Sample records for overt heart failure

  1. Heart Failure

    MedlinePLUS

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

  2. Heart Failure

    MedlinePLUS

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

  3. Heart Failure

    MedlinePLUS

    ... this? Submit What's this? Submit Button Related CDC Web Sites Heart Disease Stroke High Blood Pressure Salt ... to Prevent and Control Chronic Diseases Million Hearts® Web Sites with More Information About Heart Failure For ...

  4. Heart Failure Overview

    MedlinePLUS

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

  5. Heart Failure

    Microsoft Academic Search

    Susan Isakson BA; Alan Maisel

    Decompensated congestive heart failure (CHF) is a clinical syndrome often characterized by elevated left ventricular fi lling pressures (LVEDP). Therapy for decompensated CHF aims at normalizing fi lling pressures and thereby improves both symptoms and outcomes. However, therapy guided by direct measurements of fi lling pressure is not practical in most patients, focusing attention on non-invasive surrogate measures of LVEDP

  6. Heart failure in 2010.

    PubMed

    El-Menyar, Ayman; AlMahmeed, Wael

    2010-09-01

    The Heart Failure Congress 2010 in Berlin presented the latest trials and trends in the medical and mechanical therapy of heart failure in the presence of impaired or preserved left ventricular ejection fraction. It covered all aspects of heart failure from epidemiology through basic and translational science to prevention. The congress highlighted new drugs, novel biomarkers, updated trials, the role of imaging in risk stratification and the importance of telecare in the reduction of heart failure readmission. PMID:20828344

  7. Heart failure and depression.

    PubMed

    Newhouse, Amy; Jiang, Wei

    2014-04-01

    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

  8. Ejection Fraction Heart Failure Measurement

    MedlinePLUS

    ... HF with preserved ejection fraction. Preserved ejection fraction (HFpEF) – also referred to as diastolic heart failure. The ... fraction reading and still have heart failure (called HFpEF or heart failure with preserved ejection fraction). If ...

  9. Diminished Renal Function and the Incidence of Heart Failure

    PubMed Central

    Ärnlöv, Johan

    2009-01-01

    Heart failure is one of the most common, costly, disabling and deadly diseases. During the last decade, several different indices reflecting renal function such as creatinine-based glomerular filtration rate, circulating levels of cystatin C and low-grade albuminuria have been demonstrated to be independent risk factors for heart failure. This review summarizes our current knowledge of the relationship between diminished renal function and the incidence of heart failure in the community, and also in individuals with increased risk of heart failure such as patients with overt cardiovascular disease, hypertension or diabetes. This review will also put forward important areas of future research in this field. PMID:20676281

  10. Chronic Heart Failure

    Microsoft Academic Search

    Christopher Holley; Michael W. Rich

    \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Heart failure is the leading cause of hospitalization in the Medicare age group. The prognosis for established heart failure\\u000a in persons over age 65 is poor, with 5-year survival rates of less than 50% in both men and women.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a The pharmacotherapy of systolic heart failure is well established, with angiotensin-converting enzyme inhibitors and beta-blockers\\u000a having the most proven

  11. Lifestyle and Heart Failure Risk

    MedlinePLUS Videos and Cool Tools

    ... Videos & Tools You Are Here: Home ? Latest Health News ? Lifestyle and Heart Failure Risk URL of this page: http://www.nlm.nih.gov/medlineplus/videos/news/Life_Style_070715.html Lifestyle and Heart Failure ...

  12. [Heart failure and cachexia].

    PubMed

    Tabet, J Y; Meurin, P; Ben Driss, A; Logeart, D; Héliès-Toussaint, C; Tartière, J M; Cohen-Solal, A; Grynberg, A; Bourdel-Marchasson, I

    2006-12-01

    Cachexia is related to a malnutrition state related to hypercatabolism. Initially described in cancer, it is also related to several chronic diseases including heart failure. Defined by an unintentional weight loss exceeding 7.5% of body mass during more than 6 months, it is presented by the association of nutritional deficiencies, digestive and/or urinary losses as well as metabolic abnormalities causing fat and lean mass loss and is associated to a poor prognosis. The pathophysiology of cachexia and heart failure presented some similarities associating especially neuro-hormonal activation, a cortisol/DHEA ratio imbalance, as well as pro-inflammatory cytokines activation. Currently the treatment of cachexia is mainly preventive, based on ACE-inhibitors and beta-blockers therapy and physical reconditioning. The benefits of hormonal and nutritional substitutes remains to be evidenced. PMID:18942522

  13. Electrophysiological Remodeling in Heart Failure

    PubMed Central

    Wang, Yanggan; Hill, Joseph A.

    2010-01-01

    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. PMID:20096285

  14. Imaging Heart Failure in 2010

    Microsoft Academic Search

    Ernesto E. Salcedo; Jamaluddin Moloo; Robert Quaife; Eugene Wolfel

    2010-01-01

    Heart failure is a common and serious public health problem in industrialized countries. The epidemics of diabetes, obesity,\\u000a hypertension, and coronary disease are contributing to the increasing prevalence of heart failure. The diagnosis of heart\\u000a failure is based on a detailed history and a thorough physical examination. Echocardiography plays a central role in aiding\\u000a in the diagnosis and characterization of

  15. Nuclear cardiology and heart failure

    Microsoft Academic Search

    Raffaele Giubbini; Elisa Milan; Francesco Bertagna; Fernando Mut; Marco Metra; Carlo Rodella; Maurizio Dondi

    2009-01-01

    The prevalence of heart failure in the adult population is increasing. It varies between 1% and 2%, although it mainly affects\\u000a elderly people (6–10% of people over the age of 65 years will develop heart failure). The syndrome of heart failure arises\\u000a as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction. Coronary artery disease is the leading

  16. Heart failure in women.

    PubMed

    Taylor, Anne L

    2015-04-01

    Heart failure (HF) is increasing in incidence globally, and approximately half of all HF patients are women. When women and men with HF are compared, there are significant differences in disease etiology, expression, outcomes, and perhaps, response to therapy. Hypertension rather than coronary artery disease is a more important etiology of HF in women, and HF with preserved left ventricular ejection fraction (HFPEF) is more common in women. Regardless of its etiology, women have better survival and less sudden cardiac death, but poorer quality of life with equivalent degrees of left ventricular dysfunction. Animal studies of myocardial response to stressors resulting in heart failure corroborate sex differences in ventricular remodeling, cellular morphology, and function. Despite the fact that women make up nearly 50 % of HF patients, their inclusion in randomized clinical trials has remained at about 20 %, with no trials including women as a prespecified subgroup for statistical analysis. Thus, the evidence base for treatment of HF in women is not robustly supported by sex-specific data. PMID:25633565

  17. Congestive heart failure. New frontiers.

    PubMed Central

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

    1991-01-01

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

  18. Heart failure - discharge

    MedlinePLUS

    ... Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice ... Cardiovascular Nursing; American Heart Association Council on Clinical ... Heart Association Council on Nutrition, Physical Activity, ...

  19. Heart failure - home monitoring

    MedlinePLUS

    ... Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice ... Cardiovascular Nursing; American Heart Association Council on Clinical ... Heart Association Council on Nutrition, Physical Activity, ...

  20. Heart Failure in North America

    PubMed Central

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

    2013-01-01

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

  1. Heart Failure: Unique to Older Adults

    MedlinePLUS

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

  2. Heart Failure - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... Arabic) ???? ????? - ??????? Bilingual PDF Health Information Translations Bosnian (Bosanski) Heart Failure Zatajenje srca - Bosanski (Bosnian) Bilingual PDF Health Information Translations Chinese - Simplified (????) Heart Failure ???? - ???? (Chinese - ...

  3. Pharmacogenomics of heart failure.

    PubMed

    Lymperopoulos, Anastasios; French, Faren

    2014-01-01

    The combination of angiotensin-converting enzyme (ACE) inhibitors and ?-adrenergic receptor (?AR) blockers remains the essential component of heart failure (HF) pharmacotherapy. However, individual patient responses to these pharmacotherapies vary widely. The variability in response cannot be explained entirely by clinical characteristics, and genetic variation may play a role. The purpose of this chapter is to examine the current knowledge in the field of beta-blocker and ACE inhibitor pharmacogenetics in HF. ?-blocker and ACE inhibitor pharmacogenetic studies performed in patients with HF were identified from the PubMed database from 1966 to July 2011. Thirty beta-blocker and 10 ACE inhibitor pharmacogenetic studies in patients with HF were identified.The ACE deletion variant was associated with greater survival benefit from ACE inhibitors and beta-blockers compared with the ACE insertion. Ser49 in the ?1AR, the insertion in the ?2CAR, and Gln41 in G protein-coupled receptor (GPCR) kinase (GRK)-5 are associated with greater survival benefit from ?-blockers, compared with Gly49, the deletion, and Leu41, respectively. However, many of these associations have not been validated. The HF pharmacogenetic literature is still in its very early stages, but there are promising candidate genetic variants that may identify which HF patients are most likely to benefit from beta-blockers and ACE inhibitors and patients that may require additional therapies. PMID:25150872

  4. Thyroid hormone and heart failure

    Microsoft Academic Search

    Ursula Maria Schmidt-Ott; Deborah Davis Ascheim

    2006-01-01

    Thyroid hormone metabolic disarray has been identified as a risk factor for the progression of heart disease and the development\\u000a of heart failure (HF). Both hyper-and hypothyroidism have been associated with a failing myocardium. Poor cardiac contractility\\u000a and low cardiac output due to hyperthyroidism is a rare occurrence and is mostly seen in patients with preexisting heart disease.\\u000a Referred to

  5. Echocardiographic Ratio Indices in Overtly Healthy Boxer Dogs Screened for Heart Disease

    PubMed Central

    Cunningham, S.M.; Rush, J.E.; Freeman, L.M.; Brown, D.J.; Smith, C.E.

    2015-01-01

    Background Boxer dogs are routinely screened by echocardiography to exclude congenital and acquired heart disease. Individuals of a given breed may span a large range of body sizes, potentially invalidating linear regression of M-mode measurements against body weight. Echocardiographic ratio indices (ERIs) provide a novel method of characterizing echocardiographic differences between Boxers and other dog breeds. Hypothesis ERIs obtained from overtly healthy Boxer dogs presented for cardiac screening will be different from ERIs established for normal non-Boxer dogs, and those differences will be unrelated to aortic velocity or systolic blood pressure. Animals Eighty-one Boxers with no outward clinical signs of heart disease were studied. Methods All dogs were examined by 2-dimensional, M-mode, and Doppler echocardiography. M-mode measurements were used to perform ERI calculations, and the indices in Boxers were compared between Boxers with varying severity of arrhythmia and those of normal non-Boxer dogs. Results Differences in weight-based ERIs, which reflect increased thickness of the left ventricular free wall (LVW) and interventricular septum (IVS) and smaller aortic size, were found in overtly healthy Boxer dogs compared with normal non-Boxer dogs. ERIs of left atrial and LV cavity size in overtly healthy Boxers were not significantly different from those of non-Boxer dogs. Conclusions and Clinical Importance Boxer dogs may have an increased relative thickness of the LVW and IVS that is independent of aortic size, aortic velocity, or arterial blood pressure, and this morphology should be taken into consideration when screening Boxers by echocardiography. PMID:18537876

  6. Heart failure and Alzheimer's disease.

    PubMed

    Cermakova, P; Eriksdotter, M; Lund, L H; Winblad, B; Religa, P; Religa, D

    2015-04-01

    It has recently been proposed that heart failure is a risk factor for Alzheimer's disease. Decreased cerebral blood flow and neurohormonal activation due to heart failure may contribute to the dysfunction of the neurovascular unit and cause an energy crisis in neurons. This leads to the impaired clearance of amyloid beta and hyperphosphorylation of tau protein, resulting in the formation of amyloid beta plaques and neurofibrillary tangles. In this article, we will summarize the current understanding of the relationship between heart failure and Alzheimer's disease based on epidemiological studies, brain imaging research, pathological findings and the use of animal models. The importance of atherosclerosis, myocardial infarction, atrial fibrillation, blood pressure and valve disease as well as the effect of relevant medications will be discussed. PMID:25041352

  7. Chemoreflex Function in Heart Failure

    Microsoft Academic Search

    Harold D. Schultz; Shu-Yu Sun

    2000-01-01

    Peripheral and central chemoreflexes are the dominant autonomic mechanisms regulating ventilatory patterns in response to changes in partial pressures of oxygen and carbon dioxide in arterial blood and exert powerful effects on neural circulatory control. Both reflex pathways are capable of eliciting increases in sympathetic nerve traffic and consequent increases in blood pressure. Chronic heart failure is accompanied by a

  8. Chronic Heart Failure and Micronutrients

    Microsoft Academic Search

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

    2001-01-01

    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

  9. Diagnosis and evaluation of heart failure.

    PubMed

    King, Michael; Kingery, Joe; Casey, Baretta

    2012-06-15

    Heart failure is a common clinical syndrome characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral edema and pulmonary rales. Heart failure has high morbidity and mortality rates, especially in older persons. Many conditions, such as coronary artery disease, hypertension, valvular heart disease, and diabetes mellitus, can cause or lead to decompensation of chronic heart failure. Up to 40 to 50 percent of patients with heart failure have diastolic heart failure with preserved left ventricular function, and the overall mortality is similar to that of systolic heart failure. The initial evaluation includes a history and physical examination, chest radiography, electrocardiography, and laboratory assessment to identify causes or precipitating factors. A displaced cardiac apex, a third heart sound, and chest radiography findings of venous congestion or interstitial edema are useful in identifying heart failure. Systolic heart failure is unlikely when the Framingham criteria are not met or when B-type natriuretic peptide level is normal. Echocardiography is the diagnostic standard to confirm systolic or diastolic heart failure through assessment of left ventricular ejection fraction. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that coronary artery disease is the most common cause of heart failure. PMID:22962896

  10. Heart failure epidemiology: European perspective.

    PubMed

    Guha, K; McDonagh, T

    2013-05-01

    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). PMID:23597298

  11. Vasopressin Antagonism in Heart Failure

    Microsoft Academic Search

    Steven R. Goldsmith; Mihai Gheorghiade

    2005-01-01

    Treatment of chronic heart failure (HF) is based on interference with the renin-angiotensin- aldosterone system and the adrenergic nervous system. Diuretics are used in volume-expanded patients. Insights from clinical trials and registries establish the need to consider correcting both cardiac loading conditions and nonload-related biological factors if HF therapy is to be optimized. Arginine vasopressin (AVP) represents a potentially attractive

  12. ?-Blocker pharmacogenetics in heart failure

    Microsoft Academic Search

    Jaekyu Shin; Julie A. Johnson

    2010-01-01

    ?-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

  13. Myocardial energetics in heart failure.

    PubMed

    Nickel, Alexander; Löffler, Joachim; Maack, Christoph

    2013-07-01

    It has become common sense that the failing heart is an "engine out of fuel". However, undisputable evidence that, indeed, the failing heart is limited by insufficient ATP supply is currently lacking. Over the last couple of years, an increasingly complex picture of mechanisms evolved that suggests that potentially metabolic intermediates and redox state could play the more dominant roles for signaling that eventually results in left ventricular remodeling and contractile dysfunction. In the pathophysiology of heart failure, mitochondria emerge in the crossfire of defective excitation-contraction coupling and increased energetic demand, which may provoke oxidative stress as an important upstream mediator of cardiac remodeling and cell death. Thus, future therapies may be guided towards restoring defective ion homeostasis and mitochondrial redox shifts rather than aiming solely at improving the generation of ATP. PMID:23740216

  14. Acute Heart Failure in the Postoperative Period

    Microsoft Academic Search

    Todd A. Watson; Lee A. Fleisher

    In the perioperative period, heart failure is one of the most common conditions requiring evaluation and treatment. Furthermore,\\u000a heart failure is the most frequently encountered postoperative cardiac complication of noncardiac surgery (1, 2). Postoperatively, acute heart failure (AHF), defined as the rapid onset of symptoms and signs secondary to abnormal cardiac\\u000a function, often presents in patients with underlying chronic heart

  15. Novel vasodilators in heart failure.

    PubMed

    Zamani, Payman; Greenberg, Barry H

    2013-03-01

    Heart failure is an important public health problem that is increasing in prevalence throughout the world. Not only is this condition common, but it is associated with significant morbidity and mortality as well as high costs to medical care systems. Vasodilator drugs help unload the heart and may have other effects that could benefit heart failure patients. Consequently, they have emerged as an important therapeutic approach for patients with this condition. Novel vasodilator therapies that are currently in development target new pathways, potentially giving clinicians alternate options for improving outcomes in this vulnerable population. This review focuses on investigational drugs that have the ability to dilate blood vessels amongst their therapeutic properties. These drugs include the natriuretic peptides that activate particulate guanylate cyclase, the novel agent cinaciguat that activates the soluble guanylate cyclase system, and finally a recombinant form of the naturally occurring vasodilating agent relaxin, a hormone that mediates many of the changes that allows the cardiovascular system to successfully adapt to pregnancy. PMID:23299783

  16. Right heart failure: toward a common language.

    PubMed

    Mehra, Mandeep R; Park, Myung H; Landzberg, Michael J; Lala, Anuradha; Waxman, Aaron B

    2014-02-01

    In this perspective, 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 echanisms of disease unique to the right heart. PMID:24268184

  17. Right heart failure: toward a common language

    PubMed Central

    2013-01-01

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

  18. Understand Your Risk for Heart Failure

    MedlinePLUS

    Understand Your Risk for Heart Failure Updated:Jun 1,2015 All of us lose some blood-pumping ability in our hearts as we age, but ... increases your risk. Conditions that may lead to heart failure Coronary artery disease When cholesterol and fatty ...

  19. Diastolic Heart Failure in the Elderly

    Microsoft Academic Search

    Dalane W. Kitzman

    2002-01-01

    It is now clear that diastolic heart failure (DHF) is an important, perhaps even dominant form of heart failure in older Americans. However, our knowledge base regarding the epidemiology, pathophysiology, natural history, and therapy of this relatively recently recognized disorder is limited. A number of normal age related changes in the heart and vascular system may predispose to or lower

  20. Congestive Heart Failure: Experimental Model

    PubMed Central

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

    2013-01-01

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

  1. Heart failure in the elderly

    PubMed Central

    de Freitas, Elizabete Viana; Batlouni, Michel; Gamarsky, Roberto

    2012-01-01

    The aging of the population is, currently, a major phenomenon, drawing the attention of a number of investigators. The significant increase of life expectancies over the past few decades, in addition to social and economic consequences, has lead to a major change in the morbidity and mortality profile of elders. Heart failure (HF) is a condition in which the heart can not pump enough blood to meet the body's needs. HF is predominantly a disorder of the elderly with rates increasing exponentially. The prevalence of HF approximately doubles with each decade of life. As people live longer, the occurrence of HF rises, as well as other conditions that complicate its treatment. Impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent HF and improve outcome are known and can be applied at any stage. This review emphasizes the importance of factors inherent in aging itself, focusing on heart disease, particularly as a disease of aging, can help critically refine management of this acute and chronic disease, as well as foster preventive strategies to reduce the incidence of this common malady. PMID:22916054

  2. Disease Management Programs for Heart Failure

    Microsoft Academic Search

    Ken McDonald

    2010-01-01

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

  3. [Neuropeptide Y and heart failure].

    PubMed

    Bastagli, L; Degiovanni, M; Vallar, G; Zambrini, L; Pepe, G; De Iasio, R; Boschi, S; Puddu, P

    1992-11-01

    A time course (48 hours) of plasma neuropeptide Y (NPY) levels has been carried out in a male, 66 years old, admitted to Coronary Care Unit with inferior acute myocardial infarction within 1 hour from the onset of chest pain. On admission an increase of plasma NPY levels (38 pg/ml) has been observed. The plasma NPY value decreased to normal range (15-25 pg/ml) within 12 hours and increased again (53 pg/ml) within 12 and 24 hours. A decrease in plasma NPY values to normal range has been observed within the second day in the Coronary Care Unit. A clearcut diuresis decrease, without pulmonary signs of heart failure, was present from 12 to 24 hours followed by marked polyuria within the second day. These data point out a relative importance of NPY in the diuresis adjustments. Thus, plasma NPY measurement might be a more reliable prognostic indicator of heart failure than plasma catecholamine levels. However, further investigations have to be performed. PMID:1298555

  4. Pacific Islanders’ Perspectives on Heart Failure Management

    PubMed Central

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

    2008-01-01

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

  5. 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 ...

  6. Randomized, controlled trial of integrated heart failure management. The Auckland Heart Failure Management Study

    Microsoft Academic Search

    R. N. Doughty; S. P. Wright; A. Pearl; H. J. Walsh; S. Muncaster; G. A. Whalley; G. Gamble; N. Sharpe

    2002-01-01

    Aims To determine the effect of an integrated heart failure management programme, involving patient and family, primary and secondary care, on quality of life and death or hospital readmissions in patients with chronic heart failure. Methods and Results This trial was a cluster randomized, controlled trial of integrated primary\\/secondary care com- pared with usual care for patients with heart failure.

  7. Bumetanide and furosemide in heart failure

    Microsoft Academic Search

    D Craig Brater; Bart Day; Ann Burdette; Shirley Anderson

    1984-01-01

    Bumetanide and furosemide in heart failure. We assessed the handling of and response to oral bumetanide (1.0 and 2.0 mg) and to furosemide (40 and 80 mg) in 20 patients with stable, compensated congestive heart failure (CHF), comparing the two drugs and, in addition, examining differences from normal subjects. Bumetanide and furosemide were similar in time course of absorption, but

  8. "Playboy bunny" sign of congestive heart failure.

    PubMed

    Hokama, Akira; Arakaki, Shingo; Shibata, Daisuke; Maeshiro, Tatsuji; Kinjo, Fukunori; Fujita, Jiro

    2011-11-01

    In emergency, ultrasound has been widely used as a noninvasive and effective examination to evaluate congestive heart failure. We highlight "Playboy Bunny" sign as a reliable marker and an important clue to the diagnosis of passive hepatic congestion, caused by congestive heart failure. PMID:22224133

  9. Cardiorenal syndrome in decompensated heart failure

    Microsoft Academic Search

    W H Wilson Tang; Wilfried Mullens

    2009-01-01

    Worsening renal function during treatment of acute decompensated heart failure (ADHF) often complicates the treatment course of heart failure. Furthermore, the development of worsening renal function is a strong independent predictor of long-term adverse outcomes. Sometimes referred to as ‘cardiorenal syndrome,’ the definition varies widely, and the overall understanding of pathogenesis is limited. This is probably owing to the lack

  10. Heart failure disease management: a critical review

    Microsoft Academic Search

    Michael W. Rich

    1999-01-01

    Background: Despite major advances in the pharmacotherapy of heart failure, hospitalization rates remain high, owing in large part to a multitude of psychosocial, behavioral, and financial factors that serve as barriers to effective compliance with prescribed treatment. To deal with these issues, many centers have adopted a multidisciplinary approach to heart failure disease management.Methods and Results: A systematic review of

  11. Mesangiolytic glomerulopathy in severe congestive heart failure

    Microsoft Academic Search

    Haruyoshi Yoshida; Masatomo Yashiro; Ping Liang; Eri Muso; Eiji Takeuchi; Toshihide Shimada; Ken-Ichi Sekita; Takahiko Ono; Kazuro Kanatsu; Taketoshi Sugiyama; Chuichi Kawai; Shigetake Sasayama

    1998-01-01

    Mesangiolytic glomerulopathy in severe congestive heart failure. To study the glomerular morphological abnormalities in congestive heart failure (CHF), we analyzed 27 autopsy cases without other causes of renal disease. Their mean age was 59 years, and they showed mild prerenal azotemia. They had generally been treated with digitalis and diuretics, and a few of them with captopril or nifedipine. The

  12. Heart Failure in East Asia

    PubMed Central

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

    2013-01-01

    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. PMID:23597295

  13. The role of echocardiography in heart failure.

    PubMed

    Marwick, Thomas H

    2015-06-01

    Data from echocardiography provide a cornerstone in the management of heart failure. All imaging techniques can provide an ejection fraction, but the versatility of echocardiography makes it unique in the provision of volumes, diastolic function, right ventricular function, hemodynamics, and valvular regurgitation. The early detection of heart failure has been facilitated by the assessment of global longitudinal strain, which is also useful in later heart failure for the assessment of left ventricular synchrony. The use of echocardiography has been associated with favorable outcomes, probably on the basis of facilitation of appropriate therapy. This review examines the evidence provided by echocardiography and its application in specific settings. Although the guidelines emphasize that no single test satisfies all imaging requirements in heart failure, and other modalities can provide additional information about specific questions (especially tissue characterization), echocardiography is indispensable in the management of heart failure. PMID:26033901

  14. Invasive Ventilation and Acute Heart Failure Syndrome

    Microsoft Academic Search

    Jean-Damien Ricard; Damien Roux

    Because utilization of noninvasive ventilatory techniques considerably reduces the need for endotracheal intubation and invasive\\u000a mechanical ventilation during acute heart failure syndrome (AHFS) (1, 2), the recent guidelines issued by the European Society of Cardiology (3) recommend that invasive mechanical ventilation in the setting of acute heart failure (AHF) should be considered only after\\u000a failure of noninvasive methods, such as

  15. Heart failure and galectin 3

    PubMed Central

    Suarez, Gabriela

    2014-01-01

    Innovations in medical diagnosis and treatment have led to prolongation of life of patients. Increasing the life expectancy of cardiac patients and thereby increasing the prevalence of heart failure (HF). Currently more than one million hospital admissions per year are due to HF and it has been estimated that the cost is approximately $39 billion annually in the U.S. There are two pathophysiologic myocardial mechanisms that cause HF: systolic dysfunction and diastolic dysfunction. Normal cardiac aging is characterized by morphological and structural changes that increase cardiomyocyte size, increased number of apoptosis with decreased number in myocytes, increased collagen deposition, and functional changes at cellular level. All these factors contribute to fibrotic remodeling that leads to LV diastolic stiffness, which ultimately leads to impaired diastolic function. At the same time it has been shown that galectin-3, a soluble ?-galactoside-binding protein secreted by activated macrophages, promotes cardiac fibroblast proliferation, collagen deposition, and ventricular dysfunction. In this paper we review the prognostic value of galectin-3 as an independent predictor of mortality in patients with moderate to advanced chronic HF (CHF). PMID:25405161

  16. Atrial Fibrillation in Congestive Heart Failure

    PubMed Central

    Lubitz, Steven A.; Benjamin, Emelia J.; Ellinor, Patrick T.

    2010-01-01

    Synopsis Atrial fibrillation and congestive heart failure are morbid conditions that share common risk factors and frequently coexist. Each condition predisposes to the other, and the concomitant presence of the two identifies individuals at increased risk for mortality. Recent data have emerged which help elucidate the complex genetic and non-genetic pathophysiological mechanisms that contribute to the development of atrial fibrillation in individuals with congestive heart failure. Clinical trial results offer insights into the noninvasive prevention and management of these conditions, though the emergence of newer technologies, such as catheter ablation for atrial fibrillation, have yet to be studied extensively in patients with congestive heart failure. PMID:20347787

  17. Heart failure - surgeries and devices

    MedlinePLUS

    ... used when a person is waiting for a heart transplant . You may need a left ventricular assist device ( ... may be on a waiting list for a heart transplant. Some patients who get a VAD are very ...

  18. Changes in heart rate variability and QT dispersion in patients with overt hypothyroidism

    Microsoft Academic Search

    Fabio Galetta; Ferdinando Franzoni; Poupak Fallahi; Leonardo Tocchini; Lara Braccini; Gino Santoro; Alessandro Antonelli

    2008-01-01

    Objective: The aim of the present study was to evaluate the effect of clinical hypothyroidism on cardiovascular autonomic function and ventricular repolarization. Design and methods: We studied 31 patients (22 females and 9 males; mean age 53.6G11.8 years) with overt hypothyroidism (TSHZ56.2G14.7 mU\\/ml, low free thyroxine (T4), free tri-iodothyronine (T3)) and 31 euthyroid controls, to investigate the dispersion of the

  19. Patient Experiences of Structured Heart Failure Programmes

    PubMed Central

    Tully, Nuala E.; Morgan, Karen M.; Burke, Helen M.; McGee, Hannah M.

    2010-01-01

    Objectives. Patient experiences of structured heart failure rehabilitation and their views on the important components of heart failure services were examined. Methods. Focus groups were conducted with fifteen participants (men, n = 12) attending one of two heart failure rehabilitation programmes. Sessions were guided by a semistructured interview schedule covering participants' experiences of the programme, maintenance, and GP role. Focus group transcripts were analysed qualitatively. Results. Participants indicated that rehabilitation programmes substantially met their needs. Supervised exercise sessions increased confidence to resume physical activity, while peer-group interaction and supportive medical staff improved morale. However, once the programme ended, some participants' self-care motivation lapsed, especially maintenance of an exercise routine. Patients doubted their GPs' ability to help them manage their condition. Conclusion. Structured rehabilitation programmes are effective in enabling patients to develop lifestyle skills to live with heart failure. However, postrehabilitation maintenance interventions are necessary to sustain patients' confidence in disease self-management. PMID:22110963

  20. Heart failure with preserved ejection fraction

    PubMed Central

    Gladden, James D.; Linke, Wolfgang A.

    2014-01-01

    As part of this series devoted to heart failure (HF), we review the epidemiology, diagnosis, pathophysiology, and treatment of HF with preserved ejection fraction (HFpEF). Gaps in knowledge and needed future research are discussed. PMID:24663384

  1. Significance of hyponatremia in heart failure

    Microsoft Academic Search

    Luca Bettari; Mona Fiuzat; Gary M. Felker; Christopher M. O’Connor

    Heart failure is one of the most common, costly, disabling and growing diseases (McMurray and Pfeffer in Lancet 365(9474):1877–1889,\\u000a 2005). Hyponatremia, conventionally defined as a serum-sodium concentration equal or less than 135 mmol\\/l (American Heart\\u000a Association in Heart disease and stroke statistics—2007 update. American Heart Association, Dallas, 2007; Stewart et al. in\\u000a Eur J Heart Fail 4:361–371, 2002), is a common

  2. Adrenal adrenoceptors in heart failure

    PubMed Central

    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

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

  3. Management of Ventricular Tachycardia in Heart Failure

    PubMed Central

    Baher, Alex; Valderrabano, Miguel

    2013-01-01

    Ventricular tachyarrhythmias are common in patients with congestive heart failure. The clinical presentation ranges from an asymptomatic incidental electrocardiographic finding to palpitations, syncope, and sudden cardiac death. Although implantable cardioverter defibrillators successfully prevent sudden cardiac death associated with ventricular fibrillation and ventricular tachycardia, recurrent implantable cardioverter defibrillators shocks remain a clinical management challenge. In this review, we discuss management strategies of ventricular tachycardia in congestive heart failure, including drug therapy, radiofrequency catheter ablation (RFCA), and recent RFCA advances. PMID:23519088

  4. Biventricular Pacing for Congestive Heart Failure

    Microsoft Academic Search

    Fei Lü; Leslie W. Miller

    Despite significant advancements in pharmacological therapy, mortality continues to remain high in patients with congestive\\u000a heart failure (1). Much attention has been paid to optimization of pacing modalities for patients with left ventricular dysfunction when ventricular\\u000a pacing is required. Patients with congestive heart failure frequently have symptomatic chronotropic incompetence, sinus node\\u000a dysfunction, or atrioventricular block, all of which are class

  5. Heart failure with normal ejection fraction

    Microsoft Academic Search

    Mauro Ortiz; Gregory L. Freeman

    2001-01-01

    Opinion statement  Heart failure with normal ejection fraction, also known as diastolic heart failure, is a major problem for patients and health-care\\u000a providers and is a substantial expense to society. The main pathophysiologic processes involved are increased left ventricular\\u000a stiffness and abnormal relaxation, with resulting impaired left ventricular filling. These processes typically displace the\\u000a pressure-volume relationship in an upward direction, resulting

  6. Sex, the heart, and heart failure.

    PubMed

    Kiowski, Wolfgang; Brunner, Hanspeter; Schalcher, Christoph

    2006-09-01

    In the modern era of pharmacologic treatment of erectile dysfunction, men with heart disease increasingly approach their physicians regarding the possibility of restoring sexual activity. At the same time, patients are also frequently aware of public figures that have reportedly died during coitus, often in the arms of their mistresses or prostitutes. Added to this is the perception of patients, and oftentimes their physicians, that coitus and orgasm are associated with a near maximal or even "supermaximal" cardiac workload and therefore may be hazardous for a diseased heart. Accordingly, knowledge of the cardiovascular effects of sexual activity, the risks of triggering a cardiovascular event, and the potential risks inherent in the use of drug therapy of male impotence is important to properly advise patients and their spouses regarding this sensitive issue. PMID:16959762

  7. Heart Failure With Preserved Ejection Fraction.

    PubMed

    Rogers, Felix J; Gundala, Teja; Ramos, Jahir E; Serajian, Asif

    2015-07-01

    Heart failure with preserved ejection fraction (HFpEF) is a complex clinical condition. Initially called diastolic heart failure, it soon became clear that this condition is more than the opposite side of systolic heart failure. It is increasingly prevalent and lethal. Currently, HFpEF represents more than 50% of heart failure cases and shares a 90-day mortality and readmission rate similar to heart failure with reduced ejection fraction. Heart failure with preserved ejection fraction is best considered to be a systemic disease. From a cardiovascular standpoint, it is not just a stiff ventricle. A stiff ventricle combined with a stiff arterial and venous system account for the clinical manifestations of flash pulmonary edema and the marked changes in renal function or systemic blood pressure with minor changes in fluid volume status. No effective pharmacologic treatments are available for patients with HFpEF, but an approach to the musculoskeletal system has merit: the functional limitations and exercise intolerance that patients experience are largely due to abnormalities of peripheral vascular function and skeletal muscle dysfunction. Regular exercise training has strong objective evidence to support its use to improve quality of life and functional capacity for patients with HFpEF. This clinical review summarizes the current evidence on the pathophysiologic aspects, diagnosis, and management of HFpEF. PMID:26111131

  8. Co-morbidities in heart failure.

    PubMed

    van Deursen, Vincent M; Damman, Kevin; van der Meer, Peter; Wijkstra, Peter J; Luijckx, Gert-Jan; van Beek, Andre; van Veldhuisen, Dirk J; Voors, Adriaan A

    2014-03-01

    Heart failure is a clinical syndrome characterized by poor quality of life and high morbidity and mortality. Co-morbidities frequently accompany heart failure and further decrease in both quality of life and clinical outcome. We describe that the prevalence of co-morbidities in patients with heart failure is much higher compared to age-matched controls. We will specifically address the most studied organ-related co-morbidities, that is, renal dysfunction, cerebral dysfunction, anaemia, liver dysfunction, chronic obstructive pulmonary disease, diabetes mellitus and sleep apnoea. The pathophysiologic processes underlying the interaction between heart failure and co-morbid conditions are complex and remain largely unresolved. Although common risk factors are likely to contribute, it is reasonable to believe that factors associated with heart failure might cause other co-morbid conditions. Inflammation, neurohumoral pathway activation and hemodynamic changes are potential factors. We try to provide explanations for the observed association between co-morbidities and heart failure, as well as its impact on survival. PMID:23266884

  9. Cardiac troponin levels in heart failure.

    PubMed

    Potluri, Srinivasa; Ventura, Hector O; Mulumudi, Mahesh; Mehra, Mandeep R

    2004-01-01

    Congestive heart failure (CHF) is a major cardiovascular disorder that is increasing in incidence, prevalence, and lethality. The prognostic significance of cardiac troponin levels among symptomatic and asymptomatic CHF has attracted recent interest. We sought to assess the significance of cardiac troponins in heart failure. These cardiac markers are associated with decreased left ventricular ejection fraction and poor prognosis in patients with CHF and are related to the severity of heart failure. The mechanism for the release of these markers seems to be from ventricular remodeling, ongoing myocyte degeneration, the presence of coronary artery disease, and reduced coronary reserve. In addition to B-type (brain) natriuretic peptide (BNP), cardiac troponin levels measured in patients admitted to the hospital could help risk-stratify patients and manage them effectively. BNP and cardiac troponins are easy to measure and can be repeated many times to follow patients, without interobserver variability. Theoretically, BNP is a marker of heart failure status and cardiac troponin is a marker of myocyte injury. The first therapeutic goal could be relief of circulatory congestion and lowering of BNP. The second goal could be attenuation of myocyte injury and lowering of cardiac troponins. Measuring and monitoring the levels of both could be highly effective means to reliably stratify the patients into low-, intermediate-, and high-risk groups for cardiac events and progression of heart failure. Furthermore, large-scale trials are necessary to establish them as noninvasive monitoring markers of heart failure and effectiveness of treatment. PMID:14667259

  10. Pulmonary Hypertension in Advanced Heart Failure

    Microsoft Academic Search

    Stefano Ghio

    2005-01-01

    The diagnosis of pulmonary hypertension is easy during routine evaluation of patients with chronic heart failure by means of Doppler echocardiography. However, one must remember that an accurate hemodynamic characterization of the pulmonary circulation requires right heart catheterization to measure pulmonary vascular resistance and, if necessary, to test the reversibility of pulmonary hypertension. In addition, the importance of combining the

  11. Heart Failure in Sub-Saharan Africa

    PubMed Central

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

    2013-01-01

    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. PMID:23597299

  12. Stem cell therapy for heart failure.

    PubMed

    Patel, Amit N; Silva, Francisco; Winters, Amalia A

    2015-04-01

    "During the past decade, studies in animals and humans have suggested that cell therapy has positive effects for the treatment of heart failure. This clinical effect may be mediated by angiogenesis and reduction in fibrosis rather than by regeneration of myocytes. Increased microvasculature and decreased scar also likely lead to improved cardiac function in the failing heart. The effects of cell therapy are not limited to one type of cell or delivery technique. Well-designed, large-scale, randomized clinical trials with objective end points will help to fully realize the therapeutic potential of cell-based therapy for treating heart failure." PMID:25834975

  13. How Is Heart Failure Treated?

    MedlinePLUS

    ... a risk factor for heart disease. A healthy diet also is low in added sugars and refined grains. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). ... balanced, nutrient-rich diet can help your heart work better. Getting enough ...

  14. Stem cells for heart failure in the aging heart

    Microsoft Academic Search

    Victoria L. T. Ballard

    2010-01-01

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

  15. Recognizing Advanced Heart Failure and Knowing Your Options

    MedlinePLUS

    Recognizing Advanced Heart Failure and Knowing Your Options Updated:Jun 1,2015 Understanding the Medical Situation Having advanced heart failure does ... need in the future. Treatment Options for Advanced Heart Failure Major Interventions Open-heart surgery: For patients ...

  16. Biomarkers of inflammation in heart failure

    Microsoft Academic Search

    Biykem Bozkurt; Douglas L. Mann; Anita Deswal

    2010-01-01

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

  17. Cardiac CT Angiography in Congestive Heart Failure.

    PubMed

    Levine, Avi; Hecht, Harvey S

    2015-06-01

    Cardiac CT angiography has become an important tool for the diagnosis and treatment of congestive heart failure. Differentiation of ischemic from nonischemic cardiomyopathy; evaluation of myocardial perfusion; characterization of hypertrophic cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia; and delineation of congenital heart defects and valvular abnormalities are the primary diagnostic applications. Therapeutic use includes visualization of the coronary venous anatomy for optimal implementation of cardiac resynchronization therapy and evaluation of left ventricular assist devices and transplant vasculopathy. PMID:26033904

  18. Autonomic Regulation Therapy in Heart Failure.

    PubMed

    Buckley, Una; Shivkumar, Kalyanam; Ardell, Jeffrey L

    2015-08-01

    Autonomic regulation therapy (ART) is a rapidly emerging therapy in the management of congestive heart failure secondary to systolic dysfunction. Modulation of the cardiac neuronal hierarchy can be achieved with bioelectronics modulation of the spinal cord, cervical vagus, baroreceptor, or renal nerve ablation. This review will discuss relevant preclinical and clinical research in ART for systolic heart failure. Understanding mechanistically what is being stimulated within the autonomic nervous system by such device-based therapy and how the system reacts to such stimuli is essential for optimizing stimulation parameters and for the future development of effective ART. PMID:26054327

  19. Acute Precipitants of Congestive Heart Failure Exacerbations

    Microsoft Academic Search

    Ross T. Tsuyuki; Robert S. McKelvie; J. Malcolm O. Arnold; Antonio C. P. Barretto; Antonio C. C. Carvalho; Debra L. Isaac; Allan D. Kitching; Leopoldo S. Piegas; Koon K. Teo; Salim Yusuf

    2001-01-01

    Background: Few studies have prospectively and systematically explored the factors that acutely pre- cipitate exacerbation of congestive heart failure (CHF) in patients with left ventricular dysfunction. Knowl- edge of such factors is important in designing mea- sures to prevent deterioration of clinical status. The objective of this study was to prospectively describe the precipitants associated with exacerbation of CHF status

  20. Nurses's knowledge of heart failure education principles

    Microsoft Academic Search

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

    2002-01-01

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

  1. Imaging Techniques in Acute Heart Failure.

    PubMed

    Pérez Del Villar, Candelas; Yotti, Raquel; Bermejo, Javier

    2015-07-01

    In recent years, imaging techniques have revolutionized the diagnosis of heart failure. In patients with a clinical picture of acute decompensation, prognosis is largely determined by early implementation of general measures and treatment of the underlying cause. Given its diagnostic yield and portability, ultrasound has become an essential tool in the setting of acute heart failure, and is currently found in all medical departments involved in the care of the critically ill patient. Cardiac magnetic resonance and computed tomography allow detailed characterization of multiple aspects of cardiac structure and function that were previously unavailable. This helps guide and monitor many of the treatment decisions in the acute heart failure population in an entirely noninvasive way. This article aims to review the usefulness of the imaging techniques that are clinically relevant in the context of an episode of acute heart failure. We discuss the indications and limitations of these techniques in detail and describe the general principles for the appropriate interpretation of results. PMID:26002273

  2. Remote Monitoring of Heart Failure Patients

    PubMed Central

    Bhimaraj, Arvind

    2013-01-01

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

  3. Remote monitoring of heart failure patients.

    PubMed

    Bhimaraj, Arvind

    2013-01-01

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

  4. Self-Care Guide for the Heart Failure Patient

    MedlinePLUS

    ... Institution: NIH Library User Name Password Sign In Cardiology Patient Page Self-Care Guide for the Heart ... www.aahfnpatienteducation.com/index.php American College of Cardiology - www.cardiosmart.org/Heart-Conditions/Heart-Failure Previous ...

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

    Microsoft Academic Search

    Kengo Usui; Yasuyuki Kaneko

    2008-01-01

    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

  6. Altered Cardiac Myocyte Ca Regulation In Heart Failure

    NSDL National Science Digital Library

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

    2006-12-01

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

  7. Living with heart failure; patient and carer perspectives

    Microsoft Academic Search

    J. F. Pattenden; H. Roberts; R. J. P. Lewin

    2007-01-01

    Patients with heart failure have multiple readmissions to hospital, a poor prognosis and varying quality of life. This paper explores how patients with heart failure and their family carers cope with daily life. 36 patients and 20 family caregivers were interviewed in five centres in the UK. Analysis showed that living with heart failure can be frightening, restrictive and distressing

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

    Microsoft Academic Search

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

    2009-01-01

    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,

  9. Heart failure in the diabetic population – pathophysiology, diagnosis and management

    PubMed Central

    Drzewoski, Jozef

    2014-01-01

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

  10. Heart failure association of the European society of cardiology specialist heart failure curriculum.

    PubMed

    McDonagh, Theresa A; Gardner, Roy S; Lainscak, Mitja; Nielsen, Olav W; Parissis, John; Filippatos, Gerasimos; Anker, Stefan D

    2014-02-01

    It is well established that organized care of heart failure patients, including specialist management by cardiologists, improves patient outcomes. In response to this, other national training bodies (the UK and the USA) have developed heart failure subspecialty curricula within their Cardiology Training Curricula. In addition, European Society of Cardiology (ESC) subspecialty curricula exist for Interventional Cardiology and Heart Rhythm Management. The purpose of this heart failure curriculum is to provide a framework which can be used as a blueprint for training across Europe. This blueprint mirrors other ESC curricula. Each section has three components: the knowledge required, the skills which are necessary, and the professionalism (attitudes and behaviours) which should be attained. The programme is designed to last 2?years. The first year is devoted to the specialist heart failure module. The second year allows completion of the optional modules of advanced imaging, device therapy for implanters, cardiac transplantation, and mechanical circulatory support. The second year can also be devoted to continuation of specialist heart failure training and/or research for those not wishing to continue with the advanced modules. PMID:24464608

  11. Advanced (stage d) heart failure: a statement from the heart failure society of america guidelines committee.

    PubMed

    Fang, James C; Ewald, Gregory A; Allen, Larry A; Butler, Javed; Westlake Canary, Cheryl A; Colvin-Adams, Monica; Dickinson, Michael G; Levy, Phillip; Stough, Wendy Gattis; Sweitzer, Nancy K; Teerlink, John R; Whellan, David J; Albert, Nancy M; Krishnamani, Rajan; Rich, Michael W; Walsh, Mary N; Bonnell, Mark R; Carson, Peter E; Chan, Michael C; Dries, Daniel L; Hernandez, Adrian F; Hershberger, Ray E; Katz, Stuart D; Moore, Stephanie; Rodgers, Jo E; Rogers, Joseph G; Vest, Amanda R; Givertz, Michael M

    2015-06-01

    We propose that stage D advanced heart failure be defined as the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy. Importantly, the progressive decline should be primarily driven by the heart failure syndrome. Formally defining advanced heart failure and specifying when medical and device therapies have failed is challenging, but signs and symptoms, hemodynamics, exercise testing, biomarkers, and risk prediction models are useful in this process. Identification of patients in stage D is a clinically important task because treatments are inherently limited, morbidity is typically progressive, and survival is often short. Age, frailty, and psychosocial issues affect both outcomes and selection of therapy for stage D patients. Heart transplant and mechanical circulatory support devices are potential treatment options in select patients. In addition to considering indications, contraindications, clinical status, and comorbidities, treatment selection for stage D patients involves incorporating the patient's wishes for survival versus quality of life, and palliative and hospice care should be integrated into care plans. More research is needed to determine optimal strategies for patient selection and medical decision making, with the ultimate goal of improving clinical and patient centered outcomes in patients with stage D heart failure. PMID:25953697

  12. Heart failure and mechanical circulatory support.

    PubMed

    Esper, Stephen Andrew; Subramaniam, Kathirvel

    2012-06-01

    Cardiovascular disease (CVD) is defined as one of the following: hypertension, congestive heart failure (HF), stroke, coronary heart disease and congenital heart defects. CVD is the main cause of the disease burden (illness and death) in Europe (23% of all the disease burdens) and the second main cause of the disease burden in those European Union (EU) countries with very low child and adult mortality (17%).(1) Heart disease is a common health problem worldwide. According to the most recent Heart Disease and Stroke Statistics-2011 update,(2) greater than 82 000 000 adults living in the United States of America (USA) have one or more types of CVD. Many resources have been invested in attempting to understand and curtail the progression of congestive HF. This article attempts to address the growing concern over HF by looking at the epidemiology, pathophysiology and available therapies as anaesthesiologists encounter these patients more often nowadays in the operating room and intensive care units. Mechanical circulatory assistance and heart transplantation are two established treatment methods for end-stage HF. In this review, we also address the indications and contraindications for mechanical circulatory assistance, types and spectrum of available ventricular assist devices, efficacy, safety and cost analysis of circulatory support therapy. PMID:22910083

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

    Microsoft Academic Search

    Gloria J. Simuel

    2010-01-01

    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

  14. Bumetanide in heart failure in infancy

    Microsoft Academic Search

    O C Ward; L K Lam

    1977-01-01

    The effect of bumetanide in infants with congenital heart disease presenting with cardiac failure was studied. The study was divided into acute (3 days) and long-term (mean 10.5 weeks) cases. A total of 12 male infants was included in the acute study and 13 cases were evaluated in the long-term study. The dose used in the acute study (0.015 mg\\/kg)

  15. Chronic heart failure: ?-blockers and pharmacogenetics

    Microsoft Academic Search

    Junichi Azuma; Shinpei Nonen

    2009-01-01

    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

  16. [Cardiac rehabilitation for heart failure patients].

    PubMed

    Agard, Odile; Cristobal, Laurent; Caffray, Maxime

    2013-04-01

    The benefits of cardiac rehabilitation for patients with heart failure are well documented: greater capacity during physical effort and improved quality of life, a reduction in comorbidities and in the number and duration of hospitalisations, etc. Physiotherapy is one of the tools of this specific and multidisciplinary care which is governed by protocols and which can be offered on an outpatient basis or during hospitalisation. PMID:23697064

  17. Psychosocial factors and congestive heart failure

    Microsoft Academic Search

    Judi Profant; Joel E. Dimsdale

    2000-01-01

    The incidence and prevalence of congestive heart failure (CHF) are increasing, even after adjustment for an aging population.\\u000a Because coverage of psychosocial factors in CHF has been insufficient, we reviewed the literature in this area. Four major\\u000a themes emerged in our review as we examined relations between psychosocial factors and CHF: psychiatric comorbidity, psychosocial\\u000a precipitation and exacerbation of CHF, psychosocial

  18. Acute Heart Failure and Systemic Diseases

    Microsoft Academic Search

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

    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

  19. Energy metabolism in heart failure and remodelling

    PubMed Central

    Ingwall, Joanne S.

    2009-01-01

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

  20. Chronic heart failure: contemporary diagnosis and management.

    PubMed

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

    2010-02-01

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

  1. Chronic Heart Failure: Contemporary Diagnosis and Management

    PubMed Central

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

    2010-01-01

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

  2. Role of cardiac imaging in heart failure.

    PubMed

    Todiere, G; Marzilli, M

    2012-08-01

    Heart failure is the leading cause of mortality and rehospitalization in Western countries. With the development of new technologies applied to medical diagnostic pathways, cardiovascular imaging has rapidly gained ground. Therefore, the clinical cardiologist has to keep updated on the management of such innovative diagnostic tools which were once the exclusive domain of radiologists. The need to understand a new language is fundamental for the selection of diagnostic and therapeutic strategies in patients with heart failure, which is often the final destination for many cardiovascular diseases. Alongside standard diagnostic techniques such as chest radiography two-dimensional ultrasound and cardiac color Doppler, all of which are indispensable in daily practice, innovative tools have been defining their incremental role in cardiovascular imaging. Cardiac magnetic resonance (CMR), cardiac computed tomography (CT), speckle tracking, 3D echocardiography, new applications in nuclear medicine (SPECT MIBG), and "cardiac hybrid imaging" are emerging for research and are also playing a pivotal role in the clinical scenario. These techniques are useful the for non-invasive acquisition of diagnostic and prognostic information in heart failure. Whether the radiological and economic impact of these new technologies is sustainable is a question the clinical cardiologist will need to answer when considering the cost/benefit of the diagnostic tool selected among these methods. PMID:22858913

  3. Incretin-related drug therapy in heart failure.

    PubMed

    Vest, Amanda R

    2015-02-01

    The new pharmacological classes of GLP-1 agonists and DPP-4 inhibitors are now widely used in diabetes and have been postulated as beneficial in heart failure. These proposed benefits arise from the inter-related pathophysiologies of diabetes and heart failure (diabetes increases the risk of heart failure, and heart failure can induce insulin resistance) and also in light of the dysfunctional myocardial energetics seen in heart failure. The normal heart utilizes predominantly fatty acids for energy production, but there is some evidence to suggest that increased myocardial glucose uptake may be beneficial for the failing heart. Thus, GLP-1 agonists, which stimulate glucose-dependent insulin release and enhance myocardial glucose uptake, have become a focus of investigation in both animal models and humans with heart failure. Limited pilot data for GLP-1 agonists shows potential improvements in systolic function, hemodynamics, and quality of life, forming the basis for current phase II trials. PMID:25323108

  4. New diagnostic and therapeutic possibilities for diastolic heart failure

    PubMed Central

    Jeong, Euy-Myoung; Dudley, Samuel C.

    2014-01-01

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

  5. Mechanisms of renal hyporesponsiveness to BNP in heart failure.

    PubMed

    Egom, Emmanuel E; Feridooni, Tiam; Hotchkiss, Adam; Kruzliak, Peter; Pasumarthi, Kishore B S

    2015-06-01

    The B-type natriuretic peptide (BNP), a member of the family of vasoactive peptides, is a potent natriuretic, diuretic, and vasodilatory peptide that contributes to blood pressure and volume homeostasis. These attributes make BNP an ideal drug that could aid in diuresing a fluid-overloaded patient who had poor or worsening renal function. Despite the potential benefits of BNP, accumulating evidence suggests that simply increasing the amount of circulating BNP does not necessarily increase natriuresis in patients with heart failure (HF). Moreover, despite high BNP levels, natriuresis falls when HF progresses from a compensated to a decompensated state, suggesting the emergence of renal resistance to BNP. Although likely multifactorial, several mechanisms have been proposed to explain renal hyporesponsiveness in HF, including, but not limited to, decreased renal BNP availability, down-regulation of natriuretic peptide receptors, and altered BNP intracellular signal transduction pathways. Thus, a better understanding of renal hyporesponsiveness in HF is required to devise strategies to develop novel agents and technologies that directly restore renal BNP efficiency. It is hoped that development of these new therapeutic approaches will serve to limit sodium retention in patients with HF, which may ultimately delay the progression to overt HF. PMID:25881664

  6. Dilemmas in end-stage heart failure.

    PubMed

    Chen-Scarabelli, Carol; Saravolatz, Louis; Hirsh, Benjamin; Agrawal, Pratik; Scarabelli, Tiziano M

    2015-01-01

    Heart failure (HF), a complex clinical syndrome due to structural or functional disorder of the heart, is a major global health issue, with a prevalence of over 5.8 million in the USA alone, and over 23 million worldwide. As a leading cause of hospitalizations among patients aged 65 years or older, HF is a major consumer of healthcare resources, creating a substantial strain on the healthcare system. This paper discusses the epidemiology of HF, financial impact, and multifaceted predicaments in end-stage HF care. A search was conducted on the U.S. National Library of Medicine website (www.pubmed.gov) using keywords such as end-stage heart failure, palliative care, ethical dilemmas. Despite the poor prognosis of HF (worse than that for many cancers), many HF patients, caregivers, and clinicians are unaware of the poor prognosis. In addition, the unpredictable clinical trajectory of HF complicates the planning of end-of-life care, such as palliative care and hospice, leading to underutilization of such resources. In conclusion, ethical dilemmas in end-stage HF are numerous, embroiling not only the patient, but also the caregiver, healthcare team, and society. PMID:25678905

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

    Microsoft Academic Search

    Shunsuke Ohnishi; Noritoshi Nagaya

    2007-01-01

    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.

  8. Modelling the heart: insights, failures and progress.

    PubMed

    Noble, Denis

    2002-12-01

    Mathematical models of the heart have developed over a period of about 40 years. Cell types in all regions of the heart have been modelled and they are now being incorporated into anatomically detailed models of the whole organ. This combination is leading to the creation of the first 'virtual organ,' which is being used in drug discovery and testing, and in simulating the action of devices, such as cardiac defibrillators. Simulation is a necessary tool of analysis in attempting to understand biological complexity. We often learn as much from the failures as from the successes of mathematical models. It is the iterative interaction between experiment and simulation that is important. Examples are given where this process has been instrumental in some of the major advances in the field. PMID:12447980

  9. Positive airway pressure therapy for heart failure

    PubMed Central

    Kato, Takao; Suda, Shoko; Kasai, Takatoshi

    2014-01-01

    Heart failure (HF) is a life-threatening disease and is a growing public health concern. Despite recent advances in pharmacological management for HF, the morbidity and mortality from HF remain high. Therefore, non-pharmacological approaches for HF are being developed. However, most non-pharmacological approaches are invasive, have limited indication and are considered only for advanced HF. Accordingly, the development of less invasive, non-pharmacological approaches that improve outcomes for patients with HF is important. One such approach may include positive airway pressure (PAP) therapy. In this review, the role of PAP therapy applied through mask interfaces in the wide spectrum of HF care is discussed. PMID:25429330

  10. Functional assessment of heart failure patients.

    PubMed

    Kaminsky, Leonard A; Tuttle, Mary S

    2015-01-01

    A hallmark of heart failure (HF) is exercise intolerance, along with fatigue and shortness of breath. Functional assessments provide important clinical information. As the disease progresses, HF patients experience a downward spiral leading to a functional disability. Reduced functional abilities restrict or prevent HF patients from performing occupational tasks, which may result in loss of work and reduced quality of life. Functional assessments provide a measure of functional capacity and information on prognosis, disease severity, degree of disability, and quality of life. Direct and indirect cardiovascular and muscular functional assessments for patients with HF are provided in this review. PMID:25432472

  11. Sleep-disordered breathing in patients with decompensated heart failure

    Microsoft Academic Search

    Martin A. Valdivia-Arenas; Michael Powers; Rami N. Khayat

    2009-01-01

    Sleep-disordered breathing (SDB) has a higher prevalence in patients with heart failure than in the general middle-aged population.\\u000a Obstructive sleep apnea (OSA), one of the forms of SBD, promotes poorly controlled hypertension, coronary events, and atrial\\u000a fibrillation events that can lead to acutely decompensated heart failure (ADHF), and evidence suggests that untreated OSA\\u000a increases mortality in patients with heart failure.

  12. Cost effective management programme for heart failure reduces hospitalisation

    Microsoft Academic Search

    C M J Cline; B Y A Israelsson; R B Willenheimer; K Broms; L R Erhardt

    1998-01-01

    ObjectiveTo study the effects of a management programme on hospitalisation and health care costs one year after admission for heart failure.DesignProspective, randomised trial.SettingUniversity hospital with a primary catchment area of 250 000 inhabitants.Patients190 patients (aged 65–84 years, 52.3% men) hospitalised because of heart failure.InterventionTwo types of patient management were compared. The intervention group received education on heart failure and self

  13. Financial aspects of heart failure programs of care

    Microsoft Academic Search

    Simon Stewart

    2005-01-01

    As suggested by studies that have examined the economic burden imposed by heart failure and, more specifically where the greatest expenditure occurs, the key to cost-effectively minimising the impact of a sustained heart failure epidemic is to minimise recurrent hospital use—even at the expense of increasing levels of community-based care and prescribed pharmacotherapy (Mark DB. Economics of treating heart failure.

  14. Prospective memory and chronic heart failure

    PubMed Central

    2013-01-01

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

  15. Stage A: can heart failure be prevented?

    PubMed

    Danelich, Ilya M; Reed, Brent N; Sueta, Carla A

    2015-01-01

    Heart failure (HF) is an epidemic associated with significant morbidity and mortality, affecting over 5 million people in the United States and 1-2% of the population worldwide. Observational studies have suggested that a healthy lifestyle can reduce HF risk. Although no clinical trials have targeted the prevention of HF as a primary endpoint, many have evaluated outcomes associated with the development of symptomatic disease (i.e., progression to HF, HF hospitalization or death) as secondary endpoints. Blood pressure treatment represents the most effective strategy in preventing heart failure; each 5 mm Hg decrease in systolic blood pressures reduces the risk of HF development by 24%. Thiazide diuretics appear to be the most efficacious agents in patients with hypertension. Angiotensin converting enzyme inhibitors and angiotensin-II receptor blockers are first line agents for patients with chronic atherosclerosis, diabetes, or chronic kidney disease. Beta blockers appear less effective as single agents and cardioselective agents are preferred. Calcium channel blockers, specifically non-dihydropyridines, should be avoided and alpha blockers should not be used to reduce HF risk. PMID:24251457

  16. Treatment of Congestive Heart Failure with Triamterene

    PubMed Central

    Wener, J.; Schucher, R.; Friedman, R.

    1965-01-01

    Triamterene, a newer oral diuretic, was administered to nine hospitalized patients with congestive heart failure for an average of 15 days, and to 22 ambulatory patients for a period of three to 11 months. The daily dosage of triamterene ranged from 50 to 250 mg., but usually 100-200 mg. was administered daily in two divided doses, with or without the addition of 50 mg. of hydrochlorothiazide daily. Triamterene is a safe and effective diuretic at doses of 100-200 mg. daily and no drug tolerance develops with long-term therapy. However, when used alone, it is not as effective as hydrochlorothiazide, but in combination with the latter drug the resultant diuresis is unsurpassed by any other oral diuretic therapy that we have used to date. Triamterene itself does not produce kaliuresis and it blocks thiazide-induced kaliuresis. Serum uric acid levels may rise slightly, but no clinical gout was seen in this study. PMID:14259336

  17. Cognitive Deficits in Chronic Heart Failure

    PubMed Central

    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

    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. PMID:20216015

  18. Adriamycin-induced heart failure: mechanisms and modulation

    Microsoft Academic Search

    Pawan K. Singal; Timao Li; Dinender Kumar; Igor Danelisen; Natasha Iliskovic

    2000-01-01

    Adriamycin (doxorubicin) is one of the most effective chemotherapeutic agents against a variety of cancers, but its usefulness is seriously curtailed by the risk of developing heart failure. Available laboratory evidence suggests that an increase in oxidative stress, brought about by increased free radical production and decreased myocardial endogenous antioxidants, plays an important role in the pathogenesis of heart failure.

  19. Inflammatory markers in heart failure: hype or hope?

    PubMed

    Cialdella, Pio; Pedicino, Daniela; Gustapane, Massimo; Santangeli, Pasquale; Narducci, Maria Lucia; Pelargonio, Gemma; Basile, Eloisa; Giglio, Ada Francesca; Pazzano, Vincenzo; Vitulano, Nicola; Bellocci, Fulvio

    2013-05-01

    Heart failure is a growing global epidemic that involves in its pathophysiology a proinflammatory state. Since the first description of elevated cytokine levels in this setting, there has been increasing interest in understanding the role of these molecules in left-ventricular remodeling and function. Over the years, intense research on the 'cytokine theory' of heart failure has allowed evaluation of the role of inflammatory biomarkers not only as pathogenetic mediators, but also as potential tools in the diagnosis and risk stratification of heart failure patients. Whereas current evidence does not support the use of inflammatory biomarkers for the diagnosis of heart failure, the assessment of their levels and the connection between their changes and changes in clinical status and prognosis has been well validated. At present, the utility of anti-inflammatory therapies in heart failure is still debated, since trials of anti-inflammatory agents in this setting have pointed out controversial results. On the contrary, established treatments of heart failure, including ?-blockers, renin-angiotensin system antagonists, and aldosterone-receptor blockers seem able to act by modulating cytokine expression, suggesting a new role for these molecules in guiding heart failure therapy. Therefore, the binomial topic of heart failure and inflammation still has a number of fields not completely explored: our aim is to update current knowledge and future perspectives. PMID:22157179

  20. Program Description: Physical Therapy in a Heart Failure Clinic

    PubMed Central

    Knocke, Ann

    2012-01-01

    Aerobic exercise and resistance training have been proven to be beneficial for patients with heart failure. Current reimbursement guidelines exclude these patients from our traditional cardiac rehabilitation program, so at Newton Wellesley Hospital a clinic model was developed for the disease management and exercise of heart failure patients. PMID:22993502

  1. Simulation Study of Cellular Electric Properties in Heart Failure

    Microsoft Academic Search

    Leo Priebe; Dirk J. Beuckelmann

    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

  2. Perceived control reduces emotional stress in patients with heart failure

    Microsoft Academic Search

    Kathleen Dracup; Cheryl Westlake; Virginia S Erickson; Debra K Moser; Mary L Caldwell; Michelle A Hamilton

    2003-01-01

    We studied patients with heart failure (HF) to determine if perceived control reduces emotional distress (i.e., anxiety, depression and hostility) in chronic, debilitating cardiac illness and whether the demographic, clinical and psychologic characteristics of patients with high and low perceived control differed. Psychological assessment of 222 patients with heart failure included an evaluation of perceived control using the Control Attitudes

  3. Genetics and heart failure: a concise guide for the clinician.

    PubMed

    Skrzynia, Cecile; Berg, Jonathan S; Willis, Monte S; Jensen, Brian C

    2015-01-01

    The pathogenesis of heart failure involves a complex interaction between genetic and environmental factors. Genetic factors may influence the susceptibility to the underlying etiology of heart failure, the rapidity of disease progression, or the response to pharmacologic therapy. The genetic contribution to heart failure is relatively minor in most multifactorial cases, but more direct and profound in the case of familial dilated cardiomyopathy. Early studies of genetic risk for heart failure focused on polymorphisms in genes integral to the adrenergic and renin-angiotensin-aldosterone system. Some of these variants were found to increase the risk of developing heart failure, and others appeared to affect the therapeutic response to neurohormonal antagonists. Regardless, each variant individually confers a relatively modest increase in risk and likely requires complex interaction with other variants and the environment for heart failure to develop. Dilated cardiomyopathy frequently leads to heart failure, and a genetic etiology increasingly has been recognized in cases previously considered to be "idiopathic". Up to 50% of dilated cardiomyopathy cases without other cause likely are due to a heritable genetic mutation. Such mutations typically are found in genes encoding sarcomeric proteins and are inherited in an autosomal dominant fashion. In recent years, rapid advances in sequencing technology have improved our ability to diagnose familial dilated cardiomyopathy and those diagnostic tests are available widely. Optimal care for the expanding population of patients with heritable heart failure involves counselors and physicians with specialized training in genetics, but numerous online genetics resources are available to practicing clinicians. PMID:24251456

  4. Mechanisms by which exercise training benefits patients with heart failure

    Microsoft Academic Search

    Louis J. Ignarro; Francesco Cacciatore; Ettore Crimi; Claudio Napoli

    2009-01-01

    Clinical consequences of heart failure are fatigue, dyspnea, and progressive impairment of exercise tolerance. Regular exercise training is associated with health-improving effects. In patients with stable heart failure, exercise training can relieve symptoms, improve exercise capacity and quality of life, as well as reduce hospitalization and, to some extent, risk of mortality. Progressive exercise training is associated with pulmonary, cardiovascular,

  5. The prognostic importance of anemia in patients with heart failure

    Microsoft Academic Search

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

    2003-01-01

    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.

  6. Cheyne-Stokes respiration in patients with congestive heart failure

    Microsoft Academic Search

    Thomas Brack

    Cheyne-Stokes Respiration (CSR) is a breath- ing pattern characterised by rhythmic oscillation of tidal volume with regularly recurring periods of hyperpnoea, hypopnoea and apnoea. CSR is no longer solely regarded as a symptom of severe con- gestive heart failure (CHF), but has been recog- nised as an independent risk factor for worsening heart failure and reduced survival in patients with

  7. A systematicreview of telemonitoring for the management of heart failure

    Microsoft Academic Search

    Amala A. Louis; Tracy Turner; Marcia Gretton; Angela Baksh; John G. F. Cleland

    Background: Telemonitoring allows a clinician to monitor, on a daily basis, physiological variables measured by patients at home. This provides a means to keep patients with heart failure under close supervision, which could reduce the rate of admission to hospital and accelerate discharge. Objective: To review the literature on the application of telemedicine in the management of heart failure. Methods:

  8. The crucial role of patient education in heart failure

    Microsoft Academic Search

    Anna Strfmberg

    2005-01-01

    Background: Deterioration of heart failure causes and complicates many hospital admissions in people aged over 65 years. Frequent readmissions cause an immense burden on the individual, the family and the health care system. Heart failure management programmes, in which patient education is an important component, have been shown to be effective in improving self-care and reducing readmissions. Aim: This paper

  9. Randomised controlled trial of specialist nurse intervention in heart failure

    Microsoft Academic Search

    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

    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

  10. Increased Oxidative Stress in Patients With Congestive Heart Failure

    Microsoft Academic Search

    MARY KEITH; AMIR GERANMAYEGAN; MICHAEL J. SOLE; REGINA KURIAN; ANDREW ROBINSON; AHMAD S. OMRAN; KHURSHEED N. JEEJEEBHOY

    Objectives. We sought to study the markers of lipid peroxida- tion and defenses against oxidative stress in patients with varying degrees of heart failure. Background. Despite advances in other areas of cardiovascular disease, the morbidity and mortality from congestive heart failure (CHF) are increasing. Data mainly from animal models suggest that free radical injury may promote myocardial decompensation. However, there

  11. DEFEAT Heart Failure: Assessment and Management of Heart Failure in Nursing Homes Made Easy

    PubMed Central

    Ahmed, Ali; Jones, Linda; Hays, Clare I.

    2008-01-01

    Heart failure (HF) in older adults presents challenges which are different in many ways than those for younger adults. Diagnosis of HF in older adults can be delayed due to attributing early symptoms to normal changes of aging, or in the setting of a normal ejection fraction, failing to appreciate diastolic heart failure. Moreover, treatment of HF in the elderly is often complicated by comorbidities and polypharmacy. The long-term care setting can present even more challenges, yet can be made easy by following a simple mnemonic DEFEAT-HF. After making a clinical Diagnosis and determining the Etiology, Fluid volume must be assessed to achieve euvolemia, and Ejection frAction must be determine to guide Therapy. PMID:18585640

  12. Use of beta-blockers in congestive heart failure.

    PubMed

    Sallach, John A; Goldstein, Sidney

    2003-01-01

    While beta-adrenergic blockers have been used for decades in a variety of cardiovascular illnesses, they have traditionally been avoided in chronic heart failure. In spite of significant advances in management, mortality in patients suffering from heart failure remains unacceptably high and new therapies are urgently needed. Recently, several large clinical trials have shown a significant reduction in both morbidity and mortality in heart failure patients when beta-blockers are added to standard therapy. While further investigation is warranted in certain subgroups, the use of beta-adrenergic blockers in New York Heart Association (NYHA) class II to IV heart failure should now be considered routine. The purpose of this article is to outline and review the five major clinical trials of beta-blocker therapy in chronic heart failure; the US Carvedilol heart failure Program (USCP), the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), the Metoprolol CR/XL Randomized Intervention Trial in chronic Heart Failure (MERIT-HF), the Beta-blocker Evaluation of Survival Trial (BEST) and the Carvedilol Prospective Randomized Cumulative Survival trial (COPERNICUS), and to aid the reader in the selection of appropriate candidates for beta-blocker therapy. PMID:12846268

  13. The war against heart failure: the Lancet lecture.

    PubMed

    Braunwald, Eugene

    2015-02-28

    Heart failure is a global problem with an estimated prevalence of 38 million patients worldwide, a number that is increasing with the ageing of the population. It is the most common diagnosis in patients aged 65 years or older admitted to hospital and in high-income nations. Despite some progress, the prognosis of heart failure is worse than that of most cancers. Because of the seriousness of the condition, a declaration of war on five fronts has been proposed for heart failure. Efforts are underway to treat heart failure by enhancing myofilament sensitivity to Ca(2+); transfer of the gene for SERCA2a, the protein that pumps calcium into the sarcoplasmic reticulum of the cardiomyocyte, seems promising in a phase 2 trial. Several other abnormal calcium-handling proteins in the failing heart are candidates for gene therapy; many short, non-coding RNAs--ie, microRNAs (miRNAs)--block gene expression and protein translation. These molecules are crucial to calcium cycling and ventricular hypertrophy. The actions of miRNAs can be blocked by a new class of drugs, antagomirs, some of which have been shown to improve cardiac function in animal models of heart failure; cell therapy, with autologous bone marrow derived mononuclear cells, or autogenous mesenchymal cells, which can be administered as cryopreserved off the shelf products, seem to be promising in both preclinical and early clinical heart failure trials; and long-term ventricular assistance devices are now used increasingly as a destination therapy in patients with advanced heart failure. In selected patients, left ventricular assistance can lead to myocardial recovery and explantation of the device. The approaches to the treatment of heart failure described, when used alone or in combination, could become important weapons in the war against heart failure. PMID:25467564

  14. Deteriorated function of cutaneous microcirculation in chronic congestive heart failure

    PubMed Central

    Edvinsson, Marie-Louise; Uddman, Erik; Andersson, Sven E

    2011-01-01

    Background Chronic congestive heart failure is a complex condition that leads to dysfunction in the peripheral microcirculation. We have previously shown that vascular reactivity is reduced with increasing age. In this study, we examined a group of very old patients with severe chronic heart failure to test the hypothesis that vascular function is further compromised by a combination of heart failure and aging. Methods Cutaneous forearm blood flow was measured by laser Doppler flowmetry and compared among three groups: Group 1 (n = 20, mean ± SE: 85.5 ± 4 years), heart failure patients with New York Heart Association class IV (NYHA IV) and with a NT-proBNP level ? 5000 ng/L; Group 2 (n = 15, mean ± SE: 76.5 ± 2 years), heart failure patients with NYHA II and NT-proBNP ? 2000 ng/L, and Group 3 (n = 10, mean ± SE: 67.6 ± 3.0 years), healthy controls with no clinical signs of heart failure. The vasodilator response to the iontophoretic administration of acetylcholine (ACh), acting via an endothelial mechanism, and sodium nitroprusside (SNP), acting via a smooth muscle cell mechanism, were studied. Results All patients with heart failure had significantly reduced vascular reactivity independent of the mode of stimulation (ACh, SNP or heat) when compared to healthy controls. However, the responses did not differ between the two groups of heart failure patients. Conclusions Cutaneous vascular reactivity is reduced in heart failure patients and does not correlate with the severity of the condition or age of patients. PMID:22783290

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

    NASA Astrophysics Data System (ADS)

    Simuel, Gloria J.

    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.

  16. Death in Heart Failure: a Community Perspective

    PubMed Central

    Henkel, Danielle M.; Redfield, Margaret M.; Weston, Susan A.; Gerber, Yariv; Roger, Véronique L.

    2009-01-01

    Background Mortality in heart failure (HF) remains high but causes of death are incompletely defined. As HF is heterogeneous syndrome categorized according to ejection fraction (EF), the association between EF and causes of death is important, yet elusive. Method and Results Community subjects with HF were classified according to preserved (?50%) and reduced EF (<50%). Deaths were classified as coronary heart disease (CHD), other cardiovascular and non-cardiovascular. Among 1063 persons with HF, 45% had preserved EF with less cardiovascular risk factors and less coronary disease than those with reduced EF. At 5 years, survival was 45% (95% CI 43%–49%) and 43% of the deaths were non-cardiovascular. The leading cause of death in subjects with preserved EF was non-cardiovascular (49%) vs CHD (43%) for subjects with reduced EF. The proportion of cardiovascular deaths decreased from 69% in 1979–1984 to 40% in 1997–2002 (p=0.007) among subjects with preserved EF contrasting with a modest change among those with reduced EF (77% in to 64%, p=0.08). Advanced age, male sex, diabetes, smoking and kidney disease were associated with an increase risk of all cause and cardiovascular death. After adjustment, preserved EF was associated with a lower risk of cardiovascular death but not all cause death. Conclusion Community subjects with HF experience a persistently high mortality and a large proportion of deaths are non-cardiovascular. Subjects with preserved EF have less cardiovascular disease before death, are less likely to experience cardiovascular deaths than those with reduced EF and the proportion of cardiovascular deaths declined over time. PMID:19300532

  17. Myocardial energetics and ubiquinol in diastolic heart failure.

    PubMed

    Bates, Angelina; Shen, Qiuhua; Hiebert, John B; Thimmesch, Amanda; Pierce, Janet D

    2014-12-01

    Diastolic heart failure, or heart failure with preserved ejection fraction, is a leading cause of morbidity and mortality. There are no current therapies effective in improving outcomes for these patients. The aim of this article is to review the literature and examine the role of coenzyme Q10 in heart failure with preserved ejection fraction related to mitochondrial synthesis of adenosine triphosphate and reactive oxygen species production. The study results reflect that myocardial energetics alters in diastolic heart failure and that there is defective energy metabolism and increased oxidative stress. Studies are emerging to evaluate coenzyme Q10 , particularly ubiquinol, as a supplemental treatment for heart-failure patients. In diastolic heart-failure patients, clinicians are beginning to use supplemental therapies to improve patient outcomes, and one promising complementary treatment to improve left ventricular diastolic function is ubiquinol. Additional studies are needed using large-scale randomized models to confirm if ubiquinol would be beneficial. Since ubiquinol is an antioxidant and is required for adenosine triphosphate production, clinicians and health scientists should be aware of the potential role of this supplement in the treatment of diastolic heart failure. PMID:25263245

  18. Atrial natriuretic factor binding sites in experimental congestive heart failure

    SciTech Connect

    Bianchi, C.; Thibault, G.; Wrobel-Konrad, E.; De Lean, A.; Genest, J.; Cantin, M. (Clinical Research Institute of Montreal, Quebec (Canada))

    1989-10-01

    A quantitative in vitro autoradiographic study was performed on the aorta, renal glomeruli, and adrenal cortex of cardiomyopathic hamsters in various stages of heart failure and correlated, in some instances, with in vivo autoradiography. The results indicate virtually no correlation between the degree of congestive heart failure and the density of 125I-labeled atrial natriuretic factor ((Ser99, Tyr126)ANF) binding sites (Bmax) in the tissues examined. Whereas the Bmax was increased in the thoracic aorta in moderate and severe heart failure, there were no significant changes in the zona glomerulosa. The renal glomeruli Bmax was lower in mild and moderate heart failure compared with control and severe heart failure. The proportion of ANF B- and C-receptors was also evaluated in sections of the aorta, adrenal, and kidney of control and cardiomyopathic hamsters with severe heart failure. (Arg102, Cys121)ANF (des-(Gln113, Ser114, Gly115, Leu116, Gly117) NH2) (C-ANF) at 10(-6) M displaced approximately 505 of (Ser99, Tyr126)125I-ANF bound in the aorta and renal glomeruli and approximately 20% in the adrenal zona glomerulosa in both series of animals. These results suggest that ANF may exert a buffering effect on the vasoconstriction of heart failure and to a certain extent may inhibit aldosterone secretion. The impairment of renal sodium excretion does not appear to be related to glomerular ANF binding sites at any stage of the disease.

  19. Prospective memory impairment in chronic heart failure.

    PubMed

    Habota, Tina; McLennan, Skye N; Cameron, Jan; Henry, Julie D; Ski, Chantal F; Thompson, David R; Rendell, Peter G

    2015-03-01

    Although cognitive deficits are common in patients with chronic heart failure (CHF), no study to date has investigated whether these deficits extend to the capacity to execute delayed intentions (prospective memory, PM). This is a surprising omission given the critical role PM plays in correctly implementing many important CHF self-care behaviors. The present study aimed to provide the first empirical assessment of PM function in people with CHF. The key dependent measure was a laboratory measure of PM that closely simulates PM tasks in daily life - Virtual Week. A group comparison design was used, with 30 CHF patients compared to 30 demographically matched controls. Background measures assessing executive functions, working memory, and verbal memory were also administered. The CHF group exhibited significant PM impairment, with difficulties generalizing across different types of PM tasks (event, time, regular, irregular). The CHF group also had moderate deficits on several of the background cognitive measures. Given the level of impairment remained consistent even on tasks that imposed minimal demands on memory for task content, CHF-related difficulties most likely reflects problems with the prospective component. However, exploratory analyses suggest that difficulties with retrospective memory and global cognition (but not executive control), also contribute to the PM difficulties seen in this group. The implications of these data are discussed, and in particular, it is argued that problems with PM may help explain why patient engagement in CHF self-care behaviors is often poor. (JINS, 2015, 21, 1-10). PMID:25818386

  20. Imaging heart failure: current and future applications.

    PubMed

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

    2013-03-01

    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

  1. Heart failure with preserved ejection fraction.

    PubMed

    Rigolli, Marzia; Whalley, Gillian A

    2013-12-01

    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

  2. Cardiopulmonary Exercise Testing in Heart Failure.

    PubMed

    Myers, Jonathan; Arena, Ross; Cahalin, Lawarence P; Labate, Valentina; Guazzi, Marco

    2015-08-01

    A growing body of literature has underscored the value of ventilatory gas exchange techniques during exercise testing (commonly termed cardiopulmonary exercise testing, or CPX) and their applications in the management of patients with heart failure (HF). The added precision provided by this technology is useful in terms of understanding the physiology and mechanisms underlying exercise intolerance in HF, quantifying the response to therapy, evaluating disability, making activity recommendations, and quantifying the response to exercise training. Importantly, a wealth of data has been published in recent years on the prognostic utility of CPX in patients with HF. These studies have highlighted the concept that indices of ventilatory inefficiency, such as the VE/VCO2 slope and oscillatory breathing, are particularly powerful in stratifying risk in HF. This article provides an overview of the clinical utility of CPX in patients with HF, including the applications of ventilatory inefficiency during exercise, the role of the pulmonary system in HF, respiratory muscle performance (RMP), and the application of CPX as part of a comprehensive clinical and exercise test evaluation. PMID:26096801

  3. Reverse Remodeling in Systolic Heart Failure.

    PubMed

    Saraon, Tajinderpal; Katz, Stuart D

    2015-01-01

    Left ventricular (LV) remodeling is the most common term used to describe the functional, structural, myocellular, and interstitial changes that occur in response to myocardial injury and/or chronic changes in myocardial loading conditions. Progression of LV remodeling over time in response to neurohormonal activation, increased wall stress, and inflammatory signaling pathways is associated with an increased risk of major morbidity and mortality. LV reverse remodeling describes the process by which an injured LV with a dilated spherical phenotype may return toward a normalization of ventricular structure and function, either spontaneously or in response to therapeutic interventions. LV reverse remodeling can occur in response to interventions that mitigate the source of myocardial injury, or that reduce or eliminate the neurohormonal and/or hemodynamic factors that contribute to the progression of the LV remodeling process. In this article, we review selected studies that demonstrate the LV reverse remodeling process in response to pharmacological, pacemaker device, and mechanical circulatory support device interventions. Future therapies targeting the physiological, neurohormonal, and/or molecular signaling pathways to effect reverse remodeling may further improve clinical outcomes in heart failure patients. PMID:25839990

  4. Heart failure with preserved ejection fraction.

    PubMed

    Pellicori, Pierpaolo; Cleland, John Gf

    2014-12-01

    Many patients with heart failure (HF) have a normal left ventricular ejection fraction, and are labelled as having HF with preserved left ventricular ejection fraction (HFPEF). Hypertension, atrial fibrillation and age are important contributors to the development of HFPEF and, therefore, its prevalence is likely to increase in the next few decades. The pathophysiology of HFPEF is heterogeneous but with a final common pathway leading to congestion. HF remains a clinical diagnosis but the plasma concentration of B-type natriuretic peptide (eg BNP/N-terminal prohormone BNP (NT-proBNP)), a marker of congestion, is an essential component. Imaging, usually by echocardiography, is required to determine the cardiac phenotype (ie valve disease, left ventricular ejection fraction) underlying HF. A superficially normal echocardiogram does not exclude a diagnosis of HF. No treatment has been shown conclusively to alter the prognosis of HFPEF. However, treatments directed at congestion and hypertension, such as diuretics, mineralocorticoid receptor antagonists (MRAs) and angiotensin converting-enzyme inhibitors, may improve symptoms and probably do improve outcomes. No treatment has yet been shown to reverse the underlying myocardial pathology of HFPEF, although there is some hope that MRAs might. PMID:25468914

  5. Heart failure with preserved ejection fraction

    PubMed Central

    Rigolli, Marzia; Whalley, Gillian A

    2013-01-01

    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

  6. Incorporating Common Biomarkers into the Clinical Management of Heart Failure

    PubMed Central

    Halkar, Meghana

    2013-01-01

    Heart failure is a prevalent and costly disease, and its management with polypharmacy is complex. Commonly available biomarkers primarily help to 1) establish or refute the diagnosis of heart failure; 2) help to determine the disease severity; and 3) identify adverse consequences of treatment. Although several of them are commonly ordered (such as electrolytes, renal and liver function), their use is primarily based on broad clinical experience rather than established evidence. The availability of cardiac-specific natriuretic peptide testing has provided an evidence-based breakthrough in our abilities to establish the diagnosis and severity of heart failure, yet the appropriate boundaries to guide management are still in refinement. PMID:24085636

  7. Gene Therapy in the Treatment of Heart Failure

    NSDL National Science Digital Library

    2007-04-01

    Heart failure is a major cause of morbidity and mortality in contemporary societies. Although progress in conventional treatment modalities is making steady and incremental gains to reduce this disease burden, there remains a need to explore new and potentially therapeutic approaches. Gene therapy, for example, was initially envisioned as a treatment strategy for inherited monogenic disorders. It is now apparent that gene therapy has broader potential that also includes acquired polygenic diseases, such as heart failure. Advances in the understanding of the molecular basis of conditions such as these, together with the evolution of increasingly efficient gene transfer technology, has placed congestive heart failure within reach of gene-based therapy.

  8. Value of Cardiac CT in Patients With Heart Failure

    PubMed Central

    Mangalat, Deepa; Kalogeropoulos, Andreas; Georgiopoulou, Vasiliki; Stillman, Arthur; Butler, Javed

    2010-01-01

    Multidetector CT (MDCT) with 64-slice capability continues to gain momentum for cardiovascular imaging. Beyond images of coronary arteries, it also provides reliable information on left ventricular structure and function, cardiac venous anatomy, the pulmonary venous system, and right ventricular function—all aspects important in the management of heart failure patients. Potential unique applications in heart failure include cardiac dyssynchrony evaluation, assessing cardiomyopathies, and post-transplant annual follow-up. This review details the multiple applications and limitations of MDCT in the heart failure population, including comparison with other commonly used imaging modalities such as echocardiography and MRI. PMID:20369033

  9. Heart failure in African Americans: disparities can be overcome.

    PubMed

    Sharma, Alok; Colvin-Adams, Monica; Yancy, Clyde W

    2014-05-01

    African Americans are disproportionately affected by heart failure, with a high prevalence at an early age. Hypertension, diabetes, obesity, and chronic kidney disease are all common in African Americans and all predispose to heart failure. Neurohormonal imbalances, endothelial dysfunction, genetic polymorphisms, and socioeconomic factors also contribute. In general, the same evidence-based treatment guidelines that apply to white patients with heart failure also apply to African Americans. However, the combination of hydralazine and isosorbide dinitrate is advised specifically for African Americans. PMID:24789589

  10. Cardiac Metabolism in Heart Failure - Implications beyond ATP production

    PubMed Central

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

    2013-01-01

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

  11. How Can Heart Failure Be Prevented?

    MedlinePLUS

    ... Arrhythmia Congenital Heart Defects Coronary Heart Disease Heart Valve Disease High Blood Pressure Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the NHLBI BOOKMARK & SHARE X Share this page from the NHLBI on Blogger. ...

  12. Who Is at Risk for Heart Failure?

    MedlinePLUS

    ... Arrhythmia Congenital Heart Defects Coronary Heart Disease Heart Valve Disease High Blood Pressure Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the NHLBI BOOKMARK & SHARE X Share this page from the NHLBI on Blogger. ...

  13. D-ribose, a metabolic substrate for congestive heart failure.

    PubMed

    Wagner, Susan; Herrick, James; Shecterle, Linda M; St Cyr, John A

    2009-06-01

    The incidence of congestive heart failure continues to escalate worldwide, taxing health care systems. Current therapies focus on clinical management. Current accepted regimens have provided some success; however, most patients show progression of their disease. Because of this failure, research continues to explore therapies directed at stabilization of their disease and hopefully to improve the downward spiral. Publications have asserted that the failing heart is energy starved. D-ribose, a naturally occurring pentose carbohydrate and a key component in the adenosine triphosphate (ATP) molecule, has demonstrated an ability to replenish ATP levels and improve diastolic dysfunction following myocardial ischemia, which has been shown to improve the clinical state of patients afflicted with congestive heart failure. D-ribose may provide the necessary metabolic substrate to benefit this energy-deficient state found in heart failure. PMID:19523159

  14. MODELING CARDIOVASCULAR AND RESPIRATORY DYNAMICS IN CONGESTIVE HEART FAILURE

    E-print Network

    Olufsen, Mette Sofie

    ]. Respiratory changes duiring sleep combined with these cardiovascular and control sensitivity changes can, Respiratory modeling, Parameter estimation, Model validation, Sensitivity analysis, Subset selection. 1 #12MODELING CARDIOVASCULAR AND RESPIRATORY DYNAMICS IN CONGESTIVE HEART FAILURE LAURA M. ELLWEIN1

  15. Knowledge Is Power for Patients with Heart Failure

    MedlinePLUS

    Knowledge Is Power for Patients With Heart Failure Death rates may be higher for those lacking clear ... follow-up period than patients with higher health knowledge. Those with low health literacy tended to be ...

  16. Family Influences on Heart Failure Self-care and Outcomes

    PubMed Central

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

    2009-01-01

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

  17. Vasodilators in Acute Heart Failure: Review of the Latest Studies

    PubMed Central

    Levy, Phillip D.; Laribi, Said; Mebazaa, Alexandre

    2014-01-01

    Vasodilators play an important role in the management of acute heart failure, particularly when increased afterload is the precipitating cause of decompensation. The time-honored approach to afterload reduction has been largely focused on use of intravenous nitrovasodilators and, when properly dosed, this class of agents does provide substantial symptom relief for patients with acute hypertensive heart failure. Despite this, nitrovasodilators have never been shown to diminish mortality or provide any post-discharge outcome benefit leading to an on-going search for viable and more effective alternatives. While no new vasodilators have been approved for use in acute heart failure since nesiritide more than a decade ago, a number of novel agents have been developed, with some showing significant promise in recent clinical trials. In this review, we summarize the latest study data as it relates to vasodilator therapy and provide a glimpse into the not too distant future state of acute heart failure care. PMID:24855585

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

    MedlinePLUS

    ... 108, October 2012 Hospitalization for Congestive Heart Failure: United States, 2000–2010 On This Page Key findings Did ... estimated that 5.8 million people in the United States have CHF ( 1 ). CHF is one of the ...

  19. Using beta-blockers to treat heart failure.

    PubMed

    Nguyen, Timothy; Shaheed, Ahmed; Venigalla, Srikanth; Mullokandov, Emanuel

    2014-12-01

    Bisoprolol, carvedilol, metoprolol, and nebivolol are beta-blocker drugs used to improve survival in patients with systolic heart failure. This article reviews these drugs and how practitioners can initiate and titrate them for maximum patient benefit. PMID:25417667

  20. Vasodilators in Acute Heart Failure: Review of the Latest Studies.

    PubMed

    Levy, Phillip D; Laribi, Said; Mebazaa, Alexandre

    2014-06-01

    Vasodilators play an important role in the management of acute heart failure, particularly when increased afterload is the precipitating cause of decompensation. The time-honored approach to afterload reduction has been largely focused on use of intravenous nitrovasodilators and, when properly dosed, this class of agents does provide substantial symptom relief for patients with acute hypertensive heart failure. Despite this, nitrovasodilators have never been shown to diminish mortality or provide any post-discharge outcome benefit leading to an on-going search for viable and more effective alternatives. While no new vasodilators have been approved for use in acute heart failure since nesiritide more than a decade ago, a number of novel agents have been developed, with some showing significant promise in recent clinical trials. In this review, we summarize the latest study data as it relates to vasodilator therapy and provide a glimpse into the not too distant future state of acute heart failure care. PMID:24855585

  1. Depression Linked to Death of Many Heart Failure Patients

    MedlinePLUS

    ... said study author John Cleland, a professor of cardiology at Imperial College London and the University of ... Heart Failure Association of the European Society of Cardiology in Seville, Spain. Research presented at meetings is ...

  2. Sleep Disordered Breathing in Patients with Heart Failure

    PubMed Central

    Mentz, Robert J.; Fiuzat, Mona

    2013-01-01

    Synopsis Despite high adverse event rates in heart failure patients, the development of new therapies has slowed, and most recent studies have been neutral. This suggests the need for a reappraisal of treatment strategies, and a focus on co-morbid conditions in these patients. Sleep disordered breathing (SDB) is prevalent in heart failure patients and is associated with increased morbidity and mortality. SDB is pro-inflammatory, 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 heart failure patients 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 heart failure patients. PMID:24656103

  3. Resource use in decompensated heart failure by disease progression categories.

    PubMed

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

    2007-01-01

    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

  4. Higher salt preference in heart failure patients.

    PubMed

    de Souza, Juli Thomaz; Matsubara, Luiz S; Menani, José Vanderlei; Matsubara, Beatriz B; Johnson, Alan Kim; De Gobbi, Juliana Irani Fratucci

    2012-02-01

    Heart failure (HF) is a complex syndrome that involves changes in behavioral, neural and endocrine regulatory systems. Dietary salt restriction along with pharmacotherapy is considered an essential component in the effective management of symptomatic HF patients. However, it is well recognized that HF patients typically have great difficulty in restricting sodium intake. We hypothesized that under HF altered activity in systems that normally function to regulate body fluid and cardiovascular homeostasis could produce an increased preference for the taste of salt. Therefore, this study was conducted to evaluate the perceived palatability (defined as salt preference) of food with different concentrations of added salt in compensated chronically medicated HF patients and comparable control subjects. Healthy volunteers (n=25) and medicated, clinically stable HF patients (n=38, NYHA functional class II or III) were interviewed and given an evaluation to assess their preferences for different amounts of saltiness. Three salt concentrations (0.58, 0.82, and 1.16 g/100 g) of bean soup were presented to the subjects. Salt preference for each concentration was quantified using an adjective scale (unpleasant, fair or delicious). Healthy volunteers preferred the soup with medium salt concentration (p=0.042), HF patients disliked the low concentration (p<0.001) and preferred the high concentration of salted bean soup (p<0.001). When compared to healthy volunteers, HF patients demonstrated a significantly greater preference for the soup with a high salt concentration (p=0.038). It is concluded that medicated, compensated patients under chronic treatment for HF have an increased preference for salt. PMID:22019543

  5. Zinc and the prooxidant heart failure phenotype.

    PubMed

    Efeovbokhan, Nephertiti; Bhattacharya, Syamal K; Ahokas, Robert A; Sun, Yao; Guntaka, Ramareddy V; Gerling, Ivan C; Weber, Karl T

    2014-10-01

    Neurohormonal activation with attendant aldosteronism contributes to the clinical appearance of congestive heart failure (CHF). Aldosteronism is intrinsically coupled to Zn and Ca dyshomeostasis, in which consequent hypozincemia compromises Zn homeostasis and Zn-based antioxidant defenses that contribute to the CHF prooxidant phenotype. Ionized hypocalcemia leads to secondary hyperparathyroidism with parathyroid hormone-mediated Ca overloading of diverse cells, including cardiomyocytes. When mitochondrial Ca overload exceeds a threshold, myocyte necrosis follows. The reciprocal regulation involving cytosolic free [Zn]i as antioxidant and [Ca]i as prooxidant can be uncoupled in favor of Zn-based antioxidant defenses. Increased [Zn]i acts as a multifaceted antioxidant by: (1) inhibiting Ca entry through L-type channels and hence cardioprotectant from the Ca-driven mitochondriocentric signal-transducer effector pathway to nonischemic necrosis, (2) serving as catalytic regulator of Cu/Zn-superoxide dismutase, and (3) activating its cytosolic sensor, metal-responsive transcription factor that regulates the expression of relevant antioxidant defense genes. Albeit present in subnanomolar range, increased cytosolic free [Zn]i enhances antioxidant capacity that confers cardioprotection. It can be achieved exogenously by ZnSO4 supplementation or endogenously using a ?3-receptor agonist (eg, nebivolol) that enhances NO generation to release inactive cytosolic Zn bound to metallothionein. By recognizing the pathophysiologic relevance of Zn dyshomeostasis in the prooxidant CHF phenotype and by exploiting the pharmacophysiologic potential of [Zn]i as antioxidant, vulnerable cardiomyocytes under assault from neurohormonal activation can be protected and the myocardium spared from adverse structural remodeling. PMID:25291496

  6. [Epidemiology and prognosis of heart failure].

    PubMed

    Edelmann, F

    2015-04-01

    Heart failure (HF) is a major and growing health problem in western communities. Recent data indicate that more than 50% of patients with the clinical syndrome of HF have a preserved left ventricular ejection fraction (HF with preserved ejection fraction, HFpEF). In contrast to the calculated expectations, the observed incidence of HF is rising. Despite the fact that the relative proportion of patients with preserved left ventricular function is also increasing, other factors, such as ageing of the population and the concomitant change of compound risk factors may also contribute to the actual rise in the incidence of HF. Patients with HF suffer from reduced exercise capacity, impaired quality of life and also from recurrent hospitalization due to HF. Over the past decades, an increase of recurrent HF events has been documented. In contrast to earlier reports in which HFpEF was considered to be more benign than HF with reduced ejection fraction (HFrEF), recent data suggest that once hospitalized for HF, patients with HFpEF and those with HFrEF have a comparable prognosis in terms of morbidity and mortality. Despite increasing clinical and economic relevance, no treatment has yet been shown to convincingly reduce mortality in HFpEF. In contrast, strategies for improving survival have now been established for HFrEF. The problem of HF will continue to be major challenge for the healthcare systems in western communities; therefore, consolidated clinical research is necessary to further improve therapeutic strategies for HFrEF and to generally establish treatment options for HFpEF. PMID:25822419

  7. Role of Growth Hormone in Chronic Heart Failure: Therapeutic Implications

    Microsoft Academic Search

    Maurizio Volterrani; Filippo Manelli; Maria Cicoira; Roberto Lorusso; Andrea Giustina

    2000-01-01

    Chronic heart failure is a multi-etiological cardiovascular disorder with high prevalence and poor prognosis. Medical treatment of dilated cardiomyopathy is aimed at alleviating heart failure symptoms. Diuretics, angiotensin-converting enzyme (ACE) inhibitors and very recently, beta-blockers have been shown to have favorable effects on symptoms, exercise capacity and mortality. Growth hormone (GH) and insulin-like growth factor (IGF)-1 are involved in several

  8. Treatment of heart failure with preserved ejection fraction

    Microsoft Academic Search

    Barry A. Borlaug

    2009-01-01

    Opinion statement  Heart failure with preserved ejection fraction (HFpEF) is a major public health problem in the United States. However, in\\u000a contrast to systolic heart failure, there are little data to guide treatment decisions in HFpEF, and no therapies have been\\u000a shown to improve outcome in these patients. This review explores what is currently known about the pathophysiologic mechanisms\\u000a causing HFpEF

  9. Who cares for the patient with heart failure?

    Microsoft Academic Search

    Denise D. Barnard

    2006-01-01

    Heart failure is a progressive and often fatal clinical syndrome caused by cardiac dysfunction. Therapeutic advances in both\\u000a acute and chronic heart failure care have resulted in the ability to partially or completely reverse cardiac dysfunction,\\u000a with accompanying reductions in attributable morbidity, mortality, and cost. In order to examine who is best suited to provide\\u000a care for the patient with

  10. Observation Units in the Management of Acute Heart Failure Syndromes

    Microsoft Academic Search

    Gregory J. Fermann; Sean P. Collins

    2010-01-01

    Observation units (OUs) for acute heart failure syndromes (AHFS) have proven to be effective in reducing heart failure admissions\\u000a and may reduce costs. Goals for risk-stratifying patients with AHFS in OUs include determining patients suitable for OU management\\u000a and determining end points of treatment. Although many provider models and settings exist, management algorithms common to\\u000a most OUs include monitoring\\/nursing care,

  11. Device monitoring strategies in acute heart failure syndromes

    Microsoft Academic Search

    Michael A. Samara; W. H. Wilson Tang

    2011-01-01

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

  12. Hyponatremia in acute heart failure syndromes: A potential therapeutic target

    Microsoft Academic Search

    Filippo Brandimarte; Francesco Fedele; Leonardo De Luca; Gregg C. Fonarow; Mihai Gheorghiade

    2007-01-01

    Mild hyponatremia is common in patients hospitalized for worsening heart failure, and it is a major predictor of post-discharge\\u000a mortality and morbidity irrespective of left ventricular ejection fraction. Recent data also suggest that standard therapy\\u000a for heart failure does not improve or normalize serum sodium concentration during hospitalization. There are conclusive data\\u000a that vasopressin antagonists improve or normalize serum sodium

  13. Impact of Systemic Venous Congestion in Heart Failure

    Microsoft Academic Search

    Matthias Dupont; Wilfried Mullens; W. H. Wilson Tang

    Systemic venous congestion is one of the hallmarks of the syndrome of heart failure that results from activation of different\\u000a deleterious neurohormonal pathways. Apart from contributing to patients’ symptoms and hospital admissions, growing evidence\\u000a suggests that congestion itself drives further heart failure progression. In addition, systemic venous congestion exerts detrimental\\u000a effects on other organs (such as kidneys and liver) due

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

    Microsoft Academic Search

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

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

  15. Angiotensin II, sympathetic nerve activity and chronic heart failure.

    PubMed

    Wang, Yutang; Seto, Sai-Wang; Golledge, Jonathan

    2014-03-01

    Sympathetic nerve activity has been reported to be increased in both humans and animals with chronic heart failure. One of the mechanisms believed to be responsible for this phenomenon is increased systemic and cerebral angiotensin II signaling. Plasma angiotensin II is increased in humans and animals with chronic heart failure. The increase in angiotensin II signaling enhances sympathetic nerve activity through actions on both central and peripheral sites during chronic heart failure. Angiotensin II signaling is enhanced in different brain sites such as the paraventricular nucleus, the rostral ventrolateral medulla and the area postrema. Blocking angiotensin II type 1 receptors decreases sympathetic nerve activity and cardiac sympathetic afferent reflex when therapy is administered to the paraventricular nucleus. Injection of an angiotensin receptor blocker into the area postrema activates the sympathoinhibitory baroreflex. In peripheral regions, angiotensin II elevates both norepinephrine release and synthesis and inhibits norepinephrine uptake at nerve endings, which may contribute to the increase in sympathetic nerve activity seen in chronic heart failure. Increased circulating angiotensin II during chronic heart failure may enhance the sympathoexcitatory chemoreflex and inhibit the sympathoinhibitory baroreflex. In addition, increased circulating angiotensin II can directly act on the central nervous system via the subfornical organ and the area postrema to increase sympathetic outflow. Inhibition of angiotensin II formation and its type 1 receptor has been shown to have beneficial effects in chronic heart failure patients. PMID:23225134

  16. The Multi-Biomarker Approach for Heart Failure in Patients with Hypertension

    PubMed Central

    Bielecka-Dabrowa, Agata; Gluba-Brzózka, Anna; Michalska-Kasiczak, Marta; Misztal, Ma?gorzata; Rysz, Jacek; Banach, Maciej

    2015-01-01

    We assessed the predictive ability of selected biomarkers using N-terminal pro-brain natriuretic peptide (NT-proBNP) as the benchmark and tried to establish a multi-biomarker approach to heart failure (HF) in hypertensive patients. In 120 hypertensive patients with or without overt heart failure, the incremental predictive value of the following biomarkers was investigated: Collagen III N-terminal propeptide (PIIINP), cystatin C (CysC), lipocalin-2/NGAL, syndecan-4, tumor necrosis factor-? (TNF-?), interleukin 1 receptor type I (IL1R1), galectin-3, cardiotrophin-1 (CT-1), transforming growth factor ? (TGF-?) and N-terminal pro-brain natriuretic peptide (NT-proBNP). The highest discriminative value for HF was observed for NT-proBNP (area under the receiver operating characteristic curve (AUC) = 0.873) and TGF-? (AUC = 0.878). On the basis of ROC curve analysis we found that CT-1 > 152 pg/mL, TGF-? < 7.7 ng/mL, syndecan > 2.3 ng/mL, NT-proBNP > 332.5 pg/mL, CysC > 1 mg/L and NGAL > 39.9 ng/mL were significant predictors of overt HF. There was only a small improvement in predictive ability of the multi-biomarker panel including the four biomarkers with the best performance in the detection of HF—NT-proBNP, TGF-?, CT-1, CysC—compared to the panel with NT-proBNP, TGF-? and CT-1 only. Biomarkers with different pathophysiological backgrounds (NT-proBNP, TGF-?, CT-1, CysC) give additive prognostic value for incident HF in hypertensive patients compared to NT-proBNP alone. PMID:25984599

  17. Dilated Cardiomyopathies as a Cause of Congestive Heart Failure

    Microsoft Academic Search

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

    2002-01-01

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

  18. Prevalence and Prognostic Significance of Heart Failure Stages

    Microsoft Academic Search

    Khawaja Afzal Ammar; Steven J. Jacobsen; Douglas W. Mahoney; Jan A. Kors; Margaret M. Redfield; Richard J. Rodeheffer

    2010-01-01

    Background—Heart failure (HF) is a progressive disorder associated with frequent morbidity and mortality. An American Heart Association\\/American College of Cardiology staging classification of HF has been developed to emphasize early detection and prevention. The prevalence of HF stages and their association with mortality are unknown. We sought to estimate HF stage prevalence in the community and to measure the association

  19. 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

    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

    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

  20. Pediatric Heart Failure: Current State and Future Possibilities

    PubMed Central

    Jang, Gi Young

    2015-01-01

    Heart failure is a complex pathophysiological syndrome that can occur in children from a variety of diseases, including cardiomyopathies, myocarditis, and congenital heart disease. The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole. Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking. Ventricular assist devices (VADs) have taken an increasingly important role in the management of advanced heart failure in children. The predominant role of these devices has been as a bridge to heart transplantation, and excellent results are currently achieved for most children with cardiomyopathies. There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts. Additionally, there is an active investigation and interest in expansion of VADs beyond the predominant utilization as a bridge to a heart transplant into ventricular recovery, device explant without a heart transplantation (bridge to recovery), and placement of devices without the expectation of recovery or transplantation (destination therapy). PMID:25653697

  1. Pharmacotherapy of heart failure with preserved ejection fraction.

    PubMed

    Basaraba, Jade E; Barry, Arden R

    2015-04-01

    Heart failure with preserved ejection fraction (HFpEF) constitutes ~50% of all heart failure diagnoses and is associated with considerable morbidity and mortality. The treatment of HFpEF can be challenging due to a lack of evidence supporting the benefit of various drug therapies. In practice, treatment can be divided into acute and chronic management. Acute therapy for decompensated heart failure is similar for both HFpEF and heart failure with reduced ejection fraction. The mainstay of treatment is diuretics to reduce volume overload and improve dyspnea. Patients with an acute exacerbation of HFpEF and rapid atrial fibrillation (AF) should be rate controlled with negative chronotropic agents. For chronic therapy, patients with HFpEF should not be treated like patients with heart failure with reduced ejection fraction. Chronic management of HFpEF can be simplified by using three strategies based on applicability: treat precipitating conditions (e.g., hypertension, AF), control symptoms by maintaining euvolemia with diuretics, and avoid therapies that have been shown not to be beneficial unless another compelling indication exists. Nondrug interventions for HFpEF include salt and fluid restriction, regular physical activity, and referral to a heart function clinic, if appropriate. PMID:25884524

  2. The effect of a tailored message intervention on heart failure readmission rates, quality of life, and benefit and barrier beliefs in persons with heart failure

    Microsoft Academic Search

    Kristen A Sethares; Kathleen Elliott

    2004-01-01

    ObjectiveThe purpose of this study was to determine the effect of a tailored message intervention on heart failure readmission rates, quality of life, and health beliefs in persons with heart failure (HF).

  3. Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: A systematic review

    Microsoft Academic Search

    Joanne B. Ditewig; Helene Blok; Jeroen Havers; Haske van Veenendaal

    2010-01-01

    ObjectiveThis review examined the effectiveness of self-management interventions compared to usual care on mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure.

  4. Bisoprolol: a review of its use in chronic heart failure.

    PubMed

    McGavin, Jane K; Keating, Gillian M

    2002-01-01

    Bisoprolol is a highly selective beta(1)-adrenoceptor antagonist. Administration of bisoprolol to patients with chronic heart failure is associated with increases in left ventricular function and reductions in heart rate; increases in heart rate variability are also seen. Two major randomised, double-blind, placebo-controlled, multicentre trials have examined the clinical efficacy of bisoprolol in combination with ACE inhibitors and diuretics in patients with stable chronic heart failure (New York Heart Association class III or IV): the Cardiac Insufficiency Bisoprolol Study (CIBIS; n = 641) and CIBIS II (n = 2 647). All-cause mortality (primary endpoint) was significantly lower in bisoprolol than in placebo recipients in CIBIS II (11.8 vs 17.3%) and was reduced by bisoprolol regardless of dosage. All-cause mortality was also lower in CIBIS (16.6 vs 20.9%) although the difference did not achieve statistical significance. In a meta-analysis of CIBIS and CIBIS II (n = 3 288), a relative reduction of 29% in the incidence of all-cause mortality was seen in bisoprolol versus placebo recipients; this analysis also demonstrated that bisoprolol reduces mortality in patients with chronic heart failure regardless of aetiology or severity. In CIBIS II, there were significantly fewer cardiovascular deaths, admissions to hospital for any reason, or cardiovascular deaths or cardiovascular hospitalisations (combined endpoint) in bisoprolol, compared with placebo, recipients (secondary endpoints). Compared with standard treatment alone, the addition of bisoprolol was a cost-effective option in chronic heart failure in UK, French, German and Swedish pharmacoeconomic studies. Bisoprolol is generally well tolerated in patients with chronic heart failure. In CIBIS II, adverse events occurring more commonly in bisoprolol than placebo recipients, regardless of causal relationship with the study medication, included dizziness, bradycardia, hypotension and fatigue. Bisoprolol recipients were less likely than placebo recipients to experience worsening of heart failure, dyspnoea or tachycardia. In both CIBIS and CIBIS II there was no significant difference between bisoprolol and placebo recipients in the incidence of permanent treatment withdrawal. In conclusion, adding the highly selective beta(1)-blocker bisoprolol to a treatment regimen comprising an ACE inhibitor and a diuretic significantly improves survival in patients with stable chronic heart failure and reduces the need for hospitalisation. The use of bisoprolol in this disorder is generally well tolerated and is cost effective. Thus, bisoprolol should be considered a standard treatment option when selecting a beta-blocker for use in combination with ACE inhibitors and diuretics in patients with stable, moderate to severe chronic heart failure. PMID:12466013

  5. Effective Technologies for Noninvasive Remote Monitoring in Heart Failure

    PubMed Central

    Conway, Aaron; Inglis, Sally C.

    2014-01-01

    Abstract Background: Trials of new technologies to remotely monitor for signs and symptoms of worsening heart failure are continually emerging. The extent to which technological differences impact the effectiveness of noninvasive remote monitoring for heart failure management is unknown. This study examined the effect of specific technology used for noninvasive remote monitoring of people with heart failure on all-cause mortality and heart failure–related hospitalizations. Materials and Methods: A subanalysis of a large systematic review and meta-analysis was conducted. Studies were stratified according to the specific type of technology used, and separate meta-analyses were performed. Four different types of noninvasive remote monitoring technologies were identified, including structured telephone calls, videophone, interactive voice response devices, and telemonitoring. Results: Only structured telephone calls and telemonitoring were effective in reducing the risk of all-cause mortality (relative risk [RR]=0.87; 95% confidence interval [CI], 0.75–1.01; p=0.06; and RR=0.62; 95% CI, 0.50–0.77; p<0.0001, respectively) and heart failure–related hospitalizations (RR=0.77; 95% CI, 0.68–0.87; p<0.001; and RR=0.75; 95% CI, 0.63–0.91; p=0.003, respectively). More research data are required for videophone and interactive voice response technologies. Conclusions: This subanalysis identified that only two of the four specific technologies used for noninvasive remote monitoring in heart failure improved outcomes. When results of studies that involved these disparate technologies were combined in previous meta-analyses, significant improvements in outcomes were identified. As such, this study has highlighted implications for future meta-analyses of randomized controlled trials focused on evaluating the effectiveness of remote monitoring in heart failure. PMID:24731212

  6. Ventricular assist devices for treatment of acute heart failure and chronic heart failure.

    PubMed

    Kirkpatrick, James N; Wieselthaler, Georg; Strueber, Martin; St John Sutton, Martin G; Rame, J Eduardo

    2015-07-15

    Despite therapeutic advances that improve longevity and quality of life, heart failure (HF) remains a relentless disease. At the end stage of HF, patients may become eligible for mechanical circulatory support (MCS) for the indications of stabilising acute cardiogenic shock or for chronic HF management. MCS use is growing rapidly in the USA and some countries of the European Union, especially in transplant-ineligible patients. In others, it remains largely a tool to stabilise patients until heart transplant. MCS comprises a heterogeneous group of temporary and durable devices which augment or replace the pumping function of one or both ventricles, with postimplant 2?year survival rivalling that of transplant in selected, lower-risk patients. In transplant-eligible and non-transplant-eligible patients, improvement in end-organ perfusion, functional capacity and quality of life have been noted. Even for optimal candidates, however, there are a host of potential complications that require constant vigilance of a coordinated care team. Recently, there has been official recognition of the importance of palliative care expertise in advance care planning preimplant and management of patients with ventricular assist devices at the end of their lives. PMID:25948420

  7. Modelli integrati tra ospedale e territorio per l'assistenza al paziente con scompenso cardiaco Heart Failure Programs and Comprehensive Management in Heart Failure

    Microsoft Academic Search

    A. Di Lenard; G. Sabbadini; G. Sinagra

    Heart Failure Programs and Comprehensive Management in Heart Failure. A. Di Lenarda, G. Sabbadini, G. Sinagra. Chronic heart failure is a major health problem, which is growing parallel to the increasing proportion of el- derly in the population. Recurrent hospitalizations occur in about half of the subjects within 6 months after the initial admission. Several co-morbidities usually coexist in these

  8. Iron deficiency: an emerging therapeutic target in heart failure.

    PubMed

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

    2014-09-15

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

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

    PubMed Central

    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

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

  10. A new approach to detect congestive heart failure using short-term heart rate variability measures.

    PubMed

    Liu, Guanzheng; Wang, Lei; Wang, Qian; Zhou, Guangmin; Wang, Ying; Jiang, Qing

    2014-01-01

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

  11. Psychobiology of depression/distress in congestive heart failure

    PubMed Central

    Hassan, Mustafa; Sheps, David S.

    2011-01-01

    Heart failure affects millions of Americans and new diagnosis rates are expected to almost triple over the next 30 years as our population ages. Affective disorders including clinical depression and anxiety are common in patients with congestive heart failure. Furthermore, the presence of these disorders significantly impacts quality of life, medical outcomes, and healthcare service utilization. In recent years, the literature has attempted to describe potential pathophysiologic mechanisms relating affective disorders and psychosocial stress to heart failure. Several potential mechanisms have been proposed including autonomic nervous system dysfunction, inflammation, cardiac arrhythmias, and altered platelet function. These mechanisms are reviewed in this article. Additional novel mechanisms such as mental stress-induced myocardial ischemia are also discussed. PMID:18368481

  12. The Importance of NLRP3 Inflammasome in Heart Failure.

    PubMed

    Butts, Brittany; Gary, Rebecca A; Dunbar, Sandra B; Butler, Javed

    2015-07-01

    Patients with heart failure continue to suffer adverse health consequences despite advances in therapies over the past 2 decades. Identification of novel therapeutic targets that may attenuate disease progression is therefore needed. The inflammasome may play a central role in modulating chronic inflammation and in turn affecting heart failure progression. The inflammasome is a complex of intracellular interaction proteins that trigger maturation of proinflammatory cytokines interleukin-1? and interleukin-18 to initiate the inflammatory response. This response is amplified through production of tumor necrosis factor ? and activation of inducible nitric oxide synthase. The purpose of this review is to discuss recent evidence implicating this inflammatory pathway in the pathophysiology of heart failure. PMID:25982825

  13. Heart failure and the emergency department: epidemiology, characteristics, and outcomes.

    PubMed

    Green, Gary B

    2009-01-01

    It is widely recognized that the impact of heart failure on society is enormous. The research community has responded, resulting in an ongoing period of rapid advancement across a wide range of fields. The pace of progress is perhaps most apparent in the barrage of new and revised terminology appearing in the heart failure literature. Although sometimes confusing, the complexity of nomenclature directly reflects a growing appreciation that the symptom complex previously labeled "heart failure" is actually a spectrum of complex multisystem pathologies. Accordingly, clinicians must adopt a more sophisticated and more effective approach to evaluation and treatment that is increasingly based on objective measurement of outcome-linked physiologic parameters rather than the subjectively described symptom constellations relied on previously. PMID:19026380

  14. SUBSTANCE P IN HEART FAILURE: THE GOOD AND THE BAD

    PubMed Central

    Dehlin, Heather M.; Levick, Scott P.

    2015-01-01

    The tachykinin, substance P, is found primarily in sensory nerves. In the heart, substance P-containing nerve fibers are often found surrounding coronary vessels, making them ideally situated to sense changes in the myocardial environment. Recent studies in rodents have identified substance P as having dual roles in the heart, depending on disease etiology and/or timing. Thus far, these studies indicate that substance P may be protective acutely following ischemia-reperfusion, but damaging long-term in non-ischemic induced remodeling and heart failure. Sensory nerves may be at the apex of the cascade of events leading to heart failure, therefore, they make a promising potential therapeutic target that warrants increased investigation. PMID:24286592

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

    Microsoft Academic Search

    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

    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

  16. Current Status of Stem Cell Therapy in Heart Failure

    Microsoft Academic Search

    Marta Codina; Jeremy Elser; Kenneth B. Margulies

    2010-01-01

    Inspired by studies demonstrating the potential for new myocyte formation within adult mammalian hearts, an ongoing explosion\\u000a of research is elucidating the biology of cardiac myogenesis and angiogenesis. Multiple lines of research suggest that disease-associated\\u000a activation of endogenous cardiac repair processes are often insufficient to overcome the cell death resulting from myocardial\\u000a infarction and chronic heart failure. In this context,

  17. Heart Failure, 1992-2001. Cambridge, MA: Mathematica Policy Research

    Microsoft Academic Search

    Angela Merrill

    2005-01-01

    Congestive heart failure (CHF)—the inability of the heart to pump enough blood to the body—is the leading cause of hospitalizations among Medicare beneficiaries. Despite the fact that this is a chronic disease for which appropriate outpatient care can reduce hospitalizations, the rates of hospitalizations for Medicare beneficiaries have risen since 1980. In 2001, CHF hospitalizations cost Medicare more than $4

  18. Renal Denervation in Heart Failure: A New Therapeutic Paradigm

    PubMed Central

    Dhakal, Pramesh; Liu, Kan; Kozman, Hani; Carhart, Robert L; Villarreal, Daniel

    2015-01-01

    Heart failure constitutes a significant source of morbidity and mortality in the United States, and its incidence and prevalence continue to grow, increasing its burden on the health care system. Renal dysfunction in patients with heart failure is common and has been associated with adverse clinical outcomes. This complex interaction is characterized by a pathophysiological disequilibrium between the heart and the kidney, in which cardiac malfunction promotes renal impairment, which in turn feeds back, resulting in further deterioration of cardiovascular function. Multiple neurohumoral and hemodynamic mechanisms are involved in this cardiorenal dyshomeostasis, including resistance to compensatory cardiac natriuretic peptides, leading to sodium retention, volume overload, and organ remodeling. Previous studies in animal models of heart failure have demonstrated that renal denervation promotes a robust natriuresis and diuresis as well as increased response of endogenous and exogenous natriuretic agents. With the recent development of minimally invasive renal denervation in humans, it is possible to suggest that this technique may become effective and important in the management of renal sodium and water metabolism in heart failure. PMID:26157338

  19. Atrial natriuretic factor as a marker in congestive heart failure.

    PubMed

    Michel, J B; Arnal, J F; Corvol, P

    1990-01-01

    Cardiac overload is associated with an overexpression of the atrial natriuretic-factor (ANF) gene in experimental models and in man. Sites of ANF gene overexpression are the atria but also the ventricular myocardium. This recruitment phenomenon of the ventricle to synthesise and secrete ANF is directly dependent on the increase in stress-stretch relationship in each cardiocyte. Therefore, the levels of plasma ANF and its second messenger, cyclic glycophosphate mutase in plasma and urine appear as markers of congestive heart failure in animal models and in man. Particularly, plasma ANF has been recognized recently as independent prognostic factor in congestive heart failure. PMID:1966565

  20. Congestive heart failure caused by vitamin D deficiency?

    PubMed

    Brunvand, L; Hågå, P; Tangsrud, S E; Haug, E

    1995-01-01

    We describe a child, 3.5 months old, with severe vitamin D deficiency, profound hypocalcaemia, hyperphosphataemia, dilated left ventricle, severely reduced myocardial contractility and congestive heart failure. She also had depressed thyroid function with subnormal thyroxine and non-detectable serum thyrotropin (TSH) levels. The child promptly responded to calcium infusions, conventional anticongestive therapy and calcitriol. She is now 3 years old and received no medication. Myocardial function is normal but she has motor delay. We believe that her transitory congestive heart failure was caused by severe vitamin D deficiency with profound hypocalcaemia. PMID:7734890

  1. Pulmonary arteriovenous malformations presenting as refractory heart failure

    PubMed Central

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

    2014-01-01

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

  2. Interventional and device-based autonomic modulation in heart failure.

    PubMed

    Shen, Mark J; Zipes, Douglas P

    2015-04-01

    "Heart failure is an increasingly prevalent disease with high mortality and public health burden. It is associated with autonomic imbalance characterized by sympathetic hyperactivity and parasympathetic hypoactivity. Evolving novel interventional and device-based therapies have sought to restore autonomic balance by neuromodulation. Results of preclinical animal studies and early clinical trials have demonstrated the safety and efficacy of these therapies in heart failure. This article discusses specific neuromodulatory treatment modalities individually-spinal cord stimulation, vagus nerve stimulation, baroreceptor activation therapy, and renal sympathetic nerve denervation." PMID:25834979

  3. Similarities and Differences between the Pathogenesis and Pathophysiology of Diastolic and Systolic Heart Failure

    PubMed Central

    2013-01-01

    Pathophysiology of heart failure has been considered to be a damaged state of systolic function of the heart followed by a state of low cardiac output that is, systolic heart failure. Even if systolic function is preserved, left ventricular filling in diastole can be impeded and resulted in elevation of filling pressure and symptoms of heart failure. This kind of heart failure is called diastolic heart failure. Nowadays, diastolic heart failure is referred to as heart failure with preserved ejection fraction (HFpEF), whereas systolic heart failure is referred to as heart failure with reduced ejection fraction (HFrEF). In this paper, the similarities and differences between the pathogenesis and pathophysiology of diastolic and systolic heart failure were reviewed. Although diastolic heart failure is a common condition of heart failure worldwide, its pathophysiology has not been sufficiently elucidated. This is thought to be the most significant reason for a lack of established treatment methods for diastolic heart failure. We hope to proceed with future studies on this topic. PMID:24459600

  4. Nitric Oxide Synthases in Heart Failure

    PubMed Central

    Carnicer, Ricardo; Crabtree, Mark J.; Sivakumaran, Vidhya

    2013-01-01

    Abstract Significance: The regulation of myocardial function by constitutive nitric oxide synthases (NOS) is important for the maintenance of myocardial Ca2+ homeostasis, relaxation and distensibility, and protection from arrhythmia and abnormal stress stimuli. However, sustained insults such as diabetes, hypertension, hemodynamic overload, and atrial fibrillation lead to dysfunctional NOS activity with superoxide produced instead of NO and worse pathophysiology. Recent Advances: Major strides in understanding the role of normal and abnormal constitutive NOS in the heart have revealed molecular targets by which NO modulates myocyte function and morphology, the role and nature of post-translational modifications of NOS, and factors controlling nitroso-redox balance. Localized and differential signaling from NOS1 (neuronal) versus NOS3 (endothelial) isoforms are being identified, as are methods to restore NOS function in heart disease. Critical Issues: Abnormal NOS signaling plays a key role in many cardiac disorders, while targeted modulation may potentially reverse this pathogenic source of oxidative stress. Future Directions: Improvements in the clinical translation of potent modulators of NOS function/dysfunction may ultimately provide a powerful new treatment for many hearts diseases that are fueled by nitroso-redox imbalance. Antioxid. Redox Signal. 18, 1078–1099. PMID:22871241

  5. [On the history of heart failure].

    PubMed

    Lüderitz, B

    2011-05-01

    The heart is by far the organ that is best known and has been identified for a long time. Myogenic weakness of the heart muscle pump with left-ventricular dysfunction remains the cardiac disease with the poorest prognosis while increasing in prevalence and incidence. Aside from all sorts of mystic treatment attempts and dubious herbal medicine, bloodletting was established early on as a superior remedy, which was applied in response to almost all cardiac illnesses. The first and perhaps most important cardiac drug was digitalis, the glycoside of the red and even more so of the white foxglove, described in 1552 by Leonhart Fuchs. In the 1980s, vasodilators and inotropic drugs supplemented the classical medications digitalis and diuretics. ACE inhibitors and beta-receptor blockers were added in the 1990s; at the turn of the millennium, the cardiac resynchronization therapy (CRT) and left-heart assist systems were developed; lately, there have been cellular and genetic approaches as well as xenotransplants. Preliminary results with stem cell technology are encouraging; however, it will be years until a clinical application-if it will happen at all. PMID:22528171

  6. Ivabradine, coronary heart disease, and heart failure: time for reappraisal.

    PubMed

    Stulc, Tomáš; Ceška, Richard

    2014-12-01

    Ivabradine is generally considered to be a safe drug with well-established and substantial benefits. Nevertheless, recently published results from the SIGNIFY trial suggest that ivabradine has rather inconsistent effects on cardiovascular outcomes. In addition, careful examination of all available data from ivabradine trials reveals signals of harm that have not yet been appropriately addressed, including a markedly increased incidence of atrial fibrillation and increased risk of cardiovascular events in patients with heart rates below 70 bpm. These concerns warrant consideration, since they could have implications for the future use of ivabradine. PMID:25301354

  7. Central hemodynamic effects of diuretic therapy in chronic heart failure

    Microsoft Academic Search

    B. Silke

    1993-01-01

    Summary In chronic heart failure diuretic drugs improve central hemodynamic variables and cardiac pumping secondary to altered plasma and extracellular volumes; humoral markers of these changes include increased plasma renin and aldosterone levels. The latter increases are maximal over the first week but decline with chronic therapy. The plasma alpha-ANP levels show a reciprocal effect; these data are compatible with

  8. Self-care behaviors among patients with heart failure

    Microsoft Academic Search

    Nancy T. Artinian; Morris Magnan; Michelle Sloan; M. Patricia Lange

    2002-01-01

    Background: One way to prevent frequent hospitalizations and promote positive health outcomes among patients with heart failure (HF) is to ensure that the amount and quality of self-care used is appropriate to the patient's situation. Objectives: The following are the purposes of this study: (a) examine the frequency of performance of self-care behaviors, (b) describe personal and environmental factors (basic

  9. A review of heart failure management in the elderly population

    Microsoft Academic Search

    Judy W. M. Cheng; Monica Nayar

    2009-01-01

    Background: In the United States, the incidence of heart failure (HF) in the elderly population (age, ?65 years) approached 10 per 1000 population in 2006, and HF was a common reason for hospitalization. Many clinical features and the management of HF differ in elderly patients compared with their younger counterparts due to changes in physiology and the presence of comorbidities.Objective:

  10. Association of Functional and Health Status Measures in Heart Failure

    Microsoft Academic Search

    JONATHAN MYERS; NAYMA ZAHEER; SUSAN QUAGLIETTI; RUPA MADHAVAN; VICTOR FROELICHER; PAUL HEIDENREICH

    2006-01-01

    Background: A wide variety of instruments have been used to assess the functional capabilities and health status of patients with chronic heart failure (I-F), but it is not known how well these tests are correlated with one another, nor which one has the best association with measured exercise capacity. Methods and Results: Forty-one patients with HF were assessed with commonly

  11. Untreated heart failure: clinical and neuroendocrine effects of introducing diuretics

    Microsoft Academic Search

    J Bayliss; M Norell; R Canepa-Anson; G Sutton; P Poole-Wilson

    1987-01-01

    The clinical and neuroendocrine response to diuretic treatment was assessed at rest and on exercise in 12 patients with heart failure. Before treatment all patients were limited by breathlessness on exercise; one was oedematous. Plasma renin activity and aldosterone were normal but plasma noradrenaline was raised both at rest and on exercise. After one month's treatment with frusemide (40 mg)

  12. Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction

    Microsoft Academic Search

    Barry M. Massie; Peter E. Carson; John J. McMurray; Michel Komajda; Robert McKelvie; Michael R. Zile; Susan Anderson; Mark Donovan; Erik Iverson; Christoph Staiger; Agata Ptaszynska; Ralph H. Johnson; Veterans Affairs

    2010-01-01

    Background Approximately 50% of patients with heart failure have a left ventricular ejection fraction of at least 45%, but no therapies have been shown to improve the outcome of these patients. Therefore, we studied the effects of irbesartan in patients with this syndrome. Methods We enrolled 4128 patients who were at least 60 years of age and had New York

  13. Heart failure hospitalization prediction in remote patient management systems

    Microsoft Academic Search

    M. Pechenizkiy; E. Vasilyeva; I. Zliobaite; A. Tesanovic; G. Manev

    2010-01-01

    Healthcare systems are shifting from patient care in hospitals to monitored care at home. It is expected to improve the quality of care without exploding the costs. Remote patient management (RPM) systems offer a great potential in monitoring patients with chronic diseases, like heart failure or diabetes. Patient modeling in RPM systems opens opportunities in two broad directions: personalizing information

  14. What Are the Signs and Symptoms of Heart Failure?

    MedlinePLUS

    ... and symptoms of heart failure are: Shortness of breath or trouble breathing Fatigue (tiredness) Swelling in the ankles, feet, legs, abdomen, and veins in the neck All of these symptoms are the result of fluid ... short of breath after routine physical effort, like climbing stairs. As ...

  15. Telemonitoring for Patients with Chronic Heart Failure: A Systematic Review

    PubMed Central

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

    2007-01-01

    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. PMID:17339004

  16. Cell Death, Tissue Hypoxia and the Progression of Heart Failure

    Microsoft Academic Search

    Hani N. Sabbah; Victor G. Sharov; Sidney Goldstein

    2000-01-01

    An important feature of heart failure is the progressive deterioration of left ventricular function that occurs in the absence of clinically apparent intercurrent adverse events. The mechanism or mechanisms responsible for this hemodynamic deterioration are not known. We and others have advanced the hypothesis that this hemodynamic deterioration results from progressive intrinsic contractile dysfunction of viable cardiomyocytes and\\/or from ongoing

  17. How much responsibility should heart failure nurses take?

    Microsoft Academic Search

    Lynda Bluea

    This article examines the emerging role of the heart failure nurse and the responsibilities and educational and training requirements surrounding such a role. There may be variations in the role and its responsibilities in different health care settings. However the principles are similar and include: history taking, carrying out clinical assessment and making appropriate decisions about patient management within the

  18. Diuretic Therapy and Resistance in Congestive Heart Failure

    Microsoft Academic Search

    David H. Ellison

    2001-01-01

    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

  19. Family caregiving and congestive heart failure. Review and analysis

    Microsoft Academic Search

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

    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

  20. Medical and Ventilatory Treatment of Acute Heart Failure: New Insights

    Microsoft Academic Search

    Anders Hodt; Kjetil Steine; Dan Atar

    2006-01-01

    Background: The traditional medical treatment of acute heart failure (AHF) has remained unchanged for many years. It has been based on oxygen supplementation and mechanical ventilatory support as well as the administration of morphine, diuretics, nitrates and inotropic agents. In 2005 the European Society of Cardiology (ESC) published new guidelines on the diagnosis and treatment of AHF. Also, new therapies

  1. The Oxidative Stress Hypothesis of Congestive Heart Failure* Radical Thoughts

    Microsoft Academic Search

    Susanna Mak; Gary E. Newton

    There is extensive experimental evidence from in vitro and animal experiments that congestive heart failure (CHF) is a state of oxidative stress. Moreover, in animal models, the development of CHF is accompanied by changes in the antioxidant defense mechanisms of the myocardium as well as evidence of oxidative myocardial injury. This has led to the hypothesis that oxidative stress may

  2. Analysis of trends in hospitalizations for heart failure

    Microsoft Academic Search

    Hanyu Ni; Deirdre J. Nauman; Ray E. Hershberger

    1999-01-01

    Background: Over the past 10 years, efforts have been made to control the cost of care for patients with congestive heart failure (CHF) through reducing hospitalizations and shortening lengths of stay. Few data are available regarding the effectiveness of these intervention strategies on a community basis.Methods and Results: We analyzed the Oregon hospital discharge database. Multivariable methods were used to

  3. Skeletal Muscle Reflex in Heart Failure Patients Role of Hydrogen

    Microsoft Academic Search

    Adam C. Scott; Roland Wensel; Constantinos H. Davos; Panagiota Georgiadou; Michael Kemp; James Hooper; Andrew J. S. Coats; Massimo F. Piepoli

    Background—An important role of the increased stimulation of skeletal muscle ergoreceptors (intramuscular afferents sensitive to products of muscle work) in the genesis of symptoms of exertion intolerance in chronic heart failure (CHF) has been proposed. With the use of selective infusions and dietary manipulation methods, we sought to identify the role of H ,K , lactate, and peripheral hemodynamics on

  4. [Organ damage and cardiorenal syndrome in acute heart failure].

    PubMed

    Casado Cerrada, Jesús; Pérez Calvo, Juan Ignacio

    2014-03-01

    Heart failure is a complex syndrome that affects almost all organs and systems of the body. Signs and symptoms of organ dysfunction, in particular kidney dysfunction, may be accentuated or become evident for the first time during acute decompensation of heart failure. Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney, regardless of which of the two organs may have suffered the initial damage and regardless also of their previous functional status. Research into the mechanisms regulating the complex relationship between the two organs is prompting the search for new biomarkers to help physicians detect renal damage in subclinical stages. Hence, a preventive approach to renal dysfunction may be adopted in the clinical setting in the near future. This article provides a general overview of cardiorenal syndrome and an update of the physiopathological mechanisms involved. Special emphasis is placed on the role of visceral congestion as an emergent mechanism in this syndrome. PMID:24930080

  5. ?-1 Protein evaluation to stratify heart failure patients.

    PubMed

    Lubrano, Valter; Papa, Angela; Pingitore, Alessandro; Cocci, Franca

    2014-06-01

    Heart failure is a pathological condition characterized by cardiac dysfunction and neuroendocrine system activation. The aim of this study was to evaluate serum ?-1 proteins in the characterization of heart failure patients. The study included 69 patients with documented heart failure disease and 44 healthy individuals. We included 12 out of 69 patients with preserved (>50%) left ventricular ejection fraction. ?-1 protein levels were evaluated using routine capillary electrophoresis. Markers of inflammation, such as interleukin-6 (IL-6) and tumor necrosis factor-?, were measured with UltraSensitive ELISA Kits. C-reactive protein and brain natriuretic peptide were determined by automated assays. No difference in ?-1 protein levels between patients with reduced versus preserved left ventricular ejection fraction was observed. IL-6, tumor necrosis factor-?, and C-reactive protein concentrations were significantly increased in patients with respect to the control group (P?<0.001, P?<0.01, and P?<0.05, respectively). A progressive increase in ?-1 protein levels across NYHA classes (P?=?0.0077) was observed. Brain natriuretic peptide median value of the patient group was 287?ng/l (92-602?ng/l) and was significantly associated with ?-1 proteins and IL-6 levels (P?<0.05 and P?<0.01, respectively). Considering recent findings and our preliminary data, we hypothesized that the overexpression of ?-1 antitrypsin (AAT) protein (and probably elevated AAT levels) is a compensatory mechanism as a consequence of the loss of the antiprotease activity, induced by the increase of oxidative stress in heart failure patients. In conclusion, we assume that ?-1 proteins and AAT could contribute to the prognostic stratification of heart failure patients. PMID:24911195

  6. 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

    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

    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

  7. Reversing Heart Failure: Diastolic Recoil in a Proposed Cardiac Support Device

    E-print Network

    Snowden, Timothy D

    2012-07-11

    Congestive heart failure (CHF) holds millions in the grip of an endless cycle of decreased cardiac output and degenerative remodeling, often with little hope of recovery. Diastolic dysfunction, or failure of the heart to properly fill, is a...

  8. Reversing Heart Failure: Diastolic Recoil in a Proposed Cardiac Support Device 

    E-print Network

    Snowden, Timothy D

    2012-07-11

    Congestive heart failure (CHF) holds millions in the grip of an endless cycle of decreased cardiac output and degenerative remodeling, often with little hope of recovery. Diastolic dysfunction, or failure of the heart to properly fill, is a...

  9. Cardiorenal Syndrome in Acute Heart Failure: Revisiting Paradigms.

    PubMed

    Núñez, Julio; Miñana, Gema; Santas, Enrique; Bertomeu-González, Vicente

    2015-05-01

    Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney. Worsening renal function that occurs in patients with acute heart failure has been classified as cardiorenal syndrome type 1. In this setting, worsening renal function is a common finding and is due to complex, multifactorial, and not fully understood processes involving hemodynamic (renal arterial hypoperfusion and renal venous congestion) and nonhemodynamic factors. Traditionally, worsening renal function has been associated with worse outcomes, but recent findings have revealed mixed and heterogeneous results, perhaps suggesting that the same phenotype represents a diversity of pathophysiological and clinical situations. Interpreting the magnitude and chronology of renal changes together with baseline renal function, fluid overload status, and clinical response to therapy might help clinicians to unravel the clinical meaning of renal function changes that occur during an episode of heart failure decompensation. In this article, we critically review the contemporary evidence on the pathophysiology and clinical aspects of worsening renal function in acute heart failure. PMID:25758162

  10. BAG3: a new player in the heart failure paradigm.

    PubMed

    Knezevic, Tijana; Myers, Valerie D; Gordon, Jennifer; Tilley, Douglas G; Sharp, Thomas E; Wang, JuFang; Khalili, Kamel; Cheung, Joseph Y; Feldman, Arthur M

    2015-07-01

    BAG3 is a cellular protein that is expressed predominantly in skeletal and cardiac muscle but can also be found in the brain and in the peripheral nervous system. BAG3 functions in the cell include: serving as a co-chaperone with members of the heat-shock protein family of proteins to facilitate the removal of misfolded and degraded proteins, inhibiting apoptosis by interacting with Bcl2 and maintaining the structural integrity of the Z-disk in muscle by binding with CapZ. The importance of BAG3 in the homeostasis of myocytes and its role in the development of heart failure was evidenced by the finding that single allelic mutations in BAG3 were associated with familial dilated cardiomyopathy. Furthermore, significant decreases in the level of BAG3 have been found in end-stage failing human heart and in animal models of heart failure including mice with heart failure secondary to trans-aortic banding and in pigs after myocardial infarction. Thus, it becomes relevant to understand the cellular biology and molecular regulation of BAG3 expression in order to design new therapies for the treatment of patients with both hereditary and non-hereditary forms of dilated cardiomyopathy. PMID:25925243

  11. Depressed baroreflex in heart failure is not due to structural change in carotid sinus nerve fibers

    Microsoft Academic Search

    Wei Wang; Huai-Yun Han; Irving H. Zucker

    1996-01-01

    It is well known that the baroreceptor reflex is blunted in the heart failure state. However, the mechanisms for this depression are not well understood. The aim of the present study was to determine if carotid sinus nerve fiber density is decreased in the heart failure state. Experiments were carried out in pacing-induced heart failure and normal dogs. The carotid

  12. B-Type Natriuretic Peptide: Spectrum of Application. Nesiritide (Recombinant BNP) for Heart Failure

    Microsoft Academic Search

    Gregg C. Fonarow

    2003-01-01

    The therapeutic goals for patients hospitalized with acutely decompensated heart failure are to reverse acute hemodynamic abnormalities, relieve symptoms, and to initiate heart failure therapies which will decrease disease progression and improve long-term survival. Nesiritide (recombinant B-type natriuretic peptide) is the first in a new class of therapeutic agents for the treatment of heart failure and has been demonstrated to

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

    Microsoft Academic Search

    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

    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

  14. The development and testing of the Heart Failure Self-Care Inventory: An instrument for measuring heart failure self-care

    Microsoft Academic Search

    Susan Lynne Grass Ahrens

    2001-01-01

    Heart failure is a serious and costly chronic health problem for millions of older adults in the United States. The success of treatment depends on self-care. Currently there is no well-tested instrument to measure self-care of individuals with heart failure. ^ The purpose of this study was to develop and perform psychometric testing of such an instrument, the Heart Failure

  15. Metoprolol CR\\/XL in female patients with heart failure. Analysis of the experience in metoprolol extended-release randomized intervention trial in heart failure (MERIT-HF)

    Microsoft Academic Search

    Jalal K. Ghali; Ileana L. Piña; Stephen S. Gottlieb; Prakash C. Deedwania; J. C. Wikstrand

    2002-01-01

    Background—Underrepresentation of women in heart failure clinical trials has limited conclusions regarding the effect of various management strategies on survival in women with heart failure and decreased left ventricular ejection fraction (LVEF). Methods and Results—MERIT-HF (Metoprolol Extended-Release Randomized Intervention Trial in Heart Failure) was a randomized, placebo-controlled study, the purpose of which was to evaluate the effect of metoprolol controlled-release\\/

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

    PubMed Central

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

    2014-01-01

    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. LINKED ARTICLES This article is part of a themed issue on Mitochondrial Pharmacology: Energy, Injury & Beyond. To view the other articles in this issue visit http://dx.doi.org/10.1111/bph.2014.171.issue-8 PMID:24147975

  17. Targeting Cardiomyocyte Ca2+ Homeostasis in Heart Failure

    PubMed Central

    Røe, Åsmund T.; Frisk, Michael; Louch, William E.

    2015-01-01

    Improved treatments for heart failure patients will require the development of novel therapeutic strategies that target basal disease mechanisms. Disrupted cardiomyocyte Ca2+ homeostasis is recognized as a major contributor to the heart failure phenotype, as it plays a key role in systolic and diastolic dysfunction, arrhythmogenesis, and hypertrophy and apoptosis signaling. In this review, we outline existing knowledge of the involvement of Ca2+ homeostasis in these deficits, and identify four promising targets for therapeutic intervention: the sarcoplasmic reticulum Ca2+ ATPase, the Na+-Ca2+ exchanger, the ryanodine receptor, and t-tubule structure. We discuss experimental data indicating the applicability of these targets that has led to recent and ongoing clinical trials, and suggest future therapeutic approaches. PMID:25483944

  18. Update on heart failure with preserved ejection fraction

    PubMed Central

    Hummel, Scott L.; Kitzman, Dalane W.

    2013-01-01

    Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF) in older adults, and is increasing in prevalence as the population ages. Morbidity and long-term mortality in HFPEF are substantial and can be similar to HF with reduced ejection fraction (HFREF), yet HFPEF therapy remains empirical and treatment guidelines are based primarily on expert consensus. Neurohormonal blockade has revolutionized the management of HFREF, but trials in HFPEF based on this strategy have been disappointing to date. However, many recent studies have increased knowledge about HFPEF. The concept of HFPEF has evolved from a ‘cardio-centric’ model to a syndrome that may involve multiple cardiovascular and non-cardiovascular mechanisms. Emerging data highlight the importance of non-pharmacological management strategies and assessment of non-cardiovascular comorbidities. Animal models, epidemiological cohorts, and small human studies suggest that oxidative stress and inflammation contribute to HFPEF, potentially leading to development of new therapeutic targets. PMID:24860638

  19. Heart Failure with Preserved Ejection Fraction: Emerging Drug Strategies

    PubMed Central

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

    2013-01-01

    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. PMID:23714774

  20. The role of intravenous vasodilators in acute heart failure management.

    PubMed

    Piper, Susan; McDonagh, Theresa

    2014-08-01

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

  1. Sudden Death in Heart Failure: Risk Stratification and Treatment Strategies

    Microsoft Academic Search

    M. Zecchin; G. Vitrella; G. Sinagra

    Attempting a careful evaluation of the incidence of sudden death (SD) in congestive heart failure is inevitably a complex\\u000a and imprecise task. In particular, this is due to the difficulties in defining and understanding the baseline mechanisms underlying\\u000a SD. “Sudden” death is commonly regarded as a synonym of “cardiac arrest due to ventricular fibrillation,” which is in turn\\u000a considered to

  2. Surgical Stem Cell Therapy for the Treatment of Heart Failure

    Microsoft Academic Search

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

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

  3. Thick Filament Proteins and Performance in Human Heart Failure

    Microsoft Academic Search

    Bradley M. Palmer

    2005-01-01

    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

  4. Evolving cell-based therapies for heart failure patients

    Microsoft Academic Search

    Bruno K. Podesser; Michael Bauer; Ronglih Liao

    2008-01-01

    Opinion statement  Heart failure (HF) represents the only cardiovascular disease (CVD) whose incidence continues to rise in the developed world.\\u000a With recent advances in device and drug therapies, the prognosis is improving. Nevertheless, the mortality associated with\\u000a HF remains high, with more than 50% of patients dying within 5 years after initial diagnosis. The loss of cardiac cells is\\u000a a major

  5. Heart failure with preserved ejection fraction: uncertainties and dilemmas.

    PubMed

    Ferrari, Roberto; Böhm, Michael; Cleland, John G F; Paulus, Walter J S; Pieske, Burkert; Rapezzi, Claudio; Tavazzi, Luigi

    2015-07-01

    Many uncertainties surround the syndrome of heart failure with preserved ejection fraction (HFpEF), which was the topic reviewed in an Expert Meeting at the University of Ferrara. This concluded that the absence of clear diagnostic clinical criteria was the major barrier to progress. There was general agreement that symptoms or signs of heart failure, normal LVEF despite an elevated plasma concentration of natriuretic peptides, and signs of abnormal LV relaxation, LV filling, LV hypertrophy, or left atrial enlargement, or diastolic dysfunction supported the diagnosis. However, HFpEF, like all heart failure syndromes, is heterogeneous in aetiology and pathophysiology, rather than being a single disease. HFpEF may account for about half of all patients with heart failure. The classical risk factors for developing HFpEF include age and co-morbidities, notably hypertension, atrial fibrillation, and the metabolic syndrome. When complicated by increasing congestion requiring hospital admission, the prognosis is poor; 30% or more of patients will die within 1 year (nearly two-thirds die from cardiovascular causes). Patients with chronic stable symptoms have a much better prognosis. Despite many clinical trials, there is no solid evidence that any treatment alters the natural history of HFpEF. Several treatments have shown promising early results and are now being tested in substantial randomized clinical trials. Further basic research is required to better characterize the disease and accelerate progress. Our review highlights the many difficulties encountered in performing randomized clinical trials in HFpEF, often due to difficulties in characterizing HFpEF itself. PMID:26079097

  6. Myocardial fatty acid metabolism and cardiac performance in heart failure

    Microsoft Academic Search

    Helena Tuunanen; Heikki Ukkonen; Juhani Knuuti

    2008-01-01

    It is well established that cardiac metabolism is abnormal in heart failure (HF). Experimental studies suggest that in severe\\u000a HF, cardiac metabolism reverts to a more fetal-like substrate use characterized by enhanced glucose and downregulated free\\u000a fatty acid (FFA) metabolism. Correspondingly, in humans, when FFA levels are similar, myocardial glucose metabolism is increased,\\u000a and FFA metabolism is decreased. However, depression

  7. Transcapillary Oncotic Pressure in the Edema of Congestive Heart Failure

    Microsoft Academic Search

    T. Kwan; M. Pintea; Garcia Morino; R. R. Preston; J. Li; C. Caruso; S. D. Berlyne; G. M. Berlyne

    1990-01-01

    Tissue fluid and plasma oncotic pressure levels were measured in an unselected group of 13 patients presenting with congestive heart failure. Patients had a mean serum albumin of 3.6 g&slash;dl ± (SD) 0.35; serum oncotic pressure was 22.23 ± 1.8 mm Hg; tissue fluid (lower leg) oncotic pressure was 0.985 ± 0.34 mm Hg. The oncotic pressure gradient between plasma

  8. Dietary factors and risk of heart failure: A systematic review

    Microsoft Academic Search

    Luc Djoussé; Jinesh Kochar; J. Michael Gaziano

    2007-01-01

    Heart failure (HF) remains the leading cause of hospitalization among older individuals and is associated with a higher health\\u000a care and societal burden. With increasing life expectancy in the United States, more people will live to develop HF. Whereas\\u000a noticeable advances in medical treatment of HF have been made over the past decade, primary prevention remains critical to\\u000a curb the

  9. Evidence-based Treatment of Chronic Heart Failure

    Microsoft Academic Search

    David Rosen; Matthew V. Decaro; Mark G. Graham

    2007-01-01

    The past two decades have seen a knowledge explosion in the field of cardiovascular diseases, in general, and in the understanding\\u000a of chronic heart failure (HF) as a complex neurohumoral syndrome in particular. A new staging system for chronic HF has been\\u000a developed within the last decade to facilitate the evidence-based prescription of medications and medical devices for each\\u000a of

  10. Associations between Endothelin1 and Adiponectin in Chronic Heart Failure

    Microsoft Academic Search

    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

    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

  11. Prognostic markers of acute decompensated heart failure: the emerging roles of cardiac biomarkers and prognostic scores.

    PubMed

    Cohen-Solal, Alain; Laribi, Said; Ishihara, Shiro; Vergaro, Giuseppe; Baudet, Mathilde; Logeart, Damien; Mebazaa, Alexandre; Gayat, Etienne; Vodovar, Nicolas; Pascual-Figal, Domingo A; Seronde, Marie-France

    2015-01-01

    Rapidly assessing outcome in patients with acute decompensated heart failure is important but prognostic factors may differ from those used routinely for stable chronic heart failure. Multiple plasma biomarkers, besides the classic natriuretic peptides, have recently emerged as potential prognosticators. Furthermore, prognostic scores that combine clinical and biochemical data may also be useful. However, compared with the scores used in chronic heart failure, scores for acute decompensated heart failure have not been validated. This article reviews potential biomarkers, with a special focus on biochemical biomarkers, and possible prognostic scores that could be used by the clinician when assessing outcome in patients with acute heart failure. PMID:25534886

  12. Aging-associated cardiovascular changes and their relationship to heart failure

    PubMed Central

    Strait, James B.; Lakatta, Edward G.

    2011-01-01

    Synopsis Aging represents a convergence of declining cardioprotective systems and increasing disease processes that is fertile ground for the development of heart failure. With 50% of all heart failure diagnoses and 90% of all heart failure deaths occurring in the segment of the population over age 70, heart failure is largely a disease of the elderly. This review discusses the microscopic and macroscopic changes in cardiovascular structure, function, protective systems, and disease associated with aging. In addition to outlining important clinical considerations and conditions in older persons, the link between normal aging and the elevated risk for development of stage B heart failure is explained and potential therapeutic pathways highlighted. PMID:22108734

  13. BET bromodomains mediate transcriptional pause release in heart failure.

    PubMed

    Anand, Priti; Brown, Jonathan D; Lin, Charles Y; Qi, Jun; Zhang, Rongli; Artero, Pedro Calderon; Alaiti, M Amer; Bullard, Jace; Alazem, Kareem; Margulies, Kenneth B; Cappola, Thomas P; Lemieux, Madeleine; Plutzky, Jorge; Bradner, James E; Haldar, Saptarsi M

    2013-08-01

    Heart failure (HF) is driven by the interplay between regulatory transcription factors and dynamic alterations in chromatin structure. Pathologic gene transactivation in HF is associated with recruitment of histone acetyl-transferases and local chromatin hyperacetylation. We therefore assessed the role of acetyl-lysine reader proteins, or bromodomains, in HF. Using a chemical genetic approach, we establish a central role for BET family bromodomain proteins in gene control during HF pathogenesis. BET inhibition potently suppresses cardiomyocyte hypertrophy in vitro and pathologic cardiac remodeling in vivo. Integrative transcriptional and epigenomic analyses reveal that BET proteins function mechanistically as pause-release factors critical to expression of genes that are central to HF pathogenesis and relevant to the pathobiology of failing human hearts. This study implicates epigenetic readers as essential effectors of transcriptional pause release during HF pathogenesis and identifies BET coactivator proteins as therapeutic targets in the heart. PMID:23911322

  14. Patient selection for advanced heart failure therapy referral.

    PubMed

    Fanaroff, Alexander C; DeVore, Adam D; Mentz, Robert J; Daneshmand, Mani A; Patel, Chetan B

    2014-03-01

    Despite advances in medical therapy for chronic heart failure (HF), advanced HF carries a dismal prognosis. Options such as transplantation and durable mechanical circulatory support have greatly improved outcomes for these patients, but their introduction has introduced significant complexity to patient management. Although much of this management occurs at specialized heart transplant centers, it is the responsibility of the primary cardiologist of the patient with advanced HF to refer patients at the appropriate time and to help them navigate the difficult decisions related to the pursuit of advanced therapies. We present a unique pathway that incorporates guidelines, recent data, and expert opinion to help general cardiologists determine which patients should be referred for transplantation or durable mechanical circulatory support, and when they should be referred. Decision making on referral to the heart transplant center is also summarized. PMID:24526143

  15. Role of Monitoring Devices in Preventing Heart Failure Admissions.

    PubMed

    McDonald, Kenneth; Wilkinson, Mark; Ledwidge, Mark

    2015-08-01

    This review aims to discuss and summarize the evidence base for devices that have a role in monitoring patients with heart failure for the purpose of attempting to prevent heart failure-related admissions. Despite contemporary heart failure service provision, many patients continue to need acute admission for decompensation. There is a clinical need for a better strategy for predicting decompensation earlier so that appropriate therapeutic interventions can be commenced sooner in order to prevent the need for acute hospital admission. Between clinical assessment visits, the contemporary approach to management is based primarily on daily home monitoring of weight by patients; while this has proved useful, it falls short. For example, substantial weight gain was seen in only 20 % of ADHF admission patients according to data collected in the TEN-HMS home telemonitoring study. Monitoring devices offer the possibility of tracking additional physiological or haemodynamic parameters that may allow for earlier detection and more accurate identification of patients at risk of acute decompensation. PMID:26049264

  16. TNFalpha in atherosclerosis, myocardial ischemia/reperfusion and heart failure.

    PubMed

    Kleinbongard, Petra; Heusch, Gerd; Schulz, Rainer

    2010-09-01

    TNFalpha is crucially involved in the pathogenesis and progression of atherosclerosis, myocardial ischemia/reperfusion injury and heart failure. The formation and release of TNFalpha and its downstream signal transduction cascade following activation of its two receptor subtypes is characterized, with special emphasis on the cardiovascular system. In the vasculature, TNFalpha alters endothelial and vascular smooth muscle cell function as well as endothelial cell-blood cell interaction; the importance of such alterations for vascular dysfunction, the initiation and progression of atherosclerosis are discussed. In the myocardium, TNFalpha contributes to reversible and irreversible ischemia/reperfusion injury, post-myocardial infarction remodeling and heart failure development. Simultaneously, TNFalpha also contributes to cardioprotection by ischemic conditioning. Emphasis is placed on such ambivalent (detrimental vs. beneficial) role of TNFalpha, which appears to be dose- and time-dependent and in part related to the activation of the specific receptor subtype. Given the ambivalent role of TNFalpha and its receptors, it is not surprising that clinical trials using compounds that antagonize TNFalpha revealed ambiguous and largely disappointing results in cardiovascular disease, notably in heart failure. Future perspectives to antagonize and/or potentially recruit TNFalpha in the cardiovascular system are critically discussed. PMID:20621692

  17. The sympathorenal axis in hypertension and heart failure.

    PubMed

    Goldsmith, Steven R; Sobotka, Paul A; Bart, Bradley A

    2010-05-01

    Excessive sympathetic drive is undoubtedly a major contributing factor to the pathophysiology of hypertension and heart failure. Much of the excessive sympathetic drive in these conditions is directed to the kidney, where it leads to inappropriate sodium retention, renin stimulation, and diminished renal function. Less well appreciated is the role the kidney itself plays in the generation of increased sympathetic activity by way of the renal somatic afferent nerves. The kidney therefore is both target and contributor to increased sympathetic activity in these conditions. Although some current pharmacotherapy indirectly targets this "sympathorenal axis," resistant hypertension remains a common problem, and the prognosis in heart failure remains poor, especially in more severe cases. It is now possible to directly target this axis via procedures, which directly interrupt renal sympathetic efferent and afferent signaling. Other procedures involving chronic carotid nerve stimulation may indirectly influence renal sympathetic tone and so improve renal sodium handling. These techniques have demonstrated early promise in hypertension and offer significant potential in heart failure as well. Should their early promise be borne out in controlled studies, the "sympathorenal axis" will have been proven to be a key element in the pathophysiology of these 2 very common, and dangerous, conditions. PMID:20447571

  18. Iron Deficiency in Heart Failure: A Practical Guide

    PubMed Central

    Ebner, Nicole; von Haehling, Stephan

    2013-01-01

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

  19. [Vagus nerve stimulation for the treatment of heart failure].

    PubMed

    De Ferrari, Gaetano M; Dusi, Veronica

    2015-03-01

    In the last two decades, the autonomic imbalance characterized by vagal withdrawal and sympathetic increase has been shown to play a major role in the progression and prognosis of heart failure. Therefore, modulation of the autonomic nervous system (neuromodulation) with the aim to restore autonomic balance is gaining increasing interest as a potential therapy for patients with heart failure. Recently, different non-pharmacological approaches to neuromodulation have been evaluated in phase II and III clinical trials. Electrical vagus nerve stimulation is the most studied. This technique showed excellent results in preclinical studies, but at present the clinical experience is limited to a few studies, the results of which are apparently conflicting.This review discusses the preclinical and clinical experience of vagal stimulation in heart failure, in order to help understand the complexity of the methodology and our still limited knowledge of the dose-response relationship, which make difficult to interpret and compare the results of studies conducted with different designs and evaluating different devices and stimulation protocols. PMID:25837458

  20. Advanced therapies for end-stage heart failure.

    PubMed

    Katz, Jason N; Waters, Sarah B; Hollis, Ian B; Chang, Patricia P

    2015-01-01

    Management of the advanced heart failure patient can be complex. Therapies include cardiac transplantation and mechanical circulatory support, as well inotropic agents for the short-term. Despite a growing armamentarium of resources, the clinician must carefully weigh the risks and benefits of each therapy to develop an optimal treatment strategy. While cardiac transplantation remains the only true "cure" for end-stage disease, this resource is limited and the demand continues to far outpace the supply. For patients who are transplant-ineligible or likely to succumb to their illness prior to transplant, ventricular assist device therapy has now become a viable option for improving morbidity and mortality. Particularly for the non-operative patient, intravenous inotropes can be utilized for symptom control. Regardless of the treatments considered, care of the heart failure patient requires thoughtful dialogue, multidisciplinary collaboration, and individualized care. While survival is important, most patients covet quality of life above all outcomes. An often overlooked component is the patient's control over the dying process. It is vital that clinicians make goals-of-care discussions a priority when seeing patients with advanced heart failure. The use of palliative care consultation is well-validated and facilitates these difficult conversations to ensure that all patient needs are ultimately met. PMID:24251460

  1. Rotary blood pumps as definitive treatment for severe heart failure.

    PubMed

    Westaby, Stephen

    2013-03-01

    Rotary blood pumps are increasingly recognized as mainstream therapy for severely symptomatic heart failure. Carefully targeted refinements in patient selection and postoperative care have substantially reduced the adverse event burden. These improvements translate into better survival and quality of life in comparison with medical management. Medium-term outcomes now compete favorably with cardiac transplantation, although evidence-based outcome data indicate that transplant and 'lifetime' left ventricular-assist device (LVAD) candidates are fundamentally different. Significant challenges remain in relation to neurological injury and right heart failure, which may continue to limit exercise capacity. In the meantime, both physician awareness and patient access to LVAD technology remain limited. The debate is rarely between cardiac transplant or lifetime LVAD. It should focus on the choice between pump versus palliative care for the thousands of patients of all age groups who are judged ineligible for transplantation. Comprehensive healthcare systems must consider contemporary evidence and provide the most symptomatic of heart failure patients with effective care. Cardiac resynchronization therapy is no longer the ceiling for this. PMID:23463973

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

    PubMed Central

    Cinca, Juan; Mendez, Ana; Puig, Teresa; Ferrero, Andreu; Roig, Eulalia; Vazquez, Rafael; Gonzalez-Juanatey, Jose R.; Alonso-Pulpon, Luis; Delgado, Juan; Brugada, Josep; Pascual-Figal, Domingo; Brugada, J.; Batlle, M.; Berruezo, A.; Hevia, S.; Mont, L.; Pérez-Villa, F.; Cinca, J.; Roig, E.; Bayés de Luna, A.; Borrás, X.; Carreras, F.; Ferrero, A.; Guerra, J.M.; Hove-Madsen, L.; Jorge, E.; Martínez, R.; Padró, J.; Puig, T.; Ribas, N.; Viñolas, X.; Alvarez-Garcia, J.; González-Juanatey, J.R.; Bandín, M.; Eiras, S.; Fernández-Hernández, L.; García-Acuña, J.; Gómez-Otero, I.; Grigorian-Shamagian, L.; Lago, F.; Manzón, P.; Moure, M.; Otero-Raviña, F.; Otero-Santiago, F.; Rodino Janeiro, B.K.; Rubio, J.; Salgado, A.; Seoane, A.; Varela, A.; Lear, P.V.; Fernández-Cruz, A.; Alvarez de Arcaya Vicente, A.; Avila, M.; Bordiu, E.; Calle, L.; Fernández-Pinilla, C.; Gómez-Garre, D.; González-Rubio, L.; Marco, J.; Martell, N.; Muñoz-Pacheco, P.; Ortega, A.; Patiño, R.; Pedrajas, J.; Reinares, L.; Pérez-Villacastín, J.; Bover, R.; Cobos, M.; García-Quintanilla, J.; Moreno, J.; Pérez-Castellano, N.; Pérez-Serrano, M.; Vila, I.; Delgado, J.F.; Arribas, F.; Escribano, P.; Flox, A.; Jiménez López-Guarch, C.; Paradina, M.; Ruiz-Cano, J.; Sáenz de la Calzada, C.; Salguero, R.; Sánchez-Sánchez, V.; Tello de Meneses, R.; Vicente-Hernández, M.; Alonso-Pulpón, L.; Fernández -Lozano, I.; García-Pavía, P.; García-Touchard, A.; Gómez-Bueno, M.; Márquez, J.; Segovia, J.; Silva, L.; Vázquez-Mosquera, M.; Valdés, M.; García-Alberola, A.; Garrido, I.; Pascual-Figal, D. A.; Pastor-Pérez, F.J.; Sánchez-Más, J.; Tornel, P.; Rivera, M.; Almenar, L.; Cortés, R.; Martínez-Dolz, L.; Montero, J.; Portolés, M.; Roselló-Lleti, E.; Salvador, A.; Vila, V.; Vázquez, R.; Cubero, J.; Fernández-Palacín, A.; García-Medina, D.; García-Rey, S.; Laguna, E.; Leal del Ojo, J.; Miñano, F.; Pastor-Torres, L.; Pavón, R.; Pérez-Navarro, A.; Villagómez, D.; Vázquez, R.; Arana, R.; Bartolomé, D.; Cabeza, P.; Calle-Pérez, G.; Camacho, F.; Cano, L.; Carrillo, A.; Díaz-Retamino, E.; Escolar, V.; Fernández-Rivero, R.; Gamaza, S.; Giráldes, A.; Hernández-Vicente, N.; Lagares, M.; López-Benítez, J.; Marante, M.; Otero, E.; Pedregal, J.; Sancho-Jaldón, M.; Sevillano, R.; Zayas, R.; Verdú, J.M.; Aguilar, S.; Aizpurúa, M.; Alguacil, F.; Casacuberta, J.; Cerain, J.; Domingo, M.; García-Lareo, M.; Herrero-Melechón, J.; López-Pareja, N.; Mena, A.; Pérez-Orcero, A.; Rodríguez- Cristóbal, J.; Rozas, M.; Sorribes, J.; Torán, P.; Worner, F.; Barta, L.; Bravo, C.; Cabau, J.; Casanova, J.; Daga, B.; De la Puerta, I.; Hernández-Martín, I.; Piñol, E.; Pueo, E.; Torres, G.; Troncoso, A.; Viles, D.; Bardají, A.; Mercè, J.; Sanz-Girgas, E.; Valdovinos, P.; Aramburu, O.; Arias, J.; García-González, C.; Alonso, M.; Bischofberger, C.; Domínguez-De Pablos, G.; Jiménez-Cervantes, D.; Ureña, I.; Grau-Sepúlveda, A.; Fiol, C.; Pericas, P.; Villalonga, M.; Orosa, P.; Agüero, J.; Planas-Aymá, F.; Grau-Amoros, J.; Planas-Comes, F.; San Vicente, L.

    2013-01-01

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

  3. Intermittent Outpatient Nesiritide Infusion Reduces Hospital Admissions in Patients With Advanced Heart Failure

    Microsoft Academic Search

    Ernst R. Schwarz; Sabeen Najam; Rami Akel; Nasir Sulimanjee; Susan Bionat; Salvatore Rosanio

    2007-01-01

    Recombinant B-type natriuretic peptide (BNP) is a therapeutic modality in patients with decompensated congestive heart failure. Retrospectively tested are the effects of intermittent outpatient nesiritide infusion on symptoms, hospital readmission rates, endogenous BNP, and renal function in patients with advanced heart failure. Twenty-four patients in heart failure in New York Heart Association (NYHA) classes III-IV received a 6- to 8-hour

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

    Microsoft Academic Search

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

    1999-01-01

    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

  5. Complexity of program and clinical outcomes of heart failure disease management incorporating specialist nurse-led heart failure clinics

    Microsoft Academic Search

    Christopher O. Phillips; Ramesh M. Singasupbs; Haya R. Rubin; Tiny Jaarsma

    Abstract Objectives: To determine whether,a hierarchy of effectiveness exists with respect to complexity of published protocols of heart failure (HF) disease management,(DM) incorporating specialist nurse-led HF clinics. Data sources and study selection: We searched MEDLINE (1966–November 2004), the Cochrane Library, article bibliographies, and contacted experts. Inclusion criteria were random allocation of at least 100 patients, specialist HF nurses, HF clinics,

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

    Microsoft Academic Search

    Philippe Lechat; Jean-Sébastien Hulot; A Mallet

    2001-01-01

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

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

    SciTech Connect

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

    2012-02-10

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

  8. Changes in heart failure medications in patients hospitalised and discharged

    PubMed Central

    Scherer, Martin; Sobek, Cordula; Wetzel, Dirk; Koschack, Janka; Kochen, Michael M

    2006-01-01

    Background To date, evidence-based recommendations help doctors to manage patients with heart failure (HF). However, the implementation of these recommendations in primary care is still problematic as beneficial drugs are infrequently prescribed. The aim of the study was to determine whether admission to hospital increases usage of beneficial HF medication and if this usage is maintained directly after discharge. Methods The study was conducted from November 2002 until January 2004. In 77 patients hospitalised with heart failure (HF), the medication prescribed by the referring general practitioner (GP) and drug treatment directed by the hospital physicians was documented. Information regarding the post-discharge (14 d) therapy by the GP was evaluated via a telephone interview. Ejection fraction values, comorbidity and specifics regarding diagnostic or therapeutic intervention were collected by chart review. Results When compared to the referring GPs, hospital physicians prescribed more ACE-inhibitors (58.4% vs. 76.6%; p = 0.001) and beta-blockers of proven efficacy in HF (metoprolol, bisoprolol, carvedilol; 58.4% vs. 81.8%). Aldosterone antagonists were also administered more frequently in the hospital setting compared to general practice (14.3% vs. 37.7%). The New York Heart Association classification for heart failure did not influence whether aldosterone antagonists were administered either in primary or secondary care. Fourteen days after discharge, there was no significant discontinuity in discharge medication. Conclusion Patients suffering from HF were more likely to receive beneficial medication in hospital than prior to admission. The treatment regime then remained stable two weeks after discharge. We suggest that findings on drug continuation in different cardiovascular patients might be considered validated for patients with HF. PMID:17123439

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

    PubMed Central

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

    2012-01-01

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

  10. RESICARD: East Paris network for the management of heart failure: Absence of effect on mortality and rehospitalization in patients with severe heart failure admitted following severe decompensation

    Microsoft Academic Search

    Patrick Assyag; Thomas Renaud; Alain Cohen-Solal; Magali Viaud; Henry Krys; Aleksandra Bundalo; Pierre-Louis Michel; Robert Boukobza; Yann Bourgueil; Ariel Cohen

    2009-01-01

    Summary Background. — Heart failure presents a major public health problem due to its high prevalence and the increasing number of hospital admissions for this condition. A coordinated healthcare network involving general practitioners and cardiologists was set up in the east of Paris in an effort to improve the management and outcomes of patients with severe heart failure.

  11. Muscle reflex in heart failure: the role of exercise training

    PubMed Central

    Wang, Han-Jun; Zucker, Irving H.; Wang, Wei

    2012-01-01

    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 heart failure (CHF) patients. A therapeutic strategy for preventing or slowing the progression of the exaggerated EPR may be of benefit in CHF patients. Long-term exercise training (ExT), as a non-pharmacological treatment for CHF increases exercise capacity, reduces sympatho-excitation and improves cardiovascular function in CHF animals and patients. In this review, we will discuss the effects of ExT and the mechanisms that contribute to the exaggerated EPR in the CHF state. PMID:23060821

  12. [New therapy concepts for heart failure with preserved ejection fraction].

    PubMed

    Tschöpe, C; Pieske, B

    2015-04-01

    The management of patients with heart failure and preserved ejection fraction (HFpEF) remains challenging and requires an accurate diagnosis. Although currently no convincing therapy that can prolong survival in patients with HFpEF has been established, treatment of fluid retention, heart rate and control of comorbidities are important cornerstones to improve the quality of life and symptoms. In recent years many new therapy targets have been tested for development of successful interventional strategies for HFpEF. Insights into new mechanisms of HFpEF have shown that heart failure is associated with dysregulation of the nitric oxide-cyclic guanosine monophosphate-protein kinase (NO-cGMP-PK) pathway. Two new drugs are currently under investigation to test whether this pathway can be significantly improved by either the neprilysin inhibitor LCZ 696 due to an increase in natriuretic peptides or by the soluble guanylate cyclase stimulator vericiguat, which is also able to increase cGMP. In addition, several preclinical or early phase studies which are currently investigating new mechanisms for matrix, intracellular calcium and energy regulation including the role of microRNAs and new devices are presented and discussed. PMID:25737289

  13. Emerging hemodynamic signatures of the right heart (Third International Right Heart Failure Summit, part 2)

    PubMed Central

    2014-01-01

    Abstract Despite the importance of preserved right ventricular structure and function with respect to outcome across the spectrum of lung, cardiac, and pulmonary vascular diseases, only recently have organized efforts developed to consider the pulmonary vascular–right ventricular apparatus as a specific unit within the larger context of cardiopulmonary pathophysiology. The Third International Right Heart Failure Summit (Boston, MA) was a multidisciplinary event dedicated to promoting a dialogue about the scientific and clinical basis of right heart disease. The current review provides a synopsis of key discussions presented during the section of the summit titled “Emerging Hemodynamic Signatures of the Right Heart.” Specifically, topics emphasized in this element of the symposium included (1) the effects of pulmonary vascular dysfunction at rest or provoked by exercise on the right ventricular pressure-volume relationship, (2) the role of pressure-volume loop analysis as a method to characterize right ventricular inefficiency and predict right heart failure, and (3) the importance of a systems biology approach to identifying novel factors that contribute to pathophenotypes associated with pulmonary arterial hypertension and/or right ventricular dysfunction. Collectively, these concepts frame a forward-thinking paradigm shift in the approach to right heart disease by emphasizing factors that regulate the transition from adaptive to maladaptive right ventricular–pulmonary vascular (patho)physiology. PMID:25610606

  14. Serum uric acid correlates with extracellular superoxide dismutase activity in patients with chronic heart failure

    Microsoft Academic Search

    Hernan Alcaino; Douglas Greig; Mario Chiong; Hugo Verdejo; Rodrigo Miranda; Roberto Concepcion; José Luis Vukasovic; Guillermo Diaz-Araya; Rosemarie Mellado; Lorena Garcia; Daniela Salas; Leticia Gonzalez; Ivan Godoy; Pablo Castro; Sergio Lavandero

    Increased serum uric acid has been identified as an independent risk factor for cardiovascular disease. However, because of its antioxidant capacity, uric acid may play a beneficial role in endothelial function. This paradoxical relationship between uric acid and endothelial function in chronic heart failure patients remains poorly understood. Thirty-eight chronic heart failure patients (New York Heart Association functional class II-III,

  15. [Left atrial myxoma in a patient with heart failure after myocardial infarction - a case report].

    PubMed

    Detko-Barczy?ska, Joanna; Dabrowski, Rafa?; Kraska, Alicja; Szwed, Hanna

    2008-06-01

    A case of a 54-year-old male patient with left atrial myxoma, coronary heart disease, heart failure and multiple cardiovascular risk factors is described. The patient did not present typical symptoms of myxoma. Diagnosis and treatment of cardiac myxoma as well as the importance of echocardiographic examination in every patient with decompensated chronic heart failure are discussed. PMID:18626835

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

    Microsoft Academic Search

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

    2003-01-01

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

  17. Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure

    Microsoft Academic Search

    Anne L. Taylor; Susan Ziesche; Clyde Yancy; Peter Carson; Ralph D'Agostino; Keith Ferdinand; Malcolm Taylor; Kirkwood Adams; Michael Sabolinski; Manuel Worcel; Jay N. Cohn

    2010-01-01

    background We examined whether a fixed dose of both isosorbide dinitrate and hydralazine pro- vides additional benefit in blacks with advanced heart failure, a subgroup previously noted to have a favorable response to this therapy. methods A total of 1050 black patients who had New York Heart Association class III or IV heart failure with dilated ventricles were randomly assigned

  18. Alterations of radial artery compliance in patients with congestive heart failure

    Microsoft Academic Search

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

    1995-01-01

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

  19. Dystrophic heart failure blocked by membrane sealant poloxamer

    NASA Astrophysics Data System (ADS)

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

    2005-08-01

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

  20. Comparing new onset heart failure with reduced ejection fraction and new onset heart failure with preserved ejection fraction: an epidemiologic perspective.

    PubMed

    Brouwers, Frank P; Hillege, Hans L; van Gilst, Wiek H; van Veldhuisen, Dirk J

    2012-12-01

    The incidence and prevalence of heart failure is increasing, especially heart failure with preserved ejection fraction (HFpEF) relative to heart failure with reduced ejection fraction (HFrEF). For both HFrEF and HFpEF, there is need to shift our focus from secondary to primary prevention. Detailed epidemiologic data on both HFpEF and HFrEF are needed to allow early identification of at-risk subjects. Current cohorts with new onset heart failure lack uniformity with respect to diagnosis, follow-up, and population characteristics, but most important, fail to distinguish between HFpEF and HFrEF. Studies on prevalent heart failure show ischemic heart disease as the predominant risk factor for HFrEF, while hypertension, atrial fibrillation, and diabetes are risk factors for HFpEF. As it becomes increasingly clear that both subtypes of heart failure are different syndromes, new cohorts and trials are necessary to obtain separate data on both subtypes of heart failure. PMID:22968403

  1. Heart Failure: Advanced Development in Genetics and Epigenetics

    PubMed Central

    Yang, Jian; Xu, Wei-wei; Hu, Shen-jiang

    2015-01-01

    Heart failure (HF) is a complex pathophysiological syndrome that arises from a primary defect in the ability of the heart to take in and/or eject sufficient blood. Genetic mutations associated with familial dilated cardiomyopathy, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy can contribute to the various pathologies of HF. Therefore, genetic screening could be an approach for guiding individualized therapies and surveillance. In addition, epigenetic regulation occurs via key mechanisms, including ATP-dependent chromatin remodeling, DNA methylation, histone modification, and RNA-based mechanisms. MicroRNA is also a hot spot in HF research. This review gives an overview of genetic mutations associated with cardiomyopathy and the roles of some epigenetic mechanisms in HF. PMID:25949994

  2. Remodeling of Calcium Handling in Human Heart Failure

    PubMed Central

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

    2013-01-01

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

  3. Ventricular Remodeling in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Shah, Amil M.

    2014-01-01

    Heart failure with preserved ejection fraction (HFpEF) is common, increasing in prevalence, and causes substantial morbidity and mortality. HFpEF has commonly been viewed as an expression of advanced hypertensive heart disease, with a cardiac phenotype characterized by an increase in wall thickness-to-chamber radius ratio (concentric hypertrophy). However, marked clinical heterogeneity within this syndrome is now well appreciated, and is mirrored in the variability in left ventricular structure. A review of larger imaging studies from epidemiology and clinical trial cohorts demonstrate that while concentric LV remodeling is common, it is by no means universal and many patients demonstrate normal LV geometry or even an eccentric pattern. More detailed assessment of cardiac structure and function in broader HFpEF populations will be necessary to better define the prevalence, determinants, and prognostic relevance of these measures, which may in turn serve as a foundation to identify pathophysiologically relevant sub-phenotypes within this diverse syndrome. PMID:24097113

  4. A Correlational Pilot Study of Home Health Nurse Management of Heart Failure Patients and Hospital Readmissions

    Microsoft Academic Search

    Mary L. McCoy; Ruth Davidhizar; Deborah R. Gillum

    2007-01-01

    Heart failure is the leading cause of hospital admissions in patients more than 65 years old. The failure to provide carefully planned care to heart failure patients in the home setting predisposes patients to frequent hospital readmissions due to poor medication compliance, diet, and education of symptom management (Li, Marrow-Howell, & Proctor, 2004). The objective of this pilot study is

  5. Charting a roadmap for heart failure biomarker studies.

    PubMed

    Ahmad, Tariq; Fiuzat, Mona; Pencina, Michael J; Geller, Nancy L; Zannad, Faiez; Cleland, John G F; Snider, James V; Blankenberg, Stephan; Adams, Kirkwood F; Redberg, Rita F; Kim, Jae B; Mascette, Alice; Mentz, Robert J; O'Connor, Christopher M; Felker, G Michael; Januzzi, James L

    2014-10-01

    Heart failure is a syndrome with a pathophysiological basis that can be traced to dysfunction in several interconnected molecular pathways. Identification of biomarkers of heart failure that allow measurement of the disease on a molecular level has resulted in enthusiasm for their use in prognostication and selection of appropriate therapies. However, despite considerable amounts of information available on numerous biomarkers, inconsistent research methodologies and lack of clinical correlations have made bench-to-bedside translations rare and left the literature with countless publications of varied quality. There is a need for a systematic and collaborative approach aimed at definitively studying the clinical benefits of novel biomarkers. In this review, on the basis of input from academia, industry, and governmental agencies, we propose a systematized approach based on adherence to specific quality measures for studies looking to augment current prediction model or use biomarkers to tailor therapeutics. We suggest that study quality, rather than results, should determine publication and propose a system for grading biomarker studies. We outline the need for collaboration between clinical investigators and statisticians to introduce more advanced statistical methodologies into the field of biomarkers that would allow for data from a large number of variables to be distilled into clinically actionable information. Lastly, we propose the creation of a heart failure biomarker consortium that would allow for a comprehensive list of biomarkers to be concomitantly analyzed in a pooled sample of randomized clinical trials and hypotheses to be generated for testing in biomarker-guided trials. Such a consortium could collaborate in sharing samples to identify biomarkers, undertake meta-analyses on completed trials, and spearhead clinical trials to test the clinical utility of new biomarkers. PMID:24929535

  6. Multimarker testing with ST2 in chronic heart failure.

    PubMed

    Bayes-Genis, Antoni; Richards, A Mark; Maisel, Alan S; Mueller, Christian; Ky, Bonnie

    2015-04-01

    Despite important progress in recent decades, mortality remains high for patients with chronic heart failure. Risk stratification may be refined by the use of biomarkers for different pathophysiological processes that established mortality risk factors do not directly reflect. Biomarkers that are currently available can provide information about at least 7 pathobiological processes operative in HF, help to identify the specific processes involved in individual patients, and aid in constructing management plans. However, the additional prognostic information gained by any biomarker over a clinical risk model plus other biomarkers needs to be determined with adequate statistical tools. A major problem in selecting a biomarker profile is the proportional increase in economic burden; thus, the addition of any biomarker to a profile should be justified by adequate discrimination, calibration, reclassification, and likelihood analyses. Three studies that implemented such rigorous analyses have assessed a multimarker panel in chronic heart failure that incorporated the biomarker ST2: the Penn HF Study, the Barcelona Study, and the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) biomarker substudy. In all 3 studies, a multimarker panel appeared to provide significant information over conventional risk stratification. The latter 2 reports proposed that ST2 might be superior to natriuretic peptides. The Barcelona Bio-HF calculator (www.bcnbiohfcalculator.cat) is a novel risk calculator that considers clinical variables, treatment, and biomarkers (i.e., N terminal pro-brain natriuretic peptide [NT-proBNP], ST2, and high sensitivity troponin T [hsTnT]). The optimal panel of markers, the change in these markers over time, and how these changes might help guide therapeutic interventions remain to be defined. PMID:25697916

  7. Team-based Care for Patients Hospitalized with Heart Failure.

    PubMed

    Larsen, Paul M; Teerlink, John R

    2015-07-01

    Hospitalizations for acute heart failure (HF) and subsequent readmissions have received increased attention because of the burden they place on patients, providers, and the health care system. These hospitalizations represent a significant portion of the total cost of HF care and health care in general. Although much of the care of the patient with HF occurs outside of the hospital, the genesis of the programs that attempt to limit repeat hospitalizations begin in the impatient setting. By using evidence-based guidelines, interdisciplinary teams, and comprehensive discharge planning, costly readmissions can be reduced and outcomes improved. PMID:26142635

  8. Pharmacogenetics in Chronic Heart Failure: New Developments and Current Challenges

    PubMed Central

    Talameh, Jasmine A.

    2013-01-01

    The individual patient responses to chronic heart failure (HF) pharmacotherapies are highly variable. This variability cannot be entirely explained by clinical characteristics, and genetic variation may play a role. Therefore the purpose of this review is to 1) summarize the background pharmacogenetic literature for major HF pharmacotherapy classes (i.e. beta-blockers, angiotensin converting enzyme inhibitors, digoxin, and loop diuretics), 2) evaluate recent advances in the HF pharmacogenetic literature in the context of previous findings, and 3) discuss the challenges and conclusions for HF pharmacogenetic data and its clinical application. PMID:22135185

  9. Calcium Cycling Proteins and Their Association With Heart Failure

    PubMed Central

    Hadri, L; Hajjar, RJ

    2013-01-01

    Heart failure (HF) has reached epidemic proportions in the United States and is one of the most important challenges to public health. Severe congestive HF is associated with substantial morbidity and mortality. HF afflicts approximately 5 million patients and contributes to 3 million hospitalizations and 300,000 deaths yearly.1 Late-stage HF has a poor prognosis, and therapeutic options are limited. Defective excitation–contraction (EC) coupling in HF may result from altered density or function of proteins relevant for Ca2+ homeostasis. PMID:21832991

  10. Ablation of ventricular arrhythmia in patients with heart failure.

    PubMed

    Chik, William W B; Marchlinski, Francis E

    2015-04-01

    Ventricular arrhythmias (VAs) in patients with cardiomyopathy and advanced-symptom class heart failure (HF) are associated with significant morbidity and mortality. VAs are typically managed with antiarrhythmic drug therapy and implantable cardiac defibrillators (ICD). Although ICDs are highly effective in reducing sudden cardiac death by termination of VA, they do not prevent arrhythmia recurrences. Recurrent shocks are not only associated with poor quality of life but also progressive HF and increased mortality and morbidity. Radiofrequency catheter ablation has emerged as an important therapeutic option for patients with drug-refractory ventricular tachycardia to reduce or prevent ICD shocks. PMID:25834978

  11. Potential applications of pharmacogenomics to heart failure therapies.

    PubMed

    Parikh, Kishan S; Ahmad, Tariq; Fiuzat, Mona

    2014-10-01

    Pharmacogenomics explores one drug's varying effects on different patient genotypes. A better understanding of genomic variation's contribution to drug response can impact 4 arenas in heart failure (HF): (1) identification of patients most likely to receive benefit from therapy, (2) risk stratify patients for risk of adverse events, (3) optimize dosing of drugs, and (4) steer future clinical trial design and drug development. In this review, the authors explore the potential applications of pharmacogenomics in patients with HF in the context of these categories. PMID:25217435

  12. Prevention of readmission in elderly patients with congestive heart failure

    Microsoft Academic Search

    Michael W. Rich; Janice M. Vinson; Jane C. Sperry; Atul S. Shah; Lisa R. Spinner; Mina K. Chung; Victor Da Vila-Roman

    1993-01-01

    Objective: To determine the feasibility and potential impact of a non-pharmacologic multidisciplinary intervention for reducing hospital\\u000a readmissions in elderly patients with congestive heart failure.\\u000a \\u000a \\u000a Design: Prospective, randomized clinical trial, with 2:1 assignment to the study intervention or usual care.\\u000a \\u000a \\u000a \\u000a \\u000a Setting: 550-bed secondary and tertiary care university teaching hospital.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and participants: 98 patients ?70 years of age (mean 79±6 years)

  13. Heart failure with preserved ejection fraction - unwinding the diagnosis mystique

    PubMed Central

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

    2014-01-01

    A precise diagnosis of diastolic dysfunction is often difficult and requires invasive techniques to determine left ventricular volume, relaxation, and compliance properties. At this current point of time there is no single non-invasive index available to adequately reflect diastolic function, perhaps because of the numerous factors that can alter diastolic function. In most clinical settings, diastolic function is estimated using Doppler echocardiography. Cardiac magnetic resonance imaging (CMRI) is yet another emerging modality for diastolic function analysis. Here we present a comprehensive review of the various parameters used to assess diastolic function as part of diagnosis of clinical syndrome “Heart failure with preserved ejection fraction (HFPEF)”. PMID:25360388

  14. Stratification of the risk of sudden death in nonischemic heart failure.

    PubMed

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

    2014-10-01

    Despite significant therapeutic advancements, heart failure remains a highly prevalent clinical condition associated with significant morbidity and mortality. In 30%-40% patients, the etiology of heart failure is nonischemic. The implantable cardioverter-defibrillator (ICD) is capable of preventing sudden death and decreasing total mortality in patients with nonischemic heart failure. However, a significant number of patients receiving ICD do not receive any kind of therapy during follow-up. Moreover, considering the situation in Brazil and several other countries, ICD cannot be implanted in all patients with nonischemic heart failure. Therefore, there is an urgent need to identify patients at an increased risk of sudden death because these would benefit more than patients at a lower risk, despite the presence of heart failure in both risk groups. In this study, the authors review the primary available methods for the stratification of the risk of sudden death in patients with nonischemic heart failure. PMID:25352509

  15. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes.

    PubMed

    Senni, Michele; Paulus, Walter J; Gavazzi, Antonello; Fraser, Alan G; Díez, Javier; Solomon, Scott D; Smiseth, Otto A; Guazzi, Marco; Lam, Carolyn S P; Maggioni, Aldo P; Tschöpe, Carsten; Metra, Marco; Hummel, Scott L; Edelmann, Frank; Ambrosio, Giuseppe; Stewart Coats, Andrew J; Filippatos, Gerasimos S; Gheorghiade, Mihai; Anker, Stefan D; Levy, Daniel; Pfeffer, Marc A; Stough, Wendy Gattis; Pieske, Burkert M

    2014-10-21

    The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed. PMID:25104786

  16. Optimization of pharmacotherapy in chronic heart failure: is heart rate adequately addressed?

    PubMed

    Franke, Jennifer; Wolter, Jan Sebastian; Meme, Lillian; Keppler, Jeannette; Tschierschke, Ramon; Katus, Hugo A; Zugck, Christian

    2013-01-01

    The aim of the study is to evaluate the use of beta-blockers in chronic heart failure (CHF) and the extent of heart rate reduction achieved in clinical practice and to determine differences in outcome of patients who fulfilled select inclusion criteria of the SHIFT study according to resting heart rate modulated by beta-blocker therapy. We evaluated an all-comer population of our dedicated CHF outpatient clinic between 2006 and 2010. For inclusion, individually optimized doses of guideline-recommended pharmacotherapy including beta-blockers had to be maintained for at least 3 months and routine follow-up performed at our outpatient CHF-clinic thereafter. Treatment dosages of beta-blockers, and demographic and clinical profiles including resting heart rate were assessed. The outcome of patients who fulfilled select inclusion criteria of the SHIFT study (left-ventricular ejection fraction (LVEF) ?35 %, sinus rhythm, NYHA II-IV) and were followed-up for at least 1 year was stratified according to resting heart rates: ?75 versus <75 bpm and ?70 versus <70 bpm. The composite primary endpoint was defined as all-cause death or hospital admission for worsening heart failure during 12-month follow-up. In total, 3,181 patients were assessed in regard to treatment dosages of beta-blockers, and demographic and clinical profiles including resting heart rate. Of the overall studied population, 443 patients fulfilled all inclusion criteria and entered outcome analysis. Median observation time of survivors was 27.5 months with 1,039.7 observation-years in total. Up-titration to at least half the evidence-based target dose of beta-blockers was achieved in 69 % and full up-titration in 29 % of these patients. Patients with increased heart rates were younger, more often male, exhibited a higher NYHA functional class and lower LVEF. The primary endpoint occurred in 21 % of patients in the ?70 bpm group versus 9 % of patients in the group with heart rates <70 bpm (p <0.01). Likewise, comparing the groups ?75 and <75 bpm, the primary endpoint was significantly increased in the group of patients with heart rates ?75 bpm 27 vs. 12.2 %; p < 0.01). 5-year event-free survival was significantly lower among patients with heart rates ?70 bpm as compared to those with <70 bpm (log-rank test p < 0.05) and among patients in the ?75 bpm group versus <75 bpm group (log-rank test p < 0.01). In conclusion, in clinical practice, 53 % of CHF patients have inadequate heart rate control (heart rates ?75 bpm) despite concomitant beta-blocker therapy. In this non-randomized cohort, adequate heart rate control under individually optimized beta-blocker therapy was associated with improved mid- and long-term clinical outcome up to 5 years. As further up titration of beta-blockers is not achievable in many patients, the administration of a selective heart rate lowering agent, such as ivabradine adjuvant to beta-blockers may pose an opportunity to further modulate outcome. PMID:22760479

  17. Timing of cardiac transplantation in patients with heart failure receiving ?-adrenergic blockers

    Microsoft Academic Search

    Linda R Peterson; Kenneth B Schechtman; Gregory A Ewald; Edward M Geltman; Lisa de las Fuentes; Timothy Meyer; Pamela Krekeler; Martha L Moore; Joseph G Rogers

    2003-01-01

    Background:Previous work shows that patients with heart failure patients who have peak oxygen consumption (Vo2 peak) >14 ml\\/kg\\/min do not derive a survival benefit from cardiac transplantation. However, this was shown before ?-blocker therapy for patients with systolic heart failure became common, and ?-blockers improve survival in patients with heart failure without changing Vo2 peak. Our purpose was to re-evaluate

  18. Statin therapy and risks for death and hospitalization in chronic heart failure

    Microsoft Academic Search

    Alan S. Go; Wendy Y. Lee; Jingrong Yang; Joan C. Lo; Jerry H. Gurwitz

    2006-01-01

    CONTEXT: Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear.\\u000aOBJECTIVE: To evaluate the association between initiation of statin therapy and risks for death and hospitalization among adults with chronic heart failure.\\u000aDESIGN, SETTING, AND PATIENTS: Propensity-adjusted cohort study of adults diagnosed with heart failure who were eligible for lipid-lowering therapy but had

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

    Microsoft Academic Search

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

    1989-01-01

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

  20. Use of Genetics in the Clinical Evaluation and Management of Heart Failure

    Microsoft Academic Search

    Daniel P. Judge; Rosanne Rouf

    2010-01-01

    Opinion statement  Inherited forms of cardiomyopathy are common causes of heart failure. Applications of genetics in the evaluation and management\\u000a of heart failure include the determination of inheritance patterns within families with cardiomyopathy, the evaluation of\\u000a affected patients for syndromic features, the determination of people within families who are at risk of heart failure, and\\u000a the identification of responsible gene mutations.

  1. Clinical Use of Natriuretic Peptides for the Diagnosis and Management of Heart Failure

    Microsoft Academic Search

    Alan Maisel

    \\u000a Since the approval of B-type natriuretic peptide (BNP) as an aid to the diagnosis of heart failure by the US Food and Drug\\u000a Administration in November 2000, this novel biomarker has generated intense interest for both clinical and research applications\\u000a in patients with or at risk of heart failure. Initially focused on the urgent, bedside diagnosis of heart failure, BNP

  2. New roles for renin and prorenin in heart failure and cardiorenal crosstalk

    Microsoft Academic Search

    Nicolas F. Schroten; Carlo A. J. M. Gaillard; Dirk J. van Veldhuisen; Mariusz K. Szymanski; Hans L. Hillege; Rudolf A. de Boer

    The renin-angiotensin-aldosterone-system (RAAS) plays a central role in the pathophysiology of heart failure and cardiorenal\\u000a interaction. Drugs interfering in the RAAS form the pillars in treatment of heart failure and cardiorenal syndrome. Although\\u000a RAAS inhibitors improve prognosis, heart failure–associated morbidity and mortality remain high, especially in the presence\\u000a of kidney disease. The effect of RAAS blockade may be limited due

  3. Complement C3c as a Biomarker in Heart Failure

    PubMed Central

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

    2013-01-01

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

  4. Review: Heart failure with preserved ejection fraction in African Americans.

    PubMed

    Shah, Sachil

    2012-01-01

    Heart failure (HF) affects 5,700 000 people in the United States, with heart failure with preserved ejection fraction (HFPEF) being responsible for between 30%-50% of acute admissions. Epidemiological studies and HF registries have found HFPEF patients to be older, hypertensive and to have a history of atrial fibrillation. These findings, however, may not be fully applicable to African Americans, as they have been poorly studied making up only a minority of the test subjects. This review article is intended to discuss the pathophysiology and epidemiology of HFPEF within African Americans, highlight the differences compared to Caucasian populations and review current treatment guidelines. Studies looking at African Americans in particular have shown them to be younger, female and have worse diastolic dysfunction compared to Caucasian populations. African Americans also have been shown to have a worse mortality outcome especially in patients without coronary artery disease. The treatment of HFPEF is primarily symptomatic with no survival benefit seen in randomized controlled trials. Mechanisms postulated for the worse prognosis in African Americans with HFPEF include: greater incidence of hypertension and diastolic dysfunction, undefined race-driven genetic predispositions or relative resistance to medications that treat HF in general. The biological predispositions may also be compounded by inequality of healthcare access; something still felt to exist today. Prospective studies and randomized controlled trials need to be conducted with particular emphasis on African American populations to fully elucidate this disease and to formulate race specific treatment outcomes for the future. PMID:23140073

  5. The Emerging Epidemic of Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Oktay, A. Af?in; Rich, Jonathan D.

    2013-01-01

    Heart failure with preserved ejection fraction (HFpEF), which currently represents approximately 50 % of heart failure (HF) cases, is common and associated with high morbidity and mortality. Understanding the epidemiology of HFpEF has been difficult due to the challenges in HFpEF diagnosis and the heterogeneous etiologies and pathophysiologies that underlie HFpEF. Nevertheless, several high-quality epidemiology and observational registry studies of HFpEF demonstrate that an increasing prevalence of HFpEF in both the outpatient and inpatient settings, coupled with a lack of evidence-based effective treatments for HFpEF, is resulting in an emerging epidemic of HFpEF. In this review, we discuss the emerging HFpEF epidemic, focusing on: (1) reasons for the rising prevalence of HFpEF; (2) the abnormalities in cardiac structure and function that dictate the transition from risk factors to HFpEF; (3) novel HFpEF mechanisms that may underlie the increase in HFpEF prevalence; (4) prognosis of HFpEF; and (5) risk prediction in HFpEF. We conclude with 10 unanswered questions on HFpEF epidemiology that will be important areas for future investigation. PMID:24078336

  6. Management of chronic heart failure in the older population

    PubMed Central

    Azad, Nahid; Lemay, Genevieve

    2014-01-01

    Chronic heart failure (CHF) is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdisciplinary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic insight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. PMID:25593582

  7. Metabolomic Fingerprint of Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Zordoky, Beshay N.; Sung, Miranda M.; Ezekowitz, Justin; Mandal, Rupasri; Han, Beomsoo; Bjorndahl, Trent C.; Bouatra, Souhaila; Anderson, Todd; Oudit, Gavin Y.; Wishart, David S.; Dyck, Jason R. B.

    2015-01-01

    Background Heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly recognized as an important clinical entity. Preclinical studies have shown differences in the pathophysiology between HFpEF and HF with reduced ejection fraction (HFrEF). Therefore, we hypothesized that a systematic metabolomic analysis would reveal a novel metabolomic fingerprint of HFpEF that will help understand its pathophysiology and assist in establishing new biomarkers for its diagnosis. Methods and Results Ambulatory patients with clinical diagnosis of HFpEF (n = 24), HFrEF (n = 20), and age-matched non-HF controls (n = 38) were selected for metabolomic analysis as part of the Alberta HEART (Heart Failure Etiology and Analysis Research Team) project. 181 serum metabolites were quantified by LC-MS/MS and 1H-NMR spectroscopy. Compared to non-HF control, HFpEF patients demonstrated higher serum concentrations of acylcarnitines, carnitine, creatinine, betaine, and amino acids; and lower levels of phosphatidylcholines, lysophosphatidylcholines, and sphingomyelins. Medium and long-chain acylcarnitines and ketone bodies were higher in HFpEF than HFrEF patients. Using logistic regression, two panels of metabolites were identified that can separate HFpEF patients from both non-HF controls and HFrEF patients with area under the receiver operating characteristic (ROC) curves of 0.942 and 0.981, respectively. Conclusions The metabolomics approach employed in this study identified a unique metabolomic fingerprint of HFpEF that is distinct from that of HFrEF. This metabolomic fingerprint has been utilized to identify two novel panels of metabolites that can separate HFpEF patients from both non-HF controls and HFrEF patients. Clinical Trial Registration ClinicalTrials.gov NCT02052804 PMID:26010610

  8. AgNORs in the myocardium in ischaemic heart disease complicated by heart failure: a postmortem study.

    PubMed Central

    Mamaev, N N; Gudkova, A Y; Amineva, K K

    1998-01-01

    AIM: To evaluate the interphase ribosomal RNA cistron activity of cardiomyocytes in case with ischaemic heart disease complicated by heart failure. METHODS: Nucleoli were investigated in postmortem myocardium samples from 31 cases with ischaemic heart disease (mean (SEM), 57.4 (6.5) years) with or without severe heart failure (18 and 13, respectively) and from eight healthy people who died in accidents (mean (SEM) 25.3 (4.0) years). Myocardium obtained within one hour after death was frozen in liquid nitrogen. Silver staining for nucleolar organiser regions (AgNOR) was performed with a standard procedure and the mean score obtained. On the basis of these data, the average number of AgNORs per nucleus was determined. The Student's t test was used to compare groups. RESULTS: Compared with controls, the mean numbers of AgNORs per nucleus in cardiomyocytes from ischaemic heart disease patients not complicated with severe heart failure were higher (8.0 v 9.9; p < 0.05), but cases with severe heart failure had a progressive decrease in cardiomyocyte AgNORs. A difference in AgNOR numbers between cases with different ischaemic heart disease courses was found when cases with the same New York Heart Association (NYHA) functional stage III of heart failure were studied. CONCLUSIONS: The significant decrease of AgNORs in cardiomyocytes from cases with severe ischaemic heart disease complicated by heart failure seems to be connected with cardiomyocyte adaptation (a variant of hibernation) to a diminished circulation that, hypothetically, may affect the level of ribosomal RNA synthesis. PMID:9713594

  9. Modifications of the Skeletal Muscle Ryanodine Receptor Type 1 and Exercise Intolerance in Heart Failure

    PubMed Central

    Rullman, Eric; Andersson, Daniel C; Melin, Michael; Reiken, Steven; Mancini, Donna M.; Marks, Andrew R; Lund, Lars H.; Gustafsson, Thomas

    2015-01-01

    Background In experimental heart failure animal models, remodeling of skeletal and cardiac muscle ryanodine receptors (RyR), including phosphorylation, S-nitrosylation and oxidation, have been reported to contribute to pathological Ca2+ release, impaired muscle function and fatigue. However, it is not known if similar remodeling of RyR1 in skeletal muscle occurs in patients with heart failure, and if this is associated with impairment of physical activity. Methods We studied 8 sedentary patients with New York Heart Association (NYHA) class III heart failure and 7 age-matched healthy but sedentary controls. All heart failure patients had NYHA class III and peak VO2, echocardiography and NT-proBNP data consistent with moderate to severe heart failure. The age-matched controls were allowed hypertension but sub-clinical heart failure was ruled out by normal peak VO2, echocardiography and NT-proBNP. Results The exercise capacity (VO2max) differed almost two-fold between heart failure patients and age-matched controls. Compared to controls, skeletal muscle RyR1 in heart failure patients was excessively phosphorylated, S-nitrosylated and oxidized. Furthermore, RyR1 from heart failure patients was depleted of its stabilizing protein FK506 binding protein 12 (FKBP12 or calstabin1). Conclusions For the first time, we show that skeletal muscle RyR1 from human heart failure is post-translationally modified, which corroborates previous data from experimental animal studies. This indicates pathological Ca2+ release as a potential mechanism behind skeletal muscle weakness and impaired exercise tolerance in patients with heart failure and suggests a potential target for pharmacological intervention. PMID:23953820

  10. Water and sodium in heart failure: a spotlight on congestion.

    PubMed

    Parrinello, Gaspare; Greene, Stephen J; Torres, Daniele; Alderman, Michael; Bonventre, Joseph Vincent; Di Pasquale, Pietro; Gargani, Luna; Nohria, Anju; Fonarow, Gregg C; Vaduganathan, Muthiah; Butler, Javed; Paterna, Salvatore; Stevenson, Lynne Warner; Gheorghiade, Mihai

    2015-01-01

    Despite all available therapies, the rates of hospitalization and death from heart failure (HF) remain unacceptably high. The most common reasons for hospital admission are symptoms related to congestion. During hospitalization, most patients respond well to standard therapy and are discharged with significantly improved symptoms. Post-discharge, many patients receive diligent and frequent follow-up. However, rehospitalization rates remain high. One potential explanation is a persistent failure by clinicians to adequately manage congestion in the outpatient setting. The failure to successfully manage these patients post-discharge may represent an unmet need to improve the way congestion is both recognized and treated. A primary aim of future HF management may be to improve clinical surveillance to prevent and manage chronic fluid overload while simultaneously maximizing the use of evidence-based therapies with proven long-term benefit. Improvement in cardiac function is the ultimate goal and maintenance of a "dry" clinical profile is important to prevent hospital admission and improve prognosis. This paper focuses on methods for monitoring congestion, and strategies for water and sodium management in the context of the complex interplay between the cardiac and renal systems. A rationale for improving recognition and treatment of congestion is also proposed. PMID:24942806

  11. DuraHeart magnetically levitated centrifugal left ventricular assist system for advanced heart failure patients.

    PubMed

    Morshuis, Michiel; Schoenbrodt, Michael; Nojiri, Chisato; Roefe, Daniela; Schulte-Eistrup, Sebastian; Boergermann, Jochen; Gummert, Jan F; Arusoglu, Latif

    2010-03-01

    The implantable left ventricular assist system (LVAS) using pulsatile pump technology has become an established therapeutic option for advanced heart failure patients. However, there have been technological limitations in some older designs, including a high incidence of infection and mechanical failures associated with moving parts, and the large size of both implantable pump and percutaneous cable. A smaller rotary blood pump emerged as a possible alternative to a large pulsatile pump to overcome some of these limitations. The technological advancement that defines the third-generation LVAS was the elimination of all mechanical contacts between the impeller and the drive mechanism. The DuraHeart LVAS is the world's first third-generation implantable LVAS to obtain market approval (CE-mark), which combines a centrifugal pump and active magnetic levitation. The initial clinical experience with the DuraHeart LVAS in Europe demonstrated that it provided significantly improved survival (85% at 6 months and 79% at 1 year), reduced adverse event rates and long-term device reliability (freedom from device replacement at 2 years: 96 +/- 3%) over pulsatile LVAS. PMID:20214423

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

    PubMed Central

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

    2010-01-01

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

  13. Heart failure with preserved ejection fraction in women: the Dutch Queen of Hearts program.

    PubMed

    den Ruijter, H; Pasterkamp, G; Rutten, F H; Lam, C S P; Chi, C; Tan, K H; van Zonneveld, A J; Spaanderman, M; de Kleijn, D P V

    2015-02-01

    Heart failure (HF) poses a heavy burden on patients, their families and society. The syndrome of HF comes in two types: with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The latter is on the increase and predominantly present in women, especially the older ones. There is an urgent need for mortality-reducing drugs in HFpEF, a disease affecting around 5 % of those aged 65 years and over. HFpEF develops in patients with risk factors and comorbidities such as obesity, hypertension, diabetes, COPD, but also preeclampsia. These conditions are likely to drive microvascular disease with involvement of the coronary microvasculature, which may eventually evolve into HFpEF. Currently, the diagnosis of HFPEF relies mainly on echocardiography. There are no biomarkers that can help diagnose female microvascular disease or facilitate the diagnosis of (early stages of) HFpEF. Recently a Dutch consortium was initiated, Queen of Hearts, with support from the Netherlands Heart Foundation, with the aim to discover and validate biomarkers for diastolic dysfunction and HFpEF in women. These biomarkers come from innovative blood-derived sources such as extracellular vesicles and circulating cells. Within the Queen of Hearts consortium, we will pursue female biomarkers that have the potential for further evolution in assays with point of care capabilities. As a spin-off, the consortium will gain knowledge on gender-specific pathology of HFpEF, possibly opening up novel treatment options. PMID:25614387

  14. Progress toward genetic tailoring of heart failure therapy

    PubMed Central

    Lillvis, John H; Lanfear, David E

    2010-01-01

    Heart failure (HF) is a modern epidemic and a heterogeneous disorder with many therapeutic options. While the average response to each individual treatment is favorable, significant interindividual variation exists in the response to HF therapeutics. As a result, the optimal regimen for an individual patient or subgroup of patients is elusive, with current treatment being mainly empirical. Pharmacogenetic customization of HF therapy may provide an important opportunity to improve the treatment of HF. Common genetic variations exist in genes related to most classes of HF drugs, many of which have known functional consequences for or established relationships with drug response. This review summarizes the current understanding of the pharmacogenetics of HF therapeutics, including angiotensin-converting enzyme inhibitors and ?-blockers, and focuses on recent advances and medium-term expectations for the field. PMID:20521218

  15. Decision-making under uncertainty in advanced heart failure.

    PubMed

    Meyer, Theo E; Kiernan, Michael S; McManus, David D; Shih, Jeffrey

    2014-06-01

    The challenges managing advanced heart failure (AHF) are mounting, not least by the presence of multiple coexisting comorbidities, the lack of evidence of clinical benefit in many subsets of AHF, but also surrounding the uncertainty of the both short-term and long-term prognosis. Clinicians are highly variable in their interpretation of clinical data and are prone to considerable bias when it comes to treatment recommendations. This manuscript provides a critical appraisal of the uncertainties as it pertains to the natural history of AHF and management decisions. First, clinical examples are explored to illustrate common errors of judgment due to unrecognized biases. Secondly, a tool is provided that promulgates a structured approach to key data elements in an attempt to create a sound platform for decision-making. PMID:24691659

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

    PubMed

    von Haehling, S; Anker, S D

    2014-04-01

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

  17. Treatment Strategies for the Prevention of Heart Failure

    PubMed Central

    Grodin, Justin L.; Tang, W.H. Wilson

    2013-01-01

    With the astounding morbidity and mortality associated with heart failure (HF), preventive approaches have been explored. Controlling hypertension to prevent HF is well-established, especially with sodium restriction and thiazide-based antihypertensive therapies showing potential advantages. Control of dyslipidemia with aggressive statin therapy is particularly beneficial in preventing HF in the setting of acute coronary syndrome. The HOPE study also established the benefit of ACE inhibitors in the prevention of HF in high-risk subjects. Meanwhile old data supporting tight glycemic control in preventing HF have not been confirmed, suggesting the complexity of diabetic cardiomyopathy. Avoiding tobacco use and other known cardiotoxins are likely helpful. While there has been substantial development in identifying biomarkers predicting future development of HF, therapeutic interdiction guided by biomarker levels have yet to be established even though it offers hope in modulating the natural history of the development of HF in at risk individuals. PMID:24014140

  18. Obesity and the obesity paradox in heart failure.

    PubMed

    Gupta, Pritha P; Fonarow, Gregg C; Horwich, Tamara B

    2015-02-01

    Obesity has reached epidemic proportions in the general population and is associated with an increased risk for the development of new-onset heart failure (HF). However, in acute and chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared with normal weight. This phenomenon has been termed the "obesity paradox" in HF. The majority of data pertaining to the obesity paradox identifies obesity with body mass index; however, the reliability of this method has been questioned. Newer studies have explored the use of other measures of body fat and body composition, including waist circumference, waist-to-hip ratio, skinfold thickness, and bioelectrical impedance analysis of body composition. The relationship between the obesity paradox and cardiorespiratory fitness in HF is also discussed in this review, and we explore the various potential explanations for the obesity paradox and summarize the current evidence and guidelines for intentional weight loss treatments for HF in the obese population. PMID:25661554

  19. [Histological and ultrastructural characteristics of myocardium in heart failure].

    PubMed

    Tsyplenkova, V G

    2013-01-01

    Endomyocardial biopsies performed in patients with various forms of cardiomyopathies (CMP) and chronic myocarditis in the presence of heart failure identified changes indicative of reduction of functioning cardiomyocytes (CMC) at the account of their destruction, dedifferentiation and inefficient hypertrophy". Energy apparatus of CMC was represented by large masses of destructed small mitochondria. Myofibrils were driven to periphery of CMC and appeared atrophic. Products of catabolism (lipofuscin, autophagous vacuoles, protein conglomerates) were accumulated in CMC. This led to impairment of CMC main function - to exert contraction. Reduction of number of capillary vessels per unit of myocardial cross-section area was also found. Discussion of problems of morphogenesis of the observed changes and of pathogenetic treatment is presented in the article. PMID:24090387

  20. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives

    PubMed Central

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

    2013-01-01

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

  1. Right heart failure post left ventricular assist device implantation

    PubMed Central

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

    2014-01-01

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

  2. Preprocedural Imaging for Patients with Atrial Fibrillation and Heart Failure

    PubMed Central

    Thai, Wai-ee; Wai, Bryan; Truong, Quynh A.

    2012-01-01

    Various electrophysiological procedures and device implantation has been shown to improve morbidity and mortality in patients with atrial fibrillation (AF) and patients with heart failure (HF). Non-invasive cardiac imaging is used extensively in the pre-procedural patient selection and for procedural guidance. In this review, we will discuss the application of pre-procedural cardiac imaging in patients with AF prior to pulmonary vein and left atrial ablation as well as insertion of left atrial occluder device. We also discuss the role of non-invasive cardiac imaging in the selection of appropriate HF patients for device therapy as well as their use in guiding implantation of biventricular pacemaker for cardiac resynchronization therapy by assessing left ventricular ejection fraction, coronary venous anatomy, mechanical dyssynchrony and myocardial scar. We describe new research associated with pre-procedural imaging in these patient cohorts. PMID:22828754

  3. Heart failure with preserved ejection fraction: refocusing on diastole.

    PubMed

    Abbate, Antonio; Arena, Ross; Abouzaki, Nayef; Van Tassell, Benjamin W; Canada, Justin; Shah, Keyur; Biondi-Zoccai, Giuseppe; Voelkel, Norbert F

    2015-01-20

    Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of exercise intolerance and/or congestion, in the presence of a left ventricular (LV) ejection fraction within the normal limits (i.e. LVEF>50%). Determining the presence of impaired LV relaxation and/or filling (diastolic dysfunction) in HFpEF is needed to pragmatically to distinguish it from other cardiac and non-cardiac conditions where symptoms are not due to HF. There are multiple mechanisms for diastolic dysfunction ranging from structural abnormalities to functional derangements in HFpEF yet tailored therapies are lacking. Treatments proven effective in HF with systolic dysfunction have failed to show significant benefit in patients with HFpEF, which prognosis remains poor. This review will discuss the challenges inherent to the use of diagnostic criteria for HFpEF, differential diagnosis, prognostic evaluation, and treatment, highlighting the need for more research in this field. PMID:25465302

  4. Management strategies for heart failure with preserved ejection fraction.

    PubMed

    Vazir, Ali; Solomon, Scott D

    2014-10-01

    The management of heart failure with preserved ejection fraction (HFpEF) is challenging and requires an accurate diagnosis. Although currently there is no convincing therapy that prolongs survival in patients with HFpEF, treatment of fluid retention and of comorbidities, such as hypertension, myocardial ischemia, and atrial fibrillation, may improve symptoms and quality of life. Future outcome trials testing the efficacy of promising new agents will have better characterization of patient phenotype to maximize the potential response to therapies. This article provides current management strategies available for HFpEF, gives an overview of previous trials that have failed to prove the benefit of therapies to improve outcomes, and highlights promising novel therapies. PMID:25217434

  5. Current perspectives on hydralazine and nitrate therapies in heart failure.

    PubMed

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

    2014-10-01

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

  6. Anesthesia and congestive heart failure: pathology, medical, and surgical management.

    PubMed

    Armstrong, Christopher S; Hoover, Jason M; Fox, Charles J; Field, Aaron M; Richards, Todd A; Islam, Sameer R; Kaye, Alan D

    2006-06-01

    Congestive heart failure (CHF) is increasingly being recognized as a health problem in the United States. It is estimated that the lifetime risk for CHF is 1 in 5. The clinical anesthesiologist can expect to see several cases involving patients suffering from CHF. Because of the danger associated with surgery in a patient with CHF, a thorough knowledge of the disorder and the potential effects on the delivery of anesthetics must be considered. In addition, knowledge of the disease process and its manifestations is required for smooth guidance of the patient through the perioperative period. The understanding of current pharmacotherapies, surgical procedures and their implications related to interactions with anesthetics are all discussed. PMID:17094522

  7. Computerized practice guidelines for heart failure management: the HeartMan system.

    PubMed Central

    Margolis, A.; Bray, B. E.; Gilbert, E. M.; Warner, H. R.

    1995-01-01

    In this paper we discuss the initial stages of development and evaluation of the HeartMan system, a set of computerized practice guidelines for heart failure management. The concept of computerized guidelines as a hybrid of expert systems and practice guidelines methodologies and techniques is proposed. We show the results of the initial evaluation of the system, which are very promising, although the sample size is small, and the study is retrospective: Of 177 messages, 90% were considered appropriate, of which 97.5% would have been followed. Eight percent of the messages were classified as neutral, and 2% classified as inappropriate. The errors were correctable by changing the logic. The potential technical and sociological barriers to the complete development and clinical use of the system are discussed. PMID:8563274

  8. Reduced Regional Brain Cortical Thickness in Patients with Heart Failure

    PubMed Central

    Kumar, Rajesh; Yadav, Santosh K.; Palomares, Jose A.; Park, Bumhee; Joshi, Shantanu H.; Ogren, Jennifer A.; Macey, Paul M.; Fonarow, Gregg C.; Harper, Ronald M.; Woo, Mary A.

    2015-01-01

    Aims Autonomic, cognitive, and neuropsychologic deficits appear in heart failure (HF) subjects, and these compromised functions depend on cerebral cortex integrity in addition to that of subcortical and brainstem sites. Impaired autoregulation, low cardiac output, sleep-disordered-breathing, hypertension, and diabetic conditions in HF offer considerable potential to affect cortical areas by loss of neurons and glia, which would be expressed as reduced cortical thicknesses. However, except for gross descriptions of cortical volume loss/injury, regional cortical thickness integrity in HF is unknown. Our goal was to assess regional cortical thicknesses across the brain in HF, compared to control subjects. Methods and Results We examined localized cortical thicknesses in 35 HF and 61 control subjects with high-resolution T1-weighted images (3.0-Tesla MRI) using FreeSurfer software, and assessed group differences with analysis-of-covariance (covariates; age, gender; p<0.05; FDR). Significantly-reduced cortical thicknesses appeared in HF over controls in multiple areas, including the frontal, parietal, temporal, and occipital lobes, more markedly on the left side, within areas that control autonomic, cognitive, affective, language, and visual functions. Conclusion Heart failure subjects show reduced regional cortical thicknesses in sites that control autonomic, cognitive, affective, language, and visual functions that are deficient in the condition. The findings suggest chronic tissue alterations, with regional changes reflecting loss of neurons and glia, and presumably are related to earlier-described axonal changes. The pathological mechanisms contributing to reduced cortical thicknesses likely include hypoxia/ischemia, accompanying impaired cerebral perfusion from reduced cardiac output and sleep-disordered-breathing and other comorbidities in HF. PMID:25962164

  9. Disease management: remote monitoring in heart failure patients with implantable defibrillators, resynchronization devices, and haemodynamic monitors.

    PubMed

    Abraham, William T

    2013-06-01

    Heart failure represents a major public health concern, associated with high rates of morbidity and mortality. A particular focus of contemporary heart failure management is reduction of hospital admission and readmission rates. While optimal medical therapy favourably impacts the natural history of the disease, devices such as cardiac resynchronization therapy devices and implantable cardioverter defibrillators have added incremental value in improving heart failure outcomes. These devices also enable remote patient monitoring via device-based diagnostics. Device-based measurement of physiological parameters, such as intrathoracic impedance and heart rate variability, provide a means to assess risk of worsening heart failure and the possibility of future hospitalization. Beyond this capability, implantable haemodynamic monitors have the potential to direct day-to-day management of heart failure patients to significantly reduce hospitalization rates. The use of a pulmonary artery pressure measurement system has been shown to significantly reduce the risk of heart failure hospitalization in a large randomized controlled study, the CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients (CHAMPION) trial. Observations from a pilot study also support the potential use of a left atrial pressure monitoring system and physician-directed patient self-management paradigm; these observations are under further investigation in the ongoing LAPTOP-HF trial. All these devices depend upon high-intensity remote monitoring for successful detection of parameter deviations and for directing and following therapy. PMID:23737229

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

    Microsoft Academic Search

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

    2000-01-01

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

  11. Sex-related differences in patients' responses to heart failure therapy

    Microsoft Academic Search

    Alon Barsheshet; Andrew Brenyo; Ilan Goldenberg; Arthur J. Moss

    2012-01-01

    Men and women with heart failure display important differences in clinical characteristics that might affect their responses to pharmacological and nonpharmacological therapies. In women, heart failure is associated with a higher frequency of hypertension, nonischemic cardiomyopathy and left bundle branch block than in men. Subgroup analyses of data from randomized clinical trials suggest that these differences result in a differential

  12. Incidence and aetiology of heart failure; a population-based study

    Microsoft Academic Search

    M. R. Cowie; D. A. Wood; A. J. S. Coats; S. G. Thompson; P. A. Poole-Wilson; V. Suresh; G. C. Sutton

    1999-01-01

    Aims To determine the incidence and aetiology of heart failure in the general population. Methods and Results New cases of heart failure were identified from a population of 151 000 served by 82 general practitioners in Hillingdon, West London through surveil- lance of acute hospital admissions and through a rapid access clinic to which general practitioners referred all new cases

  13. Clinical predictors of heart failure in patients with first acute myocardial infarction

    Microsoft Academic Search

    Abbas S. Ali; Benjamin A. Rybicki; Mohsin Alam; Nancy Wulbrecht; Karen Richer-Cornish; Fareed Khaja; Hani N. Sabbah; Sidney Goldstein

    1999-01-01

    Background The occurrence of heart failure associated with an acute myocardial infarction has a strong adverse effect on long-term morbidity and mortality. The prediction and prevention of heart failure could influence these adverse events. Methods and Results We studied 483 consecutive patients who had their first acute myocardial infarction and who were admitted within 24 hours of the onset of

  14. Chronic Baroreceptor Activation Enhances Survival in Dogs With Pacing-Induced Heart Failure

    Microsoft Academic Search

    Irving H. Zucker; Johnnie F. Hackley; Kurtis G. Cornish; Bradley A. Hiser; Nicholas R. Anderson; Robert Kieval; Eric D. Irwin; David J. Serdar; Jacob D. Peuler; Martin A. Rossing

    2007-01-01

    Much of the current pharmacological therapy for chronic heart failure targets neurohormonal activation. In spite of recent advances in drug therapy, the mortality rate for chronic heart failure remains high. Activation of the carotid baroreceptor (BR) reduces sympathetic outflow and augments vagal tone. We investigated the effect of chronic activation of the carotid BR on hemodynamic and neurohormonal parameters and

  15. A RAT MODEL OF HEART FAILURE INDUCED BY ISOPROTERENOL AND A HIGH SALT DIET

    EPA Science Inventory

    Rat models of heart failure (HF) show varied pathology and time to disease outcome, dependent on induction method. We found that subchronic (4wk) isoproterenol (ISO) infusion in Spontaneously Hypertensive Heart Failure (SHHF) rats caused cardiac injury with minimal hypertrophy. O...

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

    Microsoft Academic Search

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

    1997-01-01

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

  17. Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995

    Microsoft Academic Search

    Gail A. Haldeman; Janet B. Croft; Wayne H. Giles; Ali Rashidee

    1999-01-01

    Background In the United States, heart failure has emerged as the leading first-listed diagnosis among hospitalized older adults. Methods The number and prevalence of hospitalizations, procedure use, and discharge outcomes for men and women aged ?35 years hospitalized with heart failure were estimated from National Hospital Discharge Survey data for the years 1985 through 1995. Results In 10 years, the

  18. To be on sick-leave due to heart failure: a qualitative perspective.

    PubMed

    Lindbäck, Camilla; Nordgren, Lena

    2014-10-24

    Abstract Purpose: The aim of the present study was to explore and describe meanings of being on sick leave due to heart failure. Methods: The study was conducted in Sweden during 2011-2012. Five men and one woman, aged 46 to 62, were interviewed. A reflective life-world research approach based on phenomenological philosophy was used. The result of the analysis is presented in three themes. Results: To be on sick leave due to heart failure implies a life situation characterized by anxiety, insecurity and uncertainty. When rehabilitation professionals do not take on their professional responsibility, sick listed people with heart failure perceive they are dismissed and abandoned. If rehabilitation professionals take on their professional responsibility it can be experienced as supportive. Conclusions: People who are on sick leave due to heart failure are abandoned by rehabilitation professionals and they lack opportunities to participate in their own sick leave/rehabilitation processes. Rehabilitation professionals need to take more responsibility and allow the patients to participate by connecting and recognizing patients as equal human beings. The present results can be used by rehabilitation professionals to reflect on and discuss the needs of people on sick leave due to heart failure. Implications for Rehabilitation Heart failure is a chronic condition implying a complicated life-situation. People with heart failure experience abandonment by rehabilitation professionals and lack participation in their own rehabilitation process. In order to support people on sick leave due to heart failure collaboration and coordination between rehabilitation professionals are needed. PMID:25342565

  19. Effects of lisinopril in patients with heart failure and chronic atrial fibrillation

    Microsoft Academic Search

    Maarten P. Van Den Berg; Harry JGM. Cruns; Dirk J. Van Veldhuisen; Nico Griep; Pieter J. De Kam; K. I. Lie

    1995-01-01

    Although atrial fibrillation is common in patients with heart failure, patients with atrial fibrillation are often excluded from congestive heart failure trials or are not analyzed separately. Consequently, while the effect of angiotensin-converting enzyme inhibitors in patients with sinus rhythm is well established, the effect on patients with atrial fibrillation is unknown. The authors hypothesized that these agents might be

  20. Soluble Epoxide Hydrolase Inhibitors and Heart Failure Jun-Yan Liu,3

    E-print Network

    Hammock, Bruce D.

    REVIEW Soluble Epoxide Hydrolase Inhibitors and Heart Failure Hong Qiu,1 Ning Li,1 Jun-Yan Liu,3; Epoxyeicosatrienoic acids (EETs); Heart failure; Soluble epoxide hydrolase inhibitors. Correspondence Nipavan to the increased bioavailability of endogenous EETs and other epoxylipids, and several potent sEH inhibitors have

  1. A systematic review of randomized trials of disease management programs in heart failure

    Microsoft Academic Search

    Finlay A McAlister; Fiona M. E Lawson; Koon K Teo; Paul W Armstrong

    2001-01-01

    PURPOSE: Disease management programs are often advocated for the care of patients with chronic disease. This systematic review was conducted to determine whether these programs improve outcomes for patients with heart failure.METHODS: Randomized clinical trials of disease management programs in patients with heart failure were identified by searching Medline 1966 to 1999, Embase 1980 to 1998, Cinahl 1982 to 1999,

  2. Adverse effects of ?-Blocker therapy for patients with heart failure: A quantitative overview of randomized trials

    Microsoft Academic Search

    Dennis T. Ko; Patricia R. Hebert; Christopher S. Coffey

    2004-01-01

    Background: -Blockers substantially improve sur- vival in patients with chronic heart failure (HF) with left ventricular systolic dysfunction, but concerns about car- diovascular adverse effects may deter physicians from pre- scribing this therapy. We performed an overview of ran- domized-blocker trials in patients with HF to quantify the risks of these adverse effects. Methods: Heart failure trials of -blockers were

  3. Congestive Heart Failure and Virchow’s Triad: A Neglected Association

    Microsoft Academic Search

    Michael D. Sosin; Gurbir Bhatia; Russell C. Davis; Gregory Y. H. Lip

    2003-01-01

    Summary Congestive heart failure (CHF) is associated with significant morbidity and mortality. In particular, patients with CHF have a high risk of venous thromboembolism and stroke, as well as recurrent ischaemia and infarction. However, in large heart failure trials, such thrombotic complications have often been regarded as less important end points than total mortality or readmission to hospital. In addition,

  4. Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial

    Microsoft Academic Search

    Mary D. Naylor; Dorothy A. Brooten; Roberta L. Campbell; Greg Maislin; Kathleen M. McCauley; J. Sanford Schwartz

    2004-01-01

    OBJECTIVES: To examine the effectiveness of a transi- tional care intervention delivered by advanced practice nurses (APNs) to elders hospitalized with heart failure. DESIGN: Randomized, controlled trial with follow-up through 52 weeks postindex hospital discharge. SETTING: Six Philadelphia academic and community hospitals. PARTICIPANTS: Two hundred thirty-nine eligible pa- tients were aged 65 and older and hospitalized with heart failure. INTERVENTION:

  5. Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure

    Microsoft Academic Search

    Jacky Austin; Robert Williams; Linda Ross; Laurie Moseley; Stephen Hutchison

    Background: Heart failure, a condition predominantly affecting the elderly, represents an ever-increasing clinical and financial burden for the NHS. Cardiac rehabilitation, a service that incorporates patient education, exercise training and lifestyle modification, requires further evaluation in heart failure management. Aim: The aim of this study was to determine whether a cardiac rehabilitation programme improved on the outcomes of an outpatient

  6. Does gender bias exist in the medical management of heart failure?

    Microsoft Academic Search

    Kishore J. Harjai; Eduardo Nunez; J. Stewart Humphrey; Tansel Turgut; Mehul Shah; Jeff Newman

    2000-01-01

    Introduction: The purpose of this study was to ascertain the presence of gender bias in the medical management of heart failure, and to assess its association with the specialty of the caregiver physician. Methods: In 309 patients with documented left ventricular systolic dysfunction (ejection fraction <45%) and at least one hospitalization for heart failure, we assessed the frequency of use

  7. Research Paper: Queuing Theory to Guide the Implementation of a Heart Failure Inpatient Registry Program

    Microsoft Academic Search

    Adrian H. Zai; Kit M. Farr; Richard W. Grant; Elizabeth Mort; Timothy G. Ferris; Henry C. Chueh

    2009-01-01

    ObjectiveThe authors previously implemented an electronic heart failure registry at a large academic hospital to identify heart failure patients and to connect these patients with appropriate discharge services. Despite significant improvements in patient identification and connection rates, time to connection remained high, with an average delay of 3.2 days from the time patients were admitted to the time connections were

  8. Quality and availability of consumer information on heart failure in Australia

    Microsoft Academic Search

    Agnes I Vitry; Susan M Phillips; Susan J Semple

    2008-01-01

    BACKGROUND: Provision of consumer information and patient education are considered an essential part of chronic disease management programmes developed for patients with heart failure. This study aimed to review the quality and availability of consumer information materials for people with heart failure in Australia. METHODS: The availability of consumer information was assessed through a questionnaire-based survey of the major organisations

  9. Readmissions and the quality of care in patients hospitalized with heart failure

    Microsoft Academic Search

    JEAN-CHRISTOPHE LUTHI; MARY JO LUND; LAURA SAMPIETRO-COLOM; DAVID G. KLEINBAUM; DAVID J. BALLARD; WILLIAM M. MCCLELLAN

    2003-01-01

    Objectives. Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmission. This study examined the relationship between ACEI use at discharge and readmission among patients with heart failure due to LVSD.

  10. Which patients with heart failure respond best to multidisciplinary disease management?

    Microsoft Academic Search

    Barbara Riegel; Beverly Carlson; Dale Glaser; Peter Hoagland

    2000-01-01

    Background: Multidisciplinary disease management approaches have been shown to decrease resource use in selected samples of patients with heart failure. We remain uncertain regarding the effectiveness of this approach in a general heart failure population and who can be expected to benefit most. The purpose of this study was to test the effectiveness of a multidisciplinary disease management intervention in

  11. Selegiline attenuates cardiac oxidative stress and apoptosis in heart failure: association with improvement of cardiac function

    Microsoft Academic Search

    Fuzhong Qin; Junya Shite; Weike Mao; Chang-seng Liang

    2003-01-01

    We have shown recently that selegiline exerts a cardiac neuroprotective effect in chronic heart failure. Since selegiline has an antioxidant antiapoptotic effect, we proposed to determine whether selegiline attenuates cardiac oxidative stress and myocyte apoptosis in chronic heart failure by modulating Bcl-2 and Bax protein expression, and whether the effects are associated with the improvement of cardiac function. Rabbits with

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

    E-print Network

    Street, Nick

    models with lower levels of error in predicting hospital readmission and mortality. Knowledge discoveryPredicting Outcomes of Hospitalization for Heart Failure Using Logistic Regression and Knowledge and cost of treatment than most other hospitalized diseases. The prevalence of heart failure has exceeded 4

  13. BET Bromodomains Mediate Transcriptional Pause Release in Heart Failure

    PubMed Central

    Anand, Priti; Brown, Jonathan D.; Lin, Charles Y.; Qi, Jun; Zhang, Rongli; Artero, Pedro Calderon; Alaiti, M. Amer; Bullard, Jace; Alazem, Kareem; Margulies, Kenneth B.; Cappola, Thomas P.; Lemieux, Madeleine; Plutzky, Jorge; Bradner, James E.; Haldar, Saptarsi M.

    2014-01-01

    SUMMARY Heart failure (HF) is driven by the interplay between master regulatory transcription factors and dynamic alterations in chromatin structure. While pathologic gene transactivation in this context is known to be associated with recruitment of histone acetyl-transferases and local chromatin hyperacetylation, the role of epigenetic reader proteins in cardiac biology is unknown. We therefore undertook a first study of acetyl-lysine reader proteins, or bromodomains, in HF. Using a chemical genetic approach, we establish a central role for BET-family bromodomain proteins in gene control during HF pathogenesis. BET inhibition potently suppresses cardiomyocyte hypertrophy in vitro and pathologic cardiac remodeling in vivo. Integrative transcriptional and epigenomic analyses reveal that BET proteins function mechanistically as pause-release factors critical to activation of canonical master regulators and effectors that are central to HF pathogenesis and relevant to the pathobiology of failing human hearts. This study implicates epigenetic readers in cardiac biology and identifies BET co-activator proteins as therapeutic targets in HF. PMID:23911322

  14. Effective Strategies in Reducing Rehospitalizations in Patients With Heart Failure.

    PubMed

    Al-Khazaali, Ali; Arora, Rohit; Helu, Hanan K

    2014-06-01

    Aging of the population and prolongation of the lives of patients with heart failure (HF) by advanced therapeutic innovations has led to an elevating number of patients who live with HF. The American Heart Association estimated that 5.1 million Americans were affected with HF in 2013 and approximately 23 million individuals were affected worldwide. Despite the improved management approaches, the mortality rate is still high; less than half of the patients with HF remain alive after 5 years of HF diagnosis and less than a quarter of them after 10 years. HF costs the nation a huge amount of money. The total cost comprises $34.4 billion each year, including the health care services, medications, and loss of productivity. Hospitalization is a common issue in HF, estimated as primary diagnosis in more than 1 million each year. Readmission after initial hospitalization is another concern in patients with HF. Around 25% will be readmitted in the next 30 days after hospital discharge, out of which only one-third is due to HF. It also costs the government an exhausting amount of money. The report of Medicare Payment Advisory Commission that was provided to the congress in 2008 showed that the expenses on HF readmissions were about $903. In this review, we intended to demonstrate the different strategies that could improve the readmission rates in patients with HF and ultimately decrease the health care payments. These strategies include evidence-based management programs, surgical therapy, risk factors adjustment, and disease monitoring. PMID:24914506

  15. The case for inhibiting p38 mitogen-activated protein kinase in heart failure

    PubMed Central

    Arabacilar, Pelin; Marber, Michael

    2015-01-01

    This minireview discusses the evidence that the inhibition of p38 mitogen-activated protein kinases (p38 MAPKs) maybe of therapeutic value in heart failure. Most previous experimental studies, as well as past and ongoing clinical trials, have focussed on the role of p38 MAPKs in myocardial infarction and acute coronary syndromes. There is now growing evidence that these kinases are activated within the myocardium of the failing human heart and in the heart and blood vessels of animal models of heart failure. Furthermore, from a philosophical viewpoint the chronic activation of the adaptive stress pathways that lead to the activation of p38 MAPKs in heart failure is analogous to the chronic activation of the sympathetic, renin-aldosterone-angiotensin and neprilysin systems. These have provided some of the most effective therapies for heart failure. This minireview questions whether similar and synergistic advantages would follow the inhibition of p38 MAPKs.

  16. Current challenges in the management of heart failure.

    PubMed

    Komajda, Michel

    2015-04-24

    The management of chronic heart failure (HF) with low ejection fraction (EF) has changed considerably over the past 30 years: the introduction of angiotensin-converting enzyme inhibitors (ACEIs), ?-blockers, angiotensin-receptor blockers, mineralocorticoid-receptor antagonists and recently, the Ifblocker, ivabradine, has led to a significant reduction in overall mortality and HF mortality. Recently, a trial testing a dual inhibitor blocking the angiotensin-II receptor and neprylisin, the enzyme responsible for B-type natriuretic peptide degradation, showed that this complex molecule improved clinical outcomes compared with the ACEI enalapril. However, challenges remain in the management of HF, with suboptimal implementation of guideline-recommended therapies, a changing profile of patients who are older and have multiple comorbidities and a high rate of early rehospitalization for HF. Use of devices such as implantable cardiac defibrillators and cardiac resynchronization therapy are also associated with an improvement in outcomes in this condition. HF with preserved EF (HFpEF), a growing fraction of the HF population, remains a clinical dilemma: no pharmacological intervention has so far demonstrated any convincing benefit on outcome. Heterogeneity of the populations tested, role of comorbidities, difficulties in identifying patients with HFpEF, as well as a mismatch between the clinical phenotypes and the treatments tested, can explain the failure to find beneficial interventions. Overall, the management of HF after discharge remains fragmented and concerted action by all professionals concerned is needed. (Circ J 2015; 79: 948-953). PMID:25877621

  17. Predicting therapeutic response in patients with heart failure: the story of C-reactive protein.

    PubMed

    Huynh, Kitty; Van Tassell, Benjamin; Chow, Sheryl L

    2015-02-01

    Heart failure continues to be a major public health burden in the USA. With markedly high rates of morbidity and mortality upon diagnosis, effective treatment and prognosis are critical in the management of chronic heart failure. Growing evidence now supports the hypothesis that inflammation plays a key role in the progression and worsening of heart failure. Of the various inflammatory mediators identified, C-reactive protein, an acute phase inflammatory marker, has been associated with poor prognosis in patients with heart failure. Several interventional studies have been investigated to explore C-reactive protein modulation and potential treatment options and health outcomes; however, further studies are warranted before C-reactive protein-targeted therapy may be recommended in the management of heart failure. PMID:25578159

  18. Dynamic extracellular matrix remodeling in the heart failure: cardiac hypertrophy, dilatation and fibrosis

    Microsoft Academic Search

    Suresh C Tyagi

    1997-01-01

    Over 40% of patients awaiting heart transplant surgery suffer from dilated cardiomyopathy, a life-threatening condition of impaired muscle cell metabolism, which forces the walls of the heart to balloon out under pressure. Myocardial infarction, which leads to remodeling, thinning of the ventricle wall, dilatation and heart failure, is one of the leading causes of death. Remodeling of the myocardium following

  19. Downregulation of Sirt1 as aging change in advanced heart failure

    PubMed Central

    2014-01-01

    Background In congestive heart failure the balance between cell death and cell survival in cardiomyocytes is compromised. Sirtuin 1 (Sirt1) activates cell survival machinery and has been shown to be protective against ischemia/reperfusion injury in murine heart. The role of Sirt1 in heart failure, especially in human hearts is not clear. Results The expression of Sirt1 and other (associated) downstream molecules in human cardiomyocytes from patients with advanced heart failure was examined. Sirt1 was down-regulated (54.92%?±?7.80% in advanced heart failure samples compared with healthy control cardiomyocytes). The modulation of molecules involved in cardiomyocyte survival and death in advanced heart failure were also examined. The expression of Mn-superoxide dismutase and thioredoxin1, as well as an antiapoptotic molecule, Bcl-xL, were all significantly reduced in advanced heart failure cardiomyoctes (0.71?±?0.02-fold, 0.61?±?0.05-fold, and 0.53?±?0.08-fold vs. control, respectively); whereas the expression of proapoptotic molecule Bax was significantly increased (1.62?±?0.18-fold vs. control). Increased TUNEL-positive number of cardiomyocytes and oxidative stress, confirmed by 8-hydorxydeoxyguanosine staining, were associated with advanced heart failure. The AMPK-Nampt-Sirt1 axis also showed inhibition in advanced heart failure in addition to severely impaired AMPK activation. Increased p53 (acetyl form) and decreased FoxO1 translocation in the nucleus may be the mechanism of down-regulation of antioxidants and up-regulation of proapoptotic molecules due to low expression of Sirt1. Conclusion In advanced heart failure, low Sirt1 expression, like aging change may be a significant contributing factor in the downregulation of antioxidants and upregulation of proapoptotic molecules through the p53, FoxO1, and oxidative stress pathways. PMID:24913149

  20. Baroreflex sensitivity and cardiovascular mortality in patients with mild to moderate heart failure

    Microsoft Academic Search

    K. J. Osterziel; D. Hänlein; R. Willenbrock; C. Eichhorn; F. Luft; R. Dietz

    1995-01-01

    OBJECTIVE--To assess the influence of both sympathetic (plasma noradrenaline concentrations) and parasympathetic (baroreflex activation) tone on survival in patients with congestive heart failure. DESIGN--Invasive study with determination of parasympathetic activity and follow up for at least 4.5 years. SUBJECTS--35 patients with sinus rhythm and mild to moderate heart failure (New York Heart Association grades II-III) (mean age 53 (SD 3)).

  1. Efficacy of antithrombotic therapy in chronic heart failure: The HELAS study

    Microsoft Academic Search

    Dennis V. Cokkinos; George C. Haralabopoulos; John B. Kostis; Pavlos K. Toutouzas

    2006-01-01

    Background: It is not clear if long-term antithrombotic treatment has a beneficial effect on the incidence of thromboembolism in chronic heart failure (CHF). The HELAS study (Heart failure Long-term Antithrombotic Study) is a multicentre, randomised, double-blind, placebo- controlled trial to evaluate antithrombotic treatment in patients with CHF. Methods: 197HF patients (EF <35%) were enrolled. Patients with Ischaemic Heart Disease were

  2. Enhancing the metabolic substrate: PPAR-alpha agonists in heart failure

    Microsoft Academic Search

    Satyam Sarma; Hossein Ardehali; Mihai Gheorghiade

    The prognosis for patients diagnosed with heart failure has significantly improved over the past three decades; however, the\\u000a disease still confers a high degree of morbidity and mortality. Current treatments for chronic heart failure have focused\\u000a primarily on blocking neurohormonal signaling and optimizing hemodynamic parameters. Although significant resources have been\\u000a devoted toward the development of new pharmaceutical therapies for heart

  3. Sleep Disordered Breathing in Heart Failure: Identifying and Treating an Important but Often Unrecognized Comorbidity in Heart Failure Patients

    PubMed Central

    Khayat, Rami; Small, Roy; Rathman, Lisa; Krueger, Steven; Gocke, Becky; Clark, Linda; Yamokoski, Laura; Abraham, William T.

    2013-01-01

    Sleep disordered breathing (SDB) is the most common co-morbidity in patients with heart failure (HF) and has a significant impact on quality of life, morbidity, and mortality. A number of therapeutic options have become available in recent years that can improve quality of life and potentially the outcomes of HF patients with SDB. Unfortunately, SDB is not part of the routine evaluation and management of HF, thus it remains untreated in most HF patients. While recognition of the role of SDB in HF is increasing, clinical guidelines for the management of SDB in HF patients continue to be absent. In this article we provide an overview of SDB in HF and propose a clinical care pathway to help clinicians better recognize and treat SDB in their HF patients. PMID:23743494

  4. Skeletal muscle beta-receptors and isoproterenol-stimulated vasodilation in canine heart failure

    SciTech Connect

    Frey, M.J.; Lanoce, V.; Molinoff, P.B.; Wilson, J.R. (Univ. of Pennsylvania, Philadelphia (USA))

    1989-11-01

    To investigate whether heart failure alters beta-adrenergic receptors on skeletal muscle and its associated vasculature, the density of beta-adrenergic receptors, isoproterenol-stimulated adenylate cyclase activity, and coupling of the guanine nucleotide-binding regulatory protein were compared in 18 control dogs and 16 dogs with heart failure induced by 5-8 wk of ventricular pacing at 260 beats/min. Hindlimb vascular responses to isoproterenol were compared in eight controls and eight of the dogs with heart failure. In dogs with heart failure, the density of beta-receptors on skeletal muscle was reduced in both gastrocnemius (control: 50 +/- 5; heart failure: 33 +/- 8 fmol/mg of protein) and semitendinosus muscle (control: 43 +/- 9; heart failure: 27 +/- 9 fmol/mg of protein, both P less than 0.05). Receptor coupling to the ternary complex, as determined by isoproterenol competition curves with and without guanosine 5'-triphosphate (GTP), was unchanged. Isoproterenol-stimulated adenylate cyclase activity was significantly decreased in semitendinosus muscle (control: 52.4 +/- 4.6; heart failure: 36.5 +/- 9.5 pmol.mg-1.min-1; P less than 0.05) and tended to be decreased in gastrocnemius muscle (control: 40.1 +/- 8.5; heart failure: 33.5 +/- 4.5 pmol.mg-1.min-1; P = NS). Isoproterenol-induced hindlimb vasodilation was not significantly different in controls and in dogs with heart failure. These findings suggest that heart failure causes downregulation of skeletal muscle beta-adrenergic receptors, probably due to receptor exposure to elevated catecholamine levels, but does not reduce beta-receptor-mediated vasodilation in muscle.

  5. Psychosocial risk factors and heart failure hospitalization: a prospective cohort study.

    PubMed

    Rod, Naja Hulvej; Andersen, Ingelise; Prescott, Eva

    2011-09-15

    Prospective studies on the role of psychosocial factors in heart failure development are virtually nonexistent. The authors aimed to address the effect of psychosocial factors on the risk of heart failure hospitalization in men and women free of cardiovascular disease. In 1991-1993, the 8,670 participants of the Copenhagen City Heart Study (Denmark) were asked comprehensive questions on major life events, work-related stress, social network, vital exhaustion, and sleep medication and were followed in nationwide registries until 2007, with less than 0.2% loss to follow-up. Almost one-fourth of the population reported some degree of vital exhaustion. The vital exhaustion score was associated with a higher risk of heart failure in a dose-response manner (P < 0.002), with high vital exhaustion being associated with a 2-fold higher risk of heart failure in both men (hazard ratio = 1.93, 95% confidence interval: 1.20, 3.10) and women (hazard ratio = 2.56, 95% confidence interval: 1.80, 3.65). Contrary to expectation, major life events, social network, and sleeping medication did not play an individual role for heart failure hospitalization. Because of the high prevalence of vital exhaustion in the population, even a modestly higher risk of heart failure associated with vital exhaustion may be of importance in the planning of future preventive strategies for heart failure. PMID:21821541

  6. The Influence of a High Salt Diet on a Rat Model of Isoproterenol-Induced Heart Failure

    EPA Science Inventory

    Rat models of heart failure (HF) show varied pathology and time to disease outcome, dependent on induction method. We found that subchronic (4 weeks) isoproterenol (ISO) infusion exacerbated cardiomyopathy in Spontaneously Hypertensive Heart Failure (SHHF) rats. Others have shown...

  7. Cardiac secretion of adrenomedullin in human heart failure.

    PubMed Central

    Jougasaki, M; Rodeheffer, R J; Redfield, M M; Yamamoto, K; Wei, C M; McKinley, L J; Burnett, J C

    1996-01-01

    Adrenomedullin (ADM) is a newly discovered endogenous vasorelaxing and natriuretic peptide. Recently, we have reported that plasma ADM is increased in severe congestive heart failure (CHF) in humans and that increased immunohistochemical staining is observed in the failing human ventricular myocardium. The present study was designed to test the hypothesis that the failing human ventricle secretes ADM and that circulating ADM progressively increases with the severity of clinical CHF. Plasma ADM was significantly increased in human CHF (39.8 +/- 3.6 pg/ml, P < 0.001 vs. normal) as compared with normal subjects (14.4 +/- 2.7 pg/ml). Plasma ADM was increased in mild CHF (NYHA class II, 30.1 +/- 3.4 pg/ml, P < 0.01 vs. normal), moderate CHF (NYHA class III, 31.5 +/- 3.0 pg/ml, P < 0.01 vs. normal), and severe CHF (NYHA class IV, 66.1 +/- 9.4 pg/ml, P < 0.001 vs. normal). In 13 patients with CHF in whom plasma samples were obtained from aorta (AO), coronary sinus (CS) and anterior interventricular vein (AIV), there was a significant step-up in plasma ADM between AO and AIV (50.6 +/- 9.3 pg/ml and 62.1 +/- 11.1 pg/ml, respectively, P < 0.01) and between AO and CS (50.6 +/- 9.3 pg/ml and 58.6 +/- 11.4 pg/ml, respectively, P < 0.05). The current study demonstrates that the failing human heart secretes ADM in human CHF suggesting contribution to the increase in plasma ADM, and indicates for the first time an additional endocrine system of cardiac origin which is activated in human CHF and may function in cardiorenal regulation. PMID:8636418

  8. Biventricular Pacing for Heart Failure Patientson Inotropic Support

    PubMed Central

    James, Karen B.; Militello, Michael; Gus, Barbara; Wilkoff, Bruce L.

    2006-01-01

    Biventricular pacing (BiV) has documented benefit in New York Heart Association functional class III patients. Whether BiV offers benefit to class IV patients on inotropic therapy is unclear. Retrospective review was performed on 38 consecutive heart failure patients who received BiV while on inotropic support or within 30 days of inotropic administration; the mean age was 63 ± 13 yrs; 9 were women. Fourteen who received inotropic agents did so in conjunction with coronary artery bypass grafting, or valve or infarct exclusion surgery. Twenty-three patients received inotropic therapy only before BiV. Nine other patients received inotropic therapy before BiV and at another point (5 at implant and 4 after BiV); 6 were on inotropic support only at implant. Mean follow-up was 1.2 ± 0.9 years. There were 14 deaths. Survival estimates at 6 months, 1 year, and 2 years were 74%, 71%, and 61%, respectively. When patients on inotropic therapy before BiV (n=32) were compared with patients never on such therapy before BiV (n=6), there was a survival difference (P < 0.0001); all 6 patients not on inotropic therapy before BiV died within the first 2 years. Estimated 6-month and 1-year survival for those on inotropic support before BiV was 84% and 81%, compared with 23% and 23% for the other group. Patients who required inotropic agents only before BiV fared better than those requiring inotropic support at other times. Although the patients in this survey were a very high-risk group, a small subset was weaned and had stable short-term survival. PMID:16572863

  9. Congestive heart failure adherence redesign trial: a pilot study

    PubMed Central

    Mangla, Ashvarya; Doukky, Rami; Powell, Lynda H; Avery, Elizabeth; Richardson, DeJuran; Calvin, James E

    2014-01-01

    Objective Heart failure (HF) continues to be a leading cause of hospital admissions, particularly in underserved patients. We hypothesised that providing individualised self-management support to patients and feedback on use of evidence-based HF therapies (EBT) to physicians could lead to improvements in care and decrease hospitalisations. To assess the feasibility of conducting a larger trial testing the efficacy of this dual-level intervention, we conducted the Congestive Heart failure Adherence Redesign Trial Pilot (CHART-P), a proof-of-concept, quasi-experimental, feasibility pilot study. Setting A large tertiary care medical centre in Chicago. Participants Low-income patients (80% of interventions at 1?month and by study completion, respectively. Median sodium intake declined (3.5 vs 2.0?g; p<0.01). There was no statistically significant change in medication adherence based on electronic pill cap monitoring or the Morisky Medication Adherence Scale (MMAS); however, there was a trend towards improved adherence based on MMAS. All physicians received timely intervention. Conclusions This pilot study demonstrated that the protocol was feasible. It provided important insights about the need for intervention and the difficulties in treating patients with a variety of psychosocial problems that undercut their effective care. PMID:25475245

  10. NHLBI’s Program for VAD Therapy for Moderately Advanced Heart Failure: The REVIVE-IT Pilot Trial

    Microsoft Academic Search

    J. Timothy Baldwin; Douglas L. Mann

    2010-01-01

    BackgroundVentricular assist devices (VADs) are used to bridge heart failure patients to transplantation, to allow their own hearts to recover, or as permanent (“destination”) therapy. To date, the use of VADs has been limited to late-stage heart failure patients because of the associated device risks. In 2008, a National Heart, Lung, and Blood Institute (NHLBI) working group met to evaluate

  11. Pharmacogenomics in heart failure: where are we now and how can we reach clinical application?

    PubMed

    Oni-Orisan, Akinyemi; Lanfear, David E

    2014-01-01

    Heart failure is becoming increasingly prevalent in the United States and is a significant cause of morbidity and mortality. Several therapies are currently available to treat this chronic illness; however, clinical response to these treatment options exhibit significant interpatient variation. It is now clearly understood that genetics is a key contributor to diversity in therapeutic response, and evidence that genetic polymorphisms alter the pharmacokinetics, pharmacodynamics, and clinical response of heart failure drugs continues to accumulate. This suggests that pharmacogenomics has the potential to help clinicians improve the management of heart failure by choosing the safest and most effective medications and doses. Unfortunately, despite much supportive data, pharmacogenetic optimization of heart failure treatment regimens is not yet a reality. In order to attenuate the rising burden of heart failure, particularly in the context of the recent paucity of new effective interventions, there is an urgent need to extend pharmacogenetic knowledge and leverage these associations in order to enhance the effectiveness of existing heart failure therapies. This review focuses on the current state of pharmacogenomics in heart failure and provides a glimpse of the aforementioned future needs. PMID:25093738

  12. Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials

    PubMed Central

    Howlett, Jonathan G; McKelvie, Robert S; Arnold, J Malcolm O; Costigan, Jeannine; Dorian, Paul; Ducharme, Anique; Estrella-Holder, Estrellita; Ezekowitz, Justin A; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Herd, Anthony M; Isaac, Debra; Jong, Philip; Kouz, Simon; Liu, Peter; Mann, Elizabeth; Moe, Gordon W; Tsuyuki, Ross T; Ross, Heather J; White, Michel

    2009-01-01

    The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada. PMID:19214293

  13. The Prevalence and Prognosis of Resistant Hypertension in Patients with Heart Failure

    PubMed Central

    Jin, Chun-Na; Liu, Ming; Sun, Jing-Ping; Fang, Fang; Wen, Yong-Na; Yu, Cheuk-Man; Lee, Alex Pui-Wai

    2014-01-01

    Background Resistant hypertension is associated with adverse clinical outcome in hypertensive patients. However, the prognostic significance of resistant hypertension in patients with heart failure remains uncertain. Methods and Results The 1 year survival and heart failure re-hospitalization rate of 1288 consecutive patients admitted to a university hospital for either newly diagnosed heart failure or an exacerbation of prior chronic heart failure was analyzed. Resistant hypertension was defined as uncontrolled blood pressure (>140/90 mmHg) despite being compliant with an antihypertensive regimen that includes 3 or more drugs (including a diuretic). A total of 176 (13.7%) heart failure patients had resistant hypertension. There was no difference in all cause mortality, cardiovascular mortality, and heart failure related re-hospitalization between patients with versus without resistant hypertension. Diabetes [hazard ratio?=?1.62, 95% confidence interval?=?1.13–2.34; P?=?0.010] and serum sodium >139 mmol/L (hazard ratio?=?1.54, 95% confidence interval?=?1.06–2.23; P?=?0.024) were independently associated with resistant hypertension. Patients with resistant hypertension had a relatively higher survival rate (86.9% vs. 83.8%), although the difference was not significant (log-rank x2?=?1.00, P?=?0.317). In patients with reduced ejection fraction, heart failure related re-hospitalization was significantly lower in patients with resistant hypertension (45.8% vs. 59.1%, P?=?0.050). Conclusions Resistant hypertension appears to be not associated with adverse clinical outcome in patients with heart failure, in fact may be a protective factor for reduced heart failure related re-hospitalization in patients with reduced ejection fraction. PMID:25490405

  14. Testosterone deficiency and exercise intolerance in heart failure: treatment implications.

    PubMed

    Iellamo, Ferdinando; Rosano, Giuseppe; Volterrani, Maurizio

    2010-06-01

    Chronic heart failure (CHF) is characterized by a metabolic shift favoring catabolism with impairment in skeletal muscle bulk and function. There is evidence that low plasma levels of testosterone play a role in this shift, and that hypotestosteronemia could be involved in the impairment of skeletal muscle function and exercise tolerance, which characterize CHF syndrome. Testosterone supplementation at replacement doses has been hypothesized as a potential therapy to counteract anabolic deficiency in CHF also acting on pathophysiological mechanisms, which sustain the progression of CHF. Recent studies have indeed indicated that testosterone supplementation increases functional capacity and muscle performance in patients with CHF. This review summarizes current knowledge on the role of testosterone deficiency in exercise intolerance in CHF and the potential implications of testosterone therapy. The links between testosterone and exercise tolerance in CHF, as well as the potential mechanisms of testosterone benefits in CHF syndrome, are also emphasized. Finally, unsolved issues regarding testosterone therapy in CHF and directions for future research are discussed. PMID:20424990

  15. A machine learning system to improve heart failure patient assistance.

    PubMed

    Guidi, Gabriele; Pettenati, Maria Chiara; Melillo, Paolo; Iadanza, Ernesto

    2014-11-01

    In this paper, we present a clinical decision support system (CDSS) for the analysis of heart failure (HF) patients, providing various outputs such as an HF severity evaluation, HF-type prediction, as well as a management interface that compares the different patients' follow-ups. The whole system is composed of a part of intelligent core and of an HF special-purpose management tool also providing the function to act as interface for the artificial intelligence training and use. To implement the smart intelligent functions, we adopted a machine learning approach. In this paper, we compare the performance of a neural network (NN), a support vector machine, a system with fuzzy rules genetically produced, and a classification and regression tree and its direct evolution, which is the random forest, in analyzing our database. Best performances in both HF severity evaluation and HF-type prediction functions are obtained by using the random forest algorithm. The management tool allows the cardiologist to populate a "supervised database" suitable for machine learning during his or her regular outpatient consultations. The idea comes from the fact that in literature there are a few databases of this type, and they are not scalable to our case. PMID:25029521

  16. Devices in the management of advanced, chronic heart failure

    PubMed Central

    Abraham, William T.; Smith, Sakima A.

    2013-01-01

    Heart failure (HF) is a global phenomenon, and the overall incidence and prevalence of the condition are steadily increasing. Medical therapies have proven efficacious, but only a small number of pharmacological options are in development. When patients cease to respond adequately to optimal medical therapy, cardiac resynchronization therapy has been shown to improve symptoms, reduce hospitalizations, promote reverse remodelling, and decrease mortality. However, challenges remain in identifying the ideal recipients for this therapy. The field of mechanical circulatory support has seen immense growth since the early 2000s, and left ventricular assist devices (LVADs) have transitioned over the past decade from large, pulsatile devices to smaller, more-compact, continuous-flow devices. Infections and haematological issues are still important areas that need to be addressed. Whereas LVADs were once approved only for ‘bridge to transplantation’, these devices are now used as destination therapy for critically ill patients with HF, allowing these individuals to return to the community. A host of novel strategies, including cardiac contractility modulation, implantable haemodynamic-monitoring devices, and phrenic and vagus nerve stimulation, are under investigation and might have an impact on the future care of patients with chronic HF. PMID:23229137

  17. Role of Diuretics and Ultrafiltration in Congestive Heart Failure

    PubMed Central

    Shchekochikhin, Dmitry; Al Ammary, Fawaz; Lindenfeld, JoAnn; Schrier, Robert

    2013-01-01

    Volume overload in heart failure (HF) results from neurohumoral activation causing renal sodium and water retention secondary to arterial underfilling. Volume overload not only causes signs and symptoms of congestion, but can impact myocardial remodeling and HF progression. Thus, treating congestion is a cornerstone of HF management. Loop diuretics are the most commonly used drugs in this setting. However, up to 30% of the patients with decompensated HF present with loop-diuretic resistance. A universally accepted definition of loop diuretic resistance, however, is lacking. Several approaches to treat diuretic-resistant HF are available, including addition of distal acting thiazide diuretics, natriuretic doses of mineralocorticoid receptor antagonists (MRAs), or vasoactive drugs. Slow continuous veno-venous ultrafiltration is another option. Ultrafiltration, if it is started early in the course of HF decompensation, may result in prominent decongestion and a reduction in re-hospitalization. On the other hand, ultrafiltration in HF patients with worsening renal function and volume overload after aggressive treatment with loop diuretics, failed to show benefit compared to a stepwise pharmacological approach, including diuretics and vasoactive drugs. Early detection of congested HF patients for ultrafiltration treatment might improve decongestion and reduce readmission. However, the best patient characteristics and best timing of ultrafiltration requires further evaluation in randomized controlled studies. PMID:24276318

  18. Psychological Responses and Adherence to Exercise in Heart Failure

    PubMed Central

    Duncan, Kathleen; Pozehl, Bunny; Hertzog, Melody; Norman, Joseph F.

    2013-01-01

    The purpose of this study was to describe psychological effects and exercise adherence during a multicomponent exercise training intervention. A sample of 42 patients with heart failure (HF) were randomized into an exercise (INV) group, (n=22) and an attention control (AC) group (n=20). The exercise protocol included two 12-week phases, a structured phase and a self-managed phase. The psychological responses assessed were mood states and exercise self-efficacy. To meet the second purpose of the study, the exercise group was dichotomized based on the number of sessions completed to create two adherence subgroups. Results indicate self-efficacy improved for the INV group and was maintained during the self-management phase. The adherence subgroups demonstrated different patterns for weekly exercise. Depression and confusion scores improved for the high adherence group in contrast to worsening for the low adherence group. Results suggest the need for further study of the psychological responses of exercise adherence for patients with HF. PMID:23720399

  19. Vasodilator drugs in patients with chronic ischaemic heart failure.

    PubMed

    Korewicki, J; Kraska, T; Opolski, G; Ostrzycki, A

    1985-01-01

    The effects of intravenous nitroglycerin (NTG), trimetaphan (TMP), and phentolamine (PTL) on pulmonary artery diastolic pressure (PADP), systemic arterial pressure (SAP), cardiac index (CI) and systemic vascular resistance (SVR) in patients (12 in each treated group) with chronic ischaemic heart failure are analyzed. Each group was divided into two subgroups according to the initial PADP taking into account the mean value in the whole group. A significant decrease in PADP (by 40%; p less than 0.001) was observed in the NTG-treated group, with no significant changes in CI and SVR except for patients with moderately elevated initial PADP, in whom SVR increased slightly in the early period of treatment, and CI decreased (by 25%; p less than 0.05). TMP and PTL reduced SVR (by 25 and 30% respectively; p less than 0.01) and increased CI irrespective of the initial PADP. TMP significantly decreased PADP in patients in whom its level was initially high. The results suggest that NTG is mainly a venodilating agent which should be used in patients with high PADP and normal or slightly decreased CI. PTL acts mainly by reducing SVR and increasing CI. TMP influences both PADP and SVR and is a drug of choice in patients with high or elevated PADP and low cardiac output. PMID:3935374

  20. Cardiac Rehabilitation Exercise and Self Care for Chronic Heart Failure

    PubMed Central

    Ades, Philip A.; Keteyian, Steven J.; Balady, Gary J; Houston-Miller, Nancy; Kitzman, Dalane W.; Mancini, Donna M.; Rich, Michael W.

    2014-01-01

    Chronic heart failure (CHF) is highly prevalent in older individuals and a major cause of morbidity, mortality, hospitalizations and disability. Cardiac rehabilitation (CR) exercise training and CHF self-care counseling have each been shown to improve clinical status and clinical outcomes in CHF. Systematic reviews and meta-analyses of CR exercise training alone (without counseling) have demonstrated consistent improvements in CHF symptoms in addition to reductions of cardiac mortality and hospitalizations, although individual trials have been less conclusive of the latter two findings. The largest single trial, HF-ACTION, showed a reduction in the adjusted risk for the combined end point of all-cause mortality or hospitalization (HR: 0.89, 95% CI: 0.81-0.99; P=0.03). Quality of life and mental depression also improved. CHF-related counseling whether provided in isolation or in combination with CR exercise training improves clinical outcomes and reduces CHF-related hospitalizations We review current evidence on the benefits and risks of CR and self-care counseling in patients with CHF, provide recommendations for patient selection for third party payers, and discuss the role of CR in promoting self-care and behavioral changes. PMID:24622007

  1. Left Ventricle–Arterial System Interaction in Heart Failure

    PubMed Central

    Li, John K-J; Atlas, Glen

    2015-01-01

    Ejection fraction (EF) has been viewed as an important index in assessing the contractile state of the left ventricle (LV). However, it is frequently inadequate for the diagnosis and management of heart failure (HF), as a significant subset of HF patients have been found to have reduced EF (HFrEF) whereas others have preserved EF (HFpEF). It should be noted that the function of the LV is dependent on both preload and afterload, as well as its intrinsic contractile state. Furthermore, stroke volume (SV) is dependent on the properties of the arterial system (AS). Thus, the LV-arterial system interaction plays an important role in those patients with HF. This aspect is investigated through the analysis of the specific parameters involved in the coupling of the LV and AS. This includes contractility and the systolic/diastolic indices of the LV. Furthermore, AS afterload parameters such as vascular stiffness and arterial compliance, and their derived coupling coefficient, are also investigated. We conclude that those parameters, which relate to LV structural changes, are most appropriate in quantifying the LV–AS interaction. PMID:26124691

  2. Assisted circulation for end-stage chronic heart failure.

    PubMed

    Liotta, D

    1998-03-01

    Despite the trend in the use of electromechanical left ventricular assist devices (LVAD), the highly compact, long lasting, and endurance characteristics of the new pneumatic system has its place in the treatment of end-stage chronic heart failure. The ProCor Model 1 LVAD has an implantable pump which is small in size and has a double pusher plate design. The portable power pack is small, too. It is easy to carry, and it is synchronized to the ECG to pump during the patient's diastolic period. Constant driving conditions are set as follows: frequency rate, 60 bpm; systolic percentage, 25 (250 ms); dP/dt, 1,800 (45 ms) mm Hg.s; and driving pressure, 250 mm Hg to have a basic 3.500 L/min pump output for prolonged circulatory assistance. The 6 mm internal diameter (ID) percutaneous multipurpose pneumatic tube contains within its wall both a spiral of MP35N alloy wire connected to the myocardial lead for ECG sensing and a spiral serving as mass ready to be used for cardiac pacing with an external pacemaker when necessary. The aortic porcine bioprosthesis maintains the aortic root and the sinus ridge. PMID:9527284

  3. Site selection for heart failure clinical trials in the USA.

    PubMed

    Harinstein, Matthew E; Butler, Javed; Greene, Stephen J; Fonarow, Gregg C; Stockbridge, Norman L; O'Connor, Christopher M; Pfeffer, Marc A; Mehra, Mandeep R; Solomon, Scott D; Yancy, Clyde W; Fiuzat, Mona; Mentz, Robert J; Collins, Sean P; McMurray, John J V; Vaduganathan, Muthiah; Dunnmon, Preston M; Rosano, Giuseppe M C; Dinh, Wilfried; Misselwitz, Frank; Bonow, Robert O; Gheorghiade, Mihai

    2015-07-01

    There are more than 1 million primary hospitalizations for heart failure (HF) annually in the USA alone, and post-discharge outcomes remain persistently poor despite available therapies and quality improvement initiatives. Recent international randomized clinical trials in hospitalized HF have repeatedly failed to improve this post-discharge event rate. A potential reason for this persistent lack of clinical trial success that has not previously received significant attention relates to site selection and the generally low level of patient enrollment from the USA. Only ~5 % of US hospitals participate in clinical trials, and in four recent randomized trials of hospitalized HF, only one-third of patients were enrolled in North America. This poor participation among US centers has necessitated disproportionate enrollment from non-US sites. Regional variations in HF patient characteristics and clinical outcomes are well documented, and a lack of US patient representation in clinical trials limits the generalizability of results and presents obstacles for US regulatory agency approval. There are multiple impediments to successful US enrollment including a lack of incentive for investigators and institutions, the relative value unit-based compensation system, poor institutional framework for identification of appropriate patients, and increasing liability to conduct trials. In this manuscript, we specifically identify barriers to successful hospitalized HF clinical trial participation in the USA and suggest possible solutions. PMID:25649127

  4. Brain Axonal and Myelin Evaluation in Heart Failure

    PubMed Central

    Kumar, Rajesh; Woo, Mary A.; Macey, Paul M.; Fonarow, Gregg C.; Hamilton, Michele A.; Harper, Ronald M.

    2011-01-01

    Although gray matter injury appears in heart failure (HF) patients, the presence, extent, and nature of axonal injury impacting on cardiovascular regulation and other functions is unclear. We performed diffusion tensor imaging (3.0-Tesla magnetic resonance imaging scanner) in 16 HF and 26 control subjects, and assessed whole-brain water diffusion parallel (axial diffusivity; axonal status) and perpendicular (radial diffusivity; myelin changes) to fibers. Regions with increased axial diffusivity only, indicating impaired axonal integrity, emerged in cardiovascular, hedonic, and pain regulatory areas, including basal forebrain, hypothalamic and limbic projections through the medial forebrain bundle and raphé magnus projections to the medulla and cerebellum. Other fiber paths between sites implicated in cognition, including limbic, basal-ganglia, thalamic, internal capsule, and corpus callosum were also altered. Sites with increased radial diffusivity only, indicating myelin breakdown, appeared in the corpus callosum, cingulate, and temporal, parietal, occipital, and frontal regions. Both higher axial and radial diffusivity, indicating loss of tissue integrity, appeared in parietal and occipital lobes, limbic regions, insula, internal capsule, cerebellum, and dorsolateral medulla. Axons and myelin are altered in HF, likely resulting from ischemic/hypoxic processes acting chronically and sub-acutely, respectively. The alterations would contribute to the multiple autonomic and neuropsychological symptoms found in HF. PMID:21612797

  5. Atrial fibrillation in heart failure: The sword of Damocles revisited

    PubMed Central

    Khan, Muhammad A; Ahmed, Fozia; Neyses, Ludwig; Mamas, Mamas A

    2013-01-01

    Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in selected subgroups of HF patients. Furthermore, various therapeutic modalities including pace and ablate strategies with cardiac resynchronisation or radiofrequency ablation have become increasingly adopted, although their role in the management of AF in patients with HF remains uncertain. This article presents an overview of the multidimensional impact of AF in patients with HF. Relevant literature is highlighted and the effect of various therapeutic modalities on prognosis is discussed. Finally, while novel anticoagulants usher in a new era in thromboprophylaxis, research continues in a variety of new pathways including selective atrial anti-arrhythmic agents and genomic polymorphisms in AF with HF. PMID:23888191

  6. Pulmonary hypertension secondary to heart failure with preserved ejection fraction.

    PubMed

    Thenappan, Thenappan; Prins, Kurt W; Cogswell, Rebecca; Shah, Sanjiv J

    2015-04-01

    Pulmonary hypertension (PH) secondary to heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized cause of PH due to an emerging epidemic of HFpEF. The mechanisms underlying the pathogenesis of PH in HFpEF are not well established, but the presence of PH and right ventricular dysfunction in HFpEF is associated with worse prognosis. Currently, it is unclear whether PH is just a marker of underlying disease severity or whether it could be a target of treatment in HFpEF. Although PH-HFpEF and pulmonary arterial hypertension share several clinical characteristics, the evidence supporting the use of pulmonary arterial hypertension-specific therapies in PH-HFpEF is limited. Here, we review the disease classification, epidemiology, proposed pathophysiology, and treatments for PH-HFpEF. Our limited understanding highlights an urgent need for more research to elucidate the pathogenesis of PH in HFpEF and to develop novel therapies for this challenging syndrome. PMID:25840094

  7. Epidemiology of heart failure with preserved ejection fraction.

    PubMed

    Dhingra, Abhinav; Garg, Aayushi; Kaur, Simrat; Chopra, Saurav; Batra, Jaspreet Singh; Pandey, Ambarish; Chaanine, Antoine H; Agarwal, Sunil K

    2014-12-01

    The prevalence of heart failure (HF) and its subtype, HF with preserved ejection fraction (HFpEF), is on the rise due to aging of the population. HFpEF is convergence of several pathophysiological processes, which are not yet clearly identified. HFpEF is usually seen in association with systemic diseases, such as diabetes, hypertension, atrial fibrillation, sleep apnea, renal and pulmonary disease. The proportion of HF patients with HFpEF varies by patient demographics, study settings (cohort vs. clinical trial, outpatient clinics vs. hospitalised patients) and cut points used to define preserved function. There is an expanding body of literature about prevalence and prognostic significance of both cardiovascular and non-cardiovascular comorbidities in HFpEF patients. Current therapeutic approaches are targeted towards alleviating the symptoms, treating the associated comorbid conditions, and reducing recurrent hospital admissions. There is lack of evidence-based therapies that show a reduction in the mortality amongst HFpEF patients; however, an improvement in exercise tolerance and quality of life is seen with few interventions. In this review, we highlight the epidemiology and current treatment options for HFpEF. PMID:25224319

  8. Redox-sensitive mechanisms underlying vascular dysfunction in heart failure.

    PubMed

    Konradi, J; Mollenhauer, M; Baldus, S; Klinke, A

    2015-06-01

    Regardless of the progress in therapeutic drugs and devices to treat heart failure (HF) during the last few years, the clinical outcome of this disease remains deleterious. Impaired left ventricular function leads to neurohumoral activation, altered local shear forces, and hypoxia, which might give rise to inflammatory processes within the vasculature. Among those, the imbalance of the redox equilibrium toward increased concentrations of reactive oxygen species (ROS) is particularly important, as it affects the integrity of vascular function. Apart from injured or dysfunctional cardiomyocytes, vascular dysfunction has been demonstrated to play a crucial role in the development and progression of HF, which makes it an interesting target for new HF therapies. The mechanisms that initiate vascular dysfunction in HF pathogenesis and the processes leading to oxidative stress are not yet fully elucidated. However, oxidative stress promotes a variety of redox-sensitive mechanisms contributing to vascular dysfunction in HF. Here, we will summarize the sources of ROS in the vasculature, elucidate the impact of oxidative stress on functional and structural vascular remodeling, and consider the link to vascular dysfunction. Furthermore, we will point out the importance of vascular dysfunction in HF and discuss therapeutic options. PMID:25788126

  9. Vitamin D supplementation in infants with chronic congestive heart failure.

    PubMed

    Shedeed, Soad A

    2012-06-01

    Increased circulating proinflammatory cytokines may contribute to the pathogenesis of congestive heart failure (CHF). In vitro studies have suggested that vitamin D suppresses proinflammatory cytokines and increases anti-inflammatory cytokines. The aim of this work was to evaluate the effect of vitamin D supplementation on renin-angiotensin system cytokines as well as different clinical, biochemical, and echocardiographic variables in infants with chronic CHF. This was a double-blind, placebo-controlled intervention study and included 80 infants with CHF. The intervention consisted of either giving Vitamin D(3) oral drops (group I) or placebo oral drops (group II). In both study groups, baseline 25-hydroxyvitamin D [25(OH)D] concentrations were below the lower end of the reference range. After 12 weeks of intervention, vitamin D supplementation for group I infants caused significant improvement of HF score, left-ventricular (LV) end-diastolic diameter, LV end-systolic diameter, LV ejection fraction%, and myocardial performance index together with markedly increased serum 25(OH)D and interleukin (IL)-10 and decreased PTH, IL-6, and TNF-? compared with the placebo group; these differences were statistically significant (p < 0.001). Vitamin D supplementation has great benefits as an anti-inflammatory agent in infants with CHF. It helps acceleration of the clinical improvement and cytokine profile balance. PMID:22349668

  10. Diagnosis and Treatment of Depression in Patients With Congestive Heart Failure: A Review of the Literature

    PubMed Central

    Stern, Theodore A.; Hebert, Kathy A.; Musselman, Dominique L.

    2013-01-01

    Context: Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. Objective: We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure. Data Sources: A search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression. Study Selection: We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus. Data Extraction: The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined. Results: MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart failure, particularly in those patients with coronary artery disease , and is associated with a poorer quality of life, increased use of health care resources, more frequent adverse clinical events and hospitalizations, and twice the risk of mortality. Conclusions: At present, limited empirical data exist with regard to treatment of depression in the increasingly large population of patients with congestive heart failure. Evidence reveals that both psychotherapeutic treatment (eg, cognitive-behavioral therapy) and pharmacologic treatment (eg, use of the selective serotonin reuptake inhibitor sertraline) are safe and effective in reducing depression severity in patients with cardiovascular disease. Collaborative care programs featuring interventions that work to improve adherence to medical and psychiatric treatments improve both cardiovascular disease and depression outcomes. Depression rating scales such as the 9-item Patient Health Questionnaire should be used to monitor therapeutic efficacy. PMID:24392265

  11. A Rare Etiology of Heart Failure: Traumatic Arteriovenous Fistula Due to Stab Injury 17 Years Ago

    PubMed Central

    Hüseyin, Serhat; Yüksel, Volkan; Güçlü, Orkut; Y?lmaztepe, Mustafa; Canbaz, Suat

    2015-01-01

    Background: Although traumatic fistula is frequently encountered, high-output heart failure due to fistula is a very rare condition. Despite an indefinitive history of trauma, arteriovenous (AV) fistula may develop insidiously, and therefore identification of a shunt is highly important for treatment. Case Report: Here we report a 46-year-old male patient with heart failure due to traumatic femoral arteriovenous fistula developed following a penetrating stab injury 17 years ago. Conclusion: Traumatic AV fistula is a curable cause of heart failure. Also, careful examination of the patient is as significant as radiological imaging methods. PMID:26185721

  12. Acid-base and electrolyte abnormalities in heart failure: pathophysiology and implications.

    PubMed

    Urso, Caterina; Brucculeri, Salvatore; Caimi, Gregorio

    2015-07-01

    Electrolyte and acid-base abnormalities are a frequent and potentially dangerous complication in subjects with congestive heart failure. This may be due either to the pathophysiological alterations present in the heart failure state leading to neurohumoral activation (stimulation of the renin-angiotensin-aldosterone system, sympathoadrenergic stimulation), or to the adverse events of therapy with diuretics, cardiac glycosides, and ACE inhibitors. Subjects with heart failure may show hyponatremia, magnesium, and potassium deficiencies; the latter two play a pivotal role in the development of cardiac arrhythmias. The early identification of these alterations and the knowledge of the pathophysiological mechanisms are very useful for the management of these patients. PMID:25820346

  13. Implantable device diagnostics on day of discharge identify heart failure patients at increased risk for early readmission for heart failure

    PubMed Central

    Small, Roy S; Whellan, David J; Boyle, Andrew; Sarkar, Shantanu; Koehler, Jodi; Warman, Eduardo N; Abraham, William T

    2014-01-01

    Aims We hypothesized that diagnostic data in implantable devices evaluated on the day of discharge from a heart failure hospitalization (HFH) can identify patients at risk for HF readmission (HFR) within 30 days. Methods and results In this retrospective analysis of four studies enrolling patients with CRT devices, we identified patients with a HFH, device data on the day of discharge, and 30-day post-discharge clinical follow-up. Four diagnostic criteria were evaluated on the discharge day: (i) intrathoracic impedance >8 ? below reference impedance; (ii) AF burden >6 h; (iii) CRT pacing <90%; and (iv) night heart rate >80 b.p.m. Patients were considered to have higher risk for HFR if ?2 criteria were met, average risk if 1 criterion was met, and lower risk if no criteria were met. A Cox proportional hazards model was used to compare the groups. The data cohort consisted of a total of 265 HFHs in 175 patients, of which 36 (14%) were followed by HFR. On the discharge day, ?2 criteria were met in 43 (16% of 265 HFHs), only 1 criterion was met in 92 (35%), and none of the four criteria were met in 130 HFHs (49%); HFR rates were 28, 16, and 7%, respectively. HFH with ?2 criteria met was five times more likely to have HFR compared with HFH with no criteria met (adjusted hazard ratio 5.0; 95% confidence interval 1.9–13.5, P = 0.001). Conclusion Device-derived diagnostic criteria evaluated on the day of discharge identified patients at significantly higher risk of HFR. PMID:24464745

  14. Nitric oxide production during exercise in chronic heart failure.

    PubMed

    Adachi, H; Nguyen, P H; Belardinelli, R; Hunter, D; Jung, T; Wasserman, K

    1997-08-01

    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 air, is known to increase in normal subjects during exercise. In this study, we quantified NO output in exhaled air in patients with CHF during exercise. Six patients with CHF (New York Heart Association Class II and III; two with dilated cardiomyopathy, three with ischemic heart disease, and one with hypertensive heart disease) and six normal subjects were studied with a symptom-limited incremental exercise test on a cycle ergometer. Oxygen uptake (VO2), carbon dioxide output (VCO2), and minute ventilation (VE) were measured breath by breath with a mass spectrometer, flow meter, and computer. The NO concentration was continuously measured in mixed expired air by chemiluminescence. Peak exercise work rate was lower in patients with CHF than in normal subjects (71.3 +/- 41.6 W vs 257.0 +/- 49.7 W; p < 0.01). Patients with CHF showed a higher VE/VCO2 level at peak exercise than normal subjects (CHF, 47.0 +/- 10.7; normal subjects, 35.6 +/- 5.2; p < 0.01). NO concentration of exhaled air at rest was lower in CHF patients than in normal subjects (4.0 +/- 2.2 ppb vs 10.5 +/- 6.2 ppb, respectively; p < 0.05). NO output from the respiratory tract (VNO) was significantly lower in patients with CHF compared with normal subjects at rest (45.3 +/- 24.3 nl/min, 117.5 +/- 60.1 nl/min, respectively, p < 0.05), and although it increased during exercise, it did not increase in patients with CHF as much as in normal subjects (75.3 +/- 43.4 nl/min vs 512.9 +/- 253.6 nl/min, respectively; p < 0.01). The increase above rest (exercise/rest) was smaller in patients with CHF than in normal subjects (2.10 +/- 1.92 vs 4.81 +/- 2.67, p < 0.05). These data support the concept that the smaller increase in NO production (VNO) during exercise may be responsible for a blunted vasodilation in patients with CHF, resulting in a smaller reduction in dead space/tidal volume and VE/VCO2 at the lactic acidosis threshold than normal. This finding may play a role in the abnormally high ventilatory response to exercise in patients with CHF. PMID:9313597

  15. Increased ANF secretion after volume expansion is preserved in rats with heart failure

    SciTech Connect

    Chien, Young Wei; Barbee, R.W.; MacPhee, A.L.; Frohlich, E.D.; Trippodo, N.C. (Alton Ochsner Medical Foundation, New Orleans, LA (USA))

    1988-02-01

    To examine whether the failing heart has reached a maximal capacity to increase plasma atrial natriuretic factor (ANF) concentration, the change in plasma immunoreactive ANF, measured by radioimmunoassay level due to acute blood volume expansion was determined in conscious rats with chronic heart failure. Varying degrees of myocardial infarction and thus heart failure were induced by coronary artery ligation 3 wk before study. Compared with controls, infarcted rats had decreases in mean arterial pressure cardiac index, renal blood flow, and peak left ventricle-developed pressure after aortic occlusion, and increases in central venous pressure, left ventricular end-diastolic pressure, total peripheral resistance, plasma ANF level. Plasma ANF was correlated with infarct size, cardiac filling pressures, and left ventricle pressure-generating ability. At 5 min after 25% blood volume expansion, plasma ANF in rats with heart failure increased by 2,281 {plus minus} 345 pg/ml; the magnitude of the changes in circulating ANF and hemodynamic measurements was similar in controls. The results suggest that plasma ANF level can be used as a reliable index of the severity of heart failure, and that the capacity to increase plasma ANF concentration after acute volume expansion is preserved in rats with heart failure. There was no evidence of a relative deficiency of circulating ANF in this model of heart failure.

  16. Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem.

    PubMed

    Upadhya, Bharathi; Haykowsky, Mark J; Eggebeen, Joel; Kitzman, Dalane W

    2015-05-01

    Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF in older adults, and is increasing in prevalence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF (HFrEF), and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfunction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this disease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF. PMID:26089855

  17. Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem

    PubMed Central

    Upadhya, Bharathi; Haykowsky, Mark J; Eggebeen, Joel; Kitzman, Dalane W

    2015-01-01

    Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF in older adults, and is increasing in prevalence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF (HFrEF), and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfunction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this disease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF. PMID:26089855

  18. Prognostic significance of heart rate turbulence parameters in patients with chronic heart failure

    PubMed Central

    2014-01-01

    Background This study is aimed to evaluate the clinical significance of heart rate turbulence (HRT) parameters in predicting the prognosis in patients with chronic heart failure (CHF). Methods From June 2011 to December 2012, a total of 104 CHF patients and 30 healthy controls were enrolled in this study. We obtained a 24-hour Holter ECG recording to assess the HRT parameters, included turbulence onset (TO), turbulence slope (TS), standard deviation of N-N intervals (SDNN), and resting heart rate (RHR). The relationships between HRT parameters and the prognosis of CHF patients were determined. Results The assessment follow-up period lasted until January 31, 2013. The overall mortality of CHF patients was 9.6% (10/104). Our results revealed that CHF patients had higher levels of TO than those of healthy subjects, but the TS levels of CHF patients were lower than that of the control group. CHF patients with NYHA grade IV had higher HRT1/2 rate than those with NYHA grade II/III. There were statistical differences in TS, LVEF, SDNN and RHR between the non-deteriorating group and the non-survivor group. Significant differences in TS among the three groups were also found. Furthermore, CHF patients in the non-survivor group had lower levels of TS than those in the deteriorating group. Correlation analyses indicated that TO negatively correlate with SDNN, while TS positively correlated with SDNN and left ventricular ejection fraction (LVEF). We also observed negative correlations between TS and left ventricular end-diastolic cavity dimension (LVEDD), RHR, homocysteine (Hcy) and C-reactive protein (CRP). Multivariate Cox regression analysis further confirmed that LVEF (?30%), HRT2, SDNN and RHR were independent risk factors which can indicate poor prognosis in CHF patients. Conclusions Our findings indicate that HRT may have good clinical predictive value in patients with CHF. Thus, quantifying HRT parameters could be a useful tool for predicting mortality in CHF patients. PMID:24725657

  19. Can power spectral analysis of heart rate variability identify a high risk subgroup of congestive heart failure patients with excessive sympathetic activation? A pilot study before and after heart transplantation

    Microsoft Academic Search

    A. Mortara; M. T. La Rovere; M. G. Signorini; P. Pantaleo; G. Pinna; L. Martinelli; C. Ceconi; S. Cerutti; L. Tavazzi

    1994-01-01

    BACKGROUND AND OBJECTIVES--Autonomic dysfunction seems to be involved in the progression and prognosis of severe congestive heart failure. Parasympathetic activity can still be abnormal 4-8 weeks after haemodynamic improvement by heart transplantation. To identify patients in heart failure with a more pronounced neural derangement and to analyse the changes in sympathetic and parasympathetic activity soon after heart transplantation, spectral indices

  20. The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Focus Update: anemia, biomarkers, and recent therapeutic trial implications.

    PubMed

    Moe, Gordon W; Ezekowitz, Justin A; O'Meara, Eileen; Lepage, Serge; Howlett, Jonathan G; Fremes, Steve; Al-Hesayen, Abdul; Heckman, George A; Abrams, Howard; Ducharme, Anique; Estrella-Holder, Estrellita; Grzeslo, Adam; Harkness, Karen; Koshman, Sheri L; McDonald, Michael; McKelvie, Robert; Rajda, Miroslaw; Rao, Vivek; Swiggum, Elizabeth; Virani, Sean; Zieroth, Shelley; Arnold, J Malcolm O; Ashton, Tom; D'Astous, Michel; Chan, Michael; De, Sabe; Dorian, Paul; Giannetti, Nadia; Haddad, Haissam; Isaac, Debra L; Kouz, Simon; Leblanc, Marie-Hélène; Liu, Peter; Ross, Heather J; Sussex, Bruce; White, Michel

    2015-01-01

    The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides discussion on the management recommendations on 3 focused areas: (1) anemia; (2) biomarkers, especially natriuretic peptides; and (3) clinical trials that might change practice in the management of patients with heart failure. First, all patients with heart failure and anemia should be investigated for reversible causes of anemia. Second, patients with chronic stable heart failure should undergo natriuretic peptide testing. Third, considerations should be given to treat selected patients with heart failure and preserved systolic function with a mineralocorticoid receptor antagonist and to treat patients with heart failure and reduced ejection fraction with an angiotensin receptor/neprilysin inhibitor, when the drug is approved. As with updates in previous years, the topics were chosen in response to stakeholder feedback. The 2014 Update includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers to best manage patients with heart failure. PMID:25532421

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

    MedlinePLUS

    ... often when patients are treated with medical therapy plus surgery than with medical therapy alone. These types ... done in patients who have coronary artery disease plus heart failure, which can cause additional symptoms, such ...

  2. The effects of exercise training on fatigue and dyspnea in heart failure

    Microsoft Academic Search

    Bunny Pozehl; Kathleen Duncan; Melody Hertzog

    2008-01-01

    BackgroundPhysiological benefits of exercise training for heart failure (HF) patients have been demonstrated, however little is known about the effects of training on the symptoms of fatigue and dyspnea.

  3. ACUTE EXPOSURE TO PARTICULATE MATTER IN A RAT MODEL OF HEART FAILURE

    EPA Science Inventory

    Human exposure to ambient particulate matter (PM) has been linked to cardiovascular morbidity and mortality. This association strengthens in people with preexisting cardiopulmonary diseases?especially heart failure (HF). To better characterize the cardiovascular effects of PM, we...

  4. Home Health Care With Telemonitoring Improves Health Status for Older Adults with Heart Failure

    PubMed Central

    Madigan, Elizabeth; Schmotzer, Brian J.; Struk, Cynthia J.; DiCarlo, Christina M.; Kikano, George; Piña, Ileana L.; Boxer, Rebecca S.

    2014-01-01

    Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalizations or emergency visits between those who received a telemonitoring vs. usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore for older adults with heart failure telemonitoring may be important adjunct to home health care services to improve health status. PMID:23438509

  5. Heart failure: not a single organ disease but a multisystem syndrome.

    PubMed

    Warriner, David; Sheridan, Paul; Lawford, Patricia

    2015-06-01

    Heart failure is not simply a single organ disease; rather it is a complex multi-system clinical syndrome, with impairment of endocrine, haematological, musculoskeletal, renal, respiratory and vascular systems, which influence morbidity and mortality. PMID:26053903

  6. Central sleep apnoea and heart failure (Part I).

    PubMed

    Burgess, K R

    1997-12-01

    Central sleep apnoea (CSA) in congestive heart failure is sleep state dependent and occurs typically in stages I and II of non-REM sleep. The pre-requisites are hypocapnia and some prolongation of the circulation time. It is not certain whether abnormalities in after-discharge activity in the brainstem are also important. The presence of CSA in patients with left ventricular dysfunction is a poor prognostic sign and associated with a higher mortality in that group compared to age, sex and ejection fraction matched patients with congestive cardiac failure alone. It is reasonable to speculate that the CSA causes an increase in sympathetic nervous system activity which would maintain afterload at a high level or tend to increase it with time. The application of a high afterload to an impaired left ventricle leads over time to a further reduction in ejection fraction. From other studies, particularly ACE inhibitor studies, it is known that ejection fraction and prognosis are almost linearly related. It could therefore be said that once CSA has developed it may lead to a vicious circle of increasing afterload and further reduction in ejection fraction, causing worsening CSA and further increases in afterload. A number of treatments have been shown to be of benefit: supplemental nocturnal oxygen therapy, acetazolamide and nasal CPAP therapy have all been shown to reduce CSA. In addition nasal continuous positive airways pressure (CPAP) has been shown by two groups in Canada to also improve ejection fraction. The beneficial effects on ejection fraction in particular, persist after the treatment has been withdrawn, which suggests either remodelling of the left ventricular musculature or a resetting of the baseline sympathetic nervous system activity. The impressive increase in ejection fraction due to three months nasal CPAP therapy in one study (an average 35% increase) is both dramatic and exciting for the future. It is reasonable to expect improvement in prognosis for patients with CCF whose ejection fraction rises with CPAP treatment. Finally, only a limited number of studies have been published. Unfortunately the impressive results from Canada have not yet been reproduced in other centres around the world. PMID:9525293

  7. Central sleep apnoea and heart failure (part II).

    PubMed

    Burgess, K R

    1998-03-01

    Central sleep apnoea (CSA) in congestive heart failure is sleep state dependent and occurs typically in stages I and II of non-REM sleep. The pre-requisites are hypocapnia and some prolongation of the circulation time. It is not certain whether abnormalities in after-discharge activity in the brainstem are also important. The presence of CSA in patients with left ventricular dysfunction is a poor prognostic sign and associated with a higher mortality in that group compared to age, sex and ejection fraction matched patients with congestive cardiac failure alone. It is reasonable to speculate that the CSA causes an increase in sympathetic nervous system activity which would maintain afterload at a high level or tend to increase it with time. The application of a high afterload to an impaired left ventricle leads over time to a further reduction in ejection fraction. From other studies, particularly ACE inhibitor studies, it is known that ejection fraction and prognosis are almost linearly related. It could therefore be said that once CSA has developed it may lead to a vicious circle of increasing afterload and further reduction in ejection fraction, causing worsening CSA and further increases in afterload. A number of treatments have been shown to be of benefit: supplemental nocturnal oxygen therapy, acetazolamide and nasal CPAP therapy have all been shown to reduce CSA. In addition nasal continuous positive airways pressure (CPAP) has been shown by two groups in Canada to also improve ejection fraction. The beneficial effects on ejection fraction in particular, persist after the treatment has been withdrawn, which suggests either remodelling of the left ventricular musculature or a resetting of the baseline sympathetic nervous system activity. The impressive increase in ejection fraction due to three months nasal CPAP therapy in one study (an average 35% increase) is both dramatic and exciting for the future. It is reasonable to expect improvement in prognosis for patients with CCF whose ejection fraction rises with CPAP treatment. Finally, only a limited number of studies have been published. Unfortunately the impressive results from Canada have not yet been reproduced in other centres around the world. PMID:9657653

  8. Fibroblast Growth Factor?23 and Incident Coronary Heart Disease, Heart Failure, and Cardiovascular Mortality: The Atherosclerosis Risk In Communities Study

    PubMed Central

    Lutsey, Pamela L.; Alonso, Alvaro; Selvin, Elizabeth; Pankow, James S.; Michos, Erin D.; Agarwal, Sunil K.; Loehr, Laura R.; Eckfeldt, John H.; Coresh, Josef

    2014-01-01

    Background Fibroblast growth factor?23 (FGF?23) is a hormone involved in phosphorous regulation and vitamin D metabolism that may be associated with cardiovascular risk, and it is a potential target for intervention. We tested whether elevated FGF?23 is associated with incident coronary heart disease, heart failure, and cardiovascular mortality, even at normal kidney function. Methods and Results A total of 11 638 Atherosclerosis Risk In Communities study participants, median age 57 at baseline (1990–1992), were followed through 2010. Cox regression was used to evaluate the independent association of baseline serum active FGF?23 with incident outcomes. Models were adjusted for traditional cardiovascular risk factors and estimated glomerular filtration rate. During a median follow?up of 18.6 years, 1125 participants developed coronary heart disease, 1515 developed heart failure, and 802 died of cardiovascular causes. For all 3 outcomes, there was a threshold, whereby FGF?23 was not associated with risk at <40 pg/mL but was positively associated with risk at >40 pg/mL. Compared with those with FGF?23 <40 pg/mL, those in the highest FGF?23 category (?58.8 pg/mL) had a higher risk of incident coronary heart disease (adjusted hazard ratio, 95% CIs: 1.65, 1.40 to 1.94), heart failure (1.75, 1.52 to 2.01), and cardiovascular mortality (1.65, 1.36 to 2.01). Associations were modestly attenuated but remained statistically significant after further adjustment for estimated glomerular filtration rate. In stratified analyses, similar results were observed in African Americans and among persons with normal kidney function. Conclusions High levels of serum FGF?23 were associated with increased risk of coronary heart disease, heart failure, and cardiovascular mortality in this large, biracial, population?based cohort. This association was independent of traditional cardiovascular risk factors and kidney function. PMID:24922628

  9. Protective effects of hydroalcoholic extract from rhizomes of Cynodon dactylon (L.) Pers. on compensated right heart failure in rats

    Microsoft Academic Search

    Alireza Garjani; Arash Afrooziyan; Hossein Nazemiyeh; Moslem Najafi; Ali Kharazmkia; Nasrin Maleki-Dizaji

    2009-01-01

    BACKGROUND: The rhizomes of Cynodon dactylon are used for the treatment of heart failure in folk medicine. In the present study, we investigated the effects of hydroalcoholic extract of C. dactylon rhizomes on cardiac contractility in normal hearts and on cardiac functions in right-heart failure in rats. METHODS: Right-heart failure was induced by intraperitoneal injection of monocrotaline (50 mg\\/kg). Two

  10. Treatment of anemia with darbepoetin alfa in heart failure.

    PubMed

    Abraham, William T; Anand, Inder S; Klapholz, Marc; Ponikowski, Piotr; Scarlata, Debra; Wasserman, Scott M; van Veldhuisen, Dirk J

    2010-01-01

    Anemia is common in heart failure (HF) patients. A prespecified pooled analysis of 2 randomized, double-blind, placebo-controlled studies evaluated darbepoetin alfa (DA) in 475 anemic patients with HF (hemoglobin [Hb], 9.0-12.5 g/dL). DA was administered subcutaneously every 2 weeks and titrated to achieve and maintain a target Hb level of 14.0+/-1.0 g/dL. By week 27, mean (SD) Hb concentrations did not increase with placebo but increased with DA from 11.5 (0.7) to 13.3 (1.3) g/dL. Hazard ratios (HRs) for DA compared with placebo for all-cause death or first HF hospitalization (composite end point), all-cause death, and HF hospitalization by month 12 were 0.67 (95% confidence interval [CI], 0.44-1.03; P=.067), 0.76 (95% CI, 0.39-1.48; P=.419), and 0.66 (95% CI, 0.40-1.07; P=.093), respectively. Incidence of adverse events was similar in both groups. In post hoc analyses, improvement in the composite end point was significantly associated with the mean Hb change from baseline (adjusted HR, 0.40; P=.017) with DA treatment. There was no increased risk of all-cause mortality or first HF hospitalization with DA in patients with reduced renal function or elevated baseline B-type natriuretic peptide, a biomarker of worse HF. These results suggest that DA is well tolerated, corrects HF-associated anemia, and may have favorable effects on clinical outcomes. PMID:20557327

  11. Predictors of Overall Perceived Health in Patients with Heart Failure

    PubMed Central

    Beverly, Carlson; Pozehl, Bunny; Hertzog, Melody; Zimmerman, Lani; Riegel, Barbara

    2012-01-01

    BACKGROUND Overall perceived health (OPH) is a powerful and independent predictor of negative health outcomes and low health-related quality of life. OPH is conspicuously low in patients with heart failure (HF). OBJECTIVE The purpose of this study was to determine the key predictors of OPH in persons with HF and explore possible mediating relationships. METHODS This cross-sectional predictive correlational study was a secondary analysis of an existing dataset. Individual characteristics, biophysiological variables, physical symptoms, psychological symptoms, and physical and social functioning were identified from the Wilson and Cleary Model and tested as predictors of OPH in a five-step hierarchical regression analysis. RESULTS The sample (n=265) was primarily male (64.2%), white (61.9%), with a mean age of 62 years, at least a high school education, and a household income enough or more than enough to meet needs. Most (69.1%) had systolic dysfunction, and 78.5% were NYHA III or IV. The final model containing 15 predictors explained 39.2% of the variance in OPH. Six variables were significant independent predictors of OPH: perceived sufficiency of income, social functioning, comorbid burden, symptom stability, race, and the interaction of gender and social functioning, the last indicating social functioning as a stronger predictor for males than for females. In a multiple mediation analysis, the effects of shortness of breath and fatigue on OPH were mediated by physical and social functioning. Gender moderated the effect of fatigue through social functioning. CONCLUSIONS These variables explained a significant portion of the variance in OPH and can be used to target individuals at risk for low OPH and to tailor interventions. If OPH is low, a focus on patient symptoms and ability to participate in life activities is appropriate, with particular attention to social functioning in men. PMID:22495800

  12. Management of the Cardiorenal Syndrome in Decompensated Heart Failure

    PubMed Central

    Verbrugge, Frederik Hendrik; Grieten, Lars; Mullens, Wilfried

    2014-01-01

    Background The management of the cardiorenal syndrome (CRS) in decompensated heart failure (HF) is challenging, with high-quality evidence lacking. Summary The pathophysiology of CRS in decompensated HF is complex, with glomerular filtration rate (GFR) and urine output representing different aspects of kidney function. GFR depends on structural factors (number of functional nephrons and integrity of the glomerular membrane) versus hemodynamic alterations (volume status, renal perfusion, arterial blood pressure, central venous pressure or intra-abdominal pressure) and neurohumoral activation. In contrast, urine output and volume homeostasis are mainly a function of the renal tubules. Treatment of CRS in decompensated HF patients should be individualized based on the underlying pathophysiological processes. Key Messages Congestion, defined as elevated cardiac filling pressures, is not a surrogate for volume overload. Transient decreases in GFR might be accepted during decongestion, but hypotension must be avoided. Paracentesis and compression therapy are essential to remove fluid overload from third spaces. Increasing the effective circulatory volume improves renal function when cardiac output is depressed. As mechanical support is invasive and inotropes are related to increased mortality, afterload reduction through vasodilator therapy remains the preferred strategy in patients who are normo- or hypertensive. Specific therapies to augment renal perfusion (rolofylline, dopamine or nesiritide) have rendered disappointing results, but recently, serelaxin has been shown to improve renal function, even with a trend towards reduced all-cause mortality in selected patients. Diuretic resistance is associated with worse outcomes, independent of the underlying GFR. Combinational diuretic therapy, with ultrafiltration as a bail-out strategy, is indicated in case of diuretic resistance. PMID:25737682

  13. Pulmonary hypertension in heart failure with preserved ejection fraction.

    PubMed

    Guazzi, Marco; Gomberg-Maitland, Mardi; Arena, Ross

    2015-03-01

    In heart failure with preserved ejection fraction (HFpEF), an entity that remains challenging and difficult to treat, the development of pulmonary hypertension (PH), via an increase in left atrial pressure, is the direct consequence of reduced relaxation and enhanced stiffness of the left ventricle and is now viewed as an important contributor to clinical worsening and increased mortality. PH becomes a relevant clinical phenotype in approximately 50% of patients with HFpEF and represents a true challenge in the clinical follow-up and management of these patients. Along with these epidemiologic insights, there has been increasing recognition of the pathophysiology of PH and its consequences on the right ventricle in patients with HFpEF. Novel and effective therapeutic interventions aimed at preventing and reversing PH are highly relevant in the attempt to modify the poor clinical trajectory and growing health care burden of HFpEF. Many theoretical rationales as well as progressively accumulating evidence support the usefulness of nitric oxide pathway-potentiating compounds in targeting the lung vasculature through phosphodiesterase 5 inhibitors or guanylate cyclase stimulators to produce vasodilation and potentially a biologic effect. These pharmacologic strategies may be clinically effective options for the treatment of PH in patients with HFpEF; however, large controlled trials are necessary to address definitively the safety, tolerability, and potential impact on morbidity and mortality. This review details the pathophysiologic process, prevalence, and consequences of HFpEF-associated PH and discusses current and emerging treatment strategies to prevent or treat this deleterious sequela when present. PMID:25577563

  14. The effect of chronic digitalization on pump function in systolic heart failure

    Microsoft Academic Search

    Constantine A. Hassapoyannes; Bruce M. Easterling; Kiran Chavda; Krina K. Chavda; M. Reza Movahed; Gary W. Welch

    Background: Short- and intermediate-term use of cardiac glycosides promotes inotropy and improves the ejection fraction in systolic heart failure. Aim: To determine whether chronic digitalization alters left ventricular function and performance. Ž. Methods: Eighty patients with mild-to-moderate systolic heart failure baseline ejection fraction 45% participated from our Ž institution in a multi-center, chronic, randomized, double-blind study of digitalis vs. placebo.

  15. The 6-min walk and peak oxygen consumption in advanced heart failure: Aerobic capacity and survival

    Microsoft Academic Search

    Caroline Lucas; Lynne Warner Stevenson; Wendy Johnson; Howard Hartley; Michele A. Hamilton; Julie Walden; Virginia Lem; Elizabeth Eagen-Bengsten

    1999-01-01

    Background This study sought to determine to what extent the 6-min walk (6MW) distance in advanced heart failure predicts aerobic capacity and provides comparable information regarding survival. Peak oxygen uptake ( V?O2) and the 6MW both describe function and predict outcome over a wide range of heart failure, but their determinants and implications may differ within a narrower clinical spectrum.

  16. Cardiovascular magnetic resonance in the evaluation of heart failure: a luxury or a need?

    PubMed

    D'Andrea, Antonello; Fontana, Marianna; Cocchia, Rosangela; Scarafile, Raffaella; Calabrò, Raffaele; Moon, James C

    2012-01-01

    Heart failure is a common syndrome with multiple causes. Cardiovascular magnetic resonance (CMR), using the available range of technique, is establishing itself as the gold standard noninvasive test for determining the underlying causes, and adding prognostic value, guiding therapy. Progress is continuing and rapid with promising new techniques such as diffuse fibrosis assessment. This article discusses the diverse roles of CMR in heart failure. PMID:22130042

  17. Vasodilators in the treatment of acute heart failure: what we know, what we don’t

    Microsoft Academic Search

    Marco Metra; John R. Teerlink; Adriaan A. Voors; G. Michael Felker; Olga Milo-Cotter; Beth Weatherley; Howard Dittrich; Gad Cotter

    2009-01-01

    Although we have recently witnessed substantial progress in management and outcome of patients with chronic heart failure,\\u000a acute heart failure (AHF) management and outcome have not changed over almost a generation. Vasodilators are one of the cornerstones\\u000a of AHF management; however, to a large extent, none of those currently used has been examined by large, placebo-controlled,\\u000a non-hemodynamic monitored, prospective randomized

  18. Open access echocardiography in management of the heart failure in the community

    Microsoft Academic Search

    C. M. Francis; L. Caruana; P. Kearney; M. Love; G. R. Sutherland; I. R. Starkey; T. R. D. Shaw; J. J. V. McMurray; J. R. Hampton; A. R. Barlow

    1995-01-01

    AbstractObjective: To assess the value of an open access echocardiography service.Design: Study of new open access service for general practitioners, who were invited to refer patients taking diuretics for suspected heart failure, untreated patients with symptoms of possible heart failure, and asymptomatic patients with risk factors for left ventricular systolic dysfunction.Setting: Regional cardiology centre.Subjects: 259 consecutive patients.Main outcome measures: Presence

  19. General practitioners' reasoning when considering the diagnosis heart failure: a think-aloud study

    PubMed Central

    Skånér, Ylva; Backlund, Lars; Montgomery, Henry; Bring, Johan; Strender, Lars-Erik

    2005-01-01

    Background Diagnosing chronic heart failure is difficult, especially in mild cases or early in the course of the disease, and guidelines are not easily implemented in everyday practice. The aim of this study was to investigate general practitioners' diagnostic reasoning about patients with suspected chronic heart failure in comparison with recommendations in European guidelines. Methods Think-aloud technique was used. Fifteen general practitioners reasoned about six case vignettes, representing authentic patients with suspected chronic heart failure. Information about each case was added successively in five steps. The general practitioners said their thoughts aloud while reasoning about the probability of the patient having chronic heart failure, and tried to decide about the diagnosis. Arguments for and against chronic heart failure were analysed and compared to recommendations in guidelines. Results Information about ejection fraction was the most frequent diagnostic argument, followed by information about cardiac enlargement or pulmonary congestion on chest X-ray. However, in a third of the judgement situations, no information about echocardiography was utilized in the general practitioners' diagnostic reasoning. Only three of the 15 doctors used information about a normal electrocardiography as an argument against chronic heart failure. Information about other cardio-vascular diseases was frequently used as a diagnostic argument. Conclusions The clinical information was not utilized to the extent recommended in guidelines. Some implications of our study are that 1) general practitioners need more information about how to utilize echocardiography when diagnosing chronic heart failure, 2) guidelines ought to give more importance to information about other cardio-vascular diseases in the diagnostic reasoning, and 3) guidelines ought to treat the topic of diastolic heart failure in a clearer way. PMID:15651996

  20. Survival of patients with a new diagnosis of heart failure: a population based study

    Microsoft Academic Search

    M R Cowie; D A Wood; A J S Coats; S G Thompson; V Suresh; P A Poole-Wilson; G C Sutton

    2000-01-01

    OBJECTIVETo describe the survival of a population based cohort of patients with incident (new) heart failure and the clinical features associated with mortality.DESIGNA population based observational study.SETTINGPopulation of 151 000 served by 82 general practitioners in west London.PATIENTSNew cases of heart failure were identified by daily surveillance of acute hospital admissions to the local district general hospital, and by general

  1. Cardiac resynchronisation therapy in patients with heart failure and a normal QRS duration: the RESPOND study

    Microsoft Academic Search

    Paul W X Foley; Kiran Patel; Nick Irwin; John E Sanderson; Michael P Frenneaux; Russell E A Smith; Berthold Stegemann; Francisco Leyva

    2011-01-01

    ObjectivesTo evaluate the clinical response to cardiac resynchronisation therapy (CRT) in patients with heart failure and a normal QRS duration (<120 ms).SettingSingle centre.Patients60 patients with heart failure and a normal QRS duration receiving optimal pharmacological treatment (OPT).InterventionsPatients were randomly assigned to CRT (n=29) or to a control group (OPT, n=31). Cardiovascular magnetic resonance was used in order to avoid scar

  2. Marathoners or couch potatoes: What is the role of exercise in the management of heart failure?

    Microsoft Academic Search

    Eugene E. Wolfel

    2005-01-01

    Patients with chronic heart failure have diminished exercise capacity as a major aspect of their clinical syndrome, regardless\\u000a of the cause of their left ventricular contractile dysfunction. The mechanisms for the reduction in exercise capacity are\\u000a multifactorial and include central cardiac, peripheral vascular, respiratory, and skeletal muscle maladaptations that accompany\\u000a the pathophysiology of heart failure. Increased sympathetic nervous system activity

  3. Standardized Telephonic Case Management in a Hispanic Heart Failure Population: An Effective Intervention

    Microsoft Academic Search

    Barbara Riegel; Beverly Carlson; Dale Glaser; Zoe Kopp; Tomas E. Romero

    2002-01-01

    Background: Heart failure (HF) is as common in Hispanic as it is in non-Hispanic populations. However, there do not appear to be any published reports of HF disease management programs which include Hispanic populations. Objective: To test the effectiveness of a standardized telephonic disease management intervention, Pfizer Inc.'s At Home With Heart Failure(TM), in decreasing acute care resource use and

  4. End-of-Life Options for Patients with Advanced Heart Failure

    Microsoft Academic Search

    Judith Z. Goldfinger; Eric D. Adler

    2010-01-01

    Heart failure is a progressive disease with significant morbidity and mortality, but prognostication often is difficult. Many\\u000a of the evidence-based therapies for heart failure provide symptomatic benefit, but may have intolerable side effects for patients\\u000a with advanced disease. At the end of life, there is evidence of varying strengths for pharmacologic and nonpharmacologic relief\\u000a of common symptoms like dyspnea, fatigue,

  5. Impact of Nesiritide on Renal Function and Mortality in Patients Suffering from Heart Failure

    Microsoft Academic Search

    Ioannis D. Dontas; Theodoros Xanthos; Ismene Dontas; Pavlos Lelovas; Lila Papadimitriou

    2009-01-01

    Introduction  Acutely decompensated congestive heart failure is a major public health problem, with constantly rising prevalence, morbidity,\\u000a mortality and need for hospitalization in both America and Europe. In 2001, the FDA approved the use of the drug nesiritide,\\u000a which is a recombinant form of human brain or B-type natriuretic peptide (BNP) for the treatment of acutely decompensated\\u000a congestive heart failure. In

  6. Is B-type natriuretic peptide-guided heart failure management cost-effective?

    Microsoft Academic Search

    Takeshi Morimoto; Yasuaki Hayashino; Takuro Shimbo; Tohru Izumi; Tsuguya Fukui

    2004-01-01

    Background: Chronic heart failure (CHF) is a common medical problem and B-type natriuretic peptide (BNP)-guided heart failure management for outpatients with symptomatic CHF was found to reduce the readmission rate and mortality, but the costs of treatment may provoke concern in the current cost-conscious clinical setting. Methods: We conducted a cost-effectiveness analysis using a Markov model of regular BNP measurement

  7. Therapeutic and diagnostic role of electrical devices in acute heart failure

    Microsoft Academic Search

    Frieder Braunschweig

    2007-01-01

    Electrical devices, Cardiac Resynchronization Therapy (CRT) pacemakers, the Implantable Cardiac Defibrillator (ICD) and a\\u000a combination of both, constitute an important line of treatment in the therapy of moderate to severe chronic heart failure.\\u000a The effectiveness of these devices in the treatment of acute decompensated heart failure has yet to be systematically evaluated.\\u000a However, the beneficial clinical effects of CRT translate

  8. Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure: Nesiritide Redux

    Microsoft Academic Search

    Adam P. Pleister; Ragavendra R. Baliga; Garrie J. Haas

    2011-01-01

    Nesiritide, a synthetic drug form of human B-type natriuretic peptide, is approved for the early treatment of dyspnea in acute\\u000a decompensated heart failure. Meta-analyses suggested a risk of worsening renal insufficiency and mortality with its use. Therefore,\\u000a the Acute Study of Clinical Effectiveness in Decompensated Heart Failure (ASCEND-HF) was designed as a prospective, multicenter,\\u000a double-blind, randomized trial to examine the

  9. Prognostic importance of comorbidities in heart failure with preserved left ventricular ejection fraction

    Microsoft Academic Search

    Sylvestre Maréchaux; Marie M. Six-Carpentier; Nadia Bouabdallaoui; David Montaigne; Jean Jacques Bauchart; Frédéric Mouquet; Jean Luc Auffray; Thierry Le Tourneau; Philippe Asseman; Thierry H. LeJemtel; Pierre Vladimir Ennezat

    2011-01-01

    The relative impact of comorbidities and parameters of left ventricular diastolic function on clinical outcome has not been\\u000a thoroughly investigated in patients who are hospitalized for heart failure decompensation and found to have preserved ejection\\u000a fraction. We identified 98 HFpEF patients among 1452 patients admitted with acute heart failure. Clinical characteristics,\\u000a hemoglobin levels, estimated glomerular filtration rate (eGFR), B-type natriuretic

  10. Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications

    Microsoft Academic Search

    Eugenio Picano; Luna Gargani; Mihai Gheorghiade

    2010-01-01

    Acute heart failure syndrome (AHFS) is a major public health problem. It is defined as gradual or rapid change in heart failure\\u000a (HF) signs and symptoms, which often results in an unplanned hospitalization and a need for urgent therapy. Many evidence-based\\u000a pharmacologic, device, and surgical treatment for HF are available or under development. Despite these new treatments and\\u000a improvement in

  11. Predictors of oxidative stress in heart failure patients with Cheyne–Stokes respiration

    Microsoft Academic Search

    Ana C. Krieger; Daniel Green; Muriel T. Cruz; Frank Modersitzki; Gita Yitta; Sanja Jelic; Doris S. Tse; Steven P. Sedlis

    Purpose  Cheyne–Stokes respiration during sleep is associated with increased mortality in heart failure. The magnitude of oxidative\\u000a stress is a marker of disease severity and a valuable predictor of mortality in heart failure. Increased oxidative stress\\u000a associated with periodic breathing during Cheyne–Stokes respiration may mediate increased mortality in these patients. We\\u000a hypothesized that the presence of Cheyne–Stokes respiration is associated with

  12. A quality improvement plan to reduce 30-day readmissions of heart failure patients.

    PubMed

    Simpson, Monica

    2014-01-01

    An evidence-based quality initiative to decrease heart failure 30-day readmissions was implemented at a hospital in Florida. Heart failure education and postdischarge telephone contact were provided to patients determined to be at high risk of readmission using risk stratification tools. The rate during the project decreased 13% as compared to the same time period in the previous year and 8.5% from the 2012 year to date rate. PMID:24378289

  13. Effect of a High Protein Diet on Development of Heart Failure in Response to Pressure Overload

    PubMed Central

    Ribeiro, Rogerio F.; Dabkowski, Erinne R.; O’Connell, Kelly A.; Xu, Wenhong; de Fatima Galvao, Tatiana; Hecker, Peter A.; Shekar, Kadambari C.; Stefanon, Ivanita; Stanley, William C.

    2015-01-01

    Heart failure treatment guidelines provide no recommendations regarding the intake of protein, though it has been proposed that increasing protein intake may result in clinical improvement. High protein intake mightimprove protein synthesis and cell function, and prevent deterioration in mitochondrial and left ventricular function. We assessed the effects of a high protein diet on the development of heart failure characterized by cardiac hypertrophy, impaired mitochondrial oxidative metabolism and contractile dysfunction induced by transverse aortic constriction in rats. A standard diet with 18% of energy intake from protein was compared to a high protein diet (30% of energy intake). First we evaluated the effects of protein intake on the development of heart failure during 14 weeks of aortic constriction, and found similar cardiac hypertrophy, contractile dysfunction, ventricular dilation, and decreased cardiac mitochondrial oxidative capacity with both 18% and 30% protein. We then assessed more advanced heart failure, with 22 weeks of aortic constriction. We again saw no difference in cardiac mass, left ventricular volume, mitochondrial oxidative capacity or resistance to permeability transition between the 18% and 30% protein diets. There was a modest but significant decrease in survival with heart failure with the 30% protein diet compared to 18% protein (p<0.003). In conclusion, consumption of a high protein diet did not affect cardiac mass, left ventricular volumes or ejection fraction, or myocardial mitochondrial oxidative capacity in rats with pressure overload induced heart failure, but significantly decreased survival. PMID:24476481

  14. Nutrition Intervention to Decrease Symptoms in Patients With Advanced Heart Failure

    PubMed Central

    Lennie, Terry A.; Moser, Debra. K.; Biddle, Martha J.; Welsh, Darlene; Bruckner, Geza G.; Thomas, D. Travis; Rayens, Mary Kay; Bailey, Alison L.

    2014-01-01

    For a majority of patients with advanced heart failure, there is a need for complementary, non-pharmacologic interventions that could be easily implemented by health care providers to provide palliative care. Three major pathologic pathways underlying heart failure symptoms have been identified: fluid overload, inflammation, and oxidative stress. Prior research has demonstrated that three nutrients-sodium, omega-3 fatty acids, and lycopene-can alter these pathologic pathways. Therefore, the purposes of this study are to test the effects of a 6-month nutrition intervention of dietary sodium reduction combined with supplementation of lycopene and omega-3 fatty acids on heart failure symptoms, health-related quality of life, and time to heart failure rehospitalization or all-cause death. The aims of this double blind-placebo controlled study are (1) to determine the effects of a 6-month nutrition intervention on symptom burden (edema, shortness of air, and fatigue) and health-related quality of life at 3 and 6 months, and time to heart failure rehospitalization or all-cause death over 12 months from baseline; (2) compare dietary sodium intake, inflammation, and markers of oxidative stress between the nutrition intervention group and a placebo group at 3 and 6 months; and (3) compare body weight, serum lycopene, and erythrocyte omega-3 index between the nutrition intervention group and a placebo group at 3 and 6 months. A total of 175 patients with advanced heart failure will be randomized to either the nutrition intervention or placebo group. PMID:23335263

  15. Nutrition intervention to decrease symptoms in patients with advanced heart failure.

    PubMed

    Lennie, Terry A; Moser, Debra K; Biddle, Martha J; Welsh, Darlene; Bruckner, Geza G; Thomas, D Travis; Rayens, Mary Kay; Bailey, Alison L

    2013-04-01

    For a majority of patients with advanced heart failure, there is a need for complementary, non-pharmacologic interventions that could be easily implemented by health care providers to provide palliative care. Three major pathologic pathways underlying heart failure symptoms have been identified: fluid overload, inflammation, and oxidative stress. Prior research has demonstrated that three nutrients-sodium, omega-3 fatty acids, and lycopene-can alter these pathologic pathways. Therefore, the purposes of this study are to test the effects of a 6-month nutrition intervention of dietary sodium reduction combined with supplementation of lycopene and omega-3 fatty acids on heart failure symptoms, health-related quality of life, and time to heart failure rehospitalization or all-cause death. The aims of this double blind-placebo controlled study are (1) to determine the effects of a 6-month nutrition intervention on symptom burden (edema, shortness of air, and fatigue) and health-related quality of life at 3 and 6 months, and time to heart failure rehospitalization or all-cause death over 12 months from baseline; (2) compare dietary sodium intake, inflammation, and markers of oxidative stress between the nutrition intervention group and a placebo group at 3 and 6 months; and (3) compare body weight, serum lycopene, and erythrocyte omega-3 index between the nutrition intervention group and a placebo group at 3 and 6 months. A total of 175 patients with advanced heart failure will be randomized to either the nutrition intervention or placebo group. PMID:23335263

  16. Thioredoxin 1 is Essential for Sodium Sulfide-Mediated Cardioprotection in the Setting of Heart Failure

    PubMed Central

    Nicholson, Chad K.; Lambert, Jonathan P.; Molkentin, Jeffery D.; Sadoshima, Junichi; Calvert, John W.

    2013-01-01

    Objective The aim of this study was to determine if thioredoxin-1 (Trx1) mediates the cardioprotective effects of hydrogen sulfide (H2S) in a model of ischemic-induced heart failure. Approach/Results Mice with a cardiac-specific overexpression of a dominant negative mutant of Trx1 (Tg-DN-Trx1) and wild-type littermates were subjected to ischemic-induced heart failure. Treatment with H2S as sodium sulfide (Na2S) not only increased the gene and protein expression of Trx1 in the absence of ischemia, but also augmented the heart failure-induced increase in both. Wild-type mice treated with Na2S experienced less left ventricular (LV) dilatation, improved LV function, and less cardiac hypertrophy after the induction of heart failure. In contrast, Na2S therapy failed to improve any of these parameters in the Tg-DN-Trx1 mice. Studies aimed at evaluating the underlying cardioprotective mechanisms found that Na2S therapy inhibited heart failure-induced apoptosis signaling kinase-1 (ASK1) signaling and nuclear export of histone deacetylase 4 (HDAC4) in a Trx1-dependent manner. Conclusions These findings provide novel information that the upregulation of Trx1 by Na2S therapy in the setting of heart failure sets into motion events, such as the inhibition of ASK1 signaling and HDAC4 nuclear export, which ultimately leads to the attenuation of LV remodeling. PMID:23349187

  17. Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure

    Microsoft Academic Search

    Emma J. Birks; Patrick D. Tansley; James Hardy; Robert S. George; Christopher T. Bowles; Margaret Burke; Nicholas R. Banner; Asghar Khaghani; Magdi H. Yacoub

    2006-01-01

    Background In patients with severe heart failure, prolonged unloading of the myocardium with the use of a left ventricular assist device has been reported to lead to myocardial re- covery in small numbers of patients for varying periods of time. Increasing the fre- quency and durability of myocardial recovery could reduce or postpone the need for subsequent heart transplantation. Methods

  18. Cardiac magnetic resonance imaging in small animal models of human heart failure

    Microsoft Academic Search

    Matthias Nahrendorf; Karl-Heinz Hiller; Kai Hu; Georg Ertl; Axel Haase; Wolfgang R. Bauer

    2003-01-01

    The aim of this study was to test the feasibility of cine magnetic resonance imaging (MRI) for assessment of the infarcted rat and mouse heart and to compare the results with established methods. These models have been proven to predict genesis and prevention of heart failure in patients. The value of cine MRI was tested in studies investigating interventions to

  19. Amiodarone or an Implantable Cardioverter-Defibrillator for Congestive Heart Failure

    Microsoft Academic Search

    Gust H. Bardy; Kerry L. Lee; Daniel B. Mark; Jeanne E. Poole; Douglas L. Packer; Robin Boineau; Michael Domanski; Charles Troutman; Jill Anderson; Steven E. McNulty; Nancy Clapp-Channing; Linda D. Davidson-Ray; Elizabeth S. Fraulo; Daniel P. Fishbein; Richard M. Luceri; John H. Ip

    2010-01-01

    background Sudden death from cardiac causes remains a leading cause of death among patients with congestive heart failure (CHF). Treatment with amiodarone or an implantable cardio- verter-defibrillator (ICD) has been proposed to improve the prognosis in such patients. methods We randomly assigned 2521 patients with New York Heart Association (NYHA) class II or III CHF and a left ventricular ejection

  20. Six minute walking test for assessing exercise capacity in chronic heart failure

    Microsoft Academic Search

    D P Lipkin; A J Scriven; T Crake; P A Poole-Wilson

    1986-01-01

    Twenty six patients, mean age 58 years (range 36-68), with stable chronic heart failure, New York Heart Association class II-III, and 10 normal subjects of a similar age range were studied. Exercise capacity was assessed by determining oxygen consumption reached during a maximal treadmill exercise test and by measuring the distance each patient walked in six minutes. There were significant

  1. QT dynamicity: a prognostic factor for sudden cardiac death in chronic heart failure

    Microsoft Academic Search

    Atul Pathaka; Daniel Curnierc; J oJlle; Phyllis K. Steine

    Introduction: The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate predicts sudden death in patients with chronic heart failure (CHF). Methods: We prospectively included 175 CHF patients in sinus rhythm. QT dynamicity was evaluated by analyzing 24-h Holter recordings. The linear regression slope of QT interval measured to the

  2. Pharmacological Modulation of Cardiovascular Remodeling: A Guide to Heart Failure Therapy

    Microsoft Academic Search

    W. J. Remme

    2003-01-01

    Cardiac remodeling is a complex process, which involves genetic, molecular and cellular changes in cardiomyocytes and the interstitium, leading to progressive structural and functional alterations, including cardiac dilatation, interstitial fibrosis, and a reduction in contractility and relaxation. As cardiac function worsens, ventricular dysfunction, heart failure and end-stage heart disease are the ultimate consequences.

  3. MLP-Deficient Mice Exhibit a Disruption of Cardiac Cytoarchitectural Organization, Dilated Cardiomyopathy, and Heart Failure

    Microsoft Academic Search

    Silvia Arber; John J Hunter; John Ross; Minoru Hongo; Gilles Sansig; Jacques Borg; Jean-Claude Perriard; Kenneth R Chien; Pico Caroni

    1997-01-01

    MLP is a LIM-only protein of terminally differentiated striated muscle cells, where it accumulates at actin-based structures involved in cytoarchitecture organization. To assess its role in muscle differentiation, we disrupted the MLP gene in mice. MLP (?\\/?) mice developed dilated cardiomyopathy with hypertrophy and heart failure after birth. Ultrastructural analysis revealed dramatic disruption of cardiomyocyte cytoarchitecture. At birth, these hearts

  4. Increasing glucose levels and BMI predict future heart failureExperience from the Reykjavík Study

    Microsoft Academic Search

    I. S. Thrainsdottir; T. Aspelund; V. Gudnason; K. Malmberg; G. Sigurdsson; G. Thorgeirsson; T. Hardarson; L. Rydén

    2007-01-01

    Background: Heart failure is common in diabetes and ischaemic heart disease is the most likely link. Still, it has been suggested that the relation extends beyond such disease. Methods: 7060 subjects with two or more visits in the Reykjavík Study were followed—during 30 years from 1967. All underwent oral glucose tolerance tests. Disease status was defined according to the glycaemic

  5. Risk-benefit assessment of ivabradine in the treatment of chronic heart failure

    PubMed Central

    Urbanek, Irmina; Kaczmarek, Krzysztof; Cygankiewicz, Iwona; Ptaszynski, Pawel

    2014-01-01

    Heart rate is not only a major risk marker in heart failure but also a general risk marker. Within the last few years, it has been demonstrated that reduction of resting heart rate to <70 bpm is of significant benefit for patients with heart failure, especially those with impaired left ventricular systolic function. Ivabradine is the first innovative drug synthesized to reduce heart rate. It selectively and specifically inhibits the pacemaker If ionic current, which reduces cardiac pacemaker activity. Therefore, the main effect of ivabradine therapy is a substantial lowering of heart rate. Ivabradine does not influence intracardiac conduction, contractility, or ventricular repolarization. According to the European Society of Cardiology guidelines, ivabradine should be considered in symptomatic patients (New York Heart Association functional class II–IV) with sinus rhythm, left ventricular ejection fraction ?35%, and heart rate ?70 bpm despite optimal treatment with a beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and a mineralocorticoid receptor antagonist. As shown in numerous clinical studies, ivabradine improves clinical outcomes and quality of life and reduces the risk of death from heart failure or cardiovascular causes. Treatment with ivabradine is very well tolerated and safe, even at maximal recommended doses. PMID:24855390

  6. The Relationship between Leptin and Ventilatory Control in Heart Failure Cundrle: Leptin and ventilation in heart failure

    PubMed Central

    Cundrle, Ivan; Somers, Virend K.; Singh, Prachi; Johnson, Bruce D.; Scott, Christopher G.; Olson, Lyle J.

    2014-01-01

    Background Increased serum leptin concentration has been linked to increased ventilation in patients with mild heart failure (HF). However, in animal models the absence of leptin has also been associated with increased ventilation. This study evaluated the relation of circulating leptin concentration to exercise ventilation in HF patients. Methods and Results Fifty-eight consecutive ambulatory HF patients were stratified by quintiles of leptin concentration including a lowest quintile of mean leptin concentration of 1.8±0.9ng/ml and a highest of 33.3±10.3ng/ml. Peak exercise ventilatory efficiency (V?E/V?CO2) was significantly elevated in the lowest (46±9 vs. 34±6;p<0.01) and also in the highest (38±5 vs. 34±6;p<0.05) leptin concentration quintiles compared to reference (3rd, middle quintile). Multiple regression analysis adjusted for confounders such as age, gender and BMI showed leptin concentration to be independently inversely correlated to V?/V?CO2 in the low-to-normal quintiles (b=?0.64;p<0.01), positively in the normal-to-high quintiles (b=0.52;p=0.02) and positively to PETCO2 in the low-to-normal quintiles (b=0.59;p=0.01) and inversely in the normal-to-high quintiles (b=?0.53;p=0.02). Conclusion In HF patients, both high and low leptin concentrations are associated with increased V?E/V?CO2 and decreased PETCO2 with a non-linear U-shaped relation suggesting either leptin deficiency or leptin resistance may modulate ventilatory control in HF patients. PMID:24263120

  7. Chaotic Signatures of Heart Rate Variability and Its Power Spectrum in Health, Aging and Heart Failure

    PubMed Central

    Wu, Guo-Qiang; Arzeno, Natalia M.; Shen, Lin-Lin; Tang, Da-Kan; Zheng, Da-An; Zhao, Nai-Qing; Eckberg, Dwain L.; Poon, Chi-Sang

    2009-01-01

    A paradox regarding the classic power spectral analysis of heart rate variability (HRV) is whether the characteristic high- (HF) and low-frequency (LF) spectral peaks represent stochastic or chaotic phenomena. Resolution of this fundamental issue is key to unraveling the mechanisms of HRV, which is critical to its proper use as a noninvasive marker for cardiac mortality risk assessment and stratification in congestive heart failure (CHF) and other cardiac dysfunctions. However, conventional techniques of nonlinear time series analysis generally lack sufficient sensitivity, specificity and robustness to discriminate chaos from random noise, much less quantify the chaos level. Here, we apply a ‘litmus test’ for heartbeat chaos based on a novel noise titration assay which affords a robust, specific, time-resolved and quantitative measure of the relative chaos level. Noise titration of running short-segment Holter tachograms from healthy subjects revealed circadian-dependent (or sleep/wake-dependent) heartbeat chaos that was linked to the HF component (respiratory sinus arrhythmia). The relative ‘HF chaos’ levels were similar in young and elderly subjects despite proportional age-related decreases in HF and LF power. In contrast, the near-regular heartbeat in CHF patients was primarily nonchaotic except punctuated by undetected ectopic beats and other abnormal beats, causing transient chaos. Such profound circadian-, age- and CHF-dependent changes in the chaotic and spectral characteristics of HRV were accompanied by little changes in approximate entropy, a measure of signal irregularity. The salient chaotic signatures of HRV in these subject groups reveal distinct autonomic, cardiac, respiratory and circadian/sleep-wake mechanisms that distinguish health and aging from CHF. PMID:19183809

  8. Impact of Sleep-Disordered Breathing on Heart Rate Turbulence in Heart Failure Patients

    PubMed Central

    Yoshihisa, Akiomi; Suzuki, Satoshi; Takiguchi, Mai; Shimizu, Takeshi; Abe, Satoshi; Sato, Takamasa; Yamaki, Takayoshi; Sugimoto, Koichi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-ichi; Takeishi, Yasuchika

    2014-01-01

    Background Sleep-disordered breathing (SDB) is associated with adverse outcomes in patients with chronic heart failure (CHF). Additionally, heart rate turbulence (HRT) reflects changes in the sinus cycle length of baroreceptor in response to hemodynamic fluctuations after ventricular premature beat. Recent studies have suggested that HRT as a marker of vagal activity has a predictive value of poor prognosis in CHF patients. However, little is known about the relationship between SDB and HRT in CHF patients. Methods and Results In this study, 75 patients with CHF were enrolled. We simultaneously performed Holter ECG during a 24-hr period and portable sleep monitoring at nighttime, and determined the respiratory disturbance index (RDI), HRT (turbulence onset (TO) and turbulence slope (TS)) during that 24-hr period. These patients were divided into two groups based on the presence of severe SDB: Group A (RDI?30, n?=?17) and Group B (RDI<30, n?=?58). TS was significantly lower in Group A than in Group B across the 24-hr period (nighttime: 3.6±1.1 vs. 6.9±1.3; daytime: 3.7±0.8 vs. 7.0±1.1; all-day: 3.5±0.7 vs. 6.7±0.9% ms/RR, P<0.05, respectively). TO did not differ between the two groups. Furthermore, there was a significant negative correlation between all-day TS and RDI (R?=?–0.257, P?=?0.027). Moreover, in the multiple regression analysis, RDI was an independent factor to determine all-day TS. Conclusions In patients with severe SDB, blunted TS was observed across 24 hours. These results suggest that SDB induce impairment of vagal activity across a 24-hour period and may be associated with poor prognosis in CHF patients. PMID:24968229

  9. Transmural heterogeneity of cellular level power output is reduced in human heart failure

    PubMed Central

    Haynes, Premi; Nava, Kristofer E.; Lawson, Benjamin A.; Chung, Charles S.; Mitov, Mihail I.; Campbell, Stuart G.; Stromberg, Arnold J.; Sadayappan, Sakthivel; Bonnell, Mark R.; Hoopes, Charles W.; Campbell, Kenneth S.

    2014-01-01

    Heart failure is associated with pump dysfunction and remodeling but it is not yet known if the condition affects different transmural regions of the heart in the same way. We tested the hypotheses that the left ventricles of non-failing human hearts exhibit transmural heterogeneity of cellular level contractile properties, and that heart failure produces transmural region-specific changes in contractile function. Permeabilized samples were prepared from the sub-epicardial, mid-myocardial, and sub-endocardial regions of the left ventricular free wall of non-failing (n=6) and failing (n=10) human hearts. Power, an in vitro index of systolic function, was higher in non-failing mid-myocardial samples (0.59±0.06 ?W mg?1) than in samples from the sub-epicardium (p=0.021) and the sub-endocardium (p=0.015). Non-failing mid-myocardial samples also produced more isometric force (14.3±1.33 kN m?2) than samples from the sub-epicardium (p=0.008) and the sub-endocardium (p=0.026). Heart failure reduced power (p=0.009) and force (p=0.042) but affected the mid-myocardium more than the other transmural regions. Fibrosis increased with heart failure (p=0.021) and mid-myocardial tissue from failing hearts contained more collagen than matched sub-epicardial (p<0.001) and sub-endocardial (p=0.043) samples. Power output was correlated with the relative content of actin and troponin I, and was also statistically linked to the relative content and phosphorylation of desmin and myosin light chain- 1. Non-failing human hearts exhibit transmural heterogeneity of contractile properties. In failing organs, region-specific fibrosis produces the greatest contractile deficits in the mid-myocardium. Targeting fibrosis and sarcomeric proteins in the mid-myocardium may be particularly effective therapies for heart failure. PMID:24560668

  10. Transmural heterogeneity of cellular level power output is reduced in human heart failure.

    PubMed

    Haynes, Premi; Nava, Kristofer E; Lawson, Benjamin A; Chung, Charles S; Mitov, Mihail I; Campbell, Stuart G; Stromberg, Arnold J; Sadayappan, Sakthivel; Bonnell, Mark R; Hoopes, Charles W; Campbell, Kenneth S

    2014-07-01

    Heart failure is associated with pump dysfunction and remodeling but it is not yet known if the condition affects different transmural regions of the heart in the same way. We tested the hypotheses that the left ventricles of non-failing human hearts exhibit transmural heterogeneity of cellular level contractile properties, and that heart failure produces transmural region-specific changes in contractile function. Permeabilized samples were prepared from the sub-epicardial, mid-myocardial, and sub-endocardial regions of the left ventricular free wall of non-failing (n=6) and failing (n=10) human hearts. Power, an in vitro index of systolic function, was higher in non-failing mid-myocardial samples (0.59±0.06?Wmg(-1)) than in samples from the sub-epicardium (p=0.021) and the sub-endocardium (p=0.015). Non-failing mid-myocardial samples also produced more isometric force (14.3±1.33kNm(-2)) than samples from the sub-epicardium (p=0.008) and the sub-endocardium (p=0.026). Heart failure reduced power (p=0.009) and force (p=0.042) but affected the mid-myocardium more than the other transmural regions. Fibrosis increased with heart failure (p=0.021) and mid-myocardial tissue from failing hearts contained more collagen than matched sub-epicardial (p<0.001) and sub-endocardial (p=0.043) samples. Power output was correlated with the relative content of actin and troponin I, and was also statistically linked to the relative content and phosphorylation of desmin and myosin light chain-1. Non-failing human hearts exhibit transmural heterogeneity of contractile properties. In failing organs, region-specific fibrosis produces the greatest contractile deficits in the mid-myocardium. Targeting fibrosis and sarcomeric proteins in the mid-myocardium may be particularly effective therapies for heart failure. PMID:24560668

  11. Complexity of program and clinical outcomes of heart failure disease management incorporating specialist nurse-led heart failure clinics. A meta-regression analysis

    Microsoft Academic Search

    Christopher O. Phillips; Ramesh M. Singa; Haya R. Rubin

    Objectives: To determine whether a hierarchy of effectiveness exists with respect to complexity of published protocols of heart failure (HF) disease management (DM) incorporating specialist nurse-led HF clinics. Data sources and study selection: We searched MEDLINE (1966-November 2004), the Cochrane Library, article bibliographies, and contacted experts. Inclusion criteria were random allocation of at least 100 patients, specialist HF nurses, HF

  12. Torasemide: A Pharmacoeconomic Review of its Use in Chronic Heart Failure

    Microsoft Academic Search

    Melissa Young; Greg L. Plosker

    2001-01-01

    Torasemide is a loop diuretic used for the treatment of hypertension and for oedema in chronic heart failure (CHF), renal failure and cirrhosis. The efficacy of torasemide in reducing salt and water retention in CHF has been established in double-blind comparative studies against furosemide. Torasemide has been shown to be at least as effective as furosemide in terms of total

  13. Mechanical Circulatory Support and the Role of LVADs in Heart Failure Therapy

    PubMed Central

    McLarty, Allison

    2015-01-01

    Heart failure is epidemic in the United States with a prevalence of over 5 million. The diagnosis carries a mortality risk of 50% at 5 years rivaling many diagnoses of cancer. Heart transplantation, long the “gold standard” treatment for end stage heart failure unresponsive to maximal medical therapy falls way short of meeting the need with only about 2,000 transplants performed annually in the United States due to donor limitation. Left ventricular devices have emerged as a viable option for patients as both a “bridge to transplantation” and as a final “destination therapy”. PMID:25983564

  14. Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure

    Microsoft Academic Search

    Ran Kornowski; Doron Zeeli; Mordechai Averbuch; Ariel Finkelstein; Doron Schwartz; Menachem Moshkovitz; Baruch Weinreb; Rami Hershkovitz; Dalia Eyal; Michael Miller; Yoram Levo; Amos Pines

    1995-01-01

    The purpose of this study was to examine the impact of intensive home-care surveillance on morbidity rates of elderly patients with severe congestive heart failure. Forty-two patients aged 78 ± 8 years who had severe congestive heart failure (New York Heart Association functional classes III through IV, mean ejection fraction 27% ± 6%), were examined at least once a week

  15. Factors Associated With Isolated Right Heart Failure in Women

    PubMed Central

    Lagat, David K.; DeLong, Allison K.; Wellenius, Gregory A.; Carter, E. Jane; Bloomfield, Gerald S.; Velazquez, Eric J.; Hogan, Joseph; Kimaiyo, Sylvester; Sherman, Charles B.

    2015-01-01

    Background Small observational studies have found that isolated right heart failure (IRHF) is prevalent among women of sub-Saharan Africa. Further, several risk factors for the development of IRHF have been identified. However, no similar studies have been conducted in Kenya. Objective We hypothesized that specific environmental exposures and comorbidities were associated with IRHF in women of western Kenya. Methods We conducted a case-control study at a referral hospital in western Kenya. Cases were defined as women at least 35 years old with IRHF. Control subjects were similarly aged volunteers without IRHF. Exclusion criteria in both groups included history of tobacco use, tuberculosis, or thromboembolic disease. Participants underwent echocardiography, spirometry, 6-min walk test, rest/exercise oximetry, respiratory health interviews, and human immunodeficiency virus (HIV) testing. Home visits were performed to evaluate kitchen ventilation, fuel use, and cook smoke exposure time, all surrogate measures of indoor air pollution (IAP). A total of 31 cases and 65 control subjects were enrolled. Surrogate measures of indoor air pollution were not associated with IRHF. However, lower forced expiratory volume at 1 s percent predicted (adjusted odds ratio [AOR]: 2.02, 95% confidence interval [CI]: 1.27 to 3.20; p = 0.004), HIV positivity (AOR: 40.4, 95% CI: 3.7 to 441; p < 0.01), and self-report of exposure to occupational dust (AOR: 3.9, 95% CI: 1.14 to 14.2; p = 0.04) were associated with IRHF. In an analysis of subgroups of participants with and without these factors, lower kitchen ventilation was significantly associated with IRHF among participants without airflow limitation (AOR: 2.63 per 0.10 unit lower ventilation, 95% CI: 1.06 to 6.49; p = 0.04), without HIV (AOR: 2.55, 95% CI: 1.21 to 5.37; p = 0.02), and without occupational dust exposure (AOR: 2.37, 95% CI: 1.01 to 5.56; p = 0.05). Conclusions In this pilot study among women of western Kenya, lower kitchen ventilation, airflow limitation, HIV, and occupational dust exposure were associated with IRHF, overall or in participant subgroups. Direct or indirect causality requires further study. PMID:25667096

  16. Heart Failure as a Newly Approved Diagnosis for Cardiac Rehabilitation: Challenges and Opportunities.

    PubMed

    Forman, Daniel E; Sanderson, Bonnie K; Josephson, Richard A; Raikhelkar, Jayant; Bittner, Vera

    2015-06-23

    Many see the broadened eligibility of cardiac rehabilitation (CR) to include heart failure with reduced ejection fraction (HFrEF) as a likely catalyst to high CR enrollment and improved care. However, such expectation contrasts with the reality that CR enrollment of eligible coronary heart disease patients has remained low for decades. In this review, entrenched obstacles impeding utilization of CR are considered, particularly in relation to potential HFrEF management. The strengths and limitations of the HF-ACTION (Heart Failure-A Controlled Trial Investigating Outcomes of Exercise Training) trial to advance precepts of CR are considered, as well as gaps that this trial failed to address, such as the utility of CR for patients with heart failure with preserved ejection fraction and the conundrum of poor patient adherence. PMID:26088305

  17. Sensitivity and specificity of NT-proBNP to detect heart failure at post mortem examination

    Microsoft Academic Search

    Sara Sabatasso; Paul Vaucher; Marc Augsburger; Nicolas Donzé; Patrice Mangin; Katarzyna Michaud

    NT-proBNP, a marker of cardiac failure, has been shown to be stable in post mortem samples. The aim of this study was to assess\\u000a the accuracy of NT-proBNP to detect heart failure in the forensic setting. One hundred sixty-eight consecutive autopsies were\\u000a included in the study. NT-proBNP blood concentrations were measured using a chemiluminescent immunoassay kit. Cardiac failure\\u000a was assessed

  18. Ischemia and reperfusion-induced arrhythmias in rabbits with chronic heart failure.

    PubMed

    Bril, A; Forest, M C; Gout, B

    1991-08-01

    The incidence of ventricular arrhythmias occurring during acute myocardial ischemia and reperfusion was studied in anesthetized rabbits with chronic heart failure. Cardiac failure was induced by volume and pressure overload and was characterized by marked hypertrophy (84%) and lower systolic aortic blood pressure (112 +/- 3 mmHg) than in controls (124 +/- 2 mmHg, P less than 0.01). During the first 20 min postcoronary artery ligation, the incidence and duration of ventricular fibrillation were greater in the heart failure group (76% and 485 +/- 77 s, respectively) compared with the control group (27% and 86 +/- 37 s, respectively, P less than 0.01). Reperfusion-induced arrhythmias after various ischemic durations were also more frequent in the heart failure group than in the control group. Papillary muscles taken from rabbits with heart failure showed a reduced diastolic potential and a prolonged action potential duration (APD90) compared with the control group (by 7 and 46%, respectively), but there was no change in maximum upstroke velocity. The present study established that rabbits with pronounced morphological signs of chronic heart failure have an enhanced susceptibility to ischemia and reperfusion-induced arrhythmias. As already described in situations of uncomplicated cardiac hypertrophy, a delay in the repolarization process could represent an arrhythmogenic mechanism in this model. PMID:1877658

  19. Iron therapy for the treatment of iron deficiency in chronic heart failure: intravenous or oral?

    PubMed

    McDonagh, Theresa; Macdougall, Iain C

    2015-03-01

    This article considers the use and modality of iron therapy to treat iron deficiency in patients with heart failure, an aspect of care which has received relatively little attention compared with the wider topic of anaemia management. Iron deficiency affects up to 50% of heart failure patients, and is associated with poor quality of life, impaired exercise tolerance, and mortality independent of haematopoietic effects in this patient population. The European Society of Cardiology Guidelines for heart failure 2012 recommend a diagnostic work-up for iron deficiency in patients with suspected heart failure. Iron absorption from oral iron preparations is generally poor, with slow and often inefficient iron repletion; moreover, up to 60% of patients experience gastrointestinal side effects. These problems may be exacerbated in heart failure due to decreased gastrointestinal absorption and poor compliance due to pill burden. Evidence for clinical benefits using oral iron is lacking. I.v. iron sucrose has consistently been shown to improve exercise capacity, cardiac function, symptom severity, and quality of life. Similar findings were observed recently for i.v. ferric carboxymaltose in patients with systolic heart failure and impaired LVEF in the double-blind, placebo-controlled FAIR-HF and CONFIRM-HF trials. I.v. iron therapy may be better tolerated than oral iron, although confirmation in longer clinical trials is awaited. Routine diagnosis and management of iron deficiency in patients with symptomatic heart failure regardless of anaemia status is advisable, and, based on current evidence, prompt intervention using i.v. iron therapy should now be considered. PMID:25639592

  20. Effectiveness of ?-Blockers in Heart Failure With Left Ventricular Systolic Dysfunction and Chronic Kidney Disease

    PubMed Central

    CHANG, TARA I.; YANG, JINGRONG; FREEMAN, JAMES V.; HLATKY, MARK A.; GO, ALAN S.

    2014-01-01

    Background Establishing medication effectiveness outside of a randomized trial requires careful study design to mitigate selection bias. Previous observational studies of ?-blockers in patients with chronic kidney disease and heart failure have had methodologic limitations that may have introduced bias. We examined whether initiation of ?-blocker therapy was associated with better outcomes among patients with chronic kidney disease and newly diagnosed heart failure with left ventricular systolic dysfunction. Methods and Results We identified 668 adults in the Kaiser Permanente Northern California system from 2006 to 2008 with chronic kidney disease, incident heart failure, left ventricular systolic dysfunction, and no previous ?-blocker use. We defined chronic kidney disease as estimated glomerular filtration rate <60 mL min?1 1.73 m?2 or proteinuria, and we excluded patients receiving dialysis. We used extended Cox regression to assess the association of treatment with death and the combined end point of death or heart failure hospitalization. Initiation of ?-blocker therapy was associated with a significantly lower crude risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.35–0.63), but this association was attenuated and no longer significant after multivariable adjustment (HR 0.75, CI 0.51–1.12). ?-Blocker therapy was significantly associated with a lower risk of death or heart failure hospitalization even after adjustment for potential confounders (HR 0.67, CI 0.51–0.88). Conclusions ?-Blocker therapy is associated with lower risk of death or heart failure hospitalization among patients with chronic kidney disease, incident heart failure, and left ventricular systolic dysfunction. PMID:23482078

  1. Phosphoproteomic Profiling of Human Myocardial Tissues Distinguishes Ischemic from Non-Ischemic End Stage Heart Failure

    PubMed Central

    Njoroge, Linda W.; Thompson, J. Will; Soderblom, Erik J.; Feger, Bryan J.; Troupes, Constantine D.; Hershberger, Kathleen A.; Ilkayeva, Olga R.; Nagel, Whitney L.; Landinez, Gina P.; Shah, Kishan M.; Burns, Virginia A.; Santacruz, Lucia; Hirschey, Matthew D.; Foster, Matthew W.; Milano, Carmelo A.; Moseley, M. Arthur; Piacentino, Valentino; Bowles, Dawn E.

    2014-01-01

    The molecular differences between ischemic (IF) and non-ischemic (NIF) heart failure are poorly defined. A better understanding of the molecular differences between these two heart failure etiologies may lead to the development of more effective heart failure therapeutics. In this study extensive proteomic and phosphoproteomic profiles of myocardial tissue from patients diagnosed with IF or NIF were assembled and compared. Proteins extracted from left ventricular sections were proteolyzed and phosphopeptides were enriched using titanium dioxide resin. Gel- and label-free nanoscale capillary liquid chromatography coupled to high resolution accuracy mass tandem mass spectrometry allowed for the quantification of 4,436 peptides (corresponding to 450 proteins) and 823 phosphopeptides (corresponding to 400 proteins) from the unenriched and phospho-enriched fractions, respectively. Protein abundance did not distinguish NIF from IF. In contrast, 37 peptides (corresponding to 26 proteins) exhibited a ?2-fold alteration in phosphorylation state (p<0.05) when comparing IF and NIF. The degree of protein phosphorylation at these 37 sites was specifically dependent upon the heart failure etiology examined. Proteins exhibiting phosphorylation alterations were grouped into functional categories: transcriptional activation/RNA processing; cytoskeleton structure/function; molecular chaperones; cell adhesion/signaling; apoptosis; and energetic/metabolism. Phosphoproteomic analysis demonstrated profound post-translational differences in proteins that are involved in multiple cellular processes between different heart failure phenotypes. Understanding the roles these phosphorylation alterations play in the development of NIF and IF has the potential to generate etiology-specific heart failure therapeutics, which could be more effective than current therapeutics in addressing the growing concern of heart failure. PMID:25117565

  2. A Randomized Trial of Heart Failure Disease Management in Skilled Nursing Facilities: Design and Rationale

    PubMed Central

    Boxer, Rebecca S.; Dolansky, Mary A.; Bodnar, Christine A.; Singer, Mendel E.; Albert, Jeffery M.; Gravenstein, Stefan

    2013-01-01

    Background Heart failure disease management can improve health outcomes for older community dwelling patients with heart failure. Heart failure disease management has not been studied in skilled nursing facilities, a major site of transitional care for older adults. Methods and Anticipated Results The objective of this trial is to investigate if a heart failure disease management program (HF-DMP) in skilled nursing facilities (SNF) will decrease all-cause rehospitalizations for the first 60 days post SNF admission. The trial is a randomized cluster trial to be conducted in 12 for-profit SNF in the greater Cleveland area. The study population is inclusive of patients with heart failure regardless of ejection fraction but excludes those patients on dialysis and with a life expectancy of 6 months or less. The HF-DMP includes 7 elements considered standard of care for patients with heart failure: documentation of left ventricular function, tracking of weight and symptoms, medication titration, discharge instructions, 7 day follow up appointment post SNF discharge, patient education. The HF-DMP is conducted by a research nurse tasked with adhering to each element of the program and regularly audited to maintain fidelity of the program. Additional outcomes include health status, self-care management, and discharge destination. Conclusion The SNF-Connect Trial is the first trial of its kind to assess if a HF-DMP will improve outcomes for patients in SNFs. This trial will provide evidence on the effectiveness of HF-DMP to improve outcomes for older frail heart failure patients undergoing post-acute rehabilitation. PMID:23871475

  3. Young woman with breast cancer and cardiotoxicity with severe heart failure treated with a HeartMate IITM for nearly 6 years before heart transplantation.

    PubMed

    Sundbom, Per; Hedayati, Elham; Peterzén, Bengt; Granfeldt, Hans; Ahn, Henrik; Hubbert, Laila

    2014-01-01

    Cardiotoxicity is a multifactorial problem, which has emerged with the improvement of cancer therapies and survival. Heart transplantation is relatively contraindicated in patients with breast cancer, until at least 5 years after complete remission. We present a case where a young woman who in 2001, at the age of 31, was diagnosed with breast cancer. She was considered cured, but 4 years later she suffered a relapse. During her second treatment, in 2006, she suffered from severe heart failure. She received a HeartMate II, as a long-term bridge to transplantation and 6 years later she was successfully transplanted. In this case report we discuss the use of mechanical circulatory support in cancer patients with drug-induced heart failure. PMID:25232773

  4. Keeping Fit May Halve Seniors' Heart Failure Risk

    MedlinePLUS

    ... risk, such as not smoking, engaging in moderate physical activity and maintaining a healthy weight," said study author Liana Del Gobbo, a postdoctoral fellow at the Friedman School of Nutrition Science and Policy at Tufts University in Boston. Heart ...

  5. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine.

    PubMed

    Mebazaa, Alexandre; Yilmaz, M Birhan; Levy, Phillip; Ponikowski, Piotr; Peacock, W Frank; Laribi, Said; Ristic, Arsen D; Lambrinou, Ekaterini; Masip, Josep; Riley, Jillian P; McDonagh, Theresa; Mueller, Christian; deFilippi, Christopher; Harjola, Veli-Pekka; Thiele, Holger; Piepoli, Massimo F; Metra, Marco; Maggioni, Aldo; McMurray, John; Dickstein, Kenneth; Damman, Kevin; Seferovic, Petar M; Ruschitzka, Frank; Leite-Moreira, Adelino F; Bellou, Abdelouahab; Anker, Stefan D; Filippatos, Gerasimos

    2015-06-01

    Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to practicing physicians and nurses to manage acute heart failure in the pre-hospital and hospital setting. Criteria of hospitalization and of discharge are described. Gaps in knowledge and perspectives in the management of acute heart failure are also detailed. This consensus paper on acute heart failure might help enable contiguous practice. PMID:25999021

  6. Use of isosorbide dinitrate and hydralazine in African-Americans with heart failure 9 years after the African-American Heart Failure Trial.

    PubMed

    Ferdinand, Keith Copelin; Elkayam, Uri; Mancini, Donna; Ofili, Elizabeth; Piña, Ileana; Anand, Inder; Feldman, Arthur Michael; McNamara, Dennis; Leggett, Christopher

    2014-07-01

    The 2013 American College of Cardiology Foundation/American Heart Association guidelines recommend combined isosorbide dinitrate (ISDN) and hydralazine to reduce mortality and morbidity for African-Americans with symptomatic heart failure (HF) and reduced ejection fraction, currently receiving optimal medical therapy (class I, level A). Nitrates can alleviate HF symptoms, but continuous use is limited by tolerance. Hydralazine may mitigate nitrate tolerance, and the ISDN-hydralazine combination in the Vasodilators in Heart Failure Trial (V-HeFT) I improved survival and exercise tolerance in men with dilated cardiomyopathy or HF with reduced ejection fraction, most notably in self-identified black participants. In the subsequent V-HeFT II, survival was greater with enalapril than with ISDN-hydralazine in the overall cohort, but mortality rate was similar in the enalapril and ISDN-hydralazine groups in the self-identified black patients. Consequently, in the African-American Heart Failure Trial (A-HeFT) in self-identified black patients with symptomatic HF, adding a fixed-dose combination ISDN-hydralazine to modern guideline-based care improved outcomes versus placebo, including all-cause mortality, and led to early trial termination. Hypertension underlies HF, especially in African-Americans; the A-HeFT and its substudies demonstrated not only improvements in echocardiographic parameters, morbidity, and mortality but also a decrease in hospitalizations, potentially affecting burgeoning HF health-care costs. Genetic characteristics may, therefore, determine response to ISDN-hydralazine, and the Genetic Risk Assessment in Heart Failure substudy demonstrated important hypothesis-generating pharmacogenetic data. PMID:24846808

  7. Cardiac SERCA2A/B: therapeutic targets for heart failure.

    PubMed

    Shareef, Mohammad Abrar; Anwer, Lucman A; Poizat, Coralie

    2014-02-01

    Calcium (Ca(2+)) recycling is key for effective relaxation of the cardiac muscle. Failure to properly recycle calcium through the sarcoplasmic reticulum (SR) results in severe impairment of myocardial relaxation and consequently alteration of the "beat-to-beat" heart rhythm and contractile function. The Sarco(Endo)plasmic reticulum Ca(2+) ATPase (SERCA) is instrumental for recycling cytosolic Ca(2+) into the lumen of the SR. Among the many SERCA isoforms identified so far, SERCA2a is restricted to slow-twitch skeletal and cardiac muscle, while SERCA2b is ubiquitously expressed. SERCA2a/b expression and activity are altered in major heart diseases such as ischemic heart disease, cardiomyopathies and congestive heart failure. Restoring adequate SERCA2a/b expression by pharmacological action or gene delivery has emerged as a new approach for the treatment of heart failure. In this review we describe the drugs adopted in clinical practice that activate SERCA2a/b function as well as new promising therapeutic tools using SERCA2 viral gene delivery to improve cardiac function and treat heart failure. PMID:24361307

  8. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

    PubMed Central

    Arnold, J Malcolm O; Liu, Peter; Demers, Catherine; Dorian, Paul; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Howlett, Jonathan G; Ignaszewski, Andrew; Johnstone, David E; Jong, Philip; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Rao, Vivek; Ross, Heather J; Sequeira, Errol J; Svendsen, Anna M; Teo, Koon; Tsuyuki, Ross T; White, Michel

    2006-01-01

    Heart failure remains a common diagnosis, especially in older individuals. It continues to be associated with significant morbidity and mortality, but major advances in both diagnosis and management have occurred and will continue to improve symptoms and other outcomes in patients. The Canadian Cardiovascular Society published its first consensus conference recommendations on the diagnosis and management of heart failure in 1994, followed by two brief updates, and reconvened this consensus conference to provide a comprehensive review of current knowledge and management strategies. New clinical trial evidence and meta-analyses were critically reviewed by a multidisciplinary primary panel who developed both recommendations and practical tips, which were reviewed by a secondary panel. The resulting document is intended to provide practical advice for specialists, family physicians, nurses, pharmacists and others who are involved in the care of heart failure patients. Management of heart failure begins with an accurate diagnosis, and requires rational combination drug therapy, individualization of care for each patient (based on their symptoms, clinical presentation and disease severity), appropriate mechanical interventions including revascularization and devices, collaborative efforts among health care professionals, and education and cooperation of the patient and their immediate caregivers. The goal is to translate best evidence-based therapies into clinical practice with a measureable impact on the health of heart failure patients in Canada. PMID:16450016

  9. Therapeutic patient education in heart failure: do studies provide sufficient information about the educational programme?

    PubMed

    Albano, Maria Grazia; Jourdain, Patrick; De Andrade, Vincent; Domenke, Aukse; Desnos, Michel; d'Ivernois, Jean-François

    2014-05-01

    Therapeutic patient education programmes on heart failure have been widely proposed for many years for heart failure patients, but their efficiency remains questionable, partly because most articles lack a precise programme description, which makes comparative analysis of the studies difficult. To analyse the degree of precision in describing therapeutic patient education programmes in recent randomized controlled trials. Three major recent recommendations on therapeutic patient education in heart failure inspired us to compile a list of 23 relevant items that an 'ideal' description of a therapeutic patient education programme should contain. To discover the extent to which recent studies into therapeutic patient education in heart failure included these items, we analysed 19 randomized controlled trials among 448 articles published in this field from 2005 to 2012. The major elements required to describe a therapeutic patient education programme were present, but some other very important pieces of information were missing in most of the studies we analysed: the patient's educational needs, health literacy, projects, expectations regarding therapeutic patient education and psychosocial status; the educational methodology used; outcomes evaluation; and follow-up strategies. Research into how therapeutic patient education can help heart failure patients will be improved if more precise descriptions of patients, educational methodology and evaluation protocols are given by authors, ideally in a standardized format. PMID:24613089

  10. Frailty syndrome and self-care ability in elderly patients with heart failure

    PubMed Central

    Uchmanowicz, Izabella; Wleklik, Marta; Gobbens, Robbert JJ

    2015-01-01

    Background Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty. Methods The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale. Results Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social). Conclusion The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty. PMID:26028966

  11. [Comparison of American and European (Czech) guidelines for diagnosis and treatment of chronic heart failure].

    PubMed

    Spinar, Jind?ich; Spinarová, Lenka; Vítovec, Ji?í; Ludka, Ond?ej

    2014-04-01

    The new Czech and European recommendations for diagnosis and treatment of heart failure were published in 2012. The American guidelines ACCF/AHA were published in 2013. Main difference between them is presentation of acute and chronic heart failure in the European guidelines while the American and the Czech guidelines include only chronic heart failure. The American recommendations distinguish heart failure with reduced ejection fraction and with remained ejection fraction. In the beginning, the American guidelines introduce A-D classification which doesn´t figure in the European neither Czech guidelines. Class A patients are ill with risk factors, but without heart failure. In contrast, class D patients are decompensated with symptoms in the rest. Epidemiologic data shows interesting results with prevalence about 0.2% in 60-69 years old subjects and 80% in subjects older than 85 years. 5 year mortality is 50%. The American guidelines start to treat class A which is in fact prevention and treatment of risk factors. There is mentioned inevitably treatment of hypertension, both systolic and diastolic which decrease risk of heart failure up to 50%. There is almost no difference in pharmacotherapy. Noteworthy, the American guidelines introduce also ACE inhibitors - fosinopril and quinapril, on the other hand beta-blockers don´t involve nebivolol. Wide range of diuretics are mentioned, some of them aren´t registered in the Czech Republic. European and Czech guidelines involve ivabradin. Neither nesiritid nor levosimendan for inpatients aren´t involved. There is briefly mentioned surgery and cardiac mechanical support, moreover there are references for guidelines for heart transplantation. PMID:24986000

  12. Rnd3 haploinsufficient mice are predisposed to hemodynamic stress and develop apoptotic cardiomyopathy with heart failure.

    PubMed

    Yue, X; Yang, X; Lin, X; Yang, T; Yi, X; Dai, Y; Guo, J; Li, T; Shi, J; Wei, L; Fan, G-C; Chen, C; Chang, J

    2014-01-01

    Rho family guanosine triphosphatase (GTPase) 3 (Rnd3), a member of the small Rho GTPase family, has been suggested to regulate cell actin cytoskeleton dynamics, cell migration, and apoptosis through the Rho kinase-dependent signaling pathway. The biological function of Rnd3 in the heart is unknown. The downregulation of small GTPase Rnd3 transcripts was found in patients with end-stage heart failure. The pathological significance of Rnd3 loss in the transition to heart failure remains unexplored. To investigate the functional consequence of Rnd3 downregulation and the associated molecular mechanism, we generated Rnd3(+/-) haploinsufficient mice to mimic the downregulation of Rnd3 observed in the failing human heart. Rnd3(+/-) mice were viable; however, the mice developed heart failure after pressure overload by transverse aortic constriction (TAC). Remarkable apoptosis, increased caspase-3 activity, and elevated Rho kinase activity were detected in the Rnd3(+/-) haploinsufficient animal hearts. Pharmacological inhibition of Rho kinase by fasudil treatment partially improved Rnd3(+/-) mouse cardiac functions and attenuated myocardial apoptosis. To determine if Rho-associated coiled-coil kinase 1 (ROCK1) was responsible for Rnd3 deficiency-mediated apoptotic cardiomyopathy, we established a double-knockout mouse line, the Rnd3 haploinsufficient mice with ROCK1-null background (Rnd3(+/-/ROCK1-/-)). Again, genetic deletion of ROCK1 partially but not completely rescued Rnd3 deficiency-mediated heart failure phenotype. These data suggest that downregulation of Rnd3 correlates with cardiac loss of function as in heart failure patients. Animals with Rnd3 haploinsufficiency are predisposed to hemodynamic stress. Hyperactivation of Rho kinase activity is responsible in part for the apoptotic cardiomyopathy development. Further investigation of ROCK1-independent mechanisms in Rnd3-mediated cardiac remodeling should be the focus for future study. PMID:24901055

  13. Observational longitudinal cohort study to determine progression to heart failure in a screened community population: the Echocardiographic Heart of England Screening Extension (ECHOES-X) study

    PubMed Central

    Taylor, Clare J; Roalfe, Andrea K; Tait, Lynda; Davis, Russell C; Iles, Rachel; Derit, Marites; Hobbs, F D Richard

    2014-01-01

    Objectives Rescreen a large community cohort to examine the progression to heart failure over time and the role of natriuretic peptide testing in screening. Design Observational longitudinal cohort study. Setting 16 socioeconomically diverse practices in central England. Participants Participants from the original Echocardiographic Heart of England Screening (ECHOES) study were invited to attend for rescreening. Outcome measures Prevalence of heart failure at rescreening overall and for each original ECHOES subgroup. Test performance of N Terminal pro-B-type Natriuretic Peptide (NT-proBNP) levels at different thresholds for screening. Results 1618 of 3408 participants underwent screening which represented 47% of survivors and 26% of the original ECHOES cohort. A total of 176 (11%, 95% CI 9.4% to 12.5%) participants were classified as having heart failure at rescreening; 103 had heart failure with reduced ejection fraction (HFREF) and 73 had heart failure with preserved ejection fraction (HFPEF). Sixty-eight out of 1232 (5.5%, 95% CI 4.3% to 6.9%) participants who were recruited from the general population over the age of 45 and did not have heart failure in the original study, had heart failure on rescreening. An NT-proBNP cut-off of 400?pg/mL had sensitivity for a diagnosis of heart failure of 79.5% (95% CI 72.4% to 85.5%) and specificity of 87% (95% CI 85.1% to 88.8%). Conclusions Rescreening identified new cases of HFREF and HFPEF. Progression to heart failure poses a significant threat over time. The natriuretic peptide cut-off level for ruling out heart failure must be low enough to ensure cases are not missed at screening. PMID:25015472

  14. [Clinical improvement after physical training in patient with severe postinfarction heart failure, who underwent prosthetic heart valve implantation and numerous coronary interventional procedures].

    PubMed

    Smolis B?k, Edyta; Rymuza, Hanna; Zera, Tymoteusz; Kraska, Alicja; D?browski, Rafa?

    2012-01-01

    The case of patient with advanced congestive heart failure, NYHA III, of ischaemic and valvular aetiology and concomitant diseases is presented. Introduction of 6-month, controlled physical training resulted in improvement of health status, exercise performance, ventilation and left ventricular function. Quality of life got significantly better. This aspect of treatment should be considered in majority of patients with heart failure. PMID:22623244

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

    PubMed Central

    Phillips, Kirk T.; Street, W. Nick

    2005-01-01

    The purpose of this study is to determine the best prediction of heart failure outcomes, resulting from two methods -- standard epidemiologic analysis with logistic regression and knowledge discovery with supervised learning/data mining. Heart failure was chosen for this study as it exhibits higher prevalence and cost of treatment than most other hospitalized diseases. The prevalence of heart failure has exceeded 4 million cases in the U.S.. Findings of this study should be useful for the design of quality improvement initiatives, as particular aspects of patient comorbidity and treatment are found to be associated with mortality. This is also a proof of concept study, considering the feasibility of emerging health informatics methods of data mining in conjunction with or in lieu of traditional logistic regression methods of prediction. Findings may also support the design of decision support systems and quality improvement programming for other diseases. PMID:16779367

  16. Measurement of end points in heart failure trials: jousting at windmills?

    PubMed

    Hauptman, Paul J

    2004-10-01

    Advances in the treatment of congestive heart failure, a condition of increasing incidence and prevalence, have been made possible by knowledge gained from randomized clinical trials. The selection of end points in these trials has become a pivotal step in the drug and device approval process. In part because of the success of earlier trials, the number of study subjects required in order to realize an important improvement in survival has increased. This has led to the development of alternative combined and composite end points, often including surrogates for mortality. The limitations of these end points, the specific challenges associated with studies of patients with decompensated and diastolic heart failure, and other issues encountered during and after completion of heart failure trials, are discussed. PMID:15543430

  17. The effects of resistance exercise on skeletal muscle abnormalities in patients with advanced heart failure.

    PubMed

    King, L

    2001-01-01

    Resistance exercise increases muscular strength and endurance, which prevents injuries associated with musculoskeletal disorders, favorably alters muscle fiber type distribution, and up-regulates the genetic expression of certain enzymes seen in dysfunctional skeletal muscles. Although the benefits of resistance exercise are well documented in the literature, this form of exercise is not routinely recommended for patients with heart failure for fear of symptom exacerbation, and because of poor understanding of how best to prescribe this type of exercise. Because muscle atrophy and deconditioning states are common findings in patients with heart failure, these patients stand to benefit substantially from resistance training because this type of physical activity results in functional adaptations in the neuromuscular system. This article addresses changes in skeletal muscle pathophysiology that occur in patients with heart failure and the potential role resistance training may play in reversing this sequela, and recommends a weight lifting exercise prescription for these patients. PMID:11684905

  18. [Novel possibilities of antithrombotic therapy in patients with chronic heart failure].

    PubMed

    Ol'binskaia, L I; Kolosova, K Iu; Nesterova, S G; Egorova, T D; Fedorova, A Iu

    2005-01-01

    Modern approaches to prevention of venous thromboembolic complications in patients with chronic heart failure are analyzed in this review which contains results of large studies of low molecular weight heparins. In MEDENOX trial the use of enoxaparin in medical patients was associated with 63% reduction of risk of thrombosis. The authors own experience showed that 2 weeks of therapy with enoxaparin in patients with chronic stage IIB-III heart failure caused significant lowering of soluble fibrin-monomer complexes, fibrinogen, and index of turbo-dynamic potential. These changes evidenced for decreased intravascular blood coagulation. Thus enoxaparin can be effectively used for prevention of thrombosis and thromboembolism in patients with chronic heart failure. Novel antithrombotic agents fondaparinux, idraparinux, ximelagatran, recombinant thrombomodulin are perspective medications for prevention of venous thromboses and embolism in medical patients. PMID:16353054

  19. Patient perceptions of quality of life and treatment in an outpatient congestive heart failure clinic.

    PubMed

    Paul, Sara; Sneed, Nancee

    2002-01-01

    In an effort to better understand patients' definitions of quality of life (QOL) and to determine which tools would be most appropriate for use in future studies, a descriptive study was done in a university-based congestive heart failure clinic. Participants were asked a series of five open-ended questions regarding their perceptions of QOL during recorded interviews. Most patients equated QOL with the ability to perform physical functions in the same way they did before developing heart failure. They grieved for their former abilities and expressed lower self-esteem due to loss of independence from physical limitations. The Short Form-36 and the Minnesota Living With Heart Failure Questionnaire addressed the QOL issues important to our patients. It is important for health care providers to consider the patient's perception of QOL when using quantitative tools for QOL measurement in clinical practice. PMID:11927780

  20. Renin-angiotensin-aldosterone system (RAAS) pharmacogenomics: implications in heart failure management.

    PubMed

    Beitelshees, Amber L; Zineh, Issam

    2010-05-01

    Blockade of the renin-angiotensin-aldosterone system (RAAS) with ACE inhibitors has been a cornerstone of heart failure therapy for over 15 years. More recently, further blockade of RAAS with aldosterone antagonists and angiotensin receptor blockers (ARBs) has been studied. While these therapies have certainly improved outcomes in the treatment of heart failure, morbidity and mortality remain extremely high. Furthermore, polypharmacy and complex regimens of seven medications on average is the norm for management of heart failure. This results in increased costs, patient burden, and uncertainty as to the best course of therapy. The ability to personalize patients' therapeutic regimens using pharmacogenomics has the potential of providing more effective and efficient use of RAAS-modulating medications. This review highlights the implications of major RAAS pharmacogenetic studies, while outlining future directions for translation to practice. PMID:18351457

  1. [Key messages for the initial management of the elderly patient with acute heart failure].

    PubMed

    Martín-Sánchez, F Javier; Rodríguez-Adrada, Esther; Llorens, Pere; Formiga, Francesc

    2015-01-01

    Acute heart failure is a high prevalence geriatric syndrome that has become one of the most frequent causes of visits to emergency departments, as well as hospital admission, and is associated with high morbidity, mortality and functional impairment. There has been an increasing amount of information published in recent years on the initial management of acute heart failure and the results of the short-term outcomes, as well as the natural history of the disease. The objective of this study is to provide several recommendations that should be taken into account in the initial management of the elderly patient with acute heart failure in the emergency departments, and to review the most interesting currently on-going clinical trials. PMID:25959134

  2. Functional Role of Phosphodiesterase 3 in Cardiomyocyte Apoptosis Implication in Heart Failure

    PubMed Central

    Huang, Qunhua; Walsh, Richard A.; Molina, Carlos A.; Zhao, Allan; Sadoshima, Junichi; Blaxall, Burns C.; Berk, Bradford C.; Yan, Chen

    2014-01-01

    Background Myocyte apoptosis plays an important role in pathological cardiac remodeling and the progression of heart failure. cAMP signaling is crucial in the regulation of myocyte apoptosis and cardiac remodeling. Multiple cAMP-hydrolyzing phosphodiesterases (PDEs), such as PDE3 and PDE4, coexist in cardiomyocytes and elicit differential temporal/spatial regulation of cAMP signaling. However, the role of PDE3 and PDE4 in the regulation of cardiomyocyte apoptosis remains unclear. Although chronic treatment with PDE3 inhibitors increases mortality in patients with heart failure, the contribution of PDE3 expression/activity in heart failure is not well known. Methods and Results In this study we report that PDE3A expression and activity were significantly reduced in human failing hearts as well as mouse hearts with chronic pressure overload. In primary cultured cardiomyocytes, chronic inhibition of PDE3 but not PDE4 activity by pharmacological agents or adenovirus-delivered antisense PDE3A promoted cardiomyocyte apoptosis. Both angiotensin II (Ang II) and the ?-adrenergic receptor agonist isoproterenol selectively induced a sustained downregulation of PDE3A expression and induced cardiomyocyte apoptosis. Restoring PDE3A via adenovirus-delivered expression of wild-type PDE3A1 completely blocked Ang II– and isoproterenol-induced cardiomyocyte apoptosis, suggesting the critical role of PDE3A reduction in cardiomyocyte apoptosis. Moreover, we defined a crucial role for inducible cAMP early repressor expression in PDE3A reduction–mediated cardiomyocyte apoptosis. Conclusions Our results suggest that PDE3A reduction and consequent inducible cAMP early repressor induction are critical events in Ang II– and isoproterenol-induced cardiomyocyte apoptosis and may contribute to the development of heart failure. Drugs that maintain PDE3A function may represent an attractive therapeutic approach to treat heart failure. PMID:15867171

  3. Resistance Training Improves Hemodynamic Function, Collagen Deposition and Inflammatory Profiles: Experimental Model of Heart Failure

    PubMed Central

    Alves, Jadson P.; Nunes, Ramiro B.; Stefani, Giuseppe P.; Dal Lago, Pedro

    2014-01-01

    The role of resistance training on collagen deposition, the inflammatory profile and muscle weakness in heart failure remains unclear. Therefore, this study evaluated the influence of a resistance training program on hemodynamic function, maximum strength gain, collagen deposition and inflammatory profile in chronic heart failure rats. Thirty-two male Wistar rats submitted to myocardial infarction by coronary artery ligation or sham surgery were assigned into four groups: sedentary sham (S-Sham, n?=?8); trained sham (T-Sham, n?=?8); sedentary chronic heart failure (S-CHF, n?=?8) and trained chronic heart failure (T-CHF, n?=?8). The maximum strength capacity was evaluated by the one maximum repetition test. Trained groups were submitted to an 8-week resistance training program (4 days/week, 4 sets of 10–12 repetitions/session, at 65% to 75% of one maximum repetition). After 8 weeks of the resistance training program, the T-CHF group showed lower left ventricular end diastolic pressure (P<0.001), higher left ventricular systolic pressure (P<0.05), higher systolic blood pressure (P<0.05), an improvement in the maximal positive derivative of ventricular pressure (P<0.05) and maximal negative derivative of ventricular pressure (P<0.05) when compared to the S-CHF group; no differences were observed when compared to Sham groups. In addition, resistance training was able to reduce myocardial hypertrophy (P<0.05), left ventricular total collagen volume fraction (P<0.01), IL-6 (P<0.05), and TNF-?/IL-10 ratio (P<0.05), as well as increasing IL-10 (P<0.05) in chronic heart failure rats when compared to the S-CHF group. Eight weeks of resistance training promotes an improvement of cardiac function, strength gain, collagen deposition and inflammatory profile in chronic heart failure rats. PMID:25340545

  4. Mathematical Approaches to Predictive Health Monitoring for Heart Failure Patients

    E-print Network

    consists of shortness of breath, pitting edema, enlarged tender liver, engorged neck veins, and pulmonary agents. Twelve variables were from patients' right ventricles via voltage sensors, pressure trans- ducers and oxygen sensors. The twelve observed variables and the medical de#12;nitions are listed below. (1) Heart

  5. Contemporary medical, surgical, and device therapies for end-stage heart failure

    Microsoft Academic Search

    Rajan Krishnamani; Mohamad El-Zaru; David DeNofrio

    2003-01-01

    Opinion statement  Despite recent advances in medical therapy, mortality remains high following the diagnosis of heart failure (HF). Cardiac\\u000a transplantation is still the standard surgical treatment option for highly selected patients with severe end-stage HF; however,\\u000a it is only available to a small percentage of patients. The small number of available donor hearts is an inherent limitation\\u000a on the ability of

  6. Dioxin inhibition of swim bladder development in zebrafish: is it secondary to heart failure?

    PubMed

    Yue, Monica S; Peterson, Richard E; Heideman, Warren

    2015-05-01

    The swim bladder is a gas-filled organ that is used for regulating buoyancy and is essential for survival in most teleost species. In zebrafish, swim bladder development begins during embryogenesis and inflation occurs within 5 days post fertilization (dpf). Embryos exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) before 96 h post fertilization (hpf) developed swim bladders normally until the growth/elongation phase, at which point growth was arrested. It is known that TCDD exposure causes heart malformations that lead to heart failure in zebrafish larvae, and that blood circulation is a key factor in normal development of the swim bladder. The adverse effects of TCDD exposure on the heart occur during the same period of time that swim bladder development and growth occurs. Based on this coincident timing, and the dependence of swim bladder development on proper circulatory development, we hypothesized that the adverse effects of TCDD on swim bladder development were secondary to heart failure. We compared swim bladder development in TCDD-exposed embryos to: (1) silent heart morphants, which lack cardiac contractility, and (2) transiently transgenic cmlc2:caAHR-2AtRFP embryos, which mimic TCDD-induced heart failure via heart-specific, constitutive activation of AHR signaling. Both of these treatment groups, which were not exposed to TCDD, developed hypoplastic swim bladders of comparable size and morphology to those found in TCDD-exposed embryos. Furthermore, in all treatment groups swim bladder development was arrested during the growth/elongation phase. Together, these findings support a potential role for heart failure in the inhibition of swim bladder development caused by TCDD. PMID:25766903

  7. [Right heart failure resulting from pacemaker lead-induced tricuspid valve regurgitation].

    PubMed

    Schroeter, T; Strotdrees, E; Doll, N; Mohr, F W

    2011-06-01

    Pacemaker lead-induced tricuspid valve regurgitation is a severe and often underdiagnosed complication due to the widely variable time interval between implantation and the development of severe tricuspid valve insufficiency with ensuing right heart failure. Complete explantation of inactive pacemaker leads is necessary to avoid permanent damage to right heart structures. If performed in a timely fashion, regression of tricuspid insufficiency can be achieved without additional cardiac procedures. PMID:21547560

  8. Theoretical rationale and practical recommendations for cardiopulmonary exercise testing in patients with chronic heart failure

    Microsoft Academic Search

    Lee Ingle

    2007-01-01

    The syndrome of chronic heart failure (CHF) becomes increasingly prevalent in older patients, and while mortality rates are\\u000a declining in most cardiovascular diseases, both prevalence and mortality in CHF remain high. The heart is unable to meet the\\u000a demands of the skeletal musculature, and symptoms manifest as dyspnoea and signs of fatigue during exercise. The cardiopulmonary\\u000a exercise test (CPET) can

  9. Current status and future expectations for multisite pacing in heart failure

    Microsoft Academic Search

    Eduardo B. Saad; Bruce L. Wilkoff

    2002-01-01

    The number of patients with congestive heart failure (CHF) has achieved astonishing proportions. It is a debilitating and\\u000a usually lethal condition, aside from being responsible for an enormous proportion of health care expenditures. Advances in\\u000a medical therapy have not been sufficient to significantly improve prognosis, and heart transplantation can only benefit a\\u000a minority of patients. Biventricular pacing has emerged as

  10. Dendritic cell–induced autoimmune heart failure requires cooperation between adaptive and innate immunity

    Microsoft Academic Search

    Romeo Ricci; Lukas Hunziker; Michael O Kurrer; Gavin Y Oudit; Tania H Watts; Ivo Sonderegger; Kurt Bachmaier; Manfred Kopf; Urs Eriksson; Josef M Penninger

    2003-01-01

    Genetic susceptibility and autoimmunity triggered by microbial infections are factors implicated in the pathogenesis of dilated cardiomyopathy, the most common cause of heart failure in young patients. Here we show that dendritic cells (DCs) loaded with a heart-specific self peptide induce CD4+ T-cell-mediated myocarditis in nontransgenic mice. Toll-like receptor (TLR) stimulation, in concert with CD40 triggering of self peptide–loaded dendritic

  11. Effects of exercise training in patients with heart failure: The Exercise Rehabilitation Trial (EXERT)

    Microsoft Academic Search

    Robert S. McKelvie; Koon K. Teo; Robin Roberts; Neil McCartney; Dennis Humen; Terence Montague; Katie Hendrican; Salim Yusuf

    2002-01-01

    Background The purpose of this study was to examine the effects of exercise training on functional capacity in patients with heart failure. Methods One hundred eighty-one patients in New York Heart Association class I to III, with ejection fraction <40% and 6-minute walk distance <500 meters, were recruited into a randomized, controlled, single-blind trial comparing 3 months of supervised training,

  12. Assessing patients for catheter ablation during hospitalization for acute heart failure

    Microsoft Academic Search

    Bradley P. KnightJason; Jason T. Jacobson

    2011-01-01

    Heart rhythm problems are common among patients who are hospitalized with acute heart failure (HF). Although it is often difficult\\u000a to determine whether a tachyarrhythmia is the major contributor to an acute HF decompensation or merely a consequence of the\\u000a decompensation, both issues usually need to be addressed. There is also a subset of patients with HF who have a

  13. Tissue Doppler Septal Tei Index Indicates Severity of Illness in Pediatric Patients with Congestive Heart Failure

    PubMed Central

    Mejia, Aura A Sanchez; Simpson, Kathleen E.; Hildebolt, Charles F; Pahl, Elfriede; Matthews, Kathleen L; Rainey, Cheryl A; Canter, Charles E; Jay, Patrick Y; Johnson, Mark C

    2013-01-01

    Background: The Doppler Tei index is an independent predictor of outcomes in adult heart failure. Tissue Doppler imaging (TDI) may be a superior method to measure the Tei index in children, as it is less affected by heart rate variability. We hypothesized that the TDI Tei index reflects severity of illness in pediatric heart failure. Methods: Twenty-five pediatric heart failure patients were prospectively enrolled. Listing for heart transplantation or death were the outcomes used to define severity of illness. Baseline demographics, brain natriuretic peptide (BNP), standard echocardiographic and TDI-derived parameters were analyzed to determine outcome indicators. Results: Ten of the 25 patients (40%) were listed for transplantation. There were no deaths. Multivariate analysis combining age, heart rate, standard echocardiographic parameters, and BNP, resulted in shortening fraction (p=0.002) as the best indicator of listing for transplantation (R2 = 0.32). A second multivariate analysis combining age, heart rate, TDI parameters and BNP, resulted in age (p = 0.03) and septal Tei index (p = 0.03) as the best predictive model (R2 = 0.36). The area under the receiver operating characteristic (ROC) curve for septal Tei index was 0.84 (0.64-0.96, 95% confidence interval) and it was comparable to the ROC curve for shortening fraction, p=0.76. Optimal values of sensitivity (100%) and specificity (60%) were obtained with septal Tei index values > 0.51. Conclusion: The TDI septal Tei index is an indicator of disease severity in pediatric heart failure patients and offers potential advantages in comparison with standard echocardiographic measures of left ventricular ejection. PMID:24061276

  14. Tissue Doppler septal Tei index indicates severity of illness in pediatric patients with congestive heart failure.

    PubMed

    Sanchez Mejia, Aura A; Simpson, Kathleen E; Hildebolt, Charles F; Pahl, Elfriede; Matthews, Kathleen L; Rainey, Cheryl A; Canter, Charles E; Jay, Patrick Y; Johnson, Mark C

    2014-03-01

    The Doppler Tei index is an independent predictor of outcomes in adult heart failure. Tissue Doppler imaging (TDI) may be a superior method to measure the Tei index in children because it is less affected by heart rate variability. We hypothesized that the TDI Tei index reflects severity of illness in pediatric heart failure. Twenty-five pediatric heart failure patients were prospectively enrolled. Listing for heart transplantation or death were the outcomes used to define severity of illness. Baseline demographics, brain natriuretic peptide (BNP), and standard echocardiographic and TDI-derived parameters were analyzed to determine outcome indicators. Ten of the 25 patients (40%) were listed for transplantation. There were no deaths. Multivariate analysis combining age, heart rate, standard echocardiographic parameters, and BNP resulted in shortening fraction (p = 0.002) as the best indicator of listing for transplantation (R(2) = 0.32). A second multivariate analysis combining age, heart rate, TDI parameters, and BNP resulted in age (p = 0.03) and septal Tei index (p = 0.03) as the best predictive model (R(2) = 0.36). The area under the receiver operating characteristic (ROC) curve for septal Tei index was 0.84 (95% confidence interval = 0.64-0.96,), and it was comparable with the ROC curve for shortening fraction, p = 0.76. Optimal values of sensitivity (100%) and specificity (60%) were obtained with septal Tei index values >0.51. The TDI septal Tei index is an indicator of disease severity in pediatric heart failure patients and offers potential advantages compared with standard echocardiographic measures of left-ventricular ejection. PMID:24061276

  15. Cultural implications of managing chronic illness: treating elderly Chinese patients with heart failure.

    PubMed

    Jiang, Ru-Shang; Wu, Shu-Mei; Che, Hui-Lian; Yeh, Mei-Yu

    2013-01-01

    Dietary patterns are associated with morbidity and mortality of heart failure. Volume overload was the most common cause for re-hospitalization for heart failure patients. However, recommended preventive strategies of restricting excessive dietary sodium and fluid intake were found to be in vain. This study looks at the preventive dietary instructions from a cultural context, and examined the effects of sodium and fluid restriction on twelve elderly Chinese patients hospitalized with heart failure through a qualitative design. Four themes emerged from the data: medicine-food homology, salt and sodium as synonymous, activity intolerance but still wanting social connections, and barriers to asking questions. Results suggested that living with heart failure is a complex and changeable process for both patients and caregivers. Many patients reported low levels of understanding concerning their symptoms and heart function deterioration. The findings found that good communication requires cultural sensitivity, objective listening to the patient's narrative, and helping patients find meaning between their experiences and symptom control. PMID:23473648

  16. Heart Failure with Preserved Ejection Fraction: Molecular Pathways of the Aging Myocardium

    PubMed Central

    Loffredo, Francesco S.; Nikolova, Andriana P.; Pancoast, James R.; Lee, Richard T.

    2014-01-01

    Age-related diastolic dysfunction is a major factor in the epidemic of heart failure. In patients hospitalized with heart failure, diastolic heart failure is now as common as systolic heart failure. We now have many successful treatments for HFrEF, while specific treatment options for HFpEF patients remain elusive. The lack of treatments for HFpEF reflects our very incomplete understanding of this constellation of diseases. There are many pathophysiological factors in HFpEF, but aging appears to play an important role. Here we propose that aging of the myocardium is itself a specific pathophysiological process. New insights into the aging heart, including hormonal controls and specific molecular pathways such as microRNAs, are pointing to myocardial aging as a potentially reversible process. While the overall process of aging remains mysterious, understanding the molecular pathways of myocardial aging has never been more important. Unraveling these pathways could lead to new therapies for the enormous and growing problem of HFpEF. PMID:24951760

  17. Effect of Ivabradine on Endothelial Function in Diastolic and Right Heart Failure Patients

    PubMed Central

    Orea-Tejeda, Arturo; Balderas-Muñoz, Karla; Castillo-Martínez, Lilia; Infante-Vázquez, Oscar; Martínez Memije, Raúl; Keirns-Davis, Candace; Dorantes-García, Joel; Narváez-David, René; Vázquez-Ortíz, Zuilma

    2013-01-01

    Background. Ivabradine is an If ion current inhibitor that has proved to reduce mortality in patients with systolic heart failure by slowing heart rate without decreasing myocardial contractility. Photoplethysmography is a simple, low-cost optical technique that can evaluate vascular function and detect changes in blood flow, pulse, and swelling of tissular microvascular space. Objective. To evaluate the effect of ivabradine on endothelial function by photoplethysmography in diastolic and right heart failure patients. Methodology. 15 patients were included (mean age of 78.1 ± 9.2 years) with optimally treated diastolic and right heart failure. They underwent photoplethysmography before and after induced ischemia to evaluate the wave blood flow on the finger, using the maximum amplitude time/total time (MAT/TT) index. Two measurements were made before and after oral Ivabradine (mean 12.5?mg a day during 6 months of followup). Results. In the study group, the MAT/TT index was 29.1 ± 2.2 versus 24.3 ± 3.2 (P = 0.05) in basal recording and 30.4 ± 2.1 versus 23.3 ± 2.9 (P = 0.002), before versus after ischemia and before versus after Ivabradine intervention, respectively. Conclusions. Ivabradine administration improves endothelial function (shear stress) in diastolic and right heart failure patients. PMID:24222884

  18. Appropriateness criteria for cardiovascular imaging use in heart failure: report of literature review.

    PubMed

    Garbi, Madalina; McDonagh, Theresa; Cosyns, Bernard; Bucciarelli-Ducci, Chiara; Edvardsen, Thor; Kitsiou, Anastasia; Nieman, Koen; Lancellotti, Patrizio

    2015-02-01

    The Imaging Task Force appointed by the European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging (EACVI) identified the need to develop appropriateness criteria for the use of cardiovascular imaging in heart failure as a result of continuously increasing demand for imaging in diagnosis, definition of aetiology, follow-up, and treatment planning. This article presents the report of literature review performed in order to inform the process of definition of clinical indications and to aid the decisions of the appropriateness criteria voting panel. The report is structured according to identified common heart failure clinical scenarios. PMID:25550363

  19. [Organizational and managerial model for the patient with chronic heart failure].

    PubMed

    Musca, G; Cauteruccio, M A

    2002-09-01

    Patients with chronic heart failure show a range of care and global therapeutic management problems. The main elements for an efficient management are: hospital-territory integration based on a structured mode of operating and on the healthcare professional/patient relationship; rational continuity in the treatment; multi-disciplinarity of the interventions; the patient's active participation. In the light of these considerations the authors report their own direct experience describing the organizational and management model for patients with chronic heart failure during the various phases of treatment, from the global functional evaluation and treatment program to homecare management integrated with the general practitioner. PMID:12418432

  20. Prevalence of heart failure and left ventricular dysfunction in the general population; The Rotterdam Study

    Microsoft Academic Search

    A. Mosterd; A. W. Hoes; Bruyne de M. C; D. T. Linker; D. E. Grobbee; J. W. Deckers; A. Hofman

    1999-01-01

    AIMS: To determine the prevalence of heart failure and symptomatic as well\\u000a as asymptomatic left ventricular systolic dysfunction in the general\\u000a population. METHODS AND RESULTS: In 5540 participants of the Rotterdam\\u000a Study (age 68.9+\\/-8.7 years, 2251 men) aged 55-95 years, the presence of\\u000a heart failure was determined by assessment of symptoms and signs\\u000a (shortness of breath. ankle oedema and pulmonary