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Ten years ago we published a review updating current knowl- edge on heartfailure. We summarized that heartfailure is a neuro-humoral and inflammatory syndrome, and that pro- inflammatory cytokines are involved in cardiac depression and in the complex syndrome of heartfailure. We suggested that understanding the role of these cytokines may enable us to reverse cardiac depression and
Heartfailure is a complex clinical syndrome occurring as the end result of many different forms of heart disease. There are\\u000a many different definitions and classifications of heartfailure (Table 1.1) but a simple, practical definition of the syndrome\\u000a of heartfailure is that it is characterized by typical symptoms such as shortness of breath, exercise limitation and fatigue\\u000a and
Managing patients with heartfailure is rooted in appropriate recognition of the syndrome and subsequent tailoring of therapies\\u000a to individual patients based on the stage of the disease. An individual with asymptomatic left ventricular dysfunction (the\\u000a earliest stage of heartfailure) is treated quite differently than a patient with more advanced heartfailure manifested by\\u000a problematic fluid retention, peripheral organ
The treatment for heartfailure (HF) caused by systolic dysfunction (heartfailure with reduced ejection fraction, HFREF) is currently better defined than that of HF caused by diastolic dysfunction (heartfailure with preserved ejection fraction, HFPEF). Available drugs include blockers of the renin-angiotensin-aldosterone system (i.e. angiotensin-converting enzyme inhibitors, angiotensin II AT-1 receptor blockers, aldosterone antagonists, direct renin inhibitors), beta blockers,
Heartfailure affects more than five million Americans. It is a health and financial burden on the US health care system. The 5-year mortality of heartfailure with diabetes is about 50%. This article discusses the treatment of heartfailure in the patient with diabetes, including developing effective communication skills between physicians and nurses, developing an effective plan for transitioning the patient between care settings, documenting patient visits consistently and clearly, and performing medication reconciliation at each visit. This article also discusses the need for monitoring readmission for heartfailure, length of stay, discharge on beta-blocker, and vaccination rate. PMID:23410648
Hospitalizations for acute decompensated heartfailure are increasing in the United States. Moreover, the prevalence of heartfailure is increasing consequent to an increased number of older individuals, as well as to improvement in therapies for coronary artery disease and sudden cardiac death that have enabled patients to live longer with cardiovascular disease. The main treatment goals in the hospitalized patient with heartfailure are to restore euvolemia and to minimize adverse events. Common in-hospital treatments include intravenous diuretics, vasodilators, and inotropic agents. Novel pharmaceutical agents have shown promise in the treatment of acute decompensated heartfailure and may simplify the treatment and reduce the morbidity associated with the disease. This review summarizes the contemporary management of patients with acute decompensated heartfailure.
Joseph, Susan M.; Cedars, Ari M.; Ewald, Gregory A.; Geltman, Edward M.; Mann, Douglas L.
... Suggested procedures may include: Angioplasty and stent placement Heart bypass surgery ... This problem may cause heartfailure or make heartfailure worse. As a result, the patient may need surgery to repair one of the heart valves .
Although neurohumoral antagonism has successfully reduced heartfailure morbidity and mortality, the residual disability and death rate remains unacceptably high. Though abnormalities of myocardial metabolism are associated with heartfailure, recent data suggest that heartfailure may itself promote metabolic changes such as insulin resistance, in part through neurohumoral activation. A detrimental self-perpetuating cycle (heartfailure 3 altered metabolism 3
Houman Ashrafian; Michael P. Frenneaux; Lionel H. Opie
Chronic heartfailure has an age-dependent prevalence of 2% and is therefore one of the most frequent diseases in western societies. A reduced hemoglobin concentration according to the definition of the World Health Organization is a common comorbidity affecting more than half of all heartfailure patients. Elderly patients, patients suffering from renal impairment and women are more likely to develop anemia but a definitive etiology of anemia is only identified in the minority of cases. Anemia is associated with a poor clinical status and a greater risk of hospitalization and is a predictive factor for increased mortality. The incidence of anemia appears to increase with a poorer functional class. Intravenous iron therapy improves the exercise capacity in patients with systolic heartfailure and iron deficiency and is currently being recommended for patients with persistent symptoms despite optimal medical and device therapy. However, erythropoietin-stimulating agents as a treatment for anemia in chronic heartfailure have failed to improve clinical outcome in a large randomized trial. In patients with heartfailure but with maintained ejection fraction, anemia is also associated with a poor prognosis. Specific therapeutic recommendations for these patients are still not available. PMID:23900390
The autonomic nervous system has an important role in the development and progression of the heartfailure syndrome. Increased sympathetic, reduced parasympathetic, and impaired baroreceptor activity are well-documented features of heartfailure. The analysis of heart rate variability can give insight into these autonomic abnormalities. A number of techniques now exist for assessing heart rate variability, and in general they
Opinion statement \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Physicians must aggressively treat heartfailure in the early stages to prevent disease progression and improve survival.\\u000a Early treatment implies early diagnosis of left ventricular (LV) dysfunction, before the onset of symptoms. Patients with\\u000a risk factors for the development of heartfailure, especially coronary disease or hypertension, should undergo echocardiography\\u000a to evaluate LV function. Patients with LV
Heartfailure is a complex syndrome characterized by inability of the heart to supply sufficient cardiac output to meet the metabolic needs of the body. Over the past few decades, a number of animal models of heartfailure have been developed to study questions that cannot be readily studied in the clinical setting. Because the syndrome of heartfailure in
Heartfailure is a common and serious condition. Over recent decades, its therapeutic management has changed considerably. Treatments and therapeutic education help to improve the symptoms as well as reduce mortality and the risk of rehospitalisation. Finally, the management of the condition takes into account the patient as a whole with his or her illness, comorbidities and projects. PMID:23697056
Heartfailure (HF) is a clinical syndrome comprising symptoms and signs. From a pathophysiological viewpoint, the old concept of a hemodynamic disorder has given way to a newer neurohormonal model, which underlines the deleterious role of activation of the Renin-Angiotensin-Aldosterone System (RAAS) and excessive sympathetic tone. A distinction is made between HF with predominantly systolic dysfunction (suboptimal emptying of the
Background: Current heartfailure (HF) guidelines note that alcohol use should be discouraged or restricted in patients with HF resulting from left ventricular systolic dysfunction. Existing knowledge is limited in the area of HF and alcohol. Methods and Results: The purpose of this article is to review the evidence regarding the acute and long-term use of alcohol in the setting
A study of 209 consecutive cases of hypertension, seen at the cardiac unit of the University College Hospital, Ibadan, Nigeria, showed that heartfailure occurred more commonly in patients who were in the low socio-economic class. All those who had a haematocrit below 30% had heartfailure. The lower the serum albumin, the greater the likelihood of developing heartfailure. Hypertensives who were heavy alcohol drinkers were very prone to heartfailure while a significant proportion of those who had cardiomegaly or cardiomegaly with aortic unfolding on chest x-ray had heartfailure. Age, sex, Hb genotype, obesity and retinal changes had no influence on the development of heartfailure. It is concluded that there are other factors, besides hypertension, which precipitate heartfailure in Nigerian hypertensives. This may be responsible for the high incidence of heartfailure among Nigerian with hypertension. PMID:6314794
Most heartfailure research and quality improvement efforts are targeted at treatment and secondary prevention of patients with manifest heartfailure. 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 heartfailure epidemiology, a more focused effort on prevention is urgently needed.
Several structural and functional changes contribute to heartfailure in elderly patients: an age dependent increase in sympathetic nervous activity, left ventricular wall diameter, myocardial fibrosis and apoptosis, micro- and macrovascular coronary sclerosis, aortic stiffness. As a consequence, diastolic, but also systolic heartfailure is a frequent finding in elderly patients. The relation of systolic to diastolic heartfailure is
After atrial fibrillation, heartfailure is the second most frequent cardiac association of stroke. Deteriorating left ventricular systolic function appears to increase the risk of cardioembolic stroke in heartfailure. Age, hypertension and prior stroke are also risk factors for stroke in heartfailure. Since these are risk factors for cerebral and other vascular disease rather than for cardioembolism, embolism
Over the past few years, anemia has emerged as a powerful independent predictor of adverse outcomes in chronic heartfailure\\u000a (CHF). It affects up to 50% of patients with CHF, depending on the definition of anemia used and on the population studied.\\u000a Even small reductions in hemoglobin are associated with worse outcome. However, the causes of anemia in CHF remain
There are no clear data regarding whether to use warfarin, aspirin, or no therapy in patients with left ventricular systolic\\u000a dysfunction. Aspirin use is widespread in patients with vascular disease but it can decrease renal blood flow in low output\\u000a states. Warfarin may be used in patients with advancing heartfailure due to the perceived risk of in situ thromboembolism.
Several structural and functional changes contribute to heartfailure in elderly patients: an age dependent increase in sympathetic nervous activity, left ventricular wall diameter, myocardial fibrosis and apoptosis, micro- and macrovascular coronary sclerosis, aortic stiffness. As a consequence, diastolic, but also systolic heartfailure is a frequent finding in elderly patients. The relation of systolic to diastolic heartfailure is clearly shifted towards diastolic heartfailure in elderly patients, especially in women. Mortality is increased with systolic dysfunction in elderly patients compared to younger heartfailure patients. Mortality is less with diastolic dysfunction, but still higher compared to elderly without heartfailure. In addition, morbidity is increased both with diastolic and systolic heartfailure in elderly patients. Cognitive dysfunction is a frequent finding. After exclusion of specific cardiac and extracardiac reasons for dyspnoea, drug therapy of systolic heartfailure in elderly is similar to younger patients. However, the physiological decrease of renal function and the more frequent renal impairment in elderly patients with heartfailure needs to be considered. Guideline recommendations for drug therapy are based in most cases on studies conducted in younger systolic heartfailure patients. A recent meta-analysis of randomized beta-blocker trials suggests improved survival with beta-blockers even in the elderly subgroup. Guidelines for the treatment of diastolic heartfailure are available only recently. The term heartfailure with normal left ventricular ejection fraction (LVEF) has been proposed instead of diastolic heartfailure. Given the increased morbidity and mortality in elderly patients with heartfailure and normal LVEF, therapy should include general measures, such as physical activity, weight reduction, volume restriction. Specific therapy includes optimal control of systolic and diastolic blood pressure, diuretics, nitrates, and frequency-control. However, randomized trials evaluating the efficacy of specific therapies in heartfailure with normal LVEF are still missing. PMID:16621389
We examined the influence of phosphodiesterase inhibitors (PDIs) on mortality in patients with overt chronic heartfailure. A total of 13 randomised, placebocontrolled trials of PDIs involving 2808 patients were selected.
P. Nony; J.-P. Boissel; M. Lievre; A. Leizorovicz; M. C. Haugh; S. Fareh; B. Breyne
Diastolic heartfailure, which is also called as heartfailure with preserved ejection fraction, is a clinical syndrome in which patients have signs and symptoms of heartfailure, normal or near normal left ventricular ejection fraction (? 50%) and evidence of diastolic dysfunction. Recent epidemiological studies have demonstrated that more than half of all heartfailure patients have diastolic heartfailure. The syndrome is more common in women than in men and the prevalence increases with age. Patients with diastolic heartfailure form a fairly heterogeneous group with complex pathophysiologic mechanisms. The disease is often in association with other comorbidities, such as hypertension, diabetes mellitus or obesity. The diagnosis of diastolic heartfailure is best achieved by two-dimensional and Doppler echocardiography, which can detect abnormal myocardial relaxation, decreased compliance and increased filling pressure in the setting of normal left ventricular dimensions and preserved ejection fraction. Unlike heartfailure with reduced ejection fraction, there is no such an evidence-based treatment for heartfailure with preserved ejection fraction, which would improve clinical outcomes. Thus, pharmacological therapy of diastolic heartfailure is based mainly on empiric data, and aims to the normalization of blood pressure, reduction of left ventricular dimensions and increased heart rate, maintenance of normal atrial contraction and treatment of symptoms caused by congestion. Beneficial effects of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers may be utilized in patients with diastolic dysfunction, especially in those with hypertension. Beta-blockers appear to be useful in lowering heart rate and thereby prolonging left ventricular diastolic filling time, while diuretic therapy is the mainstay of treatment for preventing pulmonary congestion. Nonetheless, treatment of the underlying disease is also an important therapeutic approach. This review summarizes the state of current knowledge with regard to diastolic heartfailure. PMID:23248058
Czuriga, István; Borbély, Attila; Czuriga, Dániel; Papp, Zoltán; Edes, István
Background: Though cardiac involvement is common in acromegaly, overt congestive heartfailure is uncommon. Materials and Methods: This is retrospective analysis of hospital record between 1996 and 2007. We analyzed records of 150 consecutive patients with acromegaly. We included the patients with acromegaly those who had overt congestive heartfailure either at presentation or during the course of illness for the present analysis. The diagnosis of acromegaly and congestive cardiac failure were based on standard criteria. Results: Out of 150 patients with acromegaly, 6 patients had overt CHF (4.0%), of which 4 presented with the features of CHF and 2 developed during the course of illness. Three patients had hypertension and 1 had diabetes. Baseline echocardiography showed severe biventricular dysfunction and global hypokinesia in all. Angiography showed dilated hypokinetic left ventricle with normal coronaries in 3, it was confirmed at autopsy in 1. Three underwent trans-sphenoidal surgery, 1 received somatostatin analogue as primary treatment modality. Normalization of growth hormone and IGF-1 led to improvement in cardiac function in 1, 1 patient lost to follow up, and 4 died during the course of illness. In 1 patient, autopsy was performed and cardiac specimen revealed normal coronaries, concentric ventricular hypertrophy, and dilatation with myofibrolysis and interfascicular fibrosis. Conclusion: Prevalence of overt CHF is 4% in present series. Overt CHF carries poor prognosis and hence, this complication should be recognized at earliest, and medical management to normalized cardiac function should be given utmost priority.
Dutta, P.; Das, S.; Bhansali, A.; Bhadada, S. K.; Rajesh, B. V.; Reddy, K. S.; Vaiphei, K.; Mukherjee, K. K.; Pathak, A.; Shah, V. N.
In patients with hypertension, pressure overload leads to left ventricular hypertrophy (LVH), myocardial fibrosis, and impaired\\u000a diastolic filling without systolic dysfunction. Presently, diastolic heartfailure accounts for about 50% of the heartfailure\\u000a population. Fatigue, dyspnea, reduced exercise tolerance, and peripheral edema are common presenting complaints. As a group,\\u000a patients with diastolic heartfailure are older and predominantly female. Diuretics
Biomarker testing in patients with heartfailure (HF) is rapidly expanding. With high-quality research indicating its diagnostic and prognostic capabilities, biomarkers are excellent adjuncts to manage patients with HF. Their superiority lies mainly in their reflection of ongoing pathophysiological events at a cellular level. Monitoring biomarker levels has been shown to provide incremental information on the progression of disease, thus allowing to better tailor treatment and management. Several biomarkers have gained attention in the past decade and continuing research demonstrates the specificity of each biomarker to be used on its own or in combination to improve diagnostic accuracy. This review will provide an insight into the role of such biomarkers, which are widely studied in the setting of HF so as to delineate their role in diagnosing, prognosticating, and titrating HF therapy. PMID:23604646
Diagnosis of heartfailure is increasingly prevalent. Each year, 550,000 new cases are anticipated. To provide quality outcomes, nurses and physicians must understand the etiology and pathophysiology of heartfailure. Research into heartfailure provides information about treatment and drug therapies that reduce heartfailure symptoms and improve quality of life. PACU nurses care for heartfailure patients in various
More than 50% of people living with congestive heartfailure have diastolic heartfailure (DHF). Most of them are older than 70 years, and female. The prevalence of DHF has increased with time. DHF is caused by left ventricular (LV) diastolic dysfunction (DD) which is induced by diastolic dyssynchrony. Cardiac and extra- cardiac factors play important roles in the development
Nitrates are drugs of first choice in patients with acute heartfailure. Acute pulmonary edema can be successfully treated with single or repeated doses of sublingual nitroglycerin. In cases of prolonged acute heartfailure, e.g. in the setting of acute myocardial infarction, nitroglycerin or isosorbide dinitrate can be given by the intravenous route for up to 24 h. Patients with
Wolfgang Schneider; Wulf-Dirk Bussmann; Andreas Hartmann; Martin Kaltenbach
Echocardiography has the ability to noninvasively explore hemodynamic variables during pharmacologic or exercise stress test in patients with heartfailure. In this review, we detail some important potential applications of stress echocardiography in patients with heartfailure. In patients with coronary artery disease and chronic LV dysfunction, dobutamine stress echocardiography is able to distinguish between viable and fibrotic tissue to
Eustachio Agricola; Michele Oppizzi; Matteo Pisani; Alberto Margonato
Most patients with chronic heartfailure (CHF) can safely engage in sexual activity and be treated for erectile dysfunction with sildenafil, provided that they do not have active coronary ischemia and do not require treatment with nitrates. Clinicians should know the physiological requirements for sexual activity and the impact chronic heartfailure has on sexual performance. Fear of cardiac events during intercourse can interfere with patients' ability to perform and enjoy sex, and thus, it is important that the physician be able to counsel patients with chronic heartfailure about sexual activity. PMID:18476642
Sekoranja, L; Bianchi-Demicheli, F; Gaspoz, J M; Mach, F
As the U.S. population ages, the prevalence of geriatric conditions in patients with heartfailure is increasing, although they currently fall outside the traditional heartfailure disease model. In this review, we describe the co-occurrence of four common geriatric conditions (cognitive impairment, frailty, falls, and incontinence) in older adults with heartfailure, their mechanisms of interaction, and their association with outcomes. We propose a new paradigm to meet the needs of the aging heartfailure population that includes comprehensive assessment of geriatric conditions and tailoring of therapy and surveillance accordingly. Coordination among relevant disciplines such as cardiology and geriatrics may facilitate this transition. Further research is needed in order to understand how to optimize care for patients with specific impairments in order to improve outcomes.
Heartfailure patients account for a hefty proportion of readmissions, so hospitals are refining their discharge processes, boosting education for patients and caregivers, and sending community health workers to their homes. PMID:23814952
Therapeutic patient education (TPE) has proved to be beneficial in a number of chronic diseases such as diabetes, asthma, chronic kidney failure. A TPE unit has been set up in Marie-Madeleine hospital in Forbach. In order to improve the actions carried out with patients with heartfailure undergoing treatment, a satisfaction survey was carried out with this group of patients. PMID:22641945
Heartfailure is a major health problem, and is one of the few cardiovascular diseases that increased its prevalence over the last decade. Increased heart rate, generally observed in patients with heartfailure, is involved in the deterioration of cardiac pump function. However, the effects of ’pure’ heart rate reduction on the progression of heartfailure are unknown. In a
Heartfailure is a common and costly medical condition. Ischemic heart disease and hypertension account for most cases of heartfailure 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 heartfailure patients by
1. The increasing burden of heartfailure is a result of the aging population and improvements in cardiac care. It is estimated that 660,000 new cases of heartfailure are diagnosed every year in the United States. 2. Heartfailure with normal ejection fraction (HFNEF) is part of a single entity of heartfailure that includes also heartfailure with
Marco Metra; Valerio Zaca; Savina Nodari; Livio Dei Cas
The classification of myocardial diseases, proposed by the WHO/ISFC task force in 1980, distinguishes specific heart muscle diseases from myocardial diseases of unknown origin, termed cardiomyopathies. In this article, specific heart muscle diseases caused by metabolic disturbances are reviewed. The disorders were categorized into 4 types: 1. endocrine disorders; 2. storage or infiltration disorders, such as amyloidosis, hemochromatosis and familial storage disorders; 3. nutritional disorders, such as Kwashiorkor, beri-beri, obesity and alcoholic and electrolyte disorders; and 4. Diabetic heart. Since the first type disorders have been covered by a separate review, the other 3 types were covered in this article. A common clinical picture of these disorders is chronic congestive heartfailure. The pathogenesis and laboratory findings of these disorders are briefly discussed. PMID:8331805
Clinical management of refractory heartfailure remains challenging, with a high rate of rehospitalizations despite advances in medical and device therapy. Care can be provided in person, via telehomecare (by telephone), or telemonitoring, which involves wireless technology for remote follow-up. Telemonitoring wirelessly transmits parameters such as weight, heart rate, or blood pressure for review by health-care professionals. Cardiac implantable devices (defibrillators and cardiac resynchronization therapy) also transmit continually interrogated physiological data, such as heart rate variability or intrathoracic impedance, which may be of value to predict patients at greater risk of hospitalization for heartfailure. The use of remote monitoring techniques facilitates a rapid and regular review of such data by health-care workers as part of a heartfailure management programme. Current evidence supports the feasibility of such an approach but routinely assessed parameters have been shown not to impact patient outcomes. Devices that directly assess cardiac haemodynamic status through invasive measurement of pressures are currently under investigation and could potentially increase the sensitivity and specificity of predicting heartfailure events. The current evidence for telemonitoring and remote monitoring, including implantable haemodynamic devices, will be reviewed. PMID:21289040
Heartfailure 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 heartfailure 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 heartfailure. 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.
Pachydermoperiostosis or primary hypertrophic osteoarthropathy is an uncommon disease of acromegaloid facial feature, but characterized by unique phenotype (digital clubbing and pachydermia) and distinctive radiographic appearances like periostosis. We experienced a case with complete form of pachydermoperiostosis accompanied by heartfailure. He presented with typical features consisting of clubbing with enlargement of the hand, thickening of facial skin and periosteal new bone formation involving lower leg. Echocardiography revealed severely decreased left ventricular systolic function. Treatment with medications resulted in an improvement of cardiac function and symptom. There is no previous report documenting pachydermoperiostosis accompanied by heartfailure. We report that case for the first time.
Shin, Kwen-Chul; Lee, Ki Young; Shin, Mi-Seung; Kim, Sei-Hyun; Jo, Yun Jeong; Park, Yae Min; Ahn, Tae Hoon; Choi, In Suk; Shin, Eak Kyun
The significant increase in the prevalence of heartfailure in the United States has made this disease a major health problem. The continued shortage of donor organs has prevented heart transplantation from becoming an effective solution for the treatment of end-stage heartfailure, and as a result, surgical treatments for heartfailure have been reexamined. Surgical therapies represent the evolution
Richard Lee; Katherine J. Hoercher; Patrick M. McCarthy
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 heartfailure. Adults with congenital heart disease develop heartfailure as a consequence of: (1) chronic cyanosis, volume overload,
Anemia is common in congestive heartfailure (CHF) and is associated with an increased mortality and morbidity. The most likely causes of anemia are chronic kidney disease (CKD) and excessive cytokine production, both of which can cause depression of erythropoietin (EPO) production and bone marrow activity. The cytokines also induce iron deficiency by both reducing gastrointestinal iron absorption and iron
Donald S. Silverberg; Dov Wexler; Alberto Palazzuoli; Adrian Iaina; Doron Schwartz
With increasing knowledge of basic molecular mechanisms governing the development of heartfailure (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
Congestive heartfailure (CHF) is the final clinical manifestation of a variety of cardiac (myopathies), coronary (atherosclerosis), and systemic diseases (diabetes, hypertension). Regardless of the origin of the cardiac insult, left ventricular dysfunction resulting in decreased cardiac output elicits a series of adaptational processes that attempt to compensate for some of the decrement in myocardial function. One of the key
Normal cardiac function requires high and continuous supply with ATP. As mitochondria are the major source of ATP production, it is apparent that mitochondrial function and cardiac function need to be closely related to each other. When subjected to overload, the heart hypertrophies. Initially, the development of hypertrophy is a compensatory mechanism, and contractile function is maintained. However, when the heart is excessively and/or persistently stressed, cardiac function may deteriorate, leading to the onset of heartfailure. There is considerable evidence that alterations in mitochondrial function are involved in the decompensation of cardiac hypertrophy. Here, we review metabolic changes occurring at the mitochondrial level during the development of cardiac hypertrophy and the transition to heartfailure. We will focus on changes in mitochondrial substrate metabolism, the electron transport chain and the role of oxidative stress. We will demonstrate that, with respect to mitochondrial adaptations, a clear distinction between hypertrophy and heartfailure cannot be made because most of the findings present in overtheartfailure can already be found in the various stages of hypertrophy. PMID:22968404
Osterholt, Moritz; Nguyen, T Dung; Schwarzer, Michael; Doenst, Torsten
Epidemiological and experimental studies have documented both the rising burden of diastolic heartfailure (DHF) and several mechanisms that distinguish this disease from systolic heartfailure (SHF). Controversies continue to surround the term 'DHF' as well as its existence as a pathophysiological entity distinct from SHF. Approximately half of all patients who present with heartfailure have near-normal systolic function
PURPOSE: Anemia is an important comorbidity in heartfailure and has been associated with increased mortality. The goals of this study were to define the prevalence of anemia in a community population with heartfailure, examine trends in prevalence over time, and evaluate the role of anemia in patients with heartfailure with preserved and reduced ejection fraction. METHODS: Two
Shannon M. Dunlay; Susan A. Weston; Margaret M. Redfield; Jill M. Killian; Véronique L. Roger
Heartfailure patients often develop cachexia, which is an independent factor for survival reduction. Cachexia can be diagnosed when there is loss of more than 6% of the body weight, in the absence of other diseases. Even though its pathophysiology has not yet been completely clarified, various factors seem to be involved, such as reduction in food consumption, gastrointestinal tract abnormalities, immunologic and neuro-hormonal activation and changes in the relationship between anabolic and catabolic processes. Since there is not specific therapy for heartfailure-induced cachexia, management is based on nutritional support, neuro-hormonal blockade, control of edema and anemia and exercise. Drugs with anabolic and immunomodulating properties are being evaluated and clinical and non-clinical trials. PMID:23568095
Okoshi, Marina Politi; Romeiro, Fernando G; Paiva, Sergio A R; Okoshi, Katashi
\\u000a Symptoms of pulmonary congestion, resulting from elevated left atrial and left ventricular filling pressures, are the most\\u000a common cause of heartfailure hospitalization. The basic goals of HF therapy are therefore grounded in improving congestion,\\u000a thereby decreasing hospitalizations and improving outcomes and quality of life in patients with HF. Ongoing evaluation of\\u000a the patient’s volume status is vital for appropriate
Androgen deficiency is a hormonal disorder that is frequently observed in advanced chronic conditions. A reduction of androgen\\u000a blood levels may be cause or consequence of the disease, or both. Typical symptoms, such as fatigue or muscle weakness, may\\u000a be particularly aggravated in heartfailure, and disease severity may be indirectly affected by low levels of androgen. Recently,\\u000a androgen replacement
Gülmisal Güder; Bruno Allolio; Christiane E. Angermann; Stefan Störk
\\u000a Heartfailure (HF) is a complex clinical syndrome whose pathogenesis involves an interplay of neurohormonal activation and\\u000a inflammatory processes at the cellular and molecular levels. Oxidative stress describes an imbalance between antioxidant defense\\u000a and the production of reactive oxygen species (ROS), which at high levels cause cell damage but at lower levels induce subtle\\u000a changes in intracellular signaling pathways. Substantial
Congestion is a major component of the clinical syndrome of heartfailure, and diuretic therapy remains the cornerstone of\\u000a congestion management. Despite being widely used, there is very limited evidence from prospective randomized studies to guide\\u000a the prescription and titration of diuretics. A thorough understanding of the pharmacology of loop diuretics is crucial to\\u000a the optimal use of these agents.
The endothelin (ET) family of peptides have potent vascular, cardiac and renal actions which may be of pathophysiological importance in congestive heartfailure (CHF).In vivo studies with selective and non-selective ET receptor antagonists (11, 12) are required to clarify the role of ET in the pathophysiology of CHF and determine whether anti-ET drugs may be therapeutically useful in CHF. The
Non-adherence with medical regimens in heartfailure 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,
Insomnia is highly prevalent in patients with chronic disease including chronic heartfailure (CHF) and is a significant contributing\\u000a factor to fatigue and poor quality of life. The pathophysiology of CHF often leads to fatigue, due to nocturnal symptoms causing\\u000a sleep disruption, including cough, orthopnea, paroxysmal nocturnal dyspnea, and nocturia. Inadequate cardiac function may\\u000a lead to hypoxemia or poor perfusion
Don Hayes; Michael I. Anstead; Julia Ho; Barbara A. Phillips
Chronic heartfailure (CHF) is a common condition with a poor prognosis. It is associated with poor exercise tolerance and debilitating symptoms. These symptoms appear to be associated with pathophysiological changes that occur systemically in the patient with CHF. Exercise training in carefully selected patients has been shown to be safe and to improve exercise capacity. Many of the pathophysiological abnormalities of CHF are improved by training. Some studies have suggested a possible improvement in morbidity and mortality with training. This review analyzes the controlled clinical trials of exercise training in CHF published to date.
Tolvaptan is the first FDA-approved oral V2 receptor antagonist for the treatment of euvolemic and hypervolemic hyponatremia, in patients with conditions associated with free water excess such as heartfailure, cirrhosis, and the syndrome of inappropriate antidiuretic hormone secretion. Tolvaptan inhibits the binding of arginine vasopressin to the V2 receptors on the collecting ducts of the kidneys resulting in aquaresis, the electrolytes sparing excretion of water. This article reviews the accumulated experience with tolvaptan and all the major clinical trials that were conducted to study its safety and efficacy and concludes by summarizing clinicians’ views of its current application in clinical practice.
Zmily, Hammam D; Daifallah, Suleiman; Ghali, Jalal K
Anemia is a common finding among patients with chronic heartfailure. Although co-morbidities, such as kidney failure, might contribute to the pathogenesis of anemia, many patients with heartfailure do not have any other obvious etiology for their anemia. We investigated whether anemia in heartfailure 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 heartfailure and in control subjects. We found that the concentration of hepcidin was lower in urine samples of patients with heartfailure compared to those of control subjects. Serum hepcidin was also reduced in heartfailure but was not significantly lower than that in controls. There were no significant differences between hepcidin levels in patients with heartfailure and anemia compared to patients with heartfailure and normal hemoglobin. We concluded that hepcidin probably does not play a major role in pathogenesis of anemia in patients with chronic heartfailure.
Divakaran, Vijay; Mehta, Sachin; Yao, David; Hassan, Saamir; Simpson, Steven; Wiegerinck, Erwin; Swinkels, Dorine W.; Mann, Douglas L.; Afshar-Kharghan, Vahid
Metformin is associated with decreased mortality and morbidity in stable heartfailure patients with diabetes mellitus type II. Diabetic heartfailure patients with elevated systolic blood pressure are at increased risk for developing acute decompensated heartfailure, which is often associated with decreased kidney function. Metformin-associated lactic acidosis is a rare but fatal side effect that may occur when kidney function is decreased. During acute decompensated heartfailure, timely treatment may prevent the decrease in kidney function to the threshold associated with an increased risk of metformin-associated lactic acidosis. Metformin should not be withheld in diabetic patients with stable heartfailure who do not have other risk factors for acute decompensated heartfailure or lactic acidosis. PMID:18708828
Nitrates are drugs of first choice in patients with acute heartfailure. Acute pulmonary edema can be successfully treated with single or repeated doses of sublingual nitroglycerin. In cases of prolonged acute heartfailure, e.g. in the setting of acute myocardial infarction, nitroglycerin or isosorbide dinitrate can be given by the intravenous route for up to 24 h. Patients with acute myocardial infarction usually benefit from nitrate therapy if filling pressures are high and/or left ventricular function is compromised. Nitrate therapy can be considered safe if arterial blood pressure is maintained above 95 mm Hg. With these precautions nitrates can reduce infarct size and the incidence of complications as well as improve long-term prognosis. In the chronic treatment concern has risen with regard to possible nitrate tolerance. Thus, therapy schedules allowing for nitrate-poor phases are generally recommended. Therapy schedules with constant-rate delivery of drugs achieved with patches or intravenous administration of nitrates should be used with caution. PMID:1760830
Schneider, W; Bussmann, W D; Hartmann, A; Kaltenbach, M
Acute heartfailure 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 heartfailure or whether mechanisms in common to both play a more\\u000a prominent role in acute heartfailure
Despite tremendous advances in the medical management of congestive heartfailure the gold standard for the treatment of end\\u000a stage congestive heartfailure remains cardiac transplantation. The acknowledged critical limitation of sufficient suitable\\u000a organ donors has resulted in the refinement and development of novel surgical alternatives for the treatment of congestive\\u000a heartfailure. These approaches include the extension of current
Daniel J. Goldstein; Douglas Smego; Robert E. Michler
Opinion statement Both acute and chronic systolic heartfailure can progress to an advanced phase, resulting in stage D heartfailure and even\\u000a cardiogenic shock. Despite significant progress in the treatment of systolic heartfailure using medical and device therapies,\\u000a this terminal phase continues to be prevalent and associated with unacceptably high morbidity and mortality. Given the inability\\u000a to offer cardiac
Chetan B. Patel; Kevin M. Alexander; Joseph G. Rogers
Opinion statement Systemic and pulmonary congestion is a central aspect of both acute and chronic heartfailure and directly leads to many of\\u000a the clinical manifestations of these syndromes. Therefore, diuretic therapy to treat congestion plays a fundamental role in\\u000a heartfailure management. However, although diuretics are the most common drugs prescribed for heartfailure, there is limited\\u000a quality evidence to
The prevalence of heartfailure and overactive bladder, both of which are already quite common, will continue to increase\\u000a as the population ages. Both create caregiver and self-management burdens, but additional research is needed to understand\\u000a the burden overactive bladder creates for heartfailure patients and their caregivers. Emerging evidence suggests a relationship\\u000a between heartfailure and overactive bladder in
Plasma lipid peroxides (malondialdehyde) and thiols were measured in 45 patients with congestive heartfailure and 45 controls. Malondialdehyde concentrations were significantly higher in the patients with congestive heartfailure (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 heartfailure (median 420 mumol\\/l (IQR 379-480))
Objective To identify the health beliefs, attitudes, practices and social and family relations important in heartfailure treatment among Pacific Islanders. Methods Four focus groups were convened with 36 Native Hawaiians and Samoans with heartfailure 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 heartfailure care. Results Common coping styles and emotional experiences of heartfailure 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 heartfailure care. Barriers to heartfailure care included poor knowledge of heartfailure, 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 heartfailure 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 heartfailure 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.
Kaholokula, Joseph Keawe'aimoku; Saito, Erin; Mau, Marjorie K.; Latimer, Renee; Seto, Todd B.
Twelve infants with heartfailure and one with perinatal oedema were treated with intramuscular frusemide (1·0-1·25 mg/kg). Frusemide was found to be a safe effective diuretic in infants with heartfailure, resulting in clinical improvement, marked excretion of water, sodium, and chloride, with a lesser and more variable effect on potassium excretion. Complications were uncommon with this dose. The drug is most effective in acute pulmonary oedema or acute worsening of heartfailure, but day-to-day control of persistent heartfailure is more easily obtained by using repeated doses of oral or intramuscular frusemide plus, if needed, aldactone A or triamterene.
BACKGROUND: Since previous studies suggest the emergency department (ED) misdiagnosis rate of heartfailure is 10–20% we sought to describe the characteristics of ED patients misdiagnosed as non-decompensated heartfailure in the ED. METHODS: We analyzed a prospective convenience sample of 439 patients at 4 emergency departments who presented with signs or symptoms of decompensated heartfailure. Patients with a
Sean P Collins; Christopher J Lindsell; W Frank Peacock; Daniel C Eckert; Jeff Askew; Alan B Storrow
Aims Here, the aim is to study the management of octogenarians hospitalized for heartfailure in Euro HeartFailure Survey I. HeartFailure (HF) is common in older people and associated with poor outcome. Methods and results We compared clinical characteristics, treatment, and short-term outcomes in 2780 octogenarians (group A, median age 85 years) and in 7912 younger patients (group
Michel Komajda; Olivier Hanon; Matthias Hochadel; Ferenc Follath; Karl Swedberg; Anselm Gitt; John G. F. Cleland
Chronic heartfailure (CHF) is a syndrome precipitated by inadequate cardiac output and neurohormonal activation, leading to sodium and water retention. With increasing prevalence of CHF, heartfailure nurse specialists (HFNS) are becoming involved in collaborative models of care in community and outpatient settings.Diuretic therapy in both acute and chronic heartfailure is effective in relieving symptoms of congestion and
Patricia Davidson; Peter Macdonald; Glenn Paull; David Rees; Laurence Howes; Jill Cockburn; Mark Brown
Aims To determine the effect of an integrated heartfailure management programme, involving patient and family, primary and secondary care, on quality of life and death or hospital readmissions in patients with chronic heartfailure. Methods and Results This trial was a cluster randomized, controlled trial of integrated primary\\/secondary care com- pared with usual care for patients with heartfailure.
R. N. Doughty; S. P. Wright; A. Pearl; H. J. Walsh; S. Muncaster; G. A. Whalley; G. Gamble; N. Sharpe
In patients with chronic but stable heartfailure (HF) exercise training is a recommended and widely accepted adjunct to an evidence-based management involving pharmacological and non-pharmacological therapies. Various pathophysiological mechanisms, such as central hemodynamics, vasculature, ventilation, skeletal muscle function as well as neurohormonal activation and inflammation are responsible for exercise intolerance described in HF patients. There is sufficient and growing evidence that exercise training in HF with reduced (HFrEF) and with preserved ejection fraction (HFpEF) is effective in improving exercise capacity, HF symptoms and quality of life. The positive effects of exercise training in HF are mediated by an improvement of central hemodynamics, endothelial function, inflammatory markers, neurohumoral activation, as well as skeletal muscle structure and function. In contrast to convincing data from a large meta-analysis, the large HF-ACTION study (HeartFailure-A Controlled Trial Investigating Outcomes of exercise TraiNing) only demonstrated a modest improvement of all cause mortality and hospitalizations in HFrEF. Outcome data in HFpEF are lacking. Whether interval training incorporating variable and higher intensities or the addition of resistance exercise to a standard aerobic prescription is superior in improving clinical status of HF patients is currently being examined. Despite increasing validation of the potential of exercise training in chronic HF, challenges remain in the routine therapeutic application, including interdisciplinary management, financing of long-term exercise programs and the need to improve short-term and long-term adherence to exercise training. PMID:23934196
Heartfailure (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 cyclic AMP-mediated mechanism by which increased adrenergic stimulation contributes to the mitochondrial dysfunction. PMID:22948484
Heartfailure (HF) carries a major burden of disease in East Asia, with high associated risk of mortality and morbidity. In recent decades, the epidemiology of HF has changed with social and economical development in East Asia. The burden of HF is still severe in East Asia. The prevalence of HF ranges from 1.3% to 6.7% throughout the region. As aetiological factors, ischaemic heart disease has increased and valvular disease reduced in most East Asian countries. Diuretics are the most commonly used drugs (51.0%-97%), followed by renin-angiotensin system (RAS) inhibitors (59%-77%), with angiotensin-converting enzyme inhibitors, ACEI, (32%-52%) and has angiotensin-2 receptor blockers, ARBs (31%-44%) in similar proportions. Betablocker use has also increased in recent years. Total mortality from HF ranges from 2% to 9% in China, Taiwan, Singapore, Thailand, and Japan. Age>65 years, diabetes mellitus, anaemia, renal dysfunction and atrial fibrillation (AF) are associated with adverse outcome. More prospective, region-specific data are still required, particularly regarding new drug therapies such as eplerenone and ivabradine. PMID:23597295
Background: Most patients with heartfailure due to left ventricular systolic dysfunction (LVSD) secondary to coronary artery disease (CAD) have evidence of myocardium in jeopardy (reversible ischaemia andyor stunning hibernation). It is not known whether revascularisation in such cases is safe or beneficial. Aims: To determine whether revascularisation will improve the survival of patients with LVSD and heartfailure secondary
J. G. F. Cleland; N. Freemantle; S. G. Ball; R. S. Bonser; P. Camici; S. Chattopadhyay; D. Dutka; J. Eastaugh; J. Hampton; M. S. Norell; D. J. Pennell; J. Pepper; S. Sanda; R. Senior; D. Smithm
Increased intracardiac filling pressure or congestion causes symptoms and leads to hospital admissions in patients with heartfailure, regardless of their systolic function. A history of hospital admission, in turn, predicts further hospitalizations and morbidity, and a higher number of hospitalizations determine higher mortality. Congestion is therefore the driving force of the natural history of heartfailure. Congestion is the syndrome shared by heartfailure with preserved and reduced systolic function. These two conditions have almost identical morbidity, mortality, and survival because the outcomes are driven by congestion. A small difference in favor of heartfailure with preserved systolic function comes from decreased ejection fraction and left ventricular remodeling which is only present in heartfailure with decreased systolic function. The magnitude of this difference reflects the contribution of decreased systolic function and ventricular remodeling to the progression of heartfailure. The only treatment available for congestion is fluid removal via diuretics, ultrafiltration, or dialysis. It is the only treatment that works equally well for heartfailure with reduced and preserved systolic function because it affects congestion, the main pathogenetic feature of the disease. Diuretics are pathogenetic therapy for heartfailure.
Using a case history to illustrate key points, this article (1) highlights depression criteria, prevalence, and later-life depression presentations; (2) discusses factors contributing to later-life depression; (3) reviews the interplay between heartfailure and later-life depression; and (4) suggests screening and treatment recommendations for depression in patients with heartfailure. PMID:21109207
Maixner, Susan M; Struble, Laura; Blazek, Mary; Kales, Helen C
Summary The number of patients with heartfailure has steadily increased during recent decades and the cost of frequent hospitalizations has had a strong economic impact on health care services. The compliance and education in heartfailure patients are poor, and only a small proportion of the patients are on optimal therapy. Therefore, it is justified to build up specific
Chronic obstructive pulmonary disease (COPD) is commonly associated with heartfailure. Individuals with COPD have a 4.5-fold greater risk of developing heartfailure than those without. The sensitivity and specificity of clinical judgment in the diagnosis of heartfailure in patients with COPD can be enhanced by biological markers such as B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Correct interpretation of imaging results (mainly echocardiographic findings) and lung function tests can also help establish the co-occurrence of both conditions. There is little evidence on the management of patients with COPD and heartfailure, although treatment of COPD undeniably affects the clinical course of patients with heartfailure and viceversa. PMID:19595494
Villar Alvarez, Felipe; Méndez Bailón, Manuel; de Miguel Díez, Javier
Medical therapy for heartfailure is quickly advancing, but long-term survival unfortunately remains poor. New surgical techniques\\u000a seek to halt and reverse the progression of heartfailure. Positron emission tomography has refined patient selection techniques\\u000a for coronary artery bypass grafting in the failing heart. Left ventricular (LV) remodeling surgery and new devices change\\u000a the shape of the LV and decrease
\\u000a An Expert Panel was convened in the Winnipeg 2001 Heart Congress to examine heartfailure recovery mechanisms after mechanical\\u000a circulatory support. The Expert Panel consisted of leading researchers, and clinicians knowledgeable in the use of mechanical\\u000a circulatory support devices, and focused on heartfailure recovery mechanisms at the gene, cell, organ and patient levels\\u000a after prolonged mechanical circulatory support. Views
Tofy Mussivand; Paul Heerdt; Kenneth B. Margulies; O. Howard Frazier; Gurmeet Singh; Hideo A. Baba
The concept of “diastolic” heartfailure grew out of the observation that many patients who have the symptoms and signs of heartfailure had an apparently normal left ventricular (LV) ejection fraction. Thus it was assumed that since systolic function was “preserved” the problem must lie in diastole, although it is not clear by whom or when this assumption was made. Nevertheless, many guidelines followed on how to diagnose “diastolic” heartfailure backed up by indicators of diastolic dysfunction derived from Doppler echoardiography. Diastolic heartfailure is associated with a lower annual mortality rate of approximately 8% as compared to annual mortality of 19% in heartfailure with systolic dysfunction, however, morbidity rate can be substantial. Thus, diastolic heartfailure is an important clinical disorder mainly seen in the elderly patients with hypertensive heart disease. Early recognition and appropriate therapy of diastolic dysfunction is advisable to prevent further progression to diastolic heartfailure and death. There is no specific therapy to improve LV diastolic function directly. Medical therapy of diastolic dysfunction is often empirical and lacks clear-cut pathophysiologic concepts. Nevertheless, there is growing evidence that calcium channel blockers, beta-blockers, ACE-inhibitors and ARB as well as nitric oxide donors can be beneficial. Treatment of the underlying disease is currently the most important therapeutic approach.
Common or sporadic systolic heartfailure (heartfailure) is the clinical syndrome of insufficient forward cardiac output resulting from myocardial disease. Most heartfailure is the consequence of ischemic or idiopathic cardiomyopathy. There is a clear familial predisposition to heartfailure, with a genetic component estimated to confer between 20 and 30% of overall risk. The multifactorial etiology of this syndrome has complicated identification of its genetic underpinnings. Until recently, almost all genetic studies of heartfailure were designed and deployed according to the common disease-common variant hypothesis, in which individual risk alleles impart a small positive or negative effect and overall genetic risk is the cumulative impact of all functional genetic variations. Early studies employed a candidate gene approach, focused mainly on factors within adrenergic and renin-angiotensin pathways that affect heartfailure progression and are targeted by standard pharmacotherapeutics. Many of these reported allelic associations with heartfailure have not been replicated. However, the preponderance of data support risk-modifier effects for the Arg389Gly polymorphism of ?1-adrenergic receptors and the intron 16 in/del polymorphism of angiotensin converting enzyme. Recent unbiased studies using genome-wide single nucleotide polymorphism (SNP) microarrays have shown fewer positive results than when these platforms were applied to hypertension, myocardial infarction, or diabetes, possibly reflecting the complex etiology of heartfailure. A new cardiovascular gene-centric sub-genome SNP array identified a common heat failure risk allele at 1p36 in multiple independent cohorts, but the biological mechanism for this association is still uncertain. It is likely that common gene polymorphisms account for only a fraction of individual genetic heartfailure risk, and future studies using deep resequencing are likely to identify rare gene variants with larger biological effects.
The present review analyses the mechanisms relating heartfailure and hyponatremia, describes the association of hyponatremia with the progress of disease and morbidity/mortality in heartfailure 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 heartfailure 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 heartfailure or outpatients with chronic heartfailure. Treatment options for hyponatremia in heartfailure, 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 heartfailure and hyponatremia have not been thoroughly examined.
Heartfailure (HF) has proven to be a major burden on the health system. The continuing prevalence of the condition and its rising associated costs and care, has amplified the need for earlier diagnosis, better risk stratification and cost-effective treatment to cut rates of hospitalization. Biomarkers seem poised to undertake such tasks, with biomarker management of patients with HF quickly evolving over the past several years. Biomarker guided diagnosis and treatment has become vital, especially during the acute setting in which the majority of patients with HF, were initially present. An adequate assessment of risk requires a multi-marker approach to a given HF patient. Established markers including brain natriuretic peptide and NT-proBNP are a significant clinical aid to physicians, though their utility is limited. In the past few years, momentous effort has been put into the discovery of new biomarkers. These endeavors have led to the emergence of several capable and promising biomarkers for HF management including troponins, mid-regional pro-adrenomedullin, GDF-15, C-reactive protein, Galectin-3, IL-6, ST-2, neutrophil gelatinase-associated lipocalin, copeptin and procalcitonin. This review will offer an insight into the novel biomarkers considered as the cutting-edge in the diagnosis and management of HF. PMID:23980627
Iqbal, Navaid; Alim, Khwaja Sami; Aramin, Hermineh; Iqbal, Fatima; Green, Erik; Higginbotham, Erin; Maisel, Alan S
Atrial fibrillation (AF) and heartfailure (HF) are two conditions widespread on the population, especially in elderly people. When AF and HF coexist in the same patient, as frequently happens, they trigger a vicious circle of mutual influence, who dramatically hesitates in lower quality of life and in increased mortality. The relationship between AF and HF is long and vigorously investigated: it is an ever-changing field of knowledge because alongside well known and proven results, especiallythe pathophysiological ones, there are new horizons of research since many aspects are still obscure. Hence, this limit is reflected in the complexity of the combined management of AF and HF in clinical practice. It also explains an ominous prognosis despite significant therapeutic advances. In this review we go over again the well-established knowledge about the pathophysiology binder HF and AF; we provide some epidemiological, clinical and therapeutic informations, we also highlight the new acquisitions, the new research areas and, finally, the still unresolved questions. PMID:20540402
With increasing knowledge of basic molecular mechanisms governing the development of heartfailure (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.
Vinge, Leif Erik; Raake, Philip W.; Koch, Walter J.
Despite the striking advances in medical and surgical therapy, the morbidity, mortality, and economic burden of heartfailure (HF) remain unacceptably high. There is increasing evidence that the risk and course of HF depend on genetic predisposition; however, the genetic contribution to HF is heterogeneous and complex. At one end of the spectrum are the familial monogenic HF syndromes in which causative mutations are rare but highly penetrant. At the other, HF susceptibility and course may be influenced by more common, less penetrant genetic variants. As detailed in this review, efforts to unravel the basis of the familial cardiomyopathies at the mendelian end of the spectrum already have begun to deliver on the promise of informative mechanisms, novel gene-based diagnostics, and therapies for distinct subtypes of HF. However, continued progress requires the differentiation of pathogenic mutations, disease modifiers, and rare, benign variants in the deluge of data emerging from increasingly accessible novel sequencing technologies. This represents a significant challenge and demands a sustained effort in analysis of extended family pedigrees, diligent clinical phenotyping, and systematic annotation of human genetic variation. PMID:23989711
Cahill, Thomas J; Ashrafian, Houman; Watkins, Hugh
Synopsis Atrial fibrillation and congestive heartfailure are morbid conditions that share common risk factors and frequently coexist. Each condition predisposes to the other, and the concomitant presence of the two identifies individuals at increased risk for mortality. Recent data have emerged which help elucidate the complex genetic and non-genetic pathophysiological mechanisms that contribute to the development of atrial fibrillation in individuals with congestive heartfailure. Clinical trial results offer insights into the noninvasive prevention and management of these conditions, though the emergence of newer technologies, such as catheter ablation for atrial fibrillation, have yet to be studied extensively in patients with congestive heartfailure.
Lubitz, Steven A.; Benjamin, Emelia J.; Ellinor, Patrick T.
Despite significant advancements in pharmacological therapy, mortality continues to remain high in patients with congestive\\u000a heartfailure (1). Much attention has been paid to optimization of pacing modalities for patients with left ventricular dysfunction when ventricular\\u000a pacing is required. Patients with congestive heartfailure frequently have symptomatic chronotropic incompetence, sinus node\\u000a dysfunction, or atrioventricular block, all of which are class
Purpose Anemia is an important comorbidity in heartfailure, and has been associated with increased mortality. The goals of this study were to define the prevalence of anemia in a community heartfailure population, examine trends in prevalence over time, and evaluate the role of anemia in heartfailure patients with preserved and reduced ejection fraction. Methods Two cohorts of Olmsted County residents with heartfailure were examined. The retrospective cohort included incident heartfailure cases from 1979–2002 (n=1063). The prospective cohort included active heartfailure cases from 2003–2006 (n=677). Clinical characteristics were collected. Anemia was defined by WHO criteria. Results The prevalence of anemia was 40% in the retrospective and 53% in the prospective cohorts. Anemia prevalence increased by an estimated 16% between 1979 and 2002 (p=0.008), and was higher in those with preserved (?50%), vs. reduced (<50%) ejection fraction (58% vs. 48%, respectively, p<0.001) from 2003–2006. Anemia was associated with a large increase in the risk of death (p<0.001 both cohorts). The relationship between mortality and hemoglobin followed a J-shaped curve, with increased mortality with hemoglobin below 14mg/dL and above 16mg/dL. In the prospective cohort, after adjustment for clinical characteristics, the HR(95%CI) for death were 3.07(1.26–6.82) in those with hemoglobin ?16mg/dL and 2.39(1.37–4.27) in those with hemoglobin<10mg/dL using hemoglobin 14–16mg/dL as the referent. Conclusions In the community half of heartfailure patients are anemic, and the prevalence of anemia increased over time. Anemia is more prevalent in heartfailure with preserved ejection fraction and is associated with a large increase in mortality.
Dunlay, Shannon M; Weston, Susan A.; Redfield, Margaret M.; Killian, Jill M.; Roger, Veronique L.
Although it is now widely recognized that isolated diastolic dysfunction can lead to the classic signs and symptoms of congestive\\u000a heartfailure (CHF), this disease process is poorly understood and remains of great interest and concern to cardiovascular\\u000a disease specialists, as well as to primary care physicians. Recent epidemiologic data have suggested that diastolic heart\\u000a failure is predominantly a disease
Heartfailure is becoming an increasing concern to healthcare worldwide. It is the only cardiovascular disorder that continues\\u000a to increase in both prevalence and incidence, and as the population continues to age, it is expected that the prevalence of\\u000a this disease will continue to rise. Guidelines on diagnosis and treatment of heartfailure are to be met.\\u000a \\u000a Most patients with
In the United States there are 4.9 million people with heartfailure, 50% of whom will be dead within 5 years. There are also\\u000a over 400 000 new cases reported annually , with approximately 43 000 deaths. The number of hospital admissions resulting from heartfailure approaches 900 000 per\\u000a annum and represents 20% of all admissions of patients over
The renin-angiotensin-aldosterone system plays an important role in the development of congestive heartfailure (CHF). In patients with chronic heartfailure, angiotensin-converting enzyme (ACE) inhibitors, such as captopril, enalapril, and quinapril, have been shown to improve hemodynamics, reduce symptoms of fatigue and dyspnea, increase exerkise capacity, correct hyponatremia, reduce diuretic requirements and ventricular arrhythmias, and conserve potassium and magnesium. ACE
In the modern era of pharmacologic treatment of erectile dysfunction, men with heart disease increasingly approach their physicians regarding the possibility of restoring sexual activity. At the same time, patients are also frequently aware of public figures that have reportedly died during coitus, often in the arms of their mistresses or prostitutes. Added to this is the perception of patients, and oftentimes their physicians, that coitus and orgasm are associated with a near maximal or even "supermaximal" cardiac workload and therefore may be hazardous for a diseased heart. Accordingly, knowledge of the cardiovascular effects of sexual activity, the risks of triggering a cardiovascular event, and the potential risks inherent in the use of drug therapy of male impotence is important to properly advise patients and their spouses regarding this sensitive issue. PMID:16959762
Kiowski, Wolfgang; Brunner, Hanspeter; Schalcher, Christoph
Advanced heartfailure is becoming an increasing cause of mortality and morbidity in a large number of patients. Heart transplantation is the treatment of choice for many selected patients in this group. According to the clinical status at the time of transplant, patients may have a different outcome related to the early survival, while the late results are similar and
Fabrizio De Vivo; Luca De Santo; Ciro Maiello; Claudio Marra; Joseph Marmo; Maurizio Cotrufo
Injury to the myocardium disrupts geometric integrity and results in changes to intracardiac pressure, wall stress and tension, and the pattern of blood flow through the heart. Significant disruption to pump function results in heartfailure which is defined in terms of symptoms: breathlessness and fatigue, signs of salt and water retention, and neurohormonal activation. This syndrome most commonly occurs
A retrospective study of 428 open heart operations showed the incidence of mild and severe renal failure to be 26% and 4·7% respectively. The mortality rate was 38% in the mild cases and 70% in the severe cases. Only half of the patients whose death was associated with renal failure showed macroscopic or microscopic renal lesions at necropsy. The patients
Ivabradine, a selective I f current inhibitor, decreasing the heart rate in those with sinus rhythm, has been added to the most recent European guidelines on heartfailure. It is indicated in addition to beta blockers in patients with decreased left ventricular ejection fraction and sinus rate of over 70 beats per minute. Several well-designed studies including the BEAUTIFUL and the SHIFT trials demonstrated clear benefits of ivabradine in symptomatic patients, both with angina and with heartfailure, with left ventricular systolic dysfunction. The main objective of this review is to provide a comprehensive summary of data on ivabradine, and to discuss the potential role of this new agent in the spectrum of modern therapeutics for heartfailure. PMID:22972475
Diastolic heartfailure occurs when signs and symptoms of heartfailure are present but left ventricular systolic function is preserved (i.e., ejection fraction greater than 45 percent). The incidence of diastolic heartfailure increases with age; therefore, 50 percent of older patients with heartfailure may have isolated diastolic dysfunction. With early diagnosis and proper management the prognosis of diastolic
CHHABI SATPATHY; TRINATH K. MISHRA; RUBY SATPATHY; HEMANT K. SATPATHY; EUGENE BARONE
The Acute Decompensated HEartFailure National REgistry (ADHERE®) confirms that the management of decompensated heartfailure is an emergency department (ED) problem, as more than 75% of patients admitted to the hospital with heartfailure arrive through the ED. This emphasizes the need for collaboration among emergency medicine, cardiology, nephrology, and hospitalists in the management of acute decompensated heartfailure.
Objectives. This study sought to determine the hemodynamic effects of oxygen therapy in heartfailure.Background. High dose oxygen has detrimental hemodynamic effects in normal subjects, yet oxygen is a common therapy for heartfailure. Whether oxygen alters hemodynamic variables in heartfailure is unknown.Methods. We studied 10 patients with New York Heart Association functional class III and IV congestive heart
Wasim A. Haque; John Boehmer; Barry S. Clemson; Urs A. Leuenberger; David H. Silber; Lawrence I. Sinoway
The derangement of the cardiac energy substrate metabolism plays a key role in the pathogenesis of heartfailure. The utilization of non-carbohydrate substrates, such as fatty acids, is the predominant metabolic pathway in the normal heart, because this provides the highest energy yield per molecule of substrate metabolized. In contrast, glucose becomes an important preferential substrate for metabolism and ATP generation under specific pathological conditions, because it can provide greater efficiency in producing high energy products per oxygen consumed compared to fatty acids. Manipulations that shift energy substrate utilization away from fatty acids toward glucose can improve the cardiac function and slow the progression of heartfailure. However, insulin resistance, which is highly prevalent in the heartfailure population, impedes this adaptive metabolic shift. Therefore, the acceleration of the glucose metabolism, along with the restoration of insulin sensitivity, would be the ideal metabolic therapy for heartfailure. This review discusses the therapeutic potential of modifying substrate utilization to optimize cardiac metabolism in heartfailure.
Nagoshi, Tomohisa; Yoshimura, Michihiro; Rosano, Giuseppe M. C; Lopaschuk, Gary D; Mochizuki, Seibu
These findings underscore the importance of understanding the complex interactions of multiple-organ systems in a chronic systemic disease state like congestive heartfailure. The exaggerated ventilatory response in patients with heartfailure is clearly multifactorial and it remains difficult to decipher whether this response results from or contributes to the sensation of dyspnea. Pulmonary dysfunction including ventilation-perfusion mismatching, decreased lung compliance, restriction, airway obstruction, decreased diffusion capacity, and decreases in respiratory muscle strength and endurance contribute to an inefficient breathing pattern and increased work of breathing. This is further compounded by the limited ability of the failing heart to meet the metabolic demands of the respiratory muscles, leading to under-perfusion and ischemia. This imbalance contributes to perceived dyspnea and exercise limitations. Understanding these physiologic cardiopulmonary interactions may lead to therapeutic modalities, such as respiratory muscle training, aimed at disrupting this intertwined cycle of events and improving functional capacity in patients with heartfailure. PMID:9559445
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 heartfailure. Here, we report that ankyrin-B levels are altered in both ischemic and non-ischemic human heartfailure. 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 heartfailure. 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 heartfailure, 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.
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.
The prognosis of heartfailure is worse than that of most cancers, but new therapeutic interventions using stem and other cell-based therapies are succeeding in the fight against it, and old drugs, with new twists, are making a comeback. Genetically engineered animal models are driving insights into the molecular mechanisms that cause hearts to fail, accelerating drug discoveries, and inspiring cell-based therapeutic interventions for both acquired and inheritable cardiac diseases.
This study reviewed 372 male patients with congestive heartfailure. Two hundred and eighty-three (77%) had congestive heartfailure due to systolic dysfunction as demonstrated by radionuclide angiography. Eighty-seven (23%) with congestive heartfailure were identified who had normal ejection fractions. All patients met the Framingham criteria for congestive heartfailure. These 87 individuals had unrecognized diastolic heartfailure. It is important to distinguish between systolic and diastolic heartfailure because the pathophysiology, treatment, and prognosis differ significantly. The most frequent cause of diastolic heartfailure in this study was hypertension. Diastolic dysfunction should be considered in patients with acute heartfailure and severe uncontrolled hypertension, or in patients with ischemic heart disease who develop acute pulmonary edema. Patients who do not respond or deteriorate when treated for heartfailure using conventional therapy may also have diastolic dysfunction. These patients warrant special recognition and tailored management.
Over the last decade, several studies were conducted on the gastrointestinal changes associated to chronic heartfailure. This article presents a literature review on the physiopathology and clinical consequences of pathological digestive changes of heartfailure patients. Structural and functional abnormalities of the gastrointestinal tract, such as edema of absorptive mucosa and intestinal bacterial overgrowth, have been leading to serious clinical consequences. Some of these consequences are cardiac cachexia, systemic inflammatory activation and anemia. These conditions, alone or in combination, may lead to worsening of the pre-existing ventricular dysfunction. Although currently there is no therapy specifically earmarked for gastrointestinal changes associated to heartfailure, the understanding of digestive abnormalities is germane for the prevention and management of systemic consequences. PMID:22527026
Romeiro, Fernando G; Okoshi, Katashi; Zornoff, Leonardo A M; Okoshi, Marina P
During the last 20 years, the management of heartfailure has significantly improved by means of new pharmacotherapies, more timely invasive treatments and device assisted therapies. Indeed, advances in mechanical support, namely with the development of more efficient left ventricular assist devices (LVAD), and the total artificial heart have reduced mortality and morbidity in patients with end-stage heartfailure awaiting for transplantation. However, the transplant cannot be the only solution, due to an insufficient number of available donors, but also because of the high number of patients who are not candidates for severe comorbidities or advanced age. New perspectives are emerging in which the VAD is no longer conceived only as a "Bridge to Transplant", but is now seen as a destination therapy. In this review, the main VAD classification, current basic indications, functioning modalities, main limitations of surgical VAD and the total artificial heart development are described. PMID:23985102
Heartfailure (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,
Despite the remarkable advances in cardiovascular therapeutics over the past four decades, little impact has been made on either the incidence or mortality rate of congestive heartfailure and it remains a major clinical and public health problem. Recent practice audits have suggested that proven efficacious therapies are not maximally applied in patients with this condition. An approach to the patient with congestive heartfailure is presented, emphasizing the two distinct syndromes of systolic dysfunction and diastolic dysfunction. Treatment recommendations are derived from consideration of the underlying pathophysiology and the evidence from randomised clinical trials.
Objective: To review current concepts in the management of patients with heartfailure. Data sources: A review of articles reported on acute and chronic heartfailure. Summary of review: Heartfailure 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
Synopsis Heartfailure is common and is associated with poor prognosis. Chronic kidney disease is common in heartfailure, and shares many risk factors with heartfailure such as age, hypertension, diabetes, and coronary artery disease. Over half of all heartfailure patients may have moderate to severe chronic kidney disease. The presence of chronic kidney disease is associated with increased morbidity and mortality, yet it is also associated with underutilization of evidence-based heartfailure therapy that may reduce morbidity and mortality. Understanding the epidemiology and outcomes of chronic kidney disease in heartfailure is essential to ensure proper management of these patients.
Objective: The goal of this study was to determine nurses' knowledge of heartfailure (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
Those of us who provide healthcare to heartfailure patients recognize the increasing numbers of patients affected by the disease and the complexity of their clinical issues. Traditional care delivery systems are often inadequate to meet their needs. Hospitalization rates are high and patient symptoms are substantive. As healthcare systems evolve to better meet these needs, multidisciplinary teams are expanding
Background We sought to assess the release of cardiac troponins in congestive heartfailure (CHF). Methods and Results We performed a computer-assisted search of the English language literature (MEDLINE database) followed by a manual search of the reference list of pertinent articles retrieved. Studies evaluating the release of cardiac troponins (T and I) in patients with CHF were screened for
Pulse pressure, an indirect measure of vascular stiffness and pulsatile load, predicts clinical events in congestive heartfailure (CHF), suggesting that abnormal pulsatile load may contribute to CHF. This study was designed to assess more direct measures of central pulsatile load in CHF. Noninvasive hemodynamic evaluations were performed in 28 subjects with CHF and 40 controls using calibrated tonometry of
Gary F. Mitchell; Jean-Claude Tardif; J. Malcolm; Gordon Marchiori; Terrence X. O'Brien; Mark E. Dunlap; Marc A. Pfeffer
Heartfailure is a frequent and life-threatening syndrome which is not only the result of myocardial injury or hemodynamic overload as commonly perceived, but appears to be the result of an interplay among genetic, neurohormonal, inflammatory, and biochemical factors, collectively referred to as biomarkers. Biomarkers can become risk factors in case their therapeutic modification results in an improvement of clinical outcomes. Among those markers identified in patients with heartfailure, a number appears to have direct clinical relevance in aiding diagnosis, risk stratification, monitoring therapy, and treating to targets in order to improve clinical outcomes. These include brain natriuretic peptides (e.g., BNP, NT-proBNP), inflammatory markers (e.g., hsCRP), neurohormones (e.g., aldosterone), cardiorenal markers (e.g., cycstatin C), and novel markers (e.g., galectin-3). While their utility to indicate risk is mostly well established, there are less data to establish that a treatment using biomarkers as a guidance results in better outcomes than a more generalized intensified treatment of patients with heartfailure. Future directions may involve larger platforms that facilitate to simultaneously analyze hundreds of biomarkers and may help to tailor heartfailure therapy on a single patient basis, considering the specific pathogenesis and prognosis. Also from a therapeutic perspective there are data that a single intervention such as aldosterone blockade may affect multiple biomarkers at the same time. Taken together the data indicate that biomarkers are evolving into a valuable addendum to the diagnostic and therapeutic armamentarium. PMID:21779815
Summary BACKGROUND: Mechanical circulatory support with left ventricular assist devices (LVADs) offers a safe and effective alternative to medical therapy for patients with advanced heartfailure. METHODS: Overview about LVAD therapy. RESULTS: LVAD therapy in this population may allow better optimization and more efficient implementation of medical therapy regimens. There is even evidence that in some cases LVAD therapy may prevent
B. Radovancevic; B. Vrtovec; R. Radovancevic; I. Gregoric
Background Although activation of the complement system in myocardial infarction and cardiopulmonary bypass has been shown to contribute to myocardial injury, its role in congestive heartfailure (CHF) is unknown. The purpose of this study was to determine the presence of terminal complement activation and its relation to clinical outcomes in patients with CHF. Methods We measured serum levels of
David J. Clark; Michael W. Cleman; Steven E. Pfau; Scott A. Rollins; Tarik M. Ramahi; Craig Mayer; Teresa Caulin-Glaser; Edouard Daher; Mikhail Kosiborod; Leonard Bell; John F. Setaro
A two day meeting on heartfailure, organised by the Cardiovascular Research Funders Forum, took place at the Royal College of Physicians, London, earlier this year. The meeting brought together over 60 researchers from the UK, North America, and continental Europe, representing basic and molecular scientists and clinicians (cardiologists, surgeons, and nurses) plus patient representatives PMID:12433879
Epidemiologic data from the Framingham Study provide insights into the population burden of heartfailure (CHF), its prognosis and modifiable risk factors that promote it. In the general population CHF is chiefly the end stage of hypertensive, coronary and valvular cardiovascular disease. It is a major and growing problem in most affluent countries because of aging populations of increased size,
In recent years, the possibility that disorders of cardiac metabolism play a role in the mechanisms that lead to ventricular dilatation and dysfunction in heartfailure 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
The negative prognostic impact of worsening renal function in patients with decompensated heartfailure has been widely recognised. As diuretics are thought to contribute to deterioration of kidney function in this setting, attempts have been made to either spare or suppress the diuretic-related pathophysiological mechanisms involved in this phenomenon. In this regard, extracorporeal ultrafiltration represents a novel therapy for patients with heartfailure, lacking the adverse impacts of diuretics on kidney function (eg, activation of tubuloglomerular feedback). Consequently, besides its other positive clinical outcomes, there has been much hope for ultrafiltration therapy to play a protective role against negative effects of diuretics in patients with decompensated heartfailure. However, the potential biological advantage has not been confirmed by clinical studies; currently available data from recent clinical trials have so far failed to demonstrate such expected positive results possibly due to counterbalance of the potential negative effects and other not well-known mechanisms. This paper briefly reviews the relevant pathophysiological mechanisms as well as existing evidence in this area and emphasises on the need for further studies specifically designed to explore the impact of ultrafiltration on kidney function in patients with decompensated heartfailure. PMID:19261603
Background: Few studies have prospectively and systematically explored the factors that acutely pre- cipitate exacerbation of congestive heartfailure (CHF) in patients with left ventricular dysfunction. Knowl- edge of such factors is important in designing mea- sures to prevent deterioration of clinical status. The objective of this study was to prospectively describe the precipitants associated with exacerbation of CHF status
Ross T. Tsuyuki; Robert S. McKelvie; J. Malcolm O. Arnold; Antonio C. P. Barretto; Antonio C. C. Carvalho; Debra L. Isaac; Allan D. Kitching; Leopoldo S. Piegas; Koon K. Teo; Salim Yusuf
Patients with congestive heartfailure (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
Patients with congestive heartfailure (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 statistically significant benefit occurs. Therefore, one of the important next steps in the field is optimization. In this paper we discuss three ways to approach this issue: a) increasing stem cell migration to the heart; b) augmenting stem cell activity; and c) combining existing stem cell therapies to recapitulate a "therapeutic niche". We conclude by describing a case report of a heartfailure patient treated with a combination stem cell protocol in an attempt to augment beneficial aspects of cord blood CD34 cells and mesenchymal-like stem cells.
The United States population, particularly among older age groups, continues to expand. Because the incidence of heartfailure increases with age, largely due to the development of heartfailure risk factors such as hypertension and coronary artery disease, the epidemic of heartfailure is likely to grow further in the coming decades. This article will review the epidemiology of heartfailure among older adults, the influence of an aging population on heartfailure prevalence and phenotype, the complications in management for a larger and older heartfailure population, and the potential implications of these changes for health care costs and delivery. Ultimately, these challenges demand research into optimal therapeutic strategies for older heartfailure patients, including improved prevention and treatment of the major causes of heartfailure, an increasing role forpalliative care, and innovations in patient-centered health care delivery. PMID:22940871
Heartfailure has reached epidemic proportions and the prevalence is increasing. The accurate and efficient diagnosis of heart\\u000a failure remains problematic, as signs and symptoms are neither sensitive nor specific. Recent advances in the diagnosis of\\u000a this condition include a conceptual change in what constitutes heartfailure, a greater understanding of heartfailure with\\u000a preserved systolic function, and an abundance
The clinical syndrome of heartfailure is increasing in prevalence, as is the number of elderly persons with heartfailure.\\u000a Increasing frailty and progression of heartfailure in large numbers of patients means clinicians are increasingly challenged\\u000a to provide end-of-life care for heartfailure patients. End-of-life care has been little studied, but management can be understood\\u000a from early clinical trials
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-HeartFailure (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
Congestive heartfailure is a major cause of morbidity and mortality as the population ages. This article reviews the progress made in treating the two major causes of heartfailure--mechanical and myocardial. New approaches to relieving mitral stenosis and guidelines for the treatment of congestive heartfailure are reviewed. Appropriate assessment and management leads to major improvement in prognosis.
Patients with heartfailure have multiple readmissions to hospital, a poor prognosis and varying quality of life. This paper explores how patients with heartfailure and their family carers cope with daily life. 36 patients and 20 family caregivers were interviewed in five centres in the UK. Analysis showed that living with heartfailure can be frightening, restrictive and distressing
'Heartfailure self care' refers to the practices in which patients engage to maintain their own health, and to the decisions that they make about managing signs or symptoms. In this article, we base our discussion of self care in chronic heartfailure on the classification of patients as being 'expert', inconsistent', or 'novice' in heartfailure self-care behaviors. The
Christopher S. Lee; Victoria Vaughan Dickson; Barbara Riegel
The central role of neurohormones, including brain natriuretic peptide (BNP), in the pathophysiology of heartfailure is now firmly established. Plasma levels of BNP are elevated in patients with chronic heartfailure (CHF); there is now the prospect of plasma BNP being used in diagnosing heartfailure, in assessing prognosis and even in tailoring therapy in CHF.Despite the increasing wealth
Patients with heartfailure should stop smoking, maintain an optimal weight and limit their intake of salt. Alcohol abuse should be avoided. The detection and early treatment of hypertension appears to have had a major impact in preventing heartfailure.Diuretics revolutionized the treatment of congestive heartfailure and their proper and appropriate use can alleviate peripheral and pulmonary oedema. Diuretics
Heartfailure affects nearly 5 million people in the United States and is a major contributor to mortality, hospitalization, and medical costs. Approximately 40% of patients with heartfailure have preserved left ventricular systolic function, thus exhibiting diastolic heartfailure. More common in women and the elderly, this condition is associated with hypertension, coronary artery disease, and\\/or atrial fibrillation. With
Jonathan P Piccini; Liviu Klein; Mihai Gheorghiade; Robert O Bonow
Background: The main symptoms of chronic heartfailure are breathlessness and fatigue on exertion. Abnormalities of skeletal muscle cause early metabolic distress on exercise, with resultant ergoreceptor stimulation causing increased ventilation. The aim of this study is to determine the extent of enhanced ergoreflex activity in chronic heartfailure in the leg. Methods: Ten patients with chronic stable heartfailure
Douglas A. A Grieve; Andrew L Clark; Gerald P McCann; W. Stewart Hillis
The management of heartfailure has evolved to become a multidisciplinary affair. Constraints of time and resources limit the amount of counselling that is given to heartfailure patients in hospital and, with the advent of community heartfailure specialist nurses, there is a trend to move more of these services into the community. Most heartfailure patients are elderly and may find the information given to them, at the time of diagnosis and later on at home by heartfailure nurses, difficult to grasp. In this study, patients' perspectives of a diagnosis of heartfailure, their understanding of the diagnosis as well as what being diagnosed with heartfailure means to them were recorded. Patients were questioned on whether the news of the heartfailure diagnosis was broken to them in a sympathetic manner and how they felt about the information provided at diagnosis. PMID:20849006
Background: Knowledge on clinical characteristics and prognosis of patients with heartfailure originates from studies of selected populations in clinical trials or from epidemiological observations. Reports on the large numbers of patients with heartfailure 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
he weight of evidence supporting the routine use of cardiac resynchronization therapy, or atrial-synchronized biventricular pacing, as a treatment for patients with moderate-to-severe chronic systolic heartfailure and ventric- ular dyssynchrony is now quite substantial. Results from mechanistic studies, observational evaluations, and random- ized, controlled trials have consistently demonstrated signif- icant improvement in quality of life, functional status, and exercise
Opinion statement Ventricular contraction is achieved by the coordinated electrical activation of the ventricles through the action of the cardiac\\u000a conduction system. In the presence of left bundle branch block (LBBB) or interventricular conduction delay (IVCD), the ventricular\\u000a contraction pattern is desynchronized and the stroke volume is reduced as a consequence. In patients with congestive heart\\u000a failure (CHF) due to systolic
\\u000a The physical, emotional, and financial burden of heartfailure (HF) on our society is incontrovertible.An estimated 5.3 million\\u000a Americans carry the diagnosis, with 80% of the men and 70% of the women under the age of 65 dying within 8 years. 8 In 2008,\\u000a we will pay an estimated 31.7 billion in direct health care fees, while facing a substantial
The syndrome of heartfailure is characterized by symptoms that are relatively insensitive and nonspecific. Physical diagnosis\\u000a may be unreliable even in the hands of experienced clinicians, despite the presence of significantly elevated filling pressures\\u000a or a significantly depressed cardiac output. Instrumentation and devices such as the insertion of a pulmonary artery catheter\\u000a and the implantable hemodynamic monitor have a
Saima Husain; Salpy V. Pamboukian; Josč A. Tallaj; David C. McGiffin; Robert C. Bourge
The objective of this cost analysis is to estimate the impact of valsartan therapy on heartfailure-related hospitalizations and net savings in varying hospital market dynamics.An economic model was developed for a health plan with commercial and Medicare enrollees. Model inputs include clinical results and health care utilization from Val-HeFT, and utilization and price data from Solucient's DRG Handbook. Val-HeFT
Cardiopulmonary exercise testing (CPX) is being increasingly used in patients with chronic heartfailure (CHF) for diagnostic\\u000a and prognostic purposes. It provides major insights regarding the degree of functional impairment, the prognosis, and the\\u000a effect of treatment. Despite the availability of simple and rapid gas analyzers, the general belief is that the procedure\\u000a is complex, which is not the case.
Alain Cohen-Solal; Florence Beauvais; Jean Yves Tabet
Cardiovascular disease remains one of the leading causes of death in the Western societies. Heartfailure (HF) is due primarily to progressive myocardial dysfunction accompanied by myocardial remodeling. Once heartfailure develops, the condition is, in most cases, irreversible and is associated with a very high mortality rate. Soluble epoxide hydrolase (sEH) is an enzyme that catalyzes the hydrolysis of epoxyeicosatrienoic acids (EETs), which are lipid mediators derived from arachidonic acid through the cytochrome P450 epoxygenase pathway. EETs have been shown to have vasodilatory, anti-inflammatory and cardioprotective effects. When EETs are hydrolyzed by sEH to corresponding dihydroxyeicosatrienoic acids (DHETs), their cardioprotective activities become less pronounced. In line with the recent genetic study that has identified sEH as a susceptibility gene for heartfailure, the sEH enzyme has received considerable attention as an attractive therapeutic target for cardiovascular diseases. Indeed, sEH inhibition has been demonstrated to have anti-hypertensive and anti-inflammatory actions, presumably due to the increased bioavailability of endogenous EETs and other epoxylipids, and several potent sEH inhibitors have been developed and tested in animal models of cardiovascular disease including hypertension, cardiac hypertrophy and ischemia/reperfusion injury. sEH inhibitor treatment has been shown to effectively prevent pressure overload- and angiotensin II-induced cardiac hypertrophy and reverse the pre-established cardiac hypertrophy caused by chronic pressure overload. Application of sEH inhibitors in several cardiac ischemia/reperfusion injury models reduced infarct size and prevented the progressive cardiac remodeling. Moreover, the use of sEH inhibitors prevented the development of electrical remodeling and ventricular arrhythmias associated with cardiac hypertrophy and ischemia/reperfusion injury. The data published to date support the notion that sEH inhibitors may represent a promising therapeutic approach for combating detrimental cardiac remodeling and heartfailure.
Approximately half of the nearly 5 million people in the United States who have heartfailure (HF) are women. The vast majority\\u000a of women with advanced HF are elderly and many of them have HF with evidence of normal or preserved left ventricular systolic\\u000a function. Although coronary disease is a common cause of HF for both men and women, a
Acute HeartFailure 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
Objective: To evaluate the role of an open access heartfailure service based at a teaching hospital for the diagnosis and treatment optimisation of patients with heartfailure in the community and to identify measures that may further enhance the effectiveness of such a service.Subjects: 963 patients with suspected heartfailure seen over an eight year period referred by their
HeartFailure continues to be a major public health problem associated with high mortality and morbidity. HeartFailure is the leading cause of hospitalization for persons older than 65 years, has a poor prognosis and is associated with poor quality of life. More than 5.3 million American adults are living with heartfailure. Despite maximum medical therapy and frequent hospitalizations
The prevalence of atrial fibrillation (AF) and heartfailure increases with advancing age. It is estimated that the annual incidence of AF in the general heartfailure population is approximately 5%, whereas as many as 40% of patients with advanced heartfailure have AF. The goals of therapy in patients with heartfailure and AF are symptom control and prevention of arterial thromboembolism. The adverse hemodynamic events of AF may lead to symptom deterioration and reduced exercise capacity. This review addresses the impact of AF on heartfailure outcomes as they pertain to prognosis and management. PMID:24054477
A retrospective study of 428 open heart operations showed the incidence of mild and severe renal failure to be 26% and 4·7% respectively. The mortality rate was 38% in the mild cases and 70% in the severe cases. Only half of the patients whose death was associated with renal failure showed macroscopic or microscopic renal lesions at necropsy. The patients who developed renal impairment had significantly higher mean preoperative blood urea (40 mg/100 ml) than the non-renal-failure cases (33 mg/100 ml). Periods of perfusion over 60 minutes, mean perfusion pressures below 80 mm Hg, and multiple valve replacement operations also increased the incidence of renal failure. There was no statistical correlation between the age of individual patients, the degree of cooling, and postoperative blood urea values. There was no evidence to suggest that frusemide or mannitol separately or together influenced the development of renal failure. Peritoneal dialysis was preferred for initial treatment of patients with severe renal failure, and haemodialysis was required only in special cases. ImagesFIG. 1FIG. 2
Growth hormone is a pituitary polypeptide hormone regulating growth in paediatric age as well as inducing anabolic actions directly or IGF-I mediated in adult age. Particularly, in many animals GH and IGF-I receptors were observed in cardiac myocyte membrane. GH modifies left ventricle structure and function. As concerns spontaneous GH secretion, some data suggest that pituitary gland can have a compensatory role on endocrine response to heartfailure. Heartfailure stage was directly correlated to nocturnal GH levels. All GH spontaneous night secretion parameters as well as IGF-I levels showed a range between normal people and very high spontaneous secretion. Therefore in these patients there are either a GH peripheric resistance or a reduction of the activity of GH/IGF-I axis. Anyhow in our patients, GH 24 hour infusion was inducing a 5 fold increase in GH concentration and a 50% increase in basal IGF-I levels. Anker et al. suggested to evaluate nutritional state in heartfailure patients, observing no differences in non-cachectic patients vs controls, while cachectic patients presented a typical GH resistance syndrome. Interestingly, cardiovascular effects of GH administration seem to be only marginally correlated to hemodynamic basal state. On the other hand basal hormonal setting of the patient seems to correlate to the GH-induced cardiovascular response. In fact, low basal IGF-I but high basal GH patients presented the worst endocrine and cardiovascular response to GH infusion. In literature there are controversial data about GH treatment in patients with chronic heartfailure. The heterogeneity of the population could be the reason for this discrepancy. Besides very different IGF-I responses to GH have been reported. Therefore, as there is good clinical evidence that GH acute infusion can improve heartfailure, it seems to be necessary firstly to evaluate the basal endocrine status of the patients. Particularly attention should be given to those patients that present a peripheric GH resistance. On the other hand, those patients with a reduced pituitary GH reserve are supposed to have very beneficial effects from GH treatment. PMID:12621359
Giustina, A; Bonadonna, S; Burattin, A; Manelli, F; Lorusso, R; Volterrani, M; Villa, S; Dei Cas, L; Agabiti Rosei, E
Little has been published about sexual function in chronic heartfailure (CHF) and knowledge among clinicians in this regard is sparse. To review data regarding sexual function and dysfunction in patients with CHF, 2 of the authors (S.A.M. and P.A.U.) independently conducted a literature search using the MEDLINE database. English-language articles and cited bibliographies published between January 1996 and November 2006 were reviewed. Search terms included heartfailure or CHF or ventricular dysfunction or heart disease in conjunction with sexual activity, erectile dysfunction, impotence, or sex. Articles were selected for inclusion if they had a primary focus on CHF and sexual function or dysfunction. Critical reviews of the literature, observational studies using self-reported patient surveys, and prospective, blinded, randomized, placebo-controlled trials were included. Articles were not excluded on the basis of patient sample size but were excluded if the article concerned a broad aspect of cardiovascular disease rather than CHF. When properly screened and treated, most patients with CHF can safely engage in sexual activity and be treated for erectile dysfunction with sildenafil, provided that they do not have active ischemia and do not require treatment with nitrates. Clinicians should know the physiological requirements of sexual activity and the impact CHF has on sexual performance. Fear of a cardiac event during intercourse can interfere with patients' ability to perform and enjoy sex, and so it is important that the physician be able to counsel patients with CHF about sexual activity. PMID:17908527
Mandras, Stacy A; Uber, Patricia A; Mehra, Mandeep R
BACKGROUND: C-reactive protein (CRP) is a marker of systemic inflammatory activity and may be modulated by physical fitness. Treadmill exercise testing is used to evaluate cardiovascular health through different variables including exercise capacity, heart rate and blood pressure responses. It was hypothesized that CRP levels are associated with these variables in men and women without overtheart disease. METHODS: A total of 584 asymptomatic subjects (317 [54.3%] women and 267 [45.7%] men) were enrolled in the present study and underwent clinical evaluation. CRP levels in men and women were examined relative to clinical characteristics and to variables of treadmill exercise testing: peak heart rate, exercise systolic blood pressure, exercise time, chronotropic reserve and heart rate recovery at the first and second minutes after exercise. Multivariate analysis was performed using a log-linear regression model. RESULTS: In women, exercise time on the treadmill exercise test (P=0.009) and high-density lipoprotein cholesterol levels (P=0.002) were inversely associated with CRP levels. Body mass index (P<0.001) and total cholesterol levels (P=0.005) were positively associated with CRP levels. In men, exercise time on the treadmill exercise test was inversely associated with CRP levels (P=0.015). Body mass index (P=0.001) and leukocyte count (P=0.002) were positively associated with CRP levels. CRP levels were not associated with peak heart rate, chronotropic reserve, heart rate recovery at the first and second minutes, or exercise systolic blood pressure. CONCLUSIONS: These findings contribute to the evidence that CRP is lower in individuals with better exercise capacity and demonstrate that this relationship is also apparent in individuals without overtheart disease undergoing cardiovascular evaluation through the treadmill exercise test. Lowering inflammatory markers may be an additional reason to stimulate sedentary individuals with low exercise capacity in the treadmill exercise test to improve physical conditioning through regular exercise.
Nunes, Rafael Amorim Belo; Araujo, Fernando; Correia, Gustavo F; da Silva, Gisela T; Mansur, Alfredo J
Chronic heartfailure is a disease with high morbidity and mortality, and its incidence is increasing rapidly worldwide. New therapies are needed that can halt or even reverse the progression of heartfailure, but little progress has been made in the last 20 years. This is partly due to the fact that chronic heartfailure is a heterogeneous disease with many different etiologies and clinical phenotypes. At present, a pathophysiological concept to unify these different phenotypes is missing. A prominent pathophysiological feature of chronic heartfailure is diastolic dysfunction, which is almost universally present in heartfailure patients. This review will examine the role and mechanisms of diastolic dysfunction in heartfailure. We will study diastolic dysfunction at different levels of complexity of organization: the cardiovascular system, the heart as an organ, the myocardium as a tissue, the myocyte as a cell and the molecular aspects of diastolic dysfunction. PMID:24020672
The energetic requirements of the heart are, weight for weight, higher than for any other organ. The heart provides non-stop function for a lifetime, while maintaining energy in reserve in order to respond to increased demand. This demand is met by continuously recycling a relatively small pool of ATP, with the creatine kinase (CK) system acting as a spatial and temporal buffer. In the failing heart, key components of this system are downregulated, but whether these energetic changes are biomarkers or drivers of dysfunction and whether they represent therapeutic targets are the subjects of ongoing research. Key methodologies are now becoming available in vivo to help address these questions in mouse models, such as (31)P magnetic resonance spectroscopy to detect high-energy phosphates and (1)H magnetic resonance spectroscopy to detect total creatine. This report briefly discusses the challenges involved in using these technologies, the application and pitfalls of murine surgical models of heartfailure, and how this has contributed to our understanding of pathophysiology in recent years. PMID:22983996
Lygate, Craig A; Schneider, Jürgen E; Neubauer, Stefan
In the advanced stages of heartfailure, 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
Heartfailure (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
Cognitive dysfunction, mainly memory impairment, characterizes congestive heartfailure (CHF). Aim of this study was to verify whether: (1) CHF has differential effects on primary and secondary memory; (2) memory dysfunction can be diagnosed by a screening instrument. In a multicenter study we enrolled 369 patients with stable CHF who underwent a structured assessment of verbal memory mechanisms and selected cognitive functions. Performance on some verbal memory indexes (Recency, Rey's immediate and delayed recall, Learning efficiency) progressively decreased from II to IV New York Heart Association (NYHA) class. Rate of forgetting was uniformly high across NYHA classes II-IV. Verbal memory indexes were highly correlated with most nonverbal scores. The Mini Mental State Examination (MMSE) had poor sensitivity and specificity versus primary or secondary verbal memory dysfunction. Therefore, a deficit of both primary and secondary memory is relatively common in CHF but cannot be accurately recognized by a screening neuropsychological test. PMID:12607168
For heartfailure patients and their physicians, these are the best of times and the worst of times. Over the past 3 decades, there have been major advances in the treatment of heartfailure, ranging from an extensive list of medical therapy (beta-blockers, angiotensin-converting enzyme in- hibitors, and so on), improvements in heart transplantation with new agents to suppress tissue
Masahiko Hoshijima; Ralph Knöll; Mohammad Pashmforoush; Kenneth R. Chien
Diuretic therapy decreases capillary wedge pressure and improves New York Heart Association (NYHA) functional class both in acute and chronic heartfailure. In advanced symptomatic heartfailure, loop diuretics are generally necessary to improve symptoms of congestion. Diuretic resistance in the edematous patient has been defined as a clinical state in which diuretic response is diminished or lost before the
Bernhard K Krämer; Frank Schweda; Günter A. J Riegger
Background Agents that increase cardiac contractility (positive inotropes) have beneficial hemodynamic effects in patients with acute and chronic heartfailure but have frequently led to increased mortality when given on a long-term basis. Despite this fact, inotropes remain commonly used in the management of heartfailure. Methods We reviewed the available data on short- and long-term inotrope use in heart
# The Author(s) 2011. This article is published with open access at Springerlink.com Cardiac resynchronization therapy (CRT) can improve heartfailure symptoms and reduce mortality in advanced heartfailure. Implantation rates have been shown to increase steadily in Europe [1, 2] and it is expected they will increase further after the recent updated European guidelines on device therapy in heart
The impact of heartfailure and its treatment on specific nutrient requirements is unknown. Furthermore, depletion of water-soluble B vitamins that play key roles in the production of cellular energy in patients with heartfailure can contribute to depletion of energy reserves observed in the failing heart. A cross-sectional study recently reported that approximately one third of hospitalized patients with
Mary E. Keith; Natalie A. Walsh; Pauline B. Darling; Stacy A. Hanninen; Subarna Thirugnanam; Howard Leong-Poi; Aiala Barr; Michael J. Sole
The management of patients with chronic congestive heartfailure has changed considerably during the last decade. Until recently, restriction of physical activity was recommended for patients with chronic heartfailure. However, the know- ledge that training influences largely the periphery rather than the heart itself has led to a dramatic change in the approach toward training in patients with chronic
The plasma and cardiac levels of immunoreactive (IR) atrial natriuretic factor (ANF) were measured during the entire lifespan of cardiomyopathic hamsters, which eventually develop spontaneous congestive heartfailure, and were correlated with immunohistochemical, ultrastructural, and immunocytochemical changes in the secretory apparatus of atrial and ventricular cardiocytes. Plasma IR-ANF rose in the early stages of the disease, reached a maximum in moderate heartfailure, and declined thereafter but remained above control values. The peptide decreased constantly in the atria during the evolution of the disease but increased markedly in the ventricles. Its highest levels were found in the inner half of the left ventricle. In atrial cardiocytes, the size and complexity of the Golgi complex increased with the progression of the disease, whereas the number, size, and IR-ANF content (as assessed by the immunogold technique) of secretory granules decreased constantly. In ventricular cardiocytes, the size of the Golgi complex increased, and typical secretory granules were present in approximately 20% of these cells, regardless of their localization in the myocardium. The results suggest that stimulation of ANF secretion in atrial cardiocytes leads to a dissociation between synthesis and release, the latter being maximal according to ultrastructural and immunocytochemical criteria. In ventricular cardiocytes, the same stimulation culminates in increased synthesis and the possibility of release via two pathways: one constitutive, the other regulated. Thus, the elevated plasma levels of IR-ANF in congestive heartfailure may be derived from secretion by both atrial and ventricular cardiocytes. Images Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 15 Figure 16 Figure 17 Figure 18
Cantin, M.; Thibault, G.; Ding, J. F.; Gutkowska, J.; Garcia, R.; Jasmin, G.; Hamet, P.; Genest, J.
Devices have become a cornerstone of heartfailure (HF) therapy. Implantable cardioverter-defibrillators (ICDs) decrease mortality, and cardiac resynchronization therapy (CRT) improves symptoms and mortality. Most data have been collected in patients with systolic dysfunction. Data in patients with preserved systolic function are scarce, but interesting therapeutic concepts are evolving. Besides therapeutic functions, devices can have add-on diagnostic features such as early detection of fluid overload. In addition, stand-alone diagnostic devices are now also being developed for HF. PMID:24048237
Heartfailure (HF) often presents as dyspnea either with exertion and/or recumbency. Patients also experience dependent swelling and fatigue. Measurement of the left ventricular ejection fraction (LVEF) identifies HF patients who may respond to pharmacologic therapy and/or electrophysiologic device implantation. Angiotension converting enzyme inhibitors, beta blockers, and aldosterone inhibitors can significantly lower the mortality and morbidity of HF in patients with an LVEF less than 35%. Cardiac defibrillators and biventricular pacemakers can also improve outcomes in selected patients with a decreased LVEF. The authors provide a guide for therapeutic decisions based on the inclusion criteria of the major clinical trials. PMID:23402460
Nicklas, John M; Bleske, Barry E; Van Harrison, Richard; Hogikyan, Robert V; Kwok, Yeong; Chavey, William E
Anemia and iron deficiency are quite prevalent in patients with heartfailure (HF) and may overlap. Both anemia and iron deficiency are associated with worse symptoms and adverse clinical outcomes. In the past few years, there has been an enormous interest in the subject of iron deficiency and its management in patients with HF. In this review, the etiology and relevance of iron deficiency, iron metabolism in the setting of HF, studies on iron supplementation in patients with HF and potential cardiovascular effects of subclinical iron overload are discussed. PMID:22948485
Diuretics are frequently administered to relieve congestive symptoms in patients with heartfailure (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.Clinical Pharmacology & Therapeutics (2013); 94 4, 490-498. doi:10.1038/clpt.2013.140. PMID:23852396
Twenty seven patients diagnosed as having systolic heartfailure with Ejection Fraction (EF) of less than 40% by echocardiography were monitored over a period of 3 years. The monitored parameters included clinical symptoms, diastolic dysfunction, therapies and survival during three years of treatment. The results indicate a beneficial effect of treatment with high doses of ACE-inhibitors, spironolactone and beta-blockers in improving clinical symptoms and diastolic function. The survival rate was similar to that in the developed European countries. PMID:18039193
Anemia is a common comorbidity in heartfailure (HF), and is associated with increased morbidity and mortality. However, it remains unclear whether anemia is merely a marker of poor prognosis or whether anemia itself confers risk. The pathogenesis of anemia in HF is multifactorial. Iron deficiency also confers risk in HF, either with or without associated anemia, and treatment of iron deficiency improves the functional status of patients with HF. An ongoing large clinical trial studying the use of darbepoetin-alfa in patients with anemia and systolic HF is expected to provide information that should improve our understanding of anemia in HF. PMID:22940847
Artificial heart valves are devices used for replacing diseased natural valves of the human heart. The failure of such a device to perform to its requirements can lead to serious complications, even threatening the life of the recipient. There are many and varied modes of valve failure that can lead to departure from specifications. These failure mechanisms can be broadly
We prospectively studied 69 consecutive patients hospitalized with a primary diagnosis of acute left ventricular failure so as to assess the impact of vasodilators on incidence and morbidity of acute symptomatic left ventricular failure. The determinants of duration of hospitalization, in-hospital mortality and symptomatic status 2 months after discharge were examined. There were 9 in-hospital deaths (13%), and survival at 60 days was 77%. Median duration of hospitalization was 9 days, and 33% of the surviving patients remained in New York Heart Association functional class III-IV 60 days subsequent to discharge. Of the patients, 49 (76%) had previously received treatment for left ventricular failure: 30 (61%) of these had received vasodilators, most commonly angiotensin converting enzyme inhibitors and nitrates. Ischaemic chest pain was present in 34 (49%) of the patients. Acute utilization of vasodilators (45% of patients) was largely limited to nitrate therapy associated with ischaemic chest pain (P less than 0.01). Multiple logistic regression revealed previous left ventricular failure, advanced age and hypokalaemia as significant correlates of prolonged hospitalization (greater than 9 days). Previous left ventricular failure was also predictive of persistent severe disability two months subsequent to discharge. No factor was a significant predictor of in-hospital death. Although preceding treatment with digoxin and incremental angiotensin converting enzyme inhibitor therapy tended to predict brief hospitalization, the parameter of acute ischaemia, other biochemical anomalies and modes of acute or chronic therapy were not significant correlates of any end point. We conclude that preceding disability, rather than mode of treatment, predicts an adverse outcome in acute left ventricular failure. PMID:1791090
Mohan, P; Hii, J T; Wuttke, R D; Esterman, A J; Hollington, P; Horowitz, J D
uring the past 10 years, the philosophy of heartfailure treatment has evolved from symptom control to a combined prevention and symptom-management strategy. Re- cent clinical trials have proved that early detection can delay progression. Treatment of asymptomatic left ventricular dysfunction is as important as treatment of symp- tomatic disease. The purpose of this review is to simplify recent guidelines
Mardi Gomberg-Maitland; David A. Baran; Valentin Fuster
Statins lower serum cholesterol and are employed for primary and secondary prevention of cardiovascular events. Clinical evidence from observational studies, retrospective data, and post hoc analyses of data from large statin trials in various cardiovascular conditions, as well as small scale randomized trials, suggest survival and other outcome benefits for heartfailure. Two recent large randomized controlled trials, however, appear to suggest statins do not have beneficial effects in heartfailure. In addition to lowering cholesterol, statins are believed to have many pleotropic effects which could possibly influence the pathophysiology of heartfailure. Following the two large trials, evidence from recent studies appears to support the use of statins in heartfailure. This review discusses the role of statins in the pathophysiology of heartfailure, current evidence for statin use in heartfailure, and suggests directions for future research.
Bonsu, Kwadwo Osei; Kadirvelu, Amudha; Reidpath, Daniel Diamond
Left ventricular systolic dysfunction is associated with neurohormonal activation which contributes to progressive ventricular remodeling and worsening clinical heartfailure. Renin-angiotensin-aldosterone and sympathetic nervous systems are activated, not only in patients with clinically overtheartfailure, but also in patients with asymptomatic or minimally symptomatic left ventricular systolic dysfunction. Activation of the angiotensin and adrenergic systems produces deleterious effects on systemic and coronary hemodynamics, promotes myocyte hypertrophy and fibroblast growth, and myocyte necrosis and apoptosis. Thus, therapy of heartfailure should consist of pharmacologic agents not only to relieve symptoms but also to prevent and attenuate ventricular remodeling and progressive heartfailure, thereby improving prognosis. In patients who are symptomatic, ACE inhibitors along with digitalis and diuretics as initial therapy (triple therapy) have the greater potential to improve exercise tolerance and decrease the incidence of treatment failure compared with diuretics alone or a combination of diuretics and digitalis. Diuretics alone should not be considered for long-term therapy as plasma renin activity, angiotensin II, aldosterone, norepinephrine and vasopressin levels may increase. ACE inhibitors decrease mortality in patients with heartfailure resulting from left ventricular systolic dysfunction. The results of presently available studies indicate that angiotensin II receptor blockers (ARBs) do not provide any advantage over ACE inhibitors regarding survival benefit but may be better tolerated. Long-term adrenergic inhibition with the use of ss-adrenoceptor antagonists added to ACE inhibitors is associated with attenuation of ventricular remodeling, improvement in ventricular function and clinical class and survival of patients with symptomatic systolic left ventricular failure. Thus, initial pharmacotherapy for systolic heartfailure should consist of: maximal tolerated dosages of ACE inhibitors;ARBs if ACE inhibitors are not tolerated because of intractable cough or angioedema;adequate dosages of hydralazine and isosorbide dinitrate if ACE inhibitors or ARBs are not tolerated; relatively low dosages of digoxin (serum concentrations of < or = 1.0 ng/dl) if not contraindicated; and diuretics to relieve congestive symptoms. Addition of spironolactone to ACE inhibitors can result in a significant reduction in the risk of sudden death in patients with symptomatic severe heartfailure. Myocardial infarction resulting from ischemic heart disease is the most common cause of systolic left ventricular failure and the therapeutic modalities with potential to reduce the risks of myocardial infraction, such as risk factor modification, adequate control of diabetes and hypertension, antiplatelet agents and lipid-lowering agents, should also be included in the initial therapy. PMID:14727993
With a prevalence of 5.8 million in the United States alone, heartfailure (HF) is associated with high morbidity, mortality, and healthcare expenditures. Close to 1 million hospitalizations for heartfailure (HHF) occur annually, accounting for over 6.5 million hospital days and a substantial portion of the estimated $37.2 billion that is spent each year on HF in the United States. Although some progress has been made in reducing mortality in patients hospitalized with HF, rates of rehospitalization continue to rise, and approach 30% within 60 to 90 days of discharge. Approximately half of HHF patients have preserved or relatively preserved ejection fraction (EF). Their post-discharge event rate is similar to those with reduced EF. HF readmission is increasingly being used as a quality metric, a basis for hospital reimbursement, and an outcome measure in HF clinical trials. In order to effectively prevent HF readmissions and improve overall outcomes, it is important to have a complete and longitudinal characterization of HHF patients. This paper highlights management strategies that when properly implemented may help reduce HF rehospitalizations and include adopting a mechanistic approach to cardiac abnormalities, treating noncardiac comorbidities, increasing utilization of evidence-based therapies, and improving care transitions, monitoring, and disease management. PMID:23219302
Gheorghiade, Mihai; Vaduganathan, Muthiah; Fonarow, Gregg C; Bonow, Robert O
Improvement of symptoms and, accordingly, quality of life, as well as prolongation of life, are the objectives of drug therapy in congestive heartfailure patients. Diuretics are most effective in relieving symptoms related to congestion, and angiotensin converting enzyme inhibitors improve exercise capacity, reduce the incidence of decompensations and hence hospitalizations, and prolong life. Angiotensin type-1 receptor antagonists also seem to improve survival, while digoxin improves symptoms and morbidity but not survival in patients in sinus rhythm. The value of prophylactic antiarrhythmic therapy with amiodarone and oral anticoagulation in the presence of sinus rhythm is not established, and the role of newer dihydropyridine calcium antagonists and betablockers is also not precisely defined. These agents should only be considered in selected cases after careful consideration of potential advantages and risks, and should usually be used as an addition to established therapy. Better understanding of the pathophysiology of congestive heartfailure will lead to the development of new treatment concepts, the clinical relevance of which will have to be tested in appropriately designed clinical trials. PMID:9476302
Kiowski, W; Sütsch, G; Fatio, R; Schalcher, C; Brunner-LaRocca, H P
Insulin resistance and associated reductions in cardiac insulin metabolic signaling is emerging as a major factor for the development of heartfailure and assumes more importance because of an epidemic increase in obesity and the cardiorenal metabolic syndrome and our aging population. Major factors contributing to the development of cardiac insulin resistance are oxidative stress, hyperglycemia, hyperlipidemia, dysregulated secretion of adipokines/cytokines and inappropriate activation of renin-angiotensin II-aldosterone system (RAAS) and the sympathetic nervous system. The effects of cardiac insulin resistance are exacerbated by metabolic, endocrine and cytokine alterations associated with systemic insulin resistance. The aggregate of these various alterations leads to an insulin resistant phenotype with metabolic inflexibility, impaired calcium handling, mitochondrial dysfunction and oxidative stress, dysregulated myocardial-endothelial interactions resulting in energy deficiency, impaired diastolic dysfunction, myocardial cell death and cardiac fibrosis. Therefore, understanding the molecular mechanisms linking insulin resistance and heartfailure may help to design new and more effective mechanism-based drugs to improve myocardial and systemic insulin resistance.
Aroor, Annayya R.; Mandavia, Chirag H.; Sowers, James R.
Heartfailure (HF) biomarkers have dramatically impacted the way HF patients are evaluated and managed. B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are the gold standard biomarkers in determining the diagnosis and prognosis of HF, and studies on natriuretic peptide-guided HF management look promising. An array of additional biomarkers has emerged, each reflecting different pathophysiological processes in the development and progression of HF: myocardial insult, inflammation and remodeling. Novel biomarkers, such as mid-regional pro atrial natriuretic peptide (MR-proANP), mid-regional pro adrenomedullin (MR-proADM), highly sensitive troponins, soluble ST2 (sST2), growth differentiation factor (GDF)-15 and Galectin-3, show potential in determining prognosis beyond the established natriuretic peptides, but their role in the clinical care of the patient is still partially defined and more studies are needed. This article is part of a Special Issue entitled: Heartfailure pathogenesis and emerging diagnostic and therapeutic interventions. PMID:23313577
According to the present guidelines for heartfailure patients, regular exercise training has obtained the class of recommendation I, level of evidence A. Despite the benefits of cardiac rehabilitation, many heartfailure patients are inactive. Common patient's rejection of existing forms of rehabilitation and limitations resulting from the disease itself hinder the outpatient cardiac rehabilitation. That is why home telerehabilitation seems to be the optimal form of physical activity for heartfailure patients. PMID:22641542
? Abstract Heartfailure is a complex,neurohumoral,and inflammatory,syndrome. Recent studies have shown that proinflammatory cytokines (interleukin-1, interleukin- 2, interleukin-6, interleukin-10, and tumor necrosis factor) are involved in cardiac depression and in the complex,syndrome,of heartfailure. Understanding,the involve- ment of these cytokines may,enable us to reverse cardiac depression and heartfailure by the use of monoclonal,antibodies directed against specific cytokines to
Heartfailure, a growing public health problem worldwide, is a leading cause of morbidity and mortality in industrialized\\u000a countries. Despite a widely varying and diverse etiology and pathophysiology of heartfailure, increased neurohormonal and\\u000a autonomic nervous system activities and maladaptive cardiac remodeling play crucial roles in the progression of most forms\\u000a of heartfailure. Recent evidence suggests that increased oxidative
Sherma Zibadi; Douglas F. Larson; Ronald Ross Watson
Heartfailure is common, and depression is common in heartfailure patients, adding substantially to the burden of the disease.\\u000a There is some evidence for the safe and at least modestly effective use of psychotherapy and antidepressants to treat depression\\u000a in heartfailure patients. Cognitive behavioral psychotherapy and selective serotonin reuptake inhibitors are first line treatments.\\u000a The efficacy of depression
Heartfailure (HF) is frequent in the elderly population and is associated with high mortality, prolonged and frequent hospitalisations. In old patients with multiple comorbid diseases, clinical symptoms of HF are less typical and the prognosis is poorer. Comprehensive geriatric assessment, using simple tests to evaluate cognitive function, falls, depression, malnutrition, dependency, comorbidities, context of life and social conditions, is needed in order to screen concomitant diseases and loss of autonomy. Because of lack of specific studies on octogenarians, most recommendations for HF treatment in this population have been extrapolated from data based on younger populations. Epidemiological studies show that recommended HF therapies as angiotensin converting enzyme inhibitors and beta-blockers are underused in elderly patients with HF. Reasons for this under prescription are various and include the absence of well-defined therapeutic strategy especially in case of preserved ejection fraction, the existence of comorbidities and the fear of adverse events. Special precautions for the use of HF drugs must be followed because of the comorbidities and age-related changes in drug pharmacokinetics or pharmacodynamics. Increase of drug dose must be closely monitored for adverse reactions. Overall, the therapeutic strategy must not be based on the subject's age, but rather on the individual analysis taking into account the severity of the heart disease, the geriatric assessment, the life expectancy and the quality of life. Clinical and laboratory monitoring should be intensified, especially in case of acute episode (infection, dehydration, introduction of a new treatment, fall…). Therefore, monitoring of heartfailure in the elderly, involves multidisciplinary collaboration between cardiologists, geriatricians, general practitioners, pharmacists and paramedical team. PMID:23726288
Sleep-disordered breathing (SDB) has a higher prevalence in patients with heartfailure 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 heartfailure (ADHF), and evidence suggests that untreated OSA increases mortality in patients with heartfailure. Cheyne–Stokes respiration and central sleep apnea (CSA) have long been associated with heartfailure 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.
Heartfailure has reached epidemic proportions and the prevalence is increasing. The accurate and efficient diagnosis of heartfailure remains problematic, as signs and symptoms are neither sensitive nor specific. Recent advances in the diagnosis of this condition include a conceptual change in what constitutes heartfailure, a greater understanding of heartfailure with preserved systolic function, and an abundance of data supporting the use of neurohormonal assays, particularly brain-type natriuretic peptide. These factors will help facilitate earlier diagnosis and targeted treatment of patients with this malady. PMID:15075057
AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heartfailure in patients with heartfailure with preserved ejection fraction and reduced ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heartfailure. Patients with ejection fraction of ? 45% were classified as having heartfailure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heartfailure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 ?m) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS: The heartfailure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heartfailure with reduced ejection fraction population (12.95 ± 8.22 ?g/m3 vs 4.50 ± 2.34 ?g/m3, P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heartfailure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heartfailure with preserved ejection fraction population.
Synopsis Sympathetic nervous system activation in heartfailure, as indexed by elevated norepinephrine levels, higher muscle sympathetic nerve activity and reduced heart rate variability, is associated with pathologic ventricular remodeling, increased arrhythmias, sudden death, and increased mortality. Recent evidence suggests that HMG-CoA reductase inhibitor (statin) therapy may provide survival benefit in heartfailure of both ischemic and non-ischemic etiology, and one potential mechanism of benefit of statins in heartfailure is modulation of the autonomic nervous system. Animal models of heartfailure demonstrate reduced sympathetic activation and improved sympathovagal balance with statin therapy. Initial human studies have reported mixed results. Ongoing translational studies and outcomes trials will help delineate the potentially beneficial effects of statins on the autonomic nervous system in heartfailure.
Despite recent advances in the diagnosis and treatment of cardiovascular disease, the prevalence of heartfailure, a highly morbid and lethal condition, is increasing. Because of recent advances in basic and clinical research, beta-blockade is now established as a highly effective therapy that reduces morbidity and mortality dramatically in patients with heartfailure associated with reduced systolic function. The new guidelines from the American College of Cardiology-American Heart Association recommend use of beta-blockers in all patients with symptomatic left ventricular systolic dysfunction. Now clinicians need to incorporate use of beta-blockers into their standard approach to the treatment of heartfailure. We briefly summarize the basic and clinical evidence establishing the benefit of beta-blockers for heartfailure and provide practical information to assist clinicians in deciding when and how to use beta-blockers in patients with heartfailure. PMID:12173717
In the year 2012, 3 scientific sections-heartfailure and transplant, congenital heart disease, and clinical cardiology-are presented together in the same article. The most relevant development in the area of heartfailure and transplantation is the 2012 publication of the European guidelines for heartfailure. These describe new possibilities for some drugs (eplerenone and ivabradine); expand the criteria for resynchronization, ventricular assist, and peritoneal dialysis; and cover possibilities of percutaneous repair of the mitral valve (MitraClip(®)). The survival of children with hypoplastic left heart syndrome in congenital heart diseases has improved significantly. Instructions for percutaneous techniques and devices have been revised and modified for the treatment of atrial septal defects, ostium secundum, and ventricular septal defects. Hybrid procedures for addressing structural congenital heart defects have become more widespread. In the area of clinical cardiology studies have demonstrated that percutaneous prosthesis implantation has lower mortality than surgical implantation. Use of the CHA2DS2-VASc criteria and of new anticoagulants (dabigatran, rivaroxaban and apixaban) is also recommended. In addition, the development of new sequencing techniques has enabled the analysis of multiple genes. Full English text available from:www.revespcardiol.org/en. PMID:23317810
Almenar, Luis; Zunzunegui, José Luis; Barón, Gonzalo; Carrasco, José Ignacio; Gómez-Doblas, Juan José; Comín, Josep; Barrios, Vivencio; Subirana, M Teresa; Díaz-Molina, Beatriz
Managing patients with heartfailure (HF) is a challenging task within itself, but the presence of associated worsening renal function can greatly increase mortality and morbidity. Early diagnosis and treatment is the key to prevent re-hospitalizations and reduce healthcare costs. Biomarkers have long been established as highly sensitive and specific tools in diagnosing and prognosticating patients with HF. Reflecting distinct pathophysiological events and ongoing cellular insult, biomarkers have been proven superior to conventional laboratory tests. Availability of better assays and rapid analysis has allowed the use of biomarkers as point-of-care tests in the emergency department and at the patient's bed-side. Acute HF patients often go on to develop worsening renal function, termed as acute cardiorenal syndrome. The growing breadth of studies has shown the implications of combining multiple biomarkers to better chart outcomes and produce desirable results in such patients.
Choudhary, Rajiv; Gopal, Dipika; Kipper, Ben A.; De La Parra Landa, Alejandro; Lee, Hermineh Aramin Elizabeth; Shah, Saloni; Maisel, Alan S.
Heartfailure (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.
Bui, Anh L.; Horwich, Tamara B.; Fonarow, Gregg C.
Chronic heartfailure (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.
Chronic heartfailure (CHF) is a complex disease process connected with cardiovascular system as well as other organs and skeletal muscles. In connection with the above, cardiac rehabilitation, consisting of exercise training and diet supplementation, aims at recovery of physical, social and psychic function and removing risk factors influencing the occurrence of circulatory system diseases. Evidence has shown that exercise training in CHF patients, both aerobic and resistance, can increase peak oxygen consumption and exercise capacity, improve NYHA (New York Heart Association) functional class, reduce mortality and improve the quality of life. Evidence suggests that most improvement is due to the effects of training on the peripheral circulation and skeletal muscle, rather than on the heart itself. Exercise training can improve skeletal muscle metabolism, increase blood flow within the active skeletal muscles, increase capillary density, promote the synthesis and release of nitric oxide, improve angiogenesis, and decrease oxidative stress. Physical effort reduces sympathetic arousal and increases parasympathetic arousal, thus reducing cardiac dysrythmia and ischemia. Mitochondria start working harder, as the demand for energy is higher and electron flow provides energy in the form of ATP. Studies have consistently demonstrated that exercise training is safe and has no deleterious effect on central haemodynamics, left ventricular remodeling, systolic or diastolic function, or myocardial metabolism. Taking several supplements that have documented roles in medical therapy, including vitamins B, C and E, coenzyme Q10, alpha-lipoic acid, chromium, omega-3 polyunsaturated fatty acids, L-carnitine, and quercetin, has beneficiary effect on many diseases, including CHF. In our experience, 19 patients with CHF who undertook resistance (weight) training and food supplementation, returned to their normal activities after 4 months, without any complaints. PMID:24069873
Heartfailure (HF) in older adults presents challenges that are different in many ways than those for younger adults. Diagnosis of HF in older adults can be delayed due to attributing early symptoms to normal changes of aging or, in the setting of a normal ejection fraction, failing to appreciate diastolic heartfailure. Moreover, treatment of HF in the elderly is often complicated by comorbidities and polypharmacy. The long-term care setting can present even more challenges, yet can be made easy by following a simple mnemonic DEFEAT-HF. After making a clinical Diagnosis and determining the Etiology, Fluid volume must be assessed to achieve euvolemia, and Ejection frAction must be determined to guide Therapy. PMID:18585640
Coronary heart disease is caused by atherosclerotic narrowing of coronary arteries. It accounts for about two-thirds of heartfailure cases, which are frequently secondary to myocardial infarction. Despite considerable progress in the understanding and management of heartfailure, its incidence, prevalence and economic burden are steadily increasing. Therefore, efficient preventive and therapeutic measures are urgently needed. In order to investigate
Rainer Klocke; Wen Tian; Michael T. Kuhlmann; Sigrid Nikol
Background—Despite the rising heartfailure (HF) incidence and aging United States population, there are no validated prediction models for incident HF in the elderly. We sought to develop a new prediction model for 5-year risk of incident HF among older persons. Methods and Results—Proportional hazards models were used to assess independent predictors of incident HF, defined as hospitalization for new-onset
Javed Butler; Andreas Kalogeropoulos; Vasiliki Georgiopoulou; Rhonda Belue; Nicolas Rodondi; Melissa Garcia; Douglas C. Bauer; Suzanne Satterfield; Andrew L. Smith; Viola Vaccarino; Anne B. Newman; Tamara B. Harris; Peter W. F. Wilson; Stephen B. Kritchevsky
Summary Background: Patients with chronic heartfailure (heartfailure) are at risk of thromboembolic events, and coronary ischaemic events also contrib- ute to the progression of heartfailure. Long-term oral anticoagulation is established in certain groups, including patients with heartfailure and atrial fibrillation, but there is wide variation in the use of oral anticoagulation in the broader heartfailure
Background: Deterioration of heartfailure causes and complicates many hospital admissions in people aged over 65 years. Frequent readmissions cause an immense burden on the individual, the family and the health care system. Heartfailure management programmes, in which patient education is an important component, have been shown to be effective in improving self-care and reducing readmissions. Aim: This paper
Patients with severe heartfailure require large quantities of health care resources, and more intensive interven- tions are not always related to a decrease in need for medical care, including hospitalization. A thoughtful ap- proach to the efficient and expeditious allocation of these resources is required. In fact, the nonpharmaco- logic therapy of patients with chronic congestive heartfailure (CHF)
Patients with severe heartfailure require large quantities of health care resources, and more intensive interventions are not always related to a decrease in need for medical care, including hospitalization. A thoughtful approach to the efficient and expeditious allocation of these resources is required. In fact, the nonpharmacologic therapy of patients with chronic congestive heartfailure (CHF) has to include
Michele D’Alto; Giuseppe Pacileo; Raffaele Calabrň
Despite considerable therapeutic advances, heartfailure remains a medical and socioeconomic problem. Thus, there is a compelling need for new drugs that could improve clinical outcomes. In recent years, new potential therapeutic targets that are involved in the pathogenesis of heartfailure have been identified, and new drugs are currently under investigation. A repeated finding is that the positive results
Heartfailure is a leading cause of morbidity and mortality. In the United States, there are more than 5 million patients with heartfailure 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
Diuretics are the mainstay of traditional therapy for congestive heartfailure. The syndrome of heartfailure is now understood to involve complex interactions of neurohumoral substances released in response to poor cardiac function. Developmental changes during infancy and childhood will affect both the activation of systemic neurohumoral responses and the pharmacokinetic and pharmacodynamic actions of diuretics. Few human studies directly
Synopsis Prognosis in congestive heartfailure is directly linked to neurohormonal activation. Angiotensin II through the activation of the renin angiotensin aldosterone system has been the principal focus of therapy over the last two decades. New agents that target selective blockade of the angiotensin II receptor have been introduced in clinical trials for the treatment of heartfailure. Aldosterone has
The aim of this study was to analyze the etiology and type of dysfunction in octogenarians with heartfailure and at the same time establish if there are differences with a geriatric but younger population. A total of 180 consecutive inpatients with heartfailure were studied between April 2001 and September 2002, 115 older than 80 years, and 65 between
Jose M. Bonorino; Juan R. Mieres; Amilcar Herbas Pozo; Freddy Padilla; Leonardo Ferrer; Roberto Bagnasco; Veronica L. Crosa; Manuel Vazquez Blanco; Sara Berensztein; Jorge Lerman
Rationale The epidemiology of heartfailure and patient management procedures may vary from one country to another. This study was designed to analyse the spectrum of patients hospitalized in France for heartfailure. Patients and Methods A registry involving 120 depart- ments (cardiology, general medicine and geriatrics) and 1058 patients. Results The patients' median age was 76 years, and the
A. Cohen-Solal; M. Desnos; F. Delahaye; J. P. Emeriau; G. Hanania
Acute heartfailure has recently become a very common syndrome. Therefore even if you are not a cardiologist you should know how to diagnose and treat it. A basic technique is here summarized. Diagnosis of heartfailure can be performed from a simple criteria including coarse crackles an extra?sound(S3) a distention of the cervical vein cardiomegaly pulmonary edema and serum
Aim: This study aimed to explore the experiences of patients with severe heartfailure and identify their needs for palliative care. Method: A qualitative design was chosen. Semi- structured interviews were used for data collection and patients were interviewed in their homes. The sample consisted of 20 patients with a confirmed diagnosis of heartfailure. Patients were between 60 and
... Diets HeartFailure FRIDAY, Sept. 27 (HealthDay News) -- Healthy eating habits can significantly reduce high blood pressure and improve ... face when they try to improve their eating habits," he added. Heartfailure ... that the low-sodium DASH diet can lower blood pressure in patients who are ...
Hypocalcemic dilated cardiomyopathy is a rare cause of heartfailure in adults. We report a case in a 19-year-old woman who developed congestive heartfailure induced by severe chronic hypocalcemia disclosing primary hypoparathyroidism. Complete regression of the clinical signs was achieved with vitamin-calcium treatment, but left ventricular systolic dysfunction persisted eight months after treatment. PMID:11965090
Chraibi, S; Drighl, A; Nafidi, S; Zahraoui, M; Tahiri, A; Chraibi, N
Because of the increasing incidence of acute heartfailure admissions to critical care units, nephrologists have been asked to become more involved in the management of these patients. Renal dysfunction is a major element in impeding clinical recovery. In acute heartfailure, renal function is often abnormal. The judicious application of ultrafiltration techniques may represent an efficacious adjunct to present
Clinical consequences of heartfailure are fatigue, dyspnea, and progressive impairment of exercise tolerance. Regular exercise training is associated with health-improving effects. In patients with stable heartfailure, exercise training can relieve symptoms, improve exercise capacity and quality of life, as well as reduce hospitalization and, to some extent, risk of mortality. Progressive exercise training is associated with pulmonary, cardiovascular,
Louis J. Ignarro; Francesco Cacciatore; Ettore Crimi; Claudio Napoli
Mechanical dyssynchrony is a common phenomenon in patients with congestive heartfailure, which usually identified by noninvasive cardiac imaging tools such as echocardiography. It demonstrates electromechanical delay in some regions of the failing heart which in turn contributes to further impairment of cardiac function. The diagnostic, therapeutic and prognostic values of mechanical dyssynchrony have been reported in a number of studies. Therefore, this review describes briefly the methods of measurement, but more importantly, explains the clinical implication of its assessment in heartfailure related aspects including cardiac resynchronization therapy, functional mitral regurgitation, diastolic heartfailure and mortality.
To investigate whether heartfailure impairs peripheral sympathetic vasoconstriction, hindlimb vascular responses to lumbar chain stimulation (0.5-20 Hz) were studied in normal dogs and in dogs with chronic heartfailure produced by rapid ventricular pacing. At lumbar chain stimulation rates of 0.5-3 Hz, hindlimb vascular responses were comparable in both groups. However, at stimulation rates of 5-20 Hz, vascular responses were significantly attenuated in the dogs with heartfailure. Vascular responses to norepinephrine (0.1, 1, and 10 micrograms/min) were not altered. These findings suggest that chronic heartfailure results in impaired sympathetic vasoconstriction, probably because of reduced neurotransmitter release. This abnormality may interfere with the capacity of the failing circulation to compensate for a low cardiac output and thereby intensify the severity of heartfailure. PMID:3354699
Wilson, J R; Matthai, W; Lanoce, V; Frey, M; Ferraro, N
The recent explosion of scientific knowledge and technological progress has led to the discovery of a large array of circulating molecules commonly referred to as biomarkers. Biomarkers in heartfailure research have been used to provide pathophysiological insights, aid in establishing the diagnosis, refine prognosis, guide management, and target treatment. However, beyond diagnostic applications of natriuretic peptides, there are currently few widely recognized applications for biomarkers in heartfailure. This represents a remarkable discordance considering the number of molecules that have been shown to correlate with outcomes, refine risk prediction, or track disease severity in heartfailure in the past decade. In this article, we use a broad framework proposed for cardiovascular risk markers to summarize the current state of biomarker development for heartfailure patients. We utilize this framework to identify the challenges of biomarker adoption for risk prediction, disease management, and treatment selection for heartfailure and suggest considerations for future research.
Kalogeropoulos, Andreas P.; Georgiopoulou, Vasiliki V.; Butler, Javed
There is a paucity of knowledge concerning how people with heartfailure experience differences between specialised heartfailure clinics and primary healthcare in Sweden. This study aimed to describe differences regarding information and follow-up in heartfailure clinics and primary healthcare. The study was conducted in Sweden in 2011. Four people (three men, one woman; aged 60 to 84) with heartfailure (NYHA II) were interviewed. The interviews were analysed with qualitative content analysis. The findings revealed after referral from the heartfailure clinic to primary healthcare, follow-ups were omitted. Still, the patients needed care, support and information. The findings are illuminated in four themes. The patients' varying and individual needs can be difficult to recognise and manage unless they are followed-up from either HFC or PHC on a regular basis. PMID:24046927
Heartfailure afflicts ~5million people and causes ~300,000 deaths a year in the United States alone. Heartfailure is defined as a deficiency in the ability of the heart to pump sufficient blood in response to systemic demands, which results in fatigue, dyspnea, and\\/or edema. Identifying new therapeutic targets is a major focus of current research in the field. We
OBJECTIVETo characterise the central and regional haemodynamic effects of insulin in patients with chronic heartfailure.DESIGNSingle blind, placebo controlled study.SETTINGUniversity teaching hospital.PATIENTSTen patients with stable chronic heartfailure.INTERVENTIONSHyperinsulinaemic euglycaemic clamp and non-invasive haemodynamic measurements.MAIN OUTCOME MEASURESChange in resting heart rate, blood pressure, cardiac output, and regional splanchnic and skeletal muscle blood flow.RESULTSInsulin infusion led to a dose dependent increase in
Hypoxic hepatitis secondary to heartfailure is a known and treatable cause of liver failure. The diagnosis may be difficult, especially when symptoms of heartfailure are absent. We present two patients who were transferred to our hospital with the diagnosis of acute liver failure to be screened for a liver transplantation. Both patients had increased serum levels ofaminotransferases, lactic acidosis, coagulation disorders, and non-specific clinical symptoms. Echocardiography revealed right ventricular dysfunction. Treatment with inotropes resulted in a fast normalization of liver enzymes, acidosis and coagulation, confirming the diagnosis hypoxic hepatitis. In conclusion, when the cause of acute liver dysfunction is unclear, hypoxic hepatitis due to heartfailure should be considered and echocardiography should be performed, even when symptoms are non-specific for heartfailure. PMID:21837938
de Leeuw, K; Meertens, J H J M; van der Horst, I C C; van der Berg, A P; Ligtenberg, J J M; Tulleken, J E; Zijlstra, J G
BackgroundHeartfailure is a major cause of morbidity and mortality and is increasing in prevalence. Treatments for heartfailure permit a growing number of persons to live with the illness for many years. The burden of symptoms in persons with advanced heartfailure is high. Fatigue, limited exertion, dyspnea, and depression are commonly associated with heartfailure, but pain is
Sarah J. Goodlin; Sue Wingate; Susan J. Pressler; John R. Teerlink; C. Porter Storey
Background: Heartfailure 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 heartfailure.Methods and Results: In the
Peter Carson; Susan Ziesche; Gary Johnson; Jay N. Cohn
HeartFailure continues to be a major public health problem associated with high mortality and morbidity. HeartFailure is the leading cause of hospitalization for persons older than 65 years, has a poor prognosis and is associated with poor quality of life. More than 5.3 million American adults are living with heartfailure. Despite maximum medical therapy and frequent hospitalizations to stabilize their condition, one in five heartfailure patients die within the first year of diagnosis. Several disease-management programs have been proposed and tested to improve the quality of heartfailure care. Studies have shown that hospital admissions and emergency room visits decrease with increased nursing interventions in the home and community setting. An alternative strategy for promoting self-management of heartfailure is the use of electronic home monitoring. The purpose of this study was to examine what effects heartfailure has on patient's quality of life that had been monitoring on an electronic home monitor longer than 2 months. Twenty-one questionnaires were given to patients utilizing an electronic home monitor by their home health agency nurse. Eleven patients completed the questionnaire. The findings showed that there is some deterioration in quality of life with more association with the physical aspects of life than with the emotional aspects of life, which probably was due to the small sample size. There was no significant difference in readmission rates in patients utilizing an electronic home monitor. Further research is needed with a larger population of patients with chronic heartfailure and other chronic diseases which may provide more data, and address issues such as patient compliance with self-care, impact of heartfailure on patient's quality of life, functional capacity, and heartfailure patient's utilization of the emergency rooms and hospital. Telemonitoring holds promise for improving the self-care abilities of persons with HF.
The purpose of this investigation was to determine whether changes in myosin heavy chain (MHC) expression and atrophy in rat skeletal muscle are observed during transition from cardiac hypertrophy to chronic heartfailure (CHF) induced by aortic stenosis (AS). AS and control animals were studied 12 and 18 weeks after surgery and when overt CHF had developed in AS animals, 28 weeks after the surgery. The following parameters were studied in the soleus muscle: muscle atrophy index (soleus weight/body weight), muscle fibre diameter and frequency and MHC expression. AS animals presented decreases in both MHC1 and type I fibres and increases in both MHC2a and type IIa fibres during late cardiac hypertrophy and CHF. Type IIa fibre atrophy occurred during CHF. In conclusion, our data demonstrate that skeletal muscle phenotype changes occur in both late cardiac hypertrophy and heartfailure; this suggests that attention should be given to the fact that skeletal muscle phenotype changes occur prior to overtheartfailure symptoms.
Carvalho, Robson Francisco; Cicogna, Antonio Carlos; Campos, Gerson Eduardo Rocha; De Assis, Jeane Marlene Fogaca; Padovani, Carlos Roberto; Okoshi, Marina Politi; Pai-Silva, Maeli Dal
Anemia is a prevalent comorbidity in chronic heartfailure (CHF). As studies have demonstrated close links between anemia and a poorer prognosis, there has been an interest in developing treatment strategies for this condition. Anemia is closely associated with disease severity and may be secondary to multiple modifiable causes; therefore, the initial strategies should always include a thorough search for etiology and should focus on optimizing heartfailure treatment. Recently, more specific therapies have been assessed, namely erythropoiesis-stimulating agents and iron supplementation therapy. Studies evaluating erythropoietin in heartfailure have demonstrated conflicting results to date, with smaller, single-center studies seeming to show a clinical benefit and larger, multicenter trials demonstrating no significant effect on clinical outcome aside from improvement in selected quality-of-life indices. Similarly, studies evaluating iron therapy alone in anemic patients with heartfailure have so far shown promising results with regard to clinical and quality-of-life outcomes, but these studies are limited in that they involved small patient numbers. Ongoing studies such as the Reduction of Events With Darbepoetin Alfa in HeartFailure (RED-HF), Iron Supplementation in HeartFailure Patients With Anemia (IRON-HF), and Ferinject Assessment in Patients With Iron Deficiency and Chronic HeartFailure (FAIR-HF) trials will determine the value of darbepoetin alfa and intravenous iron replacement therapy in anemic CHF patients. PMID:19026176
Sudden cardiac death (SCD) is the leading cause of mortality in heartfailure (HF). Today the implantable cardioverter-defibrillator (ICD) has become a commonplace therapy around the world for patients with both ischemic and non-ischemic cardiomyopathy and an ejection fraction (EF) < or = 35%. However, EF alone does not discriminate between the modes of death from HF (sudden arrhythmic death vs. non-sudden death). Other risk statifiers, such as electrophysiologic study and microvolt T-wave alternans testing, should therefore be used in the appropriate settings to minimize the number of unnecessary device implants. In addition, left ventricular mechanical dyssynchrony has now become recognized as an additional major marker of cardiac mortality. Its assessment should entail echocardiography rather than measurement of the QRS duration. This will allow us to better integrate the ability of cardiac resynchronization therapy (CRT) in enhancing cardiac function with the ability of an ICD in preventing SCD. This review aims to: 1) give a synthesis of the published evidence regarding the value of implantable ICDs and CRT in the primary prophylaxis of SCD in HF; 2) discuss controversial clinical issues in this area; and 3) recommend practical device-based management strategies. PMID:17208319
Rosanio, Salvatore; Schwarz, Ernst R; Vitarelli, Antonio; Zarraga, Ignatius Gerardo E; Kunapuli, Sanjay; Ware, David L; Birnbaum, Yochai; Tuero, Enrique; Uretsky, Barry F
Objective: To provide a critical review and analysis of heartfailure (HF)-specific symptom measures Methods: A systematic search using the PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases and reference lists of relevant papers was undertaken to identify symptom measures that were primarily designed for patients with HF. Results: The systematic search yielded seven instruments that included three or more symptoms. Of the seven instruments, only five had psychometric properties available and these were reviewed. Levels of comprehensiveness of symptom measures varied including the number of symptoms assessed (13-32 symptoms/signs) and symptom dimensions (e.g. frequency and severity). Information about reading levels, time to completion, and completion rates was limited. Psychometric properties of the five measures have not been extensively investigated or reported. Conclusion: The development and use of the HF symptoms instruments is at a relatively early stage. Thus, further investigation of the psychometric characteristics of existing HF-specific symptom instruments is necessary before one can be recommended for research and clinical use. PMID:23303769
Background Cardiovascular diseases contribute substantially to the poor health and reduced life expectancy of Indigenous Australians. Heartfailure is a common, disabling, progressive and costly complication of these disorders. The epidemiology of heartfailure and the adequacy of relevant health service provision in Indigenous Australians are not well delineated. Methods A systematic search of the electronic databases PubMed, Embase, Web of Science, Cinahl Plus, Informit and Google Scholar was undertaken in April 2012 for peer-reviewed journal articles relevant to the topic of heartfailure in Indigenous Australians. Additionally, a website search was done to identify other pertinent publications, particularly government reports. Results There was a paucity of relevant peer-reviewed research, and government reports dominated the results. Ten journal articles, 1 published conference abstract and 10 reports were eligible for inclusion. Indigenous Australians reportedly have higher morbidity and mortality from heartfailure than their non-Indigenous counterparts (age-standardised prevalence ratio 1.7; age-standardised hospital separation ratio ?3; crude per capita hospital expenditure ratio 1.58; age-adjusted mortality ratio >2). Despite the evident disproportionate burden of heartfailure in Indigenous Australians, the accuracy of estimation from administrative data is limited by poor indigenous identification, inadequate case ascertainment and exclusion of younger subjects from mortality statistics. A recent journal article specifically documented a high prevalence of heartfailure in Central Australian Aboriginal adults (5.3%), noting frequent undiagnosed disease. One study examined barriers to health service provision for Indigenous Australians in the context of heartfailure. Conclusions Despite the shortcomings of available published data, it is clear that Indigenous Australians have an excess burden of heartfailure. Emerging data suggest that undiagnosed cases may be common in this population. In order to optimise management and to inform policy, high quality research on heartfailure in Indigenous Australians is required to delineate accurate epidemiological indicators and to appraise health service provision.
Heartfailure is a chronic illness that poses a significant societal burden in the United States. Health care facilities are challenged to provide the most current treatment options available for patients with heartfailure. Patient education focusing on self-management is recognized as essential. Nurses play a key role in the delivery of patient education. This article reviews the limited available evidence regarding nurses' knowledge of heartfailure self-management principles. The key topics of symptom and weight management, dietary recommendations, medications, and activity are discussed. PMID:18557284
Atrial tachycardia and atrial flutter are common tachyarrhythmias in the heartfailure population. They commonly lead to, exacerbate, and increase the morbidity and mortality associated with heartfailure and, thereby, warrant urgent and early definitive therapy in the form of catheter ablation. Catheter ablation requires careful patient stabilization and extensive preprocedural planning, particularly with regards to anesthesia, strategy, catheter choice, mapping system, and fluid balance, to increase efficacy and limit adverse effects. Heartfailure may limit the success of catheter ablation with higher reported recurrence rates, and in selected patients, a hybrid epicardial-endocardial ablation can be considered. PMID:24054482
Background The prevalence of heartfailure is 3 to 20 per 1,000 population, but may exceed 100 per 1,000 in the over 65 age group. Some\\u000a 1–2% of the total healthcare budget is consumed in the management of heartfailure.\\u000a \\u000a \\u000a \\u000a Aim As hospital costs account for approximately 70% of this expenditure we determined the cost of treating heartfailure in an\\u000a Irish
Chronic heartfailure (CHF), the new epidemic in cardiology, is characterized by energetic failure of both cardiac and skeletal muscles. The failing heart wastes energy due to anatomical changes that include cavity enlargement, altered geometry, tachycardia, mitral insufficiency and abnormal loading, while skeletal muscle undergoes atrophy. Cardiac and skeletal muscles also have altered high-energy phosphate production and handling in CHF.
B. Mettauer; J. Zoll; A. Garnier; R. Ventura-Clapier
BACKGROUND:: In clinical practice, heartfailure (HF) medications are underused and prescribed at lower than recommended doses. Telephone care is an option that could help to titrate HF medication in a timely manner. We describe our experience of a nurse-run, cardiologist- or nurse practitioner-supervised clinic to up-titrate HF medications via telephone. METHODS:: Patients with the diagnosis of HF, New York Heart Association classes I to III, were referred to a registered nurse-run, cardiologist-/nurse practitioner-supervised HF medication titration clinic. Clinical and medication data collected at enrollment to the clinic and at 3 to 6 months after optimization of HF medications in patients who did or did not reach the target doses were compared. Effect on left ventricular (LV) function was also evaluated. RESULTS:: There were 79 patients in the evaluation: 64 with HF and LV systolic dysfunction (LVSD) and the remaining 15 with HF and preserved ejection fraction (EF). Seventy-two percent of patients with LVSD were on an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and 61% were on a ?-blocker at baseline, and this increased to 98% and 97%, respectively, after optimization. Target doses was achieved in 50% of patients for ACEI or ARB, and in 41% for ?-blockers. The median time to optimization was 54 days (interquartile range, 20-97 days). The average number of phone calls at the time of optimization were 5.4 (SD, 3.7), and the average number of clinic visits was 1.9 (SD, 1.3). Reasons for not reaching the target doses included hypotension, hyperkalemia, and renal dysfunction for ACEI and bradycardia for ?-blockers. Overall, the EF increased by 10% (SD, 10%) after 6 months, and 35% or greater in 42% of patients whose baseline EF was less than 35%. There were no adverse events related to the dose up-titration. CONCLUSION:: Telephonic titration of HF medications was feasible and safe and was achieved in 97% patients on ACEI/ARB and ?-blockers. Medication titration was associated with significant improvement in LV function, avoiding the need for device therapy in many patients. PMID:21127425
Steckler, Anne E; Bishu, Kalkidan; Wassif, Heba; Sigurdsson, Gardar; Wagner, Judy; Jaenicke, Connie; Vats, Shashank; Rector, Thomas; Anand, Inder S
Heartfailure afflicts ~5 million people and causes ~300,000 deaths a year in the United States alone. Heartfailure is defined as a deficiency in the ability of the heart to pump sufficient blood in response to systemic demands, which results in fatigue, dyspnea, and/or edema. Identifying new therapeutic targets is a major focus of current research in the field. We and others have identified critical roles for protein kinase C (PKC) family members in programming aspects of heartfailure pathogenesis. More specifically, mechanistic data have emerged over the past 6–7 years that directly implicate PKC?, a conventional PKC family member, as a nodal regulator of heartfailure propensity. Indeed, deletion of the PKC? gene in mice, or its inhibition in rodents with drugs or a dominant negative mutant and/or inhibitory peptide, have shown dramatic protective effects that antagonize the development of heartfailure. This review will weigh all the evidence implicating PKC? as a novel therapeutic target to consider for the treatment of heartfailure.
In previous experiments, we observed signs of cardiac failure in mice overexpressing lipoprotein lipase (LPL) under the control of a muscle specific promotor and in peroxisome proliferators activated receptor alpha (PPAR?) knockout mice overexpressing LPL under the control of the same promotor. In our current investigations, we focussed on morphological consequences and changes in mRNA and protein expression in hearts from these animals. mRNA expression was analysed by differential display analysis and Northern blot as well as by cDNA microarray analysis followed by pathway analysis. Protein expression was examined using immunoblot and immunohistochemistry. Fibrosis was determined by chromotrope aniline blue staining for collagen. A distinct increase in the expression of ?-tubulin mRNA was noted in hearts of all mutant mouse strains compared with the control. This result was paralleled by increased ?-tubulin protein expression. Using cDNA microarray analysis, we detected an activation of apoptosis, in particular an increase of caspase-3 expression in hearts of mice overexpressing LPL but not in PPAR? knockout mice overexpressing LPL. This finding was confirmed immunohistochemically. In addition, we identified a distinct interstitial increase in collagen and an increase around blood vessels. In our mouse model, we detect mRNA and protein changes typical for cardiomyopathy even before overt clinical signs of heartfailure. In addition, a small but distinct increase in the rate of apoptosis of cardiomyocytes and fibrotic changes contributes to cardiac failure in mice overexpressing LPL, whereas additional deficiency in PPAR? seems to protect hearts from these effects.
Introduction Biomarker changes may provide physicians with objective evidence of treatment efficacy in patients with acute decompensated heartfailure (ADHF), and facilitate early hospital discharge. We hypothesize that MR-proADM, CT-pro-ET-1 and MR-proANP change during the first 24 hours of ADHF therapy. Methods Eligible subjects had an ED diagnosis of ADHF and fulfilled modified Framingham Criteria. Clinical data, serum, and plasma were collected at enrollment, 2–4 hours, and 12–24 hours after treatment. We calculated changes in biomarker concentrations from baseline to 2–4 hours, baseline to 12–24 hours, and 2–4 to 12–24 hours. Fisher’s exact and Kruskal-Wallis tests were used for comparisons. Results Forty-eight subjects were included. Median age was 62 years (range 40–88), 54% were male and 50% were white. More subjects had changes in MR-pro-ANP levels in the first 2–4 hours after ADHF therapy compared to MR-proADM or CT-pro-ET-1 (36% vs. 16% and 24%). However, 12–24 hours after therapy similar proportions of patients had changes in MR-proANP, MR-proADM, and CT-proET-1 levels (47%, 41% and 49%). Conclusion In this preliminary study patients with ADHF had measurable changes in MR-proANP, MR-proADM and CT-pro-ET-1 24 hours after initial therapy. A study of association with clinical course and outcomes to determine the role of these markers in risk-stratification is warranted.
Boyer, Brent; Hart, Kimberly Ward; Sperling, Matthew I.; Lindsell, Christopher J.
Although dyspnea and fatigue are hallmark symptoms of heartfailure (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.
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.
Heartfailure (HF) is a complex syndrome that involves changes in behavioral, neural and endocrine regulatory systems. Dietary salt restriction along with pharmacotherapy is considered an essential component in the effective management of symptomatic HF patients. However, it is well recognized that HF patients typically have great difficulty in restricting sodium intake. We hypothesized that under HF altered activity in systems that normally function to regulate body fluid and cardiovascular homeostasis could produce an increased preference for the taste of salt. Therefore, this study was conducted to evaluate the perceived palatability (defined as salt preference) of food with different concentrations of added salt in compensated chronically medicated HF patients and comparable control subjects. Healthy volunteers (n=25) and medicated, clinically stable HF patients (n=38, NYHA functional class II or III) were interviewed and given an evaluation to assess their preferences for different amounts of saltiness. Three salt concentrations (0.58, 0.82, and 1.16 g/100 g) of bean soup were presented to the subjects. Salt preference for each concentration was quantified using an adjective scale (unpleasant, fair or delicious). Healthy volunteers preferred the soup with medium salt concentration (p=0.042), HF patients disliked the low concentration (p<0.001) and preferred the high concentration of salted bean soup (p<0.001). When compared to healthy volunteers, HF patients demonstrated a significantly greater preference for the soup with a high salt concentration (p=0.038). It is concluded that medicated, compensated patients under chronic treatment for HF have an increased preference for salt. PMID:22019543
de Souza, Juli Thomaz; Matsubara, Luiz S; Menani, José Vanderlei; Matsubara, Beatriz B; Johnson, Alan Kim; De Gobbi, Juliana Irani Fratucci
Heartfailure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Due to the aging of the population it has become a growing public health problem in recent decades. Diagnosis of HF is clinical and there is no diagnostic test, although some basic complementary testing should be performed in all patients. Depending on the ejection fraction (EF), the syndrome is classified as HF with low EF or HF with normal EF (HFNEF). Although prognosis in HF is poor, HFNEF seems to be more benign. HF and ischemic stroke (IS) share vascular risk factors such as age, hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation. Persons with HF have higher incidence of IS, varying from 1.7% to 10.4% per year across various cohort studies. The stroke rate increases with length of follow-up. Reduced EF, independent of severity, is associated with higher risk of stroke. Left ventricular mass and geometry are also related with stroke incidence, with concentric hypertrophy carrying the greatest risk. In HF with low EF, the stroke mechanism may be embolism, cerebral hypoperfusion or both, whereas in HFNEF the mechanism is more typically associated with chronic endothelial damage of the small vessels. Stroke in patients with HF is more severe and is associated with a higher rate of recurrence, dependency, and short term and long term mortality. Cardiac morbidity and mortality is also high in these patients. Acute stroke treatment in HF includes all the current therapeutic options to more carefully control blood pressure. For secondary prevention, optimal control of all vascular risk factors is essential. Antithrombotic therapy is mandatory, although the choice of a platelet inhibitor or anticoagulant drug depends on the cardiac disease. Trials are ongoing to evaluate anticoagulant therapy for prevention of embolism in patients with low EF who are at sinus rhythm.
BACKGROUND--It has been shown that heart rate variability is decreased in patients with congestive heartfailure 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 heartfailure and ventricular arrhythmias. METHODS--Spectral heart rate variability was analysed from 24 hour ambulatory electrocardiograms in 15 controls, 15 patients with non-sustained ventricular tachycardia associated with clinically normal hearts (NHVT group), and 40 patients with congestive heartfailure (CHF group) secondary to either ischaemic heart disease (n = 15) or idiopathic dilated cardiomyopathy (n = 25). Of the 40 patients with congestive heartfailure 15 had no appreciable ventricular arrhythmias (ventricular extrasystoles < 10 beats/h and no salvos) and formed the CHF-VA- group. Another 15 patients with congestive heartfailure and non-sustained ventricular tachycardia formed the CHF-NSVT group. RESULTS--Heart rate variability was significantly lower in the CHF group than in controls (mean (SD) total frequency 23 (12) v 43 (13) ms; low frequency 12 (8) v 28 (9) ms; high frequency 8 (5) v 14 (7) ms; p < 0.001). The differences in heart rate variability between controls and the NHVT group, between ischaemic heart disease and dilated cardiomyopathy, and between the CHF-VA- and CHF-NSVT groups were not significant. In the CHF group heart rate variability was significantly related to left ventricular ejection fraction but not associated with ventricular arrhythmias. The frequency of ventricular extrasystoles was significantly related to the high frequency component of heart rate variability (r = 0.54, p < 0.05) in the NHVT group. Stepwise multiple regression analysis showed that in the CHF group, heart rate variability was predominantly related to left ventricular ejection fraction (p < 0.05). There was no significant difference in heart rate variability between survivors (n = 34) and those who died suddenly (n = 6) at one year of follow up in the CHF group. CONCLUSION--In patients with congestive heartfailure, heart rate variability is significantly decreased. The depressed heart rate variability is principally related to the degree of left ventricular impairment and is independent of aetiology and the presence of ventricular arrhythmias. The data suggest that analysis of heart rate variability does not help the identification of patients with congestive heartfailure at increased risk of sudden death.
Fei, L.; Keeling, P. J.; Gill, J. S.; Bashir, Y.; Statters, D. J.; Poloniecki, J.; McKenna, W. J.; Camm, A. J.
Heartfailure is a systemic disorder characterised by tissue hypoxia and secondary organ dysfunction which occurs in response to various myocardial insults that include ischaemia, viral infections, and toxins. In addition to maladaptive neurohumoral activation, heartfailure is associated with an inflammatory state that appears to have a detrimental effect on cardiac function and prognosis. This has led to the
The disclosure pertains to methods of reducing decompensation through acute intervention including in subjects afflicted with acute decompensated heartfailure. Particularly, the disclosure provides methods for treating acute cardiac decompensation by administering a pharmaceutically effective amount of relaxin.
Unemori; Elaine (Oakland, CA); Teichman; Sam L (Alamo, CA); Cotter; Gad (Chapel Hill, NC); Stewart; Dennis R (Los Gatos, CA); Whitehouse; Martha J (San Mateo, CA)
The use of resistance exercise in patients with heartfailure (HF) is controversial because of concern that increases in rate pressure product and systemic vascular resistance might lead to increased afterload and decreased cardiac output.
The heartfailure illness trajectory is both complex and unpredictable, which makes providing palliative care services to patients with heartfailure a challenge. As a result, although services are needed, few tend to be offered beyond basic medical management. The traditional model of palliative care is typically based on palliative care being considered a system of care delivery most appropriate for patients with a predictable illness/death trajectory, such a terminal cancer. This type of model, which is based on the ability to predict the course of a terminal disease, does not fit the heartfailure trajectory. In this paper, we propose a new model of palliative care that conceptualizes palliative care as a philosophy of care that encompasses the unpredictable nature of heartfailure.
Heartfailure is a leading cause of death in industrialized nations especially in an aging population. The recent improvements in cardiac revascularization therapy reduced death rates because of myocardial infarction but steadily increased the number of individuals developing cardiac remodeling and heartfailure in the future. Conceptual novel approaches entering the clinics to treat cardiac remodeling and heartfailure remain scarce. MicroRNAs emerged as powerful and dynamic modifiers of cardiovascular diseases. In this review, the current approaches using microRNAs as novel diagnostic and therapeutic strategies for cardiac remodeling and heartfailure are highlighted. Other gene regulatory mechanisms presented include long (>200 bp) noncoding RNAs that function as an additional regulatory machinery of the genome controlling both transcriptional and post-transcriptional events also in the cardiovascular system. PMID:23989712
Heartfailure (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 heartfailure 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 heartfailure; how the measures are obtained; how measures are employed; and present and future challenges surrounding quality measurement in heartfailure. PMID:22548579
Fitzgerald, Ashley A; Allen, Larry A; Masoudi, Frederick A
Heartfailure (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 heartfailure 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 heartfailure; how the measures are obtained; how measures are employed; and present and future challenges surrounding quality measurement in heartfailure.
Fitzgerald, Ashley A.; Allen, Larry A.; Masoudi, Frederick A.
Many hospitals and health care systems are focusing on improving performance and patient outcomes in cardiovascular services, with a particular emphasis on how the management of heartfailure can prevent readmissions, decrease the cost per case, and improve the quality and satisfaction for this particular patient population. Quality outcomes and optimal lifestyle management of chronic care diseases, such as heartfailure (HF), will be deciding factors in patient choice about health care providers and systems. Implementing heartfailure programs or heartfailure readmission reduction strategies are undertakings that require significant analysis, planning, preparation, and execution. Given the significant volumes of HF readmissions, as well as numerous potential policy changes focused on reducing costs, properly aligning incentives, and improving quality, HF may be an ideal place to start to begin initiatives around readmission reduction. For an organization to identify and execute appropriate strategies, a structured approach to assessment and implementation can ensure the highest likelihood of success. PMID:20446378
The purpose of this study is to test the effectiveness of telenursing in assisting individuals with heartfailure to effectively self-manage their care and, by so doing, improve quality of life and health status and decrease hospital readmissions.
Heartfailure mortality is significantly increased in patients with baseline renal impairment and those with underlying heartfailure 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 heartfailure 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 heartfailure, it is important to establish the current understanding of the disease burden and the therapeutic implications.
Heartfailure is a complex disease that has great impact on morbidity and mortality in the general population. No recent therapies have proven to be effective; however, the discovery of new potential pathophysiological mechanisms involved in heartfailure expression and progression could offer novel therapeutic strategies. A number of studies have shown that the immune system may be a central mediator in the development and progression of heartfailure, and here we describe how the B-cell and B-cell-mediated pathways play specific roles in the heartfailure state. Therapies aimed at B-cells, either blocking antibody production or inactivating B-cell function, may suggest potential new treatment strategies.
Cordero-Reyes, Andrea M.; Youker, Keith A.; Torre-Amione, Guillermo
Synopsis Depression is a common comorbid condition in heartfailure, and there is growing evidence that it increases the risks of mortality and other adverse outcomes, including rehospitalization and functional decline. The prognostic value of depression depends, in part, on how it is defined and measured. The few studies that have compared different subsets of depressed patients suggest that major (or severe) depression is a stronger predictor of mortality than is minor (or mild) depression. Whether depression is a causal risk factor for heartfailure mortality, or simply a risk marker, has not yet been established, but mechanistic research has identified several plausible behavioral and biological pathways. Further research is needed to clarify the relationships among depression, heartfailure, and adverse outcomes, as well as to develop efficacious interventions for depressive disorders in patients with heartfailure.
Freedland, Kenneth E.; Carney, Robert M.; Rich, Michael W.
ObjectiveOur objective was to assess the prevalence of panic disorder, its influence on quality of life (QoL), and the presence of further anxiety and depressive comorbid disorders in outpatients with chronic heartfailure (CHF).
Thomas Müller-Tasch; Lutz Frankenstein; Nicole Holzapfel; Dieter Schellberg; Bernd Löwe; Manfred Nelles; Christian Zugck; Hugo Katus; Bernhard Rauch; Markus Haass; Jana Jünger; Andrew Remppis; Wolfgang Herzog
Despite evidence-based medical and pharmacologic advances the management of heartfailure remains challenging, whether in the ambulatory setting where daily weight monitoring has failed, or in the inpatient setting where readmission rates and morbidity remains high. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates for heartfailure in general. There may be a shift in the paradigm with respect to the treatment of heartfailure, which may usher in an era of invasive heartfailure therapies and specialists. Experimental invasive devices and monitors have the potential to be game-changing therapies, and cardiac resynchronization therapy has evolved beyond just resynchronization and has the potential to provide important real-time hemodynamic feedback.
Generally, the sauna bathing has been contraindicated for patients with chronic heartfailure. However, it has been well tolerated and improved hemodynamics has been shown in patients with chronic heartfailure after a single exposure and after a four-week period of sauna bathing (five days per week). Left ventricular ejection fraction increased from 24±7% to 31±9% and left ventricular end-diastolic dimension decreased from 66±6 mm to 62±5 mm after four weeks. In the present review, the mechanisms of action, the clinical data available to date and the possible beneficial effects of sauna bathing for patients with heartfailure are discussed, as well as the precautions and the contraindications in this specific group of patients with chronic heartfailure.
The prevalence of chronic heartfailure in Hungary is 1.6% in the adult population, but it occurs in 15-20% of subjects over 80 years of age. The base of treatment of heartfailure is the blockade of the neuro-hormonal system, which includes the use of angiotensin converting enzyme inhibitors (angiotensin receptor blockers in case of angiotensin converting enzyme inhibitors intolerance), beta receptor blockers and mineralocorticoid receptor antagonists. Because of their negative inotropic effect, beta blockers were neglected for a long time from the treatment of heartfailure. However, during the past decades several studies have demonstrated that beta blockers decrease mortality in patients with heartfailure. The effectiveness of bisoprolol in reducing mortality has also also been documented in a number of studies. Orv. Hetil., 154 (44), 1731-1734. PMID:24161596
Many patient education guidelines for teaching heartfailure patients recommend inclusion of the family; however, family-focused interventions to promote self-care in heartfailure are few. This article reviews the state of the science regarding family influences on heartfailure 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, heartfailure 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.
Heartfailure 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 heartfailure manifest myocardial conduction abnormalities. Conduction abnormalities, especially in the form\\u000a of left bundle branch block (LBBB) may be
Epigenetic alterations are implicated in the development of cardiac hypertrophy and heartfailure, but little is known of which epigenetic changes in which regions of the genome play such a role. We now show that trimethylation of histone H3 on lysine-4 (K4TM) or lysine-9 (K9TM) is markedly affected in cardiomyocytes in association with the development of heartfailure in a
Background. Rejection associated with heartfailure or death occurs after pediatric cardiac transplantation but has had limited analysis.Methods. We analyzed the records of 96 consecutive pediatric cardiac transplant recipients who survived to hospital discharge.Results. Eighteen patients (19%) experienced 23 episodes of heartfailure or death associated with rejection. Univariate analysis demonstrated black race (p = 0.041), transplantation after 12 months
Mindee J Flippin; David T Balzer; Paula R Murphy; Susan E Ruble; Eric N Mendeloff; Charles B Huddleston; Charles E Canter
Synopsis The major pathologic ?-adrenergic (?AR) subtype in heartfailure is the ?1AR. Our laboratory has thus pursued genetic variation of the ?1AR gene at the molecular, cellular, physiologic and clinical levels as the potential basis for interindividual variability in the response to ?-blocker treatment in heartfailure. This chapter will review these findings, with an emphasis on mechanism of action and future directions.
Opinion Statement I individualize my approach to each patient based upon their understanding of their disease process, acuity of their progression\\u000a to Stage D heartfailure, clinical setting (hospitalized vs outpatient), and family needs. My first goal is to prove intolerance\\u000a of traditional therapies for heartfailure by challenging patients with various medication combinations, including staggered\\u000a dosing regimens and alternatives to
Unraveling the molecular complexities of human heartfailure, particularly end-stage failure, can be achieved by combining\\u000a multiple investigative approaches. There are several parts to the problem. Each patient is the product of a complex set of\\u000a genetic variations, different degrees of influence of diets and lifestyles, and usually heart transplantation patients are\\u000a treated with multiple drugs. The genomic status of
C. G. Dos Remedios; C. C. Liew; P. D. Allen; R. L. Winslow; J. E. Van Eyk; M. J. Dunn
Abstract Background: Treatment of chronic heartfailure is based on the results of large clinical trials, which form the basis of treatment guidelines, such as those from,the European Society of Cardiology (ESC). The aim,of this study was,to record treatment-modalities and,the implementation of guidelines of chronic heartfailure in clinical practice in Austria. Methods: Overall 96 general physicians, specialists for internal
Friedrich M. Fruhwald; Peter Rehak; Robert Maier; Norbert Watzinger; Manfred Wonisch; Werner Klein
Symptomatic heartfailure is a complex clinical syndrome with a poor prognosis. Many efforts have been made to develop new therapeutic strategies to improve prognosis associated with heartfailure. In this context, different stem cell populations for cardiac regenerative therapy have been examined recently. Here we discuss the potential strategies for using stem cells in cardiac regenerative therapy and the barriers that remain before an effective cell-based cardiac regenerative therapy can be employed clinically.
Acute heartfailure syndromes (AHFS) represent the most common discharge diagnoses in adults over age 65 and translate into\\u000a dramatically increased heartfailure–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
Congestive heartfailure is a progressive hemodynamic disorder associated with significant morbidity and mortality. Concomitant\\u000a renal dysfunction is frequently seen in patients with heartfailure, and can compromise fluid regulation, leading to acute\\u000a decompensation, and increased morbidity and mortality. Diuretic therapy has been the mainstay for treatment of congestive\\u000a symptoms, despite documented mortality benefits. Misuse or overuse of diuretics can
Heartfailure with preserved ejection fraction (HFPEF) is increasing in prevalence with the aging of the population, and morbidity\\u000a and mortality rates are comparable to that of heartfailure with reduced ejection fraction (HFREF). The diagnosis can be difficult\\u000a to make, especially in older adults, stemming from the presence of multiple co-morbid illnesses with confounding symptoms.\\u000a New diagnostic tools have
In patients with congestive heartfailure, sleep disordered breathing occurs commonly and is associated with an increased\\u000a mortality. In addition to central sleep apnea (Cheyne–Stokes respiration), obstructive sleep apnea is more prevalent in patients\\u000a with congestive heartfailure than in the general population. As a result, a number of treatments have been investigated,\\u000a with varying results. While many therapies may
Samuel L. Krachman; Gilbert E. D’Alonzo; Irene Permut; Wissam Chatila
Congestive heartfailure (CHF) because of left ventricular systolic dysfunction is a prevalent syndrome and associated with\\u000a morbidity, mortality, and huge economic cost. Hallmarks of CHF are exercise intolerance, poor prognosis, and poor quality\\u000a of life (QoL). According to reports from several laboratories, a large number of patients with heartfailure also have sleep\\u000a apnea (SA). SAs cause arousals and
Erik C. Skobel; Christine Norra; Anil Martin Sinha; Winfried Randerath
Although chronotropic incompetence (Cl) has been shown to have important prognostic value in asymptomatic and coronary artery\\u000a disease populations, much less attention has been given to the prevalence and impact of Cl in heartfailure. There is considerable\\u000a variability in the reported prevalence of chronotropic impairment (25%–70%) in the heartfailure literature, likely due to\\u000a a lack of a standardized
BackgroundThe Valsartan HeartFailure Trial (Val-HeFT) compared valsartan versus placebo in 5010 patients taking prescribed background therapy for New York Heart Association class II to IV heartfailure. Valsartan reduced the risk of heartfailure hospitalization and improved clinical signs and symptoms of heartfailure. We sought to compare resource use, costs, and health outcomes among patients taking prescribed therapy
Shelby D Reed; Joëlle Y Friedman; Eric J Velazquez; Ari Gnanasakthy; Robert M Califf; Kevin A Schulman
Epidemiological data show an even greater prevalence of heartfailure in the general population, in particular in elderly people, both in Italy and the other European countries. Patients admitted to hospital because of heartfailure are commonly complex patients with relevant comorbidities and frequent readmissions. Hospital care accounts largely for the costs due to heartfailure, whereas expenditure for therapies (drugs, devices and surgery) is less significant; non-medical and social costs represent also a relevant part of total costs. By far, the real challenge in the care of heartfailure patients consists in the efforts to reduce hospital readmissions. A broad spectrum of interventions has been proposed for improving care of heartfailure patients: multidisciplinary interventions involving physicians and nurses consisting of different modalities of transtelephonic monitoring have been demonstrated to be effective in reducing readmission rates and improving patient outcome. New technologies for remote monitoring with implantable devices (defibrillators and pacemakers) are becoming the standard of clinical practice in a great number of cardiology departments in our country. In addition, implantable devices for automatic and continuous hemodynamic monitoring are in an advanced phase of clinical evaluation. In conclusion, new modalities of care, centered on out-of-hospital assistance by means of interactive as well as automatic remote monitoring, are now available and seem to impact positively on the growing need for resources to be allocated to the care of heartfailure patients. PMID:23096393
Apoptosis of cardiomyocytes is increased in heartfailure and has been implicated in disease progression. The activation of "proapoptotic" caspases represents a key step in cardiomyocyte apoptosis. In contrast, the role of "proinflammatory" caspases (caspases 1, 4, 5, 11, 12) is unclear. Here, we study the cardiac function of caspase-1. Gene array analysis in a murine heartfailure model showed upregulation of myocardial caspase-1. In addition, we found increased expression of caspase-1 protein in murine and human heartfailure. Mice with cardiomyocyte-specific overexpression of caspase-1 developed heartfailure in the absence of detectable formation of interleukin (IL)-1beta or IL-18 and inflammation. Transgenic caspase-1 induced primary cardiomyocyte apoptosis before structural and molecular signs of myocardial remodeling occurred. In contrast, deletion of endogenous caspase-1 was beneficial in the setting of myocardial infarction-induced heartfailure. Furthermore, caspase-1-deficient mice were protected from ischemia/reperfusion-induced cardiomyocyte apoptosis. Studies in primary rat cardiomyocytes indicated that caspase-1 induces cardiomyocyte apoptosis primarily through activation of caspases-3 and -9. In contrast to previous findings, which imply a proinflammatory role of caspase-1, these data suggest a primary proapoptotic role for caspase-1 in cardiomyocytes. Our findings support a functional role for caspase-1-mediated myocardial apoptosis contributing to the progression of heartfailure. PMID:17303764
Merkle, Sabine; Frantz, Stefan; Schön, Michael P; Bauersachs, Johann; Buitrago, Monika; Frost, Robert J A; Schmitteckert, Eva M; Lohse, Martin J; Engelhardt, Stefan
Heartfailure-related self-care behaviour is important to optimize outcomes for patients with heartfailure. Such behaviours include adherence to medication, diet and exercise, but self-care also refers to such things as seeking assistance when symptoms occur, and daily weighing. The study aim was to describe heartfailure-related self-care behaviour, to test the effect of education and support on self-care behaviour and to discuss limitations. Data were collected from 128 heartfailure patients during their hospital stay and at 1-, 3-, and 9-month follow-ups. Concepts from Orem's general theory of nursing were used to describe heartfailure-related self-care behaviour and its limitations. The effects of intensive systematized and planned education from a nurse in hospital and at home were evaluated in an experimental design. Results showed that education enhanced self-care behaviour significantly at 1 and 3 months after discharge. Despite intensive education and support, patients did not manifest all self-care behaviours that might be expected. Patients in both the intervention and control groups described limitations in knowledge, judgement/decision-making and skills. It can be concluded that supportive-educative intervention is effective in enhancing heartfailure-related self-care behaviour early after discharge. To optimize such intervention, more emphasis must be placed on behavioural strategies (e.g. self-medication), social support (e.g. from family members) and reinforcement (e.g. home visits). PMID:12035274
Abstract Clinical heartfailure has been defined for a long time as a clinical syndrome with symptoms and signs including shortness of breath, cyanosis, ascites, and edema. However, in recent years, with the thought of promoting early diagnosis and heart-failure prevention, the concept of heartfailure has often been defined simply as a subject with severe LV dysfunction and a dilated left ventricle, or by some, defined by evidence of increased circulating levels of molecular markers of cardiac dysfunction, such as ANP and BNP. Heartfailure has been considered an irreversible clinical end point. Current medical management for heartfailure only relieves symptoms, slows deterioration, and prolongs life modestly. However, in the recent years, rejuvenation of the failing myocardium began to seem possible as the accumulating preclinical studies demonstrated that rejuvenating the myocardium at the molecular and cellular level can be achieved by gene therapy or stem cell transplantation. Here, we review selected novel modalities that have been shown in preclinical studies to exert beneficial effects in animal models of severe LV dysfunction and seem to have the potential to make an impact in the clinical practice of heart-failure management. Antioxid. Redox Signal. 11, 1989–2010.
Heartfailure (HF) involves changes in cardiac structure, myocardial composition, myocyte deformation, and multiple biochemical and molecular alterations that impact heart function and reserve capacity. Collectively, these changes have been referred to as 'cardiac remodeling'. Understanding the components of this process with the goal of stopping or reversing its progression has become a major objective. This concept is often termed
The pharmacokinetic profile and pharmacodynamic activities of torasemide, a new pyridine sulfonylurea acting on the loop of Henle, are described. Absorption of the drug was unchanged in patients with congestive heartfailure, though maximum concentrations occurred at 1.7 h compared with 0.9 h in healthy subjects. The volume of distribution after oral administration was also unchanged in patients with heart
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 heartfailure 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
The etiologies, presentation, and management of acute heartfailure syndromes (AHFSs) in children vary significantly from\\u000a those in adults. Childhood cardiac disease is a result, primarily, of congenital heart defects and cardiomyopathies, rather\\u000a than coronary heart disease. Furthermore, the prevalence of cardiac disease in children is far lower than in the adult population.\\u000a Also, unlike adults, pediatric cardiac arrest is
BackgroundPrevious studies have demonstrated that women hospitalized for heartfailure receive poorer quality of care and have worse outcomes than men. However, these studies were based upon selected patient populations and lacked quality of care measures.
Saif S. Rathore; JoAnne Micale Foody; Yongfei Wang; Jeph Herrin; Frederick A. Masoudi; Edward P. Havranek; Diana L. Ordin; Harlan M. Krumholz
Diastolic heartfailure (DHF) currently accounts for more than 50\\\\% of\\u000a all heartfailure patients. DHF is also referred to as heartfailure\\u000a with normal Left ventricular (W) ejection fraction (HFNEF) to indicate\\u000a that HFNEF could be a precursor of heartfailure with reduced LVEF\\u000a Because of improved cardiac imaging and because of widespread clinical\\u000a use of plasma levels of
Walter J. Paulus; Carsten Tschope; John E. Sanderson; Cesare Rusconi; Frank A. Flachskampf; Frank E. Rademakers; Paolo Marino; Otto A. Smiseth; Gilles De Keulenaer; Adelino F. Leite-Moreira; Attila Borbely; Istvan Edes; Martin Louis Handoko; Stephane Heymans; Natalia Pezzali; Burkert Pieske; Kenneth Dickstein; Alan G. Fraser; Dirk L. Brutsaert
Both histone-acetylations and histone deacetylases have been shown to play a key role in cardiac remodeling. Recently, it has become abundantly clear that many non-histone proteins are modified by post-translational lysine acetylations and that these acetylations regulate protein activity, conformation, and binding. In the present study, non-histone acetylated proteins associated with heartfailure were identified. Global screening for lysine acetylated proteins was performed using 2-dimensional gel electrophoresis coupled with immunoblotting with a primary monoclonal anti-acetyl-lysine antibody. Lysine acetylated proteins were compared in two rodent models of hypertensive heartfailure, the Dahl salt-sensitive (SS) and spontaneously hypertensive heartfailure prone (SHHF) rats with those in corresponding controls, i.e., the Dahl salt-resistant (SR) and W (W) rat strains, respectively. Forty-one and 66 acetylated proteins were detected in SS and SHHF failing hearts, respectively, but either not detected or detected with less abundance in corresponding control hearts. Twelve of these acetylated proteins were common to both models of heartfailure. These were identified using matrix-assisted laser desorption/ionization time of flight (MALDI-TOF/TOF) mass spectrometry followed by Mascot Analysis and included mitochondrial enzymes: ATP synthase, long-chain acyl-CoA dehydrogenase, creatine kinase, malate dehydrogenase, and pyruvate dehydrogenase. The abundance of NAD-dependent deacetylase sirtuin-3 (Sirt3), a mitochondrial deacetylase was reduced in SS and SHHF failing hearts. This is the first description of non-histone protein acetylations associated with heartfailure and raises the prospect that acetylations of mitochondrial proteins linked to reduced Sirt3 mediate, in part, metabolic changes in heartfailure.1
Grillon, Jean Michel; Johnson, Keven R.; Kotlo, Kumar; Danziger, Robert S.
Both histone-acetylations and histone deacetylases have been shown to play a key role in cardiac remodeling. Recently, it has become abundantly clear that many non-histone proteins are modified by post-translational lysine acetylations and that these acetylations regulate protein activity, conformation, and binding. In the present study, non-histone acetylated proteins associated with heartfailure were identified. Global screening for lysine acetylated proteins was performed using 2-dimensional gel electrophoresis coupled with immunoblotting with a primary monoclonal anti-acetyl-lysine antibody. Lysine acetylated proteins were compared in two rodent models of hypertensive heartfailure, the Dahl salt-sensitive (SS) and spontaneously hypertensive heartfailure prone (SHHF) rats with those in corresponding controls, i.e., the Dahl salt-resistant (SR) and W (W) rat strains, respectively. Forty-one and 66 acetylated proteins were detected in SS and SHHF failing hearts, respectively, but either not detected or detected with less abundance in corresponding control hearts. Twelve of these acetylated proteins were common to both models of heartfailure. These were identified using matrix-assisted laser desorption/ionization time of flight (MALDI-TOF/TOF) mass spectrometry followed by Mascot Analysis and included mitochondrial enzymes: ATP synthase, long-chain acyl-CoA dehydrogenase, creatine kinase, malate dehydrogenase, and pyruvate dehydrogenase. The abundance of NAD-dependent deacetylase sirtuin-3 (Sirt3), a mitochondrial deacetylase was reduced in SS and SHHF failing hearts. This is the first description of non-histone protein acetylations associated with heartfailure and raises the prospect that acetylations of mitochondrial proteins linked to reduced Sirt3 mediate, in part, metabolic changes in heartfailure. PMID:22155497
Grillon, Jean Michel; Johnson, Keven R; Kotlo, Kumar; Danziger, Robert S
OBJECTIVE--To review the importance of heart rate variability analysis in left ventricular dysfunction and heartfailure and to assess the effects of drug treatment. In patients with left ventricular dysfunction or heartfailure, a low heart rate variability is a strong predictor of a low probability of survival. Because drug treatment in these patients has rapidly changed over the past two decades, the effect of these drugs on heart rate variability needs special attention. DESIGN--A study of published reports to give an overview of heart rate variability in patients with left ventricular dysfunction or heartfailure and how it is affected by drug treatment. RESULTS--Analysis of heart rate variability provides an easily obtained early marker for progression of disease. It seems to be more closely related to the degree of neurohumoral activation than to haemodynamic variables. Cardiovascular drugs may either stimulate or inhibit the degree of neurohumoral activation, and the effects of pharmacological intervention can be closely monitored with this method. CONCLUSIONS--The analysis of heart rate variability, including spectral analysis, is a novel non-invasive way to obtain potentially useful clinical information in patients with reduced left ventricular function. The effects of drug treatment on heart rate variability are in general consistent with their long-term effects in left ventricular dysfunction and heartfailure.
Tuininga, Y S; van Veldhuisen, D J; Brouwer, J; Haaksma, J; Crijns, H J; Man in't Veld, A J; Lie, K I
Endpoint selection is a critically important step in clinical trial design. It poses major challenges for investigators, regulators, and study sponsors, and it also has important clinical and practical implications for physicians and patients. Clinical outcomes of interest in heartfailure trials include all-cause mortality, cause-specific mortality, relevant non-fatal morbidity (e.g. all-cause and cause-specific hospitalization), composites capturing both morbidity and mortality, safety, symptoms, functional capacity, and patient-reported outcomes. Each of these endpoints has strengths and weaknesses that create controversies regarding which is most appropriate in terms of clinical importance, sensitivity, reliability, and consistency. Not surprisingly, a lack of consensus exists within the scientific community regarding the optimal endpoint(s) for both acute and chronic heartfailure trials. In an effort to address these issues, the HeartFailure Association of the European Society of Cardiology (HFA-ESC) convened a group of expert heartfailure clinical investigators, biostatisticians, regulators, and pharmaceutical industry scientists (Nice, France, 12-13 February 2012) to evaluate the challenges of defining heartfailure endpoints in clinical trials and to develop a consensus framework. This report summarizes the group's recommendations for achieving common views on heartfailure endpoints in clinical trials. PMID:23787718
Zannad, Faiez; Garcia, Angeles Alonso; Anker, Stefan D; Armstrong, Paul W; Calvo, Gonzalo; Cleland, John G F; Cohn, Jay N; Dickstein, Kenneth; Domanski, Michael J; Ekman, Inger; Filippatos, Gerasimos S; Gheorghiade, Mihai; Hernandez, Adrian F; Jaarsma, Tiny; Koglin, Joerg; Konstam, Marvin; Kupfer, Stuart; Maggioni, Aldo P; Mebazaa, Alexandre; Metra, Marco; Nowack, Christina; Pieske, Burkert; Pińa, Ileana L; Pocock, Stuart J; Ponikowski, Piotr; Rosano, Giuseppe; Ruilope, Luis M; Ruschitzka, Frank; Severin, Thomas; Solomon, Scott; Stein, Kenneth; Stockbridge, Norman L; Stough, Wendy Gattis; Swedberg, Karl; Tavazzi, Luigi; Voors, Adriaan A; Wasserman, Scott M; Woehrle, Holger; Zalewski, Andrew; McMurray, John J V
Background: The multidisciplinary approach to man- aging heartfailure has been shown to improve out- comes. The role of a clinical pharmacist in treating heartfailure has not been evaluated. Methods: One hundred eighty-one patients with heartfailure and left ventricular dysfunction (ejection frac- tion ,45) undergoing evaluation in clinic were random- ized to an intervention or a control group.
Wendy A. Gattis; Vic Hasselblad; David J. Whellan; Christopher M. O'Connor
Summary The increased mortality after myocardial infarction is related to the risk of reinfarction, sudden death, and the development and progression of heartfailure; in congestive heartfailure it is due to the progression of heartfailure and sudden death. ACE inhibitors have been proven to prevent cardiovascular events, especially the progression of heartfailure, in postinfarct patients with reduced
This study examines the relationship between coping styles, quality of life, and depressive symptoms in older heartfailure patients. Eighty heartfailure patients seeking treatment in an outpatient heartfailure or family practice clinic participated in a study examining depression, disability, and heartfailure. Patients completed a clinical interview and questionnaires about mood, functional impairment, comorbid illness, quality of life,
pproximately 4.7 million people in the United States have heartfailure, and approximately 550 000 new cases are diagnosed annually.1 The 5-year mortality rate among patients with heartfailure is close to 50%. The impact of heartfailure is greater among elderly patients. Almost 75% of patients with heartfailure are older than 65 years, and 80% of hospitalizations for
David J. Whellan; Melissa A. Greiner; Kevin A. Schulman; Lesley H. Curtis
Sleep apnoea, both central and obstructive disordered breathing, commonly occurs in patients with heartfailure. Obstructive sleep apnoea occurs both in systolic and diastolic heartfailure and is best treated with nasal positive airway pressure devices. Central sleep apnoea occurs primarily in systolic heartfailure and therapeutic options are evolving. Optimal therapy of systolic heartfailure, nocturnal use of supplemental
The prevalence of diabetes mellitus in heartfailure populations is close to 20% compared with 4-6% in control populations. Epidemiologic studies have demonstrated an increased risk of heartfailure in diabetics. Experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. The knowledge of the diabetes status may help to define the optimal therapeutic strategy for heartfailure patients. In ischemic cardiomyopathy the choice of the surgical treatment may differ according to diabetes status, coronary atherosclerosis and left ventricular function. At present, surgical revascularization techniques seem to be superior to interventional revascularization procedures. In the last decade a growing part of diabetics presenting severe heartfailure underwent heart transplantation. Thereby, it was found that the survival rates of patients with uncomplicated diabetes mellitus and of nondiabetics did not differ. The survival rates in patients with severe and progressive form of diabetes mellitus are discussed controversially in the literature. Because of donor organ shortage each diabetic patient presenting severe heartfailure should be evaluated to find the best therapy including permanent mechanical circulatory support ("destination therapy"). PMID:18568315
Beta blockers may benefit patients with dilated cardiomyopathy but low output failure can be a problem. Thus a beta 1-selective beta blocker with about 45% intrinsic sympathomimetic activity (ISA), such as xamoterol, was thought to have a desirable pharmacologic profile. Long-term studies of xamoterol in patients with idiopathic dilated cardiomyopathy have shown improved cardiac performance and exercise tolerance, while exercise heart rate, left ventricular ejection fraction, and pulmonary artery wedge pressure were decreased. This improvement in exercise capacity and overall quality of life in patients treated with xamoterol has been confirmed in further controlled trials of patients with mild-to-moderate heartfailure (NYHA class I and II). However, in patients with moderate-to-severe heartfailure (NYHA class III and IV), mortality was unfavorably influenced by xamoterol. The therapeutic role of xamoterol in patients with heart disease needs further refinement. PMID:8465800
Heartfailure 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 heartfailure 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 to revive the myocardium and its contractile function. This review highlights the 3 promising areas for the development of heartfailure therapies, including mitochondrial biogenesis, mitochondrial oxidative stress, and mitochondrial iron handling. Moreover, the translational potential of compounds targeting these pathways is discussed. PMID:23219298
The prevalence of chronic heartfailure is still increasing making it a major health issue in the 21st century. Tremendous evidence has emerged over the past decades that heartfailure is associated with a wide array of mechanisms subsumed under the term "inflammation". Based on the great success of immuno-suppressive treatments in auto-immunity and transplantation, clinical trials were launched targeting inflammatory mediators in patients with chronic heartfailure. However, they widely lacked positive outcomes. The failure of the initial study program directed against tumor necrosis factor-? led to the search for alternative therapeutic targets involving a broader spectrum of mechanisms besides cytokines. We here provide an overview of the current knowledge on immune activation in chronic heartfailure of different etiologies, summarize clinical studies in the field, address unresolved key questions, and highlight some promising novel therapeutic targets for clinical trials from a translational basic science and clinical perspective. PMID:23740214
Therapy has improved the survival of heartfailure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition. Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention
Marco Metra; Piotr Ponikowski; Kenneth Dickstein; John J. V. McMurray; Antonello Gavazzi; Claes-Hakan Bergh; Alan G. Fraser; Tiny Jaarsma; Antonis Pitsis; Paul Mohacsi; Michael Böhm; Stefan Anker; Henry Dargie; Dirk Brutsaert; Michel Komajda
Age-related changes of diastolic left ventricular (LV) function consist of increased diastolic wall stiffness (reduced compliance) and diminished velocity and extent of relaxation. There is a shift of ventricular filling from early to late diastole. Atrial contribution to LV filling increases, which helps maintain stroke volume. In normal cardiovascular aging this diastolic dysfunction is compensated. However, the aging heart is sensitized against influences aggravating diastolic dysfunction such as arterial hypertension, LV hypertrophy, myocardial ischemia (coronary heart disease), tachycardias/ tachyarrhythmias. In diastolic heartfailure LV is unable to fill adequately at normal diastolic pressures, resulting in symptoms of pulmonary congestion and, less often, low output despite normal LV size and contraction. Diastolic heartfailure may be misinterpreted as systolic dysfunction and, eventually, treated in an unsuitable manner. In order to obtain data on the incidence of diastolic heartfailure among inpatients of a department of geriatrics of a municipal hospital, the results of 253 patients undergoing echocardiography in the course of 1 year were analyzed. The investigations comprised 70 males and 183 females, aged 81.3 (61-98) years on average. In 164 cases, symptoms of heartfailure were present. Only in 48 of them (29%) LV proved to be dilated. In the majority, LV size was normal (116 patients; 71%): systolic function was compromised in 53 cases, whereas 63 patients (38% of all cases with heartfailure) had a normal systolic function. Most of the latter (48 patients) had diastolic dysfunction, whereas an adequate echocardiographic evaluation was not possible for technical reasons in the remaining 15 cases. It is highly probable, however, that they had diastolic LV dysfunction as well. Thus, the results show a high frequency of LV dysfunction in elderly inpatients, which underlines the importance of diastolic heartfailure in this age group. PMID:8767018
BACKGROUND Comorbidity, disability, and polypharmacy commonly complicate the care of patients with heartfailure. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heartfailure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heartfailure population. METHODS Using data from the National Health and Nutrition Examination Survey, we analyzed trends across 3 survey periods (1988–1994, 1999–2002, 2003–2008). RESULTS We identified 1395 participants with self-reported heartfailure (n = 581 in 1988–1994, n = 280 in 1999–2002, n = 534 in 2003–2008). The proportion of patients with heartfailure who were ?80 years old increased from 13.3% in 1988–1994 to 22.4% in 2003–2008 (P <.01). The proportion of patients with heartfailure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% (P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions (P <.01). The prevalence of disability did not increase but was substantial across all years. CONCLUSION The phenotype of patients with heartfailure changed substantially over the last 2 decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new research and practice strategies that accommodate the increasing complexity of this population.
Wong, Catherine Y.; Chaudhry, Sarwat I.; Desai, Mayur M.; Krumholz, Harlan M.
Despite advances in medical therapy for patients with congestive heartfailure, morbidity and mortality remain high. Conduction abnormalities, such as left bundle branch block, right bundle branch block, and nonspecific conduction delay, are observed commonly in patients with dilated cardiomyopathy. In patients with heartfailure, the presence of intraventricular conduction delay is associated with more severe mitral regurgitation and worsened left ventricular systolic and diastolic function, and is an independent risk factor for increased mortality. Conventional dual-chamber (right atrial and right ventricular) pacing with a short atrioventricular delay was initially introduced as therapy for patients with advanced congestive heartfailure to improve diastolic dysfunction and reduce mitral regurgitation. The acute beneficial hemodynamic effects observed in early, uncontrolled studies were not confirmed in subsequent randomized, controlled studies with longer follow-up. Cardiac resynchronization with novel biventricular (left and right ventricular) pacing systems has resulted in hemodynamic and functional benefits in patients with congestive heartfailure and an underlying intraventricular conduction delay. Improvements in cardiac index, systolic blood pressure, and functional class have been reported with biventricular pacing, both acutely and at more than 1 year of follow-up. These encouraging preliminary results with biventricular pacing in patients with congestive heartfailure will be validated in two prospective, randomized, controlled trials, Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic HeartFailure (COMPANION). These studies are designed to evaluate the long-term efficacy of biventricular pacing in improving exercise capacity and in reducing morbidity and mortality in patients with advanced, symptomatic congestive heartfailure. (c)2001 by CHF, Inc. PMID:11828152
BackgroundThe effect on quality of life (QOL) of valsartan administered in addition to prescribed background heartfailure therapy was assessed as a secondary endpoint in the Valsartan HeartFailure Trial (Val-HeFT).
Giuseppina Majani; Anna Giardini; Cristina Opasich; Robert Glazer; Allen Hester; Gianni Tognoni; Jay N. Cohn; Luigi Tavazzi
Arterial hypertension is the commonest cause of heartfailure in the Savannah region of Nigeria. The prevalence of diastolic dysfunction in patients with hypertensive heartfailure in this region is unknown. This needs to be determined, since it may influence therapy. Left ventricular function of 95 patients with hypertensive heartfailure and 92 age-/sex-matched, healthy normotensive control was determined by echocardiography using ALOKA SSD 1700 two-dimensional echocardiograph/ Doppler and color flow ultrasound machine. Compared to the controls, the hypertensive heartfailure patients had increased left ventricular mass index (LVMI), p = 0.0001; cardiothoracic ratio (CTR), p = 0.0001; and electrocardiographic left ventricular hypertrophy (ECG-LVH), p = 0.0001. Isolated diastolic dysfunction, E/A ratio < 1.0, and EF > 50%, was seen in 12 patients (12.6%). Twenty-three patients (24.2%) had combined diastolic and systolic dysfunction (E/A ratio < 1.0 and EF < 50%). Six patients (6.3%) had pseudonormalization (E/A ratio 1.0-2.0 and deceleration time, DT, 150-200 msec), while restrictive pattern of diastolic dysfunction was seen in 25 patients (26.3%). This prevalence of 69.4% of diastolic dysfunction in Nigerians with hypertensive heartfailure seen in this study emphasizes the need for Doppler echocardiographic evaluation and diagnosis where these facilities are available. This will aid the physician to prescribe appropriate treatment. Images Figure 1 Figure 2 Figure 3
Oyati, Imhogene Albert; Danbauchi, Sulei Solomon; Alhassan, Mohammed Ahmed; Isa, Mohammed S.
Congestive heartfailure is emerging as an important public health problem because of its frequency and high mortality. Over the past decade, a number of clinical trials have been launched in a systematic attempt to determine an optimal therapeutic strategy for the treatment of heartfailure. There appears to be a trend to begin treatment with both a diuretic and a vasodilator regimen in patients with symptomatic left ventricular dysfunction. Converting enzyme inhibitors have been shown to clearly benefit patients with class IV heartfailure. The role of digitalis, other inotropic agents, beta-blockers, partial beta-agonists and antiarrhythmic agents is still evolving, but several clinical trials of these agents have been recently launched or are in the planning stages. Patients with symptomless left ventricular dysfunction are at risk to develop heartfailure. One attractive hypothesis being tested is that preventive therapy with converting enzyme inhibitors may prevent progressive cardiac dilatation and thereby improve survival in this important reservoir of patients. Until the results of these numerous clinical trials are published, physicians should reserve judgement regarding the undefined efficacy of various investigational agents used in the treatment of heartfailure and use their experience and judgement when planning a therapeutic strategy for their individual patients. PMID:2574631
Background Identifying heartfailure 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 heartfailure 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 heartfailure 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 heartfailure 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 heartfailure that has a high death rate underscores the need for economic methods to consider how mortality should best be considered in costing studies.
Despite extensive strides in understanding pressure overload induced heartfailure, there is very little known about oxidative stress induced matrix metalloproteinase (MMP) activation, collagen degradation and remodeling in pressure overload heartfailure. We hypothesize that pressure overload leads to redox imbalance causing increased expression/activity of MMP-2/9 producing collagen degradation and heartfailure. To test this hypothesis, we created pressure overload heartfailure by abdominal aortic stenosis (AS) in wild-type C57BL/6J and collagen mutant (Col1a1 with 129 s background) mice. At 4 weeks, post surgery, functional parameters were measured. Left ventricle (LV) tissue sections were analyzed by histology, Western Blot and PCR. The results suggest an increase in iNOS with a decrease in eNOS, an increase in nitrated protein modification and depletion of antioxidants thioredoxin and SOD in pressure overload. MMP-2/9 expression/activity and collagen degradation were increased in the AS animals. To determine whether a mutation in the collagen gene at the site of MMP cleavage mitigates cardiac hypertrophy, we used Col1a1 mice. In these mice, the AS induced LV hypertrophy (LVH) was ameliorated. In conclusion, our results suggest that AS leads to increased oxidative stress, expression/activity of MMP-2/9 and a decrease in antioxidant expression producing collagen degradation and heartfailure. PMID:17306621
Neurohormonal activation has been shown to be a major factor in congestive heartfailure progression and mortality. The beneficial effects obtained in clinical trials with angiotensin converting enzyme (ACE) inhibitors, beta-blockers and aldosterone antagonists have confirmed this hypothesis. 5,6-Diisobutirroyloxy-2-methyl-aminotetraline hydrochloride (nolomirole) is a selective agonist of prejunctional D(2)-dopaminergic and alpha(2)-adrenergic receptors. The stimulation of these receptors inhibits catecholamine release from sympathetic nerve endings. To confirm that this mechanism can be useful in congestive heartfailure, we studied the effects of nolomirole on monocrotaline-induced congestive heartfailure. The ACE inhibitor trandolapril was used as reference compound. Rats were given single intraperitoneal injection of either saline (control group; n=20) or monocrotaline (50 mg kg(-1)). Three days later, the monocrotaline-treated animals were randomly allocated (n=50 per group) to oral treatment with distilled water (vehicle group), nolomirole (0.25 mg kg(-1)) twice a day, or trandolapril (0.3 mg kg(-1)) once a day up to sacrifice. On the fourth week after monocrotaline injection, animals with signs of congestive heartfailure were sacrificed for evaluation of heart hypertrophy and neuroendocrine alterations. Atrial natriuretic peptide (ANP) and alderosterone were determined by radioimmunoassay in plasma. Tissue norepinephrine concentration was quantified by high-pressure liquid chromatography. Nolomirole and trandolapril significantly reduced (a) hypertrophy of right atria and ventricles, (b) plasma levels of ANP and presence of pleural/peritoneal effusions and (c) norepinephrine depletion of right ventricle. These findings confirmed that nolomirole, like trandolapril, is able to attenuate the heartfailure signs in the monocrotaline-induced congestive heartfailure model. PMID:14597145
HeartFailure Programs and Comprehensive Management in HeartFailure. A. Di Lenarda, G. Sabbadini, G. Sinagra. Chronic heartfailure is a major health problem, which is growing parallel to the increasing proportion of el- derly in the population. Recurrent hospitalizations occur in about half of the subjects within 6 months after the initial admission. Several co-morbidities usually coexist in these
Background National surveys suggest that treatment of heartfailure in daily practice differs from guidelines and is characterized by underuse of recommended medica- tions. Accordingly, the Euro HeartFailure Survey was conducted to ascertain how patients hospitalized for heartfailure are managed in Europe and if national variations occur in the treatment of this condition. Methods The survey screened discharge
K. Swedberg; J. Cleland; J. C. Aguilar; A. Cohen-Solal; R. Dietz; A. Gavazzi; W. H. Van Gilst; R. Hobbs; J. Korewicki; H. C. Madeira; V. S. Moiseyev; I. Preda; J. Widimsky; N. Freemantle; J. Eastaugh; J. Mason
Increased myocardial collagen accumulation is present in almost every cardiac disease and plays an important role in the reduced heart function. N-terminal and C-terminal propeptides of collagen type I and III, the two major collagen types in the heart, can be assayed in serum.These propeptides (PINP, PIIINP, PICP, ICTP) reflect collagen synthesis and degradation. The use of these serum collagen biomarkers as prognostic or diagnostic tools is an area of active investigation. In this review article these studies will be discussed as well as the limitations of these serum biomarkers as indicators of cardiac fibrosis. PMID:22524171
Lijnen, P J; Maharani, T; Finahari, N; Prihadi, J S
Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heartfailure. Diesel engine exhaust (DE) is a major air pollutant suspected to exacerbate preexisting cardiac conditions, in part, through autonomic and electrophysiologic disturbance of normal cardiac function. To explore this putative mechanism, we examined cardiophysiologic responses to DE inhalation in a model of aged heartfailure-prone rats without signs or symptoms of overtheartfailure. We hypothesized that acute DE exposure would alter heart rhythm, cardiac electrophysiology, and ventricular performance and dimensions consistent with autonomic imbalance while increasing biochemical markers of toxicity. Spontaneously hypertensive heartfailure rats (16 months) were exposed once to whole DE (4h, target PM(2.5) concentration: 500 µg/m(3)) or filtered air. DE increased multiple heart rate variability (HRV) parameters during exposure. In the 4h after exposure, DE increased cardiac output, left ventricular volume (end diastolic and systolic), stroke volume, HRV, and atrioventricular block arrhythmias while increasing electrocardiographic measures of ventricular repolarization (i.e., ST and T amplitudes, ST area, T-peak to T-end duration). DE did not affect heart rate relative to air. Changes in HRV positively correlated with postexposure changes in bradyarrhythmia frequency, repolarization, and echocardiographic parameters. At 24h postexposure, DE-exposed rats had increased serum C-reactive protein and pulmonary eosinophils. This study demonstrates that cardiac effects of DE inhalation are likely to occur through changes in autonomic balance associated with modulation of cardiac electrophysiology and mechanical function and may offer insights into the adverse health effects of traffic-related air pollutants. PMID:23047911
Carll, Alex P; Lust, Robert M; Hazari, Mehdi S; Perez, Christina M; Krantz, Quentin Todd; King, Charly J; Winsett, Darrell W; Cascio, Wayne E; Costa, Daniel L; Farraj, Aimen K
Aims Intraventricular conduction defects (IVCDs) can impair prognosis of heartfailure (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.
Acute heartfailure is a public health issue with morbidity and mortality exceeding that of myocardial infarction. Novel compounds for the treatment of acute heartfailure are clearly needed and fall into the general categories of inotropic, vasodilatory and other compounds in phase I to III of development. Furthest along are omecamtiv mecarbil (a cardiac myosin activator), ularitide (a natriuretic and diuretic peptide) and relaxin (a vasodilator). Each compound has a unique set of assets and liabilities that will aid in the understanding of the syndrome and application to the right patients at the right time in this heterogeneous syndrome. This review will explore current and future novel pharmacologic therapies for the treatment of acute heartfailure. PMID:23314727
This case presents a patient with biopsy-proven, wild-type transthyretin (TTR) senile amyloidosis. The case was that of a man in his early 70s who presented with gradually progressive symptoms and signs of heartfailure. The recent history included an episode of severe pancreatitis secondary to cholelithiasis and subsequently (and incidentally) noted hepatomegaly and marked ascites. Further evaluation of the aetiology of the heartfailure, through echocardiography, coronary angiography and endomyocardial biopsy, led to an exact diagnosis of SSA. The patient is being treated with conventional heartfailure medications while consideration is given to the use of diflusinal as an antiamyloidogenic small molecular stabiliser of TTR. Monitoring and further management advice are being coordinated by the National Amyloidosis Centre. PMID:23391947
Shah, Shreena; Dungu, Jason; Dubrey, Simon William
Heartfailure affects millions of Americans and new diagnosis rates are expected to almost triple over the next 30 years as our population ages. Affective disorders including clinical depression and anxiety are common in patients with congestive heartfailure. Furthermore, the presence of these disorders significantly impacts quality of life, medical outcomes, and healthcare service utilization. In recent years, the literature has attempted to describe potential pathophysiologic mechanisms relating affective disorders and psychosocial stress to heartfailure. Several potential mechanisms have been proposed including autonomic nervous system dysfunction, inflammation, cardiac arrhythmias, and altered platelet function. These mechanisms are reviewed in this article. Additional novel mechanisms such as mental stress-induced myocardial ischemia are also discussed. PMID:18368481
Cardiovascular diseases are the most common cause of death in the world. The development of heartfailure is mainly due to the loss of cardiomyocytes following myocardial infarction and the absence of endogenous myocardial repair. Numerous studies have focused on cardiac stem cells (CSCs) due to their therapeutic benefit, particularly in the treatment of heartfailure. It has previously been demonstrated that CSCs are able to promote the regeneration of cardiomyocytes in animals following myocardial infarction. However, the underlying mechanism(s) remain unclear. This review mainly discusses the cardioprotective effect of CSCs and the effect of CSCs on the function of cardiomyocytes, and compares the efficacies of CSCs from rats, mice and humans, thereby contributing to an improved understanding of CSCs as a promising treatment option for heartfailure.
Cardiovascular diseases are the most common cause of death in the world. The development of heartfailure is mainly due to the loss of cardiomyocytes following myocardial infarction and the absence of endogenous myocardial repair. Numerous studies have focused on cardiac stem cells (CSCs) due to their therapeutic benefit, particularly in the treatment of heartfailure. It has previously been demonstrated that CSCs are able to promote the regeneration of cardiomyocytes in animals following myocardial infarction. However, the underlying mechanism(s) remain unclear. This review mainly discusses the cardioprotective effect of CSCs and the effect of CSCs on the function of cardiomyocytes, and compares the efficacies of CSCs from rats, mice and humans, thereby contributing to an improved understanding of CSCs as a promising treatment option for heartfailure. PMID:23407679
Cardiovascular diseases are the leading cause of death in patients on haemodialysis. Cardiovascular mortality rate in these patients is approximately 9% per year, with the highest prevalence of left ventricular hypertrophy, ischemic heart disease and congestive heartfailure being the most frequent cardiovascular complications. Risk factors for cardiac failure include hypertension, disturbed lipid metabolism, oxidative stress, microinflammation, hypoalbuminemia, anaemia, hyperhomocysteinemia, and increased concentration of asymmetric dimethylarginine, increased shunt blood flow and secondary hyperparathyroidism. Diagnostic strategy for early detection of patients with increased risk for the development of asymptomatic disturbances of systolic and diastolic left ventricular function should include echocardiografic examination, tests for determining coronary vascular disease, as well as tests of myocardial function (BNP, Nt-proBNP). Early detection of patients with a high risk of congestive heartfailure enables timely implementation of adequate therapeutic strategy to provide high survival rate of HD patients. PMID:21626774
Objectives: To determine the prevalence of isolated left ventricular noncompaction (IVNC) as a cause of heartfailure and heart transplantation. Methods: There were 960 patients seen in the heartfailure clinic from 1987 to 2005, with a complete evaluation including echocardiography at our center (study population, 82% men, mean age 52 years). The following data were collected: type of heart
T. Kovacevic-Preradovic; R. Jenni; E. N. Oechslin; G. Noll; B. Seifert; C. H. Attenhofer Jost
Natriuretic peptides (NPs) secreted by the heart in response to volume overload are pleiotropic molecules with vasodilating,\\u000a diuretic, natriuretic, antiproliferative, and antifibrotic actions. Functioning of the NP system is altered in congestive\\u000a heartfailure (CHF), suggesting that support of the NP system might be beneficial in treatment of acute and chronic CHF. Several\\u000a approaches alone or in combination with other
Josef Korinek; Guido Boerrigter; Selma F. Mohammed; John C. Burnett Jr
Heartfailure (HF) continues to place significant demands on health care resources because of the large number of hospital\\u000a admissions for HF, the growth of the elderly population with HF, and the improved survival of patients with chronic heart\\u000a disease who develop HF that requires continuous care. Because HF is best managed using a disease management approach, frequent\\u000a communication is
Abul Kashem; Robert C. Cross; William P. Santamore; Alfred A. Bove
Heartfailure (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
Magnetic resonance spectroscopy (MRS) allows for the non-invasive detection of a wide variety of metabolites in the heart.\\u000a To study the metabolic changes that occur in heartfailure, 31P- and 1H-MRS have been applied in both patients and experimental animal studies. 31P-MRS allows for the detection of phosphocreatine (PCr), ATP, inorganic phosphate (Pi) and intracellular pH, while 1H-MRS allows for
ObjectiveDeficiency of anabolic sex steroids is common in heartfailure (HF). The pathophysiological implications of this phenomenon, however, have not been fully elucidated. This clinical study investigated the significance of low serum androgen levels in HF.DesignProspective cohort study.Patients and MethodsIn 191 consecutively recruited men with HF (mean age 64 years; New York Heart Association (NYHA) class I–IV 24%\\/35%\\/35%\\/6%) and reduced
G Güder; S Frantz; J Bauersachs; B Allolio; G Ertl; C E Angermann; S Störk
The purpose of this study was to describe heartfailure patients' abilities to manage their disease. A descriptive correlational design was used in this study. A convenient sample of 120 adult patients with heartfailure was surveyed using Self-Management of HeartFailure tool; the New York Heart Association (NYHA) Functional Classification was used to measure functional status. The findings of this study showed that 60% of patients' age ranged from 50 to < 60 years. Men accounted for 66.7% of the patient population; 33.3% were women. Most participants were married. The study showed that recognizing a change in signs and symptoms was positively correlated with both implementing and evaluating treatment with statistical significance. In addition, the results showed the statistical significant differences between levels of patients' education and both implementing and evaluating treatment. Finally, statistically significant differences were found between functional status of patients and their ability to recognize change as well as evaluate treatment. Findings of this study highlight the need for using the Self-Management of HeartFailure tool in practice to direct the medical and nursing staff towards the specific problem area for each patient. PMID:21605261
Catopril, an inhibitor of angiotensin converting enzyme, was given orally during cardiac catheterisation to 6 normotensive patients with refractory congestive heart-failure. 60--180 minutes after administration of 25 mg captopril, arterial pressure fell by 25%, cardiac index rose by 38%, and left-ventricular pressure and right-atrial pressure fell by 25% and 40% respectively. Plasma-renin activity rose while plasma noradrenaline and aldosterone fell. These data suggest that, in the short term, captopril can reduce both preload and afterload, and improve cardiac function, in refractory congestive heart-failure. PMID:87679
Turini, G A; Brunner, H R; Gribic, M; Waeber, B; Gavras, H
Congestive heartfailure (CHF) is a leading cause of morbidity and mortality. CHF is marked by atrial and ventricular enlargement and reduced cardiac contractility, as well as an association with an increased incidence of atrial and ventricular arrhythmias and sudden cardiac death. Dysfunctional ion channel function is one of the major underlying mechanisms of the reduced contractility and arrhythmias. In this review, we explore the utility of ion channels, as well as transporters and pumps, as targets for treatment of heartfailure, focusing predominantly on treatment for reduced contractility and arrhythmias.
Chronic heartfailure (CHF) is a major and growing public health concern (~23 million people worldwide) with five-year survival rates of 25% in men and 38% in women. Objective of this study was to investigate whether linear and nonlinear heart rate variability (HRV) indices enhance risk prediction in patients with CHF. To discriminate between low risk (stable condition, N =
A. Voss; R. Schroeder; M. Vallverdu; I. Cygankiewicz; R. Vazquez; A. Bayes de Luna; P. Caminal
Background and aimIntracellular magnesium (icMg) depletion may coexist with normomagnesemia. Mg deficiency (serum and\\/or intracellular) and decreased heart rate variability (HRV) are common in heartfailure (HF). Since both are predictors of poor prognosis, it was of interest to evaluate the effect of Mg supplementation on HRV in patients with HF.
D. Almoznino-Sarafian; G. Sarafian; S. Berman; M. Shteinshnaider; I. Tzur; N. Cohen; O. Gorelik
Background Clinic-based observational studies in men have reported that obstructive sleep apnea (OSA) is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of OSA to incident coronary heart disease and heartfailure in a general community sample of adult men and women. Methods and Results A prospective, longitudinal epidemiologic study of 1927 men and 2495 women aged ? 40 years and free of coronary heart disease and heartfailure at the time of baseline polysomnography were followed for a median of 8.7 years. After adjustment for multiple risk factors, OSA was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men age ?70 years (adjusted hazard ratio 1.10 [95% CI 1.00, 1.21] per 10-unit increase in apnea-hypopnea index [AHI]), but not in older men or in women of any age. Among men age 40–70 years, those with AHI ?30 were 68% more likely to develop coronary heart disease than those with AHI <5. OSA predicted incident heartfailure in men but not in women (adjusted hazard ratio 1.13 [95% CI 1.02, 1.26] per 10-unit increase in AHI). Men with AHI ?30 were 58% more likely to develop heartfailure than those with AHI <5. Conclusion OSA is associated with increased risk of incident heartfailure in community-dwelling middle-aged and older men; its association with incident coronary heart disease in this sample is equivocal.
Gottlieb, Daniel J.; Yenokyan, Gayane; Newman, Anne B.; O'Connor, George T.; Punjabi, Naresh M.; Quan, Stuart F.; Redline, Susan; Resnick, Helaine E.; Tong, Elisa K.; Diener-West, Marie; Shahar, Eyal
High-output heartfailure may occur in anemia, thyrotoxicosis, Beriberi heart disease, arteriovenous fistula, congenital arteriovenous malformation, Paget's disease of the bone, fibrous dysplasia, polycythemia vera, multiple myeloma, and renal diseases such as glomerulonephritis, carcinoid syndrome, pregnancy and obesity. Among these conditions, reports on heartfailure resulting from an arteriovenous malformation are rare. We report a case of high-output heartfailure
OBJECTIVESWe sought to examine whether depressive symptoms are associated with poorer prognosis in patients with heartfailure.BACKGROUNDDepression is an established risk factor for poor outcome in patients with coronary heart disease (CHD). Little is known of its role in patients with heartfailure.METHODSWe prospectively followed 391 patients ?50 years of age who met criteria for decompensated heartfailure on hospital
Viola Vaccarino; Stanislav V Kasl; Jerome Abramson; Harlan M Krumholz
Heartfailure is a clinical syndrome usually caused by structural changes in the heart. These changes result in varying degrees of symptomatic functional limitation, typically shortness of breath and fatigue. Heartfailure is common, with a lifetime risk for its occurrence in a healthy 40-year-old of 20%. In the US, the cost of heartfailure care is now estimated at
Mauricio Velez; Bethany Westerfeldt; Peter S. Rahko
Chronic renal disease is responsible for various cardiac complications. After renal transplantation many of these complications improve. However the extent to which cardiac failure is reversible post transplant is not known. We report two cases of end stage renal disease (ESRD) and severe heartfailure characterized by left ventricular ejection fraction (LVEF) less than 20%. Three months after kidney transplantation, the LVEF rose to more than 50%. Successful renal transplantation can significantly improve cardiac function compromised as a result of ESRD. PMID:16868096
Abstract The healthcare system has traditionally focused on treating disease at point of failure, such as life-saving surgery or intensive medical therapy. As demographics,shifts more to an aging population, management of health-relate d quality of life and life-restricting disease becomes,more necessary. Prominent,among,such diseases is congestive heartfailure (CHF), which must be addressed as a major chronic health condition with its
Following cardiac transplantation, registry data has demonstrated a gradual improvement in survival over the last several decades, which is testament to continual improvement in aftercare strategy. However, a significant number of patients will eventually develop a new syndrome of chronic heartfailure, owing to the multitude of physiological processes that occur after transplantation. This condition, referred to as chronic graft failure (CGF) should be regarded as a unique illness rather than one that is simply analogous with chronic heartfailure. In particular, the unique pathophysiological (and pharmacological) environment in the setting of CGF presents a challenging situation to the transplant physician. There is uncertainty over which treatments to offer given a paucity of clinical trial data to support the use of standard heartfailure treatments in CGF. In this review, we discuss which chronic heartfailure treatments could be considered in the setting of CGF based on their mechanisms of action, benefits within the native heartfailure setting, and the relevant issues within the posttransplant environment. PMID:20074259
Najam, Osman; Yonan, Nizar; Williams, Simon G; Shaw, Steven M
Physiological adaptation to pregnancy exposes mother's cardiovascular system to relevant hemodynamic overload. These changes and other specific conditions of pregnancy, such as amniotic embolism, can point out unrecognized preexisting heart disease or, in the presence of some cofactors, be burdensome even for healthy hearts. Thus, tragic cases of heartfailure or cardiac arrest may occur, whose management requires several considerations with respect of trying to save two lives at the same time, the need for drugs potentially harmful to the fetus, and assessment of emergent cesarean section. PMID:21348319
Fatty acids are the main substrates used by mitochondria to provide myocardial energy under normal conditions. During heart remodeling, however, the fuel preference switches to glucose. In the earlier stages of cardiac remodeling, changes in energy metabolism are considered crucial to protect the heart from irreversible damage. Furthermore, low fatty acid oxidation and the stimulus for glycolytic pathway lead to lipotoxicity, acidosis, and low adenosine triphosphate production. While myocardial function is directly associated with energy metabolism, the metabolic pathways could be potential targets for therapy in heartfailure. PMID:22990373
Azevedo, Paula S; Minicucci, Marcos F; Santos, Priscila P; Paiva, Sergio A R; Zornoff, Leonardo A M
Background: Heartfailure is highly prevalent among older adults and is associated with high cost and societal burden. Although pre- vious studies have reported beneficial effects of dietary factors on heartfailure predictors, no previous study has examined whether frequentconsumptionofnutsisassociatedwithalowerriskofheart failure in a large prospective cohort. Objective: We examined the association between nut consumption and incident heartfailure to determine
Approximately half of heartfailure patients have a normal ejection fraction, a condition designated as heartfailure with preserved ejection fraction (HFpEF). This heartfailure subtype disproportionately affects women and the elderly and is commonly associated with other cardiovascular comorbidities, such as hypertension and diabetes. HFpEF is increasing at a steady rate and is predicted to become the leading cause of heartfailure within a decade. HFpEF is characterized by impaired diastolic function, thought to be due to concentric remodeling of the heart along with increased stiffness of both the extracellular matrix and myofilaments. In addition, oxidative stress and inflammation are thought to have a role in HFpEF progression, along with endothelial dysfunction and impaired nitric oxide-cyclic guanosine monophosphate-protein kinase G signaling. Surprisingly a number of clinical studies have failed to demonstrate any benefit of drugs effective in heartfailure with systolic dysfunction in HFpEF patients. Thus, HFpEF is one of the largest unmet needs in cardiovascular medicine, and there is a substantial need for new therapeutic approaches and strategies that target mechanisms specific for HFpEF. This conclusion is underscored by the recently reported disappointing results of the RELAX trial, which assessed the use of phosphodiesterase-5 inhibitor sildenafil for treating HFpEF. In animal models, endothelial nitric oxide synthase activators and If current inhibitors have shown benefit in improving diastolic function, and there is a rationale for assessing matrix metalloproteinase 9 inhibitors and nitroxyl donors. LCZ696, a combination drug of angiotensin II receptor blocker and neprilysin inhibitor, and the aldosterone receptor antagonist spironolactone are currently in clinical trial for treating HFpEF. Here we present an overview of the etiology and diagnosis of HFpEF that segues into a discussion of new therapeutic approaches emerging from basic research and drugs currently in clinical trial that primarily target diastolic dysfunction or imbalanced ventricular-arterial coupling. PMID:23714774
Zouein, Fouad A; de Castro Brás, Lisandra E; da Costa, Danielle V; Lindsey, Merry L; Kurdi, Mazen; Booz, George W
The 2012 Canadian Cardiovascular Society HeartFailure (HF) Guidelines Update provides management recommendations for acute and chronic HF. In 2006, the Canadian Cardiovascular Society HF Guidelines committee first published an overview of HF management. Since then, significant additions to and changes in many of these recommendations have become apparent. With this in mind and in response to stakeholder feedback, the Guidelines Committee in 2012 has updated the overview of both acute and chronic heartfailure diagnosis and management. The 2012 Update also includes recommendations, values and preferences, and practical tips to assist the medical practitioner manage their patients with HF. PMID:23201056
National and international societies have issued guidelines on the management of heartfailure: The European Society of Cardiology, WHO, ACC/AHA Task Force Report, US Department of Health and Human Services, German Society of Cardiology. The therapeutic approaches to heartfailure have undergone considerable changes during the last few years. The guidelines have to be updated almost yearly due to new results from prospective randomized studies. Although an agreement could be reached with respect to general measures and drug treatment, no agreement on mechanical devices, pacemakers and surgical interventions has been reached. The basis for medical treatment of chronic heartfailure depends on diuretics, digitalis, ACE inhibitors, and beta-blockers. Calcium antagonists and other positive inotropic drugs, other than digitalis, should be avoided as far as possible. Thiazides, loop diuretics and aldosterone antagonists are needed for acute and chronic treatment of heartfailure, alone or in combination (diuretic resistant heartfailure!). Digitalis glycosides are needed in patients with atrial fibrillation with a fast ventricular rate or atrial flutter and in patients with systolic dysfunction, large hearts and symptomatic failure class NYHA III and IV. However, digitalis does not convert atrial fibrillation to sinus rhythm. Today there is no question that ACE inhibitors improve the prognosis of all patients with heartfailure in all stages, if ejection fraction is reduced. Therefore, most patients after myocardial infarction or after having experienced pump failure due to myocarditis or cardiomyopathy are treated with ACE inhibitors and diuretics. The beneficial effects of ACE inhibitors seem to be most pronounced the worse the situation is. Relative risk reductions (mortality!) between 10% and 40% have been published depending on the severity of symptomatic left ventricular dysfunction. Those patients with high absolute risk have more to gain than those with low risk for any given "risk reduction", of course. Recent studies also indicate that most high risk cardiac patients profit from ACE inhibitors even if pump function is normal (i.e., patients with coronary heart disease, diabetes mellitus, cerebral vascular disease, hypertension) (15). AT1 antagonists can substitute for ACE inhibitors, if the latter are not tolerated due to cough. Up to now, beta-blocking agents apart from diuretics seem to be the best investigated drugs in heartfailure. Large controlled studies with bisoprolol, carvedilol and metoprolol in addition to diuretics, digitalis and ACE inhibitors convincingly yielded positive results in chronic left ventricular failure patients. Reduction of mortality by 35% and even of sudden cardiac deaths by 40% have been proven beyond doubt. Thus, heartfailure patients today should also receive beta-blocking agents in all stages of the disease. In the era of controlled prospective studies (evidence-based medicine), physicians are well advised to use only drugs that have been proven beneficial in large controlled studies. PMID:11192349
Patients with heartfailure (HF) face significant challenges in maintaining quality of life (QOL), particularly for sexual intimacy. Although recommended for all cardiac patients, it has been suggested that few HF patients receive sexual counseling. This study explored sexual counseling needs, sexual concerns, and sexual activity using a descriptive survey with HF patients (n = 45), recruited from a HF
Mary Medina; Cynthia Walker; Elaine E. Steinke; David W. Wright; Victoria Mosack; Mohammad Hussam Farhoud
Cardiac remodelling occurs in response to stress, such as chronic hypertension or myocardial infarction, and forms the substrate for subsequent development of heartfailure. Key pathophysiological features include ventricular hypertrophy, interstitial fibrosis, contractile dysfunction, and chamber dilatation. Although the molecular mechanisms are complex and not fully defined, substantial evidence now implicates increased oxidative stress as being important. The NADPH oxidase
Alexander Sirker; Min Zhang; Colin Murdoch; Ajay M. Shah
Background In patients with chronic heartfailure (CHF), diuretic requirements increase as the disease progresses. Because diuretic resistance can be overcome with escalating doses, the evaluation of CHF severity and prognosis may be incomplete without considering the intensity of therapy. Methods The prognostic importance of diuretic resistance (as evidenced by a high-dose requirement) was retrospectively evaluated in 1153 patients with
Gerald W. Neuberg; Alan B. Miller; Chris M. O'Connor; Robert N. Belkin; Peter E. Carson; Anne B. Cropp; David J. Frid; Regina G. Nye; Milton L. Pressler; John H. Wertheimer; Milton Packer
Summary form only given. The aim of this project was to build a portable system designed to monitor on a daily basis the severity of pulmonary edema in chronic heartfailure (CHF) patients. As for today, the current methods for monitoring pulmonary edema severity in these patients are inaccurate (weighing), or involve ionizing radiation (CT imaging). The proposed system is
BackgroundThere are little data on the optimization of high intensity aerobic interval exercise (HIIE) protocols in patients with chronic heartfailure (CHF). Therefore, we compared acute cardiopulmonary responses to 4 different HIIE protocols in order to identify the optimal one.
Philippe Meyer; Eve Normandin; Mathieu Gayda; Guillaume Billon; Thibaut Guiraud; Laurent Bosquet; Annick Fortier; Martin Juneau; Michel White; Anil Nigam
Renal insufficiency is one of the most common co-morbidities present in heartfailure (HF) patients. It has significant impact on mortality and adverse outcomes. Cystatin C has been shown as a promising marker of renal function. A systematic review of all the published studies evaluating the prognostic role of cystatin C in both acute and chronic HF was undertaken. A
This article examines the emerging role of the heartfailure nurse and the responsibilities and educational and training requirements surrounding such a role. There may be variations in the role and its responsibilities in different health care settings. However the principles are similar and include: history taking, carrying out clinical assessment and making appropriate decisions about patient management within the
Over the past decade, a growing body of literature has led to a greater understanding of the relationship between anemia and the outcomes in patients with heartfailure. This article reviews the current literature on the association between anemia and a broad range of clinical outcomes, including mortality, hospitalization, health status, and cost. PMID:20630410
We report herein a case of 62-year-old woman with hereditary spherocytosis (HS) and congestive heartfailure (CHF). Although her history revealed jaundice in the early neonatal period, she had never undergone a physical examination and thus, the diagnosis of HS and CHF was not made until the age of 61 when she complained of dyspnea and palpitations on exertion. The
Therapeutic education is an integral part of the care provided to patients with heartfailure. It encourages patients to think about their knowledge, as well as their behaviour in the face of given symptoms. At Wissembourg hospital in Alsace, the design and creation of an informative and fun assessment tool has helped to maximise patients' understanding. PMID:22606780
Background: Fatigue is common in patients with chronic heartfailure (CHF) and has great impact on functional ability and daily activity. Although anaemia is associated with fatigue, the relationship between fatigue and anaemia is unclear in CHF. The aim of this study was to describe the fatigue experience and its relationship to haemoglobin (Hb) concentration and to evaluate its effect
Kristin Falk; Karl Swedberg; Fannie Gaston-Johansson; Inger Ekman
Background: Patients with chronic heartfailure (CHF) have frequent episodes of exacerbation leading to recurrent hospitalization. Aims: To explore factors related to patients seeking care for worsening CHF. Methods: Eighty-eight patients diagnosed with a deteriorating CHF condition were interviewed. Data were analysed using content analysis. Results: Overall, 51 (58%) patients sought emergency care because of their symptoms while 37 (42%)
Harshida Patel; Masoud Shafazand; Maria Schaufelberger; Inger Ekman
BackgroundResearch on the cognitive capacity of heartfailure patients is limited, with a paucity of benchmark information available for this population. It is highly likely that cognitive deficits affect patients' understanding of disease and treatment requirements, as well as limiting their functional capacity and ability to implement treatment plans, and undertake self-care.
Rachel Wolfe; Linda Worrall-Carter; Kellie Foister; Nicholas Keks; Vivienne Howe
In chronic heartfailure (CHF), the ventilatory response is increased compared with normal. This response is, in part, caused by reduced perfusion to ventilated lung. Nitric oxide (NO) is a potent vasodilator and may have an important role in pulmonary vasodilatation during exercise. NO is present in exhaled air. The amount of NO in exhaled air, when breathing NO-free compressed
Hitoshi Adachi; Paul H. Nguyen; Romualdo Belardinelli; Dodie Hunter; Tyler Jung; Karlman Wasserman
Objectives. The purpose of this study was to determine the level and functional effects of endogenous bradykinin in congestive heartfailure (CHF).Background. There is experimental evidence that bradykinin is increased in several cardiac disease states. However, it is unknown whether plasma levels of bradykinin are elevated in CHF. Further, the cardiac and vascular responses to bradykinin in CHF are unclear.Methods.
Che-Ping Cheng; Katsuya Onishi; Nobuyuki Ohte; Makoto Suzuki; William C Little
Background—Anemia is often observed in patients with chronic heartfailure (CHF), but its implications for patient outcomes are not well understood. The goal of this study was to investigate the relationship between anemia, severity of CHF, and clinical outcomes. Methods and Results—Hemoglobin concentration (Hb) was measured in 912 subjects with CHF enrolled in the Randomized Etanercept North American Strategy to
Inder Anand; John J. V. McMurray; James Whitmore; Marshelle Warren; Anh Pham; Mark A. McCamish; Paul B. J. Burton
Background: To handle the increasing complexity of congestive heartfailure (CHF) care, several new models for the care of patients with CHF have been developed to replace traditional strategies. We undertook this study to evaluate the potential benefit of implementing a CHF disease management program at a tertiary care center, par- ticularly in terms of-blocker use and cost to the
David J. Whellan; Laura Gaulden; Wendy A. Gattis; Bradi Granger; Stuart D. Russell; Michael A. Blazing; Michael S. Cuffe; Christopher M. O'Connor
The objectives of this study were to evamine the prevalence of depression in hospitalized, medically ill, older patients with and without congestive heartfailure (CHF), and examine correlates, course, predictors of outcome, and treatment of depression in patients with CHF. A consecutive sample of 542 patients age 60 or over admitted to inpatient services of Duke University Medical Center were
Objectives. The purpose of this study was to determine the level and functional effects of endogenous bradykinin in congestive heartfailure (CHF). Background. There is experimental evidence that bradykinin is increased in several cardiac disease states. However, it is un- known whether plasma levels of bradykinin are elevated in CHF. Further, the cardiac and vascular responses to bradykinin in CHF
CHE-PING CHENG; KATSUYA ONISHI; NOBUYUKI OHTE; MAKOTO SUZUKI; WILLIAM C. LITTLE
BackgroundPatients with heartfailure (HF) develop abnormal pulmonary gas exchange; specifically, they have abnormal ventilation relative to metabolic demand (ventilatory efficiency\\/minute ventilation in relation to carbon dioxide production [VE\\/VCO2]) during exercise. The purpose of this investigation was to examine the factors that underlie the abnormal breathing efficiency in this population.
Paul R. Woods; Thomas P. Olson; Robert P. Frantz; Bruce D. Johnson
Our knowledge of the pathophysiology of heartfailure has advanced far beyond the classic concept of the hemodynamic overload model and associated neurohumoral changes. Current interest lies in understanding the fundamentals of cellular defects to identify new molecular targets for therapies. Some of the new target sites being explored are inflammatory cytokines, nitric oxide, oxidative stress and apoptosis during the
Pawan K. Singal; Neelam Khaper; Vince Palace; Dinender Kumar
Acute decompensated heartfailure (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 \\
The ageing of the population and improved survival following acute cardiac events have led to an increased prevalence of heartfailure (HF), especially in the elderly. Establishing the presence of HF based only on signs and symptoms is often inaccurate. Additional investigations (e.g. echocardiography) are recommended but may be difficult in patients with a wide range of comorbidity and in
BackgroundComplementary therapies such as yoga practice have become commonplace, yet the safety, physical, and psychological effects on patients with heartfailure (HF) are unknown. The purpose of this study was to determine whether an 8-week yoga program was safe and would positively influence physical and psychological function in HF patients.
Jill Howie-Esquivel; Jiyeon Lee; Gina Collier; Wolf Mehling; Kirsten Fleischmann
Fifty consecutive elderly (> 60 years) patients admitted to our department with congestive heartfailure (CHF) entered a prospective database, to define their main clinical, instrumental and cognitive characteristics. In addition we evaluated the patterns of drug therapy in this aged population. Eighty percent of this sample had been previously hospitalized for CHF. Two or more associated diseases were present
Aureliano Fraticelli; Rosaria Gesuita; Anna Vespa; Enrico Paciaroni
(Received: xx Xxxx xxxx.Accepted: xx Xxxx xxxx) Heart valve bioprostheses usually do not need anticoagulation; however they are threatened by an increasing with time risk of degeneration. The aim of this work is to find a magnetic sensor, which could be integrated in a bioprosthesis, monitoring the prosthesis in such a way that allows to confidently forecast the failure. Several
G. Rivero; J. M. García-Páez; L. Alvarez; M. Multigner; J. Valdés; I. Carabias; J. Spottorno; A. Hernando
The effect of the converting enzyme inhibitor captopril as long term treatment was investigated in 14 patients with severe congestive heartfailure in a double blind trial. Captopril reduced plasma concentrations of angiotensin II and noradrenaline, with a converse increase in active renin concentration. Effective renal plasma flow increased and renal vascular resistance fell; glomerular filtration rate did not change.
J G Cleland; H J Dargie; G P Hodsman; S G Ball; J I Robertson; J J Morton; B W East; I Robertson; G D Murray; G Gillen
Background: One way to prevent frequent hospitalizations and promote positive health outcomes among patients with heartfailure (HF) is to ensure that the amount and quality of self-care used is appropriate to the patient's situation. Objectives: The following are the purposes of this study: (a) examine the frequency of performance of self-care behaviors, (b) describe personal and environmental factors (basic
Nancy T. Artinian; Morris Magnan; Michelle Sloan; M. Patricia Lange
|This paper summarizes a lecture given to pharmacy students that emphasizes the pathophysiologic mechanisms causing congestive heartfailure 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)|
There is extensive experimental evidence from in vitro and animal experiments that congestive heartfailure (CHF) is a state of oxidative stress. Moreover, in animal models, the development of CHF is accompanied by changes in the antioxidant defense mechanisms of the myocardium as well as evidence of oxidative myocardial injury. This has led to the hypothesis that oxidative stress may
Background: Several therapies commonly used for the treatment of acute heartfailure syndromes (AHFS) present some well-known limitations and have been associated with an early increase in the risk of death. There is, therefore, an unmet need for new pharmacologic agents for the early management of AHFS that may improve both short- and long-term outcomes. Aim: To review the recent
Leonardo De Luca; Alexandre Mebazaa; Gerasimos Filippatos; John T. Parissis; Michael Böhm; Adriaan A. Voors; Markku Nieminen; Faiez Zannad; Andrew Rhodes; Ali El-Banayosy; Kenneth Dickstein; Mihai Gheorghiade
Background: There is increasing evidence that discharge planning and post-discharge support for CHF patients can contribute greatly to the medical management of heartfailure (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
Diabetes mellitus has become increasingly prevalent in recent years, the most dramatic increase being observed in younger women. Diabetes is a multiplier of cardiovascular risk and decreases life expectancy more in women than in men. Diabetic women are less likely to achieve therapeutic targets for cardiovascular risk factors and to be optimally treated. They present more often with atypical symptoms that cause delays in timely recognition and management of cardiovascular disease. Diabetes is an independent risk factor for heartfailure and is associated with a worse outcome in women than in men affected by heartfailure. Despite the high prevalence of early asymptomatic ventricular dysfunction in diabetics observed in the DYDA and SHORTWAVE studies, female gender was neither a protective nor predisposing factor to ventricular dysfunction or heartfailure. Among 1129 outpatients with heartfailure, data from the Cardiovascular Epidemiologic Observatory of Trieste show a prevalence of diabetes of 39% in men and 28% in women. In this ongoing epidemiological study, a significantly better prognosis was observed in female than in male diabetics, whereas diabetic and non-diabetic women showed comparable mortality and hospital admission rates. These findings underscore the impact and effectiveness of strict follow-up and management in the high-risk female diabetic population. PMID:23678529
Russo, Giulia; Cherubini, Antonella; Faganello, Giorgio; Candido, Riccardo; Di Lenarda, Andrea
Heartfailure is a leading cause of morbidity and mortality with a prevalence that is rising throughout the world. Currently the pharmaceutical therapy of heartfailure is mainly based on inhibition of the neurohumoral pathways that are activated secondary to the deterioration of cardiac function, and diuretics to alleviate the salt and water overload. With our increasing understanding of the pathophysiology of heartfailure, it is now clear that the macroscopic and functional changes in the failing heart result from remodeling at the cellular, interstitial, and molecular levels. Therefore, emerging therapies propose to intervene directly in the remodeling process at the cellular and the molecular levels. Here, several experimental strategies that aim to correct the abnormalities in receptor and post-receptor-function, calcium handling, excitation and contraction coupling, signaling, and changes in the extra-cellular matrix in the failing heart will be discussed. These novel approaches, aiming to reverse the remodeling process at multiple levels, may appear on the clinical arena in the coming years.
Enalapril, the new converting enzyme inhibitor, was administered to eight patients with heartfailure (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 heartfailure, 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 heartfailure are warranted.
Fitzpatrick, D; Nicholls, M G; Ikram, H; Espiner, E A
Background and Aim: Increased xanthine oxidase (XO) activity may contribute to heartfailure pathophysiology. This study evaluated whether a XO inhibitor, allopurinol produces clinical and functional benefits in patients with New York Heart Association functional class III to IV heartfailure due to systolic dysfunction receiving optimal medical therapy as estimated by global left myocardial function. Patients and Methods: Fifty-nine patients with a diagnosis of chronic heartfailure due to coronary heart disease or idiopathic dilated cardiomyopathy and 20 healthy controls who attended the outpatient clinic of cardiology were subjected to full echocardiographic study including left ventricular diastolic and systolic function, and the combined index of myocardial performance [Tei index: isovolumetric relaxation time (IRT) + isovolumetric contraction time (ICT)/ejection time (ET)]. Patients were randomized to allopurinol (300 mg/day) or placebo. Improvement at 36 weeks was assessed using a composite end point comprising global left cardiac function as well as heartfailure morbidity and mortality. Results: The percentage of patients characterized as improved, unchanged, or worsened did not differ between those receiving allopurinol or placebo. Allopurinol reduced serum uric acid (SUA) by 1.5 mg/dL (P = 0.001). In a subgroup analysis, patients with elevated SUA (more than 7mg/ dL) responded favorably to allopurinol whereas those with SUA less than 7mg/dL exhibited a trend toward no change. In addition, SUA reduction to allopurinol correlated with favorable clinical and functional response. Within the entire allopurinol patient cohort, those characterized as either improved or unchanged had significantly greater reductions in SUA compared with patients who did not change (P = 0.0007). In placebo patients, lower baseline SUA, but not change in SUA, correlated with improved clinical outcome. Conclusions: Allopurinol did not produce significant clinical and functional improvement in unselected patients with moderate-to-severe heartfailure. However, it is suggested that it is useful in patients with elevated SUA in a manner according to degree of SUA reduction. SUA may serve as a valuable biomarker to target heartfailure therapy.
Regenerative medicine represents a promising perspective on therapeutic angiogenesis in patients with cardiovascular disease, including heartfailure. However, previous or ongoing clinical trials show ambiguous outcomes with respect to the benefit of regenerative therapy by means of bone marrow stem cell infusion in myocardial infarction patients. Therefore, it is necessary to set up a rational therapeutic strategy in the treatment of congestive heartfailure. Chemokines, cytokines and growth factors, as well as pharmaceutical agents, may have an impact on endothelial progenitor cell (EPC) physiology and thus can provide targets for pharmacological intervention. Indeed, EPCs and stem cell niches both in bone marrow and myocardial tissue can be treated as an integral target for recruitment of EPCs from the bone marrow to the cardiac ischaemic niche. In this article, we individually place the signalling factors in their specified context, and explain their roles in the various phases of neovascularisation (see Part 1). (Neth Heart J 2008;16:337-43.)
Heartfailure constitutes a significant source of morbidity and mortality in the United States and its incidence and prevalence continue to grow, increasing its burden on the health care system. Renal dysfunction in patients with heartfailure is common and has been associated with adverse clinical outcomes. This complex interaction is characterized by a pathophysiological disequilibrium between the heart and the kidney, in which cardiac malfunction promotes renal impairment, which in turn feeds back for further deterioration of cardiovascular function. Multiple neurohumoral and hemodynamic mechanisms are involved in this cardiorenal dyshomeostasis, including the deficiency of and/or resistance to compensatory natriuretic peptides, leading to sodium retention, volume overload and organ remodeling. Management of patients with cardiorenal dysfunction can be challenging and should be individualized. Emerging therapies must address the impairment of both organs to secure better clinical outcomes. To this end, a multidisciplinary approach is warranted to achieve optimal results. PMID:22317900
Summary Heart-kidney interactions have been increasingly recognized by clinicians and researchers involved in the study and treatment of heartfailure and kidney disease. A classification system has been developed to categorize the different manifestations of cardiac and renal dysfunction. Recent work has highlighted the significant negative prognostic effect of worsening renal function on outcomes for individuals with heartfailure. The etiology of the concomitant cardiac and renal dysfunction remains unclear; however, increasing evidence supports alternatives to the established theory of underfilling, including effects of venous congestion and changes in intra-abdominal pressure. Conventional therapy focuses on blockade of the renin-angiotensin-aldosterone system with expanding use of direct renin and aldosterone antagonists. Novel therapeutic interventions using extracorporeal therapy and antagonists of the adenosine pathway show promise and require further investigation.
Treatment escalation of chronic systolic heartfailure depends on left ventricular function and symptoms of the patients. In symptomatic patients with severely reduced left ventricular function (ejection fraction ??30?%), the following therapeutic approaches are recommended: (1) angiotensin-converting enzyme (ACE) inhibitors (angiotensin receptor blocker in case of ACE inhibitor intolerance); (2) ?-blockers; (3) mineralocorticoid receptor antagonists; (4) diuretics in case of signs and symptoms of congestion; (5) digitalis, in particular in patients with atrial fibrillation; (6) ivabradine in patients with sinus rhythm and a heart rate ??75/min; (7) an implantable cardioverter defibrillator (ICD); (8) in case of left bundle branch block or wide QRS complex, cardiac resynchronization therapy (CRT; in most cases in combination with an implantable cardioverter defibrillator); (9) intravenous administration of iron in case of iron deficiency; (10) exercise training should be strongly recommended in patients with stable heartfailure. PMID:23860513
Penetrating chest trauma can cause a wide variety of cardiac injuries, including myocardial contusion, damage to the interventricular septum, laceration of the coronary arteries, and free-wall rupture. Herein, we describe the case of a 21-year-old man who presented with congestive heartfailure, which was secondary to an old myocardial infarction and complicated by the delayed formation of a ventricular septal defect. All of these conditions were attributable to multiple gunshot wounds that the patient had sustained 6 months earlier. Left ventricular angiography showed an apical aneurysm; a large, muscular, ventricular septal defect; and 19 gunshot pellets in the chest wall. Three months after aneurysmectomy and surgical closure of the septal defect, the patient had recovered fully and was asymptomatic.This case reaffirms the fact that substantial cardiac injuries can appear months after chest trauma. The possibility of traumatic ventricular septal defect should be considered in all multiple-trauma patients who develop a new heart murmur, even when overt chest-wall injury is absent. PMID:22412248
Stem cell and gene therapies are being pursued as strategies for repairing damaged cardiac tissue following myocardial infarction in an attempt to prevent heartfailure. The chemokine receptor-4 (CXCR4) and its ligand, CXCL12, play a critical role in stem cell recruitment post-acute myocardial infarction. Whereas progenitor cell migration via the CXCL12/CXCR4 axis is well characterized, little is known about the molecular mechanisms of CXCR4 mediated modulation of cardiac hypertrophy and failure. We used gene therapy to test the effects of CXCR4 gene delivery on adverse ventricular remodeling due to pressure overload. We assessed the effect of cardiac overexpression of CXCR4 during trans-aortic constriction (TAC) using a cardiotropic adeno-associated viral vector (AAV9) carrying the CXCR4 gene. Cardiac overexpression of CXCR4 in mice with pressure overload prevented ventricular remodeling, preserved capillary density and maintained function as determined by echocardiography and in vivo hemodynamics. In isolated adult rat cardiac myocytes, CXCL12 treatment prevented isoproterenol induced hypertrophy and interrupted the calcineurin/NFAT pathway. Finally, a complex involving the L-type calcium channel, ?2-adenoreceptor, and CXCR4 (Cav1.2/?2AR/CXCR4) was identified in healthy cardiac myocytes and was shown to dissociate as a consequence of heartfailure. CXCR4 administered to the heart via gene transfer prevents pressure overload induced heartfailure. The identification of CXCR4 participation in a Cav1.2-?2AR regulatory complex provides further insight into the mechanism by which CXCR4 modulates calcium homeostasis and chronic pressure overload responses in the cardiac myocyte. Together these results suggest AAV9.CXCR4 gene therapy is a potential therapeutic approach for congestive heartfailure.
LaRocca, Thomas J.; Jeong, Dongtak; Kohlbrenner, Erik; Lee, Ahyoung; Chen, JiQiu; Hajjar, Roger J.; Tarzami, Sima T.
The purpose of this review is to enlighten the mechanisms of skeletal muscle dysfunction in heartfailure. The muscle hypothesis suggests that chronic heartfailure (CHF) symptoms, dyspnoea and fatigue are due to skeletal muscle alterations. Hyperventilation due to altered ergoreflex seems to be the cause of shortness of breath. Qualitative and quantitative changes occurring in the skeletal muscle, such as muscle wastage and shift from slow to fast fibers type, are likely to be responsible for fatigue. Mechanisms leading to muscle wastage in chronic heartfailure, include cytokine-triggered skeletal muscle apoptosis, but also ubiquitin/proteasome and non-ubiquitin-dependent pathways. The regulation of fibre type involves the growth hormone/insulin-like growth factor 1/calcineurin/ transcriptional coactivator PGC1 cascade. The imbalance between protein synthesis and degradation plays an important role. Protein degradation can occur through ubiquitin-dependent and non-ubiquit-independent pathways. Systems controlling ubiquitin/ proteasome activation have been described. These are triggered by tumour necrosis factor and growth hormone/ insulin-like growth factor 1. However, an important role is played by apoptosis. In humans, and experimental models of heartfailure, programmed cell death has been found in skeletal muscle and interstitial cells. Apoptosis is triggered by tumour necrosis factor and in vitro experiments have shown that it can be induced by its second messenger sphingosine. Apoptosis correlates with the severity of the heartfailure syndrome. It involves activation of caspases 3 and 9 and mitochondrial cytochrome c release. Sarcomeric protein oxidation and its consequent contractile impairment can form another cause of skeletal muscle dysfunction in CHF. PMID:18991674
Dalla Libera, Luciano; Vescovo, Giorgio; Volterrani, Maurizio
The new, long acting converting enzyme inhibitor enalapril was given to 26 patients with moderate to severe heartfailure. In 23 cases the mean systolic blood pressure fell from 120 (SD 22) to 108 (25) mm Hg without adverse effects. Profound hypotension with severe bradycardia and sweating, however, occurred in three patients, most pronounced two to four hours after the first dose. The haemodynamic and biochemical changes in these patients were similar to those seen in patients with severe symptomatic hypotension after the first dose of the converting enzyme inhibitor captopril, except that with enalapril the changes occurred later and were longer lasting. Evidence of myocardial damage and reversible renal failure was seen in one patient, and acute reversible deterioration in renal function occurred in one other. In patients with heartfailure converting enzyme inhibitors should be administered initially under strict medical supervision with appropriate facilities available for dealing with occasional profound hypotension.
Cleland, J G; Dargie, H J; McAlpine, H; Ball, S G; Morton, J J; Robertson, J I; Ford, I
Background Chronic heartfailure is an important cause for morbidity and mortality in adults with congenital heart disease (ACHD). While NT-proBNP is an established biomarker for heartfailure of non-congenital origin, its application in ACHD has limitations. The angiogenic factors Angiopoietin-1 and -2 (Ang-1, Ang-2), vascular endothelial growth factor (VEGF), and soluble receptor tyrosine kinase of the Tie family (sTie2) correlate with disease severity in heartfailure of non-congenital origin. Their role in ACHD has not been studied. Methods In 91 patients Ang-2 and NT-proBNP were measured and related to New York Heart Association class, systemic ventricular function and parameters of cardiopulmonary exercise testing. Ang-1, VEGF, and sTie2 were also measured. Results Ang-2 correlates with NYHA class and ventricular dysfunction comparable to NT-proBNP. Further, Ang-2 showed a good correlation with parameters of cardiopulmonary exercise testing. Both, Ang-2 and NT-proBNP identified patients with severely limited cardiopulmonary exercise capacity. Additionally, Ang-2 is elevated in patients with a single ventricle physiology in contrast to NT-proBNP. VEGF, Ang-1, and sTie2 were not correlated with any clinical parameter. Conclusion The performance of Ang-2 as a biomarker for heartfailure in ACHD is comparable to NT-proBNP. Its significant elevation in patients with single ventricle physiology indicates potential in this patient group and warrants further studies.
The purpose of this study was to determine if relationships existed between levels of knowledge about heartfailure, attitude towards adhering to prescribed medical care and frequency of hospitalization among heartfailure patients. The study also tested ...
Inherited or non-inherited dilated cardiomyopathy (DCM) patients develop varied disease phenotypes leading to death after developing congestive heartfailure (HF) or sudden death with mild or no overt HF symptoms, suggesting that environmental and/or genetic factors may modify the disease phenotype of DCM. In this study, we sought to explore unknown genetic factors affecting the disease phenotype of monogenic inherited human DCM. Knock-in mice bearing a sarcomeric protein mutation that causes DCM were created on different genetic backgrounds; BALB/c and C57Bl/6. DCM mice on the BALB/c background showed cardiac enlargement and systolic dysfunction and developed congestive HF before died. In contrast, DCM mice on the C57Bl/6 background developed no overt HF symptoms and died suddenly, although they showed considerable cardiac enlargement and systolic dysfunction. BALB/c mice have brain serotonin dysfunction due to a single nucleotide polymorphism (SNP) in tryptophan hydroxylase 2 (TPH2). Brain serotonin dysfunction plays a critical role in depression and anxiety and BALB/c mice exhibit depression- and anxiety-related behaviors. Since depression is common and associated with poor prognosis in HF patients, we examined therapeutic effects of anti-depression drug paroxetine and anti-anxiety drug buspirone that could improve the brain serotonin function in mice. Both drugs reduced cardiac enlargement and improved systolic dysfunction and symptoms of severe congestive HF in DCM mice on the BALB/c background. These results strongly suggest that genetic backgrounds involving brain serotonin dysfunction, such as TPH2 gene SNP, may play an important role in the development of congestive HF in DCM. PMID:22921782
Heartfailure (HF) is the leading cause of morbidity and mortality in the industrialized world. While the transcriptomic changes in end-stage failing myocardium have received much attention, no information is available on the gene expression patterns associated with the development of HF in large mammals. Therefore, we used a well-controlled canine model of tachycardia-induced HF to examine global gene expression in left ventricular myocardium with Affymetrix canine oligonucleotide arrays at various stages after initiation of rapid ventricular pacing (days 3, 7, 14, and 21). The gene expression data were complemented with measurements of action potential duration, conduction velocity, and left ventricular end diastolic pressure, and dP/dt(max) over the time course of rapid ventricular pacing. As a result, we present a phenotype-centered gene association network, defining molecular systems that correspond temporally to hemodynamic and electrical remodeling processes. Gene Ontology analysis revealed an orchestrated regulation of oxidative phosphorylation, ATP synthesis, cell signaling pathways, and extracellular matrix components, which occurred as early as 3 days after the initiation of ventricular pacing, coinciding with the early decline in left ventricular pump function and prolongation of action potential duration. The development of clinically overt left ventricular dysfunction was associated with few additional changes in the myocardial transcriptome. We conclude that the majority of tachypacing-induced transcriptional changes occur early after initiation of rapid ventricular pacing. As the transition to overt HF is characterized by few additional transcriptional changes, posttranscriptional modifications may be more critical in regulating myocardial structure and function during later stages of HF.
Gao, Zhong; Barth, Andreas S.; DiSilvestre, Deborah; Akar, Fadi G.; Tian, Yanli; Tanskanen, Antti; Kass, David A.; Winslow, Raimond L.; Tomaselli, Gordon F.
Cardiac hypertrophy leading to heartfailure is a major cause of morbidity and mortality worldwide. The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, have been shown to inhibit cardiac hypertrophy and improve symptoms of heartfailure by cholesterol-independent mechanisms. Statins block the isoprenylation and function of members of the Rho guanosine triphosphatase family, such as Rac1 and RhoA. Because Rac1 is a requisite component of reduced nicotinamide adenine dinucleotide phosphate oxidase, which is a major source of reactive oxygen species in cardiovascular cells, the ability of statins to inhibit Rac1- mediated oxidative stress contributes importantly to their inhibitory effects on cardiac hypertrophy. Furthermore, inhibition of RhoA by statins leads to the activation of protein kinase B/Akt and up-regulation of endothelial nitric oxide synthase in the endothelium and the heart. This results in increased angiogenesis and myocardial perfusion, decreased myocardial apoptosis, and improvement in endothelial and cardiac function. Because these effects of statins occur independently of cholesterol lowering, statins may have therapeutic benefits in nonhyperlipidemic patients with cardiac hypertrophy and heartfailure.
In elderly patients, atrial fibrillation prevalence exceeds 10% and is commonly associated with heartfailure rendering their management even more challenging. Therapies to be considered for heartfailure related atrial fibrillation include appropriate treatment of underlying disease, prevention of thromboembolism, rate or rhythm control. The debate regarding rate versus rhythm control in the management of this group of patients has yet to be resolved. For old patients, the management requires an individual approach, which largely depends on comorbid conditions, underlying cardiac disease, and patient and physician preferences. Use of antiarrhythmic drug therapy for maintenance of sinus rhythm carries concerns of risk and limited efficacy. Catheter ablation for rhythm control is feasible for some patients, but further studies are needed to define the risks and benefits especially in older patients. Atrioventricular nodal ablation associated with pacing therapy is an effective non-pharmacological therapy in selected patients with medically refractory permanent high heart rate atrial fibrillation and heartfailure. Several studies are ongoing and will provide more insight into the management of such patients. PMID:18029038
Abi Nasr, Imad; Mansencal, Nicolas; Dubourg, Olivier
Ischemic injury, which occurs as a result of sympathetic hyperactivity, plays an important role in heartfailure. Melatonin is thought to have antiatherogenic, antioxidant, and vasodilatory effects. In this study, we investigated whether melatonin protects against ischemic heartfailure (HF). In Wistar albino rats, HF was induced by left anterior descending (LAD) coronary artery ligation and rats were treated with either vehicle or melatonin (10 mg/kg) for 4 weeks. At the end of this period, echocardiographic measurements were recorded and the rats were decapitated to obtain plasma and cardiac tissue samples. Lactate dehydrogenase, creatine kinase, aspartate aminotransferase, alanine aminotransferase, and lysosomal enzymes (?-D-glucuronidase, ?-galactosidase, ?-D-N-acetyl-glucosaminidase, acid phosphatase, and cathepsin-D) were studied in plasma samples, while malondialdehyde and glutathione levels and Na+, K+-ATPase, caspase-3 and myeloperoxidase activities were determined in the cardiac samples. Sarco/endoplasmic reticulum calcium ATPase (SERCA) and caveolin-3 levels in cardiac tissues were evaluated using Western blot analyses. Furthermore, caveolin-3 levels were also determined by histological analyses. In the vehicle-treated HF group, cardiotoxicity resulted in decreased cardiac Na+, K+-ATPase and SERCA activities, GSH contents and caveolin-3 levels, while plasma LDH, CK, and lysosomal enzyme activities and cardiac MDA and Myeloperoxidase (MPO) activities were found to be increased. On the other hand, melatonin treatment reversed all the functional and biochemical changes. The present results demonstrate that Mel ameliorates ischemic heartfailure in rats. These observations highlight that melatonin is a promising supplement for improving defense mechanisms in the heart against oxidative stress caused by heartfailure. PMID:23551402
Acute heartfailure (AHF) is defined by the presence of symptoms of heartfailure (at rest or during exercise) in conjunction\\u000a with objective evidence of cardiac dysfunction (1). It may correspond to either a new-onset heartfailure or a decompensation of chronic heartfailure. Symptoms of AHF may\\u000a predominantly reflect the decrease in cardiac output and associated peripheral hypoperfusion (e.g.,
Acute heartfailure (AHF) is characterized by the presence of signs and symptoms of heartfailure requiring urgent intervention\\u000a (1). More than 70% of patients with AHF have decompensation of chronic heartfailure and 30% have heartfailure of new onset\\u000a (2). In the emergency room most patients have signs and symptoms of pulmonary or peripheral congestion (e.g., breathlessness,\\u000a pulmonary
Gerasimos S. Filippatos; Ioannis A. Paraskevaidis; Dimitrios Th. Kremastinos
Ventricular assist devices (VADs) have become an established therapeutic option for patients with end-stage heartfailure. The appearance of heartfailure in VAD patients seems unexpected. Nevertheless, this phenomenon is not rare. We report six cases of VAD patients with clinical presentation of heartfailure at different times after implantation and describe the mechanisms involved. The aetiology of this heartfailure, like its clinical presentation, varies and has yet to be identified. PMID:23374971
Aissaoui, Nadia; Morshuis, Michiel; Diebold, Benoit; Guerot, Emmanuel; Gummert, Jan
The SEP identified priorities to support in future basic and clinical research and pointed out directions likely to result in advances against heartfailure. The list is not intended to be all-encompassing and does not address, for example, exciting lines of work already under way. Rather, the recommendations are designed to point out gaps in current knowledge not being adequately addressed and highly promising new directions. Although the incidence of heartfailure continues to grow, emerging lines of research provide hope that research advances will eventually lead to more effective treatment and ultimately to prevention. This research will be well served by bringing the latest multidisciplinary approaches and the best investigators to focus on the problems of heartfailure. It is hoped the efforts of distinguished expert entities such as the task force and SEP will be a useful guide in addressing the needs of the biomedical community and assisting in its success. PMID:9054723
Cohn, J N; Bristow, M R; Chien, K R; Colucci, W S; Frazier, O H; Leinwand, L A; Lorell, B H; Moss, A J; Sonnenblick, E H; Walsh, R A; Mockrin, S C; Reinlib, L
Linear and nonlinear indices of heart rate variability (HRV) have been shown to predict mortality in congestive heartfailure (CHF). However, most nonlinear indices describe only the fractality or complexity of HRV but not the intrinsic chaotic properties. In the present study, we performed linear (time- and frequency-domain), complexity (sample entropy), fractal (detrended fluctuation analysis) and chaos (numerical titration) analyses on the HRV of 50 CHF patients from the United Kingdom heartfailure evaluation and assessment of risk trial database. Receiver operating characteristic and survival analysis yielded the chaos level to be the best predictor of mortality (followed by low/high frequency power ratio, LF/HF), such that these indices were significant in both univariate and multivariate models. These results indicate the power of heart rate chaos analysis as a potential prognostic tool for CHF. PMID:18003141
Arzeno, Natalia M; Kearney, Mark T; Eckberg, Dwain L; Nolan, James; Poon, Chi-Sang
Surgery to correct a structural heart valve problem can restore sinus rhythm in approximately one-fifth of patients with atrial fibrillation (AF), and the addition of a maze procedure will increase this proportion. Evidence shows that the maze procedure may restore atrial function in some patients and may have beneficial effects on functional symptoms and prognosis. The role of the maze procedure as an isolated treatment for lone AF in the context of heartfailure with no structurally correctable cause is unknown. Future progress will determine the appropriate indications for treatment and the risks and benefits of any intervention. PMID:24054484
The prevalence of both chronic heartfailure and atrial fibrillation is increasing as a result of systemic multimorbid risk and improved therapy of acute heart disease. Current treatment options are unsatisfactory especially regarding antiarrhythmic drugs. We propose that a systems biology approach to increase understanding of cardiac arrhythmias offers the best immediate way forward. Such an approach would be based on an accumulation of large clinical datasets, and application of next-generation sequencing in conjunction with selected experimental and computer-based models. Such an approach would in turn facilitate the development and targeted application of currently available and novel therapeutic approaches. PMID:24054471
Although not currently indicated for chronic heartfailure (CHF), statins have been associated with improved outcome in retrospective analysis. However, statin therapy reduces plasma levels of coenzyme Q10 (ubiquinone), which may have adverse effects on heartfailure states. We hypothesized that atorvastatin treatment improves endothelial function in patients with chronic heartfailure independent of LDL-cholesterol alterations. Furthermore, we assessed how
Christopher H. Strey; Joanna M. Young; Sarah L. Molyneux; Peter M. George; Christopher M. Florkowski; Russell S. Scott; Christopher M. Frampton
Heartfailure is one of the most common reasons for admission to home health care among older adults Patients with heartfailure present complex challenges for home health care agency staff, given the chronic yet variable nature of the disease and the importance of behavioral factors in long-term management of heartfailure. The purpose of this study was to examine
Patricia J. Moulton; Amy M. McGrane; Theresa L. Beck; Nancy L. Holland; Mary Ann Christopher
Background Chronic heartfailure is associated with impaired renal function, which may worsen during therapy. The incidence, predictors, and consequences of aggravated renal dysfunction (ARD) in patients undergoing intensive therapy for advanced chronic heartfailure are unknown. Methods We reviewed the experience of 48 consecutive patients hospitalized for treatment of advanced chronic heartfailure who underwent intravenous diuretic therapy with
Mark S. Weinfeld; Glenn M. Chertow; Lynne Warner Stevenson
Despite improvements in therapy, long-term mortality remains high in patients with heartfailure and thus there remains a need for new treatment strategies to reduce the burden of mortality and morbidity associated with this condition. AT1-receptor blockers represent a rational approach to the management of heartfailure, and have been shown to have beneficial effects on heartfailure symptoms and
The therapeutic goals for patients hospitalized with acutely decompensated heartfailure are to reverse acute hemodynamic abnormalities, relieve symptoms, and to initiate heartfailure therapies which will decrease disease progression and improve long-term survival. Nesiritide (recombinant B-type natriuretic peptide) is the first in a new class of therapeutic agents for the treatment of heartfailure and has been demonstrated to
There has been a lack of research regarding nonpharmacologic interventions in heartfailure. The objective was to determine the effect of behavioral management on health related quality of life (HRQL) in patients with heartfailure. Participants (N = 116) were randomly assigned to one of two groups: usual care for heartfailure (n = 58) and the 15-week behavioral management
Martha Shively; Mary Kodiath; Tom L. Smith; Ann Kelly; Patricia Bone; Lizz Fetterly; Nancy Gardetto; Ralph Shabetai; Samuel Bozzette; Kathleen Dracup
Skeletal muscle function was measured as force production and fatigue in both the quadriceps (a large locomotive muscle) and adductor pollicis (a small intrinsic hand muscle) in five healthy volunteers, five patients with mild chronic heartfailure, and five patients with severe chronic heartfailure. The quadriceps of patients with chronic heartfailure had a reduced muscle cross sectional area,
Aims Lung dysfunction occurring in chronic heartfailure worsens clinical status and exercise performance. The prog- nostic value of airway and alveolar function measurements in chronic heartfailure has not been explored. We aimed to evaluate the prognostic value of lung function tests in a population of patients with stable chronic heartfailure. Methods and Results One hundred and six
M. Guazzi; G. Pontone; R. Brambilla; P. Agostoni; G. Reina
BACKGROUND--In a canine model of congestive heartfailure 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 heartfailure. METHODS--Plasma concentrations of beta endorphin were measured in patients with acute and chronic heartfailure and cardiogenic shock. A
K. G. Oldroyd; C. E. Gray; R. Carter; K. Harvey; W. Borland; G. Beastall; S. M. Cobbe
BACKGROUND: Heart rate variability (HRV) is known to be impaired in patients with congestive heartfailure (CHF). Time-domain analysis of ECG signals traditionally relies heavily on linear indices of an essentially non-linear phenomenon. Poincaré plots are commonly used to study non-linear behavior of physiologic signals. Lagged Poincaré plots incorporate autocovariance information and analysis of Poincaré plots for various lags can
Background Alternative mRNA splicing is an important mechanism for regulation of gene expression. Altered mRNA splicing occurs in association with several types of cancer, and a small number of disease-associated changes in splicing have been reported in heart disease. However, genome-wide approaches have not been used to study splicing changes in heart disease. We hypothesized that mRNA splicing is different in diseased hearts compared to control hearts. Methods and Results We used the Affymetrix exon array to globally evaluate mRNA splicing in LV myocardial RNA from control (n=15) and ischemic cardiomyopathy (ICM) patients. We observed a broad and significant decrease in RNA splicing efficiency in heartfailure, which affected some introns to a greater extent than others. The profile of mRNA splicing separately clustered ICM and control samples, suggesting distinct changes in RNA splicing between groups. RTPCR validated 9 previously unreported alternative splicing events. Furthermore, we demonstrated that splicing of four key sarcomere genes, cardiac troponin T (TNNT2), cardiac troponin I (TNNI3), myosin heavy chain 7 (MYH7), and filamin C gamma (FLNC), was significantly altered in ICM, as well as in dilated cardiomyopathy and aortic stenosis (AS). In AS samples, these differences preceded the onset of heartfailure. Remarkably, the ratio of minor to major splice variants of TNNT2, MYH7, and FLNC classified independent test samples as control or disease with greater than 98% accuracy. Conclusions Our data indicate that RNA splicing is broadly altered in human heart disease, and that patterns of aberrant RNA splicing accurately assign samples to control or disease classes.
Kong, Sek Won; Hu, Yong Wu; Ho, Joshua W. K.; Ikeda, Sadakatsu; Polster, Sean; John, Ranjit; Hall, Jennifer L.; Bisping, Egbert; Pieske, Burkert; Remedios, Cristobal G. dos; Pu, William T.
This thesis describes a study of the changes in the extracellular matrix (ECM) of the myocardium, in patients with end stage heartfailure and during mechanical support (Left Ventricular Assist Device support, LVAD) of the left ventricle. The changes during LVAD support may lead to recovery of the heart. Chapter 1 is a general introduction about heartfailure, heart transplantation,
Background Our hypothesis is that an enlarged heart may compete for space with the lungs, causing a restrictive pattern that is often seen in patients with chronic heartfailure. Methods Eighty patients with stable congestive heartfailure in New York Heart Association classes II and III participated in the study. We measured cardiothoracic index (chest radiography), FEV1, vital capacity, alveolar
PierGiuseppe Agostoni; Gaia Cattadori; Marco Guazzi; Pietro Palermo; Maurizio Bussotti; Giancarlo Marenzi
Approximately 5.7 million people in the United States have a diagnosis of heartfailure, and more than 3,100 patients are awaiting a heart transplant. A temporary total artificial heart (TAH-t, SynCardia Systems Inc, Tucson, Arizona) is approved by the US Food and Drug Administration (FDA) as a bridge to transplant in patients at risk of dying of biventricular heartfailure. Currently, TAH-t recipients awaiting transplant are hospital-bound and attached to a large pneumatic driver. In 2010, the FDA gave conditional approval for an Investigational Device Exemption clinical study of the portable Freedom driver (SynCardia). This case report describes a 61-year-old man admitted with acute decompensated heartfailure, which progressively worsened, eventually requiring implantation of a TAH-t. Following stabilization, the patient was switched to the Freedom driver. After the patient and his wife proved competence in managing the device, they were able to take several daylong excursions outside the hospital. The patient considered discharge from the hospital while awaiting a transplant but ultimately received a heart transplant while still an inpatient. Higher rates of survival to transplant have already been proved with the TAH-t. Potential benefits for the portable Freedom driver include increased mobility, decreased cost, and improved quality of life. PMID:22586879
Congestive heartfailure is a widespread cardiac disease in western countries. At present, the main measure for monitoring the level of pulmonary edema in telemedicine systems is weight, which is not a reliable indicator. The authors propose a novel bioimpedance telemedical system to monitor these patients. The system measures the resistivity of each lung using optimization methods and transmits the measurements via a modem to a call center. Preliminary results show that the measured resistivity values among healthy young patients are consistent and reproducible within 48 hours. The mean resistivity values in patients with pulmonary congestion were lower than those of the healthy patients: 887 [Omega*cm]+/-117 vs 1244 [Omega*cm]+/-87 (P<.01). The system is noninvasive, safe, and portable. It retrieves unique information correlated with the amount of fluid in the lungs and transmits the data to a medical call center in order to improve the diagnostics and treatment of congestive heartfailure. PMID:18983286
Radai, Michal M; Arad, Marina; Zlochiver, Sharon; Krief, Haim; Engelman, Tzvika; Abboud, Shimon
Paradigms are a part of our human nature. In the world of medicine and science, they allow investigators to work within a particular, previously accepted framework that provides certain constraints. This is the crux of Newton's quote, "If I've seen so far it's because I stood upon the shoulders of giants." However, in the same way that it allows us to build, it can constrain our thought processes if we fail to accept new data that are ill suited to an accepted paradigm. The physiological mechanisms to explain the phenomenon of chronic congestive heartfailure are similar to other paradigms of science, in that they have undergone several shifts throughout their history, and continue to change with new evidence. Here, we seek to explore how our understanding of congestive heartfailure has changed. PMID:23059652
Caring for heartfailure patients with a low socioeconomic status presents a unique set of challenges for health care providers. Heartfailure 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
Cardiorenal syndrome describes the impairment of renal function and associated diuretic resistance in patients with heartfailure and clinically manifest volume overload. The pathophysiology of this syndrome is poorly understood, but appears to be caused by impairment of tubuloglomerular feedback, neurohormonal activation, and other factors and therapies used in the management of heartfailure. Early diagnosis of the cardiorenal syndrome by way of markers of renal injury and function is critical for timely interventions that may attenuate progression. Many novel therapies have been evaluated in the cardiorenal syndrome setting, including agents that block key local factors (eg, adenosine A(I) receptor antagonists), improve diuresis, aquaresis, and natriuresis, and augment natural vasodilator mechanisms to improve renal perfusion. Furthermore, device-based approaches such as ultrafiltration may also play an important therapeutic role. PMID:19486594
Heartfailure can be the final stage of almost any type of cardiovascular diseases. Such diseases are the leading cause of recurrent hospital stay and mortality in developed countries, and an increasingly important cause of morbidity and mortality in developing countries. In consideration of the growing incidence of this syndrome, the Province of Trento (Northern Italy) supports a research project called e-HeartFailure. The aims of this project include the implementation of a web-based patient record management system which must allow all the professionals involved in the care process to provide a shared and continuous care. This paper emphasizes the role of ontologies in supporting the continuity of care. In a complex scenario where multiple agents co-operate in order to allow continuity of care, ontologies are the essential glue to ensure semantic consistency to data and knowledge shared by the different actors involved in the process, including patients and their families. PMID:16174518
Heartfailure is now considered an epidemic. In patients with heartfailure, electrical and mechanical dyssynchrony, evident primarily as prolongation of the QRS-complex on the surface electrocardiogram, is associated with detrimental effects on the cardiovascular system at several levels. In the past 10 years, studies have demonstrated that by stimulating both cardiac ventricles simultaneously, or almost simultaneously [cardiac resynchronization therapy (CRT)], the adverse effects of dyssynchrony can be overcome. Here, we provide a comprehensive overview of different aspects of CRT including the rationale behind and evidence for efficacy of the therapy. Issues with regard to gender effects and patient follow-up as well as a number of unresolved concerns will also be discussed. PMID:22882554
Stĺhlberg, M; Lund, L H; Zabarovskaja, S; Gadler, F; Braunschweig, F; Linde, C
Heartfailure with preserved ejection fraction (HFPEF) is increasing in prevalence with the aging of the population, and morbidity and mortality rates are comparable to that of heartfailure with reduced ejection fraction (HFREF). The diagnosis can be difficult to make, especially in older adults, stemming from the presence of multiple comorbid illnesses with confounding symptoms. New diagnostic tools have resulted in guidelines proposed to define and diagnose HFPEF. Recent literature focusing on the pathophysiology underlying this disease suggests multiple mechanisms are involved in the generation of the phenotype, such as abnormal relaxation and ventricular-vascular coupling, chronotropic incompetence, volume overload, and redistribution and /or endothelial dysfunction. Currently, no clinically proven treatments are shown to decrease morbidity and mortality in this population; however, there may be a novel multidisciplinary and multistage treatment strategy that can be studied to address this complex disease which incorporates pharmacologic and non-pharmacologic therapeutics.
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, heartfailure, and diabetes mellitus. In this article, we review how the mitochondrial dynamics are altered in different cardiac pathologies, with special emphasis on heartfailure, 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
ABSTRACT: 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 heartfailure. PMID:23034148
Erectile dysfunction (ED) is an increasingly common problem in the aging population and has been associated with chronic heart\\u000a failure (HF), either as an epiphenomenon or even as an early marker for underlying cardiovascular disease. ED has a significant\\u000a effect on patients’ quality of life. This chapter reviews ED in patients with HF and prevention and treatment based on current
Afshan Baraghoush; Anita Phan; Robert D. Willix Jr; Ernst R. Schwarz
Patients with chronic heartfailure (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 Damĺs; Erik Řie; Thor Ueland; Lars Gullestad; Pĺl Aukrust
In the congestive heartfailure 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
Heartfailure is a progressive condition which begins after an inciting event that leads to neurohormonal activation and cardiac\\u000a remodeling. Medical therapy with ?-blockers and angiotensin-converting enzyme inhibitors has been shown to attenuate neurohormonal\\u000a changes and left ventricular remodeling. Despite optimal medical therapy, patients often progress, and other therapeutic modalities\\u000a have been sought to interrupt and reverse the process of
Heartfailure (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
Zinc status was assessed in patients with type II diabetes mellitus and congestive heartfailure (CHF). Three groups of patients\\u000a were enrolled into the study: Group 1: 15 patients with type II diabetes mellitus and CHF; Group 2: 20 patients with isolated\\u000a type II diabetes mellitus; and Group 3: nine patients with isolated CHF. Twenty-four-hour urine was measured for creatinine,
Ahuva Golik; Nathan Cohen; Yoram Ramot; Joseph Maor; Rita Moses; Joshua Weissgarten; Yuval Leonov; David Modai
We reported previously that although there is disruption of coordinated cardiac hypertrophy and angiogenesis in transition to heartfailure, 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 heartfailure 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 heartfailure. 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 heartfailure.
Givvimani, Srikanth; Munjal, Charu; Gargoum, Riyad; Sen, Utpal; Tyagi, Neetu; Vacek, Jonathan C.
Background—HMG-CoA reductase inhibitors (statins) have been shown to beneficially affect outcomes in chronic heartfailure (CHF). We hypothesized that statins exert effects on autonomic function, as assessed by plasma norepinephrine levels, direct recordings of renal sympathetic nerve activity (RSNA), and baroreflex function. Methods and Results—Normolipidemic CHF rabbits were treated with simvastatin or vehicle. CHF was induced by continuous ventricular pacing
Rainer U. Pliquett; Kurtis G. Cornish; Jacob D. Peuler; Irving H. Zucker
In this study, the end-systolic pressure-volume relation (ESPVR) is used to derive new criteria that can help understand the problem of heartfailure with normal or preserved ejection fraction (HFpEF). It is shown that the ejection fraction (EF) is just one index of several indexes that can be derived from the parameters describing the ESPVR and related areas under ESPVR. PMID:23367195
Hypertension (HTN) is a principal risk factor for heartfailure (CHF), accounting for 39% (men) to 59% (women) of CHF cases in the Framingham Study. The expectation from these observational data that treatment of HTN should reduce risk of CHF is adequately realized in clinical trials of blood pressure treatment. Two recent meta-analyses of placebo-controlled trials that used diuretics\\/beta-blockers suggest
Opinion Statement Heartfailure (HF) is a major cause of mortality and morbidity and one of the most frequent reasons for hospital admission\\u000a in the United States and Europe. Currently, more than 50% of HF patients have a normal (N) left ventricular (LV) ejection\\u000a fraction (EF) (LVEF >50%). The main pathophysiologic processes involved in HFNEF are increased LV stiffness and abnormal
Aging is associated with numerous alterations in body composition and organ function that result in substantial changes in\\u000a the absorption, distribution, metabolism, and elimination of virtually all drugs. In addition, older patients with heartfailure\\u000a (HF) almost invariably have multiple coexisting medical conditions for which they are receiving medications. This article\\u000a reviews common adverse drug effects and drug interactions associated
Aldosterone receptor antagonists have been shown in randomized trials to reduce morbidity and mortality in adults with symptomatic systolic heartfailure. We studied the effectiveness and safety of spironolactone in adults with newly diagnosed systolic heartfailure in clinical practice. We identified all adults with newly diagnosed heartfailure, left ventricular ejection fraction of <40%, and no previous spironolactone use from 2006 to 2008 in Kaiser Permanente Northern California. We excluded patients with baseline serum creatinine level of >2.5 mg/dl or a serum potassium level of >5.0 mEq/L. We used Cox regression with time-varying covariates to evaluate the independent association between spironolactone use and death, hospitalization, severe hyperkalemia, and acute kidney injury. Among 2,538 eligible patients with a median follow-up of 2.5 years, 521 patients (22%) initiated spironolactone, which was not associated with risk of hospitalization (adjusted hazard ratio 0.91, 95% confidence interval 0.77 to 1.08) or death (adjusted hazard ratio 0.93, confidence interval 0.60 to 1.44). Crude rates of severe hyperkalemia and acute kidney injury during spironolactone use were similar to that seen in clinical trials. Spironolactone was independently associated with a 3.5-fold increased risk of hyperkalemia but not with acute kidney injury. Within a diverse community-based cohort with incident systolic heartfailure, use of spironolactone was not independently associated with risks of hospitalization or death. Our findings suggest that the benefits of spironolactone in clinical practice may be reduced compared with other guideline-recommended medications. PMID:24035170
Lee, Keane K; Shilane, David; Hlatky, Mark A; Yang, Jingrong; Steimle, Anthony E; Go, Alan S
BackgroundPatients with advanced heartfailure generally have hemodynamic perturbation characterized by low cardiac output and high ventricular filling pressures. This creates a clinical milieu with profound symptomatology that includes weakness, fatigue, and fluid-retention states causing peripheral edema, mesenteric congestion, and dyspnea syndromes. Great morbidity including hospital admissions and readmissions as well as high mortality rates ensue. Though medication and\\/or surgical
Inspiratory muscle weakness (IMW) is prevalent in patients with chronic heartfailure (CHF) caused by left ventricular systolic\\u000a dysfunction, which contributes to reduced exercise capacity and the presence of dyspnea during daily activities. Inspiratory\\u000a muscle strength (estimated by maximal inspiratory pressure) has independent prognostic value in CHF. Overall, the results\\u000a of trials with inspiratory muscle training (IMT) indicate that this
Jorge P. Ribeiro; Gaspar R. Chiappa; J. Alberto Neder; Lutz Frankenstein
Despite the high prevalence of acute heartfailure syndrome (AHFS) associated with its very high rates of morbidity and mortality,\\u000a little progress has been made in developing new therapies for treatment of this specific clinical condition. Compared with\\u000a the development of new therapies for other cardiovascular diseases, the lack of progress is striking. Many AHFS trials have\\u000a displayed negative results
Opinion statement Anemia is independently associated with an increased risk of mortality and morbidity in patients with heartfailure (HF).\\u000a The diagnosis of anemia should prompt assessment of the underlying cause(s), first by using routine laboratory measurements\\u000a (i.e., serum creatinine and estimated glomerular filtration rate [eGFR], serum iron, transferrin saturation, ferritin, vitamin\\u000a B12, folic acid, and thyroid stimulating hormone). In clinical
Improvement of health-related quality of life (HRQL) is increasingly recognized as a priority in the management of heartfailure\\u000a (HF). In this review, we highlight the dramatic improvement in HRQL often observed in patients with severe HF and give particular\\u000a emphasis to the nonpharmacologic therapy of cardiac resynchronization therapy, left ventricular assist devices, and cardiac\\u000a rehabilitation. We juxtapose this to