Note: This page contains sample records for the topic overt heart failure from Science.gov.
While these samples are representative of the content of Science.gov,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of Science.gov
to obtain the most current and comprehensive results.
Last update: August 15, 2014.
1

Heart Failure  

MedlinePLUS

... and empower Americans to make heart-healthy choices. Web Sites with More Information About Heart Failure For ... Educational Materials For Patients For Professionals Related CDC Web Sites Heart Disease Stroke High Blood Pressure Salt ...

2

Heart Failure  

Microsoft Academic Search

Summary Management 1. When performing the initial evaluation of a patient diagnosed with heart failure (HF), you should assess the following: a. The severity of the symptoms of impaired cardiac function (e.g., dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, fatigue, and leg edema) b. Evidence for risk factors strongly associated with HF: ischemic heart disease, hypertension, diabetes, valvular heart disease

William Lewis; Jim Nuovo

3

Heart failure.  

PubMed

Despite major improvements in the treatment of virtually all cardiac disorders, heart failure (HF) is an exception, in that its prevalence is rising, and only small prolongations in survival are occurring. An increasing fraction, especially older women with diabetes, obesity, and atrial fibrillation exhibit HF with preserved systolic function. Several pathogenetic mechanisms appear to be operative in HF. These include increased hemodynamic overload, ischemia-related dysfunction, ventricular remodeling, excessive neurohumoral stimulation, abnormal myocyte calcium cycling, excessive or inadequate proliferation of the extracellular matrix, accelerated apoptosis, and genetic mutations. Biomarkers released as a consequence of myocardial stretch, imbalance between formation and breakdown of extracellular matrix, inflammation, and renal failure are useful in the identification of the pathogenetic mechanism and, when used in combination, may become helpful in estimating prognosis and selecting appropriate therapy. Promising new therapies that are now undergoing intensive investigation include an angiotensin receptor neprilysin inhibitor, a naturally-occurring vasodilator peptide, a myofilament sensitizer and several drugs that enhance Ca++ uptake by the sarcoplasmic reticulum. Cell therapy, using autologous bone marrow and cardiac progenitor cells, appears to be promising, as does gene therapy. Chronic left ventricular assistance with continuous flow pumps is being applied more frequently and successfully as destination therapy, as a bridge to transplantation, and even as a bridge to recovery and explantation. While many of these therapies will improve the care of patients with HF, significant reductions in prevalence will require vigorous, multifaceted, preventive approaches. PMID:24621794

Braunwald, Eugene

2013-02-01

4

[Epidemiology of heart failure].  

PubMed

Of all persons aged over 40 years, approximately 1% have heart failure. The prevalence of heart failure doubles with each decade of life, and is around 10% in persons over 70 years of age. In Spain, heart failure causes nearly 80,000 hospital admissions every year. As in other developed countries, heart failure is the most frequent cause of hospitalization among persons 65 years of age and over, and is responsible for 5% of all hospitalizations. The incidence of heart failure increases with age, and reaches 1% per year in those over 65. Heart failure is a progressive, lethal disorder, even with adequate treatment. Five-year survival is around 50%, which is no better than that for many cancers. In Spain, heart failure is the third leading cause of cardiovascular mortality, after coronary disease and stroke. In 2000, heart failure caused 4% of all deaths and 10% of cardiovascular deaths in men; the corresponding figures for women were 8% and 18%. In recent decades the prevalence and number of hospitalizations due to heart failure have increased steadily in developed countries. Heart failure will probably continue to increase in coming years: although its incidence has not materially decreased, survival is increasing due to better treatment. The control of risk factors for hypertension and ischemic heart disease, the main causes of heart failure in Spain, is the only method to halt the foreseeable increase in heart failure in the near future. PMID:14967113

Rodríguez-Artalejo, Fernando; Banegas Banegas, José R; Guallar-Castillón, Pilar

2004-02-01

5

Therapy of heart failure  

Microsoft Academic Search

Therapy of heart failure. The incidence and prevalence of heart failure is on the rise. It has become the single most expensive health care item in the United States and the number one discharge diagnosis in the elderly. The goals of therapy include both prevention and treatment of heart failure. In recent years research studies and randomized clinical trials have

Robert W Schrier; Joseph G Abdallah; Howard H D Weinberger; William T Abraham

2000-01-01

6

Epidemiology of Heart Failure  

Microsoft Academic Search

Heart failure 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 heart failure (Table 1.1) but a simple, practical definition of the syndrome\\u000a of heart failure is that it is characterized by typical symptoms such as shortness of breath, exercise limitation and fatigue\\u000a and

Robert Neil Doughty; Harvey D. White

7

Heart failure and depression.  

PubMed

Depression frequently accompanies heart failure and has been linked with increased morbidity and mortality. Patients with heart failure who have depression have more somatic symptoms, hospitalizations, increased financial burden, and poorer quality of life. Furthermore, depression has been shown to be an independent predictor of future cardiac events in patients with heart failure, regardless of disease severity, making it worthwhile to consider among other cardiac risk factors, such as diabetes and smoking. This article summarizes the trials assessing the treatment of depression in heart failure and provides an algorithm for approaching these patients. PMID:24656106

Newhouse, Amy; Jiang, Wei

2014-04-01

8

Cardiac BNP gene delivery prolongs survival in aged spontaneously hypertensive rats with overt hypertensive heart disease  

PubMed Central

Background Hypertension is a highly prevalent disease associated with cardiovascular morbidity and mortality. Recent studies suggest that patients with hypertension also have a deficiency of certain cardiac peptides. Previously we demonstrated that a single intravenous injection of the myocardium-tropic adeno-associated virus (AAV) 9-based vector encoding for proBNP prevented the development of hypertensive heart disease (HHD) in spontaneously hypertensive rats (SHRs). The current study was designed to determine the duration of cardiac transduction after a single AAV9 injection and to determine whether cardiac BNP overexpression can delay the progression of previously established HHD, and improve survival in aged SHRs with overt HHD. Methods and Results To evaluate the duration of cardiac transduction induced by the AAV9 vector, we used four week old SHRs. Effective long-term selective cardiac transduction was determined by luciferase expression. A single intravenous administration of a luciferase-expressing AAV9 vector resulted in efficient cardiac gene delivery for up to 18-months. In aged SHRs (9-months of age), echocardiographic studies demonstrated progression of HHD in untreated controls, while AAV9-BNP vector treatment arrested the deterioration of cardiac function at six months post-injection (15-months of age). Aged SHRs with established overt HHD were further monitored to investigate survival. A single intravenous injection of the AAV9-vector encoding rat proBNP was associated with significantly prolonged survival in the treated SHRs (613±38 days, up to 669 days) compared to the untreated rats (480±69 days, up to 545 days)(p<0.05). Conclusions A single intravenous injection of AAV9 vector elicited prolonged cardiac transduction (up to 18 months post-injection). AAV9 induced cardiac BNP overexpression prevented development of congestive heart failure, and significantly prolonged the survival of aged SHRs with previously established overt HHD. These findings support the beneficial effects of chronic supplementation of BNP in a frequent and highly morbid condition such as HHD.

Oehler, Elise A; Schreiber, Claire A.; Ikeda, Yasuhiro; Cataliotti, Alessandro

2014-01-01

9

Cardiac BNP gene delivery prolongs survival in aged spontaneously hypertensive rats with overt hypertensive heart disease.  

PubMed

Background: Hypertension is a highly prevalent disease associated with cardiovascular morbidity and mortality. Recent studies suggest that patients with hypertension also have a deficiency of certain cardiac peptides. Previously we demonstrated that a single intravenous injection of the myocardium-tropic adeno-associated virus (AAV) 9-based vector encoding for proBNP prevented the development of hypertensive heart disease (HHD) in spontaneously hypertensive rats (SHRs). The current study was designed to determine the duration of cardiac transduction after a single AAV9 injection and to determine whether cardiac BNP overexpression can delay the progression of previously established HHD, and improve survival in aged SHRs with overt HHD. Methods and Results: To evaluate the duration of cardiac transduction induced by the AAV9 vector, we used four week old SHRs. Effective long-term selective cardiac transduction was determined by luciferase expression. A single intravenous administration of a luciferase-expressing AAV9 vector resulted in efficient cardiac gene delivery for up to 18-months. In aged SHRs (9-months of age), echocardiographic studies demonstrated progression of HHD in untreated controls, while AAV9-BNP vector treatment arrested the deterioration of cardiac function at six months post-injection (15-months of age). Aged SHRs with established overt HHD were further monitored to investigate survival. A single intravenous injection of the AAV9-vector encoding rat proBNP was associated with significantly prolonged survival in the treated SHRs (613?38 days, up to 669 days) compared to the untreated rats (480±69 days, up to 545 days)(p<0.05). Conclusions: A single intravenous injection of AAV9 vector elicited prolonged cardiac transduction (up to 18 months post-injection). AAV9 induced cardiac BNP overexpression prevented development of congestive heart failure, and significantly prolonged the survival of aged SHRs with previously established overt HHD. These findings support the beneficial effects of chronic supplementation of BNP in a frequent and highly morbid condition such as HHD. PMID:24799459

Tonne, Jason M; Holditch, Sara J; Oehler, Elise A; Schreiber, Claire A; Ikeda, Yasuhiro; Cataliotti, Alessandro

2014-04-01

10

Lungs in Heart Failure  

PubMed Central

Lung function abnormalities both at rest and during exercise are frequently observed in patients with chronic heart failure, also in the absence of respiratory disease. Alterations of respiratory mechanics and of gas exchange capacity are strictly related to heart failure. Severe heart failure patients often show a restrictive respiratory pattern, secondary to heart enlargement and increased lung fluids, and impairment of alveolar-capillary gas diffusion, mainly due to an increased resistance to molecular diffusion across the alveolar capillary membrane. Reduced gas diffusion contributes to exercise intolerance and to a worse prognosis. Cardiopulmonary exercise test is considered the “gold standard” when studying the cardiovascular, pulmonary, and metabolic adaptations to exercise in cardiac patients. During exercise, hyperventilation and consequent reduction of ventilation efficiency are often observed in heart failure patients, resulting in an increased slope of ventilation/carbon dioxide (VE/VCO2) relationship. Ventilatory efficiency is as strong prognostic and an important stratification marker. This paper describes the pulmonary abnormalities at rest and during exercise in the patients with heart failure, highlighting the principal diagnostic tools for evaluation of lungs function, the possible pharmacological interventions, and the parameters that could be useful in prognostic assessment of heart failure patients.

Apostolo, Anna; Giusti, Giuliano; Gargiulo, Paola; Bussotti, Maurizio; Agostoni, Piergiuseppe

2012-01-01

11

Heart failure - tests  

MedlinePLUS

... taking medicines called ACE inhibitors or ARBs (angiotensin receptor blockers) Your doctor makes changes to the doses of your medicines You have more severe heart failure Sodium and potassium levels in your blood will need ...

12

What Causes Heart Failure?  

MedlinePLUS

... by the National Institutes of Health. View all Heart Failure Press Releases March 27, 2014 The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are ...

13

Living with Heart Failure  

MedlinePLUS

... by the National Institutes of Health. View all Heart Failure Press Releases March 27, 2014 The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are ...

14

Anaemia and heart failure  

Microsoft Academic Search

Anaemia is one of the most frequent co-morbidities in patients with heart failure. Its prevalence increases from 4% to7% in\\u000a subjects with asymptomatic left ventricular dysfunction to >30% in patients with severe heart failure. Renal insufficiency,\\u000a activation of inflammatory mediators and treatment with renin-angiotensin antagonists seem to be its main determinants. The\\u000a results of many studies agree in providing evidence

Enrico Vizzardi; Tania Bordonali; Elena Tanghetti; Marco Metra; Livio Dei Cas

2011-01-01

15

Metabolic Mechanisms in Heart Failure  

Microsoft Academic Search

Although neurohumoral antagonism has successfully reduced heart failure morbidity and mortality, the residual disability and death rate remains unacceptably high. Though abnormalities of myocardial metabolism are associated with heart failure, recent data suggest that heart failure may itself promote metabolic changes such as insulin resistance, in part through neurohumoral activation. A detrimental self-perpetuating cycle (heart failure 3 altered metabolism 3

Houman Ashrafian; Michael P. Frenneaux; Lionel H. Opie

16

[Levosimendan in heart failure].  

PubMed

Clinical trials investigating traditional inotropic agents in patients with heart failure demonstrated an increased mortality rate (odds ratio 1.50; IC=0.51-3.92), high incidence of discontinuation of infusion therapy (odds ratio 0.46; IC=0.083-2.29) due to major side effects and, most of all, a limited clinical benefit (odds ratio 0.75; IC=1.42-0.08). On this background a new class of inotropic drugs, the calcium-sensitisers, have been developed. The safety and efficacy of levosimendan (Simdax) has been recently demonstrated in trials (LIDO e RUSSLAN) in patients with heart failure due to ischemic and not ischemic disease. Twenty-six patients with decompensated heart failure of different etiology have been treated with 24 hour infusion of levosimendan. In this experience the levosimendan improved the clinical status and the left ventricular ejection fraction. PMID:15303549

Scelsi, Laura; Campana, Carlo; Ghio, Stefano; Monti, Lorenzo; Opasich, Cristina; De Feo, Stefania; Cobelli, Franco; Orlandi, Mario; Di Pasquale, Giuseppe; Tavazzi, Luigi

2004-01-01

17

Imidapril in heart failure.  

PubMed

Angiotensin-converting enzyme (ACE) inhibitors improve the prognosis in mild, moderate and severe heart failure, as well as preventing the onset of heart failure in patients with chronic asymptomatic left-ventricular dysfunction and in those with reduced ejection fraction after myocardial infarction (MI). Imidapril is a long-acting ACE inhibitor that is rapidly converted in the liver to its active metabolite, imidaprilat. Maximum plasma concentrations of imidapril and imidaprilat are achieved after 2 and 5-6 hours, respectively, with corresponding elimination half-lives of 1.1-2.5 and 10-19 hours. Imidapril is used in the treatment of hypertension, chronic heart failure, acute MI and diabetic nephropathy. In patients with mild-to-moderate chronic heart failure, imidapril 10 mg once-daily increased exercise time and physical working capacity, decreased plasma atrial natriuretic peptide and brain natriuretic peptide levels and reduced blood pressure. It also improved left ventricular ejection fraction, being significantly more effective than bisoprolol, in patients with acute MI. Imidapril is well tolerated and preliminary studies suggest it has an advantage over captopril and enalapril in terms of a lower incidence of cough. In conclusion, imidapril is a well-investigated versatile ACE inhibitor for the treatment of a range of cardiovascular diseases. PMID:17094051

Dolezal, Tomas

2006-09-01

18

?-Blockade in Heart Failure  

Microsoft Academic Search

Both experimental and clinical observation suggest that activation of the sympathetic nervous system exerts an important deleterious effect in patients with chronic heart failure. The precise mechanisms responsible for this effect have not been defined, but prolonged exposure to norepinephrine is associated with a variety of adverse physiologic and biochemical\\/molecular actions. Identification of these deleterious pathways has helped to explain

Milton Packer

1998-01-01

19

Beta blockers in heart failure  

Microsoft Academic Search

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

Norman Sharpe

1996-01-01

20

Heart failure in elderly patients.  

PubMed

Several structural and functional changes contribute to heart failure 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 heart failure is a frequent finding in elderly patients. The relation of systolic to diastolic heart failure is clearly shifted towards diastolic heart failure in elderly patients, especially in women. Mortality is increased with systolic dysfunction in elderly patients compared to younger heart failure patients. Mortality is less with diastolic dysfunction, but still higher compared to elderly without heart failure. In addition, morbidity is increased both with diastolic and systolic heart failure in elderly patients. Cognitive dysfunction is a frequent finding. After exclusion of specific cardiac and extracardiac reasons for dyspnoea, drug therapy of systolic heart failure in elderly is similar to younger patients. However, the physiological decrease of renal function and the more frequent renal impairment in elderly patients with heart failure needs to be considered. Guideline recommendations for drug therapy are based in most cases on studies conducted in younger systolic heart failure 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 heart failure are available only recently. The term heart failure with normal left ventricular ejection fraction (LVEF) has been proposed instead of diastolic heart failure. Given the increased morbidity and mortality in elderly patients with heart failure 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 heart failure with normal LVEF are still missing. PMID:16621389

Spiecker, Martin

2006-05-01

21

Frailty in heart failure.  

PubMed

Considering the increasing age of individuals affected with heart failure (HF), a specific approach to their treatment is required, with more attention paid to geriatric conditions such as poor mobility, multiple disabilities, and cognitive impairment. Frailty is a distinct biological syndrome reflecting decreased physiologic reserve and resistance to stressors. It was shown to occur frequently in patients with heart failure, with the prevalence ranging from 15 to 74 %, depending on the studied population and the method of assessment. We reviewed literature data on the influence of frailty, skeletal abnormalities, comorbidities and geriatric condition on diagnosis, treatment, and outcomes in elderly patients with HF. Identification of frailty in patients with HF is important from the clinical point of view, as this condition exerts unfavorable effects on the course of heart failure. Frailty contributes to a higher frequency of visits to emergency departments, hospitalizations, and mortality in patients with HF. Exercise may improve mobility, and nursing support can be implemented to help the patients adhere to medications. Therefore, frail patients should be diagnosed and treated according to available guidelines, and successfully educated about their condition. PMID:24733407

Uchmanowicz, Izabella; Loboz-Rudnicka, Maria; Szel?g, Przemys?aw; Jankowska-Pola?ska, Beata; Loboz-Grudzie?, Krystyna

2014-09-01

22

Electrophysiological Remodeling in Heart Failure  

PubMed Central

Heart failure affects nearly 6 million Americans, with a half-million new cases emerging each year. Whereas up to 50% of heart failure patients die of arrhythmia, the diverse mechanisms underlying heart failure-associated arrhythmia are poorly understood. As a consequence, effectiveness of antiarrhythmic pharmacotherapy remains elusive. Here, we review recent advances in our understanding of heart failure-associated molecular events impacting the electrical function of the myocardium. We approach this from an anatomical standpoint, summarizing recent insights gleaned from pre-clinical models and discussing their relevance to human heart failure.

Wang, Yanggan; Hill, Joseph A.

2010-01-01

23

[Heart failure: critical patients].  

PubMed

Patients with heart failure in the "real world" are often elderly and with multiple comorbid diseases. These conditions create a dilemma for the physician responsible for the treatment of heart failure and are associated with a substantial underutilization of evidence-based treatments. Clarifying the prognostic impact of comorbidities in heart failure could provide more precise risk stratification and optimize the management of these patients. The negative prognostic impact of concomitant diseases has been shown in several studies: in the TEMISTOCLE study, carried out in Italy on patients hospitalized for heart failure in Internal Medicine and Cardiology wards, the presence of comorbidities was associated with higher in-hospital mortality and prolonged length of stay. In the IN-CHF registry, enrolling out patients with heart failure in a cardiological setting, the rate of coexisting diseases is not very high according to the epidemiological characteristics of this population. Renal impairment, particularly in patients >70 years old, and chronic obstructive pulmonary disease (COPD) are frequent comorbid diseases in heart failure. Renal impairment has been recognized as an independent risk factor for morbidity and mortality in heart failure while the role of COPD is controversial. Patients with renal dysfunction and COPD have largely been excluded from randomized controlled trials for safety reasons, so data are scarce. In the IN-CHF registry the prevalence of elderly patients with renal impairment (serum creatinine > or = 2 mg/dl and age > or = 70 years) is 5.1%; this subgroup of patients has an increased risk for both 1-year death (28.1 vs 11.2%) and hospital admission (34.9 vs 22.5%) compared with the remaining population. The prescription pattern has been evaluated in the last years (2003-2005) and shows that angiotensin system inhibitors (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) as well as beta-blockers are less prescribed in these patients (78.9 vs 86.1% and 42.2 vs 55.9%, respectively). The prevalence of patients with COPD in the registry was 13.2%: considerable differences in COPD prevalence estimates exist in the general population depending on many factors such as method for diagnosis or lack of agreement on diagnostic criteria. COPD patients were older and with more severe symptoms; with respect to the pharmacological treatment, beta-blockers are significantly less prescribed in COPD patients while a similar proportion of patients are receiving angiotensin system antagonists. The adjusted analysis shows that COPD in not an independent predictor of 1-year mortality in this population while it is independently associated with 1-year all-cause hospitalization. Non-cardiovascular hospital admissions seem to be more influenced by the presence of this comorbidity than cardiovascular admissions. PMID:17972426

Fabbri, Gianna; Gorini, Marco; Maggioni, Aldo P; Oliva, Fabrizio

2007-09-01

24

Teaching Heart Failure Treatment Guidelines and Assessing Heart Failure Therapy  

PubMed Central

Objectives To determine the effectiveness of the heart failure screening form in teaching heart failure treatment guidelines and prompting students to evaluate patients' medications to initiate patient education and provider intervention. Design Between 2002 and 2009, 123 students used the heart failure screeing form during an elective cardiology advanced pharmacy practice experience (APPE). A subset of 41 students were also assessed for change in heart failure knowledge and confidence pre- and post-APPE. Assessment A total of 1,114 heart failure patients were screened and assessed using the tool with a mean age of 71.9 ± 12.9 years. Of those, 535 (48%) patients met screening criteria and participated in heart failure education. From 2008 through 2009, there were 45 heart failure interventions with a 60% provider acceptance rate. Significant improvements were made in heart failure knowledge and in all areas of confidence at the end of the APPE for the 41 students assessed. Discussion The heart failure screening form is an effective tool to teach evidence-based medicine and to prompt students to initiate provider intervention and patient education. Its use is associated with significant increases in knowledge and confidence in heart failure medication therapy management in fourth-year pharmacy students.

Lenz, Thomas L.; Destache, Christopher J.

2010-01-01

25

Heart Failure in South America  

PubMed Central

Continued assessment of temporal trends in mortality and epidemiology of specific heart failure in South America is needed to provide a scientific basis for rational allocation of the limited health care resources, and strategies to reduce risk and predict the future burden of heart failure. The epidemiology of heart failure in South America was reviewed. Heart failure is the main cause of hospitalization based on available data from approximately 50% of the South American population. The main etiologies of heart failure are ischemic, idiopathic dilated cardiomyopathy, valvular, hypertensive and chagasic etiologies. In endemic areas, Chagas heart disease may be responsible by 41% of the HF cases. Also, heart failure presents high mortality especially in patients with Chagas etiology. Heart failure and etiologies associated with heart failure may be responsible for 6.3% of causes of deaths. Rheumatic fever is the leading cause of valvular heart disease. However, a tendency to reduction of HF mortality due to Chagas heart disease from 1985 to 2006, and reduction in mortality due to HF from 1999 to 2005 were observed in selected states in Brazil. The findings have important public health implications because the allocation of health care resources, and strategies to reduce risk of heart failure should also consider the control of neglected Chagas disease and rheumatic fever in South American countries.

Bocchi, Edimar Alcides

2013-01-01

26

Educating patients with heart failure  

Microsoft Academic Search

Heart Failure (HF) is a chronic disease syndrome that has become one of the leading causes of hospitalization in Canada. The high mortality, marked disability and subsequent lack of productivity of people with HF weigh heavily on the patient, family and society. ^ In this thesis I conducted a pilot study to determine whether intensive education provided to heart failure

Femida Gwadry-Sridhar

2005-01-01

27

Heart failure--new insights.  

PubMed

Ten years ago we published a review updating current knowledge on heart failure. We summarized that heart failure is a neuro-humoral and inflammatory syndrome, and that proinflammatory cytokines are involved in cardiac depression and in the complex syndrome of heart failure. We suggested that understanding the role of these cytokines may enable us to reverse cardiac depression and heart failure. Now we know that there are several mechanisms involved in this syndrome, including inflammation, nitric oxide-dependent pathways, apoptosis, reactive oxygen species, and mitochondrial energy metabolism. This review will focus on the up-to-date mechanistic aspects of heart failure, including clinical trials that have contributed to our better understanding of this entity. PMID:19432040

Blum, Arnon

2009-02-01

28

Gene Therapy for Heart Failure  

PubMed Central

Congestive heart failure accounts for half a million deaths per year in the US. Despite its place among the leading causes of morbidity, pharmcalogical and mechanic remedies have been able to slow the progression of the disease, today’s science has yet to provide a cure and there are few therapeutic modalities available for patients with advanced heart failure. There is a critical need to explore new therapeutic approaches in heart failure and gene therapy has emerged as a viable alternative. Recent advances in understanding of the molecular basis of myocardial dysfunction, together with the evolution of increasingly efficient gene transfer technology, has placed heart failure within reach of gene-based therapy. The recent successful and safe completion of a phase 2 trial targeting the sarcoplasmic reticulum calcium ATPase pump (SERCA2a) along with the start of more recent phase 1 trials opens a new era for gene therapy for the treatment of heart failure.

Tilemann, Lisa; Ishikawa, Kiyotake; Weber, Thomas; Hajjar, Roger J.

2012-01-01

29

Heart Failure in North America  

PubMed Central

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

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

2013-01-01

30

Atherosclerosis imaging and heart failure  

Microsoft Academic Search

Coronary atherosclerosis is the most important primary etiologic factor predisposing to the development of heart failure.\\u000a The mechanisms by which coronary atherosclerosis lead to heart failure likely involve the initial development of regional\\u000a myocardial dysfunction, later progressing to global ventricular failure and symptomatic congestive disease. A variety of imaging\\u000a strategies have been investigated for their value in identifying and characterizing

Verônica Rolim S. Fernandes; Susan Cheng; João A. C. Lima

2006-01-01

31

Metabolic and signaling alterations in dystrophin-deficient hearts precede overt cardiomyopathy.  

PubMed

The cytoskeletal protein dystrophin has been implicated in hereditary and acquired forms of cardiomyopathy. However, much remains to be learned about the role of dystrophin in the heart. We hypothesized that the dystrophin-deficient heart displays early alterations in energy metabolism that precede overt cardiomyopathy. We evaluated the metabolic and functional phenotype of dystrophin-deficient mdx mouse hearts at 10-12 weeks, when no major histological or echocardiographic abnormalities are reported. Ex vivo working mdx heart perfusions with stable isotopes revealed a marked shift in substrate fuel selection from fatty acids to carbohydrates associated with enhanced oxygen consumption. They also unmasked in the mdx heart: (i) compromised cardiac contractile function and efficiency, (ii) reduced cellular integrity, and (iii) exacerbated alterations in mitochondrial citric acid cycle-related parameters and in nutrient signaling pathways related to Akt. The observed shift in substrate selection cannot be explained by metabolic gene remodeling. However, mdx mice hearts showed an increased expression of the atrial natriuretic factor (anf) gene, an activator of the nitric oxide (NO)/cGMP signaling pathway and marker of cardiac remodeling, and, only as the cardiomyopathy progresses (at 25 weeks of age), an increased expression of the alpha1 subunit of soluble guanylate cyclase, which is known to negatively correlate with the activity NO/cGMP pathway. Collectively, our results highlight early metabolic and signaling alterations in the dystrophin-deficient heart, which may predispose these hearts to contractile dysfunction and sarcolemmal fragility. They also suggest the presence of a "sub-clinical" defect in the NO/cGMP pathway, which in vivo, at an early age, may be compensated by enhanced anf gene expression. PMID:17583724

Khairallah, Maya; Khairallah, Ramzi; Young, Martin E; Dyck, Jason R B; Petrof, Basil J; Des Rosiers, Christine

2007-08-01

32

How Is Heart Failure Treated?  

MedlinePLUS

... by the National Institutes of Health. View all Heart Failure Press Releases March 27, 2014 The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are ...

33

Heart failure: future treatment approaches  

Microsoft Academic Search

Large-scale clinical trials of vasodilators with nitrates and hydralazine and with angiotensin-converting enzyme (ACE) inhibitors in the 1980s and early 1990s provided the first credible evidence that medical therapy can prolong survival in patients with chronic heart failure (CHF). Moreover, patients treated with ACE inhibitors required fewer hospitalizations for worsening heart failure (HF). Nonetheless, the prognosis in patients with HF

Jay N. Cohn

2000-01-01

34

The pathophysiology of heart failure.  

PubMed

Heart failure is a clinical syndrome that results when the heart is unable to provide sufficient blood flow to meet metabolic requirements or accommodate systemic venous return. This common condition affects over 5 million people in the United States at a cost of $10-38 billion per year. Heart failure results from injury to the myocardium from a variety of causes including ischemic heart disease, hypertension, and diabetes. Less common etiologies include cardiomyopathies, valvular disease, myocarditis, infections, systemic toxins, and cardiotoxic drugs. As the heart fails, patients develop symptoms which include dyspnea from pulmonary congestion, and peripheral edema and ascites from impaired venous return. Constitutional symptoms such as nausea, lack of appetite, and fatigue are also common. There are several compensatory mechanisms that occur as the failing heart attempts to maintain adequate function. These include increasing cardiac output via the Frank-Starling mechanism, increasing ventricular volume and wall thickness through ventricular remodeling, and maintaining tissue perfusion with augmented mean arterial pressure through activation of neurohormonal systems. Although initially beneficial in the early stages of heart failure, all of these compensatory mechanisms eventually lead to a vicious cycle of worsening heart failure. Treatment strategies have been developed based upon the understanding of these compensatory mechanisms. Medical therapy includes diuresis, suppression of the overactive neurohormonal systems, and augmentation of contractility. Surgical options include ventricular resynchronization therapy, surgical ventricular remodeling, ventricular assist device implantation, and heart transplantation. Despite significant understanding of the underlying pathophysiological mechanisms in heart failure, this disease causes significant morbidity and carries a 50% 5-year mortality. PMID:22227365

Kemp, Clinton D; Conte, John V

2012-01-01

35

Ultrafiltration in Acute Decompensated Heart Failure  

Microsoft Academic Search

Acute heart failure is a major clinical and public health problem. Advanced refractory heart failure represents an important subgroup of patients presenting with acute heart failure syndrome. Fluid congestion is a hallmark in patients with advanced heart failure, and resistance to pharmacologic therapy - particularly diuretics - frequently develops as the disease progresses. When pharmacologic therapy is no longer feasible,

WAIL ALKASHKARI; G ORDON MOE; Beth L. Abramson; Luigi Casella; Asim Cheema; Robert J. Chisholm; Chi-Ming Chow; Paul Dorian; Neil Fam; David H. Fitchett; Michael R. Freeman; Shaun Goodman; Anthony F. Graham; Robert J. Howard; Stuart Hutchison; Victoria Korley; Michael Kutryk; Anatoly Langer; Howard Leong-Poi; Iqwal Mangat; Gordon W. Moe; Juan C. Monge; Thomas Parker; Arnold Pinter; Trevor I. Robinson; Andrew Yan

2007-01-01

36

Integrated heart failure management in the patient with heart failure caused by left ventricular systolic dysfunction  

Microsoft Academic Search

1. The increasing burden of heart failure is a result of the aging population and improvements in cardiac care. It is estimated that 660,000 new cases of heart failure are diagnosed every year in the United States. 2. Heart failure with normal ejection fraction (HFNEF) is part of a single entity of heart failure that includes also heart failure with

Marco Metra; Valerio Zaca; Savina Nodari; Livio Dei Cas

37

Treating heart failure with sildenafil.  

PubMed

Sildenafil is a selective inhibitor of type 5 phosphodiesterase, the main phosphodiesterase isoform responsible for hydrolysis of intracellular cyclic guanosine monophosphate in the pulmonary vasculature. It improves exercise capacity and quality of life in patients with systolic heart failure, especially in those who develop secondary pulmonary hypertension. It improves peak oxygen consumption, reduces minute ventilation/carbon dioxide output slope, and acts as a selective pulmonary vasodilator during rest and exercise in patients with heart failure and pulmonary hypertension. It improves flow-mediated maximal dilatation, ergoreflex on ventilation, and breathlessness both after 3 and 6 months of treatment. Sildenafil, by improving endothelial activity and muscle perfusion, improves signaling and ventilatory efficiencies, potentially indicating a novel approach in the therapeutic management of heart failure. PMID:19627292

Blum, Arnon

2009-01-01

38

Anemia in Heart Failure Patients  

PubMed Central

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

Alexandrakis, Michael G.; Tsirakis, George

2012-01-01

39

Mitochondrial centrality in heart failure  

Microsoft Academic Search

A number of observations have shown that mitochondria are at the center of the pathophysiology of the failing heart and mitochondrial-based\\u000a oxidative stress (OS), myocardial apoptosis, and cardiac bioenergetic dysfunction are implicated in the progression of heart\\u000a failure (HF), as shown by both clinical studies and animal models. In this manuscript, we review the body of evidence that\\u000a multiple defects

José Marín-García; Michael J. Goldenthal

2008-01-01

40

Pachydermoperiostosis Accompanied by Heart Failure  

PubMed Central

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 heart failure. 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 heart failure. 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

2009-01-01

41

Ventricular Reconstruction Surgery for Congestive Heart Failure  

Microsoft Academic Search

The significant increase in the prevalence of heart failure 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 heart failure, and as a result, surgical treatments for heart failure have been reexamined. Surgical therapies represent the evolution

Richard Lee; Katherine J. Hoercher; Patrick M. McCarthy

2004-01-01

42

Chronic Heart Failure and Micronutrients  

Microsoft Academic Search

Heart failure (HF) is associated with weight loss, and cachexia is a well-recognized complication. Patients have an increased risk of osteoporosis and lose muscle bulk early in the course of the disease. Basal metabolic rate is increased in HF, but general malnutrition may play a part in the development of cachexia, particularly in an elderly population. There is evidence for

Klaus K. A. Witte; Andrew L. Clark; John G. F. Cleland

2001-01-01

43

Endothelial dysfunction in heart failure.  

PubMed

Endothelial dysfunction crucially contributes to the development of impaired coronary and systemic perfusion as well as reduced exercise capacity in patients with congestive heart failure, with fundamental impact on morbidity and mortality. Reduced bioavailability of nitric oxide (NO) and abundant formation of reactive oxygen species (ROS) within the vascular wall are the key determinants in endothelial dysfunction. The imbalance between NO and ROS mainly results from neurohumoral activation associated with heart failure. As endothelial derived NO is a major endogenous modulator of platelet function, reduced intravascular bioactivity of NO contributes to platelet activation, adhesion and thromboembolic events in heart failure. Treatment with angiotensin converting enzyme (ACE) inhibitors, angiotensin and aldosterone antagonists, and statins beneficially modulates endothelial dysfunction in heart failure. All these therapies increase NO bioactivity by either modulation of ROS generation, thereby preventing the interaction of superoxide anions with NO, and/or increasing endothelial NO synthase (eNOS) expression/activity. AVE9488, a novel eNOS transcription enhancer, attenuates cardiac remodeling and endothelial dysfunction in rats after large myocardial infarction. Endothelial progenitor cell (EPC) levels and their mobilization are regulated by eNOS. After myocardial infarction in rats, EPC levels and formation of endothelial colony forming units are markedly reduced. AVE 9488, ACE or HMG-CoA reductase inhibition result in significant increases in EPC levels, and beneficial effects on bone marrow molecular alterations after myocardial infarction. PMID:18276993

Bauersachs, Johann; Widder, Julian D

2008-01-01

44

Renal denervation and heart failure.  

PubMed

Renal denervation has been developed in order to lower systolic blood pressure in resistant hypertension by a reduction in renal afferent and efferent sympathetic nerve activity. In heart failure sympathetic activation, in particular, renal norepinephrine release is closely associated with morbidity and mortality. Initial studies have shown that renal denervation is able to reduce not only blood pressure but also heart rate, and is associated with a reduction in myocardial hypertrophy, improved glucose tolerance, and ameliorated microalbuminuria. Since some experimental and observational data suggest an antiarrhythmic effect, it is possible that renal denervation might also play a therapeutic role in arrhythmias often occurring in chronic heart failure. The first proof-of-concept studies are planned to evaluate the clinical effect of this pathophysiologically plausible method, which might be able to change clinical practice. PMID:24644008

Böhm, Michael; Ewen, Sebastian; Kindermann, Ingrid; Linz, Dominik; Ukena, Christian; Mahfoud, Felix

2014-06-01

45

Multivariable analysis of heart rate recovery after cycle ergometry in heart failure: Exercise in heart failure  

Microsoft Academic Search

PurposeThe purpose of this study was to investigate the association between impairment in heart rate recovery (HRrec) after cycle ergometry and prognostic markers in patients with heart failure (HF) compared with healthy controls.

Melissa Jehn; Martin Halle; Tibor Schuster; Henner Hanssen; Friedrich Koehler; Arno Schmidt-Trucksäss

2011-01-01

46

Managing noncardiac pain in heart failure patients.  

PubMed

Both acute and chronic pain are common coexisting problems in patients with heart failure. Because nonsteroidal anti-inflammatory drugs and corticosteroids are contraindicated in heart failure, traditional pain management algorithms require modification. This article reviews pertinent pain management principles, including pain vocabulary, barriers to pain management, and general pain assessment and treatment measures. Issues unique to the heart failure patient are discussed and specific interventions for the heart failure patient with acute or chronic pain are then delineated. PMID:15529077

Wheeler, Mary; Wingate, Sue

2004-01-01

47

The problem of polypharmacy in heart failure  

Microsoft Academic Search

Improvements in the medical therapy for chronic heart failure have led to a dramatic decrease in the morbidity and mortality\\u000a of patients with heart failure over the past two decades. This improvement has been gained at the expense of an increasing\\u000a number of potent drugs that heart failure patients have to take chronically. Because heart failure forms the end-stage of

Markus Flesch; Erland Erdmann

2006-01-01

48

[Anaemia in chronic heart failure].  

PubMed

Anaemia is a relatively frequent co-morbidity of chronic heart as well as chronic renal failure. In both conditions, it represents a strong and independent predictor of increased morbidity and mortality. Aetiology of this anaemia is multi-factorial. A number of various factors play a role in its development, e.g. inadequate erythropoietin production in the kidneys, bone marrow inhibition, iron deficiency as well as haemodilution associated with fluid retention. Treatment strategies aim at two directions. One is the stimulation of erythropoiesis with recombinant human erythropoietin or its analogues such as darbepoetin alpha. The other involves iron substitution, administered preferably intravenously for improved efficacy and tolerability. Clinical studies evaluating treatment of anaemia in chronic heart failure with erythropoiesis-stimulating agents conducted so far were ofa small scale, were not controlled with placebo and usually assessed proxy parameters. Their results suggested that effective treatment of anaemia in patients with chronic heart failure improves exertion tolerance, clinical status (NYHA class) as well as the quality of life and reduces the need for blood transfusions. Recently completed TREAT study was the first large morbidity and mortality study evaluating treatment of anaemia with an erythropoietin analogue compared to placebo. On a sample of more than 4000 patients with diabetes mellitus, chronic renal failure and significant anaemia, this study has shown that effective treatment of anaemia with darbepoetin alpha did not affect at all the incidence of cardiovascular and renal events; on the other hand, it had lead to a nearly two-fold increase in the incidence of cerebrovascular events. Some doubts about the safety of treatment with erythropoiesis-stimulating agents have occurred in the past based on the studies of anaemia treatment in patients with cancer and renal diseases. An answer to the question whether the treatment of anaemia associated with chronic heart failure affects positively the patient prognosis will be provided following the completion of the currently running morbidity and mortality RED-HF study. PMID:20845618

Hradec, J

2010-08-01

49

The systemic inflammatory response in heart failure  

Microsoft Academic Search

The physiologic diagnosis of heart failure has changed very little over the past several decades: heart failure is the inability of the cardiac output to meet the metabolic demands of the organism. The clinical definition of heart failure (also relatively unchanged) describes it as ventricular dysfunction that is accompanied by reduced exercise tolerance. Our understanding of the true pathophysiologic processes

Michael R Anderson

2000-01-01

50

Cardiotonic Modulation in Heart Failure  

PubMed Central

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

Tang, W. H. Wilson; Huang, Yanming

2014-01-01

51

Oxidative Stress in Heart Failure  

Microsoft Academic Search

\\u000a Heart failure (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

Gordon Moe

52

Heart Failure Epidemiology: European Perspective  

PubMed Central

Heart failure poses an increasing problem for global healthcare systems. The epidemiological data which has been accrued over the last thirty years has predominantly been accumulated from experience within North America and Europe. Initial large cohort, prospective longitudinal studies produced the first publications; however latterly the focus has shifted onto epidemiological data governing hospitalisation and mortality. The emphasis behind this shift has been the resource implications with regards to repetitive, costly and prolonged hospitalisation. The European experience in heart failure, though similar to North America has recently demonstrated differences in hospitalisation which may underlie the differences between healthcare system configuration. Heart failure however remains an increasing global problem and the endpoint of a variety of cardiovascular diseases. Allied with the fact of increasingly elderly populations and prior data demonstrating a steep rise in prevalent cases within more elderly populations, it is likely that the increasing burden of disease will continue to pose challenges for modern healthcare. Despite the predicted increase in the number of patients affected by heart failure, over the last thirty years, a clear management algorithm has evolved for the use of pharmacotherapies (neuro-hormonal antagonists), device based therapies (Implantable Cardioverting Defibrillator (ICD) and Cardiac Resynchronisation Therapy (CRT)) and mechanical therapies including left ventricular assist devices and cardiac transplantation. Though the management of such patients has been clearly delineated in national and international guidelines, the underuse of all available and appropriate therapies remains a significant problem. When comparing various epidemiological studies from different settings and timepoints, it should be remembered that rates of prevalence and incidence may vary depending upon the definition used, methods of accumulating information (with the possibility of bias) and the chosen cut point of defining left ventricular systolic dysfunction (LVSD).

Guha, K; McDonagh, T

2013-01-01

53

Monogenic Causes of Heart Failure  

Microsoft Academic Search

Dilated cardiomyopathy (DCM) without an established causative factor for the damage to the myocardium is termed “idiopathic\\u000a DCM,” and it is the cause of approximately one-fourth of the cases of congestive heart failure in the United States. Familial\\u000a occurrence accounts for 20% or more of idiopathic DCM, and recently a considerable number of genes associated with DCM have\\u000a been identified.

Hideko Kasahara

54

Hemodynamic Monitoring in Heart Failure  

Microsoft Academic Search

\\u000a Symptoms of pulmonary congestion, resulting from elevated left atrial and left ventricular filling pressures, are the most\\u000a common cause of heart failure 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

Anju Nohria; Ami Bhatt

55

?-Blocker pharmacogenetics in heart failure  

Microsoft Academic Search

?-Blockers (metoprolol, bisoprolol, and carvedilol) are a cornerstone of heart failure (HF) treatment. However, it is well\\u000a recognized that responses to a ?-blocker are variable among patients with HF. Numerous studies now suggest that genetic polymorphisms\\u000a may contribute to variability in responses to a ?-blocker, including left ventricular ejection fraction improvement, survival,\\u000a and hospitalization due to HF exacerbation. This review

Jaekyu Shin; Julie A. Johnson

2010-01-01

56

Insomnia and chronic heart failure  

Microsoft Academic Search

Insomnia is highly prevalent in patients with chronic disease including chronic heart failure (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

2009-01-01

57

MR spectroscopy in heart failure.  

PubMed

Magnetic resonance spectroscopy (MRS) is an established technique for the non-invasive assessment of myocardial metabolism. MRS is ideal for the evaluation of heart failure, as it allows quantification of the primary energy source for all myocardial cellular functions (ATP), the energy reserve phosphocreatine (PCr), and the creatine kinase reaction, which maintains cellular energy equilibrium. PCr forms the primary ATP buffer in the cell via the creatine kinase (CK) reaction and is involved in transporting the chemical energy from the ATP-producing mitochondria to the ATP-consuming contractile proteins. Using 31phosphorus (31P) MRS, a low cardiac PCr/ATP has consistently been found in patients with heart failure, supporting the hypothesis that the failing heart is energy starved. The use of 1H MRS has allowed the detection of total creatine, which when combined with 31P MRS, provides an in depth examination of the creatine kinase reaction. MRS signals from 31P, 1H, 23Na and 13C, including novel hyperpolarization techniques, have provided considerable insight into the understanding of energy metabolism in the healthy and diseased heart. PMID:21196379

Holloway, Cameron; ten Hove, Michiel; Clarke, Kieran; Neubauer, Stefan

2011-01-01

58

Heart Failure in South Asia  

PubMed Central

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

Sivadasan Pillai, Harikrishnan; Ganapathi, Sanjay

2013-01-01

59

[Cardiorenal syndrome by heart failure].  

PubMed

Cardiorenal (CR) syndrome is defined for the purposes of the following text mainly as primary cardiac dysfunction with a consequent failure of renal haemodynamics. Heart failure leads to a decrease in cardiac output and to the activation of vasoconstrictors; this gradually precipitates a decrease in the level of renal perfusion, the vasoconstriction of renal vessels and a decrease in glomerular filtration with a gradual development of renal failure. The following paper analyses the pathophysiological mechanisms, the characteristics of the patients, the role of medication during CR syndrome, the relationship between proteinuria and anaemia during CR syndrome and the application of bio-markers and pulmonary hypertension in the prognosis of patients with CR syndrome. PMID:24007228

Vítovec, J; Murín, J; Spinarová, L; Vítovcová, L; Spinar, J

2013-08-01

60

Congestive Heart Failure: Experimental Model  

PubMed Central

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

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

2013-01-01

61

Right heart failure: toward a common language  

PubMed Central

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

2013-01-01

62

Adrenergic Nervous System in Heart Failure  

Microsoft Academic Search

Recent demonstration that the level of sympathetic nervous drive to the failing heart in patients with severe heart failure is a major determinant of prognosis, and that mortality in heart failure is decreased by ?-adrenergic blockade with carvedilol, indicates the clinical relevance of cardiac neuroscience research. Important initial findings were observations that the plasma concentration of the sympathetic neurotransmitter, norepinephrine,

Murray Esler; David Kaye; Gavin Lambert; Danielle Esler; Garry Jennings

1997-01-01

63

[Exercise training in heart failure].  

PubMed

Exercise training in patients with chronic stable heart failure (HF) is a recommended and broadly accepted treatment strategy that is an integral part of an evidence-based management involving pharmacological and non-pharmacological therapies. There is ample scientific evidence that exercise training in HF with reduced (HFrEF) and with preserved ejection fraction (HFpEF) improves exercise capacity, HF symptoms and quality of life. This is due to an improvement of central hemodynamics, endothelial function, neurohumoral activation, skeletal muscle structure and function as well as a decrease in inflammatory markers. The largest randomized, controlled HF-ACTION study (Heart Failure-A Controlled Trial Investigating Outcomes of exercise TraiNing) demonstrated that exercise training results in a modest improvement of all-cause mortality and hospitalizations in HFrEF, depending on adequate compliance. Outcome data in HFpEF are lacking. Besides compliance, efficacy of exercise training is dependent on the intensity and type of exercise. Resistance and high intensity endurance training in addition to a standard aerobic exercise seem to be superior in improving the clinical status of HF patients. In the future, individualized exercise programs will help to improve long-term adherence to exercise training. PMID:24817538

Edelmann, F; Grabs, V; Halle, M

2014-06-01

64

Heart Failure Pharmacogenetics: Past, Present and Future  

PubMed Central

Heart failure is an increasingly common disease associated with significant morbidity and mortality in the aging population. Recent advances in heart failure pharmacotherapy have established a number of agents as beneficial to disease progression and outcomes. However, current consensus guideline recommended pharmacotherapy may not represent an optimal treatment strategy in all heart failure patients. Specifically, individuals with genetic variation in regions central to mediation of beneficial response to standard heart failure agents may not receive optimal benefit from these drugs. Additionally, targeted approaches in Phase III clinical trials that select patients for inclusion based on the genotype most likely to respond might advance the currently stalled drug development pipeline in heart failure. This article reviews the literature in heart failure pharmacogenetics to date, opportunities for discovery in recent and upcoming clinical trials, as well as future directions in this field.

Davis, Heather M.; Johnson, Julie A.

2011-01-01

65

Pharmacological Management for Chronic Heart Failure  

Microsoft Academic Search

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

Yi-Lwun Ho

66

Hypertension and heart failure: Diagnosis and management  

Microsoft Academic Search

Heart failure continues to be a significant problem faced by today’s health care professional. Heart failure remains one of\\u000a the principal causes of cardiovascular morbidity and mortality. The prevalence of heart failure continues to increase, largely\\u000a due to an aging population and to modern technologic innovations that have led to prolonged survival of the cardiac patient.\\u000a Hypertension increases the risk

Kevin A. Courville; Hector O. Ventura

2006-01-01

67

Surgical aspects of congestive heart failure  

Microsoft Academic Search

Despite tremendous advances in the medical management of congestive heart failure the gold standard for the treatment of end\\u000a stage congestive heart failure 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 heart failure. These approaches include the extension of current

Daniel J. Goldstein; Douglas Smego; Robert E. Michler

2006-01-01

68

Hypertension, heart failure and diabetes mellitus  

Microsoft Academic Search

The role of hypertension and diabetes mellitus as risk factors in coronary heart disease is known but the role of diabetes mellitus in hypertensive heart failure is diffuse. Sixty eight hypertensive patients under sufficient anti-hypertensive treatment (M=42, F=26, mean age=70±8 years) with heart failure (II–IV NYHA class, EF5mm) and without known history of ischaemic heart disease or hyperlipidaemia, were studied.

D. Psirropoulos; N. Lefkos; G. Boudonas; Ap. Efthimiadis; G. Tsapas

2000-01-01

69

Genetic causes of human heart failure  

PubMed Central

Factors that render patients with cardiovascular disease at high risk for heart failure remain incompletely defined. Recent insights into molecular genetic causes of myocardial diseases have highlighted the importance of single-gene defects in the pathogenesis of heart failure. Through analyses of the mechanisms by which a mutation selectively perturbs one component of cardiac physiology and triggers cell and molecular responses, studies of human gene mutations provide a window into the complex processes of cardiac remodeling and heart failure. Knowledge gleaned from these studies shows promise for defining novel therapeutic targets for genetic and acquired causes of heart failure.

Morita, Hiroyuki; Seidman, Jonathan; Seidman, Christine E.

2005-01-01

70

How Is Heart Failure Diagnosed?  

MedlinePLUS

... in a pocket, or hung around your neck. Nuclear Heart Scan A nuclear heart scan shows how well blood is flowing ... blood is reaching your heart muscle. During a nuclear heart scan, a safe, radioactive substance called a ...

71

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

Microsoft Academic Search

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

John G. F. Cleland

1997-01-01

72

Polypharmacy in heart failure patients.  

PubMed

In heart failure (HF), the progressive use of multiple drugs and a complex therapeutic regimen is common and is recommended by international guidelines. With HF being a common disease in the elderly, patients often have numerous comorbidities that require additional specific treatment, thus producing a heavy pill burden. Polypharmacy, defined as the chronic use of five or more medications, is an underestimated problem in the management of HF patients. However, polypharmacy has an important impact on HF treatment, as it often leads to inappropriate drug prescription, poor adherence to pharmacological therapies, drug-drug interactions, and adverse effects. The growing complexity of HF patients, whose mean age increases progressively and who present multiple comorbidities, suggests the need for newer models of primary care to improve the management of HF patients. Self-care, telemonitoring, and natriuretic peptide-guided therapy represent promising new HF care models to face the complexity of the disease and its therapeutic regimen. PMID:24493574

Mastromarino, Vittoria; Casenghi, Matteo; Testa, Marco; Gabriele, Erica; Coluccia, Roberta; Rubattu, Speranza; Volpe, Massimo

2014-06-01

73

Heart Failure in East Asia  

PubMed Central

Heart failure (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. ?-blocker 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.

Guo, Yutao; Lip, Gregory YH; Banerjee, Amitava

2013-01-01

74

Heart failure in East Asia.  

PubMed

Heart failure (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

Guo, Yutao; Lip, Gregory Y H; Banerjee, Amitava

2013-05-01

75

Gender differences in patients with heart failure  

Microsoft Academic Search

Aim: The aim of this literature review was to review and discuss the differences between men and women with heart failure with regard to epidemiology, aetiology, diagnostics, prognosis, pharmacological and non-pharmacological treatment, and the impact of heart failure on psychosocial factors and healthcare utilisation. Method: Two primary health care resources, medline and cinahl, were selected to review the current literature.

Anna Strömberg; Jan Mårtensson

2003-01-01

76

Diagnosing depression in congestive heart failure.  

PubMed

Depression is an all too common occurrence in heart failure patients. Depressive symptoms, however, sometimes are confused with the physical repercussions of heart failure. This article highlights different screening assessments for major depression and recommends treatment for this population. PMID:21109210

Saveanu, Radu V; Mayes, Tara

2011-01-01

77

Molecular genetics and genomics of heart failure  

Microsoft Academic Search

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

Choong-Chin Liew; Victor J. Dzau

2004-01-01

78

Increased heteroscedasticity of heart rate in fatal heart failure  

NASA Astrophysics Data System (ADS)

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

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

2008-04-01

79

Effects of bisoprolol on heart rate variability in heart failure  

Microsoft Academic Search

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

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

1996-01-01

80

[New pharmacological agents in heart failure].  

PubMed

Heart failure is a common and growing public health problem, with increasing incidence and prevalence over the last 2 decades. Despite improvements in its current management, heart failure is still associated with significant morbidity and mortality. This has motivated the search for newer therapeutic modalities, which are based on a better understanding on the pathophysiologic events that lead to heart failure. This review summarizes the potential role of new pharmacological agents in the treatment of heart failure. These potential new agents can be classified according to their role in the modulation of the main pathophysiologic abnormalities that characterized heart failure, that include: cellular-extracellular abnormalities, endothelial dysfunction, neurohormonal and immunologic activation. PMID:11412754

Lopera, G; Castellanos, A; de Marchena, E

2001-05-01

81

Structural failure of pyrolytic carbon heart valves.  

PubMed

Pyrolite carbon has been used for the manufacture of mechanical heart valve prostheses for the past 25 years. In general, pyrolytic carbon mechanical heart valves have provided adequate physiological function and satisfactory structural performance. Although rare in occurrence, incidents of valve failure due to fracture of one or more components have been reported. These reports of failure are reviewed and a few representative examples are examined in detail in order to determine the characteristic failure mechanism. Understanding the underlying factors responsible for causing these failures provides a solid basis for improved design and manufacture of future mechanical heart valve prostheses. PMID:8803759

Richard, G; Cao, H

1996-06-01

82

Explanatory Models of Heart Failure Etiology  

PubMed Central

Chronic health failure is a leading cause of hospital readmissions and is reaching epidemic proportions in the United States. Explanatory models of illness can provide insight about how people with heart failure perceive their etiology of heart failure. Six themes were found in this descriptive, qualitative study to explore the perceived origin of heart failure in 50 participants. Forty percent of the people were unaware of why they had the diagnosis. Misconceptions and misinformation were common, including confusion about whether the symptoms themselves caused the disease.

Clark, Angela P.; McDougall, Graham J.; Joiner-Rogers, Glenda; Innerarity, Sheri; Delville, Carol; Meraviglia, Marty; Davila, Ashley

2014-01-01

83

Diastolic Heart Failure: A Concise Review  

PubMed Central

The concept of “diastolic” heart failure grew out of the observation that many patients who have the symptoms and signs of heart failure 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” heart failure backed up by indicators of diastolic dysfunction derived from Doppler echoardiography. Diastolic heart failure is associated with a lower annual mortality rate of approximately 8% as compared to annual mortality of 19% in heart failure with systolic dysfunction, however, morbidity rate can be substantial. Thus, diastolic heart failure 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 heart failure 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.

Aziz, Fahad; TK, Luqman-Arafath; Enweluzo, Chijioke; Dutta, Simanta; Zaeem, Misbah

2013-01-01

84

[Current treatment of chronic heart failure].  

PubMed

Cardiovascular diseases including heart failure represent a common disease in patients referred for anesthesia. In most cases, heart failure is caused by left ventricular dysfunction due to coronary heart disease. The aims of the treatment of chronic heart failure are the relief of symptoms, the improvement of prognosis and the prevention of the progression of heart failure. The first-line treatment involves the underlying heart disease such as myocardial revascularisation procedures in coronary heart disease or the correction of valve diseases. The pharmacological therapy depends on the stage of heart failure and symptoms of the patient. Heart failure therapy includes ACE-inhibitors, betablockers, diuretics und digitalis. Nitrates can be prescribed in patients with symptomatic heart failure despite adequate therapy but calcium antagonists are not recommended. Repeated or prolonged treatment with positive inotropic agents like phosphodiesterase inhibitors or beta-adrenergic drugs increases mortality but this is commonly used in acute stages of heart failure refractory to treatment. Interactions of ACE-inhibitors or AT1- antagonists with anesthetic agents can lead to severe hypotension especially in hypovolemic patients. Whether those drugs should be continued perioperatively or not has been controversially discussed. The use of betablockers has a positive impact on cardiac morbidity and mortality during and early after surgery. Chronic treatment with diuretics can be associated with hypovolemia and an imbalance of electrolytes leading to hypotension and arrhythmia during anesthesia but careful evaluation prior to anesthesia can avoid such complications. The continuation of digitalis during anesthesia has been controversially discussed due to the various interactions with anesthetics. PMID:12898047

Jung, J; Schreiber, J U

2003-07-01

85

The Genomic Architecture of Sporadic Heart Failure  

PubMed Central

Common or sporadic systolic heart failure (heart failure) is the clinical syndrome of insufficient forward cardiac output resulting from myocardial disease. Most heart failure is the consequence of ischemic or idiopathic cardiomyopathy. There is a clear familial predisposition to heart failure, 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 heart failure 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 heart failure progression and are targeted by standard pharmacotherapeutics. Many of these reported allelic associations with heart failure 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 heart failure. 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 heart failure risk, and future studies using deep resequencing are likely to identify rare gene variants with larger biological effects.

Dorn, Gerald W

2011-01-01

86

Cognitive Impairment in Heart Failure  

PubMed Central

Cognitive impairment (CI) is increasingly recognized as a common adverse consequence of heart failure (HF). Although the exact mechanisms remain unclear, microembolism, chronic or intermittent cerebral hypoperfusion, and/or impaired cerebral vessel reactivity that lead to cerebral hypoxia and ischemic brain damage seem to underlie the development of CI in HF. Cognitive decline in HF is characterized by deficits in one or more cognition domains, including attention, memory, executive function, and psychomotor speed. These deficits may affect patients' decision-making capacity and interfere with their ability to comply with treatment requirements, recognize and self-manage disease worsening symptoms. CI may have fluctuations in severity over time, improve with effective HF treatment or progress to dementia. CI is independently associated with disability, mortality, and decreased quality of life of HF patients. It is essential therefore for health professionals in their routine evaluations of HF patients to become familiar with assessment of cognitive performance using standardized screening instruments. Future studies should focus on elucidating the mechanisms that underlie CI in HF and establishing preventive strategies and treatment approaches.

Dardiotis, Efthimios; Giamouzis, Gregory; Mastrogiannis, Dimos; Vogiatzi, Christina; Skoularigis, John; Triposkiadis, Filippos; Hadjigeorgiou, Georgios M.

2012-01-01

87

Hyponatremia in patients with heart failure  

PubMed Central

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

Filippatos, Theodosios D; Elisaf, Moses S

2013-01-01

88

Immunological mediated therapies for heart failure.  

PubMed

Experimental and clinical data suggest a causal relationship between immunological and inflammatory processes and heart failure. Inflammatory processes may be involved in the pathogenesis of heart failure and may play a role in the progression of ventricular dysfunction. In the last decade several immunological methods were developed that tried to address these questions and overcome the inflammatory and immunological insults. We hope that the present review will increase awareness of new treatment options and encourage researchers and physicians to investigate this novel approach to treat patients with heart failure. PMID:19637509

Blum, Arnon

2009-05-01

89

Pressure-overload-induced right heart failure.  

PubMed

Although pulmonary arterial hypertension originates in the lung and is caused by progressive remodeling of the small pulmonary arterioles, patients die from the consequences of pressure-overload-induced right heart failure. Prognosis is poor, and currently there are no selective treatments targeting the failing right ventricle. Therefore, it is of utmost importance to obtain more insights into the mechanisms of right ventricular adaptation and the transition toward right heart failure. In this review, we propose that the same adaptive mechanisms, which initially preserve right ventricular systolic function and maintain cardiac output, eventually initiate the transition toward right heart failure. PMID:24488007

Rain, S; Handoko, M L; Vonk Noordegraaf, A; Bogaard, H J; van der Velden, J; de Man, F S

2014-06-01

90

Heart failure with preserved ejection fraction.  

PubMed

Heart failure with preserved ejection fraction accounts for up to 50% of hospitalized heart failure patients and is associated with significant mortality and morbidity. The pathophysiology is heterogeneous and not very well defined, which explains the lack of disease-specific therapies. The principles of treating heart failure with preserved ejection fraction are controlling volume with diuretics and diet, and controlling the comorbidities, mainly the hypertension. Further research is encouraged to ascertain the key components of the disease that will serve as targets for therapy. PMID:24746061

Alsamara, Mershed; Alharethi, Rami

2014-06-01

91

Adrenal adrenoceptors in heart failure  

PubMed Central

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

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

2014-01-01

92

Heart Failure - Multiple Languages: MedlinePlus  

MedlinePLUS

... ????) Hmong (Hmoob) Japanese (???) Korean (???) Portuguese (português) Russian (???????) Somali (af Soomaali) Spanish (español) Tagalog ( ... PDF Health Information Translations Return to top Portuguese (português) Heart Failure Insuficiência Cardíaca - português (Portuguese) Bilingual PDF ...

93

How Can Heart Failure Be Prevented?  

MedlinePLUS

... by the National Institutes of Health. View all Heart Failure Press Releases March 27, 2014 The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are ...

94

Who Is at Risk for Heart Failure?  

MedlinePLUS

... by the National Institutes of Health. View all Heart Failure Press Releases March 27, 2014 The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are ...

95

Soluble guanylate cyclase modulators in heart failure.  

PubMed

This review summarizes the role of soluble guanylate cyclase (sGC)-cyclic guanosine 3', 5'-monophosphate pathways in heart failure and several new drugs that modify guanylate cyclase. The sGC activators and stimulators as modulators of sGC are promising drugs in the therapy for decompensated heart failure and pulmonary hypertension. Cinaciguat is a nitric oxide (NO)-independent direct activator of sGC, which also may be effective under oxidative stress conditions resulting in oxidized or heme-free sGC refractory to organic nitrates. Riociguat is an NO-independent direct stimulator of sGC with beneficial effects in patients with decompensated heart failure and pulmonary hypertension. The sGC modulators play an important role in patients with heart failure and pulmonary hypertension. PMID:21207207

Mitrovic, Veselin; Jovanovic, Ana; Lehinant, Stefan

2011-03-01

96

Arrhythmias in patients with heart failure  

Microsoft Academic Search

Opinion statement  Both atrial and ventricular arrhythmias are very common in patients with congestive heart failure, and their presence is associated\\u000a with symptoms, significant morbidity, and mortality. Studies have attempted to determine the prognostic significance of atrial\\u000a and ventricular arrhythmias in patients with heart failure. Whether atrial fibrillation is an independent risk factor of mortality\\u000a remains controversial. The presence of ventricular

B. John Hynes; Jerry C. Luck; Deborah L. Wolbrette; John Boehmer; Gerald V. Naccarelli

2002-01-01

97

Genetics and pharmacogenetics in heart failure  

Microsoft Academic Search

Heart failure is a heterogeneous disease, the development and pathophysiology of which involves complex interactions between\\u000a genetic and environmental factors. It is well known that there are several heritable forms of heart failure in which genetic\\u000a variation makes an individual more likely to develop the disease; however, less is clear about the degree to which genetics\\u000a plays a role in

Eric M. Snyder; Thomas P. Olson; Bruce D. Johnson

2007-01-01

98

Beta-blockade in heart failure  

Microsoft Academic Search

OBJECTIVESThis study was performed to compare the long-term clinical efficacy of treatment with metoprolol versus carvedilol in patients with chronic heart failure.BACKGROUNDBeta-adrenergic blockade is of proven value in chronic heart failure. Metoprolol, a selective beta-blocker, is widely used, but recent trials suggest carvedilol, a nonselective beta-blocker with alpha-1-receptor antagonist activity and antioxidant activities, is also effective. It is uncertain, however,

John E Sanderson; Skiva K. W Chan; Gabriel Yip; Leata Y. C Yeung; Kam W Chan; Kenneth Raymond; Kam S Woo

1999-01-01

99

Vascular endothelial growth factor in heart failure.  

PubMed

Heart failure is a devastating condition, the progression of which culminates in a mismatch of oxygen supply and demand, with limited options for treatment. Heart failure has several underlying causes including, but not limited to, ischaemic heart disease, valvular dysfunction, and hypertensive heart disease. Dysfunctional blood vessel formation is a major problem in advanced heart failure, regardless of the aetiology. Vascular endothelial growth factor (VEGF) is the cornerstone cytokine involved in the formation of new vessels. A multitude of investigations, at both the preclinical and clinical levels, have garnered valuable information on the potential utility of targeting VEGF as a treatment option for heart failure. However, clinical trials of VEGF gene therapy in patients with coronary artery disease or peripheral artery disease have not, to date, demonstrated clinical benefit. In this Review, we outline the biological characterization of VEGF, and examine the evidence for its potential therapeutic application, including the novel concept of VEGF as adjuvant therapy to stem cell transplantation, in patients with heart failure. PMID:23856679

Taimeh, Ziad; Loughran, John; Birks, Emma J; Bolli, Roberto

2013-09-01

100

Right heart failure: best treated by avoidance  

Microsoft Academic Search

Right heart failure continues to affect our clinical success with left ventricular assist device support. The inability to consistently predict the probability of the onset of right heart dysfunction contributes to this problem. We have developed an aggressive approach to the management of these patients in an attempt to decrease the incidence of this condition, which continues to carry a

Clifford H Van Meter

2001-01-01

101

Cardiac-Resynchronization in Moderate Heart Failure  

Microsoft Academic Search

Background: Heart failure affects millions of elderly and is a major cause for hospitalization and death. A large percentage of these patients will present with a prolonged QRS interval. This lag between the firing of the right and left ventricles can make the heart inefficient, causing poor perfusion. Patients with a prolonged QRS generally do not respond well to the

Christopher Hughes

2010-01-01

102

Heart Failure in Sub-Saharan Africa  

PubMed Central

The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs.

Bloomfield, Gerald S; Barasa, Felix A; Doll, Jacob A; Velazquez, Eric J

2013-01-01

103

[Diagnosis of systolic and diastolic heart failure].  

PubMed

In this review, heart failure is confined to etiologies not due to rhythm disturbances or valvular heart disease. Besides measurement of natriuretic peptides, echocardiography is established as an important diagnostic procedure. Echocardiography is especially helpful in discriminating between heart failure with preserved ejection fraction (HF-PEF) and reduced ejection fraction (HF-REF). Because of its ease to be performed, the 6 min walk test continues to be a standard diagnostic procedure. Cardiopulmonary exercise testing provides more detailed information regarding differential diagnostic and prognostic considerations. PMID:24736933

Hummel, A; Empen, K; Dörr, M; Felix, S B

2014-06-01

104

Influence of demographic and metabolic variables on forearm blood flow and vascular conductance in individuals without overt heart disease  

PubMed Central

Purpose: Vascular reactivity is involved in the regulation of vascular function either in normal conditions or in the pathophysiology of cardiovascular diseases. We tested the hypothesis that vascular reactivity evaluated by forearm blood flow may vary according to demographic and metabolic variables in a cohort of individuals without any evidence of heart disease after clinical examination. Subjects and methods: We studied 186 individuals (mean age 41.4 years, standard deviation 13.1 years; 95 (51%) men and 91 (49%) women. We investigated forearm blood flow and vascular conductance with venous occlusion plethysmography at baseline, during handgrip isometric exercise and during the recovery phase. Demographic and laboratory data were collected. Statistical analysis was performed with mixed linear models appropriate for repeated measurements. Results: Mean forearm blood flow values in the different study conditions ranged between 1.7 ± 0.47 mL.min?1.100 mL?1 of tissue and 2.82 ± 1.13 mL.min?1.100 mL?1 of tissue. Forearm blood flow was higher in men than in women (P < 0.005) and increased as the heart rate increased during handgrip maneuver (P < 0.0001). Serum triglyceride levels were inversely related to forearm blood flow at baseline, during isometric exercise and recovery phase (P = 0.0209). Body mass index was inversely related to forearm vascular conductance at baseline, during isometric exercise and recovery phase (P = 0.0223). Conclusion: Our findings suggest that forearm blood flow and vascular conductance as a surrogate of the vascular function may be influenced by gender, heart rate, serum triglyceride levels and body mass index in individuals without overt heart disease.

Sartori, Thiago E; Nunes, Rafael AB; da Silva, Gisela T; da Silva, Sandra C; Rondon, Maria UPB; Negrao, Carlos E; Mansur, Alfredo J

2010-01-01

105

Invasive hemodynamic assessment in heart failure.  

PubMed

Routine cardiac catheterization provides data on left heart, right heart, systemic and pulmonary arterial pressures, vascular resistances, cardiac output, and ejection fraction. These data are often then applied as markers of cardiac preload, afterload, and global function, although each of these parameters reflects more complex interactions between the heart and its internal and external loads. This article reviews more specific gold standard assessments of ventricular and arterial properties, and how these relate to the parameters reported and utilized in practice, and then discusses the re-emerging importance of invasive hemodynamics in the assessment and management of heart failure. PMID:21459248

Borlaug, Barry A; Kass, David A

2011-05-01

106

Influence of Nonfatal Hospitalization for Heart Failure on Subsequent Mortality in Patients With Chronic Heart Failure  

Microsoft Academic Search

Background—Patients with chronic heart failure (HF) are at increased risk of both fatal and nonfatal major adverse cardiovascular events. We used data from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) trials to assess the influence of nonfatal hospitalizations for HF on subsequent mortality rates in a broad spectrum of HF patients. Methods and Results—In

Scott D. Solomon; Joanna Dobson; Stuart Pocock; Hicham Skali; John J. V. McMurray; Christopher B. Granger; Salim Yusuf; Karl Swedberg; James B. Young; Eric L. Michelson; Marc A. Pfeffer

107

Ethnic differences in patient perceptions of heart failure and treatment: the West Birmingham heart failure project  

Microsoft Academic Search

Objective: To investigate further the hypothesis that ethnic groups would have different levels of knowledge and perceptions of congestive heart failure (CHF) and treatments for this condition, a cross sectional survey was conducted of patients who were attending the heart failure clinics in two teaching hospitals of Birmingham, UK, that serve a multiethnic population.Methods: 103 patients with CHF (66 men,

G Y H Lip; H Khan; A Bhatnagar; N Brahmabhatt; P Crook; M K Davies

2004-01-01

108

Pharmacogenomics and heart failure in congenital heart disease.  

PubMed

Congenital heart disease (CHD) constitutes a lifelong challenge in heart failure management. Current therapy is based mainly on physiologic principles extrapolated from the management of left ventricular failure in adult populations with either ischemic or nonischemic cardiomyopathy. However, there is good evidence of genomic variability in the origin and progression of CHD that suggests the need for a individualized approach to treatment. The developing science of pharmacogenomics presents an opportunity for CHD management broadly, and especially in the context of heart failure. There is growing evidence that individualizing drug therapy for these patients might be beneficial, and that prediction of response to therapy might be possible by incorporating genomic data into the treatment algorithm for individual patients. PMID:23790550

de Denus, Simon; Kantor, Paul F

2013-07-01

109

Advanced Heart Failure and Management Strategies  

PubMed Central

The global healthcare burden attributable to heart failure is ever increasing. Patients presenting with refractory heart failure should be evaluated for compliance with medical regimens and sodium and/or fluid restriction, and every attempt should be made to optimize conventional strategies. Reversible causes such as ischemia should be identified and revascularization considered in persistently symptomatic patients, particularly those with a viable myocardium. Carefully selected patients who continue to deteriorate clinically in spite of optimization of medical therapy may be considered for advanced treatment strategies, such as continuous inotropic infusions, mechanical circulatory support devices, cardiac transplantation, or referral to hospice care. We discuss the clinical presentation and management of patients with advanced/refractory (Stage D) heart failure.

Gaddam, Krishna K.; Yelamanchili, Pridhvi; Sedghi, Yabiz; Ventura, Hector O.

2009-01-01

110

Omega-3 fatty acids and heart failure.  

PubMed

During the past three decades, the protective role of omega (n)-3 polyunsaturated fatty acids (PUFA), mainly eicosapentaenoic acid and docosahexaenoic acid, in patients with coronary heart disease has been widely reported. The Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Heart Failure (GISSI-HF) study, a large-scale clinical trial, recently showed that n-3 PUFA (850-882 mg/d) reduced mortality and admission to the hospital for cardiovascular reasons in patients with chronic heart failure (HF) who were already receiving recommended therapies. The favorable effects of n-3 PUFA in GISSI-HF suggest that marine fish oils could confer protection in HF mainly through their antiarrhythmic action and in part by influencing the mechanisms related to HF progression. This article reviews recent clinical and experimental evidence on the effect of n-3 PUFA in coronary heart disease, with particular attention on HF and its pathophysiologic mechanisms. PMID:19852885

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

2009-11-01

111

Beta-blocker treatment in heart failure.  

PubMed

Heart failure treatment has markedly changed during the last few decades, with demonstration of benefit of afterload reduction by vasodilator therapy and introduction of the concept of the deleterious consequences of the neuro-hormonal compensatory stimulation. Blockade of beta-adrenergic receptors, initially contra-indicated in heart failure, provide a marked reduction of mortality and morbidity in combination with diuretics and angiotensin-converting enzyme inhibitors, as demonstrated in many clinical trials. We performed a review of all clinical trials that compare beta-blockers vs. placebo in chronic heart failure. Beta-blockers with different pharmacological profiles have been tested, mainly metoprolol, bisoprolol, bucindolol and carvedilol. With progressive dose increment, tolerance of such treatment was generally good, left ventricular function improved, hospitalisations for heart failure were less frequent and mortality was reduced. The meta-analysis of the 16 randomised trials, with at least one death in each treatment group, provides a 24% relative risk reduction for such hospitalisations (95% CI=19%-29%) and 22% reduction for mortality (95% CI=16%-28%). Heterogeneity of beta-blocker effect for mortality was found and related to the non-significant benefit obtained in the BEST trial with bucindolol. When such a trial is excluded, the effect model analysis shows that relative risk reduction (beta-blocker induced benefit) is constant whatever the severity of the disease. The mechanism of beta-blocker induced benefit remains unclear, but is at least partly related to left ventricular function improvement and prevention of severe ventricular arrhythmias. In conclusion, beta-blocker treatment has become an established therapy for heart failure, in combination with diuretics and ACE inhibitors. Complementary informations will be needed to clarify the mechanism of benefit and to define the best therapeutic strategy according to the individual characteristics of patients with heart failure. PMID:11468019

Bouzamondo, A; Hulot, J S; Sanchez, P; Cucherat, M; Lechat, P

2001-04-01

112

Metaiodobenzylguanidine and heart rate variability in heart failure.  

PubMed

It is assumed that the low-frequency power (LF) of heart rate variability (HRV) increases with progress of congestive heart failure (CHF), therefore positively correlating with cardiac 123I-metaiodobenzylguanidine (MIBG) washout. It is demonstrated here that HRV, including normalized LF, correlated inversely with MIBG washout and positively with the ratio of heart-to-mediastinum MIBG activity in controls and CHF patients, whereas these correlations were not observed within CHF patients. Thus MIBG washout may increase and HRV including normalized LF may decrease with CHF, although the HRV and MIBG measures may not similarly change in proportion to the severity of the cardiac autonomic dysfunction in CHF. PMID:9805260

Kurata, C; Shouda, S; Mikami, T; Uehara, A; Ishikawa, K; Tawarahara, K; Nakano, T; Matoh, F; Takeuchi, K

1998-10-01

113

Occurrence of lymphopenia in heart failure  

PubMed Central

The incidence of lymphopenia and eosinopenia in 10 patients admitted to hospital in heart failure was compared with that in 11 `cold' admissions and 10 with acute diseases admitted via the Casualty Department. Plasma cortisol determinations were made simultaneously. A significant difference was found between the heart failure group and the `cold' controls in respect of lymphopenia, eosinopenia, and cortisol levels. The `acute' control patients showed an overlap with both groups. It is concluded that this lymphopenia is part of a response to stress. Seventy-two hours after admission there was no significant change in these values although the figures suggest the beginning of a return to normal. Images

Hurdle, A. D. F.; Gyde, O. H. B.; Willoughby, J. M. T.

1966-01-01

114

Tackling heart failure in the twenty-first century  

Microsoft Academic Search

Heart failure, or congestive heart failure, is a condition in which the heart cannot supply the body's tissues with enough blood. The result is a cascade of changes that lead to severe fatigue, breathlessness and, ultimately, death. In the past quarter century, much progress has been made in understanding the molecular and cellular processes that contribute to heart failure, leading

James O. Mudd; David A. Kass

2008-01-01

115

Epidemiology of Chronic Kidney Disease in Heart Failure  

PubMed Central

Synopsis Heart failure is common and is associated with poor prognosis. Chronic kidney disease is common in heart failure, and shares many risk factors with heart failure such as age, hypertension, diabetes, and coronary artery disease. Over half of all heart failure 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 heart failure therapy that may reduce morbidity and mortality. Understanding the epidemiology and outcomes of chronic kidney disease in heart failure is essential to ensure proper management of these patients.

Ahmed, Ali; Campbell, Ruth C.

2010-01-01

116

Combination stem cell therapy for heart failure  

Microsoft Academic Search

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

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

2010-01-01

117

[Giant renal angiomyolipoma with right heart failure].  

PubMed

We report the case of a 63-year-old woman presenting a 26cm right renal angiomyolipoma with intratumoral arteriovenous fistula responsible for a high-output right heart failure. A radical surgical treatment after preoperative embolization allowed rapid improvement of cardiac symptoms with an uneventful postoperative course. PMID:24861690

Le Huu Nho, R; Renard, S; Maurin, C; Souteyrand, P; Le Treut, Y P

2014-06-01

118

Advance Care Planning with Heart Failure  

MedlinePLUS

Introduction - Advance Care Planning Heart failure is a serious chronic condition that can shorten your life. With proper management and active self-care, ... module will discuss topics related to advance care planning that you can think about and talk over ...

119

Neurohormonal modulation in chronic heart failure  

Microsoft Academic Search

During the past 50 years there have been vast improvements in the treatment of chronic heart failure (CHF). CHF was initially considered to be a cardio-renal problem - an acute disorder leading to volume expansion and oedema. Diuretics and digitalis were the only available treatments. Subsequently, CHF was considered to be the result of both myocardial dysfunction and increased tone

R. Ferrara; G. PasanisP MastrorillP; S. CensP; N. D'Aiello; A. FucilP; M. ValgimiglP; R. FerrarP

2002-01-01

120

Diaphragm Strength In Chronic Heart Failure  

Microsoft Academic Search

Reduced respiratory muscle strength has been reported in chronic heart failure (CHF) in several stud- ies. The data supporting this conclusion come almost exclusively from static inspiratory and expira- tory mouth pressure maneuvers (MIP, MEP), which many subjects find difficult to perform. We there- fore performed a study using measurements that are less dependent on patient aptitude and also provide

PHILIP D. HUGHES; MICHAEL I. POLKEY; M. LOU HARRIS; ANDREW J. S. COATS; JOHN MOXHAM; MALCOLM GREEN

121

Top Ten Challenges in Heart Failure Management  

Microsoft Academic Search

The challenges of heart failure care are recognized by patients and providers. Patients experience debilitating symptoms and recurrent hospitalizations. Hospitalization rates are high, and the economic burden now exceeds $10 billion annually. Proven drug therapies are not consistently prescribed, advanced therapies are missed, and patient compliance issues are often overlooked. Using the top challenges as a framework, this article enhances

Jean A. Wagner

2006-01-01

122

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

Microsoft Academic Search

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

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

1994-01-01

123

Combination stem cell therapy for heart failure  

PubMed Central

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

2010-01-01

124

Mitochondria in cardiac hypertrophy and heart failure  

PubMed Central

Heart failure (HF) frequently is the unfavorable outcome of pathological heart hypertrophy. In contrast to physiological cardiac hypertrophy, which occurs in response to exercise and leads to full adaptation of contractility to the increased wall stress, pathological hypertrophy occurs in response to volume or pressure overload, ultimately leading to contractile dysfunction and HF. Because cardiac hypertrophy impairs the relationship between ATP demand and production, mitochondrial bioenergetics must keep up with the cardiac hypertrophic phenotype. We review data regarding the mitochondrial proteomic and energetic remodeling in cardiac hypertrophy, as well as the temporal and causal relationship between mitochondrial failure to match the increased energy demand and progression to cardiac decompensation. We suggest that the maladaptive effect of sustained neuroendocrine signals on mitochondria leads to bioenergetic fading which contributes to the progression from cardiac hypertrophy to failure.

Rosca, Mariana G.; Tandler, Bernard; Hoppel, Charles L.

2013-01-01

125

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

National Technical Information Service (NTIS)

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

M. J. De Jong D. C. Randall

2004-01-01

126

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

PubMed Central

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

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

2014-01-01

127

Hospitalization for Congestive Heart Failure: United States, 2000-2010  

MedlinePLUS

... the rate of congestive heart failure hospitalization the same for males and females under and over age ... change in congestive heart failure hospitalization rates, by sex and age: United States, 2000 to 2010 † Change ...

128

COPD Patients Face Greater Risk of Heart Failure, Study Says  

MedlinePLUS

... sharing features on this page, please enable JavaScript. COPD Patients Face Greater Risk of Heart Failure, Study ... 21, 2014 Related MedlinePlus Pages African American Health COPD Heart Failure WEDNESDAY, May 21, 2014 (HealthDay News) -- ...

129

[Cardiorenal syndrome: limits of heart failure therapy].  

PubMed

The cardiorenal syndrome is an interdisciplinary challenge with increasing health economic relevance. Renal failure is a strong predictor for mortality in patients with severe congestive heart failure (CHF) and CHF is one of the fastest increasing morbidities in western countries. For successful therapy a close cooperation between cardiology und nephrology is required. Moreover, a good compliance of the patient is needed to improve symptoms and to reduce the frequency of cardiac decompensation. A broad cardiological and nephrological evaluation and consideration of optimal conservative options according to national and international guidelines are essential. However, a renal replacement therapy might be helpful in patients with refractory heart failure even if they are not dialysis-dependent. In cases of acute heart and renal failure an intensive care management might be necessary to reduce volume overload with the help of extracorporeal ultrafiltration or a dialysis modality. Nevertheless, in cases of chronic refractory CHF peritoneal dialysis should be preferred. The first analysis of the registry of the German Society of Nephrology (http://www.herz-niere.de) confirmed that there is a benefit for health-related quality of life in chronic CHF patients treated with peritoneal dialysis. PMID:23740085

Großekettler, L; Schmack, B; Schwenger, V

2013-09-01

130

End-of-life care in heart failure  

Microsoft Academic Search

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

Sarah J. Goodlin

2009-01-01

131

Digoxin reduces cardiac sympathetic activity in severe congestive heart failure  

Microsoft Academic Search

Objectives. This study evaluated the effect of digoxin on cardiac sympathetic activity in patients with congestive heart failure.Background. Digoxin favorably alters autonomic tone in heart failure. Whether it reduces cardiac sympathetic drive in the setting of heart failure is unknown.Methods. Digoxin (0.25 mg intravenously) was administered to 12 patients with severe heart failure and elevated left ventricular end-diastolic pressure (>

Gary E. Newton; Jeffrey H. Tong; Anne M. Schofield; Andrew D. Baines; John S. Floras; John D. Parker

1996-01-01

132

The sympathetic nervous system and heart failure.  

PubMed

Heart failure (HF) is a syndrome characterized by upregulation of the sympathetic nervous system and abnormal responsiveness of the parasympathetic nervous system. Studies in the 1980s and 1990s demonstrated that inhibition of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors improved symptoms and mortality in HF resulting from systolic dysfunction, thus providing a framework to consider the use of ?-blockers for HF therapy, contrary to the prevailing wisdom of the time. Against this backdrop, this article reviews the contemporary understanding of the sympathetic nervous system and the failing heart. PMID:24286577

Zhang, David Y; Anderson, Allen S

2014-02-01

133

Interventions for heart failure readmissions: successes and failures.  

PubMed

Heart failure readmissions result in significant costs to the health care system and to patients' quality of life, but programs to reduce readmissions have met with mixed success. Successful strategies have included multidisciplinary hospital-based quality initiatives, disease management programs, and care transition interventions. Devices like telemonitors and indwelling catheters, however, have met with mixed success. Research is still needed to elucidate the most effective interventions for readmission reduction in the HF population. PMID:24578234

Fleming, Lisa M; Kociol, Robb D

2014-06-01

134

EXERCISE TESTING IN THE ASSESSMENT OF CHRONIC CONGESTIVE HEART FAILURE  

Microsoft Academic Search

Despite advances in treatment which have resulted in reductions in morbidity and mortality, heart failure remains a common condition often associated with a poor outcome. In most patients with chronic congestive heart failure, symptoms are not present at rest but become limiting with exer- tion. Despite this, the majority of measures used to characterise the severity of heart failure and

John G Lainchbury; A Mark Richards

135

Racial Differences in Incident Heart Failure among Young Adults  

Microsoft Academic Search

Background The antecedents and epidemiology of heart failure in young adults are poorly under- stood. Methods We prospectively assessed the incidence of heart failure over a 20-year period among 5115 blacks and whites of both sexes who were 18 to 30 years of age at baseline. Using Cox models, we examined predictors of hospitalization or death from heart failure. Results

Kirsten Bibbins-Domingo; Mark J. Pletcher; Feng Lin; Eric Vittinghoff; Julius M. Gardin; Alexander Arynchyn; Cora E. Lewis; O. Dale Williams; Stephen B. Hulley

2009-01-01

136

Beta-blocker benefit according to severity of heart failure  

Microsoft Academic Search

Background and aims: Beta-blockers are an established treatment for chronic heart failure. However, the relationship between their benefit and the severity of the disease remains to be determined. Methods and results: We studied the relationship between amplitude of benefit of beta-blockers and severity of chronic heart failure, based on data for mortality and hospitalizations for worsening heart failure, using a

Anissa Bouzamondo; Jean-Sebastien Hulot; Paola Sanchez

137

Continuous positive airway pressure increases heart rate variability in heart failure patients with obstructive sleep apnoea  

Microsoft Academic Search

Patients with heart failure or OSA (obstructive sleep apnoea) have reduced HF-HRV (high- frequency heart rate variability), indicating reduced cardiac vagal modulation, a marker of poor prognosis. CPAP (continuous positive airway pressure) abolishes OSA in patients with heart failure, but effects on daytime HF-HRV have not been determined. We hypothesized that, in patients with heart failure, treatment of coexisting OSA

Kengo Usui; Yasuyuki Kaneko

2008-01-01

138

Variable Effects of Physical Training of Heart Rate Variability, Heart Rate Recovery, and Heart Rate Turbulence in Chronic Heart Failure  

Microsoft Academic Search

Background: Heart rate variability (HRV), heart rate turbulence (HRT), and heart rate recovery (HRR), indices that reflect autonomic nervous system (ANS) activity, are outcome predictors in patients with chronic heart failure (CHF). It is not clear, however, whether they reflect the same components of ANS activity. No study has examined the effects of physical training (PT) training on HRV, HRT,

EWA PIOTROWICZ; RAFA? BARANOWSKI; MA?GORZATA PIOTROWSKA; TOMASZ ZIELI?SKI; RYSZARD PIOTROWICZ

2009-01-01

139

Mechanisms of renal hyporesponsiveness to ANP in heart failure.  

PubMed

The atrial natriuretic peptide (ANP) plays an important role in chronic heart failure (CHF), delaying the progression of the disease. However, despite high ANP levels, natriuresis falls when CHF progresses from a compensated to a decompensated state, suggesting emergence of renal resistance to ANP. Several mechanisms have been proposed to explain renal hyporesponsiveness, including decreased renal ANP availability, down-regulation of natriuretic peptide receptors and altered ANP intracellular transduction signal. It has been demonstrated that the activity of neutral endopeptidase (NEP) is increased in CHF, and that its inhibition enhances renal cGMP production and renal sodium excretion. In vitro as well as in vivo studies have provided strong evidence of an increased degradation of intracellular cGMP by phosphodiesterase in CHF. In experimental models, ANP-dependent natriuresis is improved by phosphodiesterase inhibitors, which may arise as new therapeutic agents in CHF. Sodium-retaining systems likely contribute to renal hyporesponsiveness to ANP through different mechanisms. Among these systems, the renin-angiotensin-aldosterone system has received particular attention, as angiotensin II and ANP have renal actions at the same sites and inhibition of angiotensin-converting enzyme and angiotensin-receptor blockade improve ANP hyporesponsiveness. Less is known about the interactions between the sympathetic nervous system, endothelin or vasopressin and ANP, which may also blunt ANP-induced natriuresis. To summarize, renal hyporesponsiveness to ANP is probably multifactorial. New treatments designed to restore renal ANP efficiency should limit sodium retention in CHF patients and thus delay the progression to overt heart failure. PMID:12925036

Charloux, A; Piquard, F; Doutreleau, S; Brandenberger, G; Geny, B

2003-09-01

140

Efficacy of B-type natriuretic peptide in assessment of heart failure severity in African American heart failure patients  

Microsoft Academic Search

Heart failure is a major cause of morbidity and mortality in the United States. B-Type natriuretic peptide (BNP)has emerged as a sensitive predictor of heart failure severity and prognosis. To date, the overall efficacy of BNP in assessing the severity of heart failure has not specifically been addressed in African Americans.Methods: 44 patients (15 African American\\/29 White) with heart failure

Robert L. Scott; Talal Hamden; Mandeep R. Mehra; Myung H. Park; Patricia Uber

2002-01-01

141

[Exercise training in heart failure patients].  

PubMed

Physical exercise has been recognized as a standard therapy in the guidelines for secondary prevention of chronic heart failure. This is mostly due to the overwhelming scientific evidence, including meta-analyses that have illustrated the positive effect of physical exercise on quality of life, hospitalisation and exercise capacity. However, it is crucial that patients undergo thorough clinical screening, including exercise testing, before starting an exercise regimen. Once a patient is eligible to exercise, it is also important that only approved exercise regimens are prescribed and that the exercise itself is monitored appropriately. Both, traditional moderate continuous endurance training and recently developed interval training have been shown to be safe and effective in chronic heart failure. Ideally, moderate intensity training should be started and later combined with interval training that is added by moderate resistance training in order to improve quality of life and prognosis. PMID:24722936

Schwarz, S; Halle, M

2014-04-01

142

Water and sodium regulation in heart failure.  

PubMed

Heart failure is the pathophysiological state characterized by ventricular dysfunction and associated clinical symptoms. Decreased cardiac output or peripheral vascular resistance lead to arterial underfilling. That is an important signal which triggers multiple neurohormonal systems to maintain adequate arterial pressure and peripheral perfusion of the vital organs. The kidney is the principal organ affected when cardiac output declines. Alterations of hemodynamics and neurohormonal systems in heart failure result in renal sodium and water retention. Activation of sympathetic nervous system, renin-angiotensin-aldosterone system and non-osmotic vasopressin release stimulate the renal tubular reabsorption of sodium and water. Dysregulation of aquaporin-2 and sodium transporters also play an important role in the pathogenesis of renal sodium and water retention. PMID:21468184

Bae, Eun Hui; Ma, Seong Kwon

2009-12-01

143

The pathophysiology of diastolic heart failure  

PubMed Central

Whilst resting disturbances of both diastolic and long-axis systolic function are observed in patients with heart failure who have normal left ventricular ejection fraction, recent evidence suggests that dynamic disturbances in cardiac function occur during exercise. A paradoxical slowing of left ventricular active relaxation during exercise limits cardiac filling and therefore stroke volume and appears to be due to the combination of cardiac energetic impairment and disturbed ventricular-vascular coupling.

Phan, Thanh Trung

2010-01-01

144

Cardiovascular Magnetic Resonance in Heart Failure  

Microsoft Academic Search

Imaging has a central role in the evaluation of patients with heart failure (HF). Cardiovascular magnetic resonance (CMR)\\u000a is rapidly evolving as a versatile imaging modality that often provides additional information to echocardiography in patients\\u000a with suspected or known HF. CMR is the only imaging modality that has the ability to assess, without exposure to ionizing\\u000a radiation, cardiac function, structure

Theodoros D. Karamitsos; Stefan Neubauer

2011-01-01

145

Acute Heart Failure and Systemic Diseases  

Microsoft Academic Search

Acute heart failure in systemic lupus erythematosus (SLE) may result from myocarditis, endocarditis, systemic hypertension,\\u000a coronary artery disease, and left ventricular dysfunction secondary to drug toxicity. Pericarditis is an early and common\\u000a cardiac manifestation of active lupus. Moderate to severe pericardial disease is infrequent (1), and constrictive pericarditis is rare. Pericardial fluid is usually exudative (1), and may contain anti-DNA

Iris Cohen; Nadia Benyounes-Iglesias; Nadia Belmatoug; Ariel A. Cohen

146

Use of Multiple Biomarkers in Heart Failure  

Microsoft Academic Search

Biomarkers are becoming increasingly available for clinical use, particularly in the care of patients with heart failure.\\u000a For health care providers, a major difficulty is how to interpret and apply these increasing amounts of diagnostic and prognostic\\u000a information. Consequently, the scientific challenge is evolving from the discovery of biomarkers to the selection and validation\\u000a of select panels of clinically useful

Larry A. Allen

2010-01-01

147

Comparative Effectiveness of ? Blockers in Heart Failure  

Microsoft Academic Search

confidence interval {CI}, 1.01-1.34)) and no ? blockers (HR, 1.63 (95% CI, 1.44-1.84)) but was not significantly different for carvedilol (HR, 1.16 (95% CI, 0.92-1.44)). Conclusion. In this study of adults with heart failure, 1-year survival after hospitalization was similar in patients receiv- ing atenolol and carvedilol but was slightly worse in patients receiving shorter-acting metoprolol tartrate as compared with

Yang J

148

Chronic heart failure: ?-blockers and pharmacogenetics  

Microsoft Academic Search

Purpose  The European Society of Cardiology recommends that ?-blockers should be considered for treating all patients with stable,\\u000a mild, moderate, or severe heart failure (HF) who are receiving standard treatment, unless there is a contraindication. Despite\\u000a the significant benefit of the drug, there is widespread recognition of patient-to-patient variability in drug response. The\\u000a genetic determinants of responses to drugs have important

Junichi Azuma; Shinpei Nonen

2009-01-01

149

Isolated ultrafiltration in heart failure patients.  

PubMed

Most heart failure hospitalizations are due to volume overload, which contributes to disease progression. Heart failure decompensation is typically treated with intravenous diuretics, which are of limited efficacy especially in patients with underlying chronic kidney disease. Since the introduction of hemodialysis, ultrafiltration has been used to remove excess body fluid. Newer, simplified isolated ultrafiltration devices make ultrafiltration feasible at most hospitals and in less acute care settings. Veno-venous ultrafiltration is characterized by transport of solutes and water across a semipermeable membrane in response to a transmembrane pressure gradient generated by a peristaltic pump. Monitoring of ultrafiltration requires a combination of clinical and biomarkers values. Hemodynamic instability due to overaggressive fluid removal must be avoided. Based on recent clinical trials, practice guidelines state that ultrafiltration is reasonable for patients with congestion refractory to medical therapy (Class IIa, Level of Evidence B). Unanswered questions regarding ultrafiltration in heart failure patients include optimal fluid removal rates, effect on long-term survival, and cost. PMID:22415396

Costanzo, Maria Rosa; Ronco, Claudio

2012-06-01

150

Chronic Heart Failure: Contemporary Diagnosis and Management  

PubMed Central

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

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

2010-01-01

151

[Treatment of heart failure: an update].  

PubMed

During the last years, the results of several trials on heart failure treatment were published or presented at international meetings. The new perspectives concern drug therapy and non-pharmacological strategies, such as cardioverter-defibrillators, biventricular resynchronization and implantable assist devices. Trials on beta-blockers extended the indication to patients with advanced heart failure, but the choice of the "best" beta-blocker to use remains an unsolved issue. Moreover, the concomitant use of ACE-inhibitors and angiotensin II receptor antagonists is a recent acquisition. However, the Val-HeFT results underscored that the add-on hypothesis of a more complete inhibition obtained with the combination of multiple agents was not confirmed in patients already taking ACE-inhibitors and beta-blockers. Regarding the new neurohormonal modulators (omapatrilat, etanercept, endothelin receptor blockers, arginine-vasopressin antagonists), more data are needed before using them in clinical practice. After the publication of the MADIT-II results, the cardioverter-defibrillator implantation will probably spread in patients with previous myocardial infarction and left ventricular dysfunction to prevent sudden death, but the cost-effectiveness ratio is still to be clarified. In the advanced or end-stage heart failure, when the improvement of quality of life represents the main target of therapy, ventricular resynchronization and implantable assist devices may play a role in clinical settings. Before considering them like a real therapeutic option, final results from ongoing investigations should be awaited. PMID:12187629

Sinagra, Gianfranco; Perkan, Andrea; Cherubini, Antonella; Salvatore, Luca; Di Lenarda, Andrea

2002-07-01

152

Heart failure with normal ejection fraction: a growing pandemic.  

PubMed

Heart failure is a heterogeneous syndrome. Approximately 30-50% of patients with heart failure have normal or near normal left ventricle function. Several epidemiological studies confirm that the prevalence of heart failure with normal ejection fraction is increasing. Given the current trends, heart failure with normal ejection fraction will become the most common form of heart failure, for which we do not currently have an evidence-based successful treatment. This article summarizes the etiology, current recommended guidelines and management options for this clinical manifestation. PMID:22642630

Singh, Satnam; Frenneaux, Michael

2012-05-01

153

Congestive heart failure in women in Iraq  

PubMed Central

Stimulated by the world-wide interest in cardiovascular diseases, the authors made a study of 1001 consecutive admissions to a female medical ward in Baghdad, Iraq, and found that 146 patients were in congestive failure on admission, and an additional 197 patients were suffering from primary cardiovascular disease without failure. Of the group in failure, 47.9% had rheumatic heart disease; none of these patients had been on chemoprophylaxis. Bilharziasis was associated with a considerable number of cases of hypertension and with a small percentage of cases of cor pulmonale. The authors feel that prevention of rheumatic fever and bilharziasis should constitute the corner-stone of any effective control programme of cardiovascular disease at this stage of medical development in Iraq.

Damluji, Salem F.; Al-Saffar, Ghanim; Thamer, Mahmoud A.; Mary, Adil S.

1964-01-01

154

Right ventricular failure in congenital heart disease  

PubMed Central

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

Ma, Jae Sook

2013-01-01

155

Key role of congestion in natural history of heart failure.  

PubMed

The natural course of heart failure with decreased and preserved systolic function is almost identical. The current concept of heart failure where decreased cardiac output plays the major role does not explain this similarity. We suggest a revised concept of heart failure where congestion plays the leading role. While congestion is almost invariably present in heart failure with normal and with reduced systolic function, the low output syndrome is only present in heart failure with reduced systolic function. The small difference in morbidity and mortality in favor of heart failure with preserved systolic function reflects the contribution of low output syndrome to the natural course of the disease. Congestion can result from low output or from multiple other conditions, but severity of congestion is the major determinant of progression of heart failure. PMID:21887112

Guglin, Maya

2011-01-01

156

Avosentan for Overt Diabetic Nephropathy  

PubMed Central

In the short term, the endothelin antagonist avosentan reduces proteinuria, but whether this translates to protection from progressive loss of renal function is unknown. We examined the effects of avosentan on progression of overt diabetic nephropathy in a multicenter, multinational, double-blind, placebo-controlled trial. We randomly assigned 1392 participants with type 2 diabetes to oral avosentan (25 or 50 mg) or placebo in addition to continued angiotensin-converting enzyme inhibition and/or angiotensin receptor blockade. The composite primary outcome was the time to doubling of serum creatinine, ESRD, or death. Secondary outcomes included changes in albumin-to-creatinine ratio (ACR) and cardiovascular outcomes. We terminated the trial prematurely after a median follow-up of 4 months (maximum 16 months) because of an excess of cardiovascular events with avosentan. We did not detect a difference in the frequency of the primary outcome between groups. Avosentan significantly reduced ACR: In patients who were treated with avosentan 25 mg/d, 50 mg/d, and placebo, the median reduction in ACR was 44.3, 49.3, and 9.7%, respectively. Adverse events led to discontinuation of trial medication significantly more often for avosentan than for placebo (19.6 and 18.2 versus 11.5% for placebo), dominated by fluid overload and congestive heart failure; death occurred in 21 (4.6%; P = 0.225), 17 (3.6%; P = 0.194), and 12 (2.6%), respectively. In conclusion, avosentan reduces albuminuria when added to standard treatment in people with type 2 diabetes and overt nephropathy but induces significant fluid overload and congestive heart failure.

Mann, Johannes F.E.; Green, Damian; Jamerson, Kenneth; Ruilope, Luis M.; Kuranoff, Susan J.; Littke, Thomas

2010-01-01

157

Avosentan for overt diabetic nephropathy.  

PubMed

In the short term, the endothelin antagonist avosentan reduces proteinuria, but whether this translates to protection from progressive loss of renal function is unknown. We examined the effects of avosentan on progression of overt diabetic nephropathy in a multicenter, multinational, double-blind, placebo-controlled trial. We randomly assigned 1392 participants with type 2 diabetes to oral avosentan (25 or 50 mg) or placebo in addition to continued angiotensin-converting enzyme inhibition and/or angiotensin receptor blockade. The composite primary outcome was the time to doubling of serum creatinine, ESRD, or death. Secondary outcomes included changes in albumin-to-creatinine ratio (ACR) and cardiovascular outcomes. We terminated the trial prematurely after a median follow-up of 4 months (maximum 16 months) because of an excess of cardiovascular events with avosentan. We did not detect a difference in the frequency of the primary outcome between groups. Avosentan significantly reduced ACR: In patients who were treated with avosentan 25 mg/d, 50 mg/d, and placebo, the median reduction in ACR was 44.3, 49.3, and 9.7%, respectively. Adverse events led to discontinuation of trial medication significantly more often for avosentan than for placebo (19.6 and 18.2 versus 11.5% for placebo), dominated by fluid overload and congestive heart failure; death occurred in 21 (4.6%; P = 0.225), 17 (3.6%; P = 0.194), and 12 (2.6%), respectively. In conclusion, avosentan reduces albuminuria when added to standard treatment in people with type 2 diabetes and overt nephropathy but induces significant fluid overload and congestive heart failure. PMID:20167702

Mann, Johannes F E; Green, Damian; Jamerson, Kenneth; Ruilope, Luis M; Kuranoff, Susan J; Littke, Thomas; Viberti, Giancarlo

2010-03-01

158

Short-stepping gait in severe heart failure  

PubMed Central

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

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

1992-01-01

159

Heart failure: TNM-like classification.  

PubMed

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

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

2014-05-20

160

Mechano-signaling in heart failure.  

PubMed

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

Buyandelger, Byambajav; Mansfield, Catherine; Knöll, Ralph

2014-06-01

161

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

PubMed Central

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

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

2013-01-01

162

Modulating fatty acid oxidation in heart failure.  

PubMed

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

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

2011-05-01

163

Modulating fatty acid oxidation in heart failure  

PubMed Central

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

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

2011-01-01

164

Ovarian carcinoid presenting with right heart failure.  

PubMed

A 69-year-old woman presented with a pelvic mass as well as a 6-month history of progressive bilateral peripheral oedema with more recent breathlessness and abdominal distension. She was found to have significant right heart failure (RHF) which was extensively investigated. No significant lung disease or pulmonary embolism was identified to explain the findings. Severe tricuspid incompetence was thus thought to be secondary to the systemic effects of a carcinoid tumour, confirmed to be ovarian in origin (on positron emission tomography/CT scan and histopathology). Prior to major pelvic surgery for removal of the ovarian mass, she underwent tricuspid and pulmonary valve replacement surgery due to the deteriorating right heart function. She had an uneventful recovery after both operations and continues to be followed up closely with serial ovarian and carcinoid tumour markers. PMID:24872492

Damen, Nikki

2014-01-01

165

Cost-effectiveness of heart failure therapies.  

PubMed

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

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

2013-06-01

166

Advances in Devices for Cardiac Resynchronization in Heart Failure  

Microsoft Academic Search

Patients with advanced heart failure have a high mortality and morbidity despite medical therapy. Depending on the underlying heart disease and severity of heart failure, 3.7 to 52.8% of patients have a QRS complex =120 ms who may have interventricular and intraventricular dyssynchrony correctible by cardiac resynchronization therapy (CRT). The latter is usually achieved with biventiricular pacing, with the left

Chu-Pak Lau; Serge Barold; Hung-Fat Tse; Kathy Lai-Fun Lee; Hon-Wah Chan; Katherine Fan; Elaine Chau; Cheuk-Man Yu

2003-01-01

167

Heart failure and sleep apnoea: To sleep perchance to dream  

Microsoft Academic Search

Heart failure and sleep apnoea are major health problems with an increasingly recognized association; evidence suggests that sleep apnoea may play a role in the progression of heart failure. However, confounding factors such as obesity, hypertension and coronary heart disease make this relationship uncertain and an independent correlation remains unproven. Diagnosis of sleep apnoea is suboptimal, as it is often

Susana Ferreira; Joao Winck; Paulo Bettencourt; Francisco Rocha-Goncalves

2006-01-01

168

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

Microsoft Academic Search

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

Shunsuke Ohnishi; Noritoshi Nagaya

2007-01-01

169

Obesity paradox, cachexia, frailty, and heart failure.  

PubMed

Overweight and obesity adversely affect cardiovascular (CV) risk factors and CV structure and function, and lead to a marked increase in the risk of developing heart failure (HF). Despite this, an obesity paradox exists, wherein those who are overweight and obese with HF have a better prognosis than their leaner counterparts, and the underweight, frail, and cachectic have a particularly poor prognosis. In light of this, the potential benefits of exercise training and efforts to improve cardiorespiratory fitness, as well as the potential for weight reduction, especially in severely obese patients with HF, are discussed. PMID:24656108

Lavie, Carl J; De Schutter, Alban; Alpert, Martin A; Mehra, Mandeep R; Milani, Richard V; Ventura, Hector O

2014-04-01

170

[Telemedicine and wireless devices in heart failure].  

PubMed

Telemedicine has the potential to constitute the central element of the future primary care and become an effective means of prevention and early warning of acute exacerbation of chronic diseases. Up to now, the application of telemedicine has found a variety of difficulties, regarding the types and methods of acquisition and transmission of biological signals, the acceptance and cooperation of the patient, etc. The latest technological developments involve the combined use of wireless technologies and smartphones, for the collection and the transmission of data, and specific softwares for their automatic analysis. This paper examines some of the critical aspects in the application of new technologies for heart failure remote management. PMID:24873944

Billeci, Lucia; Guerriero, Lorenzo; L'Abbate, Antonio; Pioggia, Giovanni; Tartarisco, Gennaro; Trivella, Maria Giovanna

2014-05-01

171

Ventricular-vascular interaction in heart failure.  

PubMed

Nearly half of all patients who have heart failure have preserved ejection fraction (HFpEF). Patients who have HFpEF tend to be older, female, and hypertensive, and characteristically display increased ventricular and arterial stiffening. In this article, we discuss the pathophysiology of abnormal ventriculoarterial stiffening and how it affects ventricular function, cardiovascular hemodynamics, reserve capacity, and symptoms. We conclude by exploring how novel treatment strategies targeting abnormal ventricular-arterial interaction might prove useful in the treatment of patients who have HFpEF. PMID:21803232

Borlaug, Barry A; Kass, David A

2011-08-01

172

Iron deficiency anemia in heart failure.  

PubMed

Anemia and iron deficiency are quite prevalent in patients with heart failure (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

Arora, Natasha P; Ghali, Jalal K

2013-07-01

173

Low-Intensity Exercise Training Delays Heart Failure and Improves Survival in Female Hypertensive Heart Failure Rats  

Microsoft Academic Search

Exercise training improves functional capacity and quality of life in patients with heart failure. However, the long-term effects of exercise on mortality associated with hypertensive heart disease have not been well defined. In the present study, we investigated the effect of low-intensity exercise training on disease progression and survival in female spontaneously hypertensive heart failure rats. Animals with severe hypertension

Adam J. Chicco; Sylvia A. McCune; Craig A. Emter; Genevieve C. Sparagna; Meredith L. Rees; David A. Bolden; Kurt D. Marshall; Robert C. Murphy; Russell L. Moore

2009-01-01

174

2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant.  

PubMed

This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices. PMID:24774396

Subirana, M Teresa; Barón-Esquivias, Gonzalo; Manito, Nicolás; Oliver, José M; Ripoll, Tomás; Lambert, Jose Luis; Zunzunegui, José L; Bover, Ramon; García-Pinilla, José Manuel

2014-03-01

175

Biomarkers and diagnostics in heart failure.  

PubMed

Heart failure (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: Heart failure pathogenesis and emerging diagnostic and therapeutic interventions. PMID:23313577

Gaggin, Hanna K; Januzzi, James L

2013-12-01

176

Debate: Should statin be used in patients with heart failure?  

PubMed Central

Statins reduce mortality of patients with coronary artery disease (CAD). However, by protocol, trials have excluded patients with chronic heart failure. Since the prevalent etiology of heart failure is CAD, preventing CAD may prevent heart failure progression. Statins may have other beneficial effects besides cholesterol lowering, such as anti-inflammatory properties and improvement of endothelial function. On the contrary, high levels of cholesterol can be beneficial in heart failure patients on the basis of the ability of serum lipoproteins to modulate inflammatory response. Furthermore, statins affecting mitochondrial function can have a deleterious effect on skeletal or cardiac muscles. Despite all these conflicting data, there is no evidence from trials on the effects of statins in patients with heart failure. For this reason, the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI) investigators planned a controlled trial testing the effect of statins in patients with heart failure of different etiology.

Pietro Maggioni, Aldo

2001-01-01

177

Beta-blockers to prevent symptomatic heart failure in patients with stage A and B heart failure  

Microsoft Academic Search

?-blockers have been well-studied in the treatment of the symptomatic stages of chronic heart failure. Frequently physicians\\u000a treat patients with asymptomatic left ventricular (LV) dysfunction and patients with hypertension on ?-blockers without clear\\u000a evidence that there is value in doing so. Chronic heart failure poses an extraordinary economic burden; any effective therapy\\u000a that limits the progression to symptomatic heart failure

David M. Wild; Marrick Kukin

2007-01-01

178

Management of ACCF/AHA Stage C heart failure.  

PubMed

ACC Stage C heart failure includes those patients with prior or current symptoms of heart failure in the context of an underlying structural heart problem who are primarily managed with medical therapy. Although there is guideline-based medical therapy for those with heart failure with reduced ejection fraction (HFrEF), therapies in heart failure with preserved ejection fraction (HFpEF) have thus far proven elusive. Emerging therapies such as serelaxin are currently under investigation and may prove beneficial. The role of advanced surgical therapies, such as mechanical circulatory support, in this population is not well defined. Further investigation is warranted for these therapies in patients with Stage C heart failure. PMID:24286580

Adigopula, Sasikanth; Vivo, Rey P; DePasquale, Eugene C; Nsair, Ali; Deng, Mario C

2014-02-01

179

Uncertainties of the heart: palliative care and adult heart failure.  

PubMed

Chronic heart failure (HF) is a growing public health concern in Western nations. Incidence of HF increases with age, and demographics in the United States support a growing HF population. Annually, more than 100,000 people are admitted to hospitals because of HF. Patients with chronic HF experience a highly morbid and life-limiting illness while suffering from substantial physical and psychosocial burdens. What is the state of the science regarding the use of palliative care for community-dwelling adult patients with HF? A review of the scientific literature was conducted using the key words "palliative care" and "heart failure" in several electronic databases (CINAHL, Medline, Proquest) from October 15 to November 15, 2011. Eleven of the 16 articles found indicated that palliative care is underused by HF patients. There is a large unmet care need for adults with chronic HF and their family caregivers. Home healthcare professionals develop and maintain relationships with community-dwelling patients with chronic HF over the course of their HF illness trajectory. Home healthcare professionals are in a unique position to identify HF patients who may benefit from palliative care programs delivered across care settings in the community. By developing ongoing relationships with patients and their family caregivers, we are able to focus on the complete care needs of this patient population and assist them with advanced care planning, psychological and social issues, and symptom management. We can also improve communication among care providers and patients/families to identify goals of care along the trajectory of HF illness. PMID:23238621

Pastor, Diane K; Moore, Geraldine

2013-01-01

180

Heart Failure with Preserved EF: A bird eye view.  

PubMed

The concept of ''diastolic'' heart failure grew out of the observation that many patients who have the symptoms and signs of heart failure had an apparently normal left ventricular (LV) ejection fraction. Thus it was assumed that since systolic function was ''pre- served'' 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'' heart failure backed up by indicators of diastolic dysfunction derived from Doppler echoardiography. Diastolic heart failure is associated with a lower annual mortality rate of approximately 8% as compared to annual mortality of 19% in heart failure with systolic dysfunction, however, morbidity rate can be substantial. Thus, diastolic heart failure 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 heart failure 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. Keywords: diastolic heart failure; doppler echocardiography; treatment. PMID:24362671

Aziz, F; Thazhatauveetil-Kunhahamed, L A; Enweluzo, C; Zaeem, M

2013-01-01

181

Pulmonary function differences in patients with chronic right heart failure secondary to pulmonary arterial hypertension and chronic left heart failure.  

PubMed

Background Pulmonary abnormalities are found in both chronic heart failure (CHF) and pulmonary arterial hypertension (PAH). The differences of pulmonary function in chronic left heart failure and chronic right heart failure are not fully understood. Material and Methods We evaluated 120 patients with stable CHF (60 with chronic left heart failure and 60 with chronic right heart failure). All patients had pulmonary function testing, including pulmonary function testing at rest and incremental cardiopulmonary exercise testing (CPX). Results Patients with right heart failure had a significantly lower end-tidal partial pressure of CO2 (PetCO2), higher end-tidal partial pressure of O2 (PetO2) and minute ventilation/CO2 production (VE/VCO2) at rest. Patients with right heart failure had a lower peak PetCO2, and a higher peak dead space volume/tidal volume (VD/VT) ratio, peak PetO2, peak VE/VCO2, and VE/VCO2 slope during exercise. Patients with right heart failure had more changes in ?PetCO2 and ?VE/VCO2, from rest to exercise. Conclusions Patients with right heart failure had worse pulmonary function at rest and exercise, which was due to severe ventilation/perfusion (V/Q) mismatching, severe ventilation inefficiency, and gas exchange abnormality. PMID:24916204

Liu, Wei-Hua; Luo, Qin; Liu, Zhi-Hong; Zhao, Qing; Xi, Qun-Ying; Xue, Hai-Feng; Zhao, Zhi-Hui

2014-01-01

182

Pulmonary function differences in patients with chronic right heart failure secondary to pulmonary arterial hypertension and chronic left heart failure  

PubMed Central

Background Pulmonary abnormalities are found in both chronic heart failure (CHF) and pulmonary arterial hypertension (PAH). The differences of pulmonary function in chronic left heart failure and chronic right heart failure are not fully understood. Material/Methods We evaluated 120 patients with stable CHF (60 with chronic left heart failure and 60 with chronic right heart failure). All patients had pulmonary function testing, including pulmonary function testing at rest and incremental cardiopulmonary exercise testing (CPX). Results Patients with right heart failure had a significantly lower end-tidal partial pressure of CO2 (PetCO2), higher end-tidal partial pressure of O2 (PetO2) and minute ventilation/CO2 production (VE/VCO2) at rest. Patients with right heart failure had a lower peak PetCO2, and a higher peak dead space volume/tidal volume (VD/VT) ratio, peak PetO2, peak VE/VCO2, and VE/VCO2 slope during exercise. Patients with right heart failure had more changes in ?PetCO2 and ?VE/VCO2, from rest to exercise. Conclusions Patients with right heart failure had worse pulmonary function at rest and exercise, which was due to severe ventilation/perfusion (V/Q) mismatching, severe ventilation inefficiency, and gas exchange abnormality.

Liu, Wei-Hua; Luo, Qin; Liu, Zhi-Hong; Zhao, Qing; Xi, Qun-Ying; Xue, Hai-Feng; Zhao, Zhi-Hui

2014-01-01

183

Parallel paths to improve heart failure outcomes: evidence matters.  

PubMed

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

Albert, Nancy M

2013-07-01

184

Cardiovascular magnetic resonance in heart failure.  

PubMed

Imaging has a central role in the evaluation of patients with heart failure (HF). Cardiovascular magnetic resonance (CMR) is rapidly evolving as a versatile imaging modality that often provides additional information to echocardiography in patients with suspected or known HF. CMR is the only imaging modality that has the ability to assess, without exposure to ionizing radiation, cardiac function, structure (tissue characterization), perfusion, and viability. Moreover, magnetic resonance spectroscopy techniques can assess the pathophysiologic role of deranged cardiac energetics in HF. In this review we discuss the role of CMR in the evaluation of patients with HF giving particular emphasis to recent developments and the additional information that can be obtained with this imaging modality, over and above standard echocardiography. PMID:21360113

Karamitsos, Theodoros D; Neubauer, Stefan

2011-06-01

185

[The heart failure patient: A case report].  

PubMed

Given its prevalence, high mortality rate, morbidity, chronicity and use of resources, heart failure (HF) is a priority issue from a social and health standpoint, due to the ageing population and to lack of adherence to and the complexity of treatment. For these reasons, an individualized care plan needs to be established to meet the real and potential needs of the patient diagnosed with HF. A clinical case is presented of a patient admitted to the Cardiology Critical Care (CCC) unit of a tertiary hospital. A patient care plan was prepared following the steps of the scienti?c method and relying on the NANDA taxonomy, and the NOC and NIC to design goals and nursing interventions, respectively. PMID:24685230

Alconero-Camarero, Ana Rosa; Arozamena-Pérez, Jorge; García-Garrido, Lluïsa

2014-01-01

186

Metabolic remodeling in chronic heart failure  

PubMed Central

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

Wang, Jing; Guo, Tao

2013-01-01

187

Ventricular arrhythmias in heart failure patients.  

PubMed

Ventricular arrhythmia represents a significant cause of mortality and morbidity. Its pathophysiologic mechanisms and electroanatomic substrates are slowly being elucidated. Clinical management in patients with heart failure has progressed from antiarrhythmic drugs to device therapy. Catheter ablation is an effective adjunct in the management of ventricular arrhythmia but remains a significant challenge. Advances in robotic and magnetic catheter manipulation may shorten procedural time and increase safety. Incorporation of imaging technologies such as CT, MRI, or ultrasound with electroanatomic mapping can enhance the ability to map and ablate ventricular arrhythmia. Novel imaging modalities may provide rapid characterization of the substrate for ventricular dysfunction and arrhythmia development and the capacity for serial assessment of the disease progression, improving risk stratification for ventricular dysfunction and arrhythmia development and the capacity for serial assessment of the disease progression, improving risk stratification. PMID:18538186

Lo, Ronald; Hsia, Henry H

2008-08-01

188

Metabolic remodeling in chronic heart failure.  

PubMed

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

Wang, Jing; Guo, Tao

2013-08-01

189

Cognitive Deficits in Chronic Heart Failure  

PubMed Central

Background: Patients with heart failure (HF) have been found to have cognitive deficits, but it remains unclear whether these deficits are associated with HF or with aging or comorbid conditions common in HF. Objectives: To 1) determine the types, frequency, and severity of cognitive deficits among patients with chronic HF compared to age- and education-matched healthy participants and participants with major medical conditions other than HF; and 2) evaluate the relationships between HF severity, age, and comorbidities and cognitive deficits. Methods: A sample of 414 participants completed the study (249 HF patients, 63 healthy and 102 medical participants). The HF patients completed measures of HF severity, comorbidity (multiple comorbidity, hypertension, depressive symptoms), and neuropsychological functioning. Blood pressure and oxygen saturation were assessed at interview; clinical variables were abstracted from records. Participants in the comparison groups completed the same measures as the HF patients except those specific to HF. Results: Compared to the healthy and medical participants, HF patients had poorer memory, psychomotor speed, and executive function. Significantly more HF patients (24%) had deficits in three or more domains. Higher (worse) HF severity was associated with more cognitive deficits; HF severity interacted with age to explain deficits in executive function. Surprisingly, men with HF had poorer memory, psychomotor speed, and visuospatial recall ability than women. Multiple comorbidity, hypertension, depressive symptoms, and medications were not associated with cognitive deficits in this sample. Discussion: Heart failure results in losses in memory, psychomotor speed, and executive function in almost one fourth of patients. Patients with more severe HF are at risk for cognitive deficits. Older patients with more severe HF may have more problems in executive function and men with HF may be at increased risk for cognitive deficits. Studies are urgently needed to identify the mechanisms for the cognitive deficits in HF and test innovative interventions to prevent cognitive loss and decline.

Pressler, Susan J.; Subramanian, Usha; Kareken, David; Perkins, Susan M.; Gradus-Pizlo, Irmina; Sauve, Mary Jane; Ding, Yan; Kim, JinShil; Sloan, Rebecca; Jaynes, Heather; Shaw, Rose Mary

2010-01-01

190

Electrocardiographic abnormalities in patients with heart failure  

PubMed Central

Summary Background The morbidity and mortality from heart failure (HF) differ between patients with reduced (< 50%) and with preserved (? 50%) left ventricular ejection fraction (LV EF) on account of many factors, including abnormalities detected in the electrocardiogram (ECG). The aim of this study was to determine and compare the ECG abnormalities between HF patients with reduced and with preserved LV EF. Methods The study was cross-sectional in design and carried out in Aminu Kano teaching hospital and Murtala Mohammed specialist hospital, Kano, Nigeria, from April 2005 to June 2006. We studied the resting electrocardiograms of all HF patients aged 15 years and older who were referred to the two centres for echocardiography. Results A total of 113 patients were studied and 98.2% of them had abnormal ECGs. Forty-two patients (37.2%) had preserved LV EF while the remaining 71 (62.8%) had reduced LV EF. Left ventricular hypertrophy (LV H) was the commonest ECG abnormality, found among 55 patients (77.5%) with reduced LV EF, and 21 patients (50%) with preserved LV EF (p = 0.0026). The commonest arrhythmia was atrial fibrillation, found among 10 patients (14.1%) with reduced LV EF and eight patients (19.1%) with preserved LV EF (p = 0.486). Prolonged corrected QT interval was found among 30 (71.4%) and 56 patients (78.9%) with preserved and reduced LV EF, respectively (p = 0.370). Conclusion Most of the patients with heart failure studied in Kano, Nigeria had abnormal electrocardiograms, and the most common abnormality was LV H.

Karaye, Kamilu M; Sani, Mahmoud U

2008-01-01

191

Surgical animal models of heart failure related to coronary heart disease  

Microsoft Academic Search

Coronary heart disease is caused by atherosclerotic narrowing of coronary arteries. It accounts for about two-thirds of heart failure cases, which are frequently secondary to myocardial infarction. Despite considerable progress in the understanding and management of heart failure, 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

2007-01-01

192

Diastolic heart failure: predictors of mortality.  

PubMed

Diastolic heart failure (HF) as defined by the symptoms and signs of HF, preserved ejection fraction and abnormal diastolic function is estimated to occur in half of all patients presenting with HF. Patients with preserved ejection fraction are older and more often female. The underlying etiology of HF differs, with hypertension being more common in patients with preserved ejection fraction and ischemic heart disease predominant among those with reduced ejection fraction. Diastolic HF is associated with high mortality comparable with that of HF with depressed ejection fraction with a five year survival rate after a first episode of 43% and a higher excess mortality compared with the general population. Despite significant disease burden, clinical and biological prognostic factors in diastolic HF remain poorly understood. There is limited data from well designed studies regarding the effective treatment strategies for this group of patients. The purpose of this review is to summarize the mortality data and predictors of mortality in patients with diastolic HF for better understanding of the prognosis. In patients with diastolic HF older age, male gender, non-Caucasian ethnicity, history of coronary artery disease and atrial fibrillation are associated with poor prognosis. Anemia and B-type natriuretic peptide are significant laboratory variable that predict mortality. Two dimensional echocardiography and tissue Doppler imaging measurements including left ventricular ejection fraction, E/Ea ratio ? 15, restrictive transmiral filling (deceleration time £ 140 ms) and Em < 3.5 cm/s are predictors of adverse outcomes in diastolic HF patients. PMID:21660911

Sherazi, Saadia; Zar?ba, Wojciech

2011-01-01

193

Comprehensive rehabilitation in chronic heart failure.  

PubMed

Chronic heart failure (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

G?siorowski, Adam; Dutkiewicz, Jacek

2013-01-01

194

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

PubMed Central

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

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

2014-01-01

195

Nonpharmacologic care of heart failure: patient, family, and hospital organization  

Microsoft Academic Search

Patients with severe heart failure 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 heart failure (CHF) has to include

Michele D’Alto; Giuseppe Pacileo; Raffaele Calabrò

2003-01-01

196

Nonpharmacologic Care of Heart Failure: Patient, Family, and Hospital Organization  

Microsoft Academic Search

Patients with severe heart failure 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 heart failure (CHF)

Michele D'Alto; Giuseppe Pacileo

197

The prognostic importance of anemia in patients with heart failure  

Microsoft Academic Search

PurposePhysiologic studies have suggested that anemia could adversely affect the cardiovascular condition of patients with heart failure. Yet, the prognostic importance of this treatable condition is not well established by epidemiologic studies. We sought to determine the prognostic value of hematocrit level in a cohort of elderly patients hospitalized with heart failure.

Mikhail Kosiborod; Grace L Smith; Martha J Radford; JoAnne M Foody; Harlan M Krumholz

2003-01-01

198

Novel therapeutic targets for the treatment of heart failure  

Microsoft Academic Search

Despite considerable therapeutic advances, heart failure 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 heart failure have been identified, and new drugs are currently under investigation. A repeated finding is that the positive results

José López-Sendón; Juan Tamargo

2011-01-01

199

Simulation Study of Cellular Electric Properties in Heart Failure  

Microsoft Academic Search

Patients with severe heart failure are at high risk of sudden cardiac death. In the majority of these patients, sudden cardiac death is thought to be due to ventricular tachyarrhythmias. Alterations of the electric properties of single myocytes in heart failure may favor the occurrence of ventricular arrhythmias in these patients by inducing early or delayed afterdepolarizations. Mathematical models of

Leo Priebe; Dirk J. Beuckelmann

200

Early Menopause Linked to Heart Failure Risk in Swedish Study  

MedlinePLUS

... page, please enable JavaScript. Early Menopause Linked to Heart Failure Risk in Swedish Study Association was even stronger ... Preidt Wednesday, May 14, 2014 Related MedlinePlus Pages Heart Failure Menopause WEDNESDAY, May 14, 2014 (HealthDay News) -- Early ...

201

Intravenous thyroid hormone supplementation in heart failure with cardiogenic shock  

Microsoft Academic Search

Background: Thyroid hormone level abnormalities commonly exist in severe heart failure and may be of prognostic value. The therapeutic potential of using thyroid hormone for cardiogenic shock resulting from progressive heart failure has not been previously delineated. We sought to evaluate the role of an intravenous infusion of thyroxine as an adjunct to conventional inotropic agents and intra-aortic balloon counterpulsation

Furrukh S. Malik; Mandeep R. Mehra; Patricia A. Uber; Myung H. Park; Robert L. Scott; Clifford H. Van Meter

1999-01-01

202

Randomised controlled trial of specialist nurse intervention in heart failure  

Microsoft Academic Search

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

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

2001-01-01

203

Cognitive impairment in heart failure with Cheyne-Stokes respiration  

PubMed Central

OBJECTIVES—To document the degree of cognitive impairment in stable heart failure, and to determine its relation to the presence of Cheyne-Stokes respiration during sleep.?SUBJECTS—104 heart failure patients and 21 healthy normal volunteers.?METHODS—Overnight oximetry was used (previously validated as a screening tool for Cheyne-Stokes respiration in heart failure). Cognitive function was assessed using a battery of neuropsychological tests. Left ventricular function was assessed by echocardiography.?RESULTS—Heart failure patients performed worse than the healthy volunteers in tests that measured vigilance. Reaction times were 48% slower (0.89 (0.03) s v 0.60 (0.05) s; p < 0.005) and they hit twice as many obstacles on the Steer Clear simulator (75 (6.4) v 33 (4.6); p < 0.005). Cognitive impairment within the heart failure group was unrelated to either the presence of Cheyne-Stokes respiration, the degree of left ventricular dysfunction, or indices of nocturnal oxygenation.?CONCLUSIONS—Vigilance was impaired in heart failure but this did not appear to be related to the presence of Cheyne-Stokes respiration during sleep. Impaired vigilance as measured on the Steer Clear test has been associated with an increased risk of motor vehicle accidents. The issue of fitness to drive in heart failure requires further attention.???Keywords: Cheyne-Stokes respiration; cognitive function; heart failure; driving

Staniforth, A; Kinnear, W; Cowley, A

2001-01-01

204

Pharmacokinetics and Pharmacodynamics of Beta Blockers in Heart Failure  

Microsoft Academic Search

Although beta-blockers have been used for nearly three decades in the management of heart failure, only recent randomized clinical trials have demonstrated substantial benefit in reducing morbidity and mortality. Carvedilol, metoprolol succinate and bisprolol have evidence supporting their use in heart failure while other beta blockers either lack evidence supporting their use or have not been shown to be useful

Robert L. Talbert

2004-01-01

205

Beta-adrenergic blocker mortality trials in congestive heart failure  

Microsoft Academic Search

Many of the current discussions of ?-adrenergic blocker therapy in patients with congestive heart failure have used fairy tales to describe the evolution of this treatment from contraindication to standard of care. This article reviews the early studies that initiated this revolution in heart failure therapy and discusses the major mortality trials that have demonstrated that these agents improve survival

John R Teerlink; Barry M Massie

1999-01-01

206

Atrial fibrillation in heart failure: stroke risk stratification and anticoagulation.  

PubMed

For an individual patient with both atrial fibrillation and heart failure, stroke risk is one of the most prominent mitigating factors for subsequent morbidity and mortality. Although the CHADS? stroke risk score is the most widely used score for risk stratification, it does not take into account the risk factors of vascular disease, female gender, or the age group 65-74 years, for which there is increasing evidence. There is also evidence that diastolic heart failure is as much a risk factor for stroke as systolic heart failure. The new oral anticoagulants dabigatran, rivaroxaban and apixaban appear to be appropriate agents in the heart failure population with atrial fibrillation and risk factors for stroke although there are dose-adjustments for renal insufficiency and these medications are contraindicated in advanced renal disease. As with the atrial fibrillation population as a whole, bleeding risk should be considered for every patient with heart failure prior to making recommendations regarding anticoagulation. PMID:24445936

Abraham, JoEllyn M; Connolly, Stuart J

2014-05-01

207

Apoptosis and heart failure: clinical relevance and therapeutic target.  

PubMed

Heart failure is the final common pathway of diverse etiologies that are characterized by impaired systolic and/or diastolic function with high morbidity and mortality. An integral part of pathogenesis of heart failure is myocyte loss. The traditional explanation for myocyte loss was cell necrosis but over the last decade, there has been a surge of evidence affirming the role of apoptosis in genesis of heart failure. Studies have raised apoptosis from a 'histologic curiosity' to an exciting 'clinical target' that can be modulated to attenuate the progression of heart failure. This review will focus on the clinical relevance of apoptosis in human and experimental heart failure and identify some of the progress made in myocardial anti-apoptotic intervention. PMID:15623423

Garg, Shaila; Narula, Jagat; Chandrashekhar, Y

2005-01-01

208

MicroRNA Involvement in Immune Activation During Heart Failure  

Microsoft Academic Search

Heart failure is one of the common end stages of cardiovascular diseases, the leading cause of death in developed countries.\\u000a Molecular mechanisms underlying the development of heart failure remain elusive but there is a consistent observation of chronic\\u000a immune activation and aberrant microRNA (miRNA) expression that is present in failing hearts. This review will focus on the\\u000a interplay between the

Mathijs van de Vrie; Stephane Heymans; Blanche Schroen

2011-01-01

209

Altered Connexin Expression in Human Congestive Heart Failure  

Microsoft Academic Search

Congestive heart failure is associated with a high risk of life-threatening ventricular re-entrant arrhythmias. Down-regulation of the principal gap-junctional protein of the ventricular myocytes, connexin43, has previously been implicated in arrhythmia in ischaemic heart disease, but it is not known whether connexin43 is similarly reduced in heart failure due to idiopathic dilated cardiomyopathy, whether disease-related connexin43 down-regulation occurs at the

Emmanuel Dupont; Tsutomu Matsushita; Riyaz A. Kaba; Cristina Vozzi; Steven R. Coppen; Natasha Khan; Raffi Kaprielian; Magdi H. Yacoub; Nicholas J. Severs

2001-01-01

210

Treatment of Heart Failure - Role of Biventricular Pacing for Heart Failure Not Responding Well to Drug Therapy  

Microsoft Academic Search

Objective: Patients with heart failure may have conduction abnormalities in up to 30%, further aggravating cardiac output. Drugs worsen these abnormalities and resynchronisation therapy with biventricular pacing improves cardiac function by effecting a more coordinated and efficient ventricular contraction. We report here the technique of biventricular pacing and its results. Methodology: Patients with NYHA Class III to IV heart failure,

W S Teo; R Kam; L F Hsu

211

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

Microsoft Academic Search

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

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

1999-01-01

212

Plasma norepinephrine and atrial natriuretic peptide in heart failure: Influence of felodipine in the third vasodilator heart failure trial  

Microsoft Academic Search

Background: Reflex activation of the sympathetic nervous system by short-acting dihydropyridine calcium channel antagonists has been reported to harm hypertensive patients. Different neurohormonal profiles and their response to treatment may influence the effectiveness of dihydropyridine vasodilator treatment of heart failure.Methods: Four hundred fifty men with left ventricular (LV) systolic dysfunction were administered standard heart failure treatment and felodipine extended release

Raphael F. Smith; Terry Germanson; Dianne Judd; Maylene Wong; Susan Ziesche; Inder S. Anand; W. Robert Taylor; Jay N. Cohn

2000-01-01

213

Differences of disease progression in congestive heart failure due to alcoholic as compared to idiopathic dilated cardiomyopathy.  

PubMed

In patients with alcoholic cardiomyopathy there is evidence that mild heart failure is reversible if patients abstain from alcohol, but there is no consensus whether the disease is progressive once structural myocardial dilation has evolved. The aim of the present study was to compare the long-term course of congestive heart failure due to alcoholic and idiopathic dilated cardiomyopathy. Of 75 patients with overt congestive heart failure, 23 had alcoholic cardiomyopathy and were compared to 52 patients with idiopathic cardiomyopathy. The mean age was 48 +/- 12 years. Despite medical therapy, heart failure class New York Heart Association III-IV was present in 52% of patients with alcoholic and 47% of patients with idiopathic cardiomyopathy (not significant). Their mean left ventricular ejection fraction was 30 +/- 12% vs 28 +/- 12% and left ventricular end-diastolic volumes were 264 +/- 125 ml and 254 +/- 100 ml respectively (not significant). Overall survival at 1, 5 and 10 years was 100%, 81% and 81% for the group with alcoholic dilated cardiomyopathy and 89%, 48% and 30% for the group with idiopathic cardiomyopathy, respectively (P = 0.041), and the difference was even greater for transplant-free survival P = 0.005). Clinical and invasive signs of left and right heart failure as well as left ventricular dimensions were predictive of a fatal outcome; however, symptom duration and left ventricular volumes were only predictive in patients with idiopathic cardiomyopathy, suggesting that in the two patient groups different mechanisms may lead to death. Mortality in patients with severe congestive heart failure and left ventricular dilatation due to alcoholic cardiomyopathy is significantly lower than that in patients with idiopathic cardiomyopathy and similar degrees of heart failure. Thus, despite structural changes inherent in marked left ventricular dilatation, disease progression in alcoholic dilated cardiomyopathy is different from that in idiopathic cardiomyopathy and thus may have implications for the choice of therapy. PMID:8732379

Prazak, P; Pfisterer, M; Osswald, S; Buser, P; Burkart, F

1996-02-01

214

Effects of dietary vitamin E and C supplementation on heart failure in fast growing commercial broiler chickens.  

PubMed

1. It has recently been shown that oxidative stress is involved in the pathogenesis of congestive heart failure (CHF) in broiler chickens. Vitamins E and C, common antioxidants, have been advocated for the prevention of heart failure in humans. The present study examines the effects of supplementation of these vitamins on incidence of CHF and prevention of oxidative stress in the myocardium. 2. Commercial male broilers were randomly allocated to three experimental groups and, respectively, offered commercial broiler diet (control), commercial diets fortified with vitamin E (960 IU/kg) or vitamin C (400 mg/kg). The broilers were monitored daily for overt signs of heart failure and clinical data including ECG and blood gas analysis were collected periodically. Lipid peroxidation was measured in cardiac tissues from apparently normal broilers and broilers developing CHF in each group using thiobarbituric acid reactive substances (TBARS) assay. 3. Overall, the incidence of CHF in broilers given diets fortified with vitamin E or vitamin C was not significantly different as compared to the control group. The incidence of overt signs of hypoxaemia was lower in the vitamin C group than in the control group. Lipid peroxidation was highest in broilers that developed CHF as compared to apparently normal broilers fed either vitamin E or C fortified diets. Neither vitamin E nor vitamin C was effective in preventing oxidative damage in broilers that developed CHF. 4. In conclusion, the present study confirmed that oxidative stress is involved in the pathogenesis of heart failure in broilers, but dietary supplementation of antioxidant vitamins did not prevent oxidative damage in broilers that developed CHF. Beneficial effects of vitamin C supplementation were evidenced by lower incidence of hypoxaemia, and the tendency to reduce the susceptibility of broilers to heart failure. However, vitamin E did not have any impact on clinical status or the incidence of CHF. PMID:19093242

Nain, S; Wojnarowicz, C; Laarveld, B; Olkowski, A A

2008-11-01

215

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

Microsoft Academic Search

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

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

216

Lung Function and Risk for Heart Failure Among Older Adults  

PubMed Central

Background The impact of abnormal spirometric findings on risk for incident heart failure among older adults without clinically apparent lung disease is not well elucidated. Methods We evaluated the association of baseline lung function with incident heart failure, defined as first hospitalization for heart failure, in 2125 participants of the community-based Health, Aging, and Body Composition Study (age, 73.6±2.9 years; 50.5% men; 62.3% white; 37.7% black) without prevalent lung disease or heart failure. Abnormal lung function was defined either as forced vital capacity (FVC) or forced expiratory volume in 1st second (FEV1) to FVC ratio below lower limit of normal. Percent predicted FVC and FEV1 were also assessed as continuous variables. Results During follow-up (median, 9.4years), heart failure developed in 68 of 350 (19.4%) participants with abnormal baseline lung function, as compared to 172 of 1775 (9.7%) participants with normal lung function (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.74-3.07; P<.001). This increased risk persisted after adjusting for previously identified heart failure risk factors in the Health ABC Study, body mass index, incident coronary heart disease, and inflammatory markers (HR, 1.83; 95% CI, 1.33-2.50; P<.001). Percent predicted (%) FVC and FEV1 had a linear association with heart failure risk (HR, 1.21; 95%CI, 1.11-1.32 and 1.18; 95%CI, 1.10-1.26, per 10% lower %FVC and %FEV1, respectively; both P<.001 in fully adjusted models). Findings were consistent in sex and race subgroups, and for heart failure with preserved or reduced ejection fraction. Conclusions Abnormal spirometric findings in older adults without clinical lung disease are associated with increased heart failure risk.

Georgiopoulou, Vasiliki V.; Kalogeropoulos, Andreas P.; Psaty, Bruce M.; Rodondi, Nicolas; Bauer, Douglas C.; Butler, Abida B.; Koster, Annemarie; Smith, Andrew L.; Harris, Tamara B.; Newman, Anne B.; Kritchevsky, Stephen B.; Butler, Javed

2011-01-01

217

Heart failure patients utilizing an electric home monitor: What effects does heart failure have on their quality of life?  

NASA Astrophysics Data System (ADS)

Heart Failure continues to be a major public health problem associated with high mortality and morbidity. Heart Failure 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 heart failure. Despite maximum medical therapy and frequent hospitalizations to stabilize their condition, one in five heart failure patients die within the first year of diagnosis. Several disease-management programs have been proposed and tested to improve the quality of heart failure 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 heart failure is the use of electronic home monitoring. The purpose of this study was to examine what effects heart failure 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 heart failure and other chronic diseases which may provide more data, and address issues such as patient compliance with self-care, impact of heart failure on patient's quality of life, functional capacity, and heart failure patient's utilization of the emergency rooms and hospital. Telemonitoring holds promise for improving the self-care abilities of persons with HF.

Simuel, Gloria J.

218

Home Monitoring for Heart Failure Management  

PubMed Central

With a prevalence of 5.8 million in the United States alone, heart failure (HF) is a common syndrome associated with substantial morbidity, mortality, and health-care expenditures. Close to 1 million HF hospitalizations occur annually in the United States, with the majority of these resulting from worsening congestion in patients previously diagnosed with HF. An estimated 37.2 billion dollars is spent each year on HF in the United States. These statistics emphasize the need to develop and implement more effective strategies to assess, monitor, and treat HF. It has also become increasingly apparent that interventions geared towards identifying and monitoring sub-clinical congestion would be of value in the home management of chronic HF. Earlier identification and treatment of congestion together with improved care coordination, management of comorbid conditions, and enhanced patient self-management may help to prevent hospitalizations in patients with chronic HF. Such home monitoring extends from the promotion of self-care and home visitations, to telemedicine and remote monitoring of external or implantable devices. This paper will discuss the challenges in monitoring patients with HF, review clinical trials testing different monitoring strategies in HF, and highlight ongoing investigations into the optimal approaches to home monitoring for HF.

Bui, Anh L.; Fonarow, Gregg C.

2011-01-01

219

Heart failure with preserved ejection fraction.  

PubMed

Progressive aging of the population and prolongation of life expectancy have led to the rising prevalence of heart failure (HF). Despite the improvements in medical therapy, the mortality rate of this condition has remained unacceptably high, becoming the primary cause of death in the elderly population. Almost half of patients with signs and symptoms of HF are found to have a nearly normal ejection fraction, which delineates a distinct clinical syndrome, known as HF with preserved ejection fraction (HF-PEF). While early research focused on the importance of diastolic dysfunction, more recent studies reported the pathophysiological complexity of the disease with multiple cardiovascular abnormalities contributing to its development and progression. HF-PEF is a challenging major health problem with yet no solution as there is no evidence-based treatment which improves clinical outcomes. This review summarizes the state of current knowledge on diagnosis, prognosis and treatment of HF-PEF, with particular insights on the pathological characteristics in the elderly population. PMID:24454331

Rigolli, Marzia; Whalley, Gillian A

2013-12-01

220

Imaging heart failure: current and future applications.  

PubMed

A variety of cardiac imaging tests are used to help manage patients with heart failure (HF). This article reviews current and future HF applications for the major noninvasive imaging modalities: transthoracic echocardiography (TTE), single-photon emission computed tomography (SPECT), positron emission tomography (PET), cardiovascular magnetic resonance (CMR), and computed tomography (CT). TTE is the primary imaging test used in the evaluation of patients with HF, given its widespread availability and reliability in assessing cardiac structure and function. Recent developments in myocardial strain, 3-dimensional TTE, and echo contrast appear to offer superior diagnostic and prognostic information. SPECT imaging is a common method employed to detect ischemia and viability in patients with HF; however, PET offers higher diagnostic accuracy for both. Ongoing study of sympathetic and molecular imaging techniques may enable early disease detection, better risk stratification, and ultimately targeted treatment interventions. CMR provides high-quality information on cardiac structure and function and allows the characterization of myocardial tissue. Myocardial late gadolinium enhancement allows the determination of HF etiology and may predict patient outcomes and treatment response. Cardiac CT has become a reliable means for detecting coronary artery disease, and recent advances have enabled concurrent myocardial function, perfusion, and scar analyses. Overall, available imaging methods provide reliable measures of cardiac performance in HF, and recent advances will allow detection of subclinical disease. More data are needed demonstrating the specific clinical value of imaging methods and particularly subclinical disease detection in large-scale, clinical settings. PMID:23439018

Paterson, Ian; Mielniczuk, Lisa M; O'Meara, Eileen; So, Aaron; White, James A

2013-03-01

221

Renal function in advanced heart failure.  

PubMed

Despite recent advances with neurohormonal antagonists and devices, the prognosis of patients with advanced heart failure (HF) remains grave. Renal dysfunction is a common comorbid condition in HF and is associated with adverse outcomes. Current evidence indicates that intrinsic renal disease and inflammation in HF makes the kidney susceptible to hemodynamic compromise and congestion and contributes to a great extent to the development of renal dysfunction. Relief of congestion requires combination treatment with diuretics, neurohormonal antagonists, and occasionally vasodilators as well as inotropes. However, high doses of diuretics may accelerate the development of renal dysfunction by increasing neurohumoral activity and inducing renal structural and functional changes. Ultrafiltration should be reserved for patients with true diuretic resistance. Finally, early identification of the "patient at risk" remains a challenging issue and is limited by the currently used conventional parameters of renal function. However, novel biomarkers of acute kidney ischemia and/or injury are emerging and promise to become a diagnostic option for this patient population. PMID:21790968

Giamouzis, Gregory; Butler, Javed; Triposkiadis, Filippos

2011-01-01

222

Exercise training in chronic heart failure  

PubMed Central

The syndrome of heart failure (HF) is a growing epidemic that causes a significant socio-economic burden. Despite considerable progress in the management of patients with HF, mortality and morbidity remain a major healthcare concern and frequent hospital admissions jeopardize daily life and social activities. Exercise training is an important adjunct nonpharmacological treatment modality for patients with HF that has proven positive effects on mortality, morbidity, exercise capacity and quality of life. Different training modalities are available to target the problems with which HF patients are faced. It is essential to tailor the prescribed exercise regimen, so that both efficiency and safety are guaranteed. Electrical implanted devices and mechanical support should not exclude patients from exercise training; however, particular precautions and a specialized approach are advised. At least 50% of patients with HF, older than 65 years of age, present with HF with preserved ejection fraction (HFPEF). Although the study populations included in studies evaluating the effect of exercise training in this population are small, the results are promising and seem to support the idea that exercise training is beneficial for HFPEF patients. Both the short- and especially long-term adherence to exercise training remain a major challenge that can only be tackled by a multidisciplinary approach. Efforts should be directed towards closing the gap between recommendations and the actual implementation of training programmes.

Beckers, Paul; Vrints, Christiaan J.; Conraads, Viviane M.

2013-01-01

223

The management of acute heart failure.  

PubMed

Hospitalization for acute heart failure (AHF) is one of the burdensome aspects of 21st century medicine, leading to significant debilitating symptoms, high morbidity and mortality and consuming significant portion of the health care budget. Management of AHF is thought-provoking given the heterogeneity of the patient population, absence of a universally accepted definition, incomplete understanding of the pathophysiology and the beneficial and adverse effects of currently used therapies and lack of robust evidence-based guidelines. The article will discuss the clinical approach to the patients admitted with AHF, reviewing types of intervention (both approved and investigational) and will delineate their role and timing in specific AHF presentations. One of the challenges of AHF management is to effectively treat the subsets of patients with slow improvement or those with refractory AHF or early recurrence (worsening HF) during their initial admission. Unfortunately, the majority of these patients are at increased risk for subsequent complications and adverse outcomes. Therefore, considerable efforts in AHF management should be directed towards this population. Regretfully, to date no specific targeted therapy was proven beneficial for these patients, being one of the leading reasons for the lack of improvement in AHF outcomes over the last 30 years. PMID:20228726

Milo-Cotter, O; Bettari, L; Kleijn, L; Bugatti, S; Lombardi, C; Rund, M; Metra, M; Voors, A A; Cotter, G; Kaluski, E; Weatherley, B D

2010-03-01

224

Membrane Associated Matrix Proteolysis and Heart Failure  

PubMed Central

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

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

2014-01-01

225

Managing erectile dysfunction in heart failure.  

PubMed

Nowadays, erectile dysfunction (ED) is considered an increasingly important clinical condition in men with heart failure (HF) which may influence the therapeutic approach to these patients. Since there is cogent evidence that ED is a "sentinel marker" of acute cardiovascular events especially in men younger than 65 years or in those affected by type 2 diabetes mellitus, it deserves an early diagnosis and an appropriate treatment. In NYHA III-IV class HF patients, sexual activity could lead to acute cardiovascular events and this should be taken into account when approaching ED patients. Moreover, it is well known that some classes of drugs, normally employed in the treatment of HF patients (e.g.thiazide diuretics, spironolactone and ?-blockers), might worsen or even contribute to ED development. On the other hand, growing evidence suggests that PDE 5 inhibitors (vardenafil, tadalafil and sildenafil) seem to better satisfy the needs of NYHA HF I- II class men suffering from ED. In fact, they show few side effects, while improving both cardiopulmonary parameters and quality of life. Therefore, the aim of this review is to sum up the most recent evidence regarding the management of ED in men suffering from HF. PMID:23369145

Giagulli, V A; Moghetti, P; Kaufman, J M; Guastamacchia, E; Iacoviello, M; Triggiani, V

2013-03-01

226

Genomics, Transcriptional Profiling and Heart Failure  

PubMed Central

Associated with technological progress in DNA and mRNA profiling, advances in basic biology have led to a more complete and sophisticated understanding of interactions between genes, environment and affected tissues in the setting of complex and heterogeneous conditions like heart failure (HF). Ongoing identification of mutations causing hereditary hypertrophic and dilated cardiomyopathies has provided both pathophysiological insights and clinically applicable diagnostics for these relatively rare conditions. Genotyping clinical trial participants and genome wide association studies (GWAS) have accelerated the identification of much more common disease-modifying and treatment modifying genes that explain patient-to-patient differences that have long been recognized by practicing clinicians. At the same time, increasingly detailed characterization of gene expression within diseased tissues and circulating cells from animal models and patients are providing new insights into pathophysiology of HF that permit identification of novel diagnostic and therapeutic targets. In this rapidly evolving field, there is already ample support for the concept that genetic and expression profiling can enhance diagnostic sensitivity and specificity while providing a rational basis for prioritizing alternative therapeutic options in patients with cardiomyopathies and HF. Though the extensive characterizations provided by genomic and transcriptional profiling will increasingly challenge clinicians’ abilities to utilize complex and diverse information, advances in clinical information technology and user interfaces will permit greater individualization of prevention and treatment strategies to address the HF epidemic.

Margulies, Kenneth B.; Bednarik, Daniel P.; Dries, Daniel L.

2009-01-01

227

Anemia in heart failure: to treat or not to treat?  

PubMed

Anemia is a prevalent comorbidity in chronic heart failure (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 heart failure treatment. Recently, more specific therapies have been assessed, namely erythropoiesis-stimulating agents and iron supplementation therapy. Studies evaluating erythropoietin in heart failure 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 heart failure 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 Heart Failure (RED-HF), Iron Supplementation in Heart Failure Patients With Anemia (IRON-HF), and Ferinject Assessment in Patients With Iron Deficiency and Chronic Heart Failure (FAIR-HF) trials will determine the value of darbepoetin alfa and intravenous iron replacement therapy in anemic CHF patients. PMID:19026176

Mak, George; Murphy, Niamh F; McDonald, Kenneth

2008-12-01

228

[Impact of comorbidities for the treatment of heart failure].  

PubMed

Heart failure is frequently associated with comorbidities, either because of the etiology of heart failure, either because the prevalence of this disease is high in older age groups, who are affected by various pathologies. Hypertension, diabetes and renal failure are the most frequent comorbidities. They worsen the prognosis of heart failure, so their management should be precise. In all these situations, besides the specific treatment of the disease, the use of inhibitors of the renin angiotensin system is imperative, due to their proven efficacy in heart failure but also because they have beneficial effects on these co-morbidities. However, their use must be strictly monitored, clinically and biologically. In patients with chronic obstructive pulmonary disease, beta-blockers can be tried and their dose adjusted according to clinical tolerance; they are contraindicated in patients with asthma. Finally, and especially in older patients, the risk of drugs interactions is harmful and should be constantly looking for. PMID:21033494

Laperche, Thierry

2010-09-20

229

Frequency of low-risk hospital admissions for heart failure.  

PubMed

Heart failure is one of the most common reasons for admission to acute care hospitals. A proportion of these admissions are probably low risk and could be managed in subacute care facilities, resulting in substantial cost savings. To investigate the proportion of low-risk hospital admissions for heart failure, all admissions for heart failure to Vanderbilt University Medical Center between July 1993 and June 1995 were identified (n = 743). One hundred twenty of these admissions were randomly selected, reviewed, and classified into a high-risk versus low-risk group on admission based on the severity of heart failure and the presence of life-threatening complications. Of the 120 admissions, 57 (48%) were classified as high risk based on the presence of moderate to severe heart failure for the first time or recurrent heart failure with a major complicating factor. Sixteen admissions (28%) were associated with adverse outcomes, including myocardial infarction in 5 (9%), intubation in 6 (11%), and death in 4 (7%). Sixty-three admissions (52%) were classified as low risk based on the presence of new-onset mild heart failure or mild to moderate recurrent heart failure with no complicating factors. Most of these admissions were for dyspnea without any life-threatening complication; 57 (91%) had no evidence of interstitial or alveolar pulmonary edema, and arterial oxygen saturation averaged 95 +/- 3%. Only 3 of these low risk admissions (5%) were associated with an adverse cardiovascular event. None of the patients died. These data suggest that over half of the patients admitted for heart failure to an acute care facility are low risk and probably could be managed in a subacute care setting, resulting in large cost savings. PMID:9462604

Butler, J; Hanumanthu, S; Chomsky, D; Wilson, J R

1998-01-01

230

Heart failure among Indigenous Australians: a systematic review  

PubMed Central

Background Cardiovascular diseases contribute substantially to the poor health and reduced life expectancy of Indigenous Australians. Heart failure is a common, disabling, progressive and costly complication of these disorders. The epidemiology of heart failure 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 heart failure 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 heart failure 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 heart failure 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 heart failure 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 heart failure. Conclusions Despite the shortcomings of available published data, it is clear that Indigenous Australians have an excess burden of heart failure. 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 heart failure in Indigenous Australians is required to delineate accurate epidemiological indicators and to appraise health service provision.

2012-01-01

231

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

Microsoft Academic Search

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

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

232

The use of biomarkers in the patient with heart failure.  

PubMed

Heart failure is a major burden to the health care system in terms of not only cost, but also morbidity and mortality. Appropriate use of biomarkers is critically important to allow rapid identification and optimal risk stratification and management of patients with both acute and chronic heart failure. This review will discuss the biomarkers that have the most diagnostic, prognostic, and therapeutic value in patients with heart failure. We will discuss established biomarkers such as natriuretic peptides as well as emerging biomarkers reflective of myocyte stress, myocyte injury, extracellular matrix injury, and both neurohormonal and cardio-renal physiology. PMID:23644993

Chowdhury, Punam; Kehl, Devin; Choudhary, Rajiv; Maisel, Alan

2013-06-01

233

Congestive Heart Failure versus Inflammatory Carcinoma in Breast  

PubMed Central

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

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

2014-01-01

234

Hypertension as a risk factor for heart failure.  

PubMed

Hypertension remains a significant risk factor for development of congestive heart failure CHF), with various mechanisms contributing to both systolic and diastolic dysfunction. The pathogenesis of myocardial changes includes structural remodeling, left ventricular hypertrophy, and fibrosis. Activation of the sympathetic nervous system and renin-angiotensin system is a key contributing factor of hypertension, and thus interventions that antagonize these systems promote regression of hypertrophy and heart failure. Control of blood pressure is of paramount importance in improving the prognosis of patients with heart failure. PMID:24792121

Kannan, Arun; Janardhanan, Rajesh

2014-07-01

235

Sleep-disordered breathing in patients with heart failure.  

PubMed

Sleep-disordered breathing (SDB) is prevalent in patients with heart failure, and is associated with increased morbidity and mortality. SDB is proinflammatory, with nocturnal oxygen desaturations and hypercapnia appearing to play a pivotal role in the development of oxidative stress and sympathetic activation. Preliminary data suggest that attention to the diagnosis and management of SDB in patients with heart failure may improve outcomes. Ongoing research into the roles of comorbidities such as SDB as a treatment target may lead to better clinical outcomes and improved quality of life for patients with heart failure. PMID:24656103

Mentz, Robert J; Fiuzat, Mona

2014-04-01

236

Present and future pharmacotherapy for heart failure.  

PubMed

The pharmacotherapy currently recommended by the American College of Cardiology and the American Heart Association for heart failure (HF) is a diuretic, an angiotensin-converting enzyme inhibitor (ACEI), a beta-adrenoceptor antagonist and (usually) digitalis. This current treatment of HF may be improved by optimising the dose of ACEI used, as increasing the dose of lisinopril increases its benefits in HF. Selective angiotensin receptor-1 (AT(1)) antagonists are effective alternatives for those who cannot tolerate ACEIs. AT(1) antagonists may also be used in combination with ACEIs, as some studies have shown cumulative benefits for the combination. In addition to being used in Stage IV HF patients, in whom it has a marked benefit, spironolactone should be studied in less severe HF and in the presence of beta-blockers. The use of carvedilol, extended-release metoprolol and bisoprolol should be extended to severe HF patients as these agents have been shown to decrease mortality in this group. The ancillary properties of carvedilol, particularly antagonism at prejunctional beta -adrenoceptors, may give it additional benefits to selective beta(1)-adrenoceptor antagonists. Celiprolol and bucindolol are not the beta-blockers of choice in HF, as they do not decrease mortality. Although digitalis does not reduce mortality, it remains the only option for a long-term positive inotropic effect, as the long-term use of the phosphodiesterase inhibitors is associated with increased mortality. The calcium sensitising drug levosimendan may be useful in the hospital treatment of decompensated HF to increase cardiac output and improve dyspnoea and fatigue. The antiarrhythmic drug amiodarone should probably be used in patients at high risk of arrhythmic or sudden death, although this treatment may soon be superseded by the more expensive implanted cardioverter defibrillators, which are probably more effective and have fewer side effects. The natriuretic peptide nesiritide has recently been introduced for the hospital treatment of decompensated HF. Novel drugs that may be beneficial in the treatment of HF include the vasopeptidase inhibitors and the selective endothelin-A receptor antagonists but these require much more investigation. However, disappointing results have been obtained in a large clinical trial of the tumour necrosis factor alpha antagonist etanercept, where no likelihood of a difference between placebo and etanercept was observed. Small clinical trials with recombinant growth hormone to thicken ventricles in dilated cardiomyopathy have given variable results. PMID:12083991

Doggrell, Sheila A; Brown, Lindsay

2002-07-01

237

Optimized Treatment and Heart Rate Reduction in Chronic Heart Failure  

PubMed Central

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

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

2013-01-01

238

Expiratory Loading Improves Cardiac Output During Exercise In Heart Failure  

PubMed Central

Purpose To investigate the effect of changes in expiratory intrathoracic pressure (ITP) on stroke volume (SV) at rest and during moderate exercise in patients with heart failure vs. healthy individuals. Methods SV was obtained by echocardiography during spontaneous breathing and during expiratory loads of 5 and 10 cm H2O produced by a ventilator in 11 patients with heart failure (61±9 years, EF: 32±4%, NYHA class I-II) and 11 age-matched healthy individuals at rest and during exercise at 60% of aerobic capacity on a semi-recumbent cycle ergometer. Results At rest, expiratory loading did not change heart rate, SV index (SVI) or cardiac index (CI) in either group. During moderate exercise, expiratory loading increased SVI and CI in patients with heart failure, but decreased SVI and CI in healthy individuals. There was a negative correlation between changes in gastric pressure and SVI (r=?0.51, p<0.05) in healthy individuals, while there was a positive correlation between changes in gastric pressure accompanying expiratory loading and CI (r=0.83, p<0.01) in patients with heart failure. Conclusion Expiratory loading during moderate exercise elicited increases in SVI and CI in patients with heart failure but decreased SVI and CI in healthy individuals. Improvements in cardiac function during submaximal exercise in patients with heart failure may be caused by a beneficial reduction in LV preload.

Lalande, Sophie; Luoma, Charles E.; Miller, Andrew D.; Johnson, Bruce D.

2012-01-01

239

Therapeutic inhibition of tumour necrosis factor ? in patients with heart failure: cooling an inflamed heart  

Microsoft Academic Search

Heart failure 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, heart failure is associated with an inflammatory state that appears to have a detrimental effect on cardiac function and prognosis. This has led to the

P A Henriksen; D E Newby

2003-01-01

240

CONGESTIVE HEART FAILURE: WHERE HOMEOSTASIS BEGETS DYSHOMEOSTASIS  

PubMed Central

Despite today’s standard of care, aimed at containing homeostatic neurohormonal activation, 1 in every 5 patients recently hospitalized with congestive heart failure (CHF) will be readmitted within 30 days of discharge because of a recurrence of their symptoms and signs. In light of recent pathophysiologic insights, it is now propitious to revisit CHF with a view toward complementary and evolving management strategies. CHF is a progressive systemic illness. Its features include: oxidative stress in diverse tissues; an immunostimulatory state with circulating proinflammatory cytokines; a wasting of soft tissues; and a resorption of bone. Its origins are rooted in homeostatic mechanisms gone awry to beget dyshomeostasis. For example, marked excretory losses of Ca2+ and Mg2+ accompany renin-angiotensin-aldosterone system (RAAS) activation, causing ionized hypocalcemia and hypomagnesemia that lead to secondary hyperparathyroidism (SHPT) with consequent bone resorption and a propensity to atraumatic fractures. Parathyroid hormone (PTH) accounts for paradoxical intracellular Ca2+ overloading in diverse tissues and consequent systemic induction of oxidative stress. In cardiac myocytes and mitochondria these events orchestrate opening of the mitochondrial membrane permeability transition pore (mPTP) with an ensuing osmotic-based destruction of these organelles and resultant cardiomyocyte necrosis with myocardial scarring. Contemporaneous with Ca2+ and Mg2+ dyshomeostasis is hypozincemia and hyposelenemia, which compromise metalloenzyme-based antioxidant defenses while hypovitaminosis D threatens Ca2+ stores needed to prevent SHPT. An intrinsically coupled dyshomeostasis of intracellular Ca2+ and Zn2+, representing prooxidant and antioxidant, respectively, is integral to regulating mitochondrial redox state; it can be uncoupled by a Zn2+ supplement in favor of antioxidant defenses. Hence, the complementary use of nutriceuticals to nullify dyshomeostatic responses involving macro- and micronutrients should be considered. Evolving strategies with mitochondria-targeted interventions interfering with their uptake of Ca2+ or serving as selective antioxidant or mPTP inhibitor may also prove efficacious in the overall management of CHF.

Kamalov, German; Bhattacharya, Syamal K.; Weber, Karl T.

2010-01-01

241

Heart failure: the hidden problem of pain.  

PubMed

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

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

2009-11-01

242

Exercise Training and Heart Failure The Effects of Exercise Training on Sympathetic Neural Activation in Advanced Heart Failure A Randomized Controlled Trial  

Microsoft Academic Search

OBJECTIVES The goal of this study was to test the hypothesis that exercise training reduces resting sympathetic neural activation in patients with chronic advanced heart failure. BACKGROUND Exercise training in heart failure has been shown to be beneficial, but its mechanisms of benefit remain unknown. METHODS Sixteen New York Heart Association class II to III heart failure patients, age 35

Fabiana Roveda; Holly R. Middlekauff; Maria Urbana; P. B. Rondon; Soraya F. Reis; Marcio Souza; Luciano Nastari; Antonio Carlos; P. Barretto; Eduardo M. Krieger; Carlos Eduardo Negrao

2003-01-01

243

Achieving Medical Stability: Wives' Experiences With Heart Failure  

PubMed Central

The incidence of heart failure continues to rise as innovative treatments are developed. Despite life-prolonging interventions, morbidity and mortality in patients younger than 65 remain high. Few studies have focused on this younger cohort and/or their family caregivers as they navigate the complex illness trajectories manifested in heart failure. Instrumental case studies were employed to present exemplars for each of the five identified heart failure trajectories. Culling data from a longitudinal study of female spousal caregivers, each case study represents a wife’s discussion of caring for a husband (<65 years) in response to the husband’s changing heart failure trajectory. The goal of medical stability and the notion of uncertainty permeate throughout the case studies. Suggestions for supporting these wives are presented.

Hupcey, Judith E.; Fenstermacher, Kimberly; Kitko, Lisa; Penrod, Janice

2013-01-01

244

Hypertensive heart failure: patient characteristics, treatment, and outcomes  

Microsoft Academic Search

BackgroundAcute heart failure (AHF) is a common, poorly characterized manifestation of hypertensive emergency. We sought to describe characteristics, treatment, and outcomes of patients with severe hypertension complicated by AHF.

Frank Peacock; Alpesh Amin; Christopher B. Granger; Charles V. Pollack Jr; Phillip Levy; Richard Nowak; Kurt Kleinschmidt; Joe Varon; Allison Wyman; Joel M. Gore

2011-01-01

245

Resource use in decompensated heart failure by disease progression categories.  

PubMed

The purpose of this study was to quantify the total hospital resource use for decompensated heart failure according to disease progression categories. Clinical and cost information was obtained from an electronic data repository and chart review. During the 1-year period from June 2002 to June 2003, qualified patients were categorized based on disease progression as (1) new onset, (2) known heart failure, or (3) readmission. The primary outcome variables were total hospital resource use and resource use by services. Analysis of variance, Scheffé analysis for pairwise comparisons, and chi-square analysis were performed to determine differences among groups. Total hospitalization costs are similar whether it is a new diagnosis of heart failure, known diagnosis, or readmission. Among the 3 categories, 5 services contained statistically significant differences in costs (P<.05): echocardiography, electrophysiology, neurodiagnostic, nuclear cardiology, and pharmacy. Careful analysis of hospital resource use by services for heart failure patients provides opportunities for institutional cost containment. PMID:17268207

Kane-Gill, Sandra L; Seybert, Amy L; Lazar, Jessica; Shatzer, Melanie B; Saul, Melissa I; Kirisci, Levent; Murali, Srinivas

2007-01-01

246

Comorbid Heart Failure and Renal Impairment: Epidemiology and Management  

PubMed Central

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

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

2012-01-01

247

The Role of B-Cells in Heart Failure  

PubMed Central

Heart failure 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 heart failure 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 heart failure, and here we describe how the B-cell and B-cell-mediated pathways play specific roles in the heart failure 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

2013-01-01

248

Implantable Cardiovascular Sensors and Computers: Interventional Heart Failure Strategies  

PubMed Central

Despite evidence-based medical and pharmacologic advances the management of heart failure 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 heart failure in general. There may be a shift in the paradigm with respect to the treatment of heart failure, which may usher in an era of invasive heart failure 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.

Smith, Sakima A.; Abraham, William T.

2013-01-01

249

Implanted Defibrillators May Help Patients with Moderate Heart Failure  

MedlinePLUS

... heart failure, according to the American College of Cardiology. Implanted defibrillators have shown a benefit in patients ... co-author Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles. However, ...

250

Congestion is the driving force behind heart failure.  

PubMed

Increased filling pressures, or congestion, cause symptoms of heart failure and lead to hospitalizations. A higher rate of hospitalizations determines higher mortality. The most reliable way to decrease admissions is to monitor for signs of congestion, by history and exam, intracardiac pressures or biomarkers, and to modify treatment based on these data. The role of congestion is best understood by comparison of heart failure with preserved and reduced ejection fraction. The morbidity and mortality in both conditions is almost identical. Decreased cardiac output and ventricular remodeling play a major role in patients with decreased ejection fraction but not in those with preserved ejection fraction. The key factor that is present in both conditions and determines their similarity is congestion. Decongestion, or fluid removal, is the most effective treatment for heart failure regardless of ejection fraction. Being the driving force of heart failure, congestion should be the focus of clinical and hemodynamic monitoring and therapy. PMID:22699923

Guglin, Maya

2012-09-01

251

A Model of Palliative Care for Heart Failure  

PubMed Central

The heart failure illness trajectory is both complex and unpredictable, which makes providing palliative care services to patients with heart failure 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 heart failure 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 heart failure.

Hupcey, Judith E.; Penrod, Janice; Fenstermacher, Kimberly

2009-01-01

252

Effect of Chronic Changes in Heart Rate on Congestive Heart Failure  

Microsoft Academic Search

BackgroundHeart rate can affect cardiac function, but the importance of rates lower than 100 paced beats per minute is unknown. We therefore sought to evaluate the impact of different heart rates on ejection fraction, 6-minute walk, and peak oxygen consumption (VO2) in heart failure patients.

Krishnamurti Rao; Michael L. Fisher; Shawn Robinson; Stephen Shorofsky; Stephen S. Gottlieb

2007-01-01

253

End of Life Care in Advanced Heart Failure  

Microsoft Academic Search

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 heart failure, clinical setting (hospitalized vs outpatient), and family needs. My first goal is to prove intolerance\\u000a of traditional therapies for heart failure by challenging patients with various medication combinations, including staggered\\u000a dosing regimens and alternatives to

Eldrin F. Lewis

2011-01-01

254

Exaggerated Renal Vasoconstriction During Exercise in Heart Failure Patients  

Microsoft Academic Search

Background—During static exercise in normal healthy humans, reflex renal cortical vasoconstriction occurs. Muscle metaboreceptors contribute importantly to this reflex renal vasoconstriction. In patients with heart failure, in whom renal vascular tone is already increased at rest, it is unknown whether there is further reflex renal vasoconstriction during exercise. Methods and Results—Thirty-nine heart failure patients (NYHA functional class III and IV)

Holly R. Middlekauff; Egbert U. Nitzsche; Carl K. Hoh; Michele A. Hamilton; Gregg C. Fonarow; Antoine Hage; Jaime D. Moriguchi

255

Carvedilol for Heart Failure: Clinical Trials in Progress  

Microsoft Academic Search

Carvedilol is the first and currently the only beta- blocker licensed for use in heart failure. Consequently, it is the beta-blocker for which the greatest patient-years expe- rience exists. The total clinical trial experience reported so far with carvedilol in heart failure amounts to over 2,000 patients but currently trials of carvedilol are running that will include almost 10,000 more

James McGowan; Richard Murphy; John G. F. Cleland

1999-01-01

256

Short-stepping gait in severe heart failure  

Microsoft Academic Search

Background—Patients with severe chronic heart failure seem to take shorter steps than healthy controls when walking on a treadmill and when walking freely along a corridor. In healthy individuals the pattern of walking affects the oxygen cost of exercise, and so this observation might be relevant to the limitation of exercise in heart failure.Method—Length of stride was analysed as stride\\/stature

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

1992-01-01

257

Promises and pitfalls in cell replacement therapy for heart failure.  

PubMed

Symptomatic heart failure is a complex clinical syndrome with a poor prognosis. Many efforts have been made to develop new therapeutic strategies to improve prognosis associated with heart failure. 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. PMID:21180399

Krane, Markus; Wernet, Oliver; Wu, Sean M

2010-01-01

258

Sarcomere Gene Mutations in Hypertrophy and Heart Failure  

Microsoft Academic Search

Despite considerable progress in identifying and modifying risk factors that cause cardiovascular disease, heart failure has\\u000a emerged as an important medical and socioeconomic problem. Hypertrophic remodeling, a common response to many cardiovascular\\u000a disorders, increases the risk of heart failure. Discovery of the genetic basis of hypertrophic cardiomyopathy has allowed\\u000a consideration of whether these genes also contribute to pathologic remodeling that

Hiroyuki Morita; Ryozo Nagai; J. G. Seidman; Christine E. Seidman

2010-01-01

259

The role of race in heart failure therapy  

Microsoft Academic Search

Heart failure in blacks is a unique malady characterized by a different natural history, more worrisome prognosis, and potential\\u000a variances in the response to current medical therapy for heart failure. The overwhelming burden of hypertension as a putative\\u000a cause of left ventricular dysfunction identifies this illness. Although differences in the response to medical therapy have\\u000a been described, angiotensin-converting enzyme inhibitors

Clyde W. Yancy

2002-01-01

260

Are all ?-blockers the same for chronic heart failure?  

Microsoft Academic Search

ß-Adrenergic receptor blockade has been conclusively proven to increase survival and morbidity in patients with heart failure.\\u000a Hospitalization rate decreases and patients feel better after receiving ß-blockers. Furthermore, this benefit is observed\\u000a in a wide range of patients. The ß-blockers bisoprolol, metoprolol, and carvedilol have been extensively evaluated in heart\\u000a failure patients. These drugs all show marked benefit. Bucindolol, an

Stephen S. Gottlieb

2001-01-01

261

The role of race in heart failure therapy.  

PubMed

Heart failure in blacks is a unique malady characterized by a different natural history, more worrisome prognosis, and potential variances in the response to current medical therapy for heart failure. The overwhelming burden of hypertension as a putative cause of left ventricular dysfunction identifies this illness. Although differences in the response to medical therapy have been described, angiotensin-converting enzyme inhibitors and beta-blockers remain the most appropriate therapy. Certain genetic polymorphisms may exist that explain the observed differences. PMID:11960591

Yancy, Clyde W

2002-05-01

262

Racial Differences in Hospice Utilization for Heart Failure  

PubMed Central

Background Heart failure is the leading non-cancer hospice diagnosis and the leading cause of hospitalization among Medicare beneficiaries. Racial differences in hospice use are well documented for cancer but poorly described for heart failure. Methods Based on a national sample of 98,258 Medicare beneficiaries aged 66 and older on January 1, 2001 with a diagnosis of heart failure, who were not enrolled in hospice in 2000, we determined the effect of race/ethnicity on hospice entry for heart failure in 2001 after adjusting for sociodemographic, clinical, and geographic factors. Results In unadjusted analysis, Blacks (odds ratio [OR] = 0.52) and Hispanics (OR = 0.43) used hospice for heart failure less than Whites. Racial/ethic differences in hospice use for heart failure persisted after adjusting for markers of income, urbanicity, severity of illness, local density of hospice use, and medical comorbidity (adjusted odds ratio (AOR) for Blacks [AOR = 0.59 (95% confidence interval (CI), 0.47-0.73)], and for Hispanics [AOR = 0.49 (95% CI 0.37-0.66)], compared to Whites). Advanced age, greater comorbidity, emergency department visits, hospitalizations, and greater local density of hospice use were also associated with hospice utilization. Conclusions In a national sample of Medicare beneficiaries with heart failure, Blacks and Hispanics used hospice for heart failure less than Whites after adjustment for individual and market factors. This work extends the findings of racial and ethnic differences in hospice utilization to the leading non-cancer diagnosis. To understand the mechanisms underlying these findings, further examination of patient preferences and physician referral behavior are needed.

Givens, Jane L.; Tjia, Jennifer; Zhou, Chao; Emanuel, Ezekiel; Ash, Arlene S.

2010-01-01

263

High-output heart failure secondary to arteriovenous fistula.  

PubMed

In the hemodialysis patient population, a surgically created arteriovenous fistula is the preferred vascular access option. Development of high-output heart failure may be an underappreciated complication in patients who have undergone this procedure. When a large proportion of arterial blood is shunted from the left-sided circulation to the right-sided circulation via the fistula, the increase in preload can lead to increased cardiac output. Over time, the demands of an increased workload may lead to cardiac hypertrophy and eventual heart failure. Patients may present with the usual signs of high-output heart failure including tachycardia, elevated pulse pressure, hyperkinetic precordium, and jugular venous distension. Typically, the AV fistula is quite large and is likely located in the upper arm, more proximal to the heart. Routine access flow monitoring should demonstrate blood flows (Qa) >2000?ML/min. Echocardiogram may reveal either a low or high left ventricular ejection fraction, and right-heart catheterization demonstrates an elevated cardiac output with a low to normal systemic vascular resistance. When addressing the problem of high-output heart failure, the nephrologist is faced with the dilemma of preventing progression of heart failure at the expense of loss of vascular access. Nevertheless, treatment should be directed at correcting the underlying problem by surgical banding or ligation of the fistula. PMID:21223485

Stern, Adam B; Klemmer, Philip J

2011-01-12

264

Telemedicine and remote management of patients with heart failure.  

PubMed

Advances in telecommunication technologies have created new opportunities to provide telemedical care as an adjunct to medical management of patients with heart failure. Meta-analyses suggest that telemedicine can reduce morbidity and mortality in such patients; however, two prospective clinical trials not included in the analyses do not support these findings. Therefore, the effectiveness of telemedicine in heart failure is not established. Telemedicine approaches range from computer-based support systems to programmes led by nurses and physicians. Standardisation and appropriate classification of telemedical systems are needed to enable accurate interpretation of clinical trials. Here we propose a classification of four generations of telemedicine in heart failure. Not all approaches are the same and not every patient with heart failure will need telemedicine. Crisis prevention and treatment, and stabilisation and self-empowerment of patients are focuses of telemedicine in heart failure. The profile of patients who can potentially benefit from telemedicine is unknown and should be investigated in adequately powered randomised clinical trials. We are optimistic that telemedicine is an efficient approach and will become an important feature of management in heart failure. PMID:21856487

Anker, Stefan D; Koehler, Friedrich; Abraham, William T

2011-08-20

265

Protease Activated Receptor-2 Contributes to Heart Failure  

PubMed Central

Heart failure is a major clinical problem worldwide. Previous studies have demonstrated an important role for G protein-coupled receptors, including protease-activated receptors (PARs), in the pathology of heart hypertrophy and failure. Activation of PAR-2 on cardiomyocytes has been shown to induce hypertrophic growth in vitro. PAR-2 also contributes to myocardial infarction and heart remodeling after ischemia/reperfusion injury. In this study, we found that PAR-2 induced hypertrophic growth of cultured rat neonatal cardiomyocytes in a MEK1/2 and p38 dependent manner. In addition, PAR-2 activation on mouse cardiomyocytes increased expression of the pro-fibrotic chemokine MCP-1. Furthermore, cardiomyocyte-specific overexpression of PAR-2 in mice induced heart hypertrophy, cardiac fibrosis, inflammation and heart failure. Finally, in a mouse model of myocardial infarction induced by permanent ligation of the left anterior descending coronary artery, PAR-2 deficiency attenuated heart remodeling and improved heart function independently of its contribution to the size of the initial infarct. Taken together, our data indicate that PAR-2 signaling contributes to the pathogenesis of hypertrophy and heart failure.

Antoniak, Silvio; Sparkenbaugh, Erica M.; Tencati, Michael; Rojas, Mauricio; Mackman, Nigel; Pawlinski, Rafal

2013-01-01

266

Increased Myocardial NADPH Oxidase Activity in Human Heart Failure  

Microsoft Academic Search

OBJECTIVES This study was designed to investigate whether nicotinamide adenine dinucleotide 3-phosphate (reduced form) (NADPH) oxidase is expressed in the human heart and whether it contributes to reactive oxygen species (ROS) production in heart failure. BACKGROUND A phagocyte-type NADPH oxidase complex is a major source of ROS in the vasculature and is implicated in the pathophysiology of hypertension and atherosclerosis.

Christophe Heymes; Jennifer K. Bendall; Philippe Ratajczak; Alison C. Cave; Jane-Lise Samuel; Gerd Hasenfuss; Ajay M. Shah

2003-01-01

267

Calcification and fatigue failure in a polyurethane heart valve  

Microsoft Academic Search

The prosthetic heart valves were fabricated from a polyurethane containing a 4,4?-diphenylmethane diisocyanate hard segment, chain-extended with butanediol and with a polyether soft segment. The rate of calcification of these polyurethane heart valves was much slower in a dynamic in vitro test system than similar bioprosthetic heart valves. The calcified deposits were located exclusively at regions of material failure. Fourier

G. M. Bernacca; T. G. Mackay; R. Wilkinson; D. J. Wheatley

1995-01-01

268

Intrarenal effects of ecadotril during acute volume expansion in dogs with congestive heart failure.  

PubMed

Neutral endopeptidase 24.11 (NEP) inhibitors are known to have vascular, diuretic, and natriuretic effects that may be helpful in the treatment of congestive heart failure (CHF). Most NEP inhibitors may act principally through intrarenal mechanisms, which are not completely understood. The purpose of this study was to determine the principal renal effects of the NEP inhibitor ecadotril in dogs with progressive CHF induced by rapid ventricular pacing. Renal function was measured before, during, and after acute i.v. infusion of normal saline in a total of six dogs during normal cardiac function, early left ventricular dysfunction, and overt CHF. During overt CHF, each dog was treated with either ecadotril or placebo orally for 1 week. Parameters measured included glomerular filtration rate, renal blood flow, urine output, sodium clearance, sodium fractional excretion, and proximal and distal sodium reabsorption. Ecadotril treatment resulted in increased urine output, sodium clearance, and renal sodium excretion relative to placebo-treated controls. The principal intrarenal effect of ecadotril was decreased distal renal tubular sodium reabsorption. Both glomerular filtration rate and renal blood flow declined during overt CHF and were unaffected by ecadotril treatment. The results of this study are consistent with the principal action of ecadotril occurring by way of intrarenal events as opposed to changes in renal hemodynamics. The principal effect of ecadotril on distal tubular sodium reabsorption suggests that inhibition of NEP activity in the proximal renal tubules may allow increased binding of filtered atrial natriuretic peptide to natriuretic peptide receptor sites in the distal renal tubules and collecting ducts. PMID:10869402

Solter, P; Sisson, D; Thomas, W; Goetze, L

2000-06-01

269

Ventilation during exercise in chronic heart failure.  

PubMed

The ventilatory response to exercise in patients with chronic heart failure (CHF) is greater than normal for a given work or metabolic rate (VO2). The factors that determine the ventilatory response to exercise are: 1) the CO2 production (VCO2), 2) the arterial CO2 set-point (arterial PCO2 (PaCO2) at rest), 3) the physiological dead space/tidal volume ratio (VD/VT), and 4) the change in PaCO2 during exercise. This report illustrates how each of these factors might influence the ventilatory response to exercise in CHF patients. Thirty-one CHF patients (New York Heart Association, Classes 2 and 3) were studied, 18 from Harbor-UCLA Medical Center (cycle-ergometer exercise) and 13 from Queen's University at Belfast (treadmill exercise). A group of healthy subjects matched for size, age and gender served as control subjects. Minute ventilation (VE) was 48, 88 and 43% greater in the CHF groups compared to the control population at 6 min of the 25w and 60w cycle and low level (2.5 km h-1 and 5% grade) treadmill exercise, respectively. VO2 kinetics were slower in CHF patients than the control group, the slowing being proportional to the lactate increase. However, the increase in VO2 above rest at 6 min of exercise was approximately the same for CHF and control subjects. VCO2 at 6 min increased in the CHF patients by 7% and 34% for 25 and 60 watts cycle and 19% for treadmill exercise, respectively, compared to the control group. Because PaCO2 was not measured in this study, neither CO2 set-point nor the VD/VT could be individually calculated. Because end-tidal PCO2 will decrease when PaCO2 decreases or VD/VT increases, the combined effect of PaCO2 change and increase in VD/VT could be assessed from the difference between the patient and the control group. Since PETCO2 was significantly reduced in the patient population at the end of 60w cycle exercise (32 versus 41 mm Hg), either the VD/VT was increased and/or the PaCO2 was reduced. Because the resting PaCO2 is generally normal in CHF patients, the increase in the ventilatory response to exercise in patients with CHF can best be accounted for by three physiological mechanisms: 1) an increase in VCO2 secondary to CO2 release from bicarbonate as it buffers lactic acid, 2) the reduction in PaCO2 secondary to the lactic acidosis-induced hyperventilation, and 3) an increase in the fraction of breath that is wasted (dead space). Mathematically, these factors interact so that relatively small changes in each cause large changes in VE. PMID:8896738

Wasserman, K; Zhang, Y Y; Riley, M S

1996-01-01

270

Management of heart failure: evidence versus practice. Does current prescribing provide optimal treatment for heart failure patients?  

PubMed

Heart failure is an increasingly common and costly chronic disorder, with a rising prevalence of at least 2% in populations over the age of 45 years, mortality rates that are as poor as common solid cancers, and very high health care utilisation costs. Despite increased evidence supporting a range of effective interventions, predominantly therapeutic, there remain significant degrees of physician underperformance in terms of heart failure diagnosis and management. Until the early 1990s, the management of heart failure was largely confined to the symptomatic relief of patients with well established heart failure in fluid overload. The introduction of angiotensin-converting enzyme (ACE) inhibitors provided the first treatments that beneficially altered the prognosis of patients with the most common expression of heart failure, namely established systolic dysfunction, whether symptomatic or asymptomatic. Evidence has now extended these benefits to delaying progression of heart failure and reducing hospitalisation. Much of our understanding of the pathophysiology of heart failure stems from these studies. More recent data has clarified the limited role of digoxin, the important benefits of beta-blockade and aldosterone blockers as adjuvants to ACE inhibition, and the emerging evidence on angiotensin II antagonists. There are, in contrast to these positive findings, reliable data from Europe and North America revealing significant underperformance of primary care and hospital physicians in heart failure diagnosis and management, with evidence of underuse and underdosing of evidence-based therapies. Limited qualitative data suggest the reasons for this underperformance are complex and relate to lack of access to objective testing of ventricular function and exaggerated concerns over treatment risks and side-effects. Heart failure represents a complex cluster of aetiologies and risks that are not easy to correctly identify, even in specialist settings. Since there is now powerful evidence on how heart failure can be modified and improved, explicit guidance is needed for which suspected patients should be referred, for confirmation of diagnosis and advice on appropriate treatment regimes, and for which patients can be handled mainly within primary care but with enhanced access to objective non-invasive tests to improve diagnostic reliability and to stratify patients to evidence-based therapies. Current evidence suggests that in North America and Europe today primary care physicians do underperform in their management of patients with heart failure, often owing to factors outside of their immediate control. PMID:11050792

Hobbs, F D

2000-09-01

271

Non-histone lysine acetylated proteins in heart failure.  

PubMed

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 heart failure 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 heart failure, the Dahl salt-sensitive (SS) and spontaneously hypertensive heart failure 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 heart failure. 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 heart failure and raises the prospect that acetylations of mitochondrial proteins linked to reduced Sirt3 mediate, in part, metabolic changes in heart failure. PMID:22155497

Grillon, Jean Michel; Johnson, Keven R; Kotlo, Kumar; Danziger, Robert S

2012-04-01

272

How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology  

Microsoft Academic Search

Diastolic heart failure (DHF) currently accounts for more than 50\\\\% of\\u000a all heart failure patients. DHF is also referred to as heart failure\\u000a with normal Left ventricular (W) ejection fraction (HFNEF) to indicate\\u000a that HFNEF could be a precursor of heart failure 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

2007-01-01

273

Safety and Effects of Physical Training in Chronic Heart Failure: Results of the Chronic Heart Failure and Graded Exercise Study  

Microsoft Academic Search

Aims Physical training is considered to be safe and beneficial as part of the treatment in heart failure patients. Prospective, suYciently large studies are still needed to confirm this hypothesis. Methods In a prospective study, 80 patients with chronic heart failure class II and III (age, 56·6&8·3 years; left ventricular ejection fraction, 26·5&9·6%) were randomized to an endurance training group

R. P. Wielenga; I. A. Huisveld; E. Bol; P. H. J. M. Dunselman; R. A. M. Erdman; M. R. P. Baselier; W. L. Mosterd

1999-01-01

274

Development of Heart Failure in Chronic Hypertensive Dahl Rats Focus on Heart Failure With Preserved Ejection Fraction  

Microsoft Academic Search

The impact of hypertension on left ventricular (LV) structure, pump function, and heart failure in Dahl salt-sensitive rats is poorly characterized but hypothesized to yield insights into the pathophysiology of heart failure with normal or preserved ejection fraction. Eighty Dahl salt-sensitive rats were fed either a high-salt (HS) or low-salt (LS, controls) diet starting at age 7 weeks. Ventricular properties

Stefan Klotz; Ilan Hay; Geping Zhang; Mathew Maurer; Jie Wang; Daniel Burkhoff

2010-01-01

275

Use of pimobendan in feline congenital heart failure  

PubMed Central

A 6-month-old domestic shorthair cat was referred for evaluation of sudden lethargy and tachypnea following ovariohysterectomy. Upon failure of improvement with supportive care, a cardiologist identified congenital tricuspid dysplasia with signs of heart failure. Furosemide, enalapril, and pimobendan were used to reduce clinical signs and improve length and quality of life.

Wainberg, Shannon

2013-01-01

276

Cardiac Autonomic Nerve Stimulation in the Treatment of Heart Failure  

PubMed Central

Research on the therapeutic modulation of cardiac autonomic tone by electrical stimulation has yielded encouraging early clinical results. Vagus nerve stimulation has reduced the rates of morbidity and sudden death from heart failure, but therapeutic vagus nerve stimulation is limited by side effects of hypotension and bradycardia. Sympathetic nerve stimulation that has been implemented in the experiment may exacerbate the sympathetic-dominated autonomic imbalance. In contrast, concurrent stimulation of both sympathetic and parasympathetic cardiac nerves increases myocardial contractility without increasing heart rate. This review assesses the current state of electrical stimulation of the cardiac autonomic nervous system to treat heart failure.

Kobayashi, Mariko; Massiello, Alex; Karimov, Jamshid H.; Van Wagoner, David R.; Fukamachi, Kiyotaka

2014-01-01

277

Clinical outcome endpoints in heart failure trials: a European Society of Cardiology Heart Failure Association consensus document.  

PubMed

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 heart failure 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 heart failure trials. In an effort to address these issues, the Heart Failure Association of the European Society of Cardiology (HFA-ESC) convened a group of expert heart failure clinical investigators, biostatisticians, regulators, and pharmaceutical industry scientists (Nice, France, 12-13 February 2012) to evaluate the challenges of defining heart failure endpoints in clinical trials and to develop a consensus framework. This report summarizes the group's recommendations for achieving common views on heart failure 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; Piña, 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

2013-10-01

278

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

Microsoft Academic Search

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

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

2005-01-01

279

Dietary Fat and Heart Failure: Moving from Lipotoxicity to Lipoprotection  

PubMed Central

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

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

2012-01-01

280

Cardiac contractility modulation in patients with advanced heart failure.  

PubMed

Cardiac contractility modulation (CCM) is a novel device-based therapy for heart failure that involves applying electrical signals during the absolute refractory period of the myocardial action potential. This therapy has been shown to augment the strength of left ventricular contraction independent of myocardial oxygen consumption in animal models as well as human studies of patients with heart failure and reduced ejection fractions. The mechanism underlying CCM is an alteration of myocardial calcium handling in a fashion that extends beyond the traditional pharmacological effects of inotropic agents. Analysis of myocardial tissue from both animal models and human hearts treated by CCM demonstrates a shift of abnormally expressed genes towards normal function, positively affecting pathways involving proteins that regulate calcium cycling and myocardial contraction. CCM effects are proven to be independent of QRS duration; however, clinical studies to date have primarily focused on patients with normal QRS since cardiac resynchronization therapy is a well-established option for patients with heart failure and a prolonged QRS duration. Clinical trials show that CCM improves exercise tolerance, as measured by VO(2,peak) and quality of life, assessed by the Minnesota Living with Heart Failure Questionnaire. The device is currently available for the treatment of heart failure in Europe. Approval in the USA is pending additional testing currently underway using a protocol approved by the US FDA. PMID:23621145

Kahwash, Rami; Burkhoff, Daniel; Abraham, William T

2013-05-01

281

Potential of gene therapy as a treatment for heart failure  

PubMed Central

Advances in understanding the molecular basis of myocardial dysfunction, together with the evolution of increasingly efficient gene transfer technology, make gene-based therapy a promising treatment option for heart conditions. Cardiovascular gene therapy has benefitted from recent advancements in vector technology, design, and delivery modalities. There is a critical need to explore new therapeutic approaches in heart failure, and gene therapy has emerged as a viable alternative. Advances in understanding of the molecular basis of myocardial dysfunction, together with the development of increasingly efficient gene transfer technology, has placed heart failure within reach of gene-based therapy. The recent successful and safe completion of a phase 2 trial targeting the cardiac sarcoplasmic/endoplasmic reticulum Ca2+ ATPase pump (SERCA2a) has the potential to open a new era for gene therapy for heart failure.

Hajjar, Roger J.

2013-01-01

282

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology  

Microsoft Academic Search

Therapy has improved the survival of heart failure (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

2007-01-01

283

Congestive heart failure due to coral reef thoracoabdominal aorta.  

PubMed

Acquired coarctation due to coral reefs is a rare and unique entity characterized by extensively calcified thrombus of the entire aorta. There are few reports of coral reef aorta resulting in severely congestive heart failure in the literature. We describe a 60-year-old female with acute heart failure. Computed tomography (CT)-scan and magnetic resonance imaging (MRI) revealed that the cause of the heart failure was cardiac after-load mismatch due to serious stenosis of the aorta. In order to prevent cardio-respiratory failure, an axillofemoral bypass was performed to release the cardiac after-load mismatch. This diminished the pressure gradient between upper and lower blood pressure that caused cardiac dysfunction. PMID:21908885

Satsu, Takuma; Saga, Toshihiko; Kaneda, Toshio; Imura, Masato

2011-12-01

284

Sleeping Pill Use Tied to Poorer Survival for Heart Failure Patients  

MedlinePLUS

... a news release from the European Society of Cardiology. However, "given that many heart failure patients have ... Heart Failure Association and the European Society of Cardiology. SOURCES: Sean Pinney, M.D., director, Advanced Heart ...

285

Protective effect of oxymatrine on chronic rat heart failure.  

PubMed

Oxymatrine is one of the alkaloids extracted from the Chinese herb Sophora japonica (Sophora flavescens Ait.) with anti-inflammatory, immune reaction inhibiting, antiviral, and hepatocyte and antihepatic fibrosis protective activities. However, the effect of oxymatrine on heart failure is not yet known. In this study, the effect of oxymatrine on heart failure was investigated using a Sprague-Dawley rat model of chronic heart failure. Morphological findings showed that in the group treated with 50 and 100 mg/kg of oxymatrine; intermyofibrillar lysis disappeared, myofilaments were orderly, closely and evenly arranged; and mitochondria contained tightly packed cristae compared with the heart failure group. We investigated the cytosolic Ca(2+) transients and sarcoplasmic reticulum (SR) Ca(2+) content, and assessed the expression of ryanodine receptor (RyR2), SR-Ca(2+) ATPase (SERCA2a), and L-type Ca(2+) channel (dihydropyridine receptor, DHPR). We found that the cytosolic Ca(2+) transients were markedly increased in amplitude in the medium- (?F/F (0) = 26.22 ± 2.01) and high-dose groups (?F/F (0) = 29.49 ± 1.17) compared to the heart failure group (?F/F (0) = 12.12 ± 1.35, P < 0.01), with changes paralleled by a significant increase in the SR Ca(2+) content (medium-dose group: ?F/F (0) = 32.20 ± 1.67, high-dose group: ?F/F (0) = 32.57 ± 1.29, HF: ?F/F (0) = 17.26 ± 1.05, P < 0.01). Moreover, we demonstrated that the expression of SERCA2a and cardiac DHPR was significantly increased in the medium- and high-dose group compared with the heart failure rats. These findings suggest that oxymatrine could improve heart failure by improving the cardiac function and that this amelioration is associated with upregulation of SERCA2a and DHPR. PMID:21691940

Hu, Shu-Ting; Tang, Ying; Shen, Ya-Feng; Ao, Hai-Hang; Bai, Jie; Wang, Yong-Liang; Yang, Yong-Ji

2011-09-01

286

[Heart failure: the importance of a disease management program].  

PubMed

Heart failure remains a growing public health problem, hospitalizations represent the main cost component of heart failure care and the poor quality of life of patients is often worsened by frequent admissions. A multidisciplinary approach and specific disease management programs are a potentially useful instrument to reducing hospitalizations in heart failure patients. These concepts have recently been discussed in a consensus document by all the Scientific Societies involved in the care of heart failure patients. The effectiveness of intervention programs delivering continuity of care by a multidisciplinary team achieved a promising reduction in admissions, but the results of the studies have not been univocal for category of strategies and about the effect on survival. Telephone intervention significantly decreased heart failure admissions but not all-cause admissions and mortality. The multicenter randomized DIAL study, comparing a centralized telephone intervention program delivering continuity of care by a multidisciplinary team with usual care in patients with heart failure, confirms these findings. After a mean 16-month follow-up, there was a benefit mostly due to a significant reduction in admissions for heart failure, but mortality was similar in both groups. Data on 9000 patients from the IN-CHF registry show that hospitalizations are a serious problem in Italy: 44% of the patients had at least one hospitalization for heart failure in the year prior to the entry visit and this is the most powerful independent predictor of rehospitalization during the follow-up. Nearly a quarter of the population with follow-up data availability (92%) has been rehospitalized in the year after enrollment; patients in advanced functional class (32.1% hospitalization rate) and with ischemic etiology (25.0%) are more likely to be hospitalized than those in NYHA class I-II and without ischemic etiology. In a survey carried out recently in Italy, in 1152 patients admitted for decompensated heart failure, readmission rate was even higher: more than 40% of patients have been readmitted once in the 6 months after discharge and 7.2% had two or more admissions. PMID:17633908

Fabbri, Gianna; Gorini, Marco; Maggioni, Aldo P; Oliva, Fabrizio

2007-06-01

287

Oxidative remodeling in pressure overload induced chronic heart failure.  

PubMed

Despite extensive strides in understanding pressure overload induced heart failure, there is very little known about oxidative stress induced matrix metalloproteinase (MMP) activation, collagen degradation and remodeling in pressure overload heart failure. We hypothesize that pressure overload leads to redox imbalance causing increased expression/activity of MMP-2/9 producing collagen degradation and heart failure. To test this hypothesis, we created pressure overload heart failure 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 heart failure. PMID:17306621

Henderson, Brooke C; Tyagi, Neetu; Ovechkin, Alexander; Kartha, Ganesh K; Moshal, Karni S; Tyagi, Suresh C

2007-05-01

288

Beta-adrenergic blocker mortality trials in congestive heart failure.  

PubMed

Many of the current discussions of beta-adrenergic blocker therapy in patients with congestive heart failure have used fairy tales to describe the evolution of this treatment from contraindication to standard of care. This article reviews the early studies that initiated this revolution in heart failure therapy and discusses the major mortality trials that have demonstrated that these agents improve survival and limit the progression of congestive heart failure. These major trials have used 1 of 4 beta blockers (metoprolol, bisoprolol, carvedilol, or bucindolol) in varying study designs with different patient populations. Each trial had different objectives and limitations, and these are described in the context of their impact on proving a survival benefit. In addition, the specific effect of beta-blocker therapy on sudden death in patients with heart failure is briefly discussed. The weight of these trials suggests that beta-adrenergic blocker therapy can save 1 life of every 35 patients treated in patients with mild-to-moderate heart failure. The data are compelling and the techniques for "starting low and going slow" with titrations have been well documented. PMID:10568667

Teerlink, J R; Massie, B M

1999-11-01

289

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

PubMed Central

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

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

2014-01-01

290

Effect of Chronic Renal Failure on Heart  

Microsoft Academic Search

This study examined the effects of chronic renal failure in rats with and without parathyroid glands on myocardial energy production, transfer and utilization as well as on cardiac index. Chronic renal failure was produced by 7\\/8 nephrectomy in rats weighing between 240 and 350 g with intact parathyroid glands (CRF-control) and in parathyroidectomized (CRF-PTX) rats maintained normocalcemic. The data were

Sami El-Belbessi; Nachman Brautbar; Kenneth Anderson; Vito M. Campese; Shaul G. Massry

1986-01-01

291

Diesel Exhaust Inhalation Increases Cardiac Output, Bradyarrhythmias, and Parasympathetic Tone in Aged Heart Failure-Prone Rats  

PubMed Central

Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heart failure. 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 heart failure–prone rats without signs or symptoms of overt heart failure. 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 heart failure rats (16 months) were exposed once to whole DE (4h, target PM2.5 concentration: 500 µg/m3) 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.

Farraj, Aimen K.

2013-01-01

292

Diesel exhaust inhalation increases cardiac output, bradyarrhythmias, and parasympathetic tone in aged heart failure-prone rats.  

PubMed

Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heart failure. 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 heart failure-prone rats without signs or symptoms of overt heart failure. 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 heart failure 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

2013-02-01

293

[Role of beta-blockers in the treatment of chronic heart heart failure].  

PubMed

Role of beta-blockers in the treatment of chronic heart failure has been changed over a 25-year period from contraindication to an established indication. To date, controlled clinical trials performed in more than 13,000 patients with chronic heart failure have consistently shown that the long term administration of beta-blockers is associated with significant improvement in left ventricular function, clinical symptoms, and survival. This favorable clinical trial experiences support a recommendation that beta-blockers should be used in all heart failure patients with stable symptoms due to left ventricular systolic dysfunction unless contraindicated. Ongoing beta-blocker studies address further new topics, such as treatment of elderly patients and direct comparison of different agents. Although, the use of beta-blockers for heart failure tends to increase, implementation of the experiences from the clinical trials to the everyday practice still remains a challenge. PMID:11582731

Czuriga, I; Edes, I

2001-09-16

294

Processed Red Meat Linked to Higher Risk of Heart Failure, Death in Men  

MedlinePLUS

... death in men American Heart Association Rapid Access Journal Report June 12, 2014 Categories: Heart News Study ... in Circulation: Heart Failure , an American Heart Association journal. Processed meats are preserved by smoking, curing, salting ...

295

Targeted deletion of Dicer in the heart leads to dilated cardiomyopathy and heart failure  

Microsoft Academic Search

Cardiovascular disease is the leading cause of human morbidity and mortality. Dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy associated with heart failure. Here, we report that cardiac-specific knockout of Dicer, a gene encoding a RNase III endonuclease essential for microRNA (miRNA) processing, leads to rapidly progressive DCM, heart failure, and postnatal lethality. Dicer mutant mice show misexpression

Jian-Fu Chen; Elizabeth P. Murchison; Ruhang Tang; Thomas E. Callis; Mariko Tatsuguchi; Zhongliang Deng; Mauricio Rojas; Scott M. Hammond; Michael D. Schneider; Craig H. Selzman; Gerhard Meissner; Cam Patterson; Gregory J. Hannon; Da-Zhi Wang

2008-01-01

296

Myofibrillar remodelling in cardiac hypertrophy, heart failure and cardiomyopathies  

PubMed Central

BACKGROUND A wide variety of pathological conditions have been shown to result in cardiac remodelling and myocardial dysfunction. However, the mechanisms of transition from adaptive to mal-adaptive alterations, as well as those for changes in cardiac performance leading to heart failure, are poorly understood. OBSERVATIONS Extensive studies have revealed a broad spectrum of progressive changes in subcellular structures and function, as well as in signal transduction and metabolism in the heart, among different cardiovascular disorders. The present review is focused on identifying the alterations in molecular and biochemical structure of myofibrils (myofibrillar remodelling) in hypertrophied and failing myocardium in different types of heart diseases. Numerous changes at the level of gene expression for both contractile and regulatory proteins have already been reported in failing hearts and heart diseases; these changes are potential precursors for heart failure such as cardiac hypertrophy and cardiomyopathies. Myofibrillar remodelling, as a consequence of proteolysis, oxidation, and phosphorylation of some functional groups in both contractile and regulatory proteins in hearts failing due to different etiologies, has also been described. CONCLUSIONS Although myofibrillar remodelling appears to be associated with cardiac dysfunction, alterations in both contractile and regulatory proteins are dependent on the type and stage of heart disease.

Machackova, Jarmila; Barta, Judit; Dhalla, Naranjan S

2006-01-01

297

Hyponatremia and heart failure--pathophysiology and implications.  

PubMed

Fluid and electrolyte disturbances are a common feature of heart failure. Among the electrolyte disturbances that occur in heart failure, disorders of potassium and magnesium have traditionally received the most attention. Abnormalities involving either of these actions serve as risk factors for sudden cardiac death/arrhythmias. More recently, a growing appreciation has emerged for the importance of hyponatremia in the heart failure patient. Hyponatremia is multifactorial in origin, and its presence correlates with disease severity and outcome. There are few effective therapies for hyponatremia, and those that are available are not viewed as offering specific survival benefits per se. The recent availability of vasopressin receptor antagonists, however, offers a different approach to the management of this complex electrolyte disturbance, but one that is still evolving as to the scope of its clinical benefits. PMID:16230871

Sica, Domenic A

2005-01-01

298

Vasodilator treatment for acute and chronic heart failure.  

PubMed Central

The current status of the use of vasodilator drugs in the treatment of acute and chronic heart failure has been reviewed. It is apparent that vasodilator treatment can be used effectively in some patients with heart failure with a beneficial haemodynamics response, and that vasodilator agents are likely to find an important place in the management of such patients. Vasodilator treatment may be associated with complications and must be used with care. Though several nonparenteral vasodilator agents have been investigated, no ideal drug is yet available for the treatment of chronic heart failure. Nevertheless, it is probable that suitable drugs will emerge and find an important place in the management of such patients. Images

Chatterjee, K; Parmley, W W

1977-01-01

299

Heart failure research: translating basic science into therapies.  

PubMed

Congestive heart failure is a syndrome characterized by decreased cardiac output with consequent neurohormonal activation leading to water and salt retention. This ultimately results in pulmonary and vascular congestion with eventual organ hypoperfusion and death. Often described as a "vicious cycle", congestive heart failure is responsible for more than 40,000 deaths per year in the United States and plays a substantial role in another 250,000 deaths; it takes a financial toll as well, with approximately $34 billion spent each year on the medical care of patients. The key to ending this vicious cycle is applied research. The Department of Cardiology within The Methodist Hospital is conducting research aimed at understanding heart failure and working towards therapies to improve patient care. PMID:20308962

Youker, Keith; Torre-Amione, Guillermo

2009-01-01

300

Cytokine mediation of experimental heart failure-induced anhedonia.  

PubMed

Immune system dysfunction is hypothesized to influence several disease states, including cardiovascular disease and psychological depression. The comorbidity of depression and coronary artery disease may be influenced by immune system-brain interactions involving proinflammatory cytokines. The present studies evaluated an index of depression in a rodent model of heart failure by measuring responses to rewarding electrical brain stimulation, which provides an experimental procedure to operationally define anhedonia in rats. Heart failure led to a rightward shift in the current-response relationship in the brain stimulation paradigm, indicative of reduced rewarding properties of the brain stimulation (i.e., anhedonia). Acute treatment with a tumor necrosis factor antagonist, etanercept, reduced circulating tumor necrosis factor- levels in rats with heart failure and restored responding for electrical brain stimulation. The current findings have implications for the study of pathophysiological mechanisms underlying the association of cardiovascular disease and depression. PMID:12611391

Grippo, Angela J; Francis, Joseph; Weiss, Robert M; Felder, Robert B; Johnson, Alan Kim

2003-03-01

301

Why does congenital heart disease cause failure to thrive?  

PubMed Central

Metabolisable energy intake, determined by bomb calorimetry of food, vomit, stool and urine, and resting metabolism, assessed by respiratory gas exchange, were studied in 21 infants with congenital heart disease and nine control infants. Weight for age, growth rates, and daily metabolisable energy intake per kg tended to be lower in infants with heart disease than in control infants. Resting oxygen consumption was high in those infants with pulmonary hypertension and persistent cardiac failure. Energy intake, as a percentage of that recommended for age, correlated with weight gain, and resting oxygen consumption correlated inversely with both percentage body mass index and relative fatness. Failure to thrive in infants with congenital heart disease may be due to a combination of low energy intakes and, in some cases, high energy requirements allowing insufficient energy for normal growth. Increasing the energy intakes of infants with congenital heart disease may be a way of improving their growth.

Menon, G; Poskitt, E M

1985-01-01

302

Potential of resveratrol in the treatment of heart failure.  

PubMed

The concept of food has expanded beyond its traditional role of survival and hunger satisfaction, to include a role in the prevention and treatment of disease. Polyphenols are classes of compounds that are synthesized by plants to serve a wide variety of functions including growth pollination and defense. These compounds have recently received increased attention in medical research. In this group, one of the most studied has been resveratrol (3,5,4,-trihydroxystilbene), a polyphenol, which is found predominantly in grapes and berries. Over the past two decades, researchers have studied the ability of resveratrol to prevent or reverse the development of abnormalities in heart structure and function in animal models of heart disease and heart failure. The results from animal studies have been promising, and very recently, this knowledge has been translated into examining the efficacy of resveratrol in humans with heart disease/failure. In this review we will discuss the current status of resveratrol research on cardioprotection. PMID:24361400

Raj, Pema; Louis, Xavier Lieben; Thandapilly, Sijo Joseph; Movahed, Ali; Zieroth, Shelley; Netticadan, Thomas

2014-01-30

303

Crosstalk of the heart and periphery: skeletal and cardiac muscle as therapeutic targets in heart failure.  

PubMed

Heart failure syndrome is initiated as the body's metabolic needs temporarily exceed the pumping capacity of the heart. In most cases, this phenomenon tends to occur during physical exercise. Although not always subjectively recognized, limited exercise capacity remains the clinical hallmark of congestive heart failure. It can be measured objectively as reduced skeletal muscle performance and maximal whole-body oxygen uptake, which are not necessarily explained by central haemodynamic abnormalities. In fact, the initial cardiac condition sets forth a series of peripheral adaptations that are potentially life-saving during acute decompensation but become disadvantageous and symptom-generating in stable heart failure. Inodilator drugs were theoretically ideal to revert the adverse haemodynamic crosstalk between the heart and periphery. However, these drugs failed to improve prognosis in congestive heart failure, whereas drugs that did so showed typically unimpressive haemodynamic effects. Exercise therapy has recently emerged as a safe and effective way to enhance physical performance and subjective well-being in congestive heart failure. A dual therapeutic approach is suggested, consisting of exercise training to improve the periphery and the use of cardioprotective drugs to limit cardiac cellular damage from neurohormonal activation. PMID:9375991

Gordon, A; Voipio-Pulkki, L M

1997-08-01

304

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

Microsoft Academic Search

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

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

1999-01-01

305

Systematic review of multidisciplinary interventions in heart failure  

PubMed Central

Objective: To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure. Design: Systematic review. Thirteen databases were searched and reference lists from included trials and related reviews were checked. Trial authors were contacted if further information was required. Setting: Randomised controlled trials conducted in both hospital and community settings. Patients: Trials were included if all, or a defined subgroup of patients, had a diagnosis of heart failure. Interventions: Multidisciplinary interventions were defined as those in which heart failure management was the responsibility of a multidisciplinary team including medical input plus one or more of the following: specialist nurse, pharmacist, dietician, or social worker. Interventions were separated into four mutually exclusive groups: provision of home visits; home physiological monitoring or televideo link; telephone follow up but no home visits; and hospital or clinic interventions alone. Pharmaceutical and exercise based interventions were excluded. Main outcome measures: All cause hospital admission, all cause mortality, and heart failure hospital admission. Results: 74 trials were identified, of which 30 contained relevant data for inclusion in meta-analyses. Multidisciplinary interventions reduced all cause admission (relative risk (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95, p ?=? 0.002), although significant heterogeneity was found (p ?=? 0.002). All cause mortality was also reduced (RR 0.79, 95% CI 0.69 to 0.92, p ?=? 0.002) as was heart failure admission (RR 0.70, 95% CI 0.61 to 0.81, p < 0.001). These results varied little with sensitivity analyses. Conclusion: Multidisciplinary interventions for heart failure reduce both hospital admission and all cause mortality. The most effective interventions were delivered at least partly in the home.

Holland, R; Battersby, J; Harvey, I; Lenaghan, E; Smith, J; Hay, L

2005-01-01

306

Intravenous Iron in Heart Failure: Beyond Targeting Anemia  

Microsoft Academic Search

Iron deficiency is commonly seen in congestive heart failure (CHF) in both anemic and nonanemic patients. In six studies in\\u000a which these iron-deficient patients with CHF were treated with intravenous (IV) iron, five found an improvement in the hemoglobin.\\u000a In uncontrolled and controlled studies, the New York Heart Association (NYHA) class, quality of life, and exercise capacity\\u000a were improved consistently

Donald S. Silverberg; Adrian Iaina; Doron Schwartz; Dov Wexler

2011-01-01

307

Management of heart failure patients using telemedicine communication systems  

Microsoft Academic Search

Heart failure (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

2006-01-01

308

UTA Urea Transporter Protein in Heart Increased Abundance During Uremia, Hypertension, and Heart Failure  

Microsoft Academic Search

Urea transporters have been cloned from kidney medulla (UT-A) and erythrocytes (UT-B). We determined whether UT-A proteins could be detected in heart and whether their abundance was altered by uremia or hypertension or in human heart failure. In normal rat heart, bands were detected at 56, 51, and 39 kDa. In uremic rats, the abundance of the 56-kDa protein increased

Rafael Duchesne; Janet D. Klein; Jeffrey B. Velotta; John J. Doran; Patricia Rouillard; Brian R. Roberts; Alicia A. McDonough; Jeff M. Sands

2010-01-01

309

Ventricular repolarization in a rat model of global heart failure.  

PubMed

Isoproterenol in high doses induces infarction-like myocardial damage and structural and functional remodelling of the ventricular myocardium. The purpose of the present study was to investigate ventricular repolarization in a rat model of isoproterenol-induced heart failure. Isoproterenol was administered twice to female Wistar rats (170 mg/kg, s.c., 24 h apart). Four weeks after the injections, cardiac output was measured and unipolar epicardial ventricular electrograms were recorded in situ. Activation-recovery intervals were calculated to assess repolarization. Histological examination of the heart ventricles was also performed. Heart failure in rats treated with isoproterenol was indicated by myocardial histopathological damage and reduced cardiac output. In rats with heart failure, the regional differences in activation-recovery interval prolongation over the ventricular epicardium resulted in increasing heterogeneity in the activation-recovery interval distribution and increasing repolarization heterogeneity of the ventricular subepicardium. Myocardial damage and haemodynamic changes in heart failure induced by isoproterenol were accompanied by significant changes in ventricular repolarization, which were not associated with myocardial hypertrophy. PMID:23647125

Krandycheva, Valeria; Kharin, Sergey; Strelkova, Marina; Shumikhin, Konstantin; Sobolev, Aleksey; Shmakov, Dmitry

2013-07-01

310

Heart failure in which coronary spasms played an important role.  

PubMed

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

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

2014-01-01

311

Changes in renal function in congestive heart failure.  

PubMed

Both cardiovascular and renal diseases are common and frequently coexist in the same patient. Indeed, renal dysfunction has been shown to be a more powerful independent predictor of poor outcomes in heart failure (HF) than left ventricular ejection fraction or functional class. Furthermore, acute kidney injury is a frequent therapeutic concern in heart failure. Consequently, there has been much interest in developing new renoprotective treatments and novel biomarkers to monitor renal function. Additionally, given the crucial cardiorenal interaction and interdependence, the concept of a cardiorenal syndrome with five different subtypes has been advanced to better categorize patients and facilitate research. PMID:24158384

Boerrigter, Guido; Hocher, Berthold; Lapp, Harald

2013-12-01

312

Leukocyte behavior in atherosclerosis, myocardial infarction, and heart failure  

PubMed Central

Cardiovascular diseases claim more lives worldwide than any other. Etiologically, the dominant trajectory involves atherosclerosis, a chronic inflammatory process of lipid-rich lesion growth in the vascular wall that can cause life-threatening myocardial infarction (MI). Those who survive MI can develop congestive heart failure, a chronic condition of inadequate pump activity that is frequently fatal. Leukocytes – white blood cells – are important participants at the various stages of cardiovascular disease progression and complication. This review will discuss leukocyte function in atherosclerosis, myocardial infarction, and heart failure.

Swirski, Filip K.; Nahrendorf, Matthias

2013-01-01

313

Leukocyte behavior in atherosclerosis, myocardial infarction, and heart failure.  

PubMed

Cardiovascular diseases claim more lives worldwide than any other. Etiologically, the dominant trajectory involves atherosclerosis, a chronic inflammatory process of lipid-rich lesion growth in the vascular wall that can cause life-threatening myocardial infarction (MI). Those who survive MI can develop congestive heart failure, a chronic condition of inadequate pump activity that is frequently fatal. Leukocytes (white blood cells) are important participants at the various stages of cardiovascular disease progression and complication. This Review will discuss leukocyte function in atherosclerosis, MI, and heart failure. PMID:23307733

Swirski, Filip K; Nahrendorf, Matthias

2013-01-11

314

Beta blocker therapy in African American patients with heart failure.  

PubMed

Data from a number of clinical trials of beta blocker therapy in heart failure, although limited in the size of African American patients included, suggest that they achieve a similar benefit as Caucasians. African Americans were usually at higher risk when enrolled in all of these studies with a higher incidence of hypertension and diabetes mellitus. The only exception is the Beta Blocker Evaluation of Survival Trial (BEST) that studied the efficacy of Bucindolol in heart failure. In that study there appeared to be a unique differential effect in African Americans compared to Caucasians which may have been in part related to the severity of the disease. PMID:15516864

Goldstein, Sidney

2004-04-01

315

Ultrastructural and cellular basis for the development of abnormal myocardial mechanics during the transition from hypertension to heart failure.  

PubMed

Although the development of abnormal myocardial mechanics represents a key step during the transition from hypertension to overt heart failure (HF), the underlying ultrastructural and cellular basis of abnormal myocardial mechanics remains unclear. We therefore investigated how changes in transverse (T)-tubule organization and the resulting altered intracellular Ca(2+) cycling in large cell populations underlie the development of abnormal myocardial mechanics in a model of chronic hypertension. Hearts from spontaneously hypertensive rats (SHRs; n = 72) were studied at different ages and stages of hypertensive heart disease and early HF and were compared with age-matched control (Wistar-Kyoto) rats (n = 34). Echocardiography, including tissue Doppler and speckle-tracking analysis, was performed just before euthanization, after which T-tubule organization and Ca(2+) transients were studied using confocal microscopy. In SHRs, abnormalities in myocardial mechanics occurred early in response to hypertension, before the development of overt systolic dysfunction and HF. Reduced longitudinal, circumferential, and radial strain as well as reduced tissue Doppler early diastolic tissue velocities occurred in concert with T-tubule disorganization and impaired Ca(2+) cycling, all of which preceded the development of cardiac fibrosis. The time to peak of intracellular Ca(2+) transients was slowed due to T-tubule disruption, providing a link between declining cell ultrastructure and abnormal myocardial mechanics. In conclusion, subclinical abnormalities in myocardial mechanics occur early in response to hypertension and coincide with the development of T-tubule disorganization and impaired intracellular Ca(2+) cycling. These changes occur before the development of significant cardiac fibrosis and precede the development of overt cardiac dysfunction and HF. PMID:24186100

Shah, Sanjiv J; Aistrup, Gary L; Gupta, Deepak K; O'Toole, Matthew J; Nahhas, Amanda F; Schuster, Daniel; Chirayil, Nimi; Bassi, Nikhil; Ramakrishna, Satvik; Beussink, Lauren; Misener, Sol; Kane, Bonnie; Wang, David; Randolph, Blake; Ito, Aiko; Wu, Megan; Akintilo, Lisa; Mongkolrattanothai, Thitipong; Reddy, Mahendra; Kumar, Manvinder; Arora, Rishi; Ng, Jason; Wasserstrom, J Andrew

2014-01-01

316

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

PubMed Central

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

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

2014-01-01

317

Congestive Heart Failure and Diabetes: Balancing Glycemic Control with Heart Failure Improvement  

PubMed Central

Diabetes and congestive heart failure (HF) commonly coexist in the same patient, and the presence of diabetes in HF patients is associated with increased adverse events compared to patients without diabetes. Recent guidelines regarding glycemic control stress individualization of glycemic therapy based on patient comorbid conditions and potential adverse effects of medical therapy. This balance in glycemic control may be particularly relevant in patients with diabetes and HF. In this review, we address data regarding the influence that certain HF medications may have on glycemic control. Despite potential modest changes in glycemic control, clinical benefits of proven pharmacologic HF therapies extend to patients with diabetes and HF. In addition, we review potential benefits and challenges associated with commonly used glycemic medications in HF patients. Finally, recent data and controversies on optimal glycemic targets in HF patients are discussed. Given the large number of patients with diabetes and HF and the health burden of these conditions, much needed future work is necessary to define the optimal glycemic treatment in HF patients with diabetes.

Nasir, Saifullah; Aguilar, David

2012-01-01

318

Cardiac Resynchronization Therapy in Asymptomatic or Mildly Symptomatic Heart Failure Patients  

Microsoft Academic Search

Opinion statement  Heart failure is a constantly progressing disease involving patients with ischemic and nonischemic cardiac disease. Cardiac\\u000a resynchronization therapy (CRT) has been used successfully in patients with severe heart failure symptoms, poor left ventricular\\u000a (LV) function, and a prolonged QRS duration. Large trials in patients with New York Heart Association (NYHA) class III\\/IV\\u000a heart failure have demonstrated that heart failure

Helmut U. Klein

2010-01-01

319

Ammonia response to exercise in patients with congestive heart failure.  

PubMed Central

OBJECTIVE: To assess energy depletion in skeletal muscle in patients with congestive heart failure by measuring blood purine metabolites during exercise and, at the same time, determine the implications of the ammonia response to exercise in these patients. SETTING: Tottori University Hospital, Yonago, Japan. PATIENTS: 49 heart failure patients (New York Heart Association (NYHA) grades I-III) and 16 normal subjects. MAIN OUTCOME MEASURES: Blood lactate, ammonia, and hypoxanthine levels were measured during exercise with expired gas analysis. RESULTS: In normal exercising subjects as well as in each heart failure subgroup, the ammonia threshold was significantly higher than both the lactate threshold [control: 21.8 (SD 5.3) v 17.4 (3.3) ml/kg/min; NYHA class I: 18.9 (3.8) v 15.5 (2.6); class II: 14.8 (2.5) v 12.7 (2.4); class III: 13.5 (2.6) v 11.8 (2.5)] and the ventilatory threshold (P < 0.01). The difference between the ammonia and lactate thresholds was noted in all normal subjects and in all heart failure patients. The ammonia threshold, however, was significantly lower in heart failure patients than in normal subjects and it decreased with increasing NYHA class (P < 0.01). Maximum ammonia levels were lower in the heart failure group and decreased further with higher NYHA classifications [control: 198 (52) mg/dl; NYHA class I: 170 (74); class II: 134 (58); class III: 72 (15); P < 0.01]. There were significant correlations between maximum ammonia values and maximum lactate, oxygen consumption, and hypoxanthine levels (r = 0.74, 0.48, and 0.87, respectively; P < 0.001). CONCLUSIONS: The ammonia threshold may reflect the onset of ATP depletion in exercising skeletal muscles, as opposed to the onset of anaerobic respiration. It seems therefore that energy depletion in skeletal muscles during exercise occurs after attaining the anaerobic threshold. Both aerobic and anaerobic capacities of skeletal muscle are reduced in patients with congestive heart failure.

Ogino, K.; Osaki, S.; Kitamura, H.; Noguchi, N.; Hisatome, I.; Matsumoto, T.; Omodani, H.; Kato, M.; Kinugawa, T.; Miyakoda, H.; Kotake, H.; Mashiba, H.

1996-01-01

320

Heart failure with preserved ejection fraction: emerging drug strategies.  

PubMed

Approximately half of heart failure patients have a normal ejection fraction, a condition designated as heart failure with preserved ejection fraction (HFpEF). This heart failure 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 heart failure 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 heart failure 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

2013-07-01

321

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

PubMed

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

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

2014-04-01

322

NADPH Oxidases in Heart Failure: Poachers or Gamekeepers?  

PubMed Central

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

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

2013-01-01

323

Alterations in beta-adrenoceptor mechanisms in the aging heart. Relationship with heart failure.  

PubMed

In chronic heart failure substantial and characteristic changes occur in the function of the adrenergic nervous system. Studies in isolated left ventricular muscle and in single cardiomyocytes from experimental models of aging and, recently, from humans show an age-related reduced contractile response to beta-adrenoceptor stimulation. "beta-adrenoceptor desensitization" is thought to be a general and common mechanism to explain the age- and heart failure-related decrease in beta-adrenoceptor response. The aim of this review is to compare alterations in beta-adrenoceptor mechanisms in physiological cardiovascular aging and chronic heart failure. From an analysis of the overall data on the role of aging in beta-adrenoceptor regulation in human and animal hearts, it is possible to conclude that the reduced response to beta-agonists is common to all species and all cardiac tissues. Moreover, the age-related changes are limited to beta-adrenoceptor-G-protein (s)-adenylyl cyclase system abnormalities, while the type and level of abnormalities change with species and tissues. The modifications shown in the aging heart are not very different from some observed in heart failure. In particular, both in aged and failing hearts we may see that the decrease in beta-adrenoceptor responsiveness is related to changes in G-protein function. PMID:9553617

Ferrara, N; Davia, K; Abete, P; Rengo, F; Harding, S E

1997-12-01

324

Peritoneal ultrafiltration in patients with advanced decompensated heart failure.  

PubMed

The aim of the Best Practice guidelines on peritoneal ultrafiltration (UF) in patients with treatment-resistant advanced decompensated heart failure (TR-AHDF) is to achieve a common approach to the management of decompensated heart failure in those situations in which all conventional treatment options have been unsuccessful, and to stimulate a closer cooperation between nephrologists and cardiologists. The standardization of the case series of different centers would allow a better definition of the results published in the literature, without which they are nothing more than anecdotes. TR-AHDF is characterized by the persistence of severe symptoms even when all possible pharmacological and surgical options have been exhausted. These patients are often treated with methods that allow extracorporeal UF - slow continuous ultrafiltration (SCUF) and continuous renal replacement therapy (CRRT) - which have to be performed in hospital facilities. Peritoneal ultrafiltration (PUF) can be considered a treatment option in patients with TR-AHDF when, despite the fact that all treatment options have been used, patients meet the following criteria: • stage D decompensated heart failure (ACC/AHA classification); • INTERMACS level 4 decompensated heart failure; • INTERMACS frequent flyer profile; • chronic renal failure (estimated glomerular filtration rate <50 ml/min per 1.73 m2: KDOQI classification stage 3 chronic kidney disease); • no obvious contraindications to peritoneal UF. PUF treatment modes are derived from the treatment regimens proposed by various authors to obtain systemic UF in patients with severe decompensated heart failure, using manual and automated incremental peritoneal dialysis involving various glucose concentrations in addition to the single icodextrin exchange. These guidelines also identify a minimum set of tests and procedures for the follow-up phase, to be supplemented, according to the center's resources and policy, with other tests that are less routine or more complex also from a logistic/organizational standpoint, emphasizing the need for the patient's clinical and treatment program to involve both the nephrologist and the cardiologist. The pathophysiological aspects of a deterioration in kidney function in patients with decompensated heart failure are also considered, and the results of PUF in patients with decompensated heart failure reported in the various case series are reviewed. PMID:24307445

Iadarola, Gian Maria; Lusardi, Paola; La Milia, Vincenzo; Amici, Gianpaolo; Santarelli, Stefano; Virga, Giovambattista; Basile, Carlo; Bertoli, Silvio; Bonofiglio, Renzo; Del Rosso, Goffredo; Feriani, Mariano; Galli, Emilio; Gallieni, Maurizio; Gambaro, Giovanni; Sandrini, Massimo; Sisca, Sergio; Cancarini, Giovanni

2013-01-01

325

The management of heart failure--an overview.  

PubMed

National and international societies have issued guidelines on the management of heart failure: 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 heart failure 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 heart failure 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 heart failure, alone or in combination (diuretic resistant heart failure!). 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 heart failure 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 heart failure. 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, heart failure 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

Erdmann, E

2000-01-01

326

A mechanistic role for cardiac myocyte apoptosis in heart failure  

PubMed Central

Heart failure is a common, lethal condition whose pathogenesis is poorly understood. Recent studies have identified low levels of myocyte apoptosis (80–250 myocytes per 105 nuclei) in failing human hearts. It remains unclear, however, whether this cell death is a coincidental finding, a protective process, or a causal component in pathogenesis. Using transgenic mice that express a conditionally active caspase exclusively in the myocardium, we demonstrate that very low levels of myocyte apoptosis (23 myocytes per 105 nuclei, compared with 1.5 myocytes per 105 nuclei in controls) are sufficient to cause a lethal, dilated cardiomyopathy. Interestingly, these levels are four- to tenfold lower than those observed in failing human hearts. Conversely, inhibition of cardiac myocyte death in this murine model largely prevents the development of cardiac dilation and contractile dysfunction, the hallmarks of heart failure. To our knowledge, these data provide the first direct evidence that myocyte apoptosis may be a causal mechanism of heart failure, and they suggest that inhibition of this cell death process may constitute the basis for novel therapies.

Wencker, Detlef; Chandra, Madhulika; Nguyen, Khanh; Miao, Wenfeng; Garantziotis, Stavros; Factor, Stephen M.; Shirani, Jamshid; Armstrong, Robert C.; Kitsis, Richard N.

2003-01-01

327

Plasma exudation in conscious dogs with experimental heart failure  

Microsoft Academic Search

The purpose of this study was to determine the effects of bradykinin (BK), substance P (SP) and histamine on plasma exudation in the skin of conscious dogs with and without pacing-induced heart failure. We also determined the role tissue angiotensin I-converting enzyme (ACE) and neutral endopeptidase (NEP) play in modulating these responses. We found that intradermal injection of BK, SP

I. Rubinstein; G. Mtins; I. H. Zucker

1994-01-01

328

Telemonitoring for Patients with Chronic Heart Failure: A Systematic Review  

PubMed Central

Background Telemonitoring, the use of communication technology to remotely monitor health status, is an appealing strategy for improving disease management. Methods We searched Medline databases, bibliographies, and spoke with experts to review the evidence on telemonitoring in heart failure patients. Results Interventions included: telephone-based symptom monitoring (n=5), automated monitoring of signs and symptoms (n=1), automated physiologic monitoring (n=1). Two studies directly compared effectiveness of 2 or more forms of telemonitoring. Study quality and intervention type varied considerably. Six studies suggested reduction in all-cause and heart failure hospitalizations (14% to 55% and 29% to 43%, respectively) or mortality (40% to 56%) with telemonitoring. Of the 3 negative studies, 2 enrolled low-risk patients and patients with access to high quality care while 1 enrolled a very high risk Hispanic population. Studies comparing forms of telemonitoring demonstrated similar effectiveness. However, intervention costs were higher with more complex programs ($8383 per patient per year) versus less complex programs ($1695 per patient per year). Conclusions The evidence base for telemonitoring in heart failure is currently quite limited. Based on the available data, telemonitoring may be an effective strategy for disease management in high-risk heart failure patients.

Chaudhry, Sarwat I.; Phillips, Christopher O.; Stewart, Simon S.; Riegel, Barbara J.; Mattera, Jennifer A.; Jerant, Anthony F.; Krumholz, Harlan M.

2007-01-01

329

A snapshot of the latest heart failure guidelines.  

PubMed

: Heart failure (HF) is a complex chronic condition with high morbidity and mortality. The purpose of this article is to present a snapshot of the 2013 ACCF/AHA guidelines focusing on management and treatment of HF in primary care. PMID:24932795

Caboral-Stevens, Meriam F

2014-07-13

330

Clinical utility of exercise training in chronic systolic heart failure  

Microsoft Academic Search

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

Andrew J. Stewart Coats

2011-01-01

331

Pharmacokinetics of oral hydralazine in chronic heart failure  

Microsoft Academic Search

The influence of various disease states, other than hypertension, on the pharmacokinetic behaviour of hydralazine is not completely known. In the present study the pharmacokinetics of oral hydralazine has been evaluated in 7 patients with severe, chronic heart failure, using 8 compensated hypertensives as controls. The pharmacokinetics was evaluated by measuring the plasma concentrations of hydralazine (“apparent” and “real” hydralazine)

A. Hanson; B. W. Johansson; B. Wernersson; L. A. Wgthlander

1983-01-01

332

Introduction: exercise in patients with chronic heart failure  

Microsoft Academic Search

The treatment of patients with chronic heart failure represents a dynamic clinical responsibility that combines the use of agents which date back decades (if not centuries) with more contemporary medical and device therapies, all aimed at preventing death, lessening hospitalizations, and improving both physical function and quality of life. Yet, the search for new agents or treatments aimed at further

Steven J. Keteyian; William E. Kraus

2008-01-01

333

Diuretic Therapy and Resistance in Congestive Heart Failure  

Microsoft Academic Search

Treatment of congestive heart failure has changed dramatically during the past 20 years, but diuretic drugs remain an essential component. Diuretics are essential despite the fact that these drugs stimulate the renin-angiotensin-aldosterone (RAA) axis and lead to adaptive responses that may be counterproductive. In this paper, new diuretic drugs and new uses of older drugs are discussed. These approaches emphasize

David H. Ellison

2001-01-01

334

Nitric oxide production during exercise in chronic heart failure  

Microsoft Academic Search

In chronic heart failure (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

1997-01-01

335

Novel Strategies for the Management of Acute Decompensated Heart Failure  

Microsoft Academic Search

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

W. H. Wilson Tang; Robert E. Hobbs

2005-01-01

336

Executive Summary: HFSA 2006 Comprehensive Heart Failure Practice Guideline  

Microsoft Academic Search

Heart failure (HF) is a syndrome characterized by high mortality, frequent hospitalization, reduced quality of life, and a complex therapeutic regimen. Knowledge about HF is accumulating so rapidly that individual clinicians may be unable to readily and adequately synthesize new information into effective strategies of care for patients with this syndrome. Trial data, though valuable, often do not give direction

2006-01-01

337

Family caregiving and congestive heart failure. Review and analysis  

Microsoft Academic Search

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

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

338

Device therapy in the management of congestive heart failure.  

PubMed

Despite significant advancements in the treatment of heart failure over the past 2 decades, this patient population is still subject to considerably high morbidity and mortality rates. In recent years, the field of device therapy as adjunctive treatment to the medical management of congestive heart failure has grown in the wake of the large number of randomized trials that have demonstrated the safety and efficacy of these devices. The implantable defibrillator currently represents the standard of care in certain segments of the heart failure population, even in those without a prior arrhythmic event. Biventricular pacing systems appear to have a role in heart failure patients with prolongation of their QRS duration in improving ventricular performance and symptoms, if not mortality. Last, the shortage of organs available for orthotopic transplant has heightened interest in using ventricular-assist devices as destination therapy, and although there is evidence for the feasibility for this approach at the current time, there is a next generation of devices that appear even more promising. PMID:15831146

Turer, Aslan T; Rao, Sunil V

2005-01-01

339

Altered Intestinal Function in Patients With Chronic Heart Failure  

Microsoft Academic Search

Objectives We evaluated morphology and function of the gut in patients with chronic heart failure (CHF). Background Intestinal translocation of bacterial endotoxin may contribute to the inflammatory state observed in patients with CHF. The morphology and function of the gut may be abnormal. Methods We studied 22 patients with CHF (age 67 2 years, left ventricular ejection fraction (LVEF) 31

Anja Sandek; Juergen Bauditz; Alexander Swidsinski; Sabine Buhner; Jutta Weber-Eibel; Stephan von Haehling; Wieland Schroedl; Tim Karhausen; Wolfram Doehner; Mathias Rauchhaus; Philip Poole-Wilson; Hans-Dieter Volk; Herbert Lochs; Stefan D. Anker

2007-01-01

340

Teaching Congestive Heart Failure to Doctor of Pharmacy Students.  

ERIC Educational Resources Information Center

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

Parker, Robert B.

1992-01-01

341

Nebivolol in the treatment of chronic heart failure.  

PubMed

Nebivolol is a highly selective beta1-adrenergic blocker that also enhances nitric oxide bioavailability via the L-arginine-nitric oxide pathway, leading to vasodilation and decreased peripheral vascular resistance. It is marketed in Europe for the treatment of hypertension and heart failure and is currently being reviewed for use in the US by the Food and Drug Administration. Nebivolol appears to be well tolerated with an adverse event profile that is at least similar, if not better, than that of other beta-adrenergic blockers. Studies suggest that long-term therapy with nebivolol improves left ventricular function, exercise capacity, and clinical endpoints of death and cardiovascular hospital admissions in patients with stable heart failure. To date, it is one of the only beta-adrenergic blockers that have been exclusively studied in elderly patients. Additionally, the unique mechanism of action of nebivolol makes it a promising agent for treatment of chronic heart failure in high-risk patient populations, such as African Americans. This article will review the pharmacologic and pharmacokinetic properties of nebivolol as well as clinical studies assessing its efficacy for the treatment of heart failure. PMID:18078016

Veverka, Angie; Salinas, Jennifer L

2007-01-01

342

Inotropes do not increase mortality in advanced heart failure  

PubMed Central

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

Guglin, Maya; Kaufman, Marc

2014-01-01

343

Cardiomyopathy, adult valve disease and heart failure in South America  

Microsoft Academic Search

Continued assessment of temporal trends in mortality and epidemiology of specific cardiovascular diseases in South America is needed to provide a scientific basis for rational allocation of the limited healthcare resources and introduction of strategies to reduce risk and predict the future burden of cardiovascular disease. The epidemiology of cardiomyopathies, adult valve disease and heart failure (HF) in South America

E A Bocchi; G Guimarães; F Tarasoutshi; G Spina; S Mangini; F Bacal

2009-01-01

344

Beta Blocker Therapy in African American Patients with Heart Failure  

Microsoft Academic Search

Data from a number of clinical trials of beta blocker therapy in heart failure, although limited in the size of African American patients included, suggest that they achieve a similar benefit as Caucasians. African Americans were usually at higher risk when enrolled in all of these studies with a higher incidence of hypertension and diabetes mellitus. The only exception is

Sidney Goldstein

2004-01-01

345

Oxidative Stress in Heart Failure: Current Understanding and Prospective  

Microsoft Academic Search

Our knowledge of the pathophysiology of heart failure 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

1999-01-01

346

[Surgical strategies for the treatment of heart failure].  

PubMed

Currently, heart transplantation is the gold standard of treatment for patients with end-stage heart failure. With the number of donor organs steadily decreasing, new surgical strategies have evolved. Selected patients with ischaemic cardiomyopathy or mitral valve insufficiency may be suitable candidates for conventional surgical procedures. New developments regarding assist devices such as LVAD and TAH increase our chances of employing these systems as a definite treatment option (destination therapy). New innovative concepts like external ventricular reshaping (Myosplints, CorCap) or left ventricular reconstruction are currently undergoing clinical evaluation. The clinical results of cardiac resynchronisation therapy offer a new treatment option for patients with LBB. The value of different treatment options and their role in modern surgical heart failure management is discussed. PMID:12806817

Gummert, Jan F; Doll, Nicolas; Rahmel, Axel; Richter, Markus; Bossert, Thorsten; Mohr, Friedrich Wilhelm

2003-04-01

347

Exercise Training Restores Cardiac Protein Quality Control in Heart Failure  

PubMed Central

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

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

2012-01-01

348

CXCR4 gene transfer prevents pressure overload induced heart failure.  

PubMed

Stem cell and gene therapies are being pursued as strategies for repairing damaged cardiac tissue following myocardial infarction in an attempt to prevent heart failure. 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-adrenoceptor, and CXCR4 (Cav1.2/?2AR/CXCR4) was identified in healthy cardiac myocytes and was shown to dissociate as a consequence of heart failure. CXCR4 administered to the heart via gene transfer prevents pressure overload induced heart failure. 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 that AAV9.CXCR4 gene therapy is a potential therapeutic approach for congestive heart failure. PMID:22668785

Larocca, Thomas J; Jeong, Dongtak; Kohlbrenner, Erik; Lee, Ahyoung; Chen, Jiqiu; Hajjar, Roger J; Tarzami, Sima T

2012-08-01

349

Severe hypotension after first dose of enalapril in heart failure.  

PubMed Central

The new, long acting converting enzyme inhibitor enalapril was given to 26 patients with moderate to severe heart failure. 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 heart failure 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

1985-01-01

350

Angiopoietin-2 in Adults with Congenital Heart Disease and Heart Failure  

PubMed Central

Background Chronic heart failure is an important cause for morbidity and mortality in adults with congenital heart disease (ACHD). While NT-proBNP is an established biomarker for heart failure 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 heart failure 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 heart failure 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.

Kumpers, Philipp; Denecke, Agnieszka; Westhoff-Bleck, Mechthild; Schieffer, Bernhard; Bauersachs, Johann; Kielstein, Jan T.; Tutarel, Oktay

2013-01-01

351

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

Microsoft Academic Search

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

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

2010-01-01

352

Dietary and blood antioxidants in patients with chronic heart failure. Insights into the potential importance of selenium in heart failure  

Microsoft Academic Search

Ž. Background: Chronic heart failure CHF seems to be associated with increased oxidative stress. However, the hypothesis that antioxidant nutrients may contribute to the clinical severity of the disease has never been investigated. Aims: To examine whether antioxidant nutrients influence the exercise capacity and left ventricular function in patients with CHF. Methods: Dietary intake and blood levels of major antioxidant

Michel de Lorgerila; Patricia Salen; Michele Accominotti; Monique Cadau; Jean-Paul Steghens; Francois Boucher; Joel de Leiris

353

Heart Failure and Diabetes The Effect of Diabetes on Outcomes of Patients With Advanced Heart Failure in the BEST Trial  

Microsoft Academic Search

OBJECTIVES This was a retrospective analysis to determine the effect of diabetes on outcome in patients with advanced heart failure (HF), and to determine the effect of beta-blockade in patients with HF with and without diabetes mellitus. BACKGROUND In chronic HF the impact on clinical outcomes and therapeutic response of the prevalent comorbid condition diabetes mellitus has not been extensively

Michael Domanski; Heidi Krause-Steinrauf; Prakash Deedwania; Dean Follmann; Jalal K. Ghali; Edward Gilbert; Steven Haffner; Richard Katz; JoAnn Lindenfeld; Brian D. Lowes; Wade Martin; Frank McGrew; Michael R. Bristow

354

Predictors of elevated NT-pro-BNP in cardiovascular patients without acute heart failure  

Microsoft Academic Search

AimB-type natriuretic peptides are recommended for evaluation of acute heart failure. Aim of this study was to identify predictors of pathologically elevated NT-pro-BNP in patients without acute heart failure.

Roman Pfister; Dajana Tan; Jaimy Thekkanal; Martin Hellmich; Chistian Alfons Schneider

2009-01-01

355

The Risk of Heart Failure and Cardiometabolic Complications in Obesity May Be Masked by an Apparent Healthy Status of Normal Blood Glucose  

PubMed Central

Although many obese individuals are normoglycemic and asymptomatic of cardiometabolic complications, this apparent healthy state may be a misnomer. Since heart failure is a major cause of mortality in obesity, we investigated the effects of heme-oxygenase (HO) on heart failure and cardiometabolic complications in obese normoglycemic Zucker-fatty rats (ZFs). Treatment with the HO-inducer, hemin, reduced markers of heart failure, such as osteopontin and osteoprotegerin, abated left-ventricular (LV) hypertrophy/fibrosis, extracellular matrix/profibrotic proteins including collagen IV, fibronectin, TGF-?1, and reduced cardiac lesions. Furthermore, hemin suppressed inflammation by abating macrophage chemoattractant protein-1, macrophage-inflammatory protein-1 alpha, TNF-?, IL-6, and IL-1? but enhanced adiponectin, atrial-natriuretic peptide (ANP), HO activity, insulin sensitivity, and glucose metabolism. Correspondingly, hemin improved several hemodynamic/echocardiographic parameters including LV-diastolic wall thickness, LV-systolic wall thickness, mean-arterial pressure, arterial-systolic pressure, arterial-diastolic pressure, LV-developed pressure, +dP/dt, and cardiac output. Contrarily, the HO-inhibitor, stannous mesoporphyrin nullified the hemin effect, exacerbating inflammatory/oxidative insults and aggravated insulin resistance (HOMA-index). We conclude that perturbations in insulin signaling and cardiac function may be forerunners to overt hyperglycemia and heart failure in obesity. Importantly, hemin improves cardiac function by suppressing markers of heart failure, LV hypertrophy, cardiac lesions, extracellular matrix/profibrotic proteins, and inflammatory/oxidative mediators, while concomitantly enhancing the HO-adiponectin-ANP axis.

Tiwari, Shuchita; Mishra, Manish; Jadhav, Ashok; Gerger, Courtney; Lee, Paul; Weber, Lynn

2013-01-01

356

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

Microsoft Academic Search

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

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

2000-01-01

357

Management of atrial fibrillation in heart failure in the elderly.  

PubMed

In elderly patients, atrial fibrillation prevalence exceeds 10% and is commonly associated with heart failure rendering their management even more challenging. Therapies to be considered for heart failure 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 heart failure. Several studies are ongoing and will provide more insight into the management of such patients. PMID:18029038

Abi Nasr, Imad; Mansencal, Nicolas; Dubourg, Olivier

2008-04-10

358

The role of nurses in the management of heart failure.  

PubMed

Care provided by specialist nurses has been shown to improve outcomes for patients with chronic heart failure (CHF), significantly reducing the number of unplanned readmissions, length of hospital stay, hospital costs, and mortality. Most patients develop CHF as a result of coronary artery disease. Once cardiac damage has occurred, the risk of developing heart failure can be reduced by providing appropriate treatment at appropriate dosages. While cardiac rehabilitation clinics provide an opportunity to check drug usage, their prime focus is on optimising patients' physical well being following a heart attack. In addition, evidence suggests that general practitioners are frequently reluctant to initiate appropriate treatments and to up-titrate drug dosages even for patients with diagnosed heart failure. Therefore, to ensure that these patients are not left on starting doses of medications many hospitals are now setting up nurse led post-myocardial infarction (MI) clinics. The Omada programme is a secondary care based, nurse led model of care set up in 1999 to improve the management of CHF by providing appropriate patient education within a nurse led clinic setting, optimising evidence based medication and fostering partnership between health professionals in both primary and secondary care. The model of care is highly applicable to the post-MI setting, where it can ensure that patients receive better care at an earlier stage. PMID:15831611

Grange, J

2005-05-01

359

Heart failure while on ventricular assist device support: a true clinical entity?  

PubMed

Ventricular assist devices (VADs) have become an established therapeutic option for patients with end-stage heart failure. The appearance of heart failure in VAD patients seems unexpected. Nevertheless, this phenomenon is not rare. We report six cases of VAD patients with clinical presentation of heart failure at different times after implantation and describe the mechanisms involved. The aetiology of this heart failure, like its clinical presentation, varies and has yet to be identified. PMID:23374971

Aissaoui, Nadia; Morshuis, Michiel; Diebold, Benoit; Guerot, Emmanuel; Gummert, Jan

2013-01-01

360

Portable Echocardiography and Acute Heart Failure Syndromes in the Emergency Room  

Microsoft Academic Search

Acute heart failure (AHF) is characterized by the presence of signs and symptoms of heart failure requiring urgent intervention\\u000a (1). More than 70% of patients with AHF have decompensation of chronic heart failure and 30% have heart failure 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

361

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

Microsoft Academic Search

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

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

362

Validation of an echocardiographic wall motion index in heart failure due to ischaemic heart disease  

Microsoft Academic Search

Abstract Ž. Aims: the echocardiographic assessment,of left ventricular ejection fraction,LVEF by geometric,methods,is limited in many,patients because,of inadequate,views and also in the presence,of regional wall motion,abnormalities,due to ischaemic Ž.,Ž . heart disease IHD . This study aimed to examine the application of a wall motion index WMI method, using a nine-segment Ž. LV model,in patients with chronic heart failure CHF due

J. h. Mcgowan; W. Martin; M. i. Burgess; G. Mccurrach; S. g. Ray; T. a. Mcdonagh; J. g. f. Cleland

2001-01-01

363

Discrimination power of long-term heart rate variability measures for chronic heart failure detection  

Microsoft Academic Search

The aim of this study was to investigate the discrimination power of standard long-term heart rate variability (HRV) measures\\u000a for the diagnosis of chronic heart failure (CHF). The authors performed a retrospective analysis on four public Holter databases,\\u000a analyzing the data of 72 normal subjects and 44 patients suffering from CHF. To assess the discrimination power of HRV measures,\\u000a an

Paolo Melillo; Roberta Fusco; Mario Sansone; Marcello Bracale; Leandro Pecchia

2011-01-01

364

Cardiovascular responses to heat stress in chronic heart failure.  

PubMed

Clinical reports have suggested that patients with heart diseases may be particularly vulnerable to heat injury. This review examines the effects of heat stress on cardiovascular and autonomic functions in patients with chronic heart failure (CHF). Laboratory investigations have shown that cutaneous vasodilator responses to heating are impaired in patients, whereas activation of skin sympathetic nerve activation is not attenuated in CHF as compared to controls. Attenuated cutaneous vasodilation may increase the risk of a heat related illness when CHF subjects are exposed to hyperthermic conditions. PMID:24599558

Cui, Jian; Sinoway, Lawrence I

2014-06-01

365

Congestive heart failure: a case of protein misfolding.  

PubMed

This article describes an interesting case of a patient presenting with congestive heart failure found to have restrictive cardiomyopathy with initial laboratory evaluation showing hypogammaglobuminemia without a monoclonal band on serum and urine electrophoresis. This case highlights the clinically significant cardiac manifestation caused by protein misfolding, a defect in protein homeostasis. In addition, the utility of a relatively newer laboratory test, serum free light chains as well as the importance of clinical and pathophysiologic correlation is also discussed. We present a relatively uncommon cause of heart disease, cardiac amyloidosis in a patient with a systemic plasma cell dyscrasia, and multiple myeloma. PMID:24959390

Ha, Chung-Eun; Bhagavan, Nadhipuram V; Loscalzo, Miki; Chan, Stephen K; Nguyen, Huy V; Rios, Carlos N; Honda, Stacey Aa

2014-06-01

366

Congestive Heart Failure: A Case of Protein Misfolding  

PubMed Central

This article describes an interesting case of a patient presenting with congestive heart failure found to have restrictive cardiomyopathy with initial laboratory evaluation showing hypogammaglobuminemia without a monoclonal band on serum and urine electrophoresis. This case highlights the clinically significant cardiac manifestation caused by protein misfolding, a defect in protein homeostasis. In addition, the utility of a relatively newer laboratory test, serum free light chains as well as the importance of clinical and pathophysiologic correlation is also discussed. We present a relatively uncommon cause of heart disease, cardiac amyloidosis in a patient with a systemic plasma cell dyscrasia, and multiple myeloma.

Ha, Chung-Eun; Bhagavan, Nadhipuram V; Loscalzo, Miki; Chan, Stephen K; Nguyen, Huy V; Rios, Carlos N

2014-01-01

367

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

Microsoft Academic Search

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

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

1999-01-01

368

Heart Failure and Left Ventricular Remodeling After Reperfused Acute Myocardial Infarction in Patients With Hypertension  

Microsoft Academic Search

In the thrombolytic era, hypertension has been shown to adversely affect the development of heart failure after acute myocardial infarction (AMI). We sought to examine the relation between antecedent hypertension and heart failure after mechanical reperfusion and to test the impact of postinfarction left ventricular remodeling on heart failure in hypertensive patients. A series of 953 patients (324 hypertensives) with

Guido Parodi; Nazario Carrabba; Giovanni M. Santoro; Gentian Memisha; Renato Valenti; Piergiovanni Buonamici; Emilio V. Dovellini; David Antoniucci

2010-01-01

369

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

Microsoft Academic Search

BACKGROUND--In a canine model of congestive heart failure beta endorphin concentrations were high and opioid receptor antagonists exerted beneficial haemodynamic effects. In humans previous studies have suggested that opioid peptides may modify the perception of breathlessness and fatigue in heart failure. METHODS--Plasma concentrations of beta endorphin were measured in patients with acute and chronic heart failure and cardiogenic shock. A

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

1995-01-01

370

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

Microsoft Academic Search

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

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

371

TNF? antagonist upregulates interleukin-6 in rats with hypertensive heart failure  

Microsoft Academic Search

BackgroundTumor necrosis factor ? (TNF?) has been shown to be a prognostic marker in heart failure, but recent clinical trials using TNF? antagonists in patients with severe heart failure have been disappointing. Hypertension is one of most common causes to chronic heart failure in humans.

Espen Haugen; Margareta Scharin Täng; Azra Isic; Bert Andersson; Michael Fu

2008-01-01

372

Heart failure in Nigerian hypertensive patients: the role of renal dysfunction  

Microsoft Academic Search

Heart failure in hypertensive patients is known to be dependent not only on the absolute value of blood pressure but also on other factors, hence the prognosis varies. In this study, the effect of renal dysfunction on the development of heart failure in hypertensive patients was assessed. Fifty-five patients who were admitted in hypertensive heart failure (HHF) were compared with

A. O. Obasohan; C. O. Ajuyah

1995-01-01

373

Arrhythmia triggers in heart failure: the smoking gun of [Ca2+]i dysregulation.  

PubMed

Among the most serious problems associated with heart failure is the increased likelihood of life-threatening arrhythmias. Both triggered and reentrant arrhythmias in heart failure may arise as a result of aberrant intracellular Ca cycling. This article presents some new ideas, based on recent studies, about how altered Ca cycling in heart failure might serve as the cellular basis for arrhythmogenesis. PMID:21699870

Aistrup, Gary L; Balke, C William; Wasserstrom, J Andrew

2011-11-01

374

Osler-Weber-Rendu (OWR) Disease and Heart Failure  

PubMed Central

OWR is a genetic disease, transmitted as an autosomal dominant disorder characterized by arteriovenous malformations predominantly involving the mucocutaneous epithelium. One of the significant complications is the development of arteriovenous fistulas in different organs like the liver and brain. One of the rarest complications of this arteriovenous conduit is a high-output heart failure. We would like to describe a 66 years old woman who was admitted with a high-output cardiac failure who deteriorated clinically and was treated successfully by conservative management.

Blum, Arnon; Shalabi, Rafea

2009-01-01

375

Osler-Weber-Rendu (OWR) Disease and Heart Failure.  

PubMed

OWR is a genetic disease, transmitted as an autosomal dominant disorder characterized by arteriovenous malformations predominantly involving the mucocutaneous epithelium. One of the significant complications is the development of arteriovenous fistulas in different organs like the liver and brain. One of the rarest complications of this arteriovenous conduit is a high-output heart failure. We would like to describe a 66 years old woman who was admitted with a high-output cardiac failure who deteriorated clinically and was treated successfully by conservative management. PMID:20508772

Blum, Arnon; Shalabi, Rafea

2009-01-01

376

Risk of Thromboembolism in Heart Failure An Analysis From the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)  

Microsoft Academic Search

Background—In patients with heart failure, rates of clinically apparent stroke range from 1.3% to 3.5% per year. Little is known about the incidence and risk factors in the absence of atrial fibrillation. In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), 2521 patients with moderate heart failure were randomized to receive amiodarone, implanted cardioverter-defibrillators (ICDs), or placebo. Methods and

Ronald S. Freudenberger; Anne S. Hellkamp; Jonathan L. Halperin; Jeanne Poole; Jill Anderson; George Johnson; Daniel B. Mark; Kerry L. Lee; Gust H. Bardy

377

The landscape of DNA repeat elements in human heart failure  

PubMed Central

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

2012-01-01

378

Ca handling during excitation-contraction coupling in heart failure.  

PubMed

In the heart, coupling between excitation of the surface membrane and activation of contractile apparatus is mediated by Ca released from the sarcoplasmic reticulum (SR). Several components of Ca machinery are perfectly arranged within the SR network and the T-tubular system to generate a regular Ca cycling and thereby rhythmic beating activity of the heart. Among these components, ryanodine receptor (RyR) and SR Ca ATPase (SERCA) complexes play a particularly important role and their dysfunction largely underlies abnormal Ca homeostasis in diseased hearts such as in heart failure. The abnormalities in Ca regulation occur at practically all main steps of Ca cycling in the failing heart, including activation and termination of SR Ca release, diastolic SR Ca leak, and SR Ca uptake. The contributions of these different mechanisms to depressed contractile function and enhanced arrhythmogenesis may vary in different HF models. This brief review will therefore focus on modifications in RyR and SERCA structure that occur in the failing heart and how these molecular modifications affect SR Ca regulation and excitation-contraction coupling. PMID:24515294

Zima, Aleksey V; Bovo, Elisa; Mazurek, Stefan R; Rochira, Jennifer A; Li, Weiyan; Terentyev, Dmitry

2014-06-01

379

Targeted deletion of Dicer in the heart leads to dilated cardiomyopathy and heart failure  

PubMed Central

Cardiovascular disease is the leading cause of human morbidity and mortality. Dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy associated with heart failure. Here, we report that cardiac-specific knockout of Dicer, a gene encoding a RNase III endonuclease essential for microRNA (miRNA) processing, leads to rapidly progressive DCM, heart failure, and postnatal lethality. Dicer mutant mice show misexpression of cardiac contractile proteins and profound sarcomere disarray. Functional analyses indicate significantly reduced heart rates and decreased fractional shortening of Dicer mutant hearts. Consistent with the role of Dicer in animal hearts, Dicer expression was decreased in end-stage human DCM and failing hearts and, most importantly, a significant increase of Dicer expression was observed in those hearts after left ventricle assist devices were inserted to improve cardiac function. Together, our studies demonstrate essential roles for Dicer in cardiac contraction and indicate that miRNAs play critical roles in normal cardiac function and under pathological conditions.

Chen, Jian-Fu; Murchison, Elizabeth P.; Tang, Ruhang; Callis, Thomas E.; Tatsuguchi, Mariko; Deng, Zhongliang; Rojas, Mauricio; Hammond, Scott M.; Schneider, Michael D.; Selzman, Craig H.; Meissner, Gerhard; Patterson, Cam; Hannon, Gregory J.; Wang, Da-Zhi

2008-01-01

380

Mechanical Circulatory Support for End-Stage Heart Failure in Repaired and Palliated Congenital Heart Disease  

PubMed Central

Approximately one in one hundred children is born with congenital heart disease. Most can be managed with corrective or palliative surgery but a small group will develop severe heart failure, leaving cardiac transplantation as the ultimate treatment option. Unfortunately, due to the inadequate number of available donor organs, only a small number of patients can benefit from this therapy, and mortality remains high for pediatric patients awaiting heart transplantation, especially compared to adults. The purpose of this review is to describe the potential role of mechanical circulatory support in this context and to review current experience. For patients with congenital heart disease, ventricular assist devices are most commonly used as a bridge to cardiac transplantation, an application which has been shown to have several important advantages over medical therapy alone or support with extracorporeal membrane oxygenation, including improved survival to transplant, less exposure to blood products with less immune sensitization, and improved organ function. While these devices may improve wait list mortality, the chronic shortage of donor organs for children is likely to remain a problem into the foreseeable future. Therefore, there is great interest in the development of mechanical ventricular assist devices as potential destination therapy for congenital heart disease patients with end-stage heart failure. This review first discusses the experience with the currently available ventricular assist devices in children with congenital heart disease, and then follows to discuss what devices are under development and may reach the bedside soon.

Clark, Joseph B; Pauliks, Linda B; Myers, John L; Undar, Akif

2011-01-01

381

The renin-angiotensin-aldosterone system and heart failure.  

PubMed

The renin-angiotensin-aldosterone system (RAAS) plays a critical role in the pathophysiology of heart failure with reduced ejection fraction (HFrEF). Targeting components of the RAAS has produced significant improvements in morbidity and mortality. Angiotensin-converting enzyme (ACE) inhibitors remain first-line therapy for all patients with a reduced ejection fraction. Angiotensin-receptor blockers may be used instead of ACE inhibitors in patients with intolerance, or in conjunction with ACE inhibitors to further reduce symptoms. Recent data support broader indications for aldosterone antagonists in heart failure, and the combination of an ACE-inhibitor and aldosterone antagonist has become the preferred strategy for dual blockade of the RAAS. PMID:24286576

Sayer, Gabriel; Bhat, Geetha

2014-02-01

382

Neuregulin-1? for the treatment of systolic heart failure.  

PubMed

The Neuregulin-1 gene encodes a family of ligands that act through the ErbB family of receptor tyrosine kinases to regulate morphogenesis of many tissues. Work in isolated cardiac cells as well as genetically altered mice demonstrates that neuregulin-1/ErbB signaling is a paracrine signaling system that functions in endocardial-endothelial/cardiomyocyte interactions to regulate tissue organization during development as well as maintain cardiac function throughout life. Treatment of animals with cardiac dysfunction with recombinant neuregulin-1beta improves cardiac function. This has led to ongoing early phase clinical studies examining neuregulin-1beta as a potential novel therapeutic for heart failure. In this review we synthesize the literature behind this rapidly evolving area of translational research. This article is part of a special issue entitled "Key Signaling Molecules in Hypertrophy and Heart Failure." PMID:21729703

Sawyer, Douglas B; Caggiano, Anthony

2011-10-01

383

Tissue Doppler imaging in coronary artery diseases and heart failure.  

PubMed

Recent studies have explored the prognostic role of TDI-derived parameters in major cardiac diseases, such as coronary artery disease (CAD) and heart failure (HF). In these conditions, myocardial mitral annular systolic (S') and early diastolic (E') velocities have been shown to predict mortality or cardiovascular events. In heart failure non invasive assessment of LV diastolic pressure by transmitral to mitral annular early diastolic velocity ratio (E/E') is a strong prognosticator, especially when E/E' is > or =15. Moreover, other parameters derived by TDI, as cardiac time intervals and Myocardial Performance Index, might play a role in the prognostic stratification in CAD and HF. Recently, a three-dimensional (3-D) TDI imaging modality, triplane TDI, has become available, and this allows calculation of 3-Dvolumes and LV ejection fraction. We present a brief update of TDI. PMID:22845815

Correale, Michele; Totaro, Antonio; Ieva, Riccardo; Ferraretti, Armando; Musaico, Francesco; Di Biase, Matteo

2012-02-01

384

Tissue Doppler Imaging in Coronary Artery Diseases and Heart Failure  

PubMed Central

Recent studies have explored the prognostic role of TDI-derived parameters in major cardiac diseases, such as coronary artery disease (CAD) and heart failure (HF). In these conditions, myocardial mitral annular systolic (S’) and early diastolic (E’) velocities have been shown to predict mortality or cardiovascular events. In heart failure non invasive assessment of LV diastolic pressure by transmitral to mitral annular early diastolic velocity ratio (E/E’) is a strong prognosticator, especially when E/E’ is > or =15. Moreover, other parameters derived by TDI, as cardiac time intervals and Myocardial Performance Index, might play a role in the prognostic stratification in CAD and HF. Recently, a three-dimensional (3-D) TDI imaging modality, triplane TDI, has become available, and this allows calculation of 3-Dvolumes and LV ejection fraction. We present a brief update of TDI.

Correale, Michele; Totaro, Antonio; Ieva, Riccardo; Ferraretti, Armando; Musaico, Francesco; Biase, Matteo Di

2012-01-01

385

Cardiorenal syndrome and the role of ultrafiltration in heart failure.  

PubMed

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

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

2013-03-01

386

A novel telemedicine system for monitoring congestive heart failure patients.  

PubMed

Congestive heart failure 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 heart failure. PMID:18983286

Radai, Michal M; Arad, Marina; Zlochiver, Sharon; Krief, Haim; Engelman, Tzvika; Abboud, Shimon

2008-01-01

387

Gene Therapy for Heart Failure: Where Do We Stand?  

PubMed Central

Advances in understanding of the molecular basis of myocardial dysfunction, together with the development of increasingly efficient gene transfer technology, has placed heart failure within reach of gene-based therapy. Multiple components of cardiac contractility, including the Beta-adrenergic system, the calcium channel cycling pathway, and cytokine mediated cell proliferation, have been identified as appropriate targets for gene therapy. The development of efficient and safe vectors such as adeno-associated viruses and polymer nanoparticles has provided an opportunity for clinical application for gene therapy. The recent successful and safe completion of a phase 2 trial targeting the sarcoplasmic reticulum calcium ATPase pump (SERCA2a) has the potential to open a new era for gene therapy in the treatment of heart failure.

Naim, Charbel; Yerevanian, Armen; Hajjar, Roger J.

2013-01-01

388

Systems Biology Applied to Heart Failure With Normal Ejection Fraction  

PubMed Central

Heart failure with normal ejection fraction (HFNEF) is currently the most prevalent clinical phenotype of heart failure. However, the treatments available have shown no reduction in mortality so far. Advances in the omics sciences and techniques of high data processing used in molecular biology have enabled the development of an integrating approach to HFNEF based on systems biology. This study aimed at presenting a systems-biology-based HFNEF model using the bottom-up and top-down approaches. A literature search was conducted for studies published between 1991 and 2013 regarding HFNEF pathophysiology, its biomarkers and systems biology. A conceptual model was developed using bottom-up and top-down approaches of systems biology. The use of systems-biology approaches for HFNEF, a complex clinical syndrome, can be useful to better understand its pathophysiology and to discover new therapeutic targets.

Mesquita, Evandro Tinoco; Jorge, Antonio Jose Lagoeiro; de Souza, Celso Vale; Cassino, Joao Paulo Pedroza

2014-01-01

389

Pathways in heart failure disease management across socioeconomic spectra.  

PubMed

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

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

2011-12-01

390

Nitrosative stress and pharmacological modulation of heart failure  

PubMed Central

Dysregulation of nitric oxide (NO) and increased oxidative and nitrosative stress are implicated in the pathogenesis of heart failure. Peroxynitrite is a reactive oxidant that is produced from the reaction of nitric oxide with superoxide anion and impairs cardiovascular function through multiple mechanisms, including activation of matrix metalloproteinases (MMPs) and nuclear enzyme poly(ADP-ribose) polymerase (PARP). Recent studies suggest that the neutralization of peroxynitrite or pharmacological inhibition of MMPs and PARP are promising new approaches in the experimental therapy of various forms of myocardial injury. In this article, the role of nitrosative stress and downstream mechanisms, including activation of MMPs and PARP, in various forms of heart failure are discussed and novel emerging therapeutic strategies offered by neutralization of peroxynitrite and inhibition of MMPs and PARP in these pathophysiological conditions are reviewed.

Pacher, Pal; Schulz, Richard; Liaudet, Lucas; Szabo, Csaba

2008-01-01

391

Heart Failure with Preserved Ejection Fraction: Emerging Drug Strategies  

PubMed Central

Approximately half of heart failure patients have a normal ejection fraction, a condition designated as heart failure with preserved ejection fraction (HFpEF). This heart failure 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 heart failure 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 (cGMP)-protein kinase G (PKG) signaling. Surprisingly a number of clinical studies have failed to demonstrate any benefit of drugs effective in heart failure 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 (eNOS) activators and If current inhibitors have shown benefit in improving diastolic function and there is a rationale for assessing matrix metalloproteinase-9 (MMP-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, as well as drugs currently in clinical trial, that primarily target diastolic dysfunction or imbalanced ventricular-arterial coupling.

Zouein, Fouad A.; de Castro Bras, Lisandra E.; da Costa, Danielle V.; Lindsey, Merry L.; Kurdi, Mazen; Booz, George W.

2013-01-01

392

High Fat Feeding in Mice Is Insufficient to Induce Cardiac Dysfunction and Does Not Exacerbate Heart Failure  

PubMed Central

Preclinical studies of animals with risk factors, and how those risk factors contribute to the development of cardiovascular disease and cardiac dysfunction, are clearly needed. One such approach is to feed mice a diet rich in fat (i.e. 60%). Here, we determined whether a high fat diet was sufficient to induce cardiac dysfunction in mice. We subjected mice to two different high fat diets (lard or milk as fat source) and followed them for over six months and found no significant decrement in cardiac function (via echocardiography), despite robust adiposity and impaired glucose disposal. We next determined whether antecedent and concomitant exposure to high fat diet (lard) altered the murine heart’s response to infarct-induced heart failure; high fat feeding during, or before and during, heart failure did not significantly exacerbate cardiac dysfunction. Given the lack of a robust effect on cardiac dysfunction with high fat feeding, we then examined a commonly used mouse model of overt diabetes, hyperglycemia, and obesity (db/db mice). db/db mice (or STZ treated wild-type mice) subjected to pressure overload exhibited no significant exacerbation of cardiac dysfunction; however, ischemia-reperfusion injury significantly depressed cardiac function in db/db mice compared to their non-diabetic littermates. Thus, we were able to document a negative influence of a risk factor in a relevant cardiovascular disease model; however, this did not involve exposure to a high fat diet. High fat diet, obesity, or hyperglycemia does not necessarily induce cardiac dysfunction in mice. Although many investigators use such diabetes/obesity models to understand cardiac defects related to risk factors, this study, along with those from several other groups, serves as a cautionary note regarding the use of murine models of diabetes and obesity in the context of heart failure.

Brainard, Robert E.; Watson, Lewis J.; DeMartino, Angelica M.; Brittian, Kenneth R.; Readnower, Ryan D.; Boakye, Adjoa Agyemang; Zhang, Deqing; Hoetker, Joseph David; Bhatnagar, Aruni; Baba, Shahid Pervez; Jones, Steven P.

2013-01-01

393

Calcium Channels in Cardiac Hypertrophy and Heart Failure  

Microsoft Academic Search

With the development of cardiac hypertrophy and heart failure, there are profound alterations in the ability of the cardiac\\u000a cell to contract and relax. Despite several decades of intensive investigation, the precise cellular mechanisms responsible\\u000a for this contractile dysfunction remain unknown. Recent advances in confocal microscopy and fluorescent calcium (Ca?2?+) indicators\\u000a have allowed investigators to image the focal release of

Stephen R. Shorofsky; C. William Balke; Judith K. Gwathmey

1998-01-01

394

Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure  

PubMed Central

BACKGROUND Patients with heart failure who receive an implantable cardioverter–defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about long-term prognosis after ICD therapy in such patients is limited. METHODS Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate. RESULTS Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P = 0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure. CONCLUSIONS Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.

Poole, Jeanne E.; Johnson, George W.; Hellkamp, Anne S.; Anderson, Jill; Callans, David J.; Raitt, Merritt H.; Reddy, Ramakota K.; Marchlinski, Francis E.; Yee, Raymond; Guarnieri, Thomas; Talajic, Mario; Wilber, David J.; Fishbein, Daniel P.; Packer, Douglas L.; Mark, Daniel B.; Lee, Kerry L.; Bardy, Gust H.

2010-01-01

395

Manipulating afterload for the treatment of acute heart failure  

Microsoft Academic Search

For decades, digitalis and diuretics presented as the mainstay of the conventional treatment of heart failure. In the late\\u000a 1960s, however, the use of positive inotropic agents was reconsidered on account of several studies demonstrating a poor hemodynamic\\u000a response to digitalis and arrhythmogenic effects in patients with coronary disease. The beneficial effect of diuretics in\\u000a relieving pulmonary congestion and acute

Claude Perret; Jean-François Enrico

396

Reversible Right-Sided Heart Failure Secondary to Carcinoid Crisis  

PubMed Central

Carcinoid crisis is an infrequent and little-described complication of neuroendocrine tumors that can be life threatening. It may develop during induction of anesthesia, intraoperatively, during tumor manipulation and arterial embolization, or even spontaneously. The massive release of neuroendocrine substances can lead to potentially fatal complications. Somatostatin analogs inhibit the release of these substances and are the mainstay of treatment. The following case report describes a patient with reversible acute right-sided heart failure posterior to hepatic artery embolization.

Soto Herrera, Mariana; Restrepo, Jose A.; Diaz, Jesus H.; Ramos, Andres; Felipe Buitrago, Andres; Gomez Mejia, Mabel

2013-01-01

397

Associations between Endothelin1 and Adiponectin in Chronic Heart Failure  

Microsoft Academic Search

Objectives: Endothelin-1 (ET-1) induces cardiac hypertrophy, whereas adiponectin may elicit protective effects in the vasculature and myocardium. We therefore evaluated the relationship between plasma ET-1 and adiponectin levels in heart failure (HF) patients, and the association between adiponectin expression and ET-1-induced hypertrophy of human cardiomyocytes (HCM) in vitro. Methods: One hundred seventeen patients with chronic HF were enrolled into this

Wei-Hsian Yin; Yung-Hsiang Chen; Jeng Wei; Hsu-Lung Jen; Wen-Ping Huang; Mason Shing Young; Der-Cherng Chen; Po-Len Liu

2011-01-01

398

Vasopeptidase inhibitors: potential role in the treatment of heart failure.  

PubMed

Current thinking views the progression of heart failure as the result of sustained activation of vasoconstrictor neurohormones. In this model, the sustained synthesis of vasoconstrictor neurohormones leads to disease progression through alterations in cardiomyocyte structure and function, which affects myocardial contractility, cardiac metabolism, and cellular growth. Ultimately, these events induce irreversible adverse ventricular remodeling through myocyte cell loss and progressive myocardial fibrosis. In the past decade, several landmark clinical trials tested the neurohormonal hypothesis, by targeting the activation of both the beta-adrenergic and the renin-angiotensin-aldosterone systems. Although the observed decrease in mortality using this strategy in heart failure populations was encouraging, morbidity and mortality levels remained elevated, and it has now been shown that several other humoral interactions are at play and potentially deserve antagonizing, or in the case of vasodilator neurohormones, deserve stimulation. It is known a family of vasodilator neurohormones - the natriuretic peptides - that have natriuretic, vasodilatory, and antiproliferative effects, endogenously inhibit the renin-angiotensin system. These peptides are degraded primarily by a neutral endopeptidase (NEP), an endothelial cell-surface zinc metallopeptidase, which shares a similar structure and catalytic site with the angiotensin converting enzyme (ACE). NEPs have broad substrate specificity, encompassing atrial natriuretic peptide, brain natriuretic peptide, and C-type natriuretic peptide, but also bradykinin and adrenomedullin. The recognition that ACE and NEP enzymes had related structures, led to the design and development of a class of molecules with a dual inhibitory effect on ACE and NEP, referred to as vasopeptidase inhibitors. Preliminary clinical trials in heart failure with vasopeptidase inhibitors have become available and show promising results. Thus, the combined inhibition of ACE and NEP, by attenuating excessive vasoconstriction and enhancing vasodilator substances, holds promise as a valuable option in heart failure treatment for the near future. PMID:12634892

Trindade, P T; Rouleau, J L

2001-01-01

399

The role of natriuretic peptides in heart failure  

Microsoft Academic Search

Heart failure is a clinical syndrome associated with progressive cardiac, vascular, and renal dysfunction. Regardless of the\\u000a initial injury, investigations have demonstrated that neurohormones play an important role in the complex multiorgan and cellular\\u000a adaptations. Natriuretic peptides play a key role in this process, antagonizing the actions of the renin-angiotensin-aldosterone\\u000a system, thus promoting vasodilatation and natriuresis. Other important physiologic properties

Daniel D. Correa de Sa; Horng H. Chen

2008-01-01

400

Sleep-disordered breathing in acute decompensated heart failure  

Microsoft Academic Search

Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is highly prevalent\\u000a and frequently unrecognized in patients with chronic heart failure (HF). Untreated SDB may worsen acute decompensation of\\u000a HF and delay recovery by increasing vascular inflammation and oxidative stress, impeding control of the blood pressure, and\\u000a promoting arrhythmias. Untreated OSA doubles the risk for developing

Sanja Jelic; Thierry H. Le Jemtel

2009-01-01

401

Thick Filament Proteins and Performance in Human Heart Failure  

Microsoft Academic Search

Modifications in thick filament protein content and performance are thought to underlie contraction-relaxation dysfunction\\u000a in human heart failure. It has been found that myofibrillar Mg.ATPase is reduced in failing myocardium, which may be due in\\u000a part to the reduction in ?-myosin heavy chain (MHC) isoform content from ?5–10% in normal myocardium to <2% in failing myocardium.\\u000a The physiological importance of

Bradley M. Palmer

2005-01-01

402

Anesthesia for Patients with Acute Heart Failure Syndromes  

Microsoft Academic Search

This chapter provides a conceptual framework for anesthesia for cardiac surgery, and discusses selected practical issues concerning\\u000a anesthesia for patients with acute heart failure syndromes (AHFSs). We first develop the conceptual framework by selectively\\u000a presenting recent knowledge (including definitions and pathophysiology) relevant for anesthesia and postanesthesia care of\\u000a patients with AHFS. We then discuss diagnosis, treatment decisions, and procedures. Finally,

Dan Longrois; Paul Michel Mertes

403

Understanding and Promoting Effective Self-Care During Heart Failure  

Microsoft Academic Search

Opinion statement  Heart failure (HF) self-care relates to the decisions made outside clinical settings by the individual with HF to maintain\\u000a life, healthy functioning, and well-being. The people who help patients most (ie, caregivers\\/family members) should be involved\\u000a in care, and general principles of health behavior change should be used to guide support. Medicines should be prescribed\\u000a with once-daily dosing, with

Alexander M. Clark; Patricia Davidson; Kay Currie; Mehri Karimi; Amanda S. Duncan; David R. Thompson

2010-01-01

404

Pulsatile Hemodynamics and Clinical Outcomes in Acute Heart Failure  

Microsoft Academic Search

BackgroundThe role of pulsatile hemodynamics in the management of patients with acute heart failure syndrome (AHFS) remains to be elucidated. We investigated the changes of the pulsatile hemodynamics along the hospital course of AHFS in relation to short-term outcomes.MethodsA total of 80 AHFS patients (73.2 ± 14.1 years, 82.5% men) were enrolled and followed up for up to 6 months

Shih-Hsien Sung; Wen-Chung Yu; Hao-Min Cheng; Shao-Yuan Chuang; Kang-Ling Wang; Chi-Ming Huang; Chen-Huan Chen

2011-01-01

405

Pulmonary hypertension, heart failure and neutropenia due to diazoxide therapy  

Microsoft Academic Search

Primary persistent hyperinsulinaemic hypoglycaemia is characterised by clinical symptoms that occur when blood glucose levels\\u000a drop below the normal range. Diazoxide treatment remains the mainstay of medical therapy. Tolerance of diazoxide is usually\\u000a excellent, but several side effects of this drug have been described. We present a 4-month-old girl who developed pulmonary\\u000a hypertension, heart failure and neutropenia during diazoxide therapy.

Dincer Yildizdas; Sevcan Erdem; Osman Küçükosmano?lu; Mustafa Yilmaz; Bilgin Yüksel

2008-01-01

406

Multiple Biomarkers for Risk Prediction in Chronic Heart Failure  

PubMed Central

Background Prior studies have suggested using a panel of biomarkers that measure diverse biological processes as a prognostic tool in chronic heart failure. Whether this approach improves risk prediction beyond clinical evaluation is unknown. Methods and Results In a multi-center cohort of 1513 chronic systolic heart failure patients, we measured a contemporary biomarker panel consisting of: high-sensitivity C-reactive protein (hsCRP), myeloperoxidase (MPO), B-type natriuretic peptide (BNP), soluble fms-like tyrosine kinase receptor-1 (sFlt-1), troponin I (TnI), soluble toll-like receptor-2 (ST2), creatinine, and uric acid. From this panel, we calculated a parsimonious multimarker score and assessed its performance in predicting risk of death, cardiac transplantation, or ventricular assist device (VAD) placement in comparison to an established clinical risk score, the Seattle Heart Failure Model (SHFM). During a median followup of 2.5 years, there were a total of 317 outcomes: 187 patients died; 99 were transplanted; and 31 had a VAD placed. In unadjusted Cox models, patients in the highest tertile of the multimarker score had a 13.7-fold increased risk of adverse outcomes compared to the lowest tertile (95%CI 8.75-21.5). These effects were independent of the SHFM (adjusted HR 6.80,95%CI 4.18-11.1). Addition of the multimarker score to the SHFM led to a significantly improved AUC of 0.803 versus 0.756 (p=0.003) and appropriately reclassified a significant number of patients who experienced the outcome into a higher risk category (NRI 25.2%,95%CI 14.2-36.2%,p<0.001). Conclusions In ambulatory chronic heart failure patients, a score derived from multiple biomarkers integrating diverse biologic pathways substantially improves prediction of adverse events beyond current metrics.

Ky, Bonnie; French, Benjamin; Levy, Wayne C.; Sweitzer, Nancy K.; Fang, James C.; Wu, Alan H.B.; Goldberg, Lee R.; Jessup, Mariell; Cappola, Thomas P.

2012-01-01

407

Absorption of digoxin in severe right heart failure  

Microsoft Academic Search

The absorption of digoxin has been investigated in 8 patients before and after successful treatment of severe right heart failure.3H-digoxin 0.1 mg as a solution, and un-labelled digoxin 0.25 mg as a tablet, were given to fasted patients. Blood samples were taken at various time intervals up to 120 hours and urine was collected over the same period. The concentrations

E. E. Ohnhaus; S. Vozeh; E. Nuesch

1979-01-01

408

Blood Signature of Pre-Heart Failure: A Microarrays Study  

Microsoft Academic Search

BackgroundThe preclinical stage of systolic heart failure (HF), known as asymptomatic left ventricular dysfunction (ALVD), is diagnosed only by echocardiography, frequent in the general population and leads to a high risk of developing severe HF. Large scale screening for ALVD is a difficult task and represents a major unmet clinical challenge that requires the determination of ALVD biomarkers.Methodology\\/Principal Findings294 individuals

Fatima Smih; Franck Desmoulin; Matthieu Berry; Annie Turkieh; Romain Harmancey; Jason Iacovoni; Charlotte Trouillet; Clement Delmas; Atul Pathak; Olivier Lairez; François Koukoui; Pierre Massabuau; Jean Ferrieres; Michel Galinier; Philippe Rouet

2011-01-01

409

Pharmacologic modulation of parasympathetic activity in heart failure  

Microsoft Academic Search

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

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

2011-01-01

410

Current Status of Stem Cell Therapy in Heart Failure  

PubMed Central

Inspired by studies demonstrating the potential for new myocyte formation within adult mammalian hearts, an ongoing explosion of research is elucidating the biology of cardiac myogenesis and angiogenesis. Multiple lines of research suggest that disease-associated activation of endogenous cardiac repair processes are often insufficient to overcome the cell death resulting from myocardial infarction and chronic heart failure. In this context, this review highlights current evidence supporting endogenous cardiac repair mechanisms in human hearts, recent progress with clinical application of myocardial cell therapy, and complementary efforts to manipulate endogenous myocardial repair processes using a variety of tissue engineering strategies. The goal of this overview is to demonstrate that the insights and opportunities derived from each of these lines of inquiry are mutually complementary for ultimately achieving the goal of therapeutic cardiac regeneration.

Codina, Marta; Elser, Jeremy; Margulies, Kenneth B.

2011-01-01

411

Emerging mechanisms of T-tubule remodelling in heart failure  

PubMed Central

Cardiac excitation–contraction coupling occurs primarily at the sites of transverse (T)-tubule/sarcoplasmic reticulum junctions. The orderly T-tubule network guarantees the instantaneous excitation and synchronous activation of nearly all Ca2+ release sites throughout the large ventricular myocyte. Because of the critical roles played by T-tubules and the array of channels and transporters localized to the T-tubule membrane network, T-tubule architecture has recently become an area of considerable research interest in the cardiovascular field. This review will focus on the current knowledge regarding normal T-tubule structure and function in the heart, T-tubule remodelling in the transition from compensated hypertrophy to heart failure, and the impact of T-tubule remodelling on myocyte Ca2+ handling function. In the last section, we discuss the molecular mechanisms underlying T-tubule remodelling in heart disease.

Guo, Ang; Zhang, Caimei; Wei, Sheng; Chen, Biyi; Song, Long-Sheng

2013-01-01

412

Failure of benefit and early hazard of bucindolol for Class IV heart failure  

Microsoft Academic Search

Objectives: The risks and benefits of ?-blockade with bucindolol were assessed in heart failure (HF) patients with Class IV symptoms within the Beta-blocker Evaluation of Survival Trial (BEST). Background: ?-blockade is accepted therapy for mild to moderate HF, but its safety and efficacy in advanced HF have not been established. Methods: BEST recruited 2708 HF patients; of these, 226 with

Jeffrey L. Anderson; Heidi Krause-Steinrauf; Steven Goldman; Barry S. Clemson; Michael J. Domanski; W. David Hager; David R. Murray; Douglas L. Mann; Barry M. Massie; Dennis M. Mcnamara; Ron Oren; William J. Rogers

2003-01-01

413

Endpoints for Comparative Effectiveness Research in Heart Failure  

PubMed Central

With the increasing availability of therapeutic strategies (drugs, devices, disease management systems) and the growing complexity of health care delivery, there is an attendant need for objective evidence of the tangible benefits of different approaches to care. This is particularly true for patients with heart failure, a common, morbid, and resource-intensive disease. There are few well-proven therapies for patients with acute decompensation or for patients with normal LVEF. Comparative effectiveness research (CER) offers an important avenue for making progress in the field. However, CER, like any well-designed research program, requires the explicit articulation of clinically important outcomes to be compared. For patients with heart failure, there is a need to develop endpoint measures that capture the totality of potential benefits and risks for alternative therapeutic approaches. Ultimately, for one therapeutic approach to be considered superior to another, it must improve one of three relevant endpoints: make patients live longer, make them feel better, or save money without adversely affecting the other two goals. Importantly, these outcomes must be measured directly and surrogates should be avoided, even if such surrogates appear to be associated with clinically meaningful, patient-centered outcomes. In this review, we discuss the available CER endpoint domains from both a clinical and a statistical perspective, summarize the wide variety of endpoints used in CER studies, and suggest steps for greater standardization of endpoints across CER studies of patients with heart failure.

Allen, Larry A.; Spertus, John A.

2012-01-01

414

Heart failure guidelines and prescribing in primary care across Europe  

PubMed Central

Background Major international differences in heart failure treatment have been repeatedly described, but the reasons for these differences remain unclear. National guideline recommendations might be a relevant factor. This study, therefore, explored variation of heart failure guideline recommendations in Europe. Methods Treatment recommendations of 14 national guidelines published after 1994 were analyzed in relation to the heart failure treatment guideline of the European Society of Cardiology. To test potential relations between recommendations and prescribing, national prescribing patterns as obtained by a European study in primary care (IMPROVEMENT-HF) were related to selected recommendations in those countries. Results Besides the 14 national guidelines used by primary care physicians in the countries contacted, the European guideline was used in four countries, and separate guidelines for specialists and primary care were available in another four countries. Two countries indicated that no guideline was used up to 2000. Comprehensiveness of the guidelines varied with respect to length, literature included and evidence ratings. Relevant differences in treatment recommendations were seen only in drug classes where evidence had changed recently (?-blockers and spironolactone). The relation between recommendation and prescribing for selected recommendations was inconsistent among countries. Conclusion Differences in guideline recommendations are not sufficient to explain variation of prescribing among countries, thus other factors must be considered.

Sturm, Heidrun B; van Gilst, Wiek H; Swedberg, Karl; Hobbs, FD Richard; Haaijer-Ruskamp, Flora M

2005-01-01

415

Ethics of the Heart: Ethical and Policy Challenges in the Treatment of Advanced Heart Failure  

Microsoft Academic Search

Heart failure is a major cause of morbidity and mortality in the United States and worldwide, accounting for immense health-care costs. Advanced therapies such as transplantation, ventricular assist devices, and implantable cardioverter defibrillators have had great success in significantly improving life expectancy and morbidity, however these advances have contributed substantially to the economic burden associated with this epidemic. Concomitantly, the

Anjali V. Fields; James N. Kirkpatrick

2012-01-01

416

[Italian Network on Congestive Heart Failure: ten-year experience].  

PubMed

IN-CHF is a multicenter registry, designed in 1995 to compile a large clinical database on the epidemiological, clinical characteristics, management and outcomes of heart failure outpatients. Main objectives of IN-CHF registry were to provide cardiological centers with a software to collect data of outpatients during office visit, for educational purpose; and to enter local data into a national registry (IN-CHF registry), for scientific purpose. Entry into the database required a diagnosis of heart failure according to the guidelines of the European Society of Cardiology. The central coordinator of the project was the ANMCO Research Center. The Italian cardiological centers participating in the project are 142, they are well representing the entire country and from March 1995 to July 2005 collected data from 23 855 outpatients. The mean age of the patients was 65+/-13 years and 71.3% were men. Main etiologies were ischemic in 39.4%, hypertensive in 15.8 %, and due to dilated cardiomyopathy in 29%. More than half of the patients (55.3%) had a history of admission for heart failure within the last year; 25.8% of the patients were in NYHA class III-IV, 9.5% showed a heart rate > 100 bpm and 16.5% third heart sound. Left ventricular ejection fraction was severely depressed (< 30%) in 27.6% of the patients, while it was > 40% in 30.9%. Renal dysfunction was present in 3.6% of the patients (serum creatinine level > 2.5 mg/dl), pulmonary disease in 18.7%, diabetes in 16.8% and anemia (hemoglobin < 12 g/dl) in 18.7%. A history of arterial hypertension was common (30.3%); 20.0% and 18.5% of the patients showed atrial fibrillation and left bundle branch block, respectively. Data from our registry provide important insights into clinical and epidemiological characteristics of heart failure outpatients followed in Italian cardiological centers. Starting from this article, every 3 months, the most relevant epidemiological data collected by the IN-CHF investigators will be published. PMID:17171992

Fabbri, Gianna; Gorini, Marco; Maggioni, Aldo P; Cacciatore, Giuseppe; Di Lenarda, Andrea

2006-10-01

417

Biologics and heart failure in rheumatoid arthritis: are we any wiser?  

PubMed Central

Purpose of review To summarize the recent literature concerning the role of TNF-a in heart failure, epidemiology of heart failure in rheumatoid arthritis and risk of heart failure associated with biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Recent findings TNF-a has been implicated in the pathogenesis of heart failure. It has direct deleterious effects on the myocardium in the setting of acute injury or chronic heart failure. In animal models, TNF-a is important in cardiac remodeling, leading to cardiac dysfunction following acute injury. Both incident and worsening heart failure have been reported in patients with rheumatoid arthritis who are treated with anti-TNF-a therapy. Recent cohort studies, however, have shown no increased risk and, in some, a protective effect on the risk of heart failure. Certain traditional cardiovascular risk factors have a relatively lesser contribution to cardiovascular morbidity and mortality in patients with rheumatoid arthritis, suggesting that disease-related perturbations of the cytokine network may contribute to the excess risk of heart failure in these patients. Summary Overall mortality in rheumatoid arthritis has remained stagnant despite advances in rheumatoid arthritis and heart failure management and improved cardiovascular mortality in the general population. Heart failure prevalence is increased in patients with rheumatoid arthritis and leads to greater mortality. Despite current expert consensus contraindicating the use of anti-TNF-a agents in patients with moderate to severe heart failure, epidemiological studies in rheumatoid arthritis have not consistently substantiated this association.

Danila, Maria I.; Patkar, Nivedita M.; Curtis, Jeffrey R.; Saag, Kenneth G.; Teng, Gim Gee

2014-01-01

418

Patient preferences for heart failure treatment: Utilities are valid measures of health-related quality of life in heart failure  

Microsoft Academic Search

Background: Current standards hold that cost-effectiveness analyses should incorporate measures of both quantity and quality of life, and that quality of life in this context is best measured by a utility. We sought to measure utility scores for patients with heart failure and to assess their validity as measures of health-related quality of life (HRQL).Methods and Results: We studied 50

Edward P. Havranek; Karen M. Mcgovern; Jennifer Weinberger; Anthony Brocato; Brian D. Lowes; William T. Abraham

1999-01-01

419

Hepatic Dysfunction in Ambulatory Patients With Heart Failure  

PubMed Central

Objectives This study evaluated the Model for End-Stage Liver Disease (MELD) score and its modified versions, which are established measures of liver dysfunction, as a tool to assess heart transplantation (HTx) urgency in ambulatory patients with heart failure. Background Liver abnormalities have a prognostic impact on the outcome of patients with advanced heart failure. Methods We retrospectively evaluated 343 patients undergoing HTx evaluation between 2005 and 2009. The prognostic effectiveness of MELD and 2 modifications (MELDNa [includes serum sodium levels] and MELD-XI [does not include international normalized ratio]) for endpoint events, defined as death/HTx/ventricular assist device requirement, was evaluated in our cohort and in subgroups of patients on and off oral anticoagulation. Results The MELD and MELDNa scores were excellent predictors for 1-year endpoint events (areas under the curve: 0.71 and 0.73, respectively). High scores (>12) were strongly associated with poor survival at 1 year (MELD 69.3% vs. 90.4% [p < 0.0001]; MELDNa 70.4% vs. 96.9% [p < 0.0001]). Increased scores were associated with increased risk for HTx (hazard ratio: 1.10 [95% confidence interval: 1.06 to 1.14]; p < 0.0001 for both scores), which was independent of other known risk factors (MELD p = 0.0055; MELDNa p = 0.0083). Anticoagulant use was associated with poor survival at 1 year (73.7% vs. 86.4%; p = 0.0118), and the statistical significance of MELD/MELDNa was higher in patients not receiving oral anticoagulation therapy. MELD-XI was a fair but limited predictor of the endpoint events in patients receiving oral anticoagulation therapy. Conclusions Assessment of liver dysfunction according to the MELD scoring system provides additional risk information in ambulatory patients with heart failure.

Farr, Maryjane; Wu, Christina; Givens, Raymond C.; Collado, Ellias; Mancini, Donna M.; Schulze, P. Christian

2013-01-01

420

Cardiac troponin I: A potential marker of exercise intolerance in patients with moderate heart failure  

Microsoft Academic Search

Background In severe heart failure, increased values of cardiac troponins have been detected during decompensation. In this study, we investigated whether an increase of cardiac troponin I can be observed after symptom-limited exercise and after an exercise training session in patients with moderate heart failure. Methods Twenty-seven patients with moderate heart failure (New York Heart Association II-III, ejection fraction 31%

Olaf Schulz; Ariane Kromer

2002-01-01

421

Mortality from heart failure in an English population, 1979-2003: study of death certification  

PubMed Central

Objective: It is widely held that there will be an epidemic of heart failure in Europe and North America as a result of increased survival from myocardial infarction and other coronary heart disease. The study objective was to discover if the decline in mortality from coronary heart disease has been accompanied by a rise in mortality from heart failure in the study population. Design: Analysis of database of mortality records including all certified causes of death, not just the underlying cause, from 1979–2003. Setting: Former Oxford NHS Region, England. Patients: Data from death certificates of all who died in the population covered. Main results: Mortality rates for heart failure fell at very similar rates as those from coronary heart disease. In men, the average annual fall in mortality from coronary heart disease was –2.7% (95% confidence intervals –2.8 to –2.5) and that from heart failure was –2.9% (–3.2 to –2.5). In women, the average annual fall in mortality from coronary heart disease was –2.3% (–2.6 to –2.1) and that from heart failure was –2.6% (–3.0 to –2.3). Conclusions: The decline in mortality from coronary heart disease has not been accompanied by a rise in mortality from heart failure. A future epidemic of heart failure, as a consequence of the decline in mortality from coronary heart disease, seems unlikely.

Goldacre, M.; Mant, D.; Duncan, M.; Griffith, M.

2005-01-01

422

Muscle reflex in heart failure: the role of exercise training  

PubMed Central

Exercise evokes sympathetic activation and increases blood pressure and heart rate (HR). Two neural mechanisms that cause the exercise-induced increase in sympathetic discharge are central command and the exercise pressor reflex (EPR). The former suggests that a volitional signal emanating from central motor areas leads to increased sympathetic activation during exercise. The latter is a reflex originating in skeletal muscle which contributes significantly to the regulation of the cardiovascular and respiratory systems during exercise. The afferent arm of this reflex is composed of metabolically sensitive (predominantly group IV, C-fibers) and mechanically sensitive (predominately group III, A-delta fibers) afferent fibers. Activation of these receptors and their associated afferent fibers reflexively adjusts sympathetic and parasympathetic nerve activity during exercise. In heart failure, the sympathetic activation during exercise is exaggerated, which potentially increases cardiovascular risk and contributes to exercise intolerance during physical activity in chronic