA), commonly occur in patients with congestive heart failure (CHF). In this setting they can have adverse pathophysiologic effects on the cardiovascular system. OSA may lead to development or progression of left ventricular (LV) dysfunction by increasing LV afterload through the combined effects of elevations in systemic blood pressure and a generation of exaggerated negative intrathoracic pressure, and by activating the sympathetic nervous system through the influence of hypoxia and arousals from sleep. Abolition of OSA by continuous positive airway pressure (CPAP) can improve cardiac function in patients with CHF. In contrast to OSA, CSR-CSA is likely a consequence rather than a cause of CHF. Here, pulmonary congestion causes hyperventilation by stimulating pulmonary irritant receptors. This leads to reductions in PaCO2 below the apneic threshold during sleep, precipitating posthyperventilatory central apneas. CSR-CSA is associated with increased mortality in CHF, probably because of sympathetic nervous system activation caused by recurrent apnea-induced hypoxia and arousals from sleep. Treatment of CSR-CSA by supplemental O2, theophylline, and CPAP can alleviate central apneas. Of these treatments, however, only CPAP has been shown to improve cardiac function and symptoms of heart failure. We conclude that effective treatments of OSA and CSR-CSA may prove to be useful adjuncts to the standard pharmacologic therapy of patients with CHF. PMID:9554221

Naughton, M T; Bradley, T D

1998-03-01

144

Metabolic and structural impairment of skeletal muscle in heart failure  

PubMed Central

Physiologic endurance exercise performance is primarily limited by cardiac function. In patients with heart failure, there is dissociation between cardiac performance and exercise capacity, suggesting a distinct role of abnormal peripheral organ function, including skeletal muscle function. The impact of heart failure upon skeletal muscle and exercise performance will be discussed with a focus on molecular, structural, and functional derangements in skeletal muscle of patients with heart failure. PMID:23065040

Zizola, Cynthia; Schulze, P. Christian

2013-01-01

145

Hyperkalemia in patients with heart failure: Incidence, prevalence, and management  

Microsoft Academic Search

Multilevel inhibition of neurohormonal activation using angiotensin-converting enzyme inhibitors, ?-blockers, angiotensin\\u000a receptor blockers, and aldosterone antagonists is the cornerstone of modern heart failure treatment. Use of these agents in\\u000a optimal doses is associated with significant improvements in heart failure-associated morbidity and mortality but also may\\u000a increase serum potassium. Because potassium excretion already is impaired in many heart failure patients because

Akshay S. Desai

2009-01-01

146

Sleep-disordered breathing in patients with decompensated heart failure  

PubMed Central

Sleep-disordered breathing (SDB) has a higher prevalence in patients with heart failure than in the general middle-aged population. Obstructive sleep apnea (OSA), one of the forms of SBD, promotes poorly controlled hypertension, coronary events, and atrial fibrillation events that can lead to acutely decompensated heart failure (ADHF), and evidence suggests that untreated OSA increases mortality in patients with heart failure. Cheyne–Stokes respiration and central sleep apnea (CSA) have long been associated with heart failure and, in many patients, can coexist with OSA. In this article, we propose a systematic approach to diagnose and treat OSA in patients with ADHF based on current evidence. PMID:18758944

Valdivia-Arenas, Martin A.; Powers, Michael

2009-01-01

147

Rethinking Phase II Clinical Trial Design in Heart Failure  

PubMed Central

The incidence and economic burden of heart failure continue to rise worldwide, despite implementation of a number of effective heart failure therapies. Although there have been a number phase I–II studies of potential novel heart failure therapies over the past decade, none of these new compounds have been successful in phase III clinical trials. While there are likely a number of reasons for this failure, one of the problems that has become increasingly apparent is the inability of phase II trials to correctly identify novel therapies that will be successful in phase III clinical trials. In the following review, we will discuss the some of the problems inherent with current phase II heart failure clinical trials, as well as discuss possible ways to rethink phase II development of new therapies for heart failure. PMID:25343020

Lavine, Kory J.; Mann, Douglas L.

2014-01-01

148

Parallel paths to improve heart failure outcomes: evidence matters.  

PubMed

Gaps and disparities in delivery of heart failure education by nurses and performance in accomplishing self-care behaviors by patients with advanced heart failure may be factors in clinical decompensation and unplanned consumption of health care. Is nurse-led education effectively delivered before hospital discharge? Nurse leaders must understand the strength of nurses' knowledge base related to self-care principles and important barriers to best practice. Nurses may not be comfortable teaching patients about dry weight, meal planning, heart failure medications, or progressive steps of activity and exercise. Further, clinical nurses may not have time to provide in-depth education to patients before discharge. Equally important, research is needed to learn about factors that enhance patients' adherence to heart failure self-care behaviors, because adherence to recommendations of national, evidence-based, heart failure guidelines improves clinical outcomes. Thus, nurses and patients are on parallel paths related to setting the foundation for improved self-care adherence in advanced heart failure. Through research, we found that nurses were not adequately prepared as heart failure educators and that patients did not believe they were able to control heart failure. In 2 educational intervention studies that aimed to help patients understand that they could control fluid management and follow a strict daily fluid limit, patients had improved clinical outcomes. Thus, misperceptions about heart failure can be overcome with interventions that move beyond communicating "what" self-care behaviors are recommended. Research results reflect that evidence matters! Systems and processes are needed to support nurses' knowledge, comfort, and frequency in delivering self-care education before discharge, increase the accuracy of patients' beliefs about controlling heart failure, and enhance patients' desire to adhere to guideline-recommended heart failure self-care behaviors. This article describes the development of the parallel paths of nurse and patient programs of research and explores translation of findings into practice and development of clinical translational research. PMID:23817817

Albert, Nancy M

2013-07-01

149

Metabolic remodeling in chronic heart failure  

PubMed Central

Although the management of chronic heart failure (CHF) has made enormous progress over the past decades, CHF is still a tremendous medical and societal burden. Metabolic remodeling might play a crucial role in the pathophysiology of CHF. The characteristics and mechanisms of metabolic remodeling remained unclear, and the main hypothesis might include the changes in the availability of metabolic substrate and the decline of metabolic capability. In the early phases of the disease, metabolism shifts toward carbohydrate utilization from fatty acids (FAs) oxidation. Along with the progress of the disease, the increasing level of the hyperadrenergic state and insulin resistance cause the changes that shift back to a greater FA uptake and oxidation. In addition, a growing body of experimental and clinical evidence suggests that the improvement in the metabolic capability is likely to be more significant than the selection of the substrate. PMID:23897787

Wang, Jing; Guo, Tao

2013-01-01

150

Heart failure in acute ischemic stroke  

Microsoft Academic Search

Background\\u000a   To determine\\u000a the impact of heart failure\\u000a (HF), with preserved or decreased\\u000a left ventricular function (LVF), on\\u000a outcome in patients with acute\\u000a ischemic stroke (AIS).\\u000a \\u000a \\u000a \\u000a \\u000a Methods\\u000a   We\\u000a studied 503 unselected ischemic\\u000a stroke patients. Poor outcome was\\u000a defined as moderate-severe disability\\u000a or death at 90 days. We analyzed\\u000a the association between poor outcome\\u000a and HF with preserved LVF\\u000a or decreased

A. Ois; M. Gomis; E. Cuadrado-Godia; J. Jiménez-Conde; A. RodrÍguez-Campello; J. Bruguera; L. Molina; J. Comin; J. Roquer

2008-01-01

151

[Heart energy metabolism and its role in the treatment of heart failure].  

PubMed

It is unknown why heart failure progresses even when patients are treated with the best therapy available. Evidences suggest that heart failure progression is due to loss of neurohumoral blockade in advanced stages of the disease and to alterations in myocardial metabolism induced, in part, by this neurohumoral activation. Alterations in cardiac energy metabolism, especially those related to substrate utilization and insulin resistance, reduce the efficiency of energy production, causing a heart energy reserve deficit. These events play a basic role in heart failure progression. Therefore, modulation of cardiac metabolism has arisen as a promissory therapy in the treatment of heart failure. This review describes myocardial energy metabolism, evaluates the role of impaired energy metabolism in heart failure progression and describes new therapies for heart failure involving metabolic intervention. PMID:21140063

Castro, Pablo; Gabrielli, Luigi; Verdejo, Hugo; Greig, Douglas; Mellado, Rosemarie; Concepción, Roberto; Sepúlveda, Luis; Vukasovic, José Luis; García, Lorena; Pizarro, Marcela; Pivet, Deisy; Carrillo, Constanza; Tapia, Fabiola; Navarro, Mario; Troncoso, Rodrigo; Baraona, Fernando; Llevaneras, Silvana; Hernández, Claudia; Godoy, Iván; Jalil, Jorge E; Quintana, Juan Carlos; Orellana, Pilar; Chiong, Mario; Lavandero, Sergio

2010-08-01

152

Vagus Nerve Stimulation in Experimental Heart Failure  

PubMed Central

Chronic heart failure (HF) is associated with autonomic dysregulation characterized by a sustained increase of sympathetic drive and by withdrawal of parasympathetic activity. Sympathetic overdrive and increased heart rate are predictors of poor long-term outcome in patients with HF. Considerable evidence exists that supports the use of pharmacologic agents that partially inhibit sympathetic activity as effective long-term therapy for patients with HF; the classic example is the wide use of selective and non-selective beta-adrenergic receptor blockers. In contrast, modulation of parasympathetic activation as potential therapy for HF has received only limited attention over the years given its complex cardiovascular effects. In this article, we review results of recent experimental animal studies that provide support for the possible use of electrical Vagus nerve stimulation (VNS) as a long-term therapy for the treatment of chronic HF. In addition to exploring the effects of chronic VNS on left ventricular (LV) function, the review will also address the effects of VNS on potential modifiers of the HF state that include cytokine production and nitric oxide elaboration. Finally, we will briefly review other nerve stimulation approaches also currently under investigation as potential therapeutic modalities for treating chronic HF. PMID:21128115

Sabbah, Hani N.; Ilsar, Itamar; Zaretsky, Asaph; Rastogi, Sharad; Wang, Mengjun; Gupta, Ramesh C.

2013-01-01

153

Epidemiology and risk profile of heart failure  

PubMed Central

Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. HF represents a considerable burden to the health-care system, responsible for costs of more than $39 billion annually in the USA alone, and high rates of hospitalizations, readmissions, and outpatient visits. HF is not a single entity, but a clinical syndrome that may have different characteristics depending on age, sex, race or ethnicity, left ventricular ejection fraction (LVEF) status, and HF etiology. Furthermore, pathophysiological differences are observed among patients diagnosed with HF and reduced LVEF compared with HF and preserved LVEF, which are beginning to be better appreciated in epidemiological studies. A number of risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes, among others, have been identified that both predict the incidence of HF as well as its severity. In this Review, we discuss key features of the epidemiology and risk profile of HF. PMID:21060326

Bui, Anh L.; Horwich, Tamara B.; Fonarow, Gregg C.

2011-01-01

154

Central sleep apnea and chronic heart failure.  

PubMed

Central sleep apnea with Cheyne-Stokes respiration (CSR) during sleep affects about 40 % of patients with chronic heart failure (CHF). During CSR simultaneous periodic fluctuations in wakefulness and respiration with accompanying changes in blood pressure and heart rate are observed. CSR can be described as an oscillation of the ventilatory feedback loop controlling respiration. The major synergistically acting mechanisms causing this oscillation include reduced body stores of oxygen and carbon dioxide, hyperventilation with concomitant hypocapnia, prolonged circulation time, and a relatively high hypercapnic ventilatory response. The repetitive desaturations and arousals following CSR cause daytime symptoms and an increase in sympathetic activity. In CHF chronically increased sympathetic activity has negative effects on left ventricular function and is associated with reduced exercise tolerance and poor prognosis. Therefore CSR is expected to have an unfavorable influence on the course of CHF. Whether successful treatment of nocturnal CSR has any impact on the high mortality of CHF needs to be resolved in controlled studies with sufficient sample size. PMID:10893107

Andreas, S

2000-06-15

155

The Alberta Heart Failure Etiology and Analysis Research Team (HEART) study  

PubMed Central

Background Nationally, symptomatic heart failure affects 1.5-2% of Canadians, incurs $3 billion in hospital costs annually and the global burden is expected to double in the next 1–2 decades. The current one-year mortality rate after diagnosis of heart failure remains high at >25%. Consequently, new therapeutic strategies need to be developed for this debilitating condition. Methods/Design The objective of the Alberta HEART program (http://albertaheartresearch.ca) is to develop novel diagnostic, therapeutic and prognostic approaches to patients with heart failure with preserved ejection fraction. We hypothesize that novel imaging techniques and biomarkers will aid in describing heart failure with preserved ejection fraction. Furthermore, the development of new diagnostic criteria will allow us to: 1) better define risk factors associated with heart failure with preserved ejection fraction; 2) elucidate clinical, cellular and molecular mechanisms involved with the development and progression of heart failure with preserved ejection fraction; 3) design and test new therapeutic strategies for patients with heart failure with preserved ejection fraction. Additionally, Alberta HEART provides training and education for enhancing translational medicine, knowledge translation and clinical practice in heart failure. This is a prospective observational cohort study of patients with, or at risk for, heart failure. Patients will have sequential testing including quality of life and clinical outcomes over 12 months. After that time, study participants will be passively followed via linkage to external administrative databases. Clinical outcomes of interest include death, hospitalization, emergency department visits, physician resource use and/or heart transplant. Patients will be followed for a total of 5 years. Discussion Alberta HEART has the primary objective to define new diagnostic criteria for patients with heart failure with preserved ejection fraction. New criteria will allow for targeted therapies, diagnostic tests and further understanding of the patients, both at-risk for and with heart failure. Trial registration ClinicalTrials.gov NCT02052804. PMID:25063541

2014-01-01

156

General public awareness of heart failure: results of questionnaire survey during Heart Failure Awareness Day 2011  

PubMed Central

Introduction General public views about heart failure (HF) alone and in comparison with other chronic conditions are largely unknown; thus we conducted this survey to evaluate general public awareness about HF and HF disease burden relative to common chronic disease. Material and methods This was a cross-sectional survey during European Heart Failure Awareness Day 2011. People visiting the stands and other activities in 12 Slovenian cities were invited to complete a 14-item questionnaire. Results The analysis included 850 subjects (age 56 ±15 years, 44% men, 55% completed secondary education or higher). Overall, 83% reported to have heard about HF, 58% knew someone with HF, and 35% believed that HF is a normal consequence of ageing. When compared to other chronic diseases, HF was perceived as less important than cancer, myocardial infarction, stroke and diabetes with only 6%, 12%, 7%, and 5% of subjects ranking HF as number 1 in terms of prevalence, cost, quality of life, and survival. A typical patient with HF symptoms was recognized by 30%, which was comparable to the description of myocardial ischemia (33%) and stroke (39%). Primary care physicians (53%) or specialists (52%) would be primary sources of information about HF. If experiencing HF, 83% would prefer their care to be focused on quality of life rather than on survival (14%). Conclusions Many participants reported to have heard about heart failure but the knowledge was poor and with several misbeliefs. Heart failure was perceived as less important than several other chronic diseases, where cancer appears as a main concern among the general public. PMID:24904672

Letonja, Mitja; Kovacic, Dragan; Hodoscek, Lea Majc; Marolt, Apolon; Bartolic, Cvetka Melihen; Mulej, Marija; Penko, Meta; Poles, Janez; Ravnikar, Tinkara; Iskra, Mojca Savnik; Pusnik, Cirila Slemenik; Jug, Borut

2014-01-01

157

Psychosocial functioning and physical symptoms in heart failure patients  

Microsoft Academic Search

ObjectiveHeart failure (HF) markedly diminishes an individual's quality of life. However, little is known about how psychosocial functioning is related to heart failure physical symptom expression (e.g., chest pain or heaviness, shortness of breath) on a day-to-day basis.

Robert A Carels; Dara Musher-Eizenman; Holly Cacciapaglia; Carlos I Pérez-Ben??tez; Samantha Christie; William O'Brien

2004-01-01

158

Randomised controlled trial of specialist nurse intervention in heart failure  

Microsoft Academic Search

Objectives To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure. Design Randomised controlled trial. Setting Acute medical admissions unit in a teaching hospital. Participants 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year. Main outcome measures

Lynda Blue; Elanor Lang; J. J V McMurray; A. P Davie; T. A McDonagh; D. R Murdoch; M. C Petrie; E. Connolly; J. Norrie; C. E Round; I. Ford; C. E Morrison

2001-01-01

159

Evaluation of depression in patients with heart failure  

Microsoft Academic Search

Background: Despite advances in medical therapy heart failure consists a prevalent debilitating disease of poor prognosis, strongly associated with high mortality and morbidity rates. On the same time, depression rates are higher in patients with heart failure than in the general population. Depression may be underdiagnosed and consequently undertreated in the patients, as symptoms can often be similar in the

Maria Polikandrioti; Apostolos Christou; Zoi Morou; Gregory Kotronoulas; Helen Evagelou; Helen Kyritsi

2010-01-01

160

A Palliative Care Approach to the Advanced Heart Failure Patient  

Microsoft Academic Search

Congestive heart failure can become a debilitating, terminal illness in many patients despite maximal medical therapy. Patients with advanced heart failure have persistence of severe clinical symptoms limiting their daily life, marked left ventricular systolic dysfunction, and poor exercise capacity. Although individual disease trajectory in these patients can be difficult to predict, overall mortality remains high despite recent advances in

Susan Quaglietti; Michael Pham; Victor Froelicher

2005-01-01

161

Pathophysiology of Sodium and Water Retention in Heart Failure  

Microsoft Academic Search

Heart failure is a leading cause of morbidity and mortality. In the United States, there are more than 5 million patients with heart failure and over 500,000 newly diagnosed cases each year. Numerous advances have been made in our understanding of the pathophysiologic mechanisms contributing to sodium and water retention in this condition. Important alterations in the sympathetic nervous system

Melissa A. Cadnapaphornchai; Andrei K. Gurevich; Howard D. Weinberger; Robert W. Schrier

2001-01-01

162

Heart Failure Patients Wind Up in ER Too Often  

MedlinePLUS

... sharing features on this page, please enable JavaScript. Heart Failure Patients Wind Up in ER Too Often: Study ... 25, 2014 Related MedlinePlus Pages Emergency Medical Services Heart Failure MONDAY, Aug. 25, 2014 (HealthDay News) -- Many acute ...

163

Heart failure caused by congenital left-sided lesions.  

PubMed

There are diverse mechanisms by which congenital left-sided cardiac lesions can precipitate heart failure. Left heart outflow obstruction can impose abnormal pressure load on the left ventricle, inducing adverse remodeling, hypertrophy, and diastolic and systolic dysfunction. Abnormalities in left ventricular inflow can increase pulmonary venous pressure and predisposing to pulmonary edema. In addition, inborn abnormalities in left ventricular myocardial structure and function can impair both systolic and diastolic function and manifest as heart failure later in life. In this article, the different mechanisms, outcomes, and treatments of heart failure in patients with congenital left-sided lesions are discussed. PMID:24275301

Krieger, Eric V; Fernandes, Susan M

2014-01-01

164

Haemodynamic studies with peruvoside in human congestive heart failure.  

PubMed

The immediate haemodynamic effects of peruvoside, a cardiac glycoside obtained from the Indian plant Thevetia neriifolia Juss, were studied in six patients with congestive heart failure. The drug was found to have an immediate and powerful positive inotropic and negative chronotropic effect, like ouabain, on the failing human heart. Oral peruvoside was also effective in the treatment of congestive heart failure when used on a short-term as well as a long-term basis. It therefore seems that peruvoside is a useful cardiac glycoside in the management of congestive heart failure in man as a quick-acting intravenous preparation. It is equally effective when used orally. PMID:4919553

Bhatia, M L; Manchanda, S C; Roy, S B

1970-09-26

165

Haemodynamic Studies with Peruvoside in Human Congestive Heart Failure  

PubMed Central

The immediate haemodynamic effects of peruvoside, a cardiac glycoside obtained from the Indian plant Thevetia neriifolia Juss, were studied in six patients with congestive heart failure. The drug was found to have an immediate and powerful positive inotropic and negative chronotropic effect, like ouabain, on the failing human heart. Oral peruvoside was also effective in the treatment of congestive heart failure when used on a short-term as well as a long-term basis. It therefore seems that peruvoside is a useful cardiac glycoside in the management of congestive heart failure in man as a quick-acting intravenous preparation. It is equally effective when used orally. PMID:4919553

Bhatia, M. L.; Manchanda, S. C.; Roy, Sujoy B.

1970-01-01

166

Anemia associated with chronic heart failure: current concepts  

PubMed Central

Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies. PMID:23403618

Shah, Ravish; Agarwal, Anil K

2013-01-01

167

Electrophysiological changes in heart failure and their implications for arrhythmogenesis.  

PubMed

Heart failure is the final common pathway of various cardiac pathologies and is associated with sudden cardiac death, mostly caused by ventricular arrhythmias. In this paper we briefly review the electrophysiological remodeling and the alterations in intracellular calcium handling, and the resulting arrhythmogenic mechanisms associated with heart failure. Intercellular uncoupling and fibrosis are identified as a major arrhythmogenic factors. Diet and ventricular wall stretch are discussed as modulating factors. Finally, emphasis is placed on the hitherto poorly studied aspects of right ventricular failure. This article is part of a Special Issue entitled: Heart failure pathogenesis and emerging diagnostic and therapeutic interventions. PMID:23579069

Coronel, R; Wilders, Ronald; Verkerk, Arie O; Wiegerinck, Rob F; Benoist, David; Bernus, Olivier

2013-12-01

168

Heart failure in older people: causes, diagnosis and treatment  

Microsoft Academic Search

Congestive heart failure affects )5% of those aged 65-75 and 10-20% of those aged )80 in the UK, and levels are likely to rise in the wake of improved therapies for hypertension and myocardial infarction. It is often multifactorial in this group. The most common causes are hypertension and coronary heart disease, with valvular heart disease playing an increasing role.

AHMED H. ABDELHAFIZ

2002-01-01

169

Investigating Pain in Heart Failure Patients: Rationale and Design of the Pain Assessment, Incidence & Nature in Heart Failure (PAIN-HF) Study  

Microsoft Academic Search

BackgroundHeart failure is a major cause of morbidity and mortality and is increasing in prevalence. Treatments for heart failure permit a growing number of persons to live with the illness for many years. The burden of symptoms in persons with advanced heart failure is high. Fatigue, limited exertion, dyspnea, and depression are commonly associated with heart failure, but pain is

Sarah J. Goodlin; Sue Wingate; Susan J. Pressler; John R. Teerlink; C. Porter Storey

2008-01-01

170

Racial differences in response to therapy for heart failure: Analysis of the vasodilator-heart failure trials  

Microsoft Academic Search

Background: Heart failure in blacks has been associated with a poorer prognosis than in whites. In such diseases as hypertension, blacks show pathophysiological differences and respond differently to some therapies than whites. The aim of this study is to evaluate the clinical characteristics and response to therapy of black compared with white patients with heart failure.Methods and Results: In the

Peter Carson; Susan Ziesche; Gary Johnson; Jay N. Cohn

1999-01-01

171

Roles of renin-angiotensin and endothelin systems in development of diastolic heart failure in hypertensive hearts  

Microsoft Academic Search

Objective: Although interest in diastolic heart failure is growing because of its clinical frequency, little is known about this type of heart failure. Our laboratory recently developed a diastolic heart failure model using Dahl salt-sensitive rat. In this model, gene expression of angiotensin-converting enzyme and endothelin (ET) system in the left ventricle was enhanced at heart failure stage without downregulation

Kazuhiro Yamamoto; Tohru Masuyama; Yasushi Sakata; Toshiaki Mano; Nagahiro Nishikawa; Hiroya Kondo; Noriyuki Akehi; Tsunehiko Kuzuya; Takeshi Miwa; Masatsugu Hori

172

Increased late sodium current in myocytes from a canine heart failure model and from failing human heart  

Microsoft Academic Search

Electrophysiological remodeling of ion channels in heart failure causes action potential prolongation and plays a role in arrhythmia mechanism. The importance of down-regulation of potassium currents is well-known, but a role for Na current (INa) in heart failure is less well established. We studied INa in heart failure ventricular cells from a canine pacing model of heart failure and also

Carmen R. Valdivia; William W. Chu; Jielin Pu; Jason D. Foell; Robert A. Haworth; Mathew R. Wolff; Timothy J. Kamp; Jonathan C. Makielski

2005-01-01

173

Blood flow dynamics in heart failure  

NASA Technical Reports Server (NTRS)

BACKGROUND: Exercise intolerance in heart failure (HF) may be due to inadequate vasodilation, augmented vasoconstriction, and/or altered muscle metabolic responses that lead to fatigue. METHODS AND RESULTS: Vascular and metabolic responses to rhythmic forearm exercise were tested in 9 HF patients and 9 control subjects (CTL) during 2 protocols designed to examine the effect of HF on the time course of oxygen delivery versus uptake (protocol 1) and on vasoconstriction during exercise with 50 mm Hg pressure about the forearm to evoke a metaboreflex (protocol 2). In protocol 1, venous lactate and H+ were greater at 4 minutes of exercise in HF versus CTL (P<0.05) despite similar blood flow and oxygen uptake responses. In protocol 2, mean arterial pressure increased similarly in each group during ischemic exercise. In CTL, forearm blood flow and vascular conductance were similar at the end of ischemic and ambient exercise. In HF, forearm blood flow and vascular conductance were reduced during ischemic exercise compared with the ambient trial. CONCLUSIONS: Intrinsic differences in skeletal muscle metabolism, not vasodilatory dynamics, must account for the augmented glycolytic metabolic responses to moderate-intensity exercise in class II and III HF. The inability to increase forearm vascular conductance during ischemic handgrip exercise, despite a normal pressor response, suggests that enhanced vasoconstriction of strenuously exercising skeletal muscle contributes to exertional fatigue in HF.

Shoemaker, J. K.; Naylor, H. L.; Hogeman, C. S.; Sinoway, L. I.

1999-01-01

174

Membrane Associated Matrix Proteolysis and Heart Failure  

PubMed Central

The extracellular matrix (ECM) is a complex entity containing a large portfolio of structural proteins, signaling molecules, and proteases. Changes in the overall integrity and activational state of these ECM constituents can contribute to tissue structure and function, which is certainly true of the myocardium. Changes in the expression patterns and activational states of a family of ECM proteolytic enzymes, the matrix metalloproteinases (MMPs), have been identified in all forms of LV remodeling and can be a contributory factor for the progression to heart failure. However, new clinical and basic research has identified some surprising and unpredicted changes in MMP profiles in LV remodeling processes, such as with pressure or volume overload, as well as with myocardial infarction. From these studies, it has become recognized that proteolytic processing of signaling molecules by certain MMP types, particularly the transmembrane MMPs, may actually facilitate ECM accumulation as well as modulate fibroblast transdifferentiation – both critical events in adverse LV remodeling. Based upon the ever increasing substrates and diversity of biological actions of MMPs, it is likely that continued research regarding the relationship of LV remodeling to this family of proteases will yield new insights into the ECM remodeling process itself as well as new therapeutic targets. PMID:23287455

Spinale, Francis G.; Janicki, Joseph S.; Zile, Michael R.

2014-01-01

175

Learning needs of congestive heart failure patients.  

PubMed

Congestive heart failure (CHF) affects approximately one-half million Canadians and five million Americans. Patient education is a vital component of nursing care of this population, with the goals of improving the CHF patient's quality of life, minimizing symptoms and hospital admissions, and reducing length of hospital stay. A review of the literature related to the educational needs of CHF patients reveals minimal research. The purpose of this study was to compare the perceived learning needs of CHF patients by patients and nurses, and to identify existing gaps between their perceptions. Fifty (50) CHF patients and 47 cardiac nurses were surveyed using a modified version of the CHF Patient Learning Needs Inventory developed by Hagenhoff et al. This instrument measured the importance of specific learning topics within the categories of anatomy and physiology, medications, diet, risk factors, activity, psychological factors, and other pertinent information. The results indicated that both groups found most information "moderately" to "very" important to learn. The patients generally rated all information items higher than nurses did. The most significant finding was that the nurses rated the diet category as second in importance, while the patients rated it last. The results from the study will be incorporated into a needs-based educational program for CHF patients. PMID:9802112

Frattini, E; Lindsay, P; Kerr, E; Park, Y J

1998-01-01

176

Nurses and heart failure education in medical wards.  

PubMed

Heart failure is a chronic debilitating disease with significant hospitalisation rates. Information and education are foundational elements in making the lifestyle changes required for effective self-management of the symptoms of heart failure. This paper reports a study of medical nurses' education activities with heart failure patients in terms of the topics they addressed and the educational resources they found most useful. A random sample of 540 medical ward nurses were surveyed in 2009 using a postal questionnaire. The response rate was 47% (234 medical ward nurses who cared for patients with heart failure). Quantitative data were analysed using descriptive statistics, qualitative data through a content analysis approach. The majority of respondents (66.7%) cared for patients with heart failure several times each week. The total time spent on educational activities by most respondents (70.6%) was estimated as 20 minutes or less over the hospitalisation. Printed material was the most commonly used education resource although 35 respondents also referred to online information and 84 nurses did not use educational material at all. The most frequent education topics discussed were medication, signs and symptoms and general information about heart failure. Psychological factors and prognosis information were the topics least discussed with patients. Respondent suggestions to improve patient access to heart failure information included more printed information in wards such as pamphlets in various languages, information about useful websites and having key resources available in te reo M?ori. The heart failure educator was identified as an important resource for both nurses and patients. The study highlighted the limited time many respondents spent on educational activities and the need for readily available educational resources to optimise patient heart failure education opportunities. PMID:24575606

Gilmour, Jean; Strong, Alison; Hawkins, Mona; Broadbent, Rachel; Huntington, Annette

2013-11-01

177

Prospective Study of Heart Rate Variability and Mortality in Chronic Heart Failure Results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-Heart)  

Microsoft Academic Search

Background—Patients with chronic heart failure (CHF) have a continuing high mortality. Autonomic dysfunction may play an important role in the pathophysiology of cardiac death in CHF. UK-HEART examined the value of heart rate variability (HRV) measures as independent predictors of death in CHF. Methods and Results—In a prospective study powered for mortality, we recruited 433 outpatients 62 69.6 years old

James Nolan; Phillip D. Batin; Richard Andrews; Steven J. Lindsay; Paul Brooksby; Michael Mullen; Wazir Baig; Andrew D. Flapan; Alan Cowley; Robin J. Prescott; James M. M. Neilson; Keith A. A. Fox

178

[Erythropoiesis-stimulating agents in congestive heart failure patients].  

PubMed

Congestive heart failure is a disease of high incidence and prevalence in the elderly. Anemia is associated with an increased mortality in these patients. This article reviews the cumulated evidence about the use of erythropoiesis-stimulating agents in congestive heart failure patients. Although some improvement in quality of life has been shown, it has not been found any decrement on mortality and, as a result, together with the high drug cost, it is not recommended the use of this kind of drugs in heart failure patients. PMID:24012446

Robles Perez-Monteoliva, Nicolás Roberto; Macías Núñez, Juan Francisco; Herrera Pérez de Villar, Julio

2014-03-01

179

Managing congestive heart failure with thoracic electrical bioimpedance.  

PubMed

Because of clinical utility, immediate feedback, absence of risk to the patient, portability, and use in virtually any practice setting, facilities using thoracic electrical bioimpedance monitoring are increasing throughout the world. Specialized centers treating patients with heart failure have shown remarkable benefits, both in health care costs and patient morbidity, attributable to the careful monitoring and management of patients with heart failure. The ability of thoracic bioimpedance monitoring to provide objective data in the management of congestive heart failure provides practitioners with the clinical reassurance to optimize pharmacologic therapy safely. PMID:10745709

Gilbert, J; Lazio, L

1999-08-01

180

Congestive Heart Failure versus Inflammatory Carcinoma in Breast  

PubMed Central

Inflammatory breast cancer is a rare highly malignant form of breast cancer. Clinical signs and symptoms with histologic examination usually confirm the diagnosis. There are rare reports of breast edema of congestive heart failure which were difficult to differentiate from inflammatory carcinoma. The differential becomes more difficult when congestive heart failure is associated with unilateral breast edema. We present a case of a 70-year-old woman with congestive heart failure associated with unilateral breast edema and skin thickening simulating inflammatory breast carcinoma on mammography. PMID:24808966

Alikhassi, A.; Omranipour, R.; Alikhassy, Z.

2014-01-01

181

Cardiac Metabolism in Heart Failure - Implications beyond ATP production  

PubMed Central

The heart has a high rate of ATP production and turnover which is required to maintain its continuous mechanical work. Perturbations in ATP generating processes may therefore affect contractile function directly. Characterizing cardiac metabolism in heart failure revealed several metabolic alterations termed metabolic remodeling, ranging from changes in substrate utilization to mitochondrial dysfunction, ultimately resulting in ATP deficiency and impaired contractility. However, ATP depletion is not the only relevant consequence of metabolic remodeling during heart failure. By providing cellular building blocks and signaling molecules, metabolic pathways control essential processes such as cell growth and regeneration. Thus, alterations in cardiac metabolism may also affect the progression to heart failure by mechanisms beyond ATP supply. Our aim is therefore to highlight that metabolic remodeling in heart failure not only results in impaired cardiac energetics, but also induces other processes implicated in the development of heart failure such as structural remodeling and oxidative stress. Accordingly, modulating cardiac metabolism in heart failure may have significant therapeutic relevance that goes beyond the energetic aspect. PMID:23989714

Doenst, Torsten; Nguyen, T. Dung; Abel, E. Dale

2013-01-01

182

Optimized Treatment and Heart Rate Reduction in Chronic Heart Failure  

PubMed Central

Background Heart failure (HF) is a syndrome that leads to poor outcome in advanced forms. The neurohormonal blockade modifies this natural history; however, it is often suboptimal. Objective The aim of this study is to assess at what percentage cardiologists used to treating HF can prescribe target doses of drugs of proven efficacy. Methods A total of 104 outpatients with systolic dysfunction were consecutively enrolled, all under stabilized treatment. Demographic and treatment data were evaluated and the doses achieved were verified. The findings are shown as percentages and correlations are made between different variables. Results The mean age of patients was 64.1 ± 14.2 years, with SBP =115.4 ± 15.3, HR = 67.8 ± 9.4 bpm, weight = 76.0 ± 17.0 kg and sinus rhythm (90.4%). As for treatment, 93.3% received a RAS blocker (ACEI 52.9%), all received beta-blockers (BB), the most often prescribed being carvedilol (92.3%). As for the doses: 97.1% of those receiving an ARB were below the optimal dose and of those who received ACEI, 52.7% received an optimized dose. As for the BB, target doses were prescribed to 76.0% of them. In this group of patients, most with BB target dose, it can be seen that 36.5% had HR ? 70 bpm in sinus rhythm. Conclusion Cardiologists used to treating HF can prescribe target doses of ACEI and BB to most patients. Even though they receive the recommended doses, about one third of patients persists with HR > 70 bpm and should have their treatment optimized. PMID:24100693

Moreno, Irineu Blanco; Del Carlo, Carlos Henrique; Pereira-Barretto, Antonio Carlos

2013-01-01

183

Heart Failure: The Hidden Problem of Pain  

PubMed Central

Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67 ± 11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pain ? 4/10). The presence of pain was reported more frequently than dyspnea (67 [71.3%] vs. 58 [61.7%]). Age (P = 0.02), psychological (depression: P = 0.002; anxiety: P = 0.001), social (P < 0.001), spiritual (P = 0.010), and physical (health status: P = 0.001; symptom frequency: P = 0.000; functional status: P = 0.002) well-being were correlated with pain severity. In the resulting model, 38% of the variance in pain severity was explained (P < 0.001); interference with relations (P < 0.001) and symptom number (P = 0.007) contributed to pain severity. The association of physical, psychological, social, and spiritual domains with pain suggests that multidisciplinary interventions are needed to address the complex nature of pain in HF. PMID:19733032

Goebel, Joy R.; Doering, Lynn V.; Shugarman, Lisa R.; Asch, Steve M.; Sherbourne, Cathy D.; Lanto, Andy B.; Evangelista, Lorraine S.; Nyamathi, Adeline M.; Maliski, Sally L.; Lorenz, Karl A.

2010-01-01

184

Comorbid Heart Failure and Renal Impairment: Epidemiology and Management  

PubMed Central

Heart failure mortality is significantly increased in patients with baseline renal impairment and those with underlying heart failure who subsequently develop renal dysfunction. This accelerated progression occurs independent of the cause or grade of renal dysfunction and baseline risk factors. Recent large prospective databases have highlighted the depth of the current problem, while longitudinal population studies support an increasing disease burden. We have extensively reviewed the epidemiological and therapeutic data among these patients. The evidence points to a progression of heart failure early in renal impairment, even in the albuminuric stage. The data also support poor prescription of prognostic therapies. As renal function is the most important prognostic factor in heart failure, it is important to establish the current understanding of the disease burden and the therapeutic implications. PMID:23381594

Iyngkaran, Pupalan; Thomas, Merlin; Majoni, William; Anavekar, Nagesh S.; Ronco, Claudio

2012-01-01

185

Does Depression Impact Cognitive Impairment in Patients with Heart Failure?  

PubMed Central

Prevalence studies have noted the cooccurrence of cognitive decline and depression in persons with heart failure. Cognitive impairment is associated with significant mortality and deteriorated quality of life, likely due to impairments in memory and executive function, which impact a patient's ability to understand and comply with prescribed treatment plans. This is especially true in complex diseases such as heart failure. Evidence from literature supports the possibility of a pathophysiological relationship between cognitive impairment, depression, and heart failure. Yet, very few studies have sought to investigate this relationship. This paper reviews current literature on the association between depression and cognitive impairment in persons with heart failure and explores possible mechanisms explaining this complex triad. PMID:22919538

Sohani, Z. N.; Samaan, Z.

2012-01-01

186

Does depression impact cognitive impairment in patients with heart failure?  

PubMed

Prevalence studies have noted the cooccurrence of cognitive decline and depression in persons with heart failure. Cognitive impairment is associated with significant mortality and deteriorated quality of life, likely due to impairments in memory and executive function, which impact a patient's ability to understand and comply with prescribed treatment plans. This is especially true in complex diseases such as heart failure. Evidence from literature supports the possibility of a pathophysiological relationship between cognitive impairment, depression, and heart failure. Yet, very few studies have sought to investigate this relationship. This paper reviews current literature on the association between depression and cognitive impairment in persons with heart failure and explores possible mechanisms explaining this complex triad. PMID:22919538

Sohani, Z N; Samaan, Z

2012-01-01

187

Family Influences on Heart Failure Self-care and Outcomes  

PubMed Central

Many patient education guidelines for teaching heart failure patients recommend inclusion of the family; however, family-focused interventions to promote self-care in heart failure are few. This article reviews the state of the science regarding family influences on heart failure self-care and outcomes. The literature and current studies suggest that family functioning, family support, problem solving, communication, self-efficacy, and caregiver burden are important areas to target for future research. In addition, heart failure patients without family and those who live alone and are socially isolated are highly vulnerable for poor self-care and should receive focused attention. Specific research questions based on existing science and gaps that need to be filled to support clinical practice are posed. PMID:18437068

Dunbar, Sandra B.; Clark, Patricia C.; Quinn, Christina; Gary, Rebecca A.; Kaslow, Nadine J.

2009-01-01

188

The evolving landscape of quality measurement for heart failure  

PubMed Central

Heart failure (HF) is a major cause of mortality and morbidity, representing a leading cause of death and hospitalization among U.S. Medicare beneficiaries. Advances in science have generated effective interventions to reduce adverse outcomes in HF, particularly in patients with reduced left ventricular ejection fraction. Unfortunately, effective therapies for heart failure are often not utilized in an effective, safe, timely, equitable, patient-centered, and efficient manner. Further, the risk of adverse outcomes for HF remains high. The last decades have witnessed the growth of efforts to measure and improve the care and outcomes of patients with HF. This paper will review the evolution of quality measurement for HF, including a brief history of quality measurement in medicine; the measures that have been employed to characterize quality in heart failure; how the measures are obtained; how measures are employed; and present and future challenges surrounding quality measurement in heart failure. PMID:22548579

Fitzgerald, Ashley A.; Allen, Larry A.; Masoudi, Frederick A.

2013-01-01

189

Device monitoring strategies in acute heart failure syndromes  

Microsoft Academic Search

Acute heart failure syndromes (AHFS) represent the most common discharge diagnoses in adults over age 65 and translate into\\u000a dramatically increased heart failure–associated morbidity and mortality. Conventional approaches to the early detection of\\u000a pulmonary and systemic congestion have been shown to be of limited sensitivity. Despite their proven efficacy, disease management\\u000a and structured telephone support programs have failed to achieve

Michael A. Samara; W. H. Wilson Tang

2011-01-01

190

Long-Term Adrenomedullin Administration in Experimental Heart Failure  

Microsoft Academic Search

Short-term administration of adrenomedullin, a recently discovered peptide with potent vasodilator, natriuretic, and aldosterone-inhibitory actions, has beneficial effects in experimental and clinical heart failure. The effects of prolonged adrenomedullin administration have not previously been assessed in this setting. Consequently, in 16 sheep with pacing-induced heart failure, we infused either adrenomedullin (10 ng\\/kg per minute; n8) or a vehicle control (Hemaccel;

Miriam T. Rademaker; Chris J. Charles; Eric A. Espiner; M. Gary Nicholls; A. Mark Richards

2010-01-01

191

Newer mechanical devices in the management of acute heart failure  

Microsoft Academic Search

Heart Failure is the only cardiovascular disease diagnosis increasing in prevalence in the United States. Currently there\\u000a are more than 5 million people diagnosed with heart failure in the United States and that population is increasing exponentially.\\u000a Clinical trials in advanced pharmacological therapies have shown a significant value in reducing the morbidity and mortality\\u000a of the disease process. Nevertheless, many patients

Paul J. Mather; Marvin A. Konstam

2007-01-01

192

Imaging of myocardial dyssynchrony in congestive heart failure  

Microsoft Academic Search

Heart failure constitutes a major health problem in USA and Europe. Angiotensin converting enzyme inhibitors and _ blockers\\u000a were shown to reduce morbidity and mortality in patients with CHF. Yet, their effectiveness is limited. A significant number\\u000a of patients with heart failure manifest myocardial conduction abnormalities. Conduction abnormalities, especially in the form\\u000a of left bundle branch block (LBBB) may be

Boaz D. Rosen; Albert C. Lardo; Ronald D. Berger

2006-01-01

193

Renal dysfunction in acute heart failure: epidemiology, mechanisms and assessment  

Microsoft Academic Search

Renal dysfunction is often present and\\/or worsens in patients with heart failure and this is associated with increased costs\\u000a of care, complications and mortality. The cardiorenal syndrome can be defined as the presence or development of renal dysfunction\\u000a in patients with heart failure. Its mechanisms are likely related to low cardiac output, increased venous congestion and renal\\u000a venous pressure, neurohormonal

Valentina Carubelli; Marco Metra; Carlo Lombardi; Luca Bettari; Silvia Bugatti; Valentina Lazzarini; Livio Dei Cas

194

Mouse models of heart failure: cell signaling and cell survival.  

PubMed

Heart failure is one of the paramount global causes of morbidity and mortality. Despite this pandemic need, the available clinical counter-measures have not altered substantially in recent decades, most notably in the context of pharmacological interventions. Cell death plays a causal role in heart failure, and its inhibition poses a promising approach that has not been thoroughly explored. In previous approaches to target discovery, clinical failures have reflected a deficiency in mechanistic understanding, and in some instances, failure to systematically translate laboratory findings toward the clinic. Here, we review diverse mouse models of heart failure, with an emphasis on those that identify potential targets for pharmacological inhibition of cell death, and on how their translation into effective therapies might be improved in the future. PMID:24947238

Fiedler, Lorna R; Maifoshie, Evie; Schneider, Michael D

2014-01-01

195

Recognizing Advanced Heart Failure and Knowing Your Options  

MedlinePLUS

... heart failure include: Intra-aortic balloon pump: A small balloon is placed inside the aorta, the major artery connected to the heart that sends blood to the body. The balloon is connected to a machine outside the body that inflates the balloon when ...

196

Effects of Thalidomide Treatment in Heart Failure Patients  

Microsoft Academic Search

Background: Several studies have reported a direct association between elevated plasma levels of inflammatory cytokines and worse functional class (New York Heart Association [NYHA]) and cardiac function, measured as left ventricular ejection fraction (LVEF). Thalidomide has recently shown to improve LVEF in chronic heart failure patients, accompanied by a marked decrease in plasma levels of tumor necrosis factor alpha (TNF-?).

Arturo Orea-Tejeda; Oscar Arrieta-Rodríguez; Lilia Castillo-Martínez; Tatiana Rodríguez-Reyna; Enrique Asensio-Lafuente; Julio Granados-Arriola; Joel Dorantes-García

2007-01-01

197

Dilated Cardiomyopathies as a Cause of Congestive Heart Failure  

Microsoft Academic Search

Definition and Classification: Cardiomyopathies are disorders affecting the heart muscle that frequently result in congestive heart failure. Five major forms are recognized: dilated, hypertrophic, restrictive, right ventricular, and nonclassifiable cardiomyopathies with distinct hemodynamic properties. Furthermore, the new WHO\\/WHF definition also comprises inflammatory cardiomyopathy, defined as myocarditis in association with cardiac dysfunction. Idiopathic, autoimmune, and infectious forms of inflammatory cardiomyopathy were

Bernhard Maisch; Arsen D. Risti?; Günter Hufnagel; Reinhard Funck; Peter Alter; Daniela Tontsch; Sabine Pankuweit

2002-01-01

198

Mechanisms of Development of Heart Failure in the Hypertensive Patient  

Microsoft Academic Search

Hypertension is a major risk factor for the development of heart failure. Mechanisms which maintain normal function in the short term in the pressure overloaded heart have longer term deleterious effects. These include left ventricular (LV) hypertrophy and chronic activation of the adrenergic and renin-angiotensin systems. ?-Blocking agents are capable of blocking the adrenergic system and, to some extent, the

Michael R. Bristow

1999-01-01

199

Treating Heart Failure With Enhanced External Counterpulsation (EECP): Design of the Prospective Evaluation of EECP in Heart Failure (PEECH) Trial  

Microsoft Academic Search

BackgroundEnhanced external counterpulsation (EECP) treatment can improve exercise tolerance in patients with ischemic heart disease; however, the possible benefits of EECP in patients with stable heart failure (HF) and left ventricular dysfunction (LVD) are unclear. An open pilot study showed significant increases in exercise tolerance in HF patients undergoing EECP. Thus a larger, controlled study of EECP in patients with

Arthur M. Feldman; Marc A. Silver; Gary S. Francis; Paul-André de Lame; William W. Parmley

2005-01-01

200

Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction  

Microsoft Academic Search

Background The prevalence of heart failure with preserved ejection fraction may be changing as a result of changes in population demographics and in the prevalence and treat- ment of risk factors for heart failure. Changes in the prevalence of heart failure with preserved ejection fraction may contribute to changes in the natural history of heart failure. We performed a study

Theophilus E. Owan; David O. Hodge; Regina M. Herges; Steven J. Jacobsen; Veronique L. Roger; Margaret M. Redfield

2010-01-01

201

Dietary Fat and Heart Failure: Moving from Lipotoxicity to Lipoprotection  

PubMed Central

There is growing evidence suggesting that dietary fat intake affects the development and progression of heart failure. Studies in rodents show that in the absence of obesity replacing refined carbohydrate with fat can attenuate or prevent ventricular expansion and contractile dysfunction in response to hypertension, infarction or genetic cardiomyopathy. Relatively low intake of n-3 polyunsaturated fatty acids from marine sources alters cardiac membrane phospholipid fatty acid composition, decreases the onset of new heart failure, and slows the progression of established heart failure. This effect is associated with decreased inflammation and improved resistance to mitochondrial permeability transition. High intake of saturated, monounsaturated or n-6 polyunsaturated fatty acids has also shown beneficial effects in rodent studies. The underlying mechanisms are complex and a more thorough understanding is needed of the effects on cardiac phospholipids, lipid metabolites and metabolic flux in the normal and failing heart. In summary, manipulation of dietary fat intake shows promise in the prevention and treatment of heart failure. Clinical studies generally support high intake of n-3 polyunsaturated fatty acids from marine sources to prevent and treat heart failure. Additional clinical and animals studies are needed to determine the optimal diet in terms of saturated, monounsaturated and n-6 polyunsaturated fatty acids intake for this vulnerable patient population. PMID:22383711

Stanley, William C.; Dabkowski, Erinne R.; Ribeiro, Rogerio F.; O'Connell, Kelly A.

2012-01-01

202

Mitochondria as a Therapeutic Target in Heart Failure  

PubMed Central

Heart failure is a pressing public health problem with no curative treatment currently available. The existing therapies provide symptomatic relief, but are unable to reverse molecular changes that occur in cardiomyocytes. The mechanisms of heart failure are complex and multiple, but mitochondrial dysfunction appears to be a critical factor in the development of this disease. Thus, it is important to focus research efforts on targeting mitochondrial dysfunction in the failing heart in order to revive the myocardium and its contractile function. This review highlights the three promising areas for the development of heart failure therapies, including mitochondrial biogenesis, mitochondrial oxidative stress and mitochondrial iron handling. Moreover, the translational potential of compounds targeting these pathways is discussed. PMID:23219298

Bayeva, Marina; Gheorghiade, Mihai; Ardehali, Hossein

2013-01-01

203

Use and Predictors of Heart Failure Disease Management Referral in Patients Hospitalized With Heart Failure: Insights From the Get With the Guidelines Program  

Microsoft Academic Search

BackgroundHeart failure disease management (HFDM) may be beneficial in heart failure (HF) patients at risk for readmission or post-discharge mortality. However, characteristics of hospitalized HF patients referred to HFDM are not known.

S. Michael Gharacholou; Anne S. Hellkamp; Adrian F. Hernandez; Eric D. Peterson; Deepak L. Bhatt; Clyde W. Yancy; Gregg C. Fonarow

2011-01-01

204

Predicting costs of care in heart failure patients  

PubMed Central

Background Identifying heart failure patients most likely to suffer poor outcomes is an essential part of delivering interventions to those most likely to benefit. We sought a comprehensive account of heart failure events and their cumulative economic burden by examining patient characteristics that predict increased cost or poor outcomes. Methods We collected electronic medical data from members of a large HMO who had a heart failure diagnosis and an echocardiogram from 1999–2004, and followed them for one year. We examined the role of demographics, clinical and laboratory findings, comorbid disease and whether the heart failure was incident, as well as mortality. We used regression methods appropriate for censored cost data. Results Of the 4,696 patients, 8% were incident. Several diseases were associated with significantly higher and economically relevant cost changes, including atrial fibrillation (15% higher), coronary artery disease (14% higher), chronic lung disease (29% higher), depression (36% higher), diabetes (38% higher) and hyperlipidemia (21% higher). Some factors were associated with costs in a counterintuitive fashion (i.e. lower costs in the presence of the factor) including age, ejection fraction and anemia. But anemia and ejection fraction were also associated with a higher death rate. Conclusions Close control of factors that are independently associated with higher cost or poor outcomes may be important for disease management. Analysis of costs in a disease like heart failure that has a high death rate underscores the need for economic methods to consider how mortality should best be considered in costing studies. PMID:23194470

2012-01-01

205

Systems Biology and Biomechanical Model of Heart Failure  

PubMed Central

Heart failure is seen as a complex disease caused by a combination of a mechanical disorder, cardiac remodeling and neurohormonal activation. To define heart failure the systems biology approach integrates genes and molecules, interprets the relationship of the molecular networks with modular functional units, and explains the interaction between mechanical dysfunction and cardiac remodeling. The biomechanical model of heart failure explains satisfactorily the progression of myocardial dysfunction and the development of clinical phenotypes. The earliest mechanical changes and stresses applied in myocardial cells and/or myocardial loss or dysfunction activate left ventricular cavity remodeling and other neurohormonal regulatory mechanisms such as early release of natriuretic peptides followed by SAS and RAAS mobilization. Eventually the neurohormonal activation and the left ventricular remodeling process are leading to clinical deterioration of heart failure towards a multi-organic damage. It is hypothesized that approaching heart failure with the methodology of systems biology we promote the elucidation of its complex pathophysiology and most probably we can invent new therapeutic strategies. PMID:22935019

Louridas, George E; Lourida, Katerina G

2012-01-01

206

Noninvasive hemodynamic monitoring in heart failure: utilization of impedance cardiography.  

PubMed

The annual health care cost incurred by heart failure patients is about $56 billion, two thirds of which is spent on management of acutely decompensated patients. Hemodynamic evaluation is helpful for optimization of treatment, monitoring clinical outcomes, and overall prognostication of heart failure patients, but historically could only be obtained via costly invasive procedures that carry substantial risks. Impedance cardiography (ICG) is a noninvasive and economical outpatient procedure that has been shown to provide reliable hemodynamic values comparable to those obtained from pulmonary artery catheterization. Recent clinical studies involving hundreds of patients have validated the accuracy and reproducibility of ICG compared with invasive techniques. The direct and derived measurements and the clinical applications of ICG in the diagnosis and treatment of heart failure are presented, as are three clinical case studies demonstrating the utility of ICG in the hemodynamic-guided management of heart failure. ICG is a viable, noninvasive technique in early- and late-stage heart failure that provides assistance in diagnostic evaluation, longitudinal prognostication, and therapeutic decisions. PMID:14564142

Yancy, Clyde; Abraham, William T

2003-01-01

207

Cardiorenal Syndrome Caused by Heart Failure with Preserved Ejection Fraction  

PubMed Central

Since cardiorenal dysfunction is usually secondary to multiple factors acting in concert (and not only reduced cardiac output) in the present paper we are going to focus on the interrelationship between heart failure with normal ejection fraction and the development of cardiorenal syndrome. The coexistence of renal impairment in heart failure with preserved ejection fraction (CRS type 2 and 4) is common especially in older females with hypertension and/or diabetes. It can be hypothesized that the incidence of this disease association is growing, while clinical trials enrolling these patients are still lacking. The main mechanisms thought to be involved in the pathophysiology of this condition are represented by the increase of intra-abdominal and central venous pressure and the activation of the renin-angiotensin system. Differently from CRS in heart failure with reduced ejection fraction, the involvement of the kidney may be under-diagnosed in patients with heart failure and preserved ejection fraction and the optimal therapeutic strategy in this condition, though challenging, is far to be completely elucidated. Further studies are needed to assess the best therapeutic regimen in patients with renal dysfunction (and worsening) and heart failure and preserved ejection fraction. PMID:21331316

Lazzeri, Chiara; Valente, Serafina; Tarquini, Roberto; Gensini, Gian Franco

2011-01-01

208

Iron deficiency: an emerging therapeutic target in heart failure.  

PubMed

In patients with heart failure, iron deficiency is frequent but overlooked, with a prevalence of 30%-50%. Since it contributes to cardiac and peripheral muscle dysfunction, iron deficiency is associated with poorer clinical outcomes and a greater risk of death, independent of haemoglobin level. Therefore, iron deficiency emerges as a new comorbidity and a therapeutic target of chronic heart failure in addition to chronic renal insufficiency, anaemia and diabetes. In a series of placebo-controlled, randomised studies in patients with heart failure and iron deficiency, intravenous iron had a favourable effect on exercise capacity, functional class, LVEF, renal function and quality of life. These clinical studies were performed in the context of a renewed interest in iron metabolism. During the past 10 years, knowledge about the transport, storage and homeostasis of iron has improved dramatically, and new molecules involved in iron metabolism have been described (eg, hepcidin, ferroportin, divalent metal transporter 1). Recent European guidelines recommend the monitoring of iron parameters (ie, serum ferritin, transferrin saturation) for all patients with heart failure. Ongoing clinical trials will explore the benefits of iron deficiency correction on various heart failure parameters. PMID:24957529

Cohen-Solal, Alain; Leclercq, Christophe; Deray, Gilbert; Lasocki, Sigismond; Zambrowski, Jean-Jacques; Mebazaa, Alexandre; de Groote, Pascal; Damy, Thibaud; Galinier, Michel

2014-09-15

209

Ivabradine, coronary artery disease, and heart failure: beyond rhythm control  

PubMed Central

Elevated heart rate could negatively influence cardiovascular risk in the general population. It can induce and promote the atherosclerotic process by means of several mechanisms involving endothelial shear stress and biochemical activities. Furthermore, elevated heart rate can directly increase heart ischemic conditions because of its skill in unbalancing demand/supply of oxygen and decreasing the diastolic period. Thus, many pharmacological treatments have been proposed in order to reduce heart rate and ameliorate the cardiovascular risk profile of individuals, especially those suffering from coronary artery diseases (CAD) and chronic heart failure (CHF). Ivabradine is the first pure heart rate reductive drug approved and currently used in humans, created in order to selectively reduce sinus node function and to overcome the many side effects of similar pharmacological tools (ie, ?-blockers or calcium channel antagonists). The aim of our review is to evaluate the role and the safety of this molecule on CAD and CHF therapeutic strategies. PMID:24940047

Scicchitano, Pietro; Cortese, Francesca; Ricci, Gabriella; Carbonara, Santa; Moncelli, Michele; Iacoviello, Massimo; Cecere, Annagrazia; Gesualdo, Michele; Zito, Annapaola; Caldarola, Pasquale; Scrutinio, Domenico; Lagioia, Rocco; Riccioni, Graziano; Ciccone, Marco Matteo

2014-01-01

210

Relation of ventricular size and function to heart failure status and ventricular dysrhythmia in patients with severe left ventricular dysfunction.  

PubMed

Patients with severe left ventricular (LV) dysfunction may or may not have overt heart failure and ventricular dysrhythmia. To study factors behind this variability, we examined a subset of 311 patients from the Studies of Left Ventricular Dysfunction-95 with a history of moderate heart failure (treatment trial) and 216 with no failure (prevention trial), all with ejection fractions <0.35. Echocardiographic variables were compared between trials and also correlated with dysrhythmia in 258 patients, and with neurohormones in 199 patients. Compared with prevention patients, treatment patients had larger LV end-diastolic diameter, end-systolic volume, sphericity index, and ratio of early to late diastolic filling velocity by Doppler (E/A ratio), lower LV ejection fraction and atrial contribution to ventricular filling, and similar LV mass, end-diastolic volume, and estimates of systolic wall stress. With prevention and treatment patients combined, the prevalence of abnormally elevated atrial natriuretic peptide was 92% in the highest tertile of E/A ratio compared with 55% in the lower tertiles (p=0.006). Across tertiles of LV end-diastolic volume, there was an increase in the prevalence of nonsustained ventricular tachycardia (24%, 45%, and 45%; p=0.007) and premature ventricular complexes >10/hour (48%, 62%, and 80%; p<0.001). Thus, in severe LV dysfunction, ventricular filling indexes suggestive of high filling pressures, along with larger and more spherical ventricles, are particularly common in patients with overt heart failure, thus suggesting that diastolic properties and the degree of ventricular remodeling affect clinical status. Once ejection fraction is significantly reduced, the prevalence of ventricular dysrhythmia correlates with LV size rather than systolic function. This observation lends support to previous experimental findings on the role of myocardial stretch and scar in the genesis of dysrhythmia. PMID:8610611

Koilpillai, C; Quiñones, M A; Greenberg, B; Limacher, M C; Shindler, D; Pratt, C M; Benedict, C R; Kopelen, H; Shelton, B

1996-03-15

211

Review Cytokines as new treatment targets in chronic heart failure  

E-print Network

Inflammatory cytokines may negatively influence contractility and contribute to the remodelling process in the failing myocardium. Traditional cardiovascular drugs appear to have little influence on the overall cytokine network in chronic heart failure (CHF). Increased interest in anticytokine therapy has therefore evolved. Several small studies have used tumour necrosis factor (TNF)-? as a target, resulting in improved functional capacity and myocardial performance. Intravenous immunoglobulin (IVIG) represents another therapeutic approach in which the impact on myocardial performance appears to be correlated with anti-inflammatory effects. These studies demonstrate potential for immunomodulation as a therapy in addition to conventional cardiovascular treatment in CHF, but the most effective drugs in this regard have yet to be identified. Keywords chronic heart failure, cytokines, immunomodulating therapy, intravenous immunoglobulin The accepted paradigms and treatment strategies for heart failure have changed during the past 50 years. Traditionally, patients with CHF were treated with diuretics, vasodilators and inotropic drugs, resulting in improvement in functional

Jan Kristian Damås; Lars Gullestad; Pål Aukrust

2001-01-01

212

A New Approach to Detect Congestive Heart Failure Using Short-Term Heart Rate Variability Measures  

PubMed Central

Heart rate variability (HRV) analysis has quantified the functioning of the autonomic regulation of the heart and heart's ability to respond. However, majority of studies on HRV report several differences between patients with congestive heart failure (CHF) and healthy subjects, such as time-domain, frequency domain and nonlinear HRV measures. In the paper, we mainly presented a new approach to detect congestive heart failure (CHF) based on combination support vector machine (SVM) and three nonstandard heart rate variability (HRV) measures (e.g. SUM_TD, SUM_FD and SUM_IE). The CHF classification model was presented by using SVM classifier with the combination SUM_TD and SUM_FD. In the analysis performed, we found that the CHF classification algorithm could obtain the best performance with the CHF classification accuracy, sensitivity and specificity of 100%, 100%, 100%, respectively. PMID:24747432

Wang, Qian; Zhou, GuangMin; Wang, Ying; Jiang, Qing

2014-01-01

213

Clinical modifiers for heart failure following myocardial infarction  

Microsoft Academic Search

Heart failure (HF) is a clinical syndrome that occurs when the ability of the heart to meet the requirements of the body fails.\\u000a Myocardial infarction (MI) is a common antecedent event that predisposes a patient to HF. Loss of cardiac function following\\u000a MI occurs in the context of myocyte death and ventricular remodeling. The clinical significance of HF following MI

Nandan S. Anavekar; Nagesh S. Anavekar

2005-01-01

214

Mechanical support in acute and chronic heart failure  

Microsoft Academic Search

Heart failure (HF) is the leading cause of hospital admissions in the United States in people over the age of 65 years. Major\\u000a advancements in the medical therapy of HF, combined with automatic implantable cardioverterdefibrillators and cardiac resynchronization\\u000a therapy, have substantially reduced the mortality and morbidity of chronic HF, but mortality remains high, and the availability\\u000a of donor hearts for

Andreas Brieke; Joseph Cleveland Jr; JoAnn Lindenfeld

2008-01-01

215

Biventricular and novel pacing mechanisms in heart failure  

Microsoft Academic Search

Biventricular pacing, often referred to as cardiac resynchronization therapy (CRT), improves subjective and objective measures\\u000a and promotes reverse ventricular remodeling in patients with chronic New York Heart Association (NYHA) class III or IV heart\\u000a failure despite optimal medical therapy, QRS duration of more than 130 ms, and left ventricular ejection fraction of less\\u000a than 35%. However, there are many nonresponders

Christina Salazar; William T. Abraham

2009-01-01

216

Role of inflammation in the progression of heart failure  

Microsoft Academic Search

Chronic heart failure (HF) is a disorder characterized in part by immune activation and inflammation. Thus, patients with\\u000a HF have elevated levels of a number of inflammatory cytokines, both in the circulation and in the failing heart itself. Several\\u000a mechanisms for this immune activation, which are not mutually exclusive, have been suggested, including neurohormonal activation,\\u000a hemodynamic overload, and activation of

Arne Yndestad; Jan Kristian Damås; Erik Øie; Thor Ueland; Lars Gullestad; Pål Aukrust

2007-01-01

217

Heart Failure in Adults with Congenital Heart Disease  

Microsoft Academic Search

\\u000a Adults with congenital heart disease (ACHD) are an expanding population, posing a significant challenge to the medical profession.\\u000a Although early surgery has transformed the outcome of these patients, it has not been curative. Exercise intolerance is a\\u000a major problem for ACHD patients, significantly affecting their quality of life. Physical limitation is common, even in patients\\u000a with simple lesions and is

Konstantinos Dimopoulos; Georgios Giannakoulas; Michael A. Gatzoulis

218

93 Optimal medical therapy in heart failure: is there space for additional heart rate control?  

Microsoft Academic Search

IntroductionCurrent evidence suggests that heart rate (HR) may serve both as a modifiable risk factor, and as a disease modifying variable in patients with impaired left ventricular (LV) systolic function. The systolic heart failure (HF) treatment with If inhibitor ivabradine trial (SHIFT) for example recently demonstrated significantly improved outcomes in otherwise optimally treated HF patients following additional HR reduction with

S Russell; M Oliver; H Rose; J Davies; H Llewellyn-Griffiths; A Raybould; V Sim; Z R Yousef

2011-01-01

219

Independent and incremental prognostic value of heart rate variability in patients with chronic heart failure  

Microsoft Academic Search

Background Decreased heart rate variability (HRV), indicating derangement in cardiac autonomic control, has been reported in patients with chronic heart failure. However, the independent and incremental prognostic value of HRV over clinical data and measures of left ventricular dysfunction has been less thoroughly investigated. This study was designed to evaluate the predictive value of HRV and Poincaré plots as assessed

Domenico Bonaduce; Mario Petretta; Fortunato Marciano; Maria L. E. Vicario; Claudio Apicella; Maria A. E. Rao; Emanuele Nicolai; Massimo Volpe

1999-01-01

220

The Importance of Heart Rate Recovery in Patients With Heart Failure or Left Ventricular Systolic Dysfunction  

Microsoft Academic Search

Background: The ability to better predict outcome with exercise testing in patients with heart failure (HF) and left ventricular systolic dysfunction (LVSD) may prove extremely valuable in determining which patients are at increased risk. This study evaluated the ability of heart rate recovery (HRR) to predict outcome in patients with HF and validate previous findings in LVSD. Methods and Results:

MICHAEL J. LIPINSKI; GEORGE W. VETROVEC; DMITRY GORELIK; VICTOR F. FROELICHER

2005-01-01

221

Cognitive and psycholologic considerations in pediatric heart failure.  

PubMed

Because children with heart failure live longer both before and after cardiac transplantation, there is renewed focus on the quality and preservation of their intellectual functioning and psychosocial health. Children with chronic heart failure are at risk for delays in both cognitive development and psychologic functioning, though the extent and permanence of impairment is not well understood. Children with medically managed heart failure have been shown to be at increased risk for anxiety and depression, with a prevalence of emotional disorders similar to that of other children with congenital heart disease. The use of ventricular assist devices as a bridge to transplantation offers both risks and benefits for the preservation of intellectual and emotional function, with an increased risk for ischemic injury to the brain, but offers the advantage of allowing for cognitive stimulation and improved social interactions. A new population of children with heart failure, those outfitted with permanent ventricular assist devices in lieu of cardiac transplantation, may represent a particular risk group regarding social and cognitive function, but as of yet this is not well studied. Early intervention and school accommodations are recommended for those with cognitive, social, or emotional deficits, and brain imaging should be considered for those with persistent difficulties. Whenever possible, patients should be referred to psychologists and developmental specialists with experience in treating this patient population. PMID:25038263

Hollander, Seth A; Callus, Edward

2014-10-01

222

Heart failure in which coronary spasms played an important role.  

PubMed

A 69-year-old woman was admitted for further examinations and treatment of chest pain. Emergency cardiac catheterization showed no significant stenosis on coronary angiograms; however, diffuse wall hypokinesis was observed on a left ventriculogram. After treating the patient's heart failure, cardiac catheterization was performed again. A spasm provocation test showed coronary spasms of the right and left coronary arteries. A right ventricular endomyocardial biopsy revealed denaturation and fibrosis of the myocardium under the endocardium, thus suggesting the presence of myocardial ischemia. This case highlights coronary spasms as a cause of heart failure. PMID:24492691

Oda, Shinsuke; Fujii, Yuichi; Takemoto, Hiroaki; Nomura, Shuichi; Nakayama, Hirofumi; Toyota, Yasushi; Nakamura, Hiroshi; Teragawa, Hiroki

2014-01-01

223

Pulmonary arteriovenous malformations presenting as refractory heart failure  

PubMed Central

A 22-year-old young man with a history of idiopathic dilated cardiomyopathy (IDC) was admitted to our hospital due to difficult-to-control heart failure. A thoracic X-ray showed multiple nodules at the both pulmonary hilus and upper lobe of the right lung. Computed tomography (CT) angiography of the thorax confirmed arteriovenous malformation (AVM). However, effective treatment was impossible due to the poor physical condition; he died a few days later. Here we reported on the case of pulmonary arteriovenous malformations (PAVMs) being misdiagnosed as refractory heart failure. PMID:25276390

Chen, Kai-Hong; Huang, Guo-Yong; Song, Wei

2014-01-01

224

Practical experience using galectin-3 in heart failure.  

PubMed

Heart failure is a complex mechanical and neurohormonal syndrome where the left ventricle fails as a pump, resulting in stasis of blood in the lungs and the periphery resulting in the cardial features of effort intolerance, fatigue, and peripheral edema. As part of the neurohormonal and local mechanical strain, tissue macrophages resident in the myocardium secrete galectin-3 which is a paracrine and endocrine factor which stimulates additional macrophages, pericytes, myofibroblasts, and fibroblasts to proliferate and secrete procollagen I which is irreversibly crosslinked resulting in myocardial fibrosis. In the general population, normal plasma concentrations of galectin-3 are <11.0 ng/mL. Galectin-3 measured in blood has been shown to: 1) identify increased risk for new onset heart failure in healthy middle-aged adults; 2) predict cardiac failure in patients after acute coronary syndromes; 3) help establish the diagnosis of heart failure with preserved ejection fraction in patients presenting with exercise intolerance; and 4) aid in the prognosis of heart failure with preserved and reduced left ventricular ejection fraction. This manuscript will present practical real case management in these applications to highlight the importance of this new in vitro diagnostic test. PMID:24810562

McCullough, Peter A

2014-10-01

225

Measurement of Sympathetic Nervous System Activity in Heart Failure: The Role of Norepinephrine Kinetics  

Microsoft Academic Search

Recent demonstration that the level of sympathetic nervous drive to the failing heart in patients with severe heart failure is a major determinant of prognosis, and that mortality in heart failure is reduced by beta-adrenergic blockade, indicate the clinical relevance of heart failure neuroscience research.

Murray Esler; David Kaye

2000-01-01

226

Antecedent Blood Pressure, Body Mass Index, and the Risk of Incident Heart Failure in Later Life  

Microsoft Academic Search

Higher blood pressure and body mass index (BMI) are risk factors for heart failure. It is unknown whether the presence of these risk factors in midadulthood affect the future development of heart failure. In the community-based Framingham Heart Study, we examined the associations of antecedent blood pressure and BMI with heart failure incidence in later life. We studied 3362 participants

Douglas S. Lee; Joseph M. Massaro; Thomas J. Wang; William B. Kannel; Emelia J. Benjamin; Satish Kenchaiah; Daniel Levy; Ralph B. D'Agostino; Ramachandran S. Vasan

2010-01-01

227

Heart Failure Re-Admission: Measuring the Ever Shortening Gap between Repeat Heart Failure Hospitalizations  

PubMed Central

Many quality-of-care and risk prediction metrics rely on time to first rehospitalization even though heart failure (HF) patients may undergo several repeat hospitalizations. The aim of this study is to compare repeat hospitalization models. Using a population-based cohort of 40,667 patients, we examined both HF and all cause re-hospitalizations using up to five years of follow-up. Two models were examined: the gap-time model which estimates the adjusted time between hospitalizations and a multistate model which considered patients to be in one of four states; community-dwelling, in hospital for HF, in hospital for any reason, or dead. The transition probabilities and times were then modeled using patient characteristics and number of repeat hospitalizations. We found that during the five years of follow-up roughly half of the patients returned for a subsequent hospitalization for each repeat hospitalization. Additionally, we noted that the unadjusted time between hospitalizations was reduced ?40% between each successive hospitalization. After adjustment each additional hospitalization was associated with a 28 day (95% CI: 22-35) reduction in time spent out of hospital. A similar pattern was seen when considering the four state model. A large proportion of patients had multiple repeat hospitalizations. Extending the gap between hospitalizations should be an important goal of treatment evaluation. PMID:25211034

Bakal, Jeffrey A.; McAlister, Finlay A.; Liu, Wei; Ezekowitz, Justin A.

2014-01-01

228

Mortality by Heart Failure and Ischemic Heart Disease in Brazil from 1996 to 2011  

PubMed Central

Background Circulatory system diseases are the first cause of death in Brazil. Objective To analyze the evolution of mortality caused by heart failure, by ischemic heart diseases and by ill-defined causes, as well as their possible relations, in Brazil and in the geoeconomic regions of the country (North, Northeast, Center-West, South and Southeast), from 1996 to 2011. Methods Data were obtained from DATASUS and death declaration records with codes I20 and I24 for acute ischemic diseases, I25 for chronic ischemic diseases, and I50 for heart failure, and codes in chapter XIII for ill-defined causes, according to geoeconomic regions of Brazil, from 1996 to 2011. Results Mortality rates due to heart failure declined in Brazil and its regions, except for the North and the Northeast. Mortality rates due to acute ischemic heart diseases increased in the North and Northeast regions, especially from 2005 on; they remained stable in the Center-West region; and decreased in the South and in the Southeast. Mortality due to chronic ischemic heart diseases decreased in Brazil and in the Center-West, South and Southeast regions, and had little variation in the North and in the Northeast. The highest mortality rates due to ill-defined causes occurred in the Northeast until 2005. Conclusions Mortality due to heart failure is decreasing in Brazil and in all of its geoeconomic regions. The temporal evolution of mortality caused by ischemic heart diseases was similar to that of heart failure. The decreasing number of deaths due to ill-defined causes may represent the improvement in the quality of information about mortality in Brazil. The evolution of acute ischemic heart diseases ranged according to regions, being possibly confused with the differential evolution of ill-defined causes. PMID:25004417

Gaui, Eduardo Nagib; de Oliveira, Glaucia Maria Moraes; Klein, Carlos Henrique

2014-01-01

229

Increased walking variability in elderly persons with congestive heart failure  

NASA Technical Reports Server (NTRS)

OBJECTIVES: To determine the effects of congestive heart failure on a person's ability to walk at a steady pace while ambulating at a self-determined rate. SETTING: Beth Israel Hospital, Boston, a primary and tertiary teaching hospital, and a social activity center for elderly adults living in the community. PARTICIPANTS: Eleven elderly subjects (aged 70-93 years) with well compensated congestive heart failure (NY Heart Association class I or II), seven elderly subjects (aged 70-79 years) without congestive heart failure, and 10 healthy young adult subjects (aged 20-30 years). MEASUREMENTS: Subjects walked for 8 minutes on level ground at their own selected walking rate. Footswitches were used to measure the time between steps. Step rate (steps/minute) and step rate variability were calculated for the entire walking period, for 30 seconds during the first minute of the walk, for 30 seconds during the last minute of the walk, and for the 30-second period when each subject's step rate variability was minimal. Group means and 5% and 95% confidence intervals were computed. MAIN RESULTS: All measures of walking variability were significantly increased in the elderly subjects with congestive heart failure, intermediate in the elderly controls, and lowest in the young subjects. There was no overlap between the three groups using the minimal 30-second variability (elderly CHF vs elderly controls: P < 0.001, elderly controls vs young: P < 0.001), and no overlap between elderly subjects with and without congestive heart failure when using the overall variability. For all four measures, there was no overlap in any of the confidence intervals, and all group means were significantly different (P < 0.05).

Hausdorff, J. M.; Forman, D. E.; Ladin, Z.; Goldberger, A. L.; Rigney, D. R.; Wei, J. Y.

1994-01-01

230

NADPH Oxidases in Heart Failure: Poachers or Gamekeepers?  

PubMed Central

Abstract Significance: Oxidative stress is involved in the pathogenesis of heart failure but clinical antioxidant trials have been unsuccessful. This may be because effects of reactive oxygen species (ROS) depend upon their source, location, and concentration. Nicotinamide adenine dinucleotide phosphate oxidase (Nox) proteins generate ROS in a highly regulated fashion and modulate several components of the heart failure phenotype. Recent Advances: Two Nox isoforms, Nox2 and Nox4, are expressed in the heart. Studies using gene-modified mice deficient in Nox2 activity indicate that Nox2 activation contributes to angiotensin II–induced cardiomyocyte hypertrophy, atrial fibrillation, and the development of interstitial fibrosis but may also positively modulate physiological excitation-contraction coupling. Nox2 contributes to myocyte death under stress situations and plays important roles in postmyocardial infarction remodeling, in part by modulating matrix metalloprotease activity. In contrast to Nox2, Nox4 is constitutively active at a low level and induces protective effects in the heart under chronic stress, for example, by maintaining myocardial capillary density. However, high levels of Nox4 could have detrimental effects. Critical Issues: The effects of Nox proteins during the development of heart failure likely depend upon the isoform, activation level, and cellular distribution, and may include beneficial as well as detrimental effects. More needs to be learnt about the precise regulation of abundance and biochemical activity of these proteins in the heart as well as the downstream signaling pathways that they regulate. Future Directions: The development of specific approaches to target individual Nox isoforms and/or specific cell types may be important for the achievement of therapeutic efficacy in heart failure. Antioxid. Redox Signal. 18, 1024–1041. PMID:22747566

Zhang, Min; Perino, Alessia; Ghigo, Alessandra; Hirsch, Emilio

2013-01-01

231

Mitochondrial fatty acid oxidation alterations in heart failure, ischaemic heart disease and diabetic cardiomyopathy.  

PubMed

Heart disease is a leading cause of death worldwide. In many forms of heart disease, including heart failure, ischaemic heart disease and diabetic cardiomyopathies, changes in cardiac mitochondrial energy metabolism contribute to contractile dysfunction and to a decrease in cardiac efficiency. Specific metabolic changes include a relative increase in cardiac fatty acid oxidation rates and an uncoupling of glycolysis from glucose oxidation. In heart failure, overall mitochondrial oxidative metabolism can be impaired while, in ischaemic heart disease, energy production is impaired due to a limitation of oxygen supply. In both of these conditions, residual mitochondrial fatty acid oxidation dominates over mitochondrial glucose oxidation. In diabetes, the ratio of cardiac fatty acid oxidation to glucose oxidation also increases, although primarily due to an increase in fatty acid oxidation and an inhibition of glucose oxidation. Recent evidence suggests that therapeutically regulating cardiac energy metabolism by reducing fatty acid oxidation and/or increasing glucose oxidation can improve cardiac function of the ischaemic heart, the failing heart and in diabetic cardiomyopathies. In this article, we review the cardiac mitochondrial energy metabolic changes that occur in these forms of heart disease, what role alterations in mitochondrial fatty acid oxidation have in contributing to cardiac dysfunction and the potential for targeting fatty acid oxidation to treat these forms of heart disease. PMID:24147975

Fillmore, N; Mori, J; Lopaschuk, G D

2014-04-01

232

Haemodynamic, hormonal, and electrolyte effects of enalapril in heart failure.  

PubMed Central

Enalapril, the new converting enzyme inhibitor, was administered to eight patients with heart failure (NYHA Functional Class II to IV) during standardised and intensive haemodynamic, hormone, and electrolyte monitoring. The first dose (5 mg) of enalapril induced a fall in plasma angiotensin II and noradrenaline levels, and prolonged decrements in systemic vascular resistance, arterial pressure, heart rate, and right heart pressures. Maximum haemodynamic effects were evident four to eight hours after the first dose, with return to baseline by 24 hours. Plasma angiotensin II levels, however, were still suppressed at 24 hours. The magnitude of haemodynamic response was related closely to baseline (pre-enalapril) activity of the renin-angiotensin system and the sympathetic system. Enalapril treatment over three days induced a positive cumulative balance of sodium and potassium, and a small increase in plasma potassium. Urine aldosterone excretion decreased in a stepwise fashion. Continued enalapril administration for four to eight weeks resulted in improved clinical status (NYHA Functional Class) and exercise tolerance in patients who initially were most severely incapacitated, but little change was observed in healthier subjects. We conclude that in heart failure, enalapril is a long acting converting enzyme inhibitor with clear cut beneficial haemodynamic effects in the short term. Long term controlled studies of enalapril in heart failure are warranted. PMID:6309203

Fitzpatrick, D; Nicholls, M G; Ikram, H; Espiner, E A

1983-01-01

233

Tissue inhibitor of metalloproteinases (TIMPs) in heart failure.  

PubMed

Remodeling of the myocardium and the extracellular matrix (ECM) occurs in heart failure irrespective of its initial cause. The ECM serves as a scaffold to provide structural support as well as housing a number of cytokines and growth factors. Hence, disruption of the ECM will result in structural instability as well as activation of a number of signaling pathways that could lead to fibrosis, hypertrophy, and apoptosis. The ECM is a dynamic entity that undergoes constant turnover, and the integrity of its network structure is maintained by a balance in the function of matrix metalloproteinases (MMPs) and their inhibitors, the tissue inhibitor of metalloproteinases (TIMPs). In heart disease, levels of MMPs and TIMPs are altered resulting in an imbalance between these two families of proteins. In this review, we will discuss the structure, function, and regulation of TIMPs, their MMP-independent functions, and their role in heart failure. We will review the knowledge that we have gained from clinical studies and animal models on the contribution of TIMPs in the development and progression of heart disease. We will further discuss how ECM molecules and regulatory genes can be used as biomarkers of disease in heart failure patients. PMID:21717224

Moore, Linn; Fan, Dong; Basu, Ratnadeep; Kandalam, Vijay; Kassiri, Zamaneh

2012-09-01

234

Non-transplant surgical therapy options of heart failure.  

PubMed

Congestive heart failure (CHF) results from damage to the myocardium and has a broad etiology ranging from ischemic to non-ischemic etiology. It is one of the leading causes of cardiovascular morbidity and mortality and carries a 5-year mortality of 50%, estimated by WHO to represent 30% of deaths in the United States. Costs related to the care of patients with CHF have increased substantially over the past 2 decades partly owing to increased frequency of hospitalization, implantation of costly novel devices and, as the disease progresses, consideration for heart transplantation, mechanical circulatory support, and end-of-life care. CHF progression is accompanied by changes within the myocardium, collectively referred to as left ventricular remodeling, which can be categorized into changes in the cardiomyocytes and changes that occur in the volume and composition of the extracellular matrix. Since remodeling in heart failure is progressive and detrimental, the majority of treatment strategies are aimed at stopping or possibly reversing this process. Some successful methods include medical management, long-term or destination mechanical circulatory support, cardiac resychronization therapy, and biventricular pacemakers. During the last few decades, the management of heart failure has evolved tremendously with the introduction of new therapies and assist devices. Advances in mechanical support, left ventricular assist devices (LVADs), and total artificial heart have significantly reduced mortality in patients awaiting transplantation. This manuscript is an overview of non-transplant surgical options in the management of CHF. PMID:25420501

Neragi-Miandoab, S

2014-12-01

235

Inotropes do not increase mortality in advanced heart failure  

PubMed Central

Inotrope use is one of the most controversial topics in the management of heart failure. While the heart failure community utilizes them and recognizes the state of inotrope dependency, retrospective analyses and registry data have overwhelmingly suggested high mortality, which is logically to be expected given the advanced disease states of those requiring their use. Currently, there is a relative paucity of randomized control trials due to the ethical dilemma of creating control groups by withholding inotropes from patients who require them. Nonetheless, results of such trials have been mixed. Many were also performed with agents no longer in use, on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. Thus, their results may not be generalizable to current clinical practice. In this review, we discuss current indications for inotrope use, specifically dobutamine and milrinone, depicting their mechanisms of action, delineating their patterns of use in clinical practice, defining the state of inotrope dependency, and ultimately examining the literature to ascertain whether evidence is sufficient to support the current view that these agents increase mortality in patients with heart failure. Our conclusion is that the evidence is insufficient to link inotropes and increased mortality in low output heart failure. PMID:24899821

Guglin, Maya; Kaufman, Marc

2014-01-01

236

Pacing Therapies in Congestive Heart Failure II Study  

Microsoft Academic Search

here is increasing evidence that ventricular resyn- chronization therapy (VRT) achieved by atrial synchronous bi- or left ventricular pacing leads to acute hemodynamic benefit and long-term functional improvement in patients with advanced congestive heart failure (CHF) and intraventricular conduction disturbances. In several studies, left ventricular- based pacing has been shown to be superior to conventional (i.e., right ventricular) DDD pacing

Christoph Stellbrink; Angelo Auricchio; Christian Butter; Stefan Sack; Dirk Bocker; Michael Block; Hans Kirkels; Anand Ramdat-Misier

237

Clinical utility of exercise training in chronic systolic heart failure  

Microsoft Academic Search

The volume of literature attesting to the clinical benefits of exercise training in patients with stable chronic heart failure (CHF) is substantial. Training can improve symptoms and exercise capacity, as well as reducing morbidity, mortality, and rates of emergency hospitalization. These benefits are apparent in all patients with stable CHF, irrespective of age or sex, or the etiology or severity

Andrew J. Stewart Coats

2011-01-01

238

Encouraging exercise in older adults with congestive heart failure  

Microsoft Academic Search

Congestive heart failure (CHF) is a chronic medical problem commonly found in older adults. Management of CHF ideally should combine lifestyle modifications and medication management. Exercise prescriptions and encouraging patients with CHF to exercise can have a significant impact on management of symptoms as well as exacerbation of further disease. The recommended exercise program should ideally incorporate 10 to 15

Barbara Resnick

2004-01-01

239

Cheyne-stokes respiration in patients with heart failure.  

PubMed

Cheyne-Stokes respiration (CSR) is a form of central sleep-disordered breathing (SDB) in which there are cyclical fluctuations in breathing that lead to periods of central apneas/hypopnea, which alternate with periods of hyperpnea. The crescendo-decrescendo pattern of respiration in CSR is a compensation for the changing levels of blood oxygen and carbon dioxide. Severe congestive heart failure seems to be the most important risk factor for the development of CSR. A number of pathophysiologic changes, such as sleep disruption, arousals, hypoxemia-reoxygenation, hypercapnia/hypocapnia, and changes in intrathoracic pressure have harmful effects on the cardiovascular system, and the presence of CSR is associated with increased mortality and morbidity in subjects with variable degrees of heart failure. The management of CSR involves optimal control of underlying heart failure, oxygen therapy, and positive airway pressure support. In this review, we initially define and describe the epidemiology of central sleep apnea (CSA) and CSR, its pathogenesis, clinical presentation, diagnostic methods, and then discuss the recent developments in the management in patients with heart failure. PMID:19956965

AlDabal, Laila; BaHammam, Ahmed S

2010-01-01

240

Chronic heart failure consumer information: an exploratory study.  

PubMed

The purpose of this project was to explore how persons with chronic heart failure (CHF) obtain and use health information about their condition and how health literacy might have an impact. We interviewed 28 patients with CHF regarding their quality of life, chronic illness care, literacy level, and knowledge about self-management care for CHF. PMID:18998896

Boren, Suzanne Austin; Wakefield, Bonnie J; Dohrmann, Mary

2008-01-01

241

[Cheyne-Stokes respiration in patients with congestive heart failure].  

PubMed

Cheyne-Stokes respiration (CSR) during sleep is common in patients with severe congestive heart failure induces repetitive oxygen desaturation with arousals, and impairs sleep. This causes daytime symptoms and likely an increase in sympathetic activity. It has, therefore, been suggested that CSR is independently related to mortality. The major mechanisms behind CSR include reduced body stores of oxygen, a low apneic threshold for carbon dioxide, prolonged circulation time between the lung and the carotid body, and disturbance of respiratory control due to arousals. It is apparent that the main task in treating CSR is the therapy of congestive heart failure. Indeed, diuretics to treat pulmonary congestion as well as ACE-inhibitors reduce CSR. Recently, theophylline (an antagonist of the ventilatory depressant adenosine) was shown to reduce CSR and oxygen-desaturation. Continuous positive airway pressure did improve CSR but not sleep and may reduce cardiac output in a subgroup of patients with heart failure. Nocturnal oxygen reduces CSR and improves exercise tolerance as well as sleep. This and its apparent safety makes oxygen an appropriate treatment for nocturnal CSR. Whether successful treatment of nocturnal CSR has any impact on the natural course of heart failure needs to be determined in further studies. PMID:9531695

Andreas, S; Kreuzer, H

1998-01-01

242

Inotropes do not increase mortality in advanced heart failure.  

PubMed

Inotrope use is one of the most controversial topics in the management of heart failure. While the heart failure community utilizes them and recognizes the state of inotrope dependency, retrospective analyses and registry data have overwhelmingly suggested high mortality, which is logically to be expected given the advanced disease states of those requiring their use. Currently, there is a relative paucity of randomized control trials due to the ethical dilemma of creating control groups by withholding inotropes from patients who require them. Nonetheless, results of such trials have been mixed. Many were also performed with agents no longer in use, on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. Thus, their results may not be generalizable to current clinical practice. In this review, we discuss current indications for inotrope use, specifically dobutamine and milrinone, depicting their mechanisms of action, delineating their patterns of use in clinical practice, defining the state of inotrope dependency, and ultimately examining the literature to ascertain whether evidence is sufficient to support the current view that these agents increase mortality in patients with heart failure. Our conclusion is that the evidence is insufficient to link inotropes and increased mortality in low output heart failure. PMID:24899821

Guglin, Maya; Kaufman, Marc

2014-01-01

243

Novel Strategies for the Management of Acute Decompensated Heart Failure  

Microsoft Academic Search

Acute decompensated heart failure (ADHF) is the primary diagnosis for approximately one million hospital admissions in the United States, with an estimated $13.6 billion dollars of direct hospital cost in 2003. Until recently, diagnosis and management of ADHF has largely been \\

W. H. Wilson Tang; Robert E. Hobbs

2005-01-01

244

The effect of physical training in chronic heart failure  

Microsoft Academic Search

Background: Supervised cardiac rehabilitation programs have been offered to patients following myocardial infarct (MI), coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) for many years. However, limited information is available on the usefulness of rehabilitation programs in chronic heart failure (CHF). The aim of our study was to evaluate the outcome of supervised physical training on CHF

Solrun Jonsdottir; Karl K. Andersen; Axel F. Sigurðsson; Stefan B. Sigurðsson

245

Heart failure and chronic obstructive pulmonary disease: An ignored combination?  

Microsoft Academic Search

Aims: To quantify the prevalence of heart failure and left ventricular systolic dysfunction (LVSD) in chronic obstructive pulmonary disease (COPD) patients and vice versa. Further, to discuss diagnostic and therapeutic implications of the co-existence of both syndromes. Methods and results: We performed a Medline search from 1966 to March 2005. The reported prevalence of LVSD among COPD patients varied considerably,

Frans H. Rutten; Maarten-Jan M. Cramer; Jan-Willem J. Lammers; Diederick E. Grobbee; Arno W. Hoes

2006-01-01

246

Family caregiving and congestive heart failure. Review and analysis  

Microsoft Academic Search

Background: There is increasing evidence that discharge planning and post-discharge support for CHF patients can contribute greatly to the medical management of heart failure (CHF) in the community and that the quality of the CHF patient's close personal relationships can influence outcome in CHF. However, there has been little research on the impact of CHF on the family or the

Gerard J. Molloy; Derek W. Johnston; Miles D. Witham

247

Sleep Apnea and Heart Failure: Part II: Central Sleep Apnea  

Microsoft Academic Search

n the first part of this 2-part review, we provided a synopsis of the cardiovascular effects of normal sleep and an overview of the diagnostic, pathophysiological, and therapeu- tic implications of obstructive sleep apnea (OSA) in the setting of heart failure (HF). In this second part, we turn our attention to central sleep apnea (CSA), commonly referred to as Cheyne-Stokes

T. Douglas Bradley; John S. Floras

2003-01-01

248

Teaching Congestive Heart Failure to Doctor of Pharmacy Students.  

ERIC Educational Resources Information Center

This paper summarizes a lecture given to pharmacy students that emphasizes the pathophysiologic mechanisms causing congestive heart failure and the effects of drugs on these mechanisms. The approach shows the importance of drug therapy in this disorder and how this knowledge can improve patient care. An appendix provides a case study. (GLR)

Parker, Robert B.

1992-01-01

249

Molecular imaging to predict ventricular arrhythmia in heart failure.  

PubMed

Ventricular tachycardia (VT) is a major cause of sudden cardiac death (SCD) in patients with heart failure (HF). Left ventricular ejection fraction (LVEF) and heart failure class according to the New York Heart association (NYHA) are in most common use to identify patients that may benefit from implantable cardioverter defibrillator (ICD) therapy. But during 3 years of follow up only 35% of patients receive appropriate ICD action. Therefore, there is a continued need for refinement of selection criteria for ICD implantation. In this regard, molecular imaging of the autonomic nervous system, which plays a central role in HF progression and cardiac electro-mechanical regulation, can make a substantial contribution. This article reviews the currently available literature concerning the value of molecular neuronal cardiac imaging for prediction of ventricular arrhythmias in HF patients. PMID:25138427

Wollenweber, Tim; Bengel, Frank M

2014-12-01

250

Exercise Training Restores Cardiac Protein Quality Control in Heart Failure  

PubMed Central

Exercise training is a well-known coadjuvant in heart failure treatment; however, the molecular mechanisms underlying its beneficial effects remain elusive. Despite the primary cause, heart failure is often preceded by two distinct phenomena: mitochondria dysfunction and cytosolic protein quality control disruption. The objective of the study was to determine the contribution of exercise training in regulating cardiac mitochondria metabolism and cytosolic protein quality control in a post-myocardial infarction-induced heart failure (MI-HF) animal model. Our data demonstrated that isolated cardiac mitochondria from MI-HF rats displayed decreased oxygen consumption, reduced maximum calcium uptake and elevated H2O2 release. These changes were accompanied by exacerbated cardiac oxidative stress and proteasomal insufficiency. Declined proteasomal activity contributes to cardiac protein quality control disruption in our MI-HF model. Using cultured neonatal cardiomyocytes, we showed that either antimycin A or H2O2 resulted in inactivation of proteasomal peptidase activity, accumulation of oxidized proteins and cell death, recapitulating our in vivo model. Of interest, eight weeks of exercise training improved cardiac function, peak oxygen uptake and exercise tolerance in MI-HF rats. Moreover, exercise training restored mitochondrial oxygen consumption, increased Ca2+-induced permeability transition and reduced H2O2 release in MI-HF rats. These changes were followed by reduced oxidative stress and better cardiac protein quality control. Taken together, our findings uncover the potential contribution of mitochondrial dysfunction and cytosolic protein quality control disruption to heart failure and highlight the positive effects of exercise training in re-establishing cardiac mitochondrial physiology and protein quality control, reinforcing the importance of this intervention as a non-pharmacological tool for heart failure therapy. PMID:23300764

Campos, Juliane C.; Queliconi, Bruno B.; Dourado, Paulo M. M.; Cunha, Telma F.; Zambelli, Vanessa O.; Bechara, Luiz R. G.; Kowaltowski, Alicia J.; Brum, Patricia C.; Mochly-Rosen, Daria; Ferreira, Julio C. B.

2012-01-01

251

Physician-Determined Worsening Heart Failure: A Novel Definition for Early Worsening Heart Failure in Patients Hospitalized for Acute Heart Failure – Association with Signs and Symptoms, Hospitalization Duration, and 60Day Outcomes  

Microsoft Academic Search

Objectives: To evaluate physician-determined worsening heart failure (PD-WHF) in patients admitted with acute heart failure (AHF). Methods: The PROTECT pilot study evaluated rolofylline, an adenosine A1 receptor antagonist, versus placebo in patients with AHF and renal impairment. Signs and symptoms of heart failure (HF) and diuretic administration were prospectively recorded daily for 7 days and patients were followed for 60

Gad Cotter; Marco Metra; Beth Davison Weatherley; Howard C. Dittrich; Barry M. Massie; Piotr Ponikowski; Daniel M. Bloomfield; Christopher M. O’Connor

2010-01-01

252

Induction of high STAT1 expression in transgenic mice with LQTS and heart failure  

E-print Network

cardiomyopathy and heart failure; STAT1 The long QT syndrome (LQTS) is characterized by pro- longation of the QT have also been reported to be involved in dilated cardiomyopathy/heart failure [8,9]. The N1325S

253

Symptoms, Depression, and Quality of Life in Patients With Heart Failure  

Microsoft Academic Search

BackgroundLittle is known about symptoms and their burden in outpatients with chronic heart failure. Diverse symptoms may be associated with poor heart failure-related quality of life, and depression may be related to increased symptoms.

David B. Bekelman; Edward P. Havranek; Diane M. Becker; Jean S. Kutner; Pamela N. Peterson; Ilan S. Wittstein; Sheldon H. Gottlieb; Traci E. Yamashita; Diane L. Fairclough; Sydney M. Dy

2007-01-01

254

Drug Does Not Improve Set of Cardiovascular Outcomes for Diastolic Heart Failure  

MedlinePLUS

... not improve set of cardiovascular outcomes for diastolic heart failure NIH-supported study finds drug does appear to reduce hospitalizations for diastolic heart failure A drug that blocks the action of a ...

255

Quality of Life After Bypass Surgery in Patients with Chest Pain and Heart Failure  

MedlinePLUS

... Bypass Surgery in Patients With Chest Pain and Heart Failure The full report is titled “Quality-of-Life ... in patients who have coronary artery disease plus heart failure, which can cause additional symptoms, such as shortness ...

256

Following Your Heart Failure Treatment Plan and Dealing with Your Symptoms  

MedlinePLUS

... it in a convenient spot. Emergency Symptoms of Heart Failure Call 911 for emergency help, if you have: ... breath. Fainted or passed out. Urgent Symptoms of Heart Failure Call your doctor immediately, if you have any ...

257

Lesions of right heart failure and ascites in broiler chickens.  

PubMed

A naturally occurring cardiomyopathy in broiler chickens from a single Ontario farm was studied in order to define the morphologic changes. Gross and histologic features of affected birds were compared with those in age-matched control penmates. Body weight and weight and volume of individual cardiac chambers were measured. Histologic sections of 18 different tissues were examined, and lesions observed were scored subjectively. Affected birds were stunted and had marked right ventricular dilation and hypertrophy, atrial hypertrophy, ascites, pulmonary congestion and edema, and hepatic capsular fibrosis. Microscopic changes in the heart of affected birds were mild and did not suggest a specific cause of heart failure. Lungs had marked hypertrophy of parabronchial smooth muscle and collapse and apparent loss of associated air capillaries. Other histologic changes observed were thought to be the result of passive congestion of viscera caused by right heart failure and chronic debility. Although the specific etiology of this condition could not be determined, it was felt that this syndrome was unlikely to have been the result of any of the commonly recognized causes of congestive heart failure and ascites in broilers. PMID:3041956

Wilson, J B; Julian, R J; Barker, I K

1988-01-01

258

Effects of spironolactone on heart rate variability and left ventricular systolic function in severe ischemic heart failure  

Microsoft Academic Search

Recent data show that blockade of aldosterone receptors by spironolactone reduces the risk of morbidity and death among patients with severe heart failure. Heart failure secondary to ischemia is characterized by an imbalance of the autonomic nervous system, which can be assessed by analysis of the heart rate variability (HRV). Spironolactone’s effects on HRV are not well defined. If spironolactone

Mehmet Emin Korkmaz; Haldun Müderriso?lu; Melek Uluçam; Bülent Özin

2000-01-01

259

Electronically monitored medication adherence predicts hospitalization in heart failure patients  

PubMed Central

Background Hospitalization contributes enormously to health care costs associated with heart failure. Many investigators have attempted to predict hospitalization in these patients. None of these models has been highly effective in prediction, suggesting that important risk factors remain unidentified. Purpose To assess prospectively collected medication adherence, objectively measured by the Medication Event Monitoring System, as a predictor of hospitalization in heart failure patients. Materials and methods We used recently developed adaptive modeling methods to describe patterns of medication adherence in a sample of heart failure patients, and tested the hypothesis that poor medication adherence as determined by adaptive methods was a significant predictor of hospitalization within 6 months. Results Medication adherence was the best predictor of hospitalization. Besides two dimensions of poor adherence (adherence pattern type and low percentage of prescribed doses taken), four other single factors predicted hospitalization: low hemoglobin, depressed ejection fraction, New York Heart Association class IV, and 12 or more medications taken daily. Seven interactions increased the predictive capability of the model: 1) pattern of poor adherence type and lower score on the Letter–Number Sequencing test, a measure of short-term memory; 2) higher number of comorbid conditions and higher number of daily medications; 3) higher blood urea nitrogen and lower percentage of prescribed doses taken; 4) lower hemoglobin and much worse perceived health compared to last year; 5) older age and lower score on the Telephone Interview of Cognitive Status; 6) higher body mass index and lower hemoglobin; and 7) lower ejection fraction and higher fatigue. Patients with none of these seven interactions had a hospitalization rate of 9.7%. For those with five of these interaction risk factors, 100% were hospitalized. The C-index (the area under the receiver-operating characteristics [ROC] curve) for the model based on the seven interactions was 0.83, indicating excellent discrimination. Conclusion Medication adherence adds important new information to the list of variables previously shown to predict hospitalization in adults with heart failure. PMID:24353407

Riegel, Barbara; Knafl, George J

2014-01-01

260

Bio-Artificial Heart as Ultimate Treatment of End-Stage Heart Failure  

PubMed Central

End-stage heart failure is a major health problem, but implementation of guidelines and optimizing medical therapy for this devastating disease should decrease mortality. If optimal conservative therapy is no longer sufficient, a mechanical support system may be required as final destination therapy or as bridge-to-transplant. Since the first heart transplantation in 1967, this therapy has become the criterion standard for end-stage heart failure, but is limited due to organ shortage. Tissue engineering could help overcome this limitation and provide regeneration, remodeling, and growth potential. This so-called bio-artificial heart would be available, created by a decellularized extracellular matrix and seeded with in vitro proliferated autologous cardiovascular cells. Results of the first experimental studies have been promising, but numerous challenges must be met before this procedure will be available. PMID:25321347

Smit, Francis E.; Dohmen, Pascal M.

2014-01-01

261

Bio-artificial heart as ultimate treatment of end-stage heart failure.  

PubMed

Abstract End-stage heart failure is a major health problem, but implementation of guidelines and optimizing medical therapy for this devastating disease should decrease mortality. If optimal conservative therapy is no longer sufficient, a mechanical support system may be required as final destination therapy or as bridge-to-transplant. Since the first heart transplantation in 1967, this therapy has become the criterion standard for end-stage heart failure, but is limited due to organ shortage. Tissue engineering could help overcome this limitation and provide regeneration, remodeling, and growth potential. This so-called bio-artificial heart would be available, created by a decellularized extracellular matrix and seeded with in vitro proliferated autologous cardiovascular cells. Results of the first experimental studies have been promising, but numerous challenges must be met before this procedure will be available. PMID:25321347

Smit, Francis Edwin; Dohmen, Pascal Maria

2014-01-01

262

An Hour of Moderate Exercise a Day May Decrease Heart Failure Risk  

MedlinePLUS

An hour of moderate exercise a day may decrease heart failure risk American Heart Association Rapid Access Journal Report September 02, 2014 Categories: Heart News Study Highlights Being physically ...

263

Heart failure in elderly patients: distinctive features and unresolved issues.  

PubMed

The prevalence of heart failure (HF) increases with age. While clinical trials suggest that contemporary evidence-based HF therapies have reduced morbidity and mortality, these trials largely excluded the elderly. Questions remain regarding the clinical characteristics of elderly HF patients and the impact of contemporary therapies on their outcomes. This review presents the epidemiology of HF in the elderly and summarizes the data on the pathophysiology of the ageing heart. The clinical characteristics, treatment patterns, and outcomes of elderly HF patients are explored. Finally, the main gaps regarding HF therapies in the elderly and the opportunities for future trials are highlighted. PMID:23429975

Lazzarini, Valentina; Mentz, Robert J; Fiuzat, Mona; Metra, Marco; O'Connor, Christopher M

2013-07-01

264

Heart failure in elderly patients: distinctive features and unresolved issues  

PubMed Central

The prevalence of heart failure (HF) increases with age. While clinical trials suggest that contemporary evidence-based HF therapies have reduced morbidity and mortality, these trials largely excluded the elderly. Questions remain regarding the clinical characteristics of elderly HF patients and the impact of contemporary therapies on their outcomes. This review presents the epidemiology of HF in the elderly and summarizes the data on the pathophysiology of the ageing heart. The clinical characteristics, treatment patterns, and outcomes of elderly HF patients are explored. Finally, the main gaps regarding HF therapies in the elderly and the opportunities for future trials are highlighted. PMID:23429975

Lazzarini, Valentina; Mentz, Robert J.; Fiuzat, Mona; Metra, Marco; O'Connor, Christopher M.

2013-01-01

265

Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients  

Microsoft Academic Search

Background—The predictive value of heart rate variability (HRV) in chronic heart failure (CHF) has never been tested in a comprehensive multivariate model using short-term laboratory recordings designed to avoid the confounding effects of respiration and behavioral factors. Methods and Results—A multivariate survival model for the identification of sudden (presumably arrhythmic) death was developed with data from 202 consecutive patients referred

Maria Teresa La Rovere; Gian Domenico Pinna; Roberto Maestri; Andrea Mortara; Soccorso Capomolla; Oreste Febo; Roberto Ferrari; Mariella Franchini; Marco Gnemmi; Cristina Opasich; Pier Giorgio Riccardi; Egidio Traversi; Franco Cobelli

266

COMMON MISCONCEPTIONS THAT ARISE IN THE FIRST-YEAR MEDICAL PHYSIOLOGY CURRICULUM CONCERNING HEART FAILURE  

Microsoft Academic Search

here are a number of misconceptions that first-year medical students have concerning the pathophysiology of heart failure. These stem from 1) a poor definition of heart failure, 2) a lack of care in distinguishing between similar but distinct concepts, and 3) the inability to recognize the relationship between the various stages of heart failure and the clinical manifestation of the

Thomas H. Hintze; Gong Zhao

267

The Cost-Effectiveness of Losartan versus Captopril in Patients with Symptomatic Heart Failure  

Microsoft Academic Search

The Losartan Heart Failure ELITE Study recently found that in patients with symptomatic heart failure and a left ventricular ejection fraction of ?0.40, losartan compared to captopril improved survival with better tolerability. The objective of this study was to perform an economic evaluation of losartan versus captopril based on the results of the Losartan Heart Failure ELITE Study. The Losartan

Erik J. Dasbach; Michael W. Rich; Robert Segal; William C. Gerth; George W. Carides; John R. Cook; James F. Murray; Duane B. Snavely; Bertram Pitt

1999-01-01

268

Promoting Dietary Changes in Patients with Congestive Heart Failure During Inotropic Infusion Therapy  

Microsoft Academic Search

Patients with advanced heart failure may experience an improved quality of life with inotropic infusion therapy. Patients who receive intermittent infusions spend four hours per day, three days per week for eight weeks at the Heart Failure Center. The Registered Dietitian (RD) in our Heart Failure Center found this time to be an opportunity for effective nutrition education. The RD

T. Kuehneman; D. Saulsbury; P. L. Splett

1999-01-01

269

Incidence of Heart Failure after Myocardial Infarction: Is It Changing over Time?  

Microsoft Academic Search

Improved survival after myocardial infarction (MI) could result in MI survivors' contributing to the US heart failure epidemic. Conversely, since the severity of MI is declining over time, a decline in post-MI heart failure might also be anticipated. This study tested the hypothesis that the incidence of post-MI heart failure was declining over time in a geographically defined MI incidence

Jens P. Hellermann; Tauqir Y. Goraya; Steven J. Jacobsen; Susan A. Weston; Guy S. Reeder; Bernard J. Gersh; Margaret M. Redfield; Richard J. Rodeheffer; Barbara P. Yawn; Véronique L. Roger

270

The Role of Echocardiography in the Diagnosis and Management of Heart Failure  

Microsoft Academic Search

Heart failure has emerged as one of the most pressing health care issues in the United States. It is estimated that 4.8 million people have chronic heart failure, and approximately 400,000 new cases are diagnosed each year. Since the incidence of heart failure increases significantly with age, its prevalence is likely to increase as the population grows older. The American

Antonio Vitarelli; Susan Tiukinhoy; Silvia Di Luzio; Manuela Zampino; Mihai Gheorghiade

2003-01-01

271

Predicting Outcomes of Hospitalization for Heart Failure Using Logistic Regression and Knowledge Discovery Methods  

E-print Network

Predicting Outcomes of Hospitalization for Heart Failure Using Logistic Regression and Knowledge and cost of treatment than most other hospitalized diseases. The prevalence of heart failure has exceeded 4 of administrative data representing 2,500 hospitalized heart failure patients treated in eight Iowa hospitals

Street, Nick

272

The landscape of DNA repeat elements in human heart failure  

PubMed Central

Background The epigenomes of healthy and diseased human hearts were recently examined by genome-wide DNA methylation profiling. Repetitive elements, heavily methylated in post-natal tissue, have variable methylation profiles in cancer but methylation of repetitive elements in the heart has never been examined. Results We analyzed repetitive elements from all repeat families in human myocardial samples, and found that satellite repeat elements were significantly hypomethylated in end-stage cardiomyopathic hearts relative to healthy normal controls. Satellite repeat elements are almost always centromeric or juxtacentromeric, and their overexpression correlates with disease aggressiveness in cancer. Similarly, we found that hypomethylation of satellite repeat elements correlated with up to 27-fold upregulation of the corresponding transcripts in end-stage cardiomyopathic hearts. No other repeat family exhibited differential methylation between healthy and cardiomyopathic hearts, with the exception of the Alu element SINE1/7SL, for which a modestly consistent trend of increased methylation was observed. Conclusions Satellite repeat element transcripts, a form of non-coding RNA, have putative functions in maintaining genomic stability and chromosomal integrity. Further studies will be needed to establish the functional significance of these non-coding RNAs in the context of heart failure. PMID:23034148

2012-01-01

273

[Mitochondrial dynamics: a potential new therapeutic target for heart failure].  

PubMed

Mitochondria are dynamic organelles able to vary their morphology between elongated interconnected mitochondrial networks and fragmented disconnected arrays, through events of mitochondrial fusion and fission, respectively. These events allow the transmission of signaling messengers and exchange of metabolites within the cell. They have also been implicated in a variety of biological processes including embryonic development, metabolism, apoptosis, and autophagy. Although the majority of these studies have been confined to noncardiac cells, emerging evidence suggests that changes in mitochondrial morphology could participate in cardiac development, the response to ischemia-reperfusion injury, heart failure, and diabetes mellitus. In this article, we review how the mitochondrial dynamics are altered in different cardiac pathologies, with special emphasis on heart failure, and how this knowledge may provide new therapeutic targets for treating cardiovascular diseases. PMID:21820793

Kuzmicic, Jovan; Del Campo, Andrea; López-Crisosto, Camila; Morales, Pablo E; Pennanen, Christian; Bravo-Sagua, Roberto; Hechenleitner, Jonathan; Zepeda, Ramiro; Castro, Pablo F; Verdejo, Hugo E; Parra, Valentina; Chiong, Mario; Lavandero, Sergio

2011-10-01

274

Cardiac Depression Scale: Mokken scaling in heart failure patients  

PubMed Central

Background There is a high prevalence of depression in patients with heart failure (HF) that is associated with worsening prognosis. The value of using a reliable and valid instrument to measure depression in this population is therefore essential. We validated the Cardiac Depression Scale (CDS) in heart failure patients using a model of ordinal unidimensional measurement known as Mokken scaling. Findings We administered in face-to-face interviews the CDS to 603 patients with HF. Data were analysed using Mokken scale analysis. Items of the CDS formed a statistically significant unidimensional Mokken scale of low strength (H<0.40) and high reliability (Rho>0.8). Conclusions The CDS has a hierarchy of items which can be interpreted in terms of the increasingly serious effects of depression occurring as a result of HF. Identifying an appropriate instrument to measure depression in patients with HF allows for early identification and better medical management. PMID:23176125

2012-01-01

275

Cardiorenal syndrome and the role of ultrafiltration in heart failure.  

PubMed

Acute decompensated heart failure (ADHF) with associated volume overload is the most common cause of hospitalization in heart failure patients. When accompanied by worsening renal function, it is described as a cardiorenal syndrome and is a therapeutic challenge. Initial treatment commonly encompasses intravenous diuretics however, suboptimal results and high rehospitalization rates have led experts to search for alternative therapeutic strategies. Recent technological advances in extracorporeal therapies have made ultrafiltration a feasible option for treatment of hypervolemia in ADHF. Recent large randomized trials have compared the efficacy and safety of ultrafiltration with diuretics. Additionally, the benefits of novel pharmacologic approaches, including combining hypertonic saline with diuretics, have recently been studied. The aim of this review is to discuss the developments in both pharmacologic and extracorporeal methods for treating hypervolemia in ADHF and acute cardiorenal syndrome. PMID:23354831

Prosek, Jason; Agarwal, Anil; Parikh, Samir V

2013-03-01

276

Novelties in the early management of acute heart failure syndromes.  

PubMed

The recent European Society of Cardiology (ESC) guidelines delineate the diagnosis and management of distinct categories of acute heart failure syndromes. However, physicians dealing with these patients may need guidance in choosing therapeutic alternatives as soon as the dyspneic patient arrives at the emergency department, until distinct categories of the ESC guidelines are identified. Hence, this manuscript summarizes practical recommendations for the very early management of patients with acute heart failure syndromes. The recommendations are based on a clinical classification system considering the initial systolic blood pressure and other symptoms. Early initiation of diagnostic and goal-directed treatment strategies are key factors in improving patient outcomes. Early and frequent reassessment is also imperative so that adjustments to the initial therapeutic approach can be made, as clinically indicated. PMID:20407961

Salem, Reda; Sibellas, Franck; Socrates, Thenral; Arenja, Nisha; Yilmaz, Mehmet Birhan; Mueller, Christian; Mebazaa, Alexandre

2010-01-01

277

Pathways in heart failure disease management across socioeconomic spectra.  

PubMed

Caring for heart failure patients with a low socioeconomic status presents a unique set of challenges for health care providers. Heart failure disease management programs can integrate the use of teaching DVDs to overcome deficiencies in health literacy and take advantage of the Wal-Mart/Target $4 dollar medication program to provide life-saving medical therapy. In addition, open discussions with the patient and family regarding the costs of medications and the reality of what they can afford to pay monthly on a long term basis can guide the physician to prescribing medications by prioritizing use with a focus on evidence-based data for the medications with the highest mortality reduction. Finally, connecting inpatient visits to outpatient visits through the use of electronic medical records systems can facilitate avoidance of unnecessary repeat lab and diagnostic testing. PMID:22089272

Hebert, Kathy; Gogichaishvili, Ilia; Gopie, Stephanie; Arcement, Lee

2011-12-01

278

Transgenic simulation of human heart failure-like L-type Ca2+-channels: implications for fibrosis and heart rate in mice  

PubMed Central

Aims Cardiac L-type Ca2+-currents show distinct alterations in chronic heart failure, including increased single-channel activity and blunted adrenergic stimulation, but minor changes of whole-cell currents. Expression of L-type Ca2+-channel ?2-subunits is enhanced in human failing hearts. In order to determine whether prolonged alteration of Ca2+-channel gating by ?2-subunits contributes to heart failure pathogenesis, we generated and characterized transgenic mice with cardiac overexpression of a ?2a-subunit or the pore Cav1.2 or both, respectively. Methods and results Four weeks induction of cardiac-specific overexpression of rat ?2a-subunits shifted steady-state activation and inactivation of whole-cell currents towards more negative potentials, leading to increased Ca2+-current density at more negative test potentials. Activity of single Ca2+-channels was increased in myocytes isolated from ?2a-transgenic mice. Ca2+-current stimulation by 8-Br-cAMP and okadaic acid was blunted in ?2a-transgenic myocytes. In vivo investigation revealed hypotension and bradycardia upon Cav1.2-transgene expression but not in mice only overexpressing ?2a. Double-transgenics showed cardiac arrhythmia. Interstitial fibrosis was aggravated by the ?2a-transgene compared with Cav1.2-transgene expression alone. Overt cardiac hypertrophy was not observed in any model. Conclusion Cardiac overexpression of a Ca2+-channel ?2a-subunit alone is sufficient to induce Ca2+-channel properties characteristic of chronic human heart failure. ?2a-overexpression by itself did not induce cardiac hypertrophy or contractile dysfunction, but aggravated the development of arrhythmia and fibrosis in Cav1.2-transgenic mice. PMID:19620129

Beetz, Nadine; Hein, Lutz; Meszaros, Janos; Gilsbach, Ralf; Barreto, Frederico; Meissner, Marcel; Hoppe, Uta C.; Schwartz, Arnold; Herzig, Stefan; Matthes, Jan

2009-01-01

279

Cellular cardiomyoplasty for a patient with heart failure  

SciTech Connect

Background: A 73-year-old man with a history of myocardial infarction and hypertension for 5 years suffered heart failure (NYHA III-IV). Methods: 2D echo indicated hypokinesia at septal, left ventricular anterior wall and apical regions. Coronary angiograms demonstrated 60% stenosis in distal left main and 99% stenosis in proximal and distal left anterior descending coronary arteries (LAD). Both proximal artery and middle left circumflex coronary artery (LC) had 90% stenosis, and diffuse stenosis of right coronary artery (RC) was found. Myocardial perfusion imaging using {sup 99m}Tc-MIBI indicated defective perfusion of left ventricular apex, anterior wall and septal region and severe reduced perfusion of posterior inferior wall. Myocardial metabolic activities ({sup 18}F-deoxyglucose) also showed comparable reductions. After exposing the heart, LAD, LC, and RC were all completely occluded and bypass procedure could not be completed. Autologous satellite cells were implanted without any complication and the patient had an uneventful recovery. Results: During the first 2 months, he remained in heart failure, and by the third month, he gradually improved and reached NYHA II. At fifth month after the procedure, significant increased ejection fraction (37.1-48.6%) and wall movement with modest reduction of left ventricular systolic diameter (48-45 mm) were observed. Imaging with {sup 18}F-deoxyglucose showed dramatic improvement in myocardial metabolic activity with similar improvement in myocardial perfusion ({sup 99m}Tc-MIBI). Conclusion: This is the first successful case of cellular cardiomyoplasty without any conjunctional procedure for patient with severe coronary heart disease and heart failure.

Zhang Fumin; Chen Yijiang; Yang Zhijian; Gao Xiang; Ma Wenzhu; Li Chuanfu; Kao, Race L

2003-03-01

280

Role of guanylate cyclase modulators in decompensated heart failure  

Microsoft Academic Search

In this review we investigate the role of particulate and soluble guanylate cyclase (pGC and sGC, respectively) pathways in\\u000a heart failure, and several novel drugs that modify guanylate cyclase. Nesiritide and ularitide\\/urodilatin are natriuretic\\u000a peptides with vasodilating, natriuretic and diuretic effects, acting on pGC, whilst cinaciguat (BAY 58-2667) is a novel sGC\\u000a activator. Cinaciguat has a promising and novel mode

Veselin Mitrovic; Adrian F. Hernandez; Markus Meyer; Mihai Gheorghiade

2009-01-01

281

Principles of exercise prescription for patients with chronic heart failure  

Microsoft Academic Search

Chronic heart failure (CHF) is a common and debilitating condition characterized by reduced exercise tolerance. While exercise\\u000a training was once thought to be contraindicated for patients with CHF, a substantial body of data has been published over\\u000a the last two decades to support the use of exercise programs for these patients. Improvements in exercise capacity, quality\\u000a of life, and mortality

Jonathan Myers

2008-01-01

282

Biventricular pacing in a patient with severe congestive heart failure  

Microsoft Academic Search

We report a case of dilated cardiomyopathy with severe congestive heart failure (ejection fraction 19%) and complete left\\u000a bundle branch block (QRS duration: 240 ms) 13 years after aortic valve replacement. Permanent biventricular pacing was implanted\\u000a by inserting a left ventricular lead thorough a small left thoracotomy following intraveneous insertion of right atrial and\\u000a ventricular endocardial leads. Biventricular pacing increased

Hiroyuki Tanaka; Kaoru Okishige; Mikiko Murakami; Takeshi Someya; Hirokuni Arai; Makoto Sunamori

2002-01-01

283

Cheyne-Stokes respiration in patients hospitalised for heart failure  

PubMed Central

Background Previous studies showing a strong relationship between Cheyne-Stokes respiration and the severity of left ventricular systolic dysfunction have usually been done in selected patient populations with lower age and a higher proportion of males than the "typical" in-hospital patient with heart failure. The purpose of the present study was test the strength of this relationship in unselected patients admitted to hospital due to decompensated chronic heart failure. Methods We evaluated 191 patients (32% women), mean age 73 years, ready for discharge from the heart failure unit in the University Hospital of Malmö, Sweden. The patients underwent echocardiography for determination of left ventricular ejection fraction and left ventricular inner diastolic diameter. A respiratory investigation during sleep was performed the last night before discharge. Results We found that 66% of the patients had Cheyne-Stokes respiration more than 10% of the total recording time. Only 7 (3.6%) of the patients had predominantly obstructive apnoeas. There was a significant but very weak relationship between left ventricular ejection fraction and left ventricular inner diastolic diameter on one hand and Cheyne-Stokes respiration on the other. Age was a stronger determinant of Cheyne-Stokes respiration than any of the cardiac or other clinical variables. Conclusion Although presence of Cheyne-Stokes respiration indicates left ventricular dysfunction, its severity seems only weakly related to the severity of heart failure. Age was found to be a stronger determinant, which may reflect the underlying age-dependency found also in healthy subjects. Due to age restrictions or other selection criteria, the importance of age may have been underestimated in many previous studies on factors associated with Cheyne-Stokes respiration. PMID:15380031

Mared, Lena; Cline, Charles; Erhardt, Leif; Berg, S?ren; Midgren, Bengt

2004-01-01

284

Treatment of patients with heart failure and preserved ejection fraction  

Microsoft Academic Search

Opinion statement  Of the more than 5 million Americans who have heart failure (HF), 30% to 50% have HF with preserved ejection fraction (HF-PEF).\\u000a HF-PEF commonly occurs in elderly patients, especially women, with comorbidities of hypertension, left ventricular hypertrophy,\\u000a diabetes, myocardial ischemia, and obesity. HF-PEF is associated with high morbidity and mortality. Although two large multicenter\\u000a randomized, placebo-controlled trials evaluating an

Anita Deswal; Biykem Bozkurt

2008-01-01

285

Surgical Stem Cell Therapy for the Treatment of Heart Failure  

Microsoft Academic Search

Congestive heart failure (CHF) is a complex clinical syndrome resulting from myocardial dysfunction that impairs the cardiovascular\\u000a system’s function. Both medical and surgical therapy still results in a large number of patients with very few options and\\u000a persistent ventricular dysfunction. The major process to reverse ventricular remodeling would be the enhancement of regeneration\\u000a of cardiac myocytes, as well as the

Federico Benetti; Luis Geffner; Daniel Brusich; Agustin Fronzutti; Roberto Paganini; Juan Paganini; Amit Patel

286

Do statins prevent heart failure in patients after myocardial infarction?  

Microsoft Academic Search

3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, reduce morbidity and mortality in patients with coronary\\u000a artery disease (CAD). Because CAD is the major cause of heart failure (HF) in developed countries, prevention of CAD may result\\u000a in reduced HF. Evidence from randomized trials on lipid reduction (Cholesterol and Recurrent Events and the Scandinavian Simvastatin\\u000a Survival Study) has shown statins to

Anique Ducharme; Jean Lucien Rouleau

2004-01-01

287

Systemic inflammation in heart failure – The whys and wherefores  

Microsoft Academic Search

Patients with chronic heart failure (HF) are characterized by systemic inflammation, as evident by raised circulating levels\\u000a of several inflammatory cytokines with increasing levels according to the degree of disease severity. In addition to the myocardium\\u000a itself, several tissues and cells can contribute to this inflammation, including leukocytes, platelets, tissue macrophages\\u000a and endothelial cells. Although the mechanisms for the systemic

Arne Yndestad; Jan Kristian Damås; Erik Øie; Thor Ueland; Lars Gullestad; Pål Aukrust

2006-01-01

288

Mesenchymal Stem Cells for the Treatment of Heart Failure  

Microsoft Academic Search

Heart failure is one of the most important cardiovascular health problems throughout the world and has high mortality, and\\u000a there is a need to develop more effective therapeutic strategies to replace such specialized treatment as mechanical circulatory\\u000a support and cardiac transplantation. Mesenchymal stem cells (MSC) are multipotent plastic-adherent cells obtained from bone\\u000a marrow, adipose tissue, and other tissues and can

Shunsuke Ohnishi; Hajime Ohgushi; Soichiro Kitamura; Noritoshi Nagaya

2007-01-01

289

Tissue inhibitor of metalloproteinases (TIMPs) in heart failure  

Microsoft Academic Search

Remodeling of the myocardium and the extracellular matrix (ECM) occurs in heart failure irrespective of its initial cause.\\u000a The ECM serves as a scaffold to provide structural support as well as housing a number of cytokines and growth factors. Hence,\\u000a disruption of the ECM will result in structural instability as well as activation of a number of signaling pathways that

Linn Moore; Dong Fan; Ratnadeep Basu; Vijay Kandalam; Zamaneh Kassiri

290

Pharmacologic modulation of parasympathetic activity in heart failure  

Microsoft Academic Search

In the congestive heart failure state, autonomic dysregulation involves an increase in sympathetic tone and decrease in parasympathetic\\u000a tone and is associated with increased mortality. It is possible that augmentation of the parasympathetic nervous system (PNS)\\u000a with pharmacologic therapy may lead to improved symptoms and\\/or clinical outcomes. There are several new and established pharmacologic\\u000a interventions that have been studied for

Monali Y. Desai; Mari A. Watanabe; Abhay A. Laddu; Paul J. Hauptman

2011-01-01

291

Current role of neprilysin inhibitors in hypertension and heart failure.  

PubMed

Cardiovascular diseases (CVD) continue to represent the major cause of death, morbidity and healthcare expenditure worldwide. Current medical therapy fails to effectively halt disease progression and to reduce adverse clinical outcomes, reflecting incomplete understanding of pathomechanisms as well as the need to expand current pharmacotherapeutic strategies. Hypertension and heart failure, the most important CVD entities, are associated with imbalance in neurohormonal systems activity such as the renin-angiotensin-aldosterone system (RAAS), the sympathetic nervous system and the endothelin system. Blockade of the RAAS constitutes the most successful pharmacotherapeutic concept in hypertension and heart failure to date. The RAAS-opposing natriuretic peptide system constitutes the body's own BP-lowering system, and mediates a multitude of beneficial actions within cardiovascular tissues. The metallopeptidase neprilysin (NEP) hydrolyzes natriuretic peptides. Conceptually, NEP inhibition would increase salutary natriuretic peptide actions in CVD. However, stand-alone NEP inhibitors (NEPi) lacked efficacy beyond standard pharmacotherapy. Combined blockers of NEP and the endothelin system demonstrated efficacy in preclinical studies but have not been evaluated in clinical trials. A decade ago, omapatrilat and other dual-acting NEPi-ACEi (vasopeptidase-inhibitors) were promising agents for hypertension and heart failure. Despite greater efficacy, development of vasopeptidase-inhibitors was halted due to significant off-target effects in some cohorts, most notably increased frequency of angioedema in hypertensive subjects. Novel angiotensin-receptor-neprilysin-inhibitors (ARNi) seek to fully exploit clinical efficacy of combined RAAS-blockade and NEPi-mediated natriuretic peptide augmentation, and hopefully do so with improved clinical safety. We herein review current knowledge of NEPi as stand-alone and combined pharmacotherapeutic agents in hypertension and heart failure. PMID:24836726

von Lueder, Thomas G; Atar, Dan; Krum, Henry

2014-10-01

292

Alcohol consumption and heart failure: A systematic review  

Microsoft Academic Search

Heart failure (HF) remains a major public health issue. It is estimated that about 500,000 Americans per year are diagnosed\\u000a with HF. Despite advanced medical and surgical treatments for HF, mortality after the onset of HF is still high, thereby underscoring\\u000a the importance of primary prevention. Among modifiable lifestyle factors, alcohol consumption appears to play a role in the\\u000a development

Luc Djoussé; J. Michael Gaziano

2008-01-01

293

Hydrogen sulfide mitigates transition from compensatory hypertrophy to heart failure  

PubMed Central

We reported previously that although there is disruption of coordinated cardiac hypertrophy and angiogenesis in transition to heart failure, matrix metalloproteinase (MMP)-9 induced antiangiogenic factors play a vital role in this process. Previous studies have shown the cardioprotective role of hydrogen sulfide (H2S) in various cardiac diseases, but its role during transition from compensatory hypertrophy to heart failure is yet to be unveiled. We hypothesize that H2S induces MMP-2 activation and inhibits MMP-9 activation, thus promoting angiogenesis, and mitigates transition from compensatory cardiac hypertrophy to heart failure. To verify this, aortic banding (AB) was created to mimic pressure overload in wild-type (WT) mice, which were treated with sodium hydrosulfide (NaHS, H2S donor) in drinking water and compared with untreated control mice. Mice were studied at 3 and 8 wk. In the NaHS-treated AB 8 wk group, the expression of MMP-2, CD31, and VEGF was increased while the expression of MMP-9, endostatin, angiostatin, and tissue inhibitor of matrix metalloproteinase (TIMP)-3 was decreased compared with untreated control mice. There was significant reduction in fibrosis in NaHS-treated groups. Echocardiograph and pressure-volume data revealed improvement of cardiac function in NaHS-treated groups over untreated controls. These results show that H2S by inducing MMP-2 promotes VEGF synthesis and angiogenesis while it suppresses MMP-9 and TIMP-3 levels, inhibits antiangiogenic factors, reduces intracardiac fibrosis, and mitigates transition from compensatory hypertrophy to heart failure. PMID:21233344

Givvimani, Srikanth; Munjal, Charu; Gargoum, Riyad; Sen, Utpal; Tyagi, Neetu; Vacek, Jonathan C.

2011-01-01

294

The role of intravenous vasodilators in acute heart failure management.  

PubMed

Acute heart failure is a major cause of emergency hospital admission, with significant impact on health resources and patient outcomes. With no new treatments for over 20 years, the advent of new innovative therapies may facilitate a radical change in our approach to such patients. In this article, we examine the current evidence for the use of current intravenous vasodilators in AHF management, and review the potential of novel therapies currently in development. PMID:25100108

Piper, Susan; McDonagh, Theresa

2014-08-01

295

Prophylaxis of thromboembolic events in congestive heart failure  

Microsoft Academic Search

In patients with heart failure the incidence of thromboembolism is 0.9–5.5%\\/year (mean 1.9%\\/year), but no randomized studies are available to support the indication for anticoagulant therapy in those patients. Atrial fibrillation and previous thromboembolic events seem to be the major risk factors, whereas the effect of ventricular dysfunction has not been independently evaluated; nonetheless several studies suggest that thromboembolism is

Giuseppe Di Pasquale; Paola Passarelli; Maria Angela Ribani; Maria Lucia Borgatti; Stefano Urbinati; Giuseppe Pinelli

1996-01-01

296

Emerging therapies for heart failure: renal mechanisms and effects  

Microsoft Academic Search

Improved understanding of the pathophysiology of salt and water homeostasis has provided a foundation for explaining the renal\\u000a mechanisms of emerging therapies for heart failure, as well as why renal function might potentially be improved or harmed.\\u000a These aspects are reviewed in this article for a number of newer therapies including adenosine, endothelin, and vasopressin\\u000a receptor antagonists, as well as

Amir KazoryEdward; Edward A. Ross

297

?-Adrenergic Signaling in Chronic Heart Failure—Friend or Foe?  

Microsoft Academic Search

\\u000a In chronic heart failure, a number of compensatory mechanisms are activated in order to maintain circulation and thus supply\\u000a of the body with blood and oxygen. One important mechanism is the activation of the sympathetic nervous system, resulting\\u000a in increased ?-adrenergic signaling. This leads to both adaptive and pathological processes within the cell, including a desensitization\\u000a of the ?-adrenergic signal

Christoph Maack; Michael Böhm

298

The ubiquitin proteasome system in human cardiomyopathies and heart failure  

PubMed Central

Maintenance of protein quality control is a critical function of the ubiquitin proteasome system (UPS). Evidence is rapidly mounting to link proteasome dysfunction with a multitude of cardiac diseases, including ischemia, reperfusion, atherosclerosis, hypertrophy, heart failure, and cardiomyopathies. Recent studies have demonstrated a remarkable level of complexity in the regulation of the UPS in the heart and suggest that our understanding of how UPS dysfunction might contribute to the pathophysiology of such a wide range of cardiac afflictions is still very limited. Whereas experimental systems, including animal models, are invaluable for exploring mechanisms and establishing pathogenicity of UPS dysfunction in cardiac disease, studies using human heart tissue provide a vital adjunct for establishing clinical relevance of experimental findings and promoting new hypotheses. Accordingly, this review will focus on UPS dysfunction in human dilated and hypertrophic cardiomyopathies and highlight areas rich for further study in this expanding field. PMID:23479263

2013-01-01

299

[Volume retention in heart failure, nephrotic syndrome, and liver cirrhosis].  

PubMed

Volume retention in heart failure, nephrotic syndrome, and liver cirrhosis reflects pathological changes in homeostatic mechanisms that regulate the extracellular volume (sympathetic activity, renin-angiotensin-aldosterone system [RAAS], natriuretic peptides) and plasma osmolality (antidiuretic hormone [ADH]). In heart failure and liver cirrhosis, these changes are induced by a reduction of the effective circulating volume, which is the part of the extracellular fluid that is within the arterial system and effectively perfusing the tissues. This reduction in the effective circulating volume is caused by reduced cardiac output (heart failure), or by splanchnic vasodilatation with arterial underfilling (liver cirrhosis). In both cases, baroreceptors in both the carotid sinuses and in the glomerular afferent arterioles upregulate RAAS- and sympathetic activity, resulting in systemic vasoconstriction and renal sodium (and volume) retention. More severe reductions in the effective circulating volume may additionally stimulate ADH release, thus increasing the reabsorption of free water with subsequent hyponatriemia. In nephrotic syndrome, volume retention results either directly from the primary renal disease, which induces renal sodium and volume retention ("overfilling"), or indirectly from the reduced plasma oncotic pressure due to hypoalbuminemia, which induces a fluid shift from the intravascular to the interstitial space ("underfilling") with subsequent acitivation of baroreceptors and secondary sodium and volume retention. PMID:17009041

Heine, G H; Sester, U; Köhler, H

2006-11-01

300

Novel biomarkers in acute heart failure: MR-pro-adrenomedullin.  

PubMed

Abstract First isolated from human pheochromocytoma cells, adrenomedullin (ADM) is a peptide hormone with natriuretic, vasodilatory, and hypotensive effects mediated by cyclic adenosine monophosphate (cAMP), nitric oxide, and renal prostaglandin systems. ADM expression occurs in many tissues and organ systems, including cardiovascular, renal, pulmonary, cerebrovascular, gastrointestinal, and endocrine tissues where it acts as a circulating hormone and a local autocrine and paracrine hormone. ADM plasma concentrations are increased in hypertension, chronic renal disease, and heart failure. As ADM is unstable in vitro, it is necessary to measure its mid-regional pro-hormone fragment, the levels of which correspond to ADM concentration (MR-proADM). The prognostic potential of MR-proADM was recently demonstrated in the Biomarkers in Acute Heart Failure (BACH) trial. In this trial of 568 acute heart failure patients, MR-proADM was superior to both brain natriuretic peptide (BNP) and NT-proBNP in predicting mortality within 14 days. MR-proADM also provided significant additive incremental predictive value for 90-day mortality when added to BNP and NT-proBNP. PMID:24756062

Peacock, W Frank

2014-10-01

301

Prevalence and management of chronotropic incompetence in heart failure.  

PubMed

Although chronotropic incompetence (CI) has been shown to have important prognostic value in asymptomatic and coronary artery disease populations, much less attention has been given to the prevalence and impact of CI in heart failure. There is considerable variability in the reported prevalence of chronotropic impairment (25%-70%) in the heart failure literature, likely due to a lack of a standardized definition and/or differing assessment methodologies. Although the exact prevalence of CI is debatable and the precise pathophysiologic mechanisms involved remain uncertain, there is unambiguous evidence indicating that chronotropic impairment contributes significantly to the myriad of cardiovascular, neuromuscular, pulmonary, and neurohormonal maladaptations known to negatively impact the physical functional and quality of life of most heart failure patients. Specifically, an inappropriate chronotropic response to exercise can decrease peak exercise oxygen uptake by as much as 15% to 20%. Therapeutic interventions to improve chronotropic function, including endurance exercise training and rate-adaptive pacing, although promising, still warrant further investigation. PMID:17470336

Brubaker, Peter H; Kitzman, Dalane W

2007-05-01

302

Iron Deficiency in Heart Failure: A Practical Guide  

PubMed Central

Iron is an element necessary for cells due to its capacity of transporting oxygen and electrons. One of the important co-morbidities in heart failure is iron deficiency. Iron has relevant biological functions, for example, the formation of haemoglobin, myoglobin and numerous enzymatic groups. The prevalence of iron deficiency increases with the severity of heart failure. For a long time, the influence of iron deficiency was underestimated especially in terms of worsening of cardiovascular diseases and of developing anaemia. In recent years, studies with intravenous iron agents in patients with iron deficiency and cardiovascular diseases indicated new insights in the improvement of therapy. Experimental studies support the understanding of iron metabolism. Many physicians remain doubtful of the use of intravenous iron due to reports of side effects. The aim of this review is to describe iron metabolism in humans, to highlight the influence of iron deficiency on the course and symptoms of heart failure, discuss diagnostic tools of iron deficiency and provide guidance on the use of intravenous iron. PMID:24064572

Ebner, Nicole; von Haehling, Stephan

2013-01-01

303

The Emergence of a Dynamic Intervention Paradigm in Heart Failure  

PubMed Central

Traditionally, the heart failure management model has focused on crisis intervention, which allows the disease syndrome to progress to a point that requires emergent care followed by a cycle of prolonged and repeated hospitalizations (such contacts between the patient and care providers occur at times when the heart failure syndrome has deteriorated dangerously, and are only concerned with resolving the immediate crisis). Over time this approach of emergent care results in a marked decline in the patient's quality of life and creates a “revolving door” effect with the combined use of emergency department and hospital inpatient resources. The alternative is to become proactive and optimize treatment before such emergencies arise. This model relies on effective continuous outpatient and home care to stabilize the chronic condition and avoid hospital admissions. These concepts have led to the development of a new model or paradigm of outpatient strategies that have resulted in the creation of specialized heart failure disease management centers. This article discusses the economic and epidemiological forces that are driving this shift in our treatment focus and evaluates strategies that strike an optimum balance between cost containment and quality. PMID:21845121

Mehra, Mandeep R.

1999-01-01

304

The Adrenergic Nervous System in Heart Failure: Pathophysiology and Therapy  

PubMed Central

Heart failure (HF), the leading cause of death in the western world, develops when a cardiac injury or insult impairs the ability of the heart to pump blood and maintain tissue perfusion. It is characterized by a complex interplay of several neurohormonal mechanisms that get activated in the syndrome in order to try and sustain cardiac output in the face of decompensating function. Perhaps the most prominent among these neurohormonal mechanisms is the adrenergic (or sympathetic) nervous system (ANS), whose activity and outflow are enormously elevated in HF. Acutely, and if the heart works properly, this activation of the ANS will promptly restore cardiac function. However, if the cardiac insult persists over time, chances are the ANS will not be able to maintain cardiac function, the heart will progress into a state of chronic decompensated HF, and the hyperactive ANS will continue to “push” the heart to work at a level much higher than the cardiac muscle can handle. From that point on, ANS hyperactivity becomes a major problem in HF, conferring significant toxicity to the failing heart and markedly increasing its morbidity and mortality. The present review discusses the role of the ANS in cardiac physiology and in HF pathophysiology, the mechanisms of regulation of ANS activity and how they go awry in chronic HF, methods of measuring ANS activity in HF, the molecular alterations in heart physiology that occur in HF along with their pharmacological and therapeutic implications, and, finally, drugs and other therapeutic modalities used in HF treatment that target or affect the ANS and its effects on the failing heart. PMID:23989716

Lymperopoulos, Anastasios; Rengo, Giuseppe; Koch, Walter J.

2013-01-01

305

Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial  

Microsoft Academic Search

Objective To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients.Design Randomised controlled trial.Setting Home based intervention in heart failure patients.Participants 293 patients diagnosed with heart failure were included (149 intervention, 144 control) after an emergency admission.Intervention Two home visits by one of

Richard Holland; Iain Brooksby; Elizabeth Lenaghan; Kate Ashton; Laura Hay; Richard Smith; Lee Shepstone; Alistair Lipp; Clare Daly; Amanda Howe; Roger Hall; Ian Harvey

2007-01-01

306

Calcium cycling proteins and heart failure: mechanisms and therapeutics  

PubMed Central

Ca2+-dependent signaling is highly regulated in cardiomyocytes and determines the force of cardiac muscle contraction. Ca2+ cycling refers to the release and reuptake of intracellular Ca2+ that drives muscle contraction and relaxation. In failing hearts, Ca2+ cycling is profoundly altered, resulting in impaired contractility and fatal cardiac arrhythmias. The key defects in Ca2+ cycling occur at the level of the sarcoplasmic reticulum (SR), a Ca2+ storage organelle in muscle. Defects in the regulation of Ca2+ cycling proteins including the ryanodine receptor 2, cardiac (RyR2)/Ca2+ release channel macromolecular complexes and the sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a (SERCA2a)/phospholamban complex contribute to heart failure. RyR2s are oxidized, nitrosylated, and PKA hyperphosphorylated, resulting in “leaky” channels in failing hearts. These leaky RyR2s contribute to depletion of Ca2+ from the SR, and the leaking Ca2+ depolarizes cardiomyocytes and triggers fatal arrhythmias. SERCA2a is downregulated and phospholamban is hypophosphorylated in failing hearts, resulting in impaired SR Ca2+ reuptake that conspires with leaky RyR2 to deplete SR Ca2+. Two new therapeutic strategies for heart failure (HF) are now being tested in clinical trials: (a) fixing the leak in RyR2 channels with a novel class of Ca2+-release channel stabilizers called Rycals and (b) increasing expression of SERCA2a to improve SR Ca2+ reuptake with viral-mediated gene therapy. There are many potential opportunities for additional mechanism-based therapeutics involving the machinery that regulates Ca2+ cycling in the heart. PMID:23281409

Marks, Andrew R.

2013-01-01

307

Endothelial function is preserved in Chagas' heart disease patients without heart failure.  

PubMed

Endothelium may be damaged, especially at the coronary microcirculation, in animal models of Chagas' disease by several mechanisms. Endothelial dysfunction has been reported in chronic Chagas' heart disease patients with heart failure. Nevertheless, peripheral endothelial function has never been studied in patients with Chagas' heart disease without heart failure and other conditions that could per se alter the endothelial function. Endothelial function was evaluated in 9 patients with Chagas' heart disease (44.8 +/- 1.5 years, 5 females, left ventricular ejection fraction > or = 60%) and 10 healthy matched controls (38.6 +/- 5.5 years, 5 females). Extreme caution was exercised to select patients with no other conditions that could per se alter the endothelial function. Forearm blood flow was measured at baseline and during intra-brachial artery infusion of crescent doses of acetylcholine (0.75, 5, and 15 microg/100 mL tissue/min) and nitroprusside (1, 2, and 4 microg/ 100 mL tissue/min), an endothelium-dependent and an endothelium-independent vasoactive drug, respectively. At baseline, blood pressure and heart rate (continuously recorded with Finapress) and the forearm blood flow were similar in both groups. Acetylcholine (ACh) and sodium nitroprusside (SNP) caused significant and similar dose-dependent increases in forearm blood flow of all subjects: maximum ACh response of 24.8 versus 23.7, and maximum SNP response 24.4 versus 23.7 mL/100 mL tissue/min, respectively, for control and chagasic Groups. No significant systemic hemodynamic changes were observed during the intra-arterial infusion of the drugs. The authors conclude that the peripheral endothelial function is preserved in Chagas' heart disease patients without heart failure. PMID:15763943

Consolim-Colombo, Fernanda M; Lopes, Heno F; Rosetto, Eliana A; Rubira, Marcelo C; Barreto-Filho, José Augusto S; Baruzzi, Antonio Cláudio A; Rocha, Nazareth N; Mady, Charles; Irigoyen, Maria Claudia; Krieger, Eduardo M

2004-01-01

308

Liguzinediol improved the heart function and inhibited myocardial cell apoptosis in rats with heart failure  

PubMed Central

Aim: Liguzinediol is a novel derivative of ligustrazine isolated from the traditional Chinese medicine Chuanxiong (Ligusticum wallichii Franch), and produces significant positive inotropic effect in isolated rat hearts. In this study we investigated the effects of liguzinediol on a rat model of heart failure. Methods: To induce heart failure, male SD rats were injected with doxorubicin (DOX, 2 mg/kg, ip) once a week for 4 weeks. Then the rats were administered with liguzinediol (5, 10, 20 mg·kg?1·d?1, po) for 2 weeks. Hemodynamic examination was conducted to evaluate heart function. Myocardial cell apoptosis was examined morphologically. The expression of related genes and proteins were analyzed using immunohistochemical staining and Western blot assays, respectively. Results: Oral administration of liguzinediol dose-dependently improved the heart function in DOX-treated rats. Electron microscopy revealed that liguzinediol (10 mg·kg?1·d?1) markedly attenuated DOX-induced injury of cardiomyocytes, and decreased the number of apoptotic bodies in cardiomyocytes. Furthermore, liguzinediol significantly decreased Bax protein level, and increased Bcl-2 protein level in cardiomyocytes of DOX-treated rats, led to an increase in the ratio of Bcl-2/Bax. Moreover, liguzinediol significantly decreased the expression of both cleaved caspase-3 and NF-?B in cardiomyocytes of DOX-treated rats. Administration of digitalis (0.0225 mg·kg?1·d?1) also markedly improved the heart function and the morphology of cardiomyocytes in DOX-treated rats. Conclusion: Liguzinediol improves the heart function and inhibits myocardial cell apoptosis in the rat model of heart failure, which is associated with regulating Bcl-2, Bax, caspase-3 and NF-?B expression. PMID:25220638

Li, Yu; Song, Ping; Zhu, Qing; Yin, Qiu-yi; Ji, Jia-wen; Li, Wei; Bian, Hui-min

2014-01-01

309

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure  

PubMed Central

Aims Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Methods and results Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. Conclusion LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted. PMID:23512097

Cinca, Juan; Mendez, Ana; Puig, Teresa; Ferrero, Andreu; Roig, Eulalia; Vazquez, Rafael; Gonzalez-Juanatey, Jose R.; Alonso-Pulpon, Luis; Delgado, Juan; Brugada, Josep; Pascual-Figal, Domingo; Brugada, J.; Batlle, M.; Berruezo, A.; Hevia, S.; Mont, L.; Perez-Villa, F.; Cinca, J.; Roig, E.; Bayes de Luna, A.; Borras, X.; Carreras, F.; Ferrero, A.; Guerra, J.M.; Hove-Madsen, L.; Jorge, E.; Martinez, R.; Padro, J.; Puig, T.; Ribas, N.; Vinolas, X.; Alvarez-Garcia, J.; Gonzalez-Juanatey, J.R.; Bandin, M.; Eiras, S.; Fernandez-Hernandez, L.; Garcia-Acuna, J.; Gomez-Otero, I.; Grigorian-Shamagian, L.; Lago, F.; Manzon, P.; Moure, M.; Otero-Ravina, F.; Otero-Santiago, F.; Rodino Janeiro, B.K.; Rubio, J.; Salgado, A.; Seoane, A.; Varela, A.; Lear, P.V.; Fernandez-Cruz, A.; Alvarez de Arcaya Vicente, A.; Avila, M.; Bordiu, E.; Calle, L.; Fernandez-Pinilla, C.; Gomez-Garre, D.; Gonzalez-Rubio, L.; Marco, J.; Martell, N.; Munoz-Pacheco, P.; Ortega, A.; Patino, R.; Pedrajas, J.; Reinares, L.; Perez-Villacastin, J.; Bover, R.; Cobos, M.; Garcia-Quintanilla, J.; Moreno, J.; Perez-Castellano, N.; Perez-Serrano, M.; Vila, I.; Delgado, J.F.; Arribas, F.; Escribano, P.; Flox, A.; Jimenez Lopez-Guarch, C.; Paradina, M.; Ruiz-Cano, J.; Saenz de la Calzada, C.; Salguero, R.; Sanchez-Sanchez, V.; Tello de Meneses, R.; Vicente-Hernandez, M.; Alonso-Pulpon, L.; Fernandez -Lozano, I.; Garcia-Pavia, P.; Garcia-Touchard, A.; Gomez-Bueno, M.; Marquez, J.; Segovia, J.; Silva, L.; Vazquez-Mosquera, M.; Valdes, M.; Garcia-Alberola, A.; Garrido, I.; Pascual-Figal, D. A.; Pastor-Perez, F.J.; Sanchez-Mas, J.; Tornel, P.; Rivera, M.; Almenar, L.; Cortes, R.; Martinez-Dolz, L.; Montero, J.; Portoles, M.; Rosello-Lleti, E.; Salvador, A.; Vila, V.; Vazquez, R.; Cubero, J.; Fernandez-Palacin, A.; Garcia-Medina, D.; Garcia-Rey, S.; Laguna, E.; Leal del Ojo, J.; Minano, F.; Pastor-Torres, L.; Pavon, R.; Perez-Navarro, A.; Villagomez, D.; Vazquez, R.; Arana, R.; Bartolome, D.; Cabeza, P.; Calle-Perez, G.; Camacho, F.; Cano, L.; Carrillo, A.; Diaz-Retamino, E.; Escolar, V.; Fernandez-Rivero, R.; Gamaza, S.; Giraldes, A.; Hernandez-Vicente, N.; Lagares, M.; Lopez-Benitez, J.; Marante, M.; Otero, E.; Pedregal, J.; Sancho-Jaldon, M.; Sevillano, R.; Zayas, R.; Verdu, J.M.; Aguilar, S.; Aizpurua, M.; Alguacil, F.; Casacuberta, J.; Cerain, J.; Domingo, M.; Garcia-Lareo, M.; Herrero-Melechon, J.; Lopez-Pareja, N.; Mena, A.; Perez-Orcero, A.; Rodriguez- Cristobal, J.; Rozas, M.; Sorribes, J.; Toran, P.; Worner, F.; Barta, L.; Bravo, C.; Cabau, J.; Casanova, J.; Daga, B.; De la Puerta, I.; Hernandez-Martin, I.; Pinol, E.; Pueo, E.; Torres, G.; Troncoso, A.; Viles, D.; Bardaji, A.; Merce, J.; Sanz-Girgas, E.; Valdovinos, P.; Aramburu, O.; Arias, J.; Garcia-Gonzalez, C.; Alonso, M.; Bischofberger, C.; Dominguez-De Pablos, G.; Jimenez-Cervantes, D.; Urena, I.; Grau-Sepulveda, A.; Fiol, C.; Pericas, P.; Villalonga, M.; Orosa, P.; Aguero, J.; Planas-Ayma, F.; Grau-Amoros, J.; Planas-Comes, F.; San Vicente, L.

2013-01-01

310

Simulation of dilated heart failure with continuous flow circulatory support.  

PubMed

Lumped parameter models have been employed for decades to simulate important hemodynamic couplings between a left ventricular assist device (LVAD) and the native circulation. However, these studies seldom consider the pathological descending limb of the Frank-Starling response of the overloaded ventricle. This study introduces a dilated heart failure model featuring a unimodal end systolic pressure-volume relationship (ESPVR) to address this critical shortcoming. The resulting hemodynamic response to mechanical circulatory support are illustrated through numerical simulations of a rotodynamic, continuous flow ventricular assist device (cfVAD) coupled to systemic and pulmonary circulations with baroreflex control. The model further incorporated septal interaction to capture the influence of left ventricular (LV) unloading on right ventricular function. Four heart failure conditions were simulated (LV and bi-ventricular failure with/without pulmonary hypertension) in addition to normal baseline. Several metrics of LV function, including cardiac output and stroke work, exhibited a unimodal response whereby initial unloading improved function, and further unloading depleted preload reserve thereby reducing ventricular output. The concept of extremal loading was introduced to reflect the loading condition in which the intrinsic LV stroke work is maximized. Simulation of bi-ventricular failure with pulmonary hypertension revealed inadequacy of LV support alone. These simulations motivate the implementation of an extremum tracking feedback controller to potentially optimize ventricular recovery. PMID:24465511

Wang, Yajuan; Loghmanpour, Natasha; Vandenberghe, Stijn; Ferreira, Antonio; Keller, Bradley; Gorcsan, John; Antaki, James

2014-01-01

311

Simulation of Dilated Heart Failure with Continuous Flow Circulatory Support  

PubMed Central

Lumped parameter models have been employed for decades to simulate important hemodynamic couplings between a left ventricular assist device (LVAD) and the native circulation. However, these studies seldom consider the pathological descending limb of the Frank-Starling response of the overloaded ventricle. This study introduces a dilated heart failure model featuring a unimodal end systolic pressure-volume relationship (ESPVR) to address this critical shortcoming. The resulting hemodynamic response to mechanical circulatory support are illustrated through numerical simulations of a rotodynamic, continuous flow ventricular assist device (cfVAD) coupled to systemic and pulmonary circulations with baroreflex control. The model further incorporated septal interaction to capture the influence of left ventricular (LV) unloading on right ventricular function. Four heart failure conditions were simulated (LV and bi-ventricular failure with/without pulmonary hypertension) in addition to normal baseline. Several metrics of LV function, including cardiac output and stroke work, exhibited a unimodal response whereby initial unloading improved function, and further unloading depleted preload reserve thereby reducing ventricular output. The concept of extremal loading was introduced to reflect the loading condition in which the intrinsic LV stroke work is maximized. Simulation of bi-ventricular failure with pulmonary hypertension revealed inadequacy of LV support alone. These simulations motivate the implementation of an extremum tracking feedback controller to potentially optimize ventricular recovery. PMID:24465511

Wang, Yajuan; Loghmanpour, Natasha; Vandenberghe, Stijn; Ferreira, Antonio; Keller, Bradley; Gorcsan, John; Antaki, James

2014-01-01

312

Monoamine oxidases (MAO) in the pathogenesis of heart failure and ischemia/reperfusion injury  

PubMed Central

Recent evidence highlights monoamine oxidases (MAO) as another prominent source of oxidative stress. MAO are a class of enzymes located in the outer mitochondrial membrane, deputed to the oxidative breakdown of key neurotransmitters such as norepinephrine, epinephrine and dopamine, and in the process generate H2O2. All these monoamines are endowed with potent modulatory effects on myocardial function. Thus, when the heart is subjected to chronic neuro-hormonal and/or peripheral hemodynamic stress, the abundance of circulating/tissue monoamines can make MAO-derived H2O2 production particularly prominent. This is the case of acute cardiac damage due to ischemia/reperfusion injury or, on a more chronic stand, of the transition from compensated hypertrophy to overt ventricular dilation/pump failure. Here, we will first briefly discuss mitochondrial status and contribution to acute and chronic cardiac disorders. We will illustrate possible mechanisms by which MAO activity affects cardiac biology and function, along with a discussion as to their role as a prominent source of reactive oxygen species. Finally, we will speculate on why MAO inhibition might have therapeutic value for treating cardiac affections of ischemic and non-ischemic origin. PMID:20869994

Kaludercic, Nina; Carpi, Andrea; Menabo, Roberta; Lisa, Fabio Di; Paolocci, Nazareno

2010-01-01

313

Decrease of cardiac chaos in congestive heart failure  

NASA Astrophysics Data System (ADS)

The electrical properties of the mammalian heart undergo many complex transitions in normal and diseased states. It has been proposed that the normal heartbeat may display complex nonlinear dynamics, including deterministic chaos,, and that such cardiac chaos may be a useful physiological marker for the diagnosis and management, of certain heart trouble. However, it is not clear whether the heartbeat series of healthy and diseased hearts are chaotic or stochastic, or whether cardiac chaos represents normal or abnormal behaviour. Here we have used a highly sensitive technique, which is robust to random noise, to detect chaos. We analysed the electrocardiograms from a group of healthy subjects and those with severe congestive heart failure (CHF), a clinical condition associated with a high risk of sudden death. The short-term variations of beat-to-beat interval exhibited strongly and consistently chaotic behaviour in all healthy subjects, but were frequently interrupted by periods of seemingly non-chaotic fluctuations in patients with CHF. Chaotic dynamics in the CHF data, even when discernible, exhibited a high degree of random variability over time, suggesting a weaker form of chaos. These findings suggest that cardiac chaos is prevalent in healthy heart, and a decrease in such chaos may be indicative of CHF.

Poon, Chi-Sang; Merrill, Christopher K.

1997-10-01

314

Inflammatory cytokines and nitric oxide in heart failure and potential modulation by vagus nerve stimulation  

Microsoft Academic Search

In heart failure, an inflammatory response may occur. The relationship between inflammatory cytokines, NOS and heart failure\\u000a progression remains uncertain. Parasympathetic activation can affect heart rate and AV conduction. In heart failure, a relationship\\u000a between the vagus nerve and the inflammatory response has been proposed. Vagal nerve stimulation can modulate the inflammatory\\u000a response and affect specific inflammatory mediators including nitric

Weiwei Li; Brian Olshansky

2011-01-01

315

The role of inflammatory and fibrogenic pathways in heart failure associated with aging  

Microsoft Academic Search

Heart failure is strongly associated with aging. Elderly patients with heart failure often have preserved systolic function\\u000a exhibiting left ventricular hypertrophy accompanied by a decline in diastolic function. Experimental studies have demonstrated\\u000a that age-related cardiac fibrosis plays an important role in the pathogenesis of diastolic heart failure in senescent hearts.\\u000a Reactive oxygen species and angiotensin II are critically involved in

Wei Chen; Nikolaos G. Frangogiannis

2010-01-01

316

Influence of heart failure on nucleolar organization and protein expression in human hearts  

SciTech Connect

Highlights: Black-Right-Pointing-Pointer Heart failure alters nucleolar morphology and organization. Black-Right-Pointing-Pointer Nucleolin expression is significant increased in ischemic and dilated cardiomyopathy. Black-Right-Pointing-Pointer Ventricular function of heart failure patients was related with nucleolin levels. -- Abstract: We investigate for the first time the influence of heart failure (HF) on nucleolar organization and proteins in patients with ischemic (ICM) or dilated cardiomyopathy (DCM). A total of 71 human hearts from ICM (n = 38) and DCM (n = 27) patients, undergoing heart transplantation and control donors (n = 6), were analysed by western-blotting, RT-PCR and cell biology methods. When we compared protein levels according to HF etiology, nucleolin was increased in both ICM (117%, p < 0.05) and DCM (141%, p < 0.01). Moreover, mRNA expression were also upregulated in ICM (1.46-fold, p < 0.05) and DCM (1.70-fold, p < 0.05. Immunofluorescence studies showed that the highest intensity of nucleolin was into nucleolus (p < 0.0001), and it was increased in pathological hearts (p < 0.0001). Ultrastructure analysis by electron microscopy showed an increase in the nucleus and nucleolus size in ICM (17%, p < 0.05 and 131%, p < 0.001) and DCM (56%, p < 0.01 and 69%, p < 0.01). Nucleolar organization was influenced by HF irrespective of etiology, increasing fibrillar centers (p < 0.001), perinucleolar chromatin (p < 0.01) and dense fibrillar components (p < 0.01). Finally, left ventricular function parameters were related with nucleolin levels in ischemic hearts (p < 0.0001). The present study demonstrates that HF influences on morphology and organization of nucleolar components, revealing changes in the expression and in the levels of nucleolin protein.

Rosello-Lleti, Esther; Rivera, Miguel; Cortes, Raquel [Cardiocirculatory Unit, Research Center, Hospital Universitario La Fe, Valencia (Spain)] [Cardiocirculatory Unit, Research Center, Hospital Universitario La Fe, Valencia (Spain); Azorin, Inmaculada [Experimental Neurology, Research Center, Hospital Universitario La Fe, Valencia (Spain)] [Experimental Neurology, Research Center, Hospital Universitario La Fe, Valencia (Spain); Sirera, Rafael [Biotechnology Department, Universidad Politecnica, Valencia (Spain)] [Biotechnology Department, Universidad Politecnica, Valencia (Spain); Martinez-Dolz, Luis [Cardiology Unit, Hospital Universitario La Fe, Valencia (Spain)] [Cardiology Unit, Hospital Universitario La Fe, Valencia (Spain); Hove, Leif; Cinca, Juan [Cardiology Unit, Hospital San Pau, Barcelona (Spain)] [Cardiology Unit, Hospital San Pau, Barcelona (Spain); Lago, Francisca; Gonzalez-Juanatey, Jose R. [Cardiology Unit, Institute of Biomedical Research, Hospital Clinicode Santiagode Compostela (Spain)] [Cardiology Unit, Institute of Biomedical Research, Hospital Clinicode Santiagode Compostela (Spain); Salvador, Antonio [Experimental Neurology, Research Center, Hospital Universitario La Fe, Valencia (Spain)] [Experimental Neurology, Research Center, Hospital Universitario La Fe, Valencia (Spain); Portoles, Manuel, E-mail: portoles_man@gva.es [Cell Biology and Pathology Unit, Research Center, Hospital Universitario La Fe, Valencia (Spain)] [Cell Biology and Pathology Unit, Research Center, Hospital Universitario La Fe, Valencia (Spain)

2012-02-10

317

Heart rate and cardiac rhythm relationships with bisoprolol benefit in chronic heart failure in CIBIS II trial  

Microsoft Academic Search

Background— b-Blockade-induced benefit in heart failure (HF) could be related to baseline heart rate and treatment- induced heart rate reduction, but no such relationships have been demonstrated. Methods and Results—In CIBIS II, we studied the relationships between baseline heart rate (BHR), heart rate changes at 2 months (HRC), nature of cardiac rhythm (sinus rhythm or atrial fibrillation), and outcomes (mortality

Philippe Lechat; Jean-Sébastien Hulot; A Mallet

2001-01-01

318

Pattern of heart failure in a Nigerian teaching hospital  

PubMed Central

Background Congestive cardiac failure (CCF) has emerged as a major public health problem worldwide and imposes an escalating burden on the health care system. Objective To determine the causes and mortality rate of CCF in the University of Port Harcourt Teaching Hospital (UPTH), south Nigeria, over a five-year period from January 2001 to December 2005. Methods A retrospective study of CCF cases were identified from the admission and discharge register of the medical wards of UPTH and the case notes were retrieved from the medical records department and analyzed. Results There were 423 patients: 242 males and 181 females. Their ages ranged from 18 to 100 years with a mean of 54.4 ± 17.3. The commonest causes of CCF were hypertension (56.3%) and cardiomyopathy (12.3%). Chronic renal failure, rheumatic heart disease, and ischemic heart disease accounted for 7.8%, 4.3%, and 0.2% of CCF, respectively. Peripartum heart disease was rare despite being commonly reported in northern Nigerian females. Eighteen patients died from various complications with a mortality rate of 4.3%. Conclusion The burden of CCF in the Niger Delta is mainly attributed to hypertension. Efforts should be geared towards hypertension awareness, detection, treatment, and prevention in the region. PMID:19774215

Onwuchekwa, Arthur C; Asekomeh, Godspower E

2009-01-01

319

New-onset atrial fibrillation is an independent predictor of in-hospital mortality in hospitalized heart failure patients: Results of the EuroHeart Failure Survey  

Microsoft Academic Search

Aims: The prognostic significance of atrial fibrillation (AF) in hospitalized patients with heart failure (HF) remains poorly understood. To evaluate in what way AF and its different modes of presentation affect the in-hospital mortality in patients admitted with HF. Methods and results: The EuroHeart Failure Survey was conducted to ascertain how hospitalized HF patients are managed in Europe. The survey

M. Rivero-Ayerza; W. J. M. Scholte op Reimer; M. J. Lenzen; D. A. M. J. Theuns; L. J. L. M. Jordaens; M. Komajda; F. Follath; K. Swedberg; J. G. F. Cleland

2008-01-01

320

A Simple New Visualization of Exercise Data Discloses Pathophysiology and Severity of Heart Failure  

PubMed Central

Background The complexity of cardiopulmonary exercise testing data and their displays tends to make assessment of patients, including those with heart failure, time consuming. Methods and Results We postulated that a new single display that uses concurrent values of oxygen uptake / ventilation versus carbon dioxide output / ventilation ratios (–versus–), plotted on equal X–Y axes, would better quantify normality and heart failure severity and would clarify pathophysiology. Consecutive –versus– values from rest to recovery were displayed on X–Y axes for patients with Class II and IV heart failure and for healthy subjects without heart failure. The displays revealed distinctive patterns for each group, reflecting sequential changes in cardiac output, arterial and mixed venous O2 and CO2 content differences, and ventilation (). On the basis of exercise tests of 417 healthy subjects, reference formulas for highest and , which normally occur during moderate exercise, are presented. Absolute and percent predicted values of highest and were recorded for 10 individuals from each group: Those of healthy subjects were significantly higher than those of patients with Class II heart failure, and those of patients with Class II heart failure were higher than those of patients with Class IV heart failure. These values differentiated heart failure severity better than peak , anaerobic threshold, peak oxygen pulse, and slopes. Resting –versus– values were strikingly low for patients with Class IV heart failure, and with exercise, increased minimally or even decreased. With regard to the pathophysiology of heart failure, high values during milder exercise, previously attributed to ventilatory inefficiency, seem to be caused primarily by reduced cardiac output rather than increased . Conclusion –versus– measurements and displays, extractable from future or existing exercise data, separate the 3 groups (healthy subjects, patients with Class II heart failure, and patients with Class IV heart failure) well and confirm the dominant role of low cardiac output rather than excessive in heart failure pathophysiology. (J Am Heart Assoc. 2012;1:e001883 doi: 10.1161/JAHA.112.001883.) PMID:23130146

Hansen, James E.; Sun, Xing-Guo; Stringer, William W.

2012-01-01

321

Atrioventricular junction ablation and pacemaker implantation for heart failure associated with atrial fibrillation: potential issues and therapies in the setting of acute heart failure syndrome.  

PubMed

Atrial fibrillation is the most common arrhythmia and is especially clinically important in patients with heart failure. Prolonged atrial fibrillation with high ventricular rate response may lead to development or worsening of left ventricular function. If adequate heart rate control cannot be obtained medically, often patients will undergo pacemaker implant and catheter ablation of the atrioventricular junction. This intervention can have profound effects on the course of heart failure. This article reviews the technique, complications, outcome data, and alternatives to this management strategy. The potential role of this therapeutic modality in those hospitalized with acute heart failure syndromes is discussed. PMID:21424742

Rubenstein, Jason C; Roth, James A

2011-09-01

322

Air Travel Considerations for the Patients With Heart Failure  

PubMed Central

Context: Prevalence of patients with heart failure (HF) is increasing in worldwide, and also the number of people with HF traveling long distances is increasing. These patients are more prone to experience problems contributed air travel and needs more attention during flight. However, observational studies about problems of HF patients during flight and appropriated considerations for them are limited. Evidence Acquisition: We evaluated the conditions that may be encountered in a HF patient and provide the recommendations to prevent the exacerbation of cardiac failure during air travel. For this review article, a comprehensive search was undertaken for the studies that evaluated the complications and considerations of HF patients during flight. Data bases searched were: MEDLINE, EMBASE, Science Direct, and Google Scholar. Results: HF patients are more prone to experience respiratory distress, anxiety, stress, cardiac decompensation, and venous thromboembolism (VTE) during air travel. Although stable HF patients can tolerate air travel, but those with acute heart failure syndrome should not fly until complete improvement is achieved. Conclusions: Thus, identifying the HF patients before the flight and providing them proper education about the events that may occur during flight is necessary. PMID:25068047

Izadi, Morteza; Alemzadeh-Ansari, Mohammad Javad; Kazemisaleh, Davood; Moshkani-Farahani, Maryam

2014-01-01

323

Dystrophic heart failure blocked by membrane sealant poloxamer  

NASA Astrophysics Data System (ADS)

Dystrophin deficiency causes Duchenne muscular dystrophy (DMD) in humans, an inherited and progressive disease of striated muscle deterioration that frequently involves pronounced cardiomyopathy. Heart failure is the second leading cause of fatalities in DMD. Progress towards defining the molecular basis of disease in DMD has mostly come from studies on skeletal muscle, with comparatively little attention directed to cardiac muscle. The pathophysiological mechanisms involved in cardiac myocytes may differ significantly from skeletal myofibres; this is underscored by the presence of significant cardiac disease in patients with truncated or reduced levels of dystrophin but without skeletal muscle disease. Here we show that intact, isolated dystrophin-deficient cardiac myocytes have reduced compliance and increased susceptibility to stretch-mediated calcium overload, leading to cell contracture and death, and that application of the membrane sealant poloxamer 188 corrects these defects in vitro. In vivo administration of poloxamer 188 to dystrophic mice instantly improved ventricular geometry and blocked the development of acute cardiac failure during a dobutamine-mediated stress protocol. Once issues relating to optimal dosing and long-term effects of poloxamer 188 in humans have been resolved, chemical-based membrane sealants could represent a new therapeutic approach for preventing or reversing the progression of cardiomyopathy and heart failure in muscular dystrophy.

Yasuda, Soichiro; Townsend, Dewayne; Michele, Daniel E.; Favre, Elizabeth G.; Day, Sharlene M.; Metzger, Joseph M.

2005-08-01

324

Influence of heart failure on nucleocytoplasmic transport in human cardiomyocytes  

PubMed Central

Aims The role of the cell nucleus in the development of heart failure (HF) is unknown, so the objectives of this study were to analyse the effect of HF on nucleocytoplasmic transport and density of the nuclear pore complex (NPC). Methods and results A total of 51 human heart samples from ischaemic (ICM, n = 30) and dilated (DCM, n = 16) patients undergoing heart transplantation and control donors (CNT, n = 5) were analysed by western blotting. Subcellular distribution of proteins and NPC were analysed by fluorescence and electron microscopy, respectively. When we compared nucleocytoplasmic machinery protein levels according to aetiology of HF, ICM showed higher levels of importins [(IMP-?3) (150%, P < 0.0001), IMP-?2 (69%, P = 0.001)] and exportins [EXP-1 (178%, P < 0.0001), EXP-4 (81%, P = 0.006)] than those of the CNT group. Furthermore, DCM also showed significant differences for IMP-?3 (192%, P < 0.0001), IMP-?2 (52%, P = 0.025), and EXP-1 (228%, P < 0.0001). RanGTPase-activating proteins (RanGAP1 and RaGAP1u) were increased in ICM (76%, P = 0.005; 51%, P = 0.012) and DCM (41%, P = 0.042; 50%, P = 0.029). Furthermore, subcellular distribution of nucleocytoplasmic machinery was not altered in pathological hearts. Finally, nucleoporin (Nup) p62 was increased in ICM (80%) and DCM (109%) (P < 0.001 and P = 0.024). Nuclear pore density was comparable in pathological and CNT hearts, and ICM showed a low diameter (P = 0.005) and different structural configuration of NPC. Conclusion This study shows the effect of HF on nucleocytoplasmic trafficking machinery, evidenced by higher levels of importins, exportins, Ran regulators and Nup p62 in ischaemic and dilated human hearts than those in the controls, with NPCs acquiring a different configuration and morphology in ICM. PMID:19819881

Cortes, Raquel; Rosello-Lleti, Esther; Rivera, Miguel; Martinez-Dolz, Luis; Salvador, Antonio; Azorin, Inmaculada; Portoles, Manuel

2010-01-01

325

Inflammation as a therapeutic target in heart failure? A scientific statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology  

PubMed Central

The increasing prevalence of heart failure poses enormous challenges for health care systems worldwide. Despite effective medical interventions that target neurohumoral activation, mortality and morbidity remain substantial. Evidence for inflammatory activation as an important pathway in disease progression in chronic heart failure has emerged in the last two decades. However, clinical trials of ‘anti-inflammatory’ therapies (such as anti-tumor necrosis factor-? approaches) have to date failed to show benefit in heart failure patients. The Heart Failure Association of the European Society of Cardiology recently organized an expert workshop to address the issue of inflammation in heart failure from a basic science, translational and clinical perspective, and to assess whether specific inflammatory pathways may yet serve as novel therapeutic targets for this condition. This consensus document represents the outcome of the workshop and defines key research questions that still need to be addressed as well as considering the requirements for future clinical trials in this area. PMID:19168509

Heymans, Stephane; Hirsch, Emilio; Anker, Stefan D.; Aukrust, Pal; Balligand, Jean-Luc; Cohen-Tervaert, Jan W.; Drexler, Helmut; Filippatos, Gerasimos; Felix, Stephan B.; Gullestad, Lars; Hilfiker-Kleiner, Denise; Janssens, Stefan; Latini, Roberto; Neubauer, Gitte; Paulus, Walter J.; Pieske, Burkert; Ponikowski, Piotr; Schroen, Blanche; Schultheiss, Heinz-Peter; Tschope, Carsten; Van Bilsen, Marc; Zannad, Faiez; McMurray, John; Shah, Ajay M.

2009-01-01

326

Cheyne-Stokes respiration in patients with heart failure: prevalence, causes, consequences and treatments.  

PubMed

Cheyne-Stokes respiration (CSR) is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment. PMID:22025128

Brack, Thomas; Randerath, Winfried; Bloch, Konrad E

2012-01-01

327

Post-Exercise Heart Rate Recovery Independently Predicts Mortality Risk in Patients with Chronic Heart Failure  

PubMed Central

Background Post-exercise heart rate recovery (HRR) is an index of parasympathetic function associated with clinical outcomes in populations with and without documented coronary heart disease. Decreased parasympathetic activity is thought to be associated with disease progression in chronic heart failure (HF), but an independent association between post-exercise HRR and clinical outcomes among such patients has not been established. Methods and Results We measured HRR (calculated as the difference between heart rate at peak exercise and after 1 minute of recovery) in 202 HF subjects and recorded 17 mortality and 15 urgent transplantation outcome events over 624 days of follow-up. Reduced post-exercise HRR was independently associated with increased event risk after adjusting for other exercise-derived variables (peak oxygen uptake and VE/VCO2 slope), for the Heart Failure Survival Score (adjusted HR 1.09 for one beat/min reduction, 95% CI 1.05-1.13, p<0.0001) and the Seattle Heart Failure Model score (adjusted HR 1.08 for one beat/min reduction, 95% CI 1.05-1.12, p<0.0001). Subjects in the lowest risk tertile based on post-exercise HRR (?30 beats/min) had low risk of events irrespective of the risk predicted by the survival scores. In a subgroup of 15 subjects, reduced post-exercise HRR was associated with increased serum markers of inflammation (interleukin-6 r=0.58, p=0.024, high sensitivity C-reactive protein r=0.66, p=0.007). Conclusions Post-exercise HRR predicts mortality risk in patients with HF and provides prognostic information independent of previously described survival models. Pathophysiologic links between autonomic function and inflammation may be mediators of this association. PMID:19944361

Tang, Yi-Da; Dewland, Thomas A.; Wencker, Detlef; Katz, Stuart D.

2009-01-01

328

Remodeling of Calcium Handling in Human Heart Failure  

PubMed Central

Heart failure (HF) is an increasing public health problem accelerated by a rapidly aging global population. Despite considerable progress in managing the disease, the development of new therapies for effective treatment of HF remains a challenge. To identify targets for early diagnosis and therapeutic intervention, it is essential to understand the molecular and cellular basis of calcium handling and the signaling pathways governing the functional remodeling associated with HF in humans. Calcium (Ca2+) cycling is an essential mediator of cardiac contractile function, and remodeling of calcium handling is thought to be one of the major factors contributing to the mechanical and electrical dysfunction observed in HF. Active research in this field aims to bridge the gap between basic research and effective clinical treatments of HF. This chapter reviews the most relevant studies of calcium remodeling in failing human hearts and discusses their connections to current and emerging clinical therapies for HF patients. PMID:22453987

Lou, Qing; Janardhan, Ajit; Efimov, Igor R.

2013-01-01

329

Metastatic Carcinoid Tumor Presenting As Right Sided Heart Failure  

PubMed Central

Carcinoid tumor is a slow-growing type of neuroendocrine tumor, originating in the enterochromaffin cells and secreting mainly serotonin. The diagnosis is based on clinical symptoms, hormone levels, radiological and nuclear imaging, and histological confirmation. The clinical symptoms are characterized by flushing, diarrhea, abdominal pain, telangiectasia and/or bronchoconstriction. However, most patients have metastatic disease at diagnosis because the clinic goes unnoticed or are ascribed to other abdominal conditions. We report the clinical symptoms, hormone levels, radiological and nuclear imaging, histological diagnosis, treatment and evaluation of a 44-year-old female patient with congestive heart failure secondary to carcinoid heart disease in the context of liver metastases of an ileum carcinoid tumor. PMID:23825984

Martinez-Quintana, Efren; Avila-Gonzalez, Maria Del Mar; Suarez-Castellano, Laura; Rodriguez-Gonzalez, Fayna

2013-01-01

330

Telemonitoring in Chronic Heart Failure: A Systematic Review  

PubMed Central

Heart failure (HF) is a growing epidemic with the annual number of hospitalizations constantly increasing over the last decades for HF as a primary or secondary diagnosis. Despite the emergence of novel therapeutic approached that can prolong life and shorten hospital stay, HF patients will be needing rehospitalization and will often have a poor prognosis. Telemonitoring is a novel diagnostic modality that has been suggested to be beneficial for HF patients. Telemonitoring is viewed as a means of recording physiological data, such as body weight, heart rate, arterial blood pressure, and electrocardiogram recordings, by portable devices and transmitting these data remotely (via a telephone line, a mobile phone or a computer) to a server where they can be stored, reviewed and analyzed by the research team. In this systematic review of all randomized clinical trials evaluating telemonitoring in chronic HF, we aim to assess whether telemonitoring provides any substantial benefit in this patient population. PMID:22720184

Giamouzis, Gregory; Mastrogiannis, Dimos; Koutrakis, Konstantinos; Karayannis, George; Parisis, Charalambos; Rountas, Chris; Adreanides, Elias; Dafoulas, George E.; Stafylas, Panagiotis C.; Skoularigis, John; Giacomelli, Sara; Olivari, Zoran; Triposkiadis, Filippos

2012-01-01

331

Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure  

Microsoft Academic Search

OBJECTIVESTo quantify the short term haemodynamic effects of biventricular pacing in patients with heart failure and left bundle branch block by using three dimensional echocardiography.DESIGNThree dimensional echocardiography was performed in 15 consecutive heart failure patients (New York Heart Association functional class III or IV) with an implanted biventricular pacing system. Six minute walk tests were performed to investigate the effect

W Y Kim; P Søgaard; P T Mortensen; H Kjærulf Jensen; A Kirstein Pedersen; B Ø Kristensen; H Egeblad

2001-01-01

332

Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea  

Microsoft Academic Search

background Obstructive sleep apnea subjects the failing heart to adverse hemodynamic and adre- nergic loads and may thereby contribute to the progression of heart failure. We hypoth- esized that treatment of obstructive sleep apnea by continuous positive airway pressure in patients with heart failure would improve left ventricular systolic function. methods Twenty-four patients with a depressed left ventricular ejection fraction

Yasuyuki Kaneko; John S. Floras; Kengo Usui; Julie Plante; Ruzena Tkacova; Toshihiko Kubo; Shin-ichi Ando; T. Douglas Bradley

2003-01-01

333

Alterations of radial artery compliance in patients with congestive heart failure  

Microsoft Academic Search

Congestive heart failure is accompanied by several hemodynamic alterations. To investigate whether these alterations include reduced arterial compliance, we studied 25 patients (age 57 ± 2 years, mean ± SE) with a mild or severe congestive heart failure based on clinical symptoms (New York Heart Association class II vs III or IV) and on echocardiographic alterations of left ventricular diastolic

Cristina Giannattasio; Monica Failla; Maria Luisa Stella; Arduino A. Mangoni; Stefano Carugo; Massimo Pozzi; Guido Grossi; Giuseppe Mancia

1995-01-01

334

[Biventicular pacing in patients with severe heart failure].  

PubMed

According to initial clinical results biventricular pacing seems to be effective in the treatment of patients suffering from drug refractory severe heart failure combined with intraventricular conduction disturbance. Biventricular cardioverter defibrillators and biventricular pacemakers were implanted in patients suffering from drug refractory severe heart failure in 3 and in 2 cases, respectively (follow up > 6 months). NYHA III-IV functional class, low left ventricular ejection fraction (23.2 +/- 5.4%), wide QRS (> 150 ms) with left bundle branch block and lateral dyssynchrony were present in each case. The left ventricle was enlarged in each patient (end-diastolic/end-systolic diameter: 78.6 +/- 9.2/66.2 +/- 8.1 mm). The indications of cardioverter defibrillator implantations were both sustained ventricular tachycardia and ventricular fibrillation, nonsustained ventricular tachycardia combined with syncope in 2 and in 1 case, respectively. The duration of QRS decreased (190 +/- 36 vs. 134 +/- 17 ms, p = 0.012) and wall movement disorder disappeared. At the last follow up every patients were in NYHA II functional class and a decrease in left ventricular diameter could be observed (end-diastolic: 72 +/- 10.4 mm, p = 0.07; end-systolic: 62 +/- 10 mm, p = 0.09). During the follow up period (7.3 +/- 1.7 months) 18 episodes of ventricular arrhythmias could be detected in the same patient. Biventricular pacemakers and cardioverter defibrillators were implanted and applied successfully in the treatment of congestive heart failure for the first time in Hungary. The effect of biventricular pacing on morbidity and mortality, the cost-effectiveness, the exact indication and the combined use with cardioverter defibrillator have yet to be proven in future randomized trials. PMID:11828932

Merkely, B; Vágó, H; Bartha, E; Zima, E; Moravcsik, E; Gellér, L

2001-12-23

335

Cardiovascular remodelling in coronary artery disease and heart failure.  

PubMed

Remodelling is a response of the myocardium and vasculature to a range of potentially noxious haemodynamic, metabolic, and inflammatory stimuli. Remodelling is initially functional, compensatory, and adaptive but, when sustained, progresses to structural changes that become self-perpetuating and pathogenic. Remodelling involves responses not only of the cardiomyocytes, endothelium, and vascular smooth muscle cells, but also of interstitial cells and matrix. In this Review we characterise the remodelling processes in atherosclerosis, vascular and myocardial ischaemia-reperfusion injury, and heart failure, and we draw attention to potential avenues for innovative therapeutic approaches, including conditioning and metabolic strategies. PMID:24831770

Heusch, Gerd; Libby, Peter; Gersh, Bernard; Yellon, Derek; Böhm, Michael; Lopaschuk, Gary; Opie, Lionel

2014-05-31

336

Epidemiology of heart failure and scope of the problem.  

PubMed

Heart failure (HF) is typically a chronic disease, with progressive deterioration occurring over a period of years or even decades. HF poses an especially large public health burden. It represents a new epidemic of cardiovascular disease, affecting nearly 5.8 million people in the United States, and over 23 million worldwide. In the present article, our goal is to describe the most up-to-date epidemiology of HF in the United States and worldwide, and challenges facing HF prevention and treatment. PMID:24286574

Liu, Longjian; Eisen, Howard J

2014-02-01

337

Heart failure with preserved ejection fraction - unwinding the diagnosis mystique  

PubMed Central

A precise diagnosis of diastolic dysfunction is often difficult and requires invasive techniques to determine left ventricular volume, relaxation, and compliance properties. At this current point of time there is no single non-invasive index available to adequately reflect diastolic function, perhaps because of the numerous factors that can alter diastolic function. In most clinical settings, diastolic function is estimated using Doppler echocardiography. Cardiac magnetic resonance imaging (CMRI) is yet another emerging modality for diastolic function analysis. Here we present a comprehensive review of the various parameters used to assess diastolic function as part of diagnosis of clinical syndrome “Heart failure with preserved ejection fraction (HFPEF)”.

Asrar ul Haq, Muhammad; Mutha, Vivek; Rudd, Nima; Hare, David L; Wong, Chiew

2014-01-01

338

Current therapeutic approach in heart failure with preserved ejection fraction.  

PubMed

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by decreased exercise capacity and fluid retention in the setting of preserved left ventricular systolic function and evidence of abnormal diastolic function. Therapeutic strategies include pharmacologic agents, pacing, baroreflex modification, diet, and exercise. Despite symptomatic and hemodynamic improvements with some therapies, large clinical trials have not demonstrated a clear improvement in clinical outcomes. The current management of patients with HFpEF is directed to symptomatic relief of congestion with diuretics and risk factor modification. In this article, we summarize the available evidence base for potential targets of therapy. PMID:24975914

Nativi-Nicolau, Jose; Ryan, John J; Fang, James C

2014-07-01

339

Biventricular pacing in a patient with severe congestive heart failure.  

PubMed

We report a case of dilated cardiomyopathy with severe congestive heart failure (ejection fraction: 19%) and complete left bundle branch block (QRS duration: 240 ms) 13 years after aortic valve replacement. Permanent biventricular pacing was implanted by inserting a left ventricular lead thorough a small left thoracotomy following intravenous insertion of right atrial and ventricular endocardial leads. Biventricular pacing increased hemodynamic parameters such as blood pressure, cardiac output and decreased mitral regurgitation. Symptoms and exercise tolerance improved dramatically. Left ventricular epicardial lead insertion via a small thoracotomy is thus useful in selected patients. PMID:12166268

Tanaka, Hiroyuki; Okishige, Kaoru; Murakami, Mikiko; Someya, Takeshi; Arai, Hirokuni; Sunamori, Makoto

2002-07-01

340

Massive left atrial sarcoma presenting with severe congestive heart failure.  

PubMed

Primary intimal sarcomas of the left atrium are extremely rare and highly aggressive tumours. To our knowledge, only 4 cases have been reported to date. We report on a 42-year-old man who presented with signs of congestive heart failure and was found to have an enormous left atrial bilobed tumour with obstruction of the mitral valve. The patient underwent a surgical excision of the sarcoma. The tumour recurred 8.5 months later and the patient required right pneumonectomy. PMID:25108492

Kuurstra, Emily J; Mullen, John C; MacArthur, Roderick G

2014-10-01

341

PTH: Potential role in management of heart failure.  

PubMed

Biomarkers play an important role for the diagnosis and prognosis of heart failure (HF), a disease with high morbidity and mortality as well as a huge impact on healthcare budgets. Parathyroid hormone (PTH) is a major systemic calcium-regulating hormone and an important regulator of bone and mineral homeostasis. PTH testing is important for differential diagnosis of calcemia related disorders and for the management of patients with chronic kidney disease. As secondary hyperparathyroidism has been evidenced in HF patients, PTH testing might be relevant in HF patients for risk stratification and more personalized selection of treatment. PMID:24704306

Gruson, D; Buglioni, A; Burnett, J C

2014-06-10

342

Nitric oxide modulation as a therapeutic strategy in heart failure.  

PubMed

Nitric oxide (NO) is recognized as one of the most important cardiovascular signaling molecules, with multiple regulatory effects on myocardial and vascular tissue as well as on other tissues and organ systems. With the growth in understanding of the range and mechanisms of NO effects on the cardiovascular system, it is now possible to consider pharmaceutical interventions that directly target NO or key steps in NO effector pathways. This article reviews aspects of the cardiovascular effects of NO, abnormalities in NO regulation in heart failure, and clinical trials of drugs that target specific aspects of NO signaling pathways. PMID:22405665

Taylor, Anne L

2012-04-01

343

How to measure dyspnea in acute heart failure?  

PubMed

Dyspnea is the most common presenting symptom of patients with acute heart failure (AHF). Although dyspnea is an important target for treatment in clinical practice and clinical trials, there remains a lack of consensus on how to assess it. We describe and recommend to use absolute scales such the Likert 5-point or the Visual Analogue Scale rather than any comparator scale such as the Likert 7-point scale. We further recommend starting dyspnea measurements in sitting position and perform, if possible, similar measurements in lying position. The same set of measurements may be repeated as needed during the time course of disease and the treatment. PMID:19725007

Socrates, Thenral; Mebazaa, Alexandre

2009-09-01

344

Metabolic impairment in heart failure: the myocardial and systemic perspective.  

PubMed

Although bioenergetic starvation is not a new concept in heart failure (HF), recent research has led to a growing appreciation of the complexity of metabolic aspects of HF pathophysiology. All steps of energy extraction, transfer, and utilization are affected, and structural metabolism is impaired, leading to compromised functional integrity of tissues. Not only the myocardium, but also peripheral tissues and organs are affected by metabolic failure, resulting in a global imbalance between catabolic and anabolic signals, leading to tissue wasting and, ultimately, to cachexia. Metabolic feedback signals from muscle and fat actively contribute to further myocardial strain, promoting disease progression. The prolonged survival of patients with stable, compensated HF will increasingly bring chronic metabolic complications of HF to the fore and gradually shift its clinical presentation. This paper reviews recent evidence on myocardial and systemic metabolic impairment in HF and summarizes current and emerging therapeutic concepts with specific metabolic targets. PMID:25257642

Doehner, Wolfram; Frenneaux, Michael; Anker, Stefan D

2014-09-30

345

[Surgical heart failure treatment program - the experience of Kazakhstan].  

PubMed

In Kazakhstan, geographical and cultural reasons do not favor the development of heart transplant activity. Thus, a surgical program for treatment of advanced, refractory heart failure was implemented, focusing the efforts on ventricular assist device (VAD) therapy. The program, supported and funded by the national healthcare system, is based on a single, highly specialized surgical Center for the operation, and on a regional infrastructure for outpatient follow-up. Regional VAD coordinators are educated by the National Center. They are in charge of regular patient check, anticoagulant and antiplatelet treatment prescription, and continuing patients' and caregivers' education, mainly regarding driveline exit site dressing and driveline stabilization. From November 2011 to November 2013, 95 patients received 100 devices, mainly for left ventricular support (LVAD): HeartMate II, n=70, HeartWare, n=25. Mean age was 49.5 years, and 87.37% of the patients were males. Most patients had INTERMACS profile 4 (55%), followed by 3 and 2 (17% each). Symptomatic and functional improvement are testified by changes from baseline to month 3 of NYHA functional class (from III-IV to I-II), results of the 6-min walk test (from 152 to 440 m), and NT-proBNP levels (from 6997 to 1126 pg/ml). Overall 1-year survival was 69%, with a trend for outcome improvement over time and a relationship with preoperative INTERMACS profile (1-year survival of 60% in patients with INTERMACS profile 1-2 vs 75% in those with INTERMACS profile 3-4). In summary, where and when a heart transplant program cannot be implemented, LVAD represents a realistic therapeutic alternative. The key points for a successful VAD program are a dedicated, highly specialized multidisciplinary team at the Cardiac Surgery Center, an infrastructure throughout the country for coordinated outpatient follow-up, adequate reimbursement for this activity, and support by the healthcare system. PMID:24770427

Bekbossynov, Serik; Medressova, Assel; Murzagaliyev, Muradym; Salov, Roman; Dzhetybayeva, Saltanat; Andossova, Saltanat; Bekbossynova, Makhabbat; Pya, Yuriy

2014-03-01

346

A network against failing hearts--introducing the German "Competence Network Heart Failure".  

PubMed

Heart failure (HF) has been identified as one of the most threatening diseases for the western civilisation, posing a risk to health for a rising number of patients. Acknowledging the medical problem of HF to be both economically and socially threatening the German Federal Ministry of Research and Education (BMBF) initiated a nationwide research network aiming to find new ways in prevention, alleviation and treatment of the widespread disease. The "Competence Network Heart Failure" (CNHF), initiated in 2003, bundles the scientific expertise in a large-scale research network; its aims are the coordination of basic and applied clinical research as well as dissemination of findings into clinical practice in order to consolidate and perpetuate the achieved improvements. The scope of this paper is to introduce the CNHF and to provide an overview of the tasks and hitherto attained achievements to a broad spectrum of health care providers. PMID:19679361

Mehrhof, Felix; Löffler, Markus; Gelbrich, Götz; Ozcelik, Cemil; Posch, Maximilian; Hense, Hans-Werner; Keil, Ulrich; Scheffold, Thomas; Schunkert, Heribert; Angermann, Christiane; Ertl, Georg; Jahns, Roland; Pieske, Burkert; Wachter, Rolf; Edelmann, Frank; Wollert, Kai C; Maisch, Bernhard; Pankuweit, Sabine; Erbel, Raimund; Neumann, Till; Herzog, Wolfgang; Katus, Hugo; Müller-Tasch, Thomas; Zugck, Christian; Düngen, Hans-Dirk; Regitz-Zagrosek, Vera; Lehmkuhl, Elke; Störk, Stefan; Siebert, Uwe; Wasem, Jürgen; Neumann, Anja; Göhler, Alexander; Anker, Stefan D; Köhler, Friedrich; Möckel, Martin; Osterziel, Karl-Josef; Dietz, Rainer; Rauchhaus, Mathias

2010-11-01

347

Ceruloplasmin and the Extent of Heart Failure in Ischemic and Nonischemic Cardiomyopathy Patients  

PubMed Central

Objective. Ceruloplasmin was elevated in patients with coronary heart disease, but the relationship between ceruloplasmin and heart failure was still unknown. We aimed to evaluate ceruloplasmin in heart failure patients and assess association between ceruloplasmin and the extent of heart failure. Methods and Results. 202 heart failure patients were divided into ischemic (78 with coronary stenosis) and nonischemic groups (124 without coronary stenosis). 94 subjects without heart failure were included as controls. The extent of heart failure was defined according to NYHA classification. Ceruloplasmin levels in ischemic (P < 0.001) and nonischemic groups (P < 0.001) were higher than those in control group. Ceruloplasmin had a positive linear correlation with C-reactive protein (P < 0.01) and a negative linear correlation with LVEF (P < 0.05). In nonischemic group, CP levels were significantly different among different NYHA subgroups (P < 0.05). The correlation between ceruloplasmin and extent of heart failure was calculated by binary logistic regression. Ceruloplasmin showed an independent association with the extent of heart failure in nonischemic cardiomyopathy patients (P < 0.05). Conclusions. Ceruloplasmin was significantly elevated in patients with ischemic or nonischemic cardiomyopathy and had linear correlation with C-reactive protein and LVEF. In nonischemic cardiomyopathy patients, the ceruloplasmin value was an independent biomarker associated with the extent of heart failure. PMID:23781119

2013-01-01

348

Heart failure treatment in adults with congenital heart disease: where do we stand in 2014?  

PubMed

Heart failure (HF) is the leading cause of death in adults with repaired congenital heart disease (CHD). However there is currently little evidence to guide treatment strategies in this growing group of patients. Unlike the majority of HF, which is usually caused by LV systolic or diastolic dysfunction, CHD-HF is more often a consequence of RV disease, valve dysfunction, shunting or pulmonary hypertension. It is therefore not appropriate to extrapolate from the acquired HF literature and apply it to this heterogeneous population of CHD patients. Additionally, patients with CHD have been excluded from most large trials of medical or device therapy of HF, which has resulted in small retrospective and underpowered studies in the CHD population. This article critically reviews the current knowledge about CHD-HF, paying particular attention to medical therapy in different CHD populations, cardiac resynchronisation therapy and implantable cardiac defibrillators, and the challenges of heart transplantation and mechanical circulatory support in CHD patients. PMID:24924621

Krieger, Eric V; Valente, Anne Marie

2014-09-01

349

Hemodynamic effects of quinidine and famotidine in patients with congestive heart failure  

Microsoft Academic Search

In a randomized, placebo-controlled, double-blind study, 12 patients with congestive heart failure (New York Heart Association class II) were successively treated for 1 week each with placebo, 40 mg famotidine, and 1000 mg quinidine. On the seventh treatment day, heart rate, blood pressure, systolic time intervals, impedance cardiography, and Doppler ultrasound were measured. Heart rate and blood pressure were not

Wilhelm Kirch; Atef Halabi; Holger Hinrichsen

1992-01-01

350

Stratification of the Risk of Sudden Death in Nonischemic Heart Failure  

PubMed Central

Despite significant therapeutic advancements, heart failure remains a highly prevalent clinical condition associated with significant morbidity and mortality. In 30%-40% patients, the etiology of heart failure is nonischemic. The implantable cardioverter-defibrillator (ICD) is capable of preventing sudden death and decreasing total mortality in patients with nonischemic heart failure. However, a significant number of patients receiving ICD do not receive any kind of therapy during follow-up. Moreover, considering the situation in Brazil and several other countries, ICD cannot be implanted in all patients with nonischemic heart failure. Therefore, there is an urgent need to identify patients at an increased risk of sudden death because these would benefit more than patients at a lower risk, despite the presence of heart failure in both risk groups. In this study, the authors review the primary available methods for the stratification of the risk of sudden death in patients with nonischemic heart failure.

Pimentel, Mauricio; Zimerman, Leandro Ioschpe; Rohde, Luis Eduardo

2014-01-01

351

Experiences of air travel in patients with chronic heart failure  

PubMed Central

Aim To conduct a survey in a representative cohort of ambulatory patients with stable, well managed chronic heart failure (CHF) to discover their experiences of air travel. Methods An expert panel including a cardiologist, an exercise scientist, and a psychologist developed a series of survey questions designed to elicit CHF patients' experiences of air travel (Appendix 1). The survey questions, information sheets and consent forms were posted out in a self-addressed envelope to 1293 CHF patients. Results 464 patients (response rate 39%) completed the survey questionnaires. 54% of patients had travelled by air since their heart failure diagnosis. 20% of all patients reported difficulties acquiring travel insurance. 65% of patients who travelled by air experienced no health-related problems. 35% of patients who travelled by air experienced health problems, mainly at the final destination, going through security and on the aircraft. 27% of all patients would not travel by air in the future. 38% of patients would consider flying again if there were more leg room on the aeroplane, if their personal health improved (18%), if they could find cheaper travel insurance (19%), if there were less waiting at the airport (11%), or if there were less walking/fewer stairs to negotiate at the airport (7%). Conclusion For most patients in this sample of stable, well managed CHF, air travel was safe. PMID:21256607

Ingle, Lee; Hobkirk, James; Damy, Thibaud; Nabb, Samantha; Clark, Andrew L.; Cleland, John G.F.

2012-01-01

352

Dopamine induced hypoxemia in patients with left heart failure.  

PubMed

Previous studies in our laboratory have demonstrated that dopamine produces a significant decrease in arterial PO2 and a mild increase in arterial PCO2 in patients with left heart failure. The present investigations were designed to find out dopamine-induced effects impairing gas exchange. In patients with left heart failure and pulmonary congestion the true pulmonary shunt has been determined by O2-breathing. A statistically significant increase of true shunting could be evaluated. However, from calculations of the components composing AaDO2-air it can be demonstrated that most of dopamine-dependent increase of AaDO2-air is due to an elevated diffusion-distribution gradient. This dopamine effect on arterial PO2 does not limit dopamine application because oxygen administration will outrange the side effect. As changes of ventilation did not occur dopamine is assumed to open up pulmonary vessels producing blood flow in poorly ventilated parts of the lungs and causing an increased disturbance of ventilation/perfusion ratio. The increased true pulmonary shunt can be regarded as result of perfusion of totally unventilated lung areas when dopamine is infused. Haloperidol can attenuate dopamine-dependent decrease in arterial PO2. How haloperidol abolishes this dopamine effect on arterial oxygen tension remains unknown. PMID:1002356

Huckauf, H; Ramdohr, B; Schröder, R

1976-10-01

353

Physical training in patients with chronic heart failure  

PubMed Central

Chronic heart failure (CHF) can be defined as a complex of symptoms and signs caused by cardiac dysfunction. Dyspnoea on exertion, fatigue, reduced exercise tolerance and fluid retention are hallmarks of the syndrome. Reduced peripheral blood flow, endothelial dysfunction, alterations in skeletal muscle structure and function, an increased activity of the muscle ergoreflex, as well as autonomic and neurohormonal activation reduce exercise performance, ultimately leading to physical deconditioning in CHF patients. The beneficial effects of physical training for CHF patients are increasingly acknowledged. Based on European and American guidelines on physical training in CHF, results from controlled randomised trials (summarised in this paper) and expert opinions, the Dutch Committee on Cardiac Rehabilitation has formulated statements on physical training in CHF. In addition, recommendations implementing physical training programmes in CHF patients are given. The selection criteria, contraindications and methods, and duration of a physical training programme in heart failure are discussed. Concomitant with the training programme, a multidisciplinary intervention programme is needed to stimulate patients to adopt and maintain an active and healthy lifestyle.

Senden, P.J.; Mosterd, A.; Brugemann, J.

2004-01-01

354

Hyperglycemia in acute heart failure: an opportunity to intervene?  

PubMed

In patients with acute heart failure (AHF) syndromes, little data are so far available on the relation between glucose values and insulin resistance and mortality, both in the short and long term. The present review is aimed at summarizing available evidence on the prognostic role of hyperglycemia in acute heart failure syndromes. Despite the fact that glucose values are widely measured, inexpensive, and easy to interpret, hyperglycemia in AHF patients still appears to be (or at least to have been) a neglected factor. Scarce information is available on incidence of admission hyperglycemia (especially in nondiabetic AHF patients) and data on in-hospital and discharge glucose values are lacking. Overall, the scarcity of data and the unanswered questions conjure up the need for trials investigating the clinical and prognostic role of glucose abnormalities (hyperglycemia and acute insulin resistance) on admission and during hospital stay in AHF patients. Preliminary evidence suggests that hyperglycemia is an important prognostic factor in AHF; however, whether targeting hyperglycemia via an aggressive versus permissive glycemic management strategy influences AHF outcomes remains unknown. PMID:24890901

Lazzeri, Chiara; Valente, Serafina; Gensini, Gian Franco

2014-09-01

355

Nonlinear dynamics of congestive heart failure (Invited Paper)  

NASA Astrophysics Data System (ADS)

Preliminary results are reported from a research project analysing congestive heart failure in terms a stochastic coupled-oscillator model of the cardiovascular system. Measurements of blood flow by laser Doppler flowmetry (LDF) have been processed by use of the wavelet transform to separate its oscillatory components, which number at least five. Particular attention was concentrated on the frequency content near 0.01 Hz, which is known to be associated with endothelial function. The LDF was carried out in conjunction with iontophoretically administered acetylcholine (ACh) and sodium nitroprusside (SNP) in order to evaluate endothelial reactivity. Measurements were made on 17 congestive heart failure (CHF) patients (a) on first diagnosis, and (b) again several weeks later after their treatment with a ?-blocker had been stabilised. The results of these two sets of measurements are being compared with each other, and with data from an age and sex-matched group of healthy controls. It is confirmed that endothelial reactivity is reduced in CHF patients, as compared to healthy controls, and it is found that one effect of the Beta-blocker is to ameliorate the loss of endothelial function in CHF. The implications of these results are discussed.

Bernjak, Alan; Clarkson, Peter B. M.; McClintock, Peter V. E.; Stefanovska, Aneta

2005-05-01

356

Complement C3c as a Biomarker in Heart Failure  

PubMed Central

Introduction. Experimental data indicates an important role of the innate immune system in cardiac remodeling and heart failure (HF). Complement is a central effector pathway of the innate immune system. Animals lacking parts of the complement system are protected from adverse remodeling. Based on these data, we hypothesized that peripheral complement levels could be a good marker for adverse remodeling and prognosis in patients with HF. Methods and Results. Since complement activation converges on the complement factor C3, we measured serum C3c, a stable C3-conversion product, in 197 patients with stable systolic HF. Subgroups with normal and elevated C3c levels were compared. C3c levels were elevated in 17% of the cohort. Patients with elevated C3c levels exhibited a trend to better survival, slightly higher LVEF, and lower NTpro-BNP values in comparison to patients with normal C3c values. No differences were found regarding NYHA functional class. Significantly more patients with elevated C3c had preexisting diabetes. The prevalence of CAD, arterial hypertension, and atrial fibrillation was not increased in patients with elevated C3c. Conclusion. Elevated C3c levels are associated with less adverse remodeling and improved survival in patients with stable systolic heart failure. PMID:24489446

Frey, A.; Ertl, G.; Angermann, C. E.; Hofmann, U.; Stork, S.; Frantz, S.

2013-01-01

357

Ventricular assist devices in heart failure: how to support the heart but prevent atrophy?  

PubMed

Ventricular assist devices (VAD) have recently established themselves as an irreplaceable therapeutic modality of terminal heart failure. Because of the worldwide shortage of donors, ventricular assist devices play a key role in modern heart failure therapy. Some clinical data have revealed the possibility of cardiac recovery during VAD application. On the other hand, both clinical and experimental studies indicate the risk of the cardiac atrophy development, especially after prolonged mechanical unloading. Little is known about the specific mechanisms governing the unloading-induced cardiac atrophy and about the exact ultrastructural changes in cardiomyocytes, and even less is known about the ways in which possible therapeutical interventions may affect heart atrophy. One aim of this review was to present important aspects of the development of VAD-related cardiac atrophy in humans and we also review the most significant observations linking clinical data and those derived from studies using experimental models. The focus of this article was to review current methods applied to alleviate cardiac atrophy which follows mechanical unloading of the heart. Out of many pharmacological agents studied, only the selective beta2 agonist clenbuterol has been proved to have a significantly beneficial effect on unloading-induced atrophy. Mechanical means of atrophy alleviation also seem to be effective and promising. PMID:24779607

Pokorný, M; Cervenka, L; Netuka, I; Pirk, J; Ko?a?ík, M; Malý, J

2014-01-01

358

Ethics of the heart: ethical and policy challenges in the treatment of advanced heart failure.  

PubMed

Heart failure is a major cause of morbidity and mortality in the United States and worldwide, accounting for immense health-care costs. Advanced therapies such as transplantation, ventricular assist devices, and implantable cardioverter defibrillators have had great success in significantly improving life expectancy and morbidity, however these advances have contributed substantially to the economic burden associated with this epidemic. Concomitantly, the accessibility of these advanced therapies is limited, due to a finite number of available organs for heart transplantation and, in the future, the economic costs associated with both transplant and device therapy. This article discusses ethical and policy challenges in the treatment of advanced heart failure, including decisions regarding procurement of hearts for transplant and allocation to recipients; and the complex issues surrounding the use of implantable cardioverter defibrillators and ventricular assist devices, including quality of life, advanced directive planning in the context of these devices, and resource utilization. Based on these challenges, we recommend that a discussion of these complex matters be incorporated into cardiovascular training programs. PMID:22643717

Fields, Anjali V; Kirkpatrick, James N

2012-01-01

359

Adiponectin Deficiency, Diastolic Dysfunction, and Diastolic Heart Failure  

PubMed Central

Aldosterone infusion results in left ventricular hypertrophy (LVH) and hypertension and may involve profibrotic and proinflammatory mechanisms. In turn, hypertension is the major cause of diastolic heart failure (HF). Adiponectin, an adipose-derived plasma protein, exerts antiinflammatory and anti-hypertrophic effects and is implicated in the development of hypertension and systolic HF. We thus tested the hypothesis that hypoadiponectinemia in aldosterone-induced hypertension exacerbated cardiac remodeling and diastolic HF. Wild-type (WT) or adiponectin-deficient (APNKO) mice underwent saline or aldosterone infusion and uninephrectomy and were fed 1% salt water for 4 wk. Blood pressure was increased in aldosterone-infused WT (132 ± 2 vs. 109 ± 3 mm Hg; P < 0.01) and further augmented in APNKO mice (140 ± 3 mm Hg; P < 0.05 vs. aldosterone-infused WT). LVH was increased in aldosterone-infused WT vs. WT mice (LV/body weight ratio, 4.8 ± 0.2 vs. 4.1 ± 0.2 mg/g) and further increased in aldosterone-infused APNKO mice (LV/body weight ratio, 6.0 ± 0.4 mg/g). Left ventricular ejection fraction was not decreased in either aldosterone-infused WT or APNKO hearts. Pulmonary congestion however was worse in APNKO mice (P < 0.01). The ratio of early ventricular filling over late ventricular filling (E/A) and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e’), measures of diastolic function, were increased in aldosterone-infused WT hearts and further increased in APNKO hearts (P < 0.05 for both). Renal function and cardiac fibrosis were no different between both aldosterone-infused groups. Aldosterone increased matrix metalloproteinase-2 expression in WT hearts (P < 0.05 vs. WT and P < 0.01 vs. APNKO). Myocardial atrial natriuretic peptide, interferon-?, and TNF-? expression were increased in aldosterone-infused WT hearts. Expression of these proteins was further increased in aldosterone-infused APNKO hearts. Therefore, hypoadiponectinemia in hypertension-induced diastolic HF exacerbates LVH, diastolic dysfunction, and diastolic HF. Whether or not adiponectin replacement prevents the progression to diastolic HF will warrant further study. PMID:19850745

Sam, Flora; Duhaney, Toni-Ann S.; Sato, Kaori; Wilson, Richard M.; Ohashi, Koji; Sono-Romanelli, Saki; Higuchi, Akiko; De Silva, Deepa S.; Qin, Fuzhong; Walsh, Kenneth; Ouchi, Noriyuki

2010-01-01

360

Loss of cardiac microRNA-mediated regulation leads to dilated cardiomyopathy and heart failure  

E-print Network

Rationale: Heart failure is a deadly and devastating disease that places immense costs on an aging society. To develop therapies aimed at rescuing the failing heart, it is important to understand the molecular mechanisms ...

Rao, Prakash K.

361

Development and testing of a new measure of health status for clinical trials in heart failure  

Microsoft Academic Search

The authors developed a new measure of subjective health status for patients with heart failure. Eighty-eight patients with\\u000a heart failure were asked about the impact of their condition on 123 items related to physical and emotional function. The\\u000a most frequently chosen and important items were included in a 16-item Chronic Heart Failure Questionnaire (CHQ) that examines\\u000a dyspnea during daily activities,

Gordon H. Guyatt; Sharon Nogradi; Susan Halcrow; Joel Singer; Michael J. J. Sullivan; Ernest L. Fallen

1989-01-01

362

[Volume assessment in the acute heart and renal failure].  

PubMed

Acute kidney injury (AKI) is an important clinical issue, especially in the setting of critical care. It has been shown in multiple studies to be a key independent risk factor for mortality, even after adjustment for demographics and severity of illness. There is wide agreement that a generally applicable classification system is required for AKI which helps to standardize estimation of severity of renal disfunction and to predict outcome associated with this condition. That's how RIFLE (Risk-Injury-Failure-Loss-End-stage renal disease), and AKIN (Acute Kidney Injury Network) classifications for AKI were found in 2004 and 2007, respectively. In the clinical setting of heart failure, a positive fluid balance (often expressed in the literature as weight gain) is used by disease management programs as a marker of heart failure decompensation. Oliguria is defined as urine output less than 0,3 ml/kg/h for at least 24 h. Since any delay in treatment can lead to a dangerous progression of the AKI, early recognition of oliguria appears to be crucial. Critically ill patients with oliguric AKI are at increased risk for fluid imbalance due to widespread systemic inflammation, reduced plasma oncotic pressure and increased capillary leak. These patients are particulary at risk of fluid overload and therefore restrictive strategy of fluid administration should be used. Objective, rapid and accurate volume assessment is important in undiagnosed patients presenting with critical illness, as errors may result in interventions with fatal outcomes. The historical tools such as physical exam, and chest radiography suffer from significant limitations. As gold standard, radioisolopic measurement of volume is impractical in the acute care enviroment. Newer technologies offer the promise of both rapid and accurate bedside estimation of volume status with the potential to improve clinical outcomes. Blood assessment with bioimpendance vector analysis, and bedside ultrasound seem to be promising technologies for this need. PMID:23513416

Vujici?, Bozidar; Ruzi?, Alen; Zaputovi?, Luka; Racki, Sanjin

2012-10-01

363

Targeting myocardial substrate metabolism in heart failure: potential for new therapies  

PubMed Central

The incidence and prevalence of heart failure have increased significantly over the past few decades. Available data suggest that patients with heart failure independent of the aetiology have viable but dysfunctional myocardium that is potentially salvageable. Although a great deal of research effort has focused on characterizing the molecular basis of heart failure, cardiac metabolism in this disorder remains an understudied discipline. It is known that many aspects of cardiomyocyte energetics are altered in heart failure. These include a shift from fatty acid to glucose as a preferred substrate and a decline in the levels of ATP. Despite these demonstrated changes, there are currently no approved drugs that target metabolic enzymes or proteins in heart failure. This is partly due to our limited knowledge of the mechanisms and pathways that regulate cardiac metabolism. Better characterization of these pathways may potentially lead to new therapies for heart failure. Targeting myocardial energetics in the viable and potentially salvageable tissue may be particularly effective in the treatment of heart failure. Here, we will review metabolic changes that occur in fatty acid and glucose metabolism and AMP-activated kinase in heart failure. We propose that cardiac energetics should be considered as a potential target for therapy in heart failure and more research should be done in this area. PMID:22253453

Ardehali, Hossein; Sabbah, Hani N.; Burke, Michael A.; Sarma, Satyam; Liu, Peter P.; Cleland, John G.F.; Maggioni, Aldo; Fonarow, Gregg C.; Abel, E. Dale; Campia, Umberto; Gheorghiade, Mihai

2012-01-01

364

Lipid-modifying treatments for heart failure: is their use justified?  

PubMed

Interventions for coronary artery disease in heart failure have not been successful. It seems unlikely that coronary events play no role in the progression of heart failure and the ultimate demise of the patient. Meta-analysis suggests no benefit of fibrates in cardiovascular disease or heart failure. Polyunsaturated fats have equal benefit in cardiovascular disease. Two large trials of statins found no effect on mortality, but one trial found a reduction in morbidity. Retrospective analyses suggest that patients with milder disease might retain the benefit observed with statins in patients with coronary disease who do not have heart failure. Differences among statins may exist. PMID:25217437

Cleland, John G F; Hutchinson, Kate; Pellicori, Pierpaolo; Clark, Andrew

2014-10-01

365

The role of enhanced external counterpulsation in the treatment of angina and heart failure  

PubMed Central

As the incidence of angina and heart failure continue to rise, new therapeutic options will be needed to treat patients who remain symptomatic or who are intolerant to current treatment. Enhanced external counterpulsation (EECP) is a noninvasive modality being investigated in both angina and congestive heart failure patients. It has been proven to provide symptomatic benefit in angina patients, but has not been proven to show an increase in life expectancy or decrease in cardiovascular events. EECP in heart failure has been proven to be safe, but its efficacy is still uncertain. The present paper summarizes the current literature on the clinical use of EECP in angina and heart failure. PMID:17703254

Arora, Rohit R; Shah, Ankur G

2007-01-01

366

The role of enhanced external counterpulsation in the treatment of angina and heart failure.  

PubMed

As the incidence of angina and heart failure continue to rise, new therapeutic options will be needed to treat patients who remain symptomatic or who are intolerant to current treatment. Enhanced external counterpulsation (EECP) is a noninvasive modality being investigated in both angina and congestive heart failure patients. It has been proven to provide symptomatic benefit in angina patients, but has not been proven to show an increase in life expectancy or decrease in cardiovascular events. EECP in heart failure has been proven to be safe, but its efficacy is still uncertain. The present paper summarizes the current literature on the clinical use of EECP in angina and heart failure. PMID:17703254

Arora, Rohit R; Shah, Ankur G

2007-08-01

367

Could garlic be an useful adjuvant therapy in adriamycin heart failure?  

PubMed

50 year old suffering from breast carcinoma, treated with adriamycin developed heart failure with 22.82% ejection fraction. Added garlic pearl to routine anti-failure measures for 9 months to achieve 51.6% ejection fraction. PMID:18603930

Das, R N; Poudel, N

2006-01-01

368

The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.  

PubMed

Heart failure is a global pandemic affecting an estimated 26 million people worldwide and resulting in more than 1 million hospitalizations annually in both the United States and Europe. Although the outcomes for ambulatory HF patients with a reduced ejection fraction (EF) have improved with the discovery of multiple evidence-based drug and device therapies, hospitalized heart failure (HHF) patients continue to experience unacceptably high post-discharge mortality and readmission rates that have not changed in the last 2 decades. In addition, the proportion of HHF patients classified as having a preserved EF continues to grow and may overtake HF with a reduced EF in the near future. However, the prognosis for HF with a preserved EF is similar and there are currently no available disease-modifying therapies. HHF registries have significantly improved our understanding of this clinical entity and remain an important source of data shaping both public policy and research efforts. The authors review global HHF registries to describe the patient characteristics, management, outcomes and their predictors, quality improvement initiatives, regional differences, and limitations of the available data. Moreover, based on the lessons learned, they also propose a roadmap for the design and conduct of future HHF registries. PMID:24491689

Ambrosy, Andrew P; Fonarow, Gregg C; Butler, Javed; Chioncel, Ovidiu; Greene, Stephen J; Vaduganathan, Muthiah; Nodari, Savina; Lam, Carolyn S P; Sato, Naoki; Shah, Ami N; Gheorghiade, Mihai

2014-04-01

369

Activation and inhibition of the endogenous opioid system in human heart failure.  

PubMed Central

BACKGROUND--In a canine model of congestive heart failure beta endorphin concentrations were high and opioid receptor antagonists exerted beneficial haemodynamic effects. In humans previous studies have suggested that opioid peptides may modify the perception of breathlessness and fatigue in heart failure. METHODS--Plasma concentrations of beta endorphin were measured in patients with acute and chronic heart failure and cardiogenic shock. A subgroup of eight patients with New York Heart Association (NYHA) class III-IV heart failure was assessed for acute haemodynamic effects of naloxone, an opioid receptor antagonist. A separate group of 10 patients with class II-III heart failure, was randomised to a double blind placebo controlled study of the effects of intravenous naloxone on cardiopulmonary exercise performance. RESULTS--Plasma concentrations of beta endorphin were usually normal in patients with chronic heart failure and did not correlate with severity as assessed by NYHA class. In 29% of patients with acute heart failure and 71% of those with cardiogenic shock beta endorphin concentrations were high. The median concentration in the cardiogenic shock group was significantly higher than in either of the two heart failure groups and there was some evidence of a relation between beta endorphin concentrations and survival. At the doses tested, naloxone was unable to modify systemic haemodynamics, exercise performance, or symptoms in patients with chronic congestive heart failure. CONCLUSIONS--Circulating concentrations of beta endorphin are usually normal in patients with chronic congestive heart failure. Inhibition of the endogenous opioid system is unlikely to have therapeutic potential in heart failure. PMID:7888260

Oldroyd, K. G.; Gray, C. E.; Carter, R.; Harvey, K.; Borland, W.; Beastall, G.; Cobbe, S. M.

1995-01-01

370

Salt Intake Is Associated with Inflammation in Chronic Heart Failure  

PubMed Central

Background: Chronic Heart Failure (CHF) is highly prevalent and is associated with high morbidity and mortality rates. It has been well established that excessive intake of sodium chloride (salt) induced hypertension in some populations. Although salt seems to induce cardiovascular diseases through elevation of blood pressure, it has also been indicated that salt can induce cardiovascular diseases independently from blood pressure elevation. Objectives: The present study aimed to evaluate the association between salt consumption and inflammation in CHF patients. Patients and Methods: This study was conducted on 86 patients between 18 and 65 years old who were diagnosed with New York Heart Association (NYHA) functional class I and II heart failure. Salt intake was calculated by using 24 hour urine sodium excretion. Besides, the association between inflammation and daily salt intake was evaluated regarding C - reactive protein (CPR), High sensitive CRP (HsCPR), Erythrocyte Sedimentation Rate (ESR), and ferritin and fibrinogen levels using Pearson correlation analysis. Results: Our results showed a statistically significant difference between the low (n = 41) and high (n = 45) salt intake groups in terms of serum HsCRP levels (5.21 ± 2.62 vs. 6.36 ± 2.64) (P < 0.048). Additionally, a significant correlation was observed between the amount of salt consumption and HsCRP levels. In this study, daily salt consumption of the enrolled patients was 8.53 gram/day. The medications and even the blood pressures were similar in the two groups, but daily pill count, prevalence of hypertension, and coronary heart disease were higher in the high salt intake group; however, the differences were not statistically significant (P = 0.065). Also, no significant difference was observed between the groups concerning the inflammation markers, such as CRP, ESR, ferritin, and fibrinogen. Conclusions: Neurohumoral and inflammatory factors are thought to contribute to high mortality and morbidity rates in CHF. Yet, inflammatory markers may early diagnose CHF and predict the prognosis. Excessive salt intake also worsens the inflammation as well as volume control. PMID:25177670

Azak, Alper; Huddam, Bulent; Gonen, Namik; Yilmaz, Seref Rahmi; Kocak, Gulay; Duranay, Murat

2014-01-01

371

Heart disease in cattle with clinical signs of heart failure: 59 cases  

PubMed Central

This retrospective study identified clinical signs, underlying cardiac conditions, blood findings, echocardiographic findings, and prognosis for 59 cattle with clinical signs of congestive heart failure. Signalment; history; clinical signs; clinicopathologic, echocardiographic, and radiographic findings; and treatment were determined by reviewing medical records. Follow-up information was obtained by telephone conversation with owners. Most patients were tachycardic (n = 50), and tachypneic (n = 55). Pericarditis of traumatic origin (n = 21), by extension from pleuritis (n = 3), or of idiopathic origin (n = 1) was diagnosed in 25 cases. Other diagnoses were congenital heart defect (n = 13), cardiomyopathy (n = 9), bacterial endocarditis (n = 7), and neoplasm (n = 5). Twelve cases (20%) were discharged. Long-term survival was good in 2 out of 3 cases treated by pericardiostomy. The prognosis is poor in cases of heart failure in cattle and deaths within 1 mo (n = 3) or between 1 to 3 mo after discharge (n = 3) were common in cases for which follow-up was available (n = 8). PMID:21197204

Buczinski, Sebastien; Francoz, David; Fecteau, Gilles; DiFruscia, Rocky

2010-01-01

372

Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment  

PubMed Central

Half of patients with heart failure (HF) have a preserved left ventricular ejection fraction (HFpEF). Morbidity and mortality in HFpEF are similar to values observed in patients with HF and reduced EF, yet no effective treatment has been identified. While early research focused on the importance of diastolic dysfunction in the pathophysiology of HFpEF, recent studies have revealed that multiple non-diastolic abnormalities in cardiovascular function also contribute. Diagnosis of HFpEF is frequently challenging and relies upon careful clinical evaluation, echo-Doppler cardiography, and invasive haemodynamic assessment. In this review, the principal mechanisms, diagnostic approaches, and clinical trials are reviewed, along with a discussion of novel treatment strategies that are currently under investigation or hold promise for the future. PMID:21138935

Borlaug, Barry A.; Paulus, Walter J.

2011-01-01

373

Palliative Care and Hospice in Advanced Heart Failure  

PubMed Central

Advanced heart failure (HF) is a disease process that carries a high burden of symptoms, suffering, and death. Palliative care can complement traditional care to improve symptom amelioration, patient-caregiver communication, emotional support, and medical decision making. Despite a growing body of evidence supporting the integration of palliative care into the overall care of patients with HF and some recent evidence of increased use, palliative therapies remain underused in the treatment of advanced HF. Review of the literature reveals that although barriers to integrating palliative care are not fully understood, difficult prognostication combined with caregiver inexperience with end-of-life issues specific to advanced HF is likely to contribute. In this review, we have outlined the general need for palliative care in advanced HF, detailed how palliative measures can be integrated into the care of those having this disease, and explored end-of-life issues specific to these patients. PMID:21875515

LeMond, Lisa; Allen, Larry A.

2013-01-01

374

Factors associated with depressive symptoms in patients with heart failure.  

PubMed

Home healthcare clinicians commonly provide care for individuals with heart failure (HF). Certain factors may influence the development of depressive symptoms in those with HF. This cross-sectional, descriptive, correlational pilot study (N = 50) examined interrelationships among HF symptoms, social support (actual and perceived), social problem-solving, and depressive symptoms. Findings indicated that increased HF symptoms were related to more depressive symptoms, whereas higher levels of social support were related to fewer depressive symptoms. The use of more maladaptive problem-solving strategies was also associated with more depressive symptoms. Study results have implications for home healthcare clinicians providing care for individuals with HF, indicating a need for programs that strengthen coping skills and resources (i.e., social support and problem solving) in an effort to decrease the risk of developing depressive symptomatology. PMID:25268530

Graven, Lucinda J; Grant, Joan S; Vance, David E; Pryor, Erica R; Grubbs, Laurie; Karioth, Sally

2014-10-01

375

[Iron deficiency in chronic heart failure: from diagnosis to therapy].  

PubMed

Anaemia and iron deficiency are frequent co-morbidities in patients with chronic heart failure. Both are bound to worsen an already reduced exercise capacity in these patients. Recent data have demonstrated that iron deficiency alone, i.e. without concomitant anaemia, reduces quality of life, exercise capacity and likely also survival. Two clinical entities should be differentiated in this context: absolute and functional iron deficiency, the first being an absolute deficiency of iron, the second representing a disturbed mobilisation capacity. The FAIR-HF study has shown that intravenous iron administration can improve quality of life and exercise capacity in affected patients. A correct diagnosis can easily be arrived at using parameters such as serum ferritin and transferrin saturation. Replenishing iron stores is most useful using the intravenous route, and administered doses need to be adjusted to individual needs. PMID:24722935

von Haehling, S; Anker, S D

2014-04-01

376

Obesity and heart failure: epidemiology, pathophysiology, clinical manifestations, and management.  

PubMed

Obesity is a risk factor for heart failure (HF) in both men and women. The mortality risk of overweight and class I and II obese adults with HF is lower than that of normal weight or underweight adults with HF of comparable severity, a phenomenon referred to as the obesity paradox. Severe obesity produces hemodynamic alterations that predispose to changes in cardiac morphology and ventricular function, which may lead to the development of HF. The presence of systemic hypertension, sleep apnea, and hypoventilation, comorbidities that occur commonly with severe obesity, may contribute to HF in such patients. The resultant syndrome is known as obesity cardiomyopathy. Substantial weight loss in severely obese persons is capable of reversing most obesity-related abnormalities of cardiac performance and morphology and improving the clinical manifestations of obesity cardiomyopathy. PMID:24814682

Alpert, Martin A; Lavie, Carl J; Agrawal, Harsh; Aggarwal, Kul B; Kumar, Senthil A

2014-10-01

377

Right heart failure post left ventricular assist device implantation  

PubMed Central

Right heart failure (RHF) is a frequent complication following left ventricular assist device (LVAD) implantation. The incidence of RHF complicates 20-50% (range, 9-44%) of cases and is a major factor of postoperative morbidity and mortality. Unfortunately, despite the fact that many risk factors contributing to the development of RHF after LVAD implantation have been identified, it seems to be extremely difficult to avoid them. Prevention of RHF consists of the management of the preload and the afterload of the right ventricle with optimum inotropic support. The administration of vasodilators designed to reduce pulmonary vascular resistance is standard practice in most centers. The surgical attempt of implantation of a right ventricular assist device does not always resolve the problem and is not available in all cardiac surgery centers. PMID:24672699

Argiriou, Mihalis; Kolokotron, Styliani-Maria; Sakellaridis, Timothy; Argiriou, Orestis; Charitos, Christos; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Tsakiridis, Kosmas; Zarogoulidis, Konstantinos

2014-01-01

378

Disparities in heart failure and other cardiovascular diseases among women  

PubMed Central

This article reviews literature pertinent to cardiovascular disparities in women, focusing primarily on heart failure (HF). It provides an in-depth look at causes, biological influences, self-management and lack of adherence to HF-treatment guidelines in women. Disparities in treatment of causative factors of HF, such as myocardial infarction and hypertension, contribute to women having poorer HF outcomes than men. This article discusses major contributing reasons for nonadherence to medication regimes for HF in women, including advanced age at time of diagnosis, likelihood of multiple comorbidities, lack of social support and low socioeconomic status. Limited inclusion of women in clinical trials and the scarcity of gender analyses for HF and other cardiovascular diseases continues to limit the applicability of research findings to women. PMID:22757737

McSweeney, Jean; Pettey, Christina; Lefler, Leanne L; Heo, Seongkum

2012-01-01

379

Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives  

PubMed Central

Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinical consequences (e.g. impaired exercise capacity) and poor prognosis in HF patients. Experimental evidence suggests that iron therapy in iron-deficient animals may activate molecular pathways that can be cardio-protective. Clinical studies have demonstrated favourable effects of i.v. iron on the functional status, quality of life, and exercise capacity in HF patients. It is hypothesized that i.v. iron supplementation may become a novel therapy in HF patients with iron deficiency. PMID:23100285

Jankowska, Ewa A.; von Haehling, Stephan; Anker, Stefan D.; Macdougall, Iain C.; Ponikowski, Piotr

2013-01-01

380

Current perspectives on hydralazine and nitrate therapies in heart failure.  

PubMed

The origins of the hydralazine/isosorbide dinitrate (H+ISDN) combination therapy are rooted in the first large-scale clinical trial in heart failure: V-HeFT I. Initially utilized for the balanced vasodilatory properties of each drug, we now know there is "more to the story." In fact, the maintenance of the nitroso-redox balance may be the true mechanism of benefit. Since the publication of V-HeFT I 30 years ago, H+ISDN has been the subject of much discussion and debate. Regardless of the many controversies surrounding H+ISDN, one thing is clear: therapy is underutilized and many patients who could benefit never receive the drugs. Ongoing physician and patient education are mandatory to improve the rates of H+ISDN use. PMID:25217432

Cole, Robert T; Gupta, Divya; Butler, Javed

2014-10-01

381

GPCR biased ligands as novel heart failure therapeutics.  

PubMed

G protein-coupled receptors have been successfully targeted by numerous therapeutics including drugs that have transformed the management of cardiovascular disease. However, many GPCRs, when activated or blocked by drugs, elicit both beneficial and adverse pharmacology. Recent work has demonstrated that in some cases, the salutary and deleterious signals linked to a specific GPCR can be selectively targeted by "biased ligands" that entrain subsets of a receptor's normal pharmacology. This review briefly summarizes the advances and current state of the biased ligand field, focusing on an example: biased ligands targeting the angiotensin II type 1 receptor. These compounds exhibit unique pharmacology, distinct from classic agonists or antagonists, and one such molecule is now in clinical development for the treatment of acute heart failure. PMID:23499300

Violin, Jonathan D; Soergel, David G; Boerrigter, Guido; Burnett, John C; Lark, Michael W

2013-10-01

382

The role of glycemia in acute heart failure patients.  

PubMed

Acute heart failure (AHF) is one of the most important cardiovascular syndromes associated with high cardiovascular morbidity, and is the major cause of admission in emergency departments worldwide. The clinical complexity of AHF has significantly increased, mostly due to the comorbidities: diabetes, arterial hypertension, dyslipidemia, obesity, peripheral vascular disease, renal insufficiency and anemia. Numerous clinical trials have demonstrated a frequent association of AHF and diabetes. Since AHF is a very heterogeneous condition, it is important to identify clinical and laboratory parameters useful for risk stratification of these populations. Hyperglycemia may be one of the most convenient, since it is widely measured, easily interpreted, and inexpensive. Acute coronary syndrome (ACS), arrhythmias and poor compliance to chronic medications are considered to be the most frequent precipitating factors of AHF in diabetics. Several studies identified diabetes as the most prominent independent predictor of morbidity and mortality in both acute and chronic heart failure (HF) patients. The following parameters were identified as the independent predictors of in-hospital mortality in patients with AHF and diabetes: older age, systolic blood pressure <100 mmHg, ACS, non-compliance, history of hypertension, left ventricular ejection fraction (LVEF) <50%, serum creatinine >1.5 mg/dL, marked elevation of natriuretic peptides, hyponatremia, treatment at admission without ACE inhibitors/ARBs/?-blockers, and no percutaneous coronary intervention (PCI) as a treatment modality. The most frequent cause of AHF is ACS, both with ST segment elevation (STEMI) or without (NSTEMI). Hyperglycemia is very common in these patients and although frequently unrecognized and untreated, has a large in-hospital and mortality significance. PMID:24988247

Seferovi?, Jelena P; Milinkovi?, Ivan; Teši?, Milorad; Risti?, Arsen; Lali?, Nebojša; Simeunovi?, Dejan; Zivkovi?, Ivana; Di Somma, Salvatore; Seferovic, Petar M

2014-10-01

383

Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II  

Microsoft Academic Search

Summary Background The ELITE study showed an association between the angiotensin II antagonist losartan and an unexpected survival benefit in elderly heart-failure patients, compared with captopril, an angiotensin-converting-enzyme (ACE) inhibitor. We did the ELITE II Losartan Heart Failure Survival Study to confirm whether losartan is superior to captopril in improving survival and is better tolerated. Methods We undertook a double-blind,

Bertram Pitt; Philip A Poole-Wilson; Robert Segal; Felipe A Martinez; A John Camm; Marvin A Konstam; Günter Riegger; James Neaton; Divakar Sharma

2000-01-01

384

CaMKII: linking heart failure and arrhythmias  

PubMed Central

Understanding relationships between heart failure and arrhythmias, important causes of suffering and sudden death, remains an unmet goal for biomedical researchers and physicians. Evidence assembled over the last decade supports a view that activation of the multifunctional Ca2+ and calmodulin-dependent protein kinase II (CaMKII) favors myocardial dysfunction and cell membrane electrical instability. CaMKII activation follows increases in intracellular Ca2+ or oxidation, upstream signals with the capacity to transition CaMKII into a Ca2+ and calmodulin-independeant, constitutively active enzyme. Constitutively active CaMKII appears poised to participate in disease pathways by catalyzing the phosphorylation of classes of protein targets important for excitation-contraction coupling and cell survival, including ion channels and Ca2+ homeostatic proteins, and transcription factors that drive hypertrophic and inflammatory gene expression. This rich diversity of downstream targets helps to explain the potential for CaMKII to simultaneously affect mechanical and electrical properties of heart muscle cells. Proof of concept studies from a growing number of investigators show that CaMKII inhibition is beneficial for improving myocardial performance and reducing arrhythmias. Here we review the molecular physiology of CaMKII, discuss CaMKII actions at key cellular targets and results of animal models of myocardial hypertrophy, dysfunction and arrhythmias that suggest CaMKII inhibition may benefit myocardial function while reducing arrhythmias. PMID:22679140

Swaminathan, Paari Dominic; Purohit, Anil; Hund, Thomas J; Anderson, Mark E

2013-01-01

385

Therapeutic Strategies for Sleep Apnea in Hypertension and Heart Failure  

PubMed Central

Sleep-disordered breathing (SDB) causes hypoxemia, negative intrathoracic pressure, and frequent arousal, contributing to increased cardiovascular disease mortality and morbidity. Obstructive sleep apnea syndrome (OSAS) is linked to hypertension, ischemic heart disease, and cardiac arrhythmias. Successful continuous positive airway pressure (CPAP) treatment has a beneficial effect on hypertension and improves the survival rate of patients with cardiovascular disease. Thus, long-term compliance with CPAP treatment may result in substantial blood pressure reduction in patients with resistant hypertension suffering from OSAS. Central sleep apnea and Cheyne-Stokes respiration occur in 30–50% of patients with heart failure (HF). Intermittent hypoxemia, nocturnal surges in sympathetic activity, and increased left ventricular preload and afterload due to negative intrathoracic pressure all lead to impaired cardiac function and poor life prognosis. SDB-related HF has been considered the potential therapeutic target. CPAP, nocturnal O2 therapy, and adaptive servoventilation minimize the effects of sleep apnea, thereby improving cardiac function, prognosis, and quality of life. Early diagnosis and treatment of SDB will yield better therapeutic outcomes for hypertension and HF. PMID:23509623

Noda, Akiko; Miyata, Seiko; Yasuda, Yoshinari

2013-01-01

386

Genetics and epigenetics of arrhythmia and heart failure  

PubMed Central

Heart failure (HF) is the end stage of several pathological cardiac conditions including myocardial infarction, cardiac hypertrophy and hypertension. Various molecular and cellular mechanisms are involved in the development of HF. At the molecular level, the onset of HF is associated with reprogramming of gene expression, including downregulation of the alpha-myosin heavy chain (?-MHC) gene and sarcoplasmic reticulum Ca 2+ ATPase genes and reactivation of specific fetal cardiac genes such as atrial natriuretic factor and brain natriuretic peptide. These deviations in gene expression result in structural and electrophysiological changes, which eventually progress to HF. Cardiac arrhythmia is caused by altered conduction properties of the heart, which may arise in response to ischemia, inflammation, fibrosis, aging or from genetic factors. Because changes in the gene transcription program may have crucial consequences as deteriorated cardiac function, understanding the molecular mechanisms involved in the process has become a priority in the field. In this context, various studies besides having identified different DNA methylation patterns in HF patients, have also focused on specific disease processes and their underlying mechanisms, also introducing new concepts such as epigenomics. This review highlights specific genetic mutations associated with the onset and progression of HF, also providing an introduction to epigenetic mechanisms such as histone modifications, DNA methylation and RNA-based modification, and highlights the relation between epigenetics, arrhythmogenesis and HF. PMID:24198825

Duygu, Burcu; Poels, Ella M.; da Costa Martins, Paula A.

2013-01-01

387

Integrating the Myocardial Matrix into Heart Failure Recognition and Management  

PubMed Central

In contrast to public perception, the morbidity and mortality as well as the resultant health care costs associated with chronic heart failure (HF) are increasing and arguably reaching epidemic proportions. While basic research efforts have provided unique insights into fundamental processes that govern myocardial extracellular matrix (ECM) growth and function, the translation of these findings to improved diagnostics and therapeutics for HF have not been as forthcoming. The factors that contribute to this relative paucity of new clinical tools for HF are multifactorial but likely include the need to recognize and differentiate HF phenotypes, and to couple the use of biomarkers and multimodality imaging in early translational research studies. Recognizing the classification scheme of HF with a reduced ejection fraction (HFrEF) to that of HF with a preserved ejection fraction (HFpEF)and incorporating unique and differential measurements of ECM remodeling to these specific disease processes are warranted. For example, profiling pathways of ECM degradation such as the matrix metalloproteinases (MMPs) in patients with ischemic heart disease and HFrEF can provide prognostic information in terms of risk of progression to HF. In patients with chronic hypertensive disease and HFpEF, plasma profiling indices of ECM synthesis and turnover, as well as advances in ECM imaging have been shown to provide diagnostic and prognostic utility. In terms of therapeutics, strategies which stabilize the ECM in HFrEF hold potential, whereas in contradistinction, selective antifibrotic agents may hold promise with HFpEF. PMID:23989715

Spinale, Francis G.; Zile, Michael R.

2013-01-01

388

Forecasting the Impact of Heart Failure in the United States  

PubMed Central

Background Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. Methods and Results We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). Conclusions The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed. PMID:23616602

Heidenreich, Paul A.; Albert, Nancy M.; Allen, Larry A.; Bluemke, David A.; Butler, Javed; Fonarow, Gregg C.; Ikonomidis, John S.; Khavjou, Olga; Konstam, Marvin A.; Maddox, Thomas M.; Nichol, Graham; Pham, Michael; Pina, Ileana L.; Trogdon, Justin G.

2013-01-01

389

Microalbuminuria in nondiabetic and nonhypertensive systolic heart failure patients.  

PubMed

The American Diabetes Association and the National Kidney Foundation define microalbuminuria as an albumin (microg)/creatinine (mg) ratio (ACR) between 30 and 300 microg/mg regardless of sex. Microalbuminuria is associated with increased cardiovascular risk. The authors evaluated the prevalence of microalbuminuria in nondiabetic and nonhypertensive systolic heart failure (SHF) patients. Twenty-seven SHF patients, 18 years and older, with New York Heart Association functional classes II through IV and left ventricular ejection fraction < or =40%, who were nondiabetic and nonhypertensive and not receiving angiotensin-converting enzyme inhibitors, were selected. Twenty-seven healthy individuals, paired according to sex, ethnicity, and age, were used as controls. Early-morning midstream urine was used. Data are expressed as medians. Excretion of albumin in SHF patients (39 microg/mL urine) was significantly higher than in controls (26 microg/mL urine). Creatinine excretion was not significantly different between patients and controls. ACR was significantly higher in patients (54 microg/mg) than in controls (24 microg/mg). The results indicate that microalbuminuria was significantly present in nondiabetic and nonhypertensive SHF patients. PMID:18983285

Figueiredo, Estêvão L; Leão, Fabiana V G; Oliveira, Lílian V; Moreira, Maria C V; Figueiredo, Amintas F S

2008-01-01

390

Assessment of Commonly Available Educational Materials in Heart Failure Clinics  

PubMed Central

Background Health literacy (HL) is an established independent predictor of cardiovascular outcomes. Approximately 90 million Americans have limited HL and read at ? 5th grade-level. Therefore, we sought to determine the suitability and readability level of common cardiovascular patient education materials (PEM) related to heart failure and heart-healthy lifestyle. Methods and Results The suitability and readability of written PEMs were assessed using the suitability assessment of materials (SAM) and Fry readability formula. The SAM criteria are comprised of the following categories: message content, text appearance, visuals, and layout and design. We obtained a convenience sample of 18 English-written cardiovascular PEMs freely available from major health organizations. Two reviewers independently appraised the PEMs. Final suitability scores ranged from 12 to 87%. Readability levels ranged between 3rd and 15th grade-level; the average readability level was 8th grade. Ninety-four percent of the PEMs were rated either superior or adequate on text appearance, but ? 50% of the PEMs were rated inadequate on each of the other categories of the SAM criteria. Only two (11%) PEMs had the optimum suitability score of ? 70% and ? 5th grade readability level suitable for populations with limited HL. Conclusions Commonly available cardiovascular PEMs used by some major healthcare institutions are not suitable for the average American patient. The true prevalence of suboptimal PEMs needs to be determined as it potentially negatively impacts optimal healthcare delivery and outcomes. PMID:21743339

Taylor-Clarke, Kimberli; Henry-Okafor, Queen; Murphy, Clare; Keyes, Madeline; Rothman, Russell; Churchwell, Andre; Mensah, George A.; Sawyer, Douglas; Sampson, Uchechukwu K. A.

2014-01-01

391

A Remote Patient Monitoring System for Congestive Heart Failure  

PubMed Central

Congestive heart failure (CHF) is a leading cause of death in the United States affecting approximately 670,000 individuals. Due to the prevalence of CHF related issues, it is prudent to seek out methodologies that would facilitate the prevention, monitoring, and treatment of heart disease on a daily basis. This paper describes WANDA (Weight and Activity with Blood Pressure Monitoring System); a study that leverages sensor technologies and wireless communications to monitor the health related measurements of patients with CHF. The WANDA system is a three-tier architecture consisting of sensors, web servers, and back-end databases. The system was developed in conjunction with the UCLA School of Nursing and the UCLA Wireless Health Institute to enable early detection of key clinical symptoms indicative of CHF-related decompensation. This study shows that CHF patients monitored by WANDA are less likely to have readings fall outside a healthy range. In addition, WANDA provides a useful feedback system for regulating readings of CHF patients. PMID:21611788

Suh, Myung-kyung; Chen, Chien-An; Woodbridge, Jonathan; Tu, Michael Kai; Kim, Jung In; Nahapetian, Ani; Evangelista, Lorraine S.; Sarrafzadeh, Majid

2011-01-01

392

A study of heart diseases without clinical signs of heart failure in 47 cattle  

PubMed Central

In this retrospective study, features of 47 cattle suffering from heart disease (HD) without clinical signs of heart failure (HF) were reviewed. The most common reasons for referral were respiratory problems (n =14), anorexia (n = 13), fever (n = 10), and lameness (n = 9). Thirty-nine animals were tachypneic. In 31 cases, cardiac auscultation revealed abnormalities. The final diagnoses were bacterial endocarditis (BE; n = 19), congenital heart disease (CHD; n = 18), pericarditis (n = 8), cardiomyopathy (n = 1), and lymphoma (n = 1). Echocardiography was performed in 39 cases. Gross pathology examination confirmed the echocardiographic diagnosis in 4 of 5 cases of pericarditis, 6 of 6 cases of BE, and 4 of 6 cases of CHD. Short-term prognosis was guarded with 19 cases (40.4%) being discharged. Premature death within 2 mo after discharge (n = 5), early culling because of poor breeding performance (n = 5), and normal productive life in the herd (n = 5) were observed in the cases that were followed. Echocardiography may be the most sensitive tool for the antemortem diagnosis of heart disease in cattle. PMID:21286323

Buczinski, Sebastien; Francoz, David; Fecteau, Gilles; DiFruscia, Rocky

2010-01-01

393

Dramatic improvement in decompensated right heart failure due to severe tricuspid regurgitation following ligation of arteriovenous fistula in a renal transplant recipient.  

PubMed

Arteriovenous (AV) fistulas with high blood flow rate are necessary for adequate hemodialysis, but they can also cause significant hemodynamic changes, including raised cardiac output, left ventricular hypertrophy and occasionally overt cardiac failure (Basile et al., Nephrol Dial Transplant, 23, 2008, 282; Unger et al., Am J Transplant, 4, 2004, 2038). We now report a case of rapid and dramatic improvement in symptomatic right heart failure due to severe tricuspid regurgitation following ligation of an arteriovenous fistula. Cardiac magnetic resonance imaging (MRI) performed before and after the ligation of fistula showed striking improvement in both the tricuspid regurgitation and right ventricular dimensions, with minimal impact on left ventricular mass, size, and function. PMID:24118598

Rao, Nitesh; Worthley, Matthew; Disney, Patrick; Faull, Randall

2014-03-01

394

The association between COPD and heart failure risk: a review  

PubMed Central

Chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure (HF) in clinical practice since they share the same pathogenic mechanism. Both conditions incur significant morbidity and mortality. Therefore, the prognosis of COPD and HF combined is poorer than for either disease alone. Nevertheless, usually only one of them is diagnosed. An active search for each condition using clinical examination and additional tests including plasma natriuretic peptides, lung function testing, and echocardiography should be obtained. The combination of COPD and HF presents many therapeutic challenges. The beneficial effects of selective ?1-blockers should not be denied in stable patients who have HF and coexisting COPD. Additionally, statins, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers may reduce the morbidity and mortality of COPD patients. Moreover, caution is advised with use of inhaled ?2-agonists for the treatment of COPD in patients with HF. Finally, noninvasive ventilation, added to conventional therapy, improves the outcome of patients with acute respiratory failure due to hypercapnic exacerbation of COPD or HF in situations of acute pulmonary edema. The establishment of a combined and integrated approach to managing these comorbidities would seem an appropriate strategy. Additional studies providing new data on the pathogenesis and management of patients with COPD and HF are needed, with the purpose of trying to improve quality of life as well as survival of these patients. PMID:23847414

de Miguel Diez, Javier; Morgan, Jorge Chancafe; Garcia, Rodrigo Jimenez

2013-01-01

395

[Alternatives to conventional diuretic therapy in heart failure].  

PubMed

Although treatment of acute heart failure is based primarily on the administration of intravenous loop diuretics, evidence supporting this practice is still scarce and there is uncertainty about the optimal dose. The existence of a considerable percentage of patients refractory to diuretic therapy and worsening of renal failure associated with the use of these drugs, with possible implications for medium-term mortality, have prompted the search for more effective and safer alternatives. Extracorporeal purification techniques, such as ultrafiltration, have demonstrated efficacy, although their superiority is unclear, due to the possible adverse effects associated with the procedure. The use of low-dose dopamine is not superior to conventional diuretic therapy after the first few hours of treatment. Moreover, combination with furosemide and hypertonic saline could be a valid alternative for patients with refractory congestion and depressed ejection fraction and serum creatinine ? 2.5mg/dL, but further studies are needed before its widespread use. The use of tolvaptan may be an effective alternative in the short-term but its use may be limited by its price. There is still controversy about whether treatment with loop diuretics is associated with higher mortality in all groups of patients with HF exacerbations. These controversies should be clarified by future clinical trials. PMID:24930083

Morales-Rull, José Luis; Trullàs, Joan Carles; Formiga, Francesc

2014-03-01

396

Geometrical characteristics of left ventricular dyssynchrony in advanced heart failure.  

PubMed

The aims of this study were to quantify the geometrical differences in left ventricular (LV) dyssynchrony in patients with heart failure (HF) using cine-tagged MRI, and to investigate the relationship between dyssynchrony and major adverse cardiac events (MACE) in HF.In 67 patients with HF [mean LV ejection fraction (LVEF), 34%], cardiac MRI using a 3-Tesla scanner was performed. The dyssynchrony time between septal and lateral segments (SL-DT) and between basal and apical segments (BA-DT) was computed by cross-correlation analysis of the strain time-curves from the cine-tagged MRI. After receiving optimal medical treatment, all patients were followed-up for a mean period of 27 months. The primary endpoint was MACE that consisted of cardiac death or HF hospitalization or a left ventricular assist device due to refractory pump failure. Multivariate logistic regression analysis was performed to determine the ability of SL-DT, BA-DT, and HF biomarkers to predict MACE.Multivariate logistic regression analysis showed that the odds ratio to predict MACE was 0.935 for LVEF (P = 0.021), 1.016 for BA-DT (P = 0.026), and 0.971 for systolic blood pressure (P = 0.126).The results show that basal-apical dyssynchrony is an independent predictor of MACE in HF patients. PMID:25310930

Nagao, Michinobu; Yamasaki, Yuzo; Yonezawa, Masato; Kamitani, Takeshi; Kawanami, Satoshi; Mukai, Yasushi; Higo, Taiki; Yabuuchi, Hidetake; Sunagawa, Kenji; Honda, Hiroshi

2014-11-13

397

Heart failure and the aging myocardium: Possible role of cardiac mitochondria  

Microsoft Academic Search

The incidence of congestive heart failure (CHF) increases with advancing age and many of these individuals have diastolic dysfunction with preserved systolic function. The role of cardiac mitochondrial function to diastolic dysfunction\\/heart failure has not been studied extensively. This review discusses the mitochondrial changes that occur with age and their possible contribution to myocardial aging and CHF (e.g., mitochondrial structure,

Jeff A. Odiet; Jeanne Y. Wei

1996-01-01

398

Prevalence of Anemia in Children with Congestive Heart Failure due to Dilated Cardiomyopathy  

PubMed Central

Introduction. Anemia is prevalent in adult heart failure patients and appears to be an independent risk factor for morbidity and mortality. The purpose of this work is to determine the prevalence of anemia in children with heart failure from dilated cardiomyopathy (DCM) and to evaluate its influence on morbidity and mortality. Methods. A homogenous group of 58 children with congestive heart failure from DCM was evaluated for heart failure symptoms, appearance of anemia, hospitalization, age of first clinical appearance, necessity of transfusion, and death during medical attendance. Anemic and nonanemic patients were analyzed for differences in age distribution, morbidity, and mortality. Results. Anemia was present in 64% of DCM patients. Hospitalization secondary to heart failure was significantly elevated in heart failure patients with anemia (mean 35.1 ± 40.5 versus 9.97 ± 9.65 days per year, P < 0.05). However, mortality was not elevated. Significant relations of age and prevalence of anemia or age and severity of anemia did not appear. Conclusion. Anemia is prevalent in pediatric patients with congestive heart failure from DCM and appears in all age classes. Hospitalization as a surrogate of morbidity is elevated in heart failure patients developing anemia, but mortality risk did not increase. PMID:23213342

Mueller, Goetz Christoph; Schlueter, Emmy Lou; Arndt, Florian; Dodge-Khatami, Ali; Weil, Jochen; Mir, Thomas S.

2012-01-01

399

Clinical Correlates and Prognostic Significance of the Ventilatory Response to Exercise in Chronic Heart Failure  

Microsoft Academic Search

Objectives. This study sought to investigate the clinical characteristics of patients with chronic heart failure and an increased ventilatory response to exercise and to examine the prognostic usefulness of this response.Background. The ventilatory response to exercise is increased in many patients with chronic heart failure and may be characterized by the regression slope relating minute ventilation to carbon dioxide output

Tuan Peng Chua; Piotr Ponikowski; Derek Harrington; Stefan D Anker; Katharine Webb-Peploe; Andrew L Clark; Philip A Poole-Wilson; Andrew J. S Coats

1997-01-01

400

Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography.  

PubMed

There are many myocardial and non-myocardial conditions that cause heart failure with normal left ventricular ejection fraction (LVEF). Among them, diastolic heart failure (heart failure due to diastolic dysfunction) is the most common cause of heart failure with normal LVEF. Diastolic heart failure easily can be diagnosed by comprehensive two-dimensional and Doppler echocardiography, which can demonstrate abnormal myocardial relaxation, decreased compliance, and increased filling pressure in the setting of normal LV dimensions and preserved LVEF. Therefore, diastolic heart failure should always be considered when LVEF is normal on two-dimensional echocardiography in patients with clinical evidence of heart failure. The diagnosis can be confirmed if Doppler echocardiography and myocardial tissue imaging provide evidence for impaired myocardial relaxation (i.e., decreased longitudinal velocity of the mitral annulus during early diastole and decreased propagation velocity mitral inflow), decreased compliance (shortened mitral A-wave duration and mitral deceleration time), and increased filling pressure (shortened isovolumic relaxation time and an increased ratio between early diastolic mitral and mitral annular velocities). Early identification of diastolic dysfunction in asymptomatic patients by the use of echocardiography may provide an opportunity to manage the underlying etiology to prevent progression to diastolic heart failure. PMID:16458127

Oh, Jae K; Hatle, Liv; Tajik, A Jamil; Little, William C

2006-02-01

401

PATHOPHYSIOLOGICAL MECHANISMS AND DRUGS LEADING TO DECREASE IN RENAL FUNCTION IN CONGESTIVE HEART FAILURE  

Microsoft Academic Search

Summary. Literature review shows that elevated serum creatinine (or diminished creatinine clearance) is frequent in patients with heart failure (40%) and prognostically bad as it indicates an independently manifold increased mortality. In addition, even renal function worsening during hospitalization (increase in serum creatinine by approximately 30 micromol\\/L or higher) is not a rare finding (every 4 patients with heart failure)

Goran P. Kora?evi?

2005-01-01

402

Selective low-level leg muscle training alleviates dyspnea in patients with heart failure  

Microsoft Academic Search

OBJECTIVES The purpose of this study was to demonstrate in patients with moderate to severe heart failure that exertional dyspnea can be alleviated by improving muscle function. BACKGROUND Dyspnea is a frequent limiting symptom in patients with chronic heart failure (CHF). This sensation may originate from activation of receptors in the musculature rather than the lung. METHODS To investigate whether

Ainat Beniaminovitz; Chim C. Lang; John LaManca; Donna M. Mancini

2003-01-01

403

Effects of Eprosartan on Renal Function and Cardiac Hypertrophy in Rats With Experimental Heart Failure  

Microsoft Academic Search

Activation of the renin-angiotensin system may contribute to the derangement in renal and cardiac function in congestive heart failure. The present study evaluated the effects of eprosartan, a selective angiotensin II receptor antagonist, on renal hemodynamic and excretory parameters and on the development of cardiac hypertrophy in rats with aortocaval fistula, an experimental model of congestive heart failure. Infusion of

Sergey Brodsky; Konstantin Gurbanov; Zaid Abassi; Aaron Hoffman; Robert R. Ruffolo; Giora Z. Feuerstein; Joseph Winaver

404

Biologic Rationale for the Use of Beta-Blockers in the Treatment of Heart Failure  

Microsoft Academic Search

Enhanced and sustained cardiac adrenergic drive occurs in heart failure and contributes, in part, to the progression of left ventricular (LV) dysfunction and remodeling that are characteristic features of this disease state. Enhanced sympathetic drive in heart failure can lead to down-regulation and desensitization of cardiac beta-adrenergic receptors with a consequent impairment of myocardial reserve and exercise tolerance. This sympathoadrenergic

Hani N. Sabbah

2004-01-01

405

Reduction of inflammatory cytokine expression and oxidative damage by erythropoietin in chronic heart failure  

Microsoft Academic Search

Objectives: Late treatment with erythropoietin (EPO), as well as the administration before the onset of or during the acute stage of myocardial infarction (MI), has recently been shown to mitigate post-MI heart failure. We investigated the mechanisms, including the downstream signaling pathways, for the beneficial effect of late treatment with EPO on chronic post-MI heart failure. Methods and results: EPO

Yiwen Li; Genzou Takemura; Hideshi Okada; Shusaku Miyata; Rumi Maruyama; Longhu Li; Masato Higuchi; Shinya Minatoguchi; Takako Fujiwara; Hisayoshi Fujiwara

2006-01-01

406

Carvedilol Exerts More Potent Antiadrenergic Effect than Metoprolol in Heart Failure  

Microsoft Academic Search

Background: It is still uncertain whether or not there is a difference between metoprolol and carvedilol for the treatment of congestive heart failure. We attempted to determine the difference between the two ?-blockers in terms of their antiadrenergic effect during exercise in patients with heart failure and their efficacy based on the baseline plasma brain natriuretic peptide concentration. Methods: Fifty-three

Takashi Kohno; Tsutomu Yoshikawa; Akihiro Yoshizawa; Iwao Nakamura; Toshihisa Anzai; Toru Satoh; Satoshi Ogawa

2005-01-01

407

Can new inodilators displace digitalis in the therapy of congestive heart failure?  

Microsoft Academic Search

New inodilators that possess both positive inotropic and vasodilator actions have many favorable effects in patients with congestive heart failure, even in those with refractory heart failure. These effects are expected to prevent myocardial injury, improve peripheral circulation, depress the excessive endogenous neurohumoral activation, and, finally, improve the quality of life, and increase lifespan. However, experience with new inodilators has

Toshiaki Kumada; Chuichi Kawai

1989-01-01

408

Biventricular Pacing in End-Stage Heart Failure Improves Functional Capacity and Left Ventricular Function  

Microsoft Academic Search

Background Asynchronous patterns of contraction and relaxation may contribute to hemodynamic and functional impairment in heart failure. In 1993, we introduced biventricular pacing as a novel method to treat heart failure by synchronous stimulation of the right and left ventricles after an appropriate atrioventricular delay. The objectives of this study were to assess the early and long-term effects of this

Patricia F. Bakker; Huub W. Meijburg; Jaap W. de Vries; Morton M. Mower; Andra C. Thomas; Michael L. Hull; Etienne O. Robles de Medina; Johan J. Bredée

2000-01-01

409

Pathophysiology and potential treatments of pulmonary hypertension due to systolic left heart failure.  

PubMed

Pulmonary hypertension (PH) due to left heart failure is becoming increasingly prevalent and is associated with poor outcome. The precise pathophysiological mechanisms behind PH due to left heart failure are, however, still unclear. In its early course, PH is caused by increased left ventricular filling pressures, without pulmonary vessel abnormalities. Conventional treatment for heart failure may partly reverse such passive PH by optimizing left ventricular function. However, if increased pulmonary pressures persist, endothelial damage, excessive vasoconstriction and structural changes in the pulmonary vasculature may occur. There is, at present, no recommended medical treatment for this active component of PH due to left heart failure. However, as the vascular changes in PH due to left heart failure may be similar to those in pulmonary arterial hypertension (PAH), a selected group of these patients may benefit from PAH treatment targeting the endothelin, nitric oxide or prostacyclin pathways. Such potent pulmonary vasodilators could, however, be detrimental in patients with left heart failure without pulmonary vascular pathology, as selective pulmonary vasodilatation may lead to further congestion in the pulmonary circuit, resulting in pulmonary oedema. The use of PAH therapies is therefore currently not recommended and would require the selection of suitable patients based on the underlying causes of the disease and careful monitoring of their progress. The present review focuses on the following: (i) the pathophysiology behind PH resulting from systolic left heart failure, and (ii) the current evidence for medical treatment of this condition, especially the role of PAH-targeted therapies in systolic left heart failure. PMID:24703457

Lundgren, J; Rådegran, G

2014-06-01

410

Health literacy and self-care of patients with heart failure: A longitudinal study  

Microsoft Academic Search

Background. Inadequate health literacy, or difficulty in obtaining and understanding health information, may be a barrier in educating patients about their heart failure. ^ Objectives. The first objective of this study was to model the relationship between health literacy, health locus of control, years of formal education, knowledge, self-efficacy, and self-care in patients with heart failure. The second objective of

Aleda M Chen

2011-01-01

411

‘Maintaining the balance’—nursing care of patients with chronic heart failure  

Microsoft Academic Search

Nurses in different settings are involved in caring for patients with heart failure. In the clinic, hospital, nursing home or patients' home, the nurse has a role in detecting, identifying and treating heart failure. In order to provide optimal care, literature on possible and effective interventions should be available to nurses.This study gives an overview of nursing care for patients

Tiny Jaarsma; Huda Huijer Abu-Saad; Ruud Halfens; Kathleen Dracup

1997-01-01

412

Congestive heart failure in dialysis patients: Prevalence, incidence, prognosis and risk factors  

Microsoft Academic Search

Congestive heart failure in dialysis patients: Prevalence, incidence, prognosis and risk factors. Cardiovascular disease is the most common cause of death in dialysis subjects. Congestive heart failure (CHF) is a common presenting symptom of cardiovascular disease in the dialysis population. Information regarding prevalence, incidence, risk factors and prognosis is crucial for planning rational interventional studies. A prospective multicenter cohort study

John D Harnett; Robert N Foley; Gloria M Kent; Paul E Barre; David Murray; Patrick S Parfrey

1995-01-01

413

Homocysteine Levels in Patients with Heart Failure with Preserved Ejection Fraction  

Microsoft Academic Search

Objectives: Increased homocysteine (HCY) levels are associated with an increased risk of cardiovascular disease. Plasma HCY is increased in chronic heart failure (CHF) patients, and previous studies suggest that hyperhomocysteinemia causes adverse cardiac remodeling and affects pump function. We aimed to evaluate the HCY levels in patients with diastolic heart failure with preserved left ventricular ejection fraction (LVEF). Methods: We

Ahmet Uslu; Mehmet Akif Çakar; Irfan Sahin; Imran Önür; Halil Ibrahim Biter; Mustafa Hakan Dinçkal

2010-01-01

414

Serum Gamma Glutamyl Transferase and Risk of Heart Failure in the Community  

PubMed Central

Objective To examine the association of serum gamma glutamyl transferase (GGT) to incident heart failure. Methods and Results We related serum GGT to the incidence of heart failure in 3544 (mean age 44.5yrs; 1833 women) Framingham Study participants who were free of heart failure and myocardial infarction. On follow-up (mean 23.6yrs), 188 participants (77 women) developed new-onset heart failure. In multivariable Cox models adjusting for standard risk factors and alcohol consumption as time-varying covariates (updated every 4 years), each standard deviation increase in log-GGT was associated with a 1.39-fold risk of heart failure (95% confidence intervals [CI] 1.20-1.62). The linearity of the association was confirmed by multivariable-adjusted splines and the relations remained robust upon additional adjustment for hepatic aminotransferases and C-reactive protein. Participants with serum GGT ?median had a 1.71-fold risk of heart failure (95% CI 1.21-2.41) compared to individuals with GGT concentrations below the median. GGT marginally increased the model c-statistic from 0.85 to 0.86, but improved the risk reclassification modestly (net reclassification index 5.7%, p=0.01). Conclusions In our prospective study of large community-based sample higher serum GGT concentrations within the ‘normal’ range were associated with greater risk of heart failure and incrementally improved prediction of heart failure risk. PMID:20539015

Dhingra, Ravi; Gona, Philimon; Wang, Thomas J; Fox, Caroline S; D'Agostino, Ralph B; Vasan, Ramachandran S.

2010-01-01

415

Bedside B-type natriuretic peptide and functional capacity in chronic heart failure  

Microsoft Academic Search

c ˆ Abstract Objectives: To determine if B-type natriuretic peptide (BNP) measurement could be useful in determination of functional capacity in patients suffering from chronic heart failure. Background: Evaluating functional capacity is a crucial factor in the follow-up of patients with chronic heart failure. There are numerous methods for measuring functional capacity and their relative merits remain under discussion. Clinical

P. Jourdain; F. Funck; M. Bellorini; N. Guillard; J. Loiret; B. Thebault; M. Desnos; D. Duboc

2003-01-01

416

Dietary habits moderate the association between heart failure and cognitive impairment.  

PubMed

Cognitive impairment is common in heart failure patients. Poor dietary habits are associated with reduced neurocognitive function in other medical populations, including diabetes and Alzheimer's disease. This study examined whether dietary habits help moderate the relationship between heart failure severity and cognitive function. A total of 152 persons with heart failure completed neuropsychological testing and a fitness assessment. Dietary habits were assessed using the Starting the Conversation-Diet questionnaire, a nutrition measure suggested for use in primary care settings. Moderation analyses showed that better dietary habits attenuated the adverse impact of heart failure severity on frontal functioning (b = 1.28, p < 0.05). Follow-up analyses revealed consumption of foods high in sodium was associated with reduced cognitive function (p < 0.05). This study suggests dietary habits can moderate the association between heart failure and performance on tests of attention and executive function. Longitudinal studies are needed to confirm and clarify the mechanisms for our findings. PMID:23663211

Alosco, Michael L; Spitznagel, Mary Beth; Raz, Naftali; Cohen, Ronald; Sweet, Lawrence H; Colbert, Lisa H; Josephson, Richard; van Dulmen, Manfred; Hughes, Joel; Rosneck, Jim; Gunstad, John

2013-01-01

417

Impact of heart rate on mechanical dyssynchrony and left ventricular contractility in patients with heart failure and normal QRS duration  

Microsoft Academic Search

Aims: The quantification of mechanical dyssynchrony has important diagnostic value and may help to determine optimal therapy in heart failure (HF). We hypothesized that mechanical dyssynchrony may be augmented at increased heart rates in patients with HF and normal QRS duration. Methods and results: From online segmental conductance catheter signals, we derived indices to quantify temporal and spatial aspects of

Tairo Kurita; Katsuya Onishi; Kaoru Dohi; Masaki Tanabe; Naoki Fujimoto; Takashi Tanigawa; Morimichi Setsuda; Naoki Isaka; Tsutomu Nobori; Masaaki Ito

2007-01-01

418

Heart rate recovery after exercise in chronic heart failure: Role of vital exhaustion and type D personality  

Microsoft Academic Search

Summary Objective: Vital exhaustion and type D personality previously predicted mortality and cardiac events in patients with chronic heart failure (CHF). Reduced heart rate recovery (HRR) also predicts morbidity and mortality in CHF. We hypothesized that elevated levels of vital exhaustion and type D personality are both associated with decreased HRR. Methods: Fifty-one patients with CHF (mean age 58 ±

Roland von Känel; Jürgen Barth; Sonja Kohls; Hugo Saner; Hansjörg Znoj; Gaby Saner; Jean-Paul Schmid

2009-01-01

419

Multifractal properties of ECG patterns of patients suffering from congestive heart failure  

Microsoft Academic Search

The multifractal properties of two-channel ECG patterns of patients suffering from severe congestive heart failure (New York Heart Association (NYHA) classes III-IV) are studied and are compared with those for normal healthy people using the multifractal detrended fluctuation analysis methodology. Ivanov et al (1999 Nature 399 461) have studied the multifractality of human heart rate dynamics using the wavelet transformation

Srimonti Dutta

2010-01-01

420

Senescence and Death of Primitive Cells and Myocytes Lead to Premature Cardiac Aging and Heart Failure  

Microsoft Academic Search

Abstract—Chronological myocardial aging is viewed as the inevitable effect of time on the functional reserve of the heart. Cardiac failure in elderly patients is commonly,interpreted as an idiopathic or secondary myopathy,superimposed,on the old heart independently from the aging process. Thus, aged diseased hearts were studied to determine whether cell

Cristina Chimenti; Jan Kajstura; Daniele Torella; Konrad Urbanek; Hubert Heleniak; Claudia Colussi; Bernardo Nadal-Ginard; Andrea Frustaci; Annarosa Leri; Attilio Maseri; Piero Anversa

2010-01-01

421

Primary cardiac sarcoma presenting as acute left-sided heart failure  

PubMed Central

Primary cardiac sarcomas are rare malignant tumors of the heart. Clinical features depend on the site of tumor and vary from symptoms of congestive heart failure to thromboembolism and arrhythmias. Echocardiography is helpful but definitive diagnosis is established by histopathology. Surgical resection is the mainstay of treatment, and the role of chemotherapy and radiotherapy is unclear. We report a case of primary cardiac sarcoma which presented with signs and symptoms of acute left-sided heart failure. PMID:25147639

Pathak, Ranjan; Nepal, Santosh; Giri, Smith; Ghimire, Sushil; Aryal, Madan Raj

2014-01-01

422

Cardiac remodeling and subcellular defects in heart failure due to myocardial infarction and aging  

Microsoft Academic Search

Although several risk factors including hypertension, cardiac hypertrophy, coronary artery disease, and diabetes are known\\u000a to result in heart failure, elderly subjects are more susceptible to myocardial infarction and more likely to develop heart\\u000a failure. This article is intended to discuss that cardiac dysfunction in hearts failing due to myocardial infarction and aging\\u000a is associated with cardiac remodeling and defects

Naranjan S. Dhalla; Shashanka Rangi; Andrea P. Babick; Shelley Zieroth; Vijayan Elimban

423

349 Hallmarks of ion channel gene expression in end-stage heart failure  

Microsoft Academic Search

Electrical conductance is greatly altered in end-stage heart failure, but little is known about the underlying events. We therefore investigated the ex- pression of genes coding for major inward and outward ion channels, calcium binding proteins, ion receptors, ion exchangers, calcium ATPases, and calcium\\/cal- modulin-dependent protein kinases in explanted hearts (n13) of patients diagnosed with end-stage heart failure. With the

JURGEN BORLAK; THOMAS THUM

2003-01-01

424

Snoring and risk for obstructive sleep apnea among nigerians with heart failure: Prevalence and clinical correlates  

PubMed Central

Background: Heart failure is an important cause of morbidity and mortality in developing nations like Nigeria. Sleep apnea and snoring has recently been recognized to be a cardiovascular risk factor. Sleep apnea is yet to be well studied among Africans with heart failure. We aimed to determine the prevalence of snoring and high risk for obstructive sleep apnea among Nigerians with stable heart failure. Materials and Methods: We studied 103 subjects that included 62 patients with heart failure and 41 control subjects. Demographic parameters and clinical examination were performed on the participants. The Berlin score and the Epworth Sleepiness Scale were administered for each participant. Echocardiography was done on all participants. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) 17.0. Results: Snoring was reported in 48.4% of subjects with heart failure compared to 22.0% of control subjects ( P < 0.005). High risk for obstructive sleep apnea using the Berlin score was documented in 51.6% of heart failure subjects compared to 7.31% of controls. Excessive daytime somnolence occurred more in heart failure patients (51.6% vs. 9.8%, P < 0.05). Snorers tended to be older and were more likely to be obese than nonsnorers. Systolic blood pressure and fasting blood sugar were significantly higher among heart failure subjects with snoring than those without snoring (131.9 ± 19.2 vs. 119.2 ± 15.7 and 6.0 ± 0.8 vs. 5.4 ± 2.7, P < 0.005). Conclusion: Heart failure seems to be associated with snoring and a high risk for obstructive sleep apnea among Africans with heart failure. Assessment for sleep disordered breathing should be incorporated into their routine clinical workup. PMID:23580920

Akintunde, Adeseye A.

2013-01-01

425

Failing the failing heart: a review of palliative care in heart failure.  

PubMed

Heart failure (HF) is the most common reason for hospital admission for patients older than 65 years. With an aging population and improving survival in heart failure patients, the number of people living with HF continues to grow. As this population increases, the importance of treating symptoms of fatigue, dyspnea, pain, and depression that diminish the quality of life in HF patients becomes increasingly important. Palliative care has been shown to help alleviate these symptoms and improve patients' satisfaction with the care they receive. Despite this growing body of evidence, palliative care consultation remains underutilized and is not standard practice in the management of HF. With an emphasis on communication, symptom management, and coordinated care, palliative care provides an integrated approach to support patients and families with chronic illnesses. Early communication with patients and families regarding the unpredictable nature of HF and the increased risk of sudden cardiac death enables discussions around advanced care directives, health care proxies, and deactivation of permanent pacemakers or implantable cardioverter defibrillators. Cardiologists and primary care physicians who are comfortable initiating these discussions are encouraged to do so; however, many fear destroying hope and are uncertain how to discuss end-of-life issues. Thus, in order to facilitate these discussions and establish an appropriate relationship, we recommend that patients and families be introduced to a palliative care team at the earliest appropriate time after diagnosis. PMID:23651985

Shah, Ankit B; Morrissey, Ryan P; Baraghoush, Afshan; Bharadwaj, Parag; Phan, Anita; Hamilton, Michele; Kobashigawa, Jon; Schwarz, Ernst R

2013-01-01

426

Dantrolene prevents arrhythmogenic Ca2+ release in heart failure  

PubMed Central

In heart failure (HF), arrhythmogenic Ca2+ release and chronic Ca2+ depletion of the sarcoplasmic reticulum (SR) arise due to altered function of the ryanodine receptor (RyR) SR Ca2+-release channel. Dantrolene, a therapeutic agent used to treat malignant hyperthermia associated with mutations of the skeletal muscle type 1 RyR (RyR1), has recently been suggested to have effects on the cardiac type 2 RyR (RyR2). In this investigation, we tested the hypothesis that dantrolene exerts antiarrhythmic and inotropic effects on HF ventricular myocytes by examining multiple aspects of intracellular Ca2+ handling. In normal rabbit myocytes, dantrolene (1 ?M) had no effect on SR Ca2+ load, postrest decay of SR Ca2+ content, the threshold for spontaneous Ca2+ wave initiation (i.e., the SR Ca2+ content at which spontaneous waves initiate) and Ca2+ spark frequency. In cardiomyocytes from failing rabbit hearts, SR Ca2+ load and the wave initiation threshold were decreased compared with normal myocytes, Ca2+ spark frequency was increased, and the postrest decay was potentiated. Using a novel approach of measuring cytosolic and intra-SR Ca2+ concentration (using the low-affinity Ca2+ indicator fluo-5N entrapped within the SR), we showed that treatment of HF cardiomyocytes with dantrolene rescued postrest decay and increased the wave initiation threshold. Additionally, dantrolene decreased Ca2+ spark frequency while increasing the SR Ca2+ content in HF myocytes. These data suggest that dantrolene exerts antiarrhythmic effects and preserves inotropy in HF cardiomyocytes by decreasing the incidence of diastolic Ca2+ sparks, increasing the intra-SR Ca2+ threshold at which spontaneous Ca2+ waves occur, and decreasing the loss of Ca2+ from the SR. Furthermore, the observation that dantrolene reduces arrhythmogenicity while at the same time preserves inotropy suggests that dantrolene is a potentially useful drug in the treatment of arrhythmia associated with HF. PMID:22180651

Maxwell, Joshua T.; Domeier, Timothy L.

2012-01-01

427

New advances in beta-blocker therapy in heart failure  

PubMed Central

The use of ?-blockers (BB) in heart failure (HF) has been considered a contradiction for many years. Considering HF simply as a state of inadequate systolic function, BB were contraindicated because of their negative effects on myocardial contractility. Nevertheless, evidence collected in the past years have suggested that additional mechanisms, such as compensatory neuro-humoral hyperactivation or inflammation, could participate in the pathogenesis of this complex disease. Indeed, chronic activation of the sympathetic nervous system, although initially compensating the reduced cardiac output from the failing heart, increases myocardial oxygen demand, ischemia and oxidative stress; moreover, high catecholamine levels induce peripheral vasoconstriction and increase both cardiac pre- and after-load, thus determining additional stress to the cardiac muscle (1). As a consequence of such a different view of the pathogenic mechanisms of HF, the efficacy of BB in the treatment of HF has been investigated in numerous clinical trials. Results from these trials highlighted BB as valid therapeutic tools in HF, providing rational basis for their inclusion in many HF treatment guidelines. However, controversy still exists about their use, in particular with regards to the selection of specific molecules, since BB differ in terms of adrenergic ?-receptors selectivity, adjunctive effects on ?-receptors, and effects on reactive oxygen species and inflammatory cytokines production. Further concerns about the heterogeneity in the response to BB, as well as the use in specific patients, are matter of debate among clinicians. In this review, we will recapitulate the pharmacological properties and the classification of BB, and the alteration of the adrenergic system occurring during HF that provide a rationale for their use; we will also focus on the possible molecular mechanisms, such as genetic polymorphisms, underlying the different efficacy of molecules belonging to this class. PMID:24294204

Barrese, Vincenzo; Taglialatela, Maurizio

2013-01-01

428

Effects of bucindolol on neurohormonal activation in congestive heart failure  

SciTech Connect

To examine the effects of beta-adrenergic blockade on neurohormonal activation in patients with congestive heart failure, 15 men had assessments of hemodynamics and supine peripheral renin and norepinephrine levels before and after 3 months of oral therapy with bucindolol, a nonselective beta antagonist. At baseline, plasma renin activity did not correlate with any hemodynamic parameter. However, norepinephrine levels had a weak correlation with left ventricular end-diastolic pressure (r = 0.74, p less than 0.01), stroke volume index (r = 0.61, p less than 0.02) and pulmonary vascular resistance (r = 0.54, p less than 0.05). Plasma renin decreased with bucindolol therapy, from 11.6 +/- 13.4 to 4.3 +/- 4.1 ng/ml/hour (mean +/- standard deviation; p less than 0.05), whereas plasma norepinephrine was unchanged, from 403 +/- 231 to 408 +/- 217 pg/ml. A wide diversity of the norepinephrine response to bucindolol was observed with reduction of levels in some patients and elevation in others. Although plasma norepinephrine did not decrease, heart rate tended to decrease (from 82 +/- 20 vs 73 +/- 11 min-1, p = 0.059) with beta-adrenergic blockade, suggesting neurohormonal antagonism at the receptor level. No changes in I-123 metaiodobenzylguanidine uptake occurred after bucindolol therapy, suggesting unchanged adrenergic uptake of norepinephrine with beta-blocker therapy. Despite reductions in plasma renin activity and the presence of beta blockade, the response of renin or norepinephrine levels to long-term bucindolol therapy did not predict which patients had improved in hemodynamic status (chi-square = 0.37 for renin, 0.82 for norepinephrine).

Eichhorn, E.J.; McGhie, A.L.; Bedotto, J.B.; Corbett, J.R.; Malloy, C.R.; Hatfield, B.A.; Deitchman, D.; Willard, J.E.; Grayburn, P.A. (Dallas Veterans Administration Hospital, TX (USA))

1991-01-01

429

Iron status in patients with chronic heart failure  

PubMed Central

Aims The changes in iron status occurring during the course of heart failure (HF) and the underlying pathomechanisms are largely unknown. Hepcidin, the major regulatory protein for iron metabolism, may play a causative role. We investigated iron status in a broad spectrum of patients with systolic HF in order to determine the changes in iron status in parallel with disease progression, and to associate iron status with long-term prognosis. Methods and results Serum concentrations of ferritin, transferrin saturation (Tsat), soluble transferrin receptor (sTfR), and hepcidin were assessed as the biomarkers of iron status in 321 patients with chronic systolic HF [age: 61 ± 11 years, men: 84%, left ventricular ejection fraction: 31 ± 9%, New York Heart Association (NYHA) class: 72/144/87/18] at a tertiary cardiology centre and 66 age- and gender-matched healthy subjects. Compared with healthy subjects, asymptomatic HF patients had similar haematological status, but increased iron stores (evidenced by higher serum ferritin without distinct inflammation, P < 0.01) with markedly elevated serum hepcidin (P < 0.001). With increasing HF severity, patients in advanced NYHA classes had iron deficiency (ID) (reduced serum ferritin, low Tsat, high sTfR), iron-restricted erythropoiesis (reduced haemoglobin, high red cell distribution width), and inflammation (high serum high-sensitivity-C-reactive protein and interleukin 6), which was accompanied by decreased circulating hepcidin (all P < 0.001). In multivariable Cox models, low hepcidin was independently associated with increased 3-year mortality among HF patients (P < 0.001). Conclusions Increased level of circulating hepcidin characterizes an early stage of HF, and is not accompanied by either anaemia or inflammation. The progression of HF is associated with the decline in circulating hepcidin and the development of ID. Low hepcidin independently relates to unfavourable outcome. PMID:23178646

Jankowska, Ewa A.; Malyszko, Jolanta; Ardehali, Hossein; Koc-Zorawska, Ewa; Banasiak, Waldemar; von Haehling, Stephan; Macdougall, Iain C.; Weiss, Guenter; McMurray, John J.V.; Anker, Stefan D.; Gheorghiade, Mihai; Ponikowski, Piotr

2013-01-01

430

The Influence of a High Salt Diet on a Rat Model of Isoproterenol-Induced Heart Failure  

EPA Science Inventory

Rat models of heart failure (HF) show varied pathology and time to disease outcome, dependent on induction method. We found that subchronic (4 weeks) isoproterenol (ISO) infusion exacerbated cardiomyopathy in Spontaneously Hypertensive Heart Failure (SHHF) rats. Others have shown...

431

Characterisation of heart failure with normal ejection fraction in a tertiary hospital in Nigeria  

PubMed Central

Background The study aimed to determine the frequency and characteristics of heart failure with normal EF in a native African population with heart failure. Methods It was a hospital cohort study. Subjects were 177 consecutive individuals with heart failure and ninety apparently normal control subjects. All the subjects underwent transthoracic echocardiography. The group with heart failure was further subdivided into heart failure with normal EF (EF ? 50) (HFNEF) and heart failure with low EF(EF <50)(HFLEF). Results The subjects with heart failure have a mean age of 52.3 ± 16.64 years vs 52.1 ± 11.84 years in the control subjects; p = 0.914. Other baseline characteristics except blood pressure parameters and height were comparable between the group with heart failure and the control subjects. The frequency of HFNEF was 39.5%. Compared with the HFLEF group, the HFNEF group have a smaller left ventricular diameter (in diastole and systole): (5.2 ± 1.22 cm vs 6.2 ± 1.39 cm; p < 0.0001 and 3.6 ± 1.24 cm vs 5.4 ± 1.35 cm;p < 0.0001) respectively, a higher relative wall thickness and deceleration time of the early mitral inflow velocity: (0.4 ± 0.12 vs 0.3 ± 0.14 p < 0.0001 and 149.6 ± 72.35 vs 110.9 ± 63.40 p = 0.001) respectively. The two groups with heart failure differed significantly from the control subjects in virtually all echocardiographic measurements except aortic root diameter, LV posterior wall thickness(HFLEF), and late mitral inflow velocity(HFNEF). HFNEF accounted for 70(39.5%) of cases of heart failure in this study. Hypertension is the underlying cardiovascular disease in 134(75.7%) of the combined heart failure population, 58 (82.9%) of the subjects with HFNEF group and 76(71%) of the HFLEF group. Females accounted for 44 (62.9%) of the subjects with HFNEF against 42(39.3%) in the HFLEF group (p = 0.002). Conclusion The frequency of heart failure with normal EF in this native African cohort with heart failure is comparable with the frequency in other populations. These groups of patients are more likely female, hypertensive with concentric pattern of left ventricular hypertrophy. PMID:19922629

2009-01-01

432

Epicardial adipose tissue in patients with heart failure  

PubMed Central

Purpose The aim of this study was to evaluate the extent of epicardial adipose tissue (EAT) and its relationship with left ventricular (LV) parameters assessed by cardiovascular magnetic resonance (CMR) in patients with congestive heart failure (CHF) and healthy controls. Background EAT is the true visceral fat deposited around the heart which generates various bioactive molecules. Previous studies found that EAT is related to left ventricular mass (LVM) in healthy subjects. Further studies showed a constant EAT to myocardial mass ratio in normal, ischemic and hypertrophied hearts. Methods CMR was performed in 66 patients with CHF due to ischemic cardiomyopathy (ICM), or dilated cardiomyopathy (DCM) and 32 healthy controls. Ventricular volumes, dimensions and LV function were assessed. The amount of EAT was determined volumetrically and expressed as mass indexed to body surface area. Additionally, the EAT/LVM and the EAT/left ventricular remodelling index (LVRI) ratios were calculated. Results Patients with CHF had less indexed EAT mass than controls (22 ± 5 g/m2 versus 34 ± 4 g/m2, p < 0.0001). In the subgroup analysis there were no sig