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1

Heart Failure  

MedlinePLUS

... page from the NHLBI on Twitter. What Is Heart Failure? Heart failure is a condition in which the ... underway for Heart Failure, visit www.clinicaltrials.gov . Heart Failure in the News April 9, 2014 Drug does ...

2

Heart Failure  

MedlinePLUS

... Pressure High Blood Pressure Tools & Resources Stroke More Heart Failure Sign Up for Our Heart-Health E-news ... with brochures and downloadable patient information sheets. Downloadable Heart Failure Resources What is Heart Failure? (PDF) How Can ...

3

Heart Failure  

MedlinePLUS

... this? Submit What's this? Submit Button Related CDC Web Sites Heart Disease Stroke High Blood Pressure Salt ... and empower Americans to make heart-healthy choices. Web Sites with More Information About Heart Failure For ...

4

Heart Failure  

MedlinePLUS

... of breath Common causes of heart failure are coronary artery disease, high blood pressure and diabetes. It is more common in people who are 65 years old or older, African Americans, people who are ... treatments fail. NIH: National Heart, Lung, and Blood Institute

5

Living with Heart Failure  

MedlinePLUS

... page from the NHLBI on Twitter. Living With Heart Failure Currently, heart failure has no cure. You'll ... avoid harmful side effects. Take Steps To Prevent Heart Failure From Getting Worse Certain actions can worsen your ...

6

Types of Heart Failure  

MedlinePLUS

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

7

Classes of Heart Failure  

MedlinePLUS

... Blood Pressure Tools & Resources Stroke More Classes of Heart Failure Updated:Dec 17,2014 Doctors usually classify patients' ... is classified: Functional Capacity IV, Objective Assessment A Heart Failure Questions to Ask Your Doctor Use these questions ...

8

Antithrombotics in heart failure  

PubMed Central

Heart failure is a common clinical condition associated with high morbidity and mortality rate despite significant improvements in pharmacotherapy and implementation of medical procedures. Patients with heart failure are at an increased risk of developing arterial and venous thrombosis, which contribute to the high rate of adverse events and fatal outcomes. Many heart failure patients routinely receive antithrombotic therapy due to the presence of a specific indication for its use, like ischemic heart disease or atrial fibrillation. However, there is no solid evidence to support the routine use of antithrombotic agents in all heart failure patients. This article reviews the evidence for using antithrombotic therapy in heart failure patients. PMID:25559833

Mili?i?, Davor; Samardži?, Jure; Petri?evi?, Mate

2014-01-01

9

Heart failure - palliative care  

MedlinePLUS

Chronic heart failure very often gets worse over time. Many people who have heart failure die of the condition. It can be hard ... whether to continue active or aggressive treatment of heart failure. Then, you may want to discuss the option ...

10

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

PubMed Central

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

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

2014-01-01

11

Ejection Fraction Heart Failure Measurement  

MedlinePLUS

... Blood Pressure Tools & Resources Stroke More Ejection Fraction Heart Failure Measurement Updated:Dec 17,2014 The ejection ... was last reviewed on 07/09/2013. Downloadable Heart Failure Resources What is Heart Failure? How Can ...

12

Your Heart Failure Healthcare Team  

MedlinePLUS

Your Heart Failure Healthcare Team Updated:Sep 2,2014 Patients with heart failure may work with multiple healthcare professionals. It's ... during their journey. Visit our Support Network today . Heart Failure Questions to Ask Your Doctor Use these questions ...

13

Heart failure - medicines  

MedlinePLUS

... blockers used for heart failure include carvedilol (Coreg), bisoprolol (Zebeta), and metoprolol (Toprol). Do not abruptly stop ... are: Thiazides. Chlorothiazide (Diuril), chlorthalidone (Hygroton), ... HydroDiuril), and metolazone (Mykrox, Zaroxolyn) Loop diuretics. ...

14

Devices in Heart Failure  

PubMed Central

Congestive heart failure has long been one of the most serious medical conditions in the United States; in fact, in the United States alone, heart failure accounts for 6.5 million days of hospitalization each year. One important goal of heart-failure therapy is to inhibit the progression of congestive heart failure through pharmacologic and device-based therapies. Therefore, there have been efforts to develop device-based therapies aimed at improving cardiac reserve and optimizing pump function to meet metabolic requirements. The course of congestive heart failure is often worsened by other conditions, including new-onset arrhythmias, ischemia and infarction, valvulopathy, decompensation, end-organ damage, and therapeutic refractoriness, that have an impact on outcomes. The onset of such conditions is sometimes heralded by subtle pathophysiologic changes, and the timely identification of these changes may promote the use of preventive measures. Consequently, device-based methods could in the future have an important role in the timely identification of the subtle pathophysiologic changes associated with congestive heart failure. PMID:18612451

Munir, Shahzeb M.; Bogaev, Roberta C.; Sobash, Ed; Shankar, K. J.; Gondi, Sreedevi; Stupin, Igor V.; Robertson, Jillian; Brewer, M. Alan; Casscells, S. Ward; Delgado, Reynolds M.; Ahmed, Amany

2008-01-01

15

Hibernation and Congestive Heart Failure  

Microsoft Academic Search

The most common cause of heart failure is coronary artery disease, and whilst intensive treatment of acute coronary syndromes and myocardial infarction continue to reduce the mortality associated with these conditions, many survivors develop heart failure. In general, heart failure secondary to ischaemic heart disease results from: (i) irreversible myocyte loss due to infarction with scar formation; (ii) chronic left

David P. Dutka; Paolo G. Camici

2003-01-01

16

Primary Prevention of Heart Failure  

PubMed Central

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

Butler, Javed

2012-01-01

17

The Brain in Heart Failure  

Microsoft Academic Search

After atrial fibrillation, heart failure is the second most frequent cardiac association of stroke. Deteriorating left ventricular systolic function appears to increase the risk of cardioembolic stroke in heart failure. Age, hypertension and prior stroke are also risk factors for stroke in heart failure. Since these are risk factors for cerebral and other vascular disease rather than for cardioembolism, embolism

Patrick Pullicino

2004-01-01

18

Electrophysiological Remodeling in Heart Failure  

PubMed Central

Heart failure affects nearly 6 million Americans, with a half-million new cases emerging each year. Whereas up to 50% of heart failure patients die of arrhythmia, the diverse mechanisms underlying heart failure-associated arrhythmia are poorly understood. As a consequence, effectiveness of antiarrhythmic pharmacotherapy remains elusive. Here, we review recent advances in our understanding of heart failure-associated molecular events impacting the electrical function of the myocardium. We approach this from an anatomical standpoint, summarizing recent insights gleaned from pre-clinical models and discussing their relevance to human heart failure. PMID:20096285

Wang, Yanggan; Hill, Joseph A.

2010-01-01

19

Heart Failure in South America  

PubMed Central

Continued assessment of temporal trends in mortality and epidemiology of specific heart failure in South America is needed to provide a scientific basis for rational allocation of the limited health care resources, and strategies to reduce risk and predict the future burden of heart failure. The epidemiology of heart failure in South America was reviewed. Heart failure is the main cause of hospitalization based on available data from approximately 50% of the South American population. The main etiologies of heart failure are ischemic, idiopathic dilated cardiomyopathy, valvular, hypertensive and chagasic etiologies. In endemic areas, Chagas heart disease may be responsible by 41% of the HF cases. Also, heart failure presents high mortality especially in patients with Chagas etiology. Heart failure and etiologies associated with heart failure may be responsible for 6.3% of causes of deaths. Rheumatic fever is the leading cause of valvular heart disease. However, a tendency to reduction of HF mortality due to Chagas heart disease from 1985 to 2006, and reduction in mortality due to HF from 1999 to 2005 were observed in selected states in Brazil. The findings have important public health implications because the allocation of health care resources, and strategies to reduce risk of heart failure should also consider the control of neglected Chagas disease and rheumatic fever in South American countries. PMID:23597301

Bocchi, Edimar Alcides

2013-01-01

20

Heart failure - fluids and diuretics  

MedlinePLUS

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

21

Hypertension and diastolic heart failure  

Microsoft Academic Search

In patients with hypertension, pressure overload leads to left ventricular hypertrophy (LVH), myocardial fibrosis, and impaired\\u000a diastolic filling without systolic dysfunction. Presently, diastolic heart failure accounts for about 50% of the heart failure\\u000a population. Fatigue, dyspnea, reduced exercise tolerance, and peripheral edema are common presenting complaints. As a group,\\u000a patients with diastolic heart failure are older and predominantly female. Diuretics

Alan H. Gradman; J. Travis Wilson

2009-01-01

22

Mitophagy and heart failure.  

PubMed

Cardiac mitochondria are responsible for generating energy in the form of ATP through oxidative phosphorylation and are crucial for cardiac function. Mitochondrial dysfunction is a major contributor to loss of myocytes and development of heart failure. Myocytes have quality control mechanisms in place to ensure a network of functional mitochondria. Damaged mitochondria are degraded by a process called mitochondrial autophagy, or mitophagy, where the organelle is engulfed by an autophagosome and subsequently delivered to a lysosome for degradation. Evidence suggests that mitophagy is important for cellular homeostasis, and reduced mitophagy leads to inadequate removal of dysfunctional mitochondria. In this review, we discuss the regulation of mitophagy and the emerging evidence of the cardioprotective role of mitophagy. We also address the prospect of therapeutically targeting mitophagy to treat patients with cardiovascular disease. PMID:25609139

Shires, Sarah E; Gustafsson, Åsa B

2015-03-01

23

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

E-print Network

CONGESTIVE HEART FAILURE Congestive Heart Failure: Condition in which the heart muscle can not pump enough blood to the body to meet the organs demands. Heart muscle dilatation, muscle fibers hypertrophy, and increased heart rate are the clinical markers of disease progression as the heart attempts to compensate

24

Heart Failure in North America  

PubMed Central

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

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

2013-01-01

25

Heart Failure Questions to Ask Your Doctor  

MedlinePLUS

... Pressure High Blood Pressure Tools & Resources Stroke More Heart Failure Questions to Ask Your Doctor Updated:Apr 2, ... was last reviewed on 08/20/2012." Downloadable Heart Failure Resources What is Heart Failure? (PDF) How Can ...

26

Who Is at Risk for Heart Failure?  

MedlinePLUS

... NHLBI on Twitter. Who Is at Risk for Heart Failure? About 5.8 million people in the United ... underway for Heart Failure, visit www.clinicaltrials.gov . Heart Failure in the News April 9, 2014 Drug does ...

27

Aging, telomeres and heart failure  

PubMed Central

During normal aging, the heart undergoes functional, morphological and cellular changes. Although aging per se does not lead to the expression of heart failure, it is likely that age-associated changes lower the threshold for the manifestation of signs and symptoms of heart failure. In patients, the susceptibility, age of onset and pace of progression of heart failure are highly variable. The presence of conventional risk factors cannot completely explain this variability. Accumulation of DNA damage and telomere attrition results in an increase in cellular senescence and apoptosis, resulting in a decrease in the number and function of cells, contributing to the overall tissue and organ dysfunction. Biological aging, characterized by reduced telomere length, provides an explanation for the highly interindividual variable threshold to express the clinical syndrome of heart failure at some stage during life. In this review, we will elaborate on the current knowledge of aging of the heart, telomere biology and its potential role in the development of heart failure. PMID:20532978

Wong, Liza S. M.; de Boer, Rudolf A.; Huzen, Jardi; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

2010-01-01

28

The pathophysiology of heart failure.  

PubMed

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

Kemp, Clinton D; Conte, John V

2012-01-01

29

Acute decompensated heart failure update.  

PubMed

Acute decompensated heart failure (ADHF) continues to increase in prevalence and is associated with substantial mortality and morbidity including frequent hospitalizations. The American Heart Association is predicting that more than eight million Americans will have heart failure by 2030 and that the total direct costs associated with the disease will rise from $21 billion in 2012 to $70 billion in 2030. The increase in the prevalence and cost of HF is primarily the result of shifting demographics and a growing population. Although many large, randomized, controlled clinical trials have been conducted in patients with chronic heart failure, it was not until recently that a growing number of studies began to address the management of ADHF. It is the intent of this review to update the clinician regarding the evaluation and optimal management of ADHF. PMID:24251454

Teerlink, John R; Alburikan, Khalid; Metra, Marco; Rodgers, Jo E

2015-01-01

30

Heart Failure in Children and Adolescents  

MedlinePLUS

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

31

Heart failure - what to ask your doctor  

MedlinePLUS

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

32

Ventricular Reconstruction Surgery for Congestive Heart Failure  

Microsoft Academic Search

The significant increase in the prevalence of heart failure in the United States has made this disease a major health problem. The continued shortage of donor organs has prevented heart transplantation from becoming an effective solution for the treatment of end-stage heart failure, and as a result, surgical treatments for heart failure have been reexamined. Surgical therapies represent the evolution

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

2004-01-01

33

Pachydermoperiostosis Accompanied by Heart Failure  

PubMed Central

Pachydermoperiostosis or primary hypertrophic osteoarthropathy is an uncommon disease of acromegaloid facial feature, but characterized by unique phenotype (digital clubbing and pachydermia) and distinctive radiographic appearances like periostosis. We experienced a case with complete form of pachydermoperiostosis accompanied by heart failure. He presented with typical features consisting of clubbing with enlargement of the hand, thickening of facial skin and periosteal new bone formation involving lower leg. Echocardiography revealed severely decreased left ventricular systolic function. Treatment with medications resulted in an improvement of cardiac function and symptom. There is no previous report documenting pachydermoperiostosis accompanied by heart failure. We report that case for the first time. PMID:20661338

Shin, Kwen-Chul; Lee, Ki Young; Shin, Mi-Seung; Kim, Sei-Hyun; Jo, Yun Jeong; Park, Yae Min; Ahn, Tae Hoon; Choi, In Suk; Shin, Eak Kyun

2009-01-01

34

The Anemia of Heart Failure  

Microsoft Academic Search

Anemia is common in congestive heart failure (CHF) and is associated with an increased mortality and morbidity. The most likely causes of anemia are chronic kidney disease (CKD) and excessive cytokine production, both of which can cause depression of erythropoietin (EPO) production and bone marrow activity. The cytokines also induce iron deficiency by both reducing gastrointestinal iron absorption and iron

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

2009-01-01

35

Pathophysiology of chronic heart failure  

Microsoft Academic Search

Heart failure is a changing paradigm. The hemodynamic model, which served our needs well from the 1950s through the early 1980s, has now been largely abandoned, except for the management of decompensated patients in the hospital. The pathophysiology is exceedingly complex and involves structural changes, such as loss of myofilaments, apoptosis and disorganization of the cytoskeleton, as well as disturbances

Gary S Francis

2001-01-01

36

Heart Failure: Unique to Older Adults  

MedlinePLUS

... of bed each time you have to urinate. Renal Insufficiency and Heart Failure One of the common conditions that occurs along with heart failure is renal (kidney) insufficiency—a situation in which your kidneys ...

37

How Can I Live with Heart Failure?  

MedlinePLUS

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

38

Cardiotonic Modulation in Heart Failure  

PubMed Central

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

Tang, W. H. Wilson; Huang, Yanming

2014-01-01

39

Management of severe heart failure.  

PubMed

Patients admitted to the hospital with heart failure (HF) include those with new-onset of acute HF and those with acute exacerbation of chronic HF (CHF). In therapy for new-onset acute HF associated with acute myocardial infarction, therapy to inhibit left ventricular (LV) remodeling in the convalescent phase is required in addition to that needed to overcome the acute phase. Hitherto, CHF therapy was aimed at improving LV contractability, whereas more recently the aim has shifted to resting the heart. Most patients with HF should be routinely managed with a combination of 3 types of drugs: a diuretic; an angiotensin converting enzyme inhibitor and/or an angiotensin II receptor blocker; and a beta-blocker. The administration of beta-blockers is of particular importance. For HF unresponsive to medical therapy, non-pharmacological therapies are considered. When a HF patient fails to respond to all available therapies, heart transplantation becomes necessary. Of the 1,000 HF patients admitted to our hospital, two cases received heart transplants. 11 cases were indicated for heart transplantation but died before registration. It should be remembered that although in Japan the possibility of receiving a heart transplant is very low, it is by no means entirely impossible. PMID:19474507

Hiramitsu, Shinya; Miyagishima, Kenji; Kimura, Hisashi; Mori, Kazumasa; Shiino, Kenji; Yamada, Akira; Kato, Shigeru; Kato, Yasuchika; Morimoto, Shin-ichiro; Hishida, Hitoshi; Ozaki, Yukio

2009-06-01

40

Endothelin in congestive heart failure  

Microsoft Academic Search

The endothelin (ET) family of peptides have potent vascular, cardiac and renal actions which may be of pathophysiological importance in congestive heart failure (CHF).In vivo studies with selective and non-selective ET receptor antagonists (11, 12) are required to clarify the role of ET in the pathophysiology of CHF and determine whether anti-ET drugs may be therapeutically useful in CHF. The

M. P. Love; J. J. V. McMurray

1996-01-01

41

Medication adherence in heart failure  

Microsoft Academic Search

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

Paul J. Hauptman

2008-01-01

42

Heart Failure in South Asia  

PubMed Central

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

Sivadasan Pillai, Harikrishnan; Ganapathi, Sanjay

2013-01-01

43

Pediatric Heart Failure in the Developing World.  

PubMed

The exact prevalence of heart failure among children of developing countries is not known, as the data is limited. The relative frequency of different causes of pediatric heart failure varies widely across different countries and even among different parts of large countries like India. Children of developing countries face a double burden of etiologies. Conditions such as congenital heart disease, myocarditis and cardiomyopathies are common causes of pediatric of heart failure. In addition, diseases like rheumatic heart disease, nutritional deficiencies, and other tropical diseases also result in heart failure among children of the developing countries. However, most of the developing countries have low resources and hence management of pediatric heart failure becomes challenging. Advanced therapies for heart failure are rarely used in children of developing countries and cardiac transplant remains a distant dream. PMID:25198734

Ramakrishnan, Sivasubramanian

2014-09-01

44

CLINICAL RESEARCH Heart failure/cardiomyopathy  

E-print Network

RESEARCH Heart failure/cardiomyopathy Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure Jianwen Wang, Dirar SBakey Heart Center, The Methodist Hospital, Houston, TX 77030-2717, USA Received 27 September 2007; revised 15

Duncan, James S.

45

Vital epidemiologic clues in heart failure  

Microsoft Academic Search

The epidemiologic investigation of heart failure evolution by the Framingham Heart Study has provided vital clues concerning the pathogenesis, predisposing conditions, other predictive risk factors, and indicators of deteriorating ventricular function related to the disease. This information is important in the early detection of those susceptible to heart failure who are candidates for preventive measures—of importance because the prevalence of

W. B Kannel

2000-01-01

46

Heart failure in the elderly  

PubMed Central

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

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

2012-01-01

47

[Spironolactone not effective in diastolic heart failure].  

PubMed

The treatment of chronic systolic heart failure has shown important improvements, but there are no evidence-based medical treatment options for patients with diastolic heart failure. A recent elaborate study, the TOPCAT trial, failed to show a beneficial effect of spironolactone on the primary composite endpoint of cardiovascular death or hospital admission for heart failure in patients with heart failure and preserved ejection fraction (HFpEF). After ACE inhibitors and angiotensin receptor blockers, this is the third group of medications that previously showed a beneficial effect in patients with heart failure and a reduced ejection fraction (HFrEF), but failed in HFpEF patients. The difficulties in the study design and in interpreting the results of the TOPCAT study may contribute to this negative conclusion. However, a better understanding of the pathophysiology of HFpEF is needed to find strategies that improve the clinical outcome in patients with diastolic heart failure. PMID:25004789

Voors, Adriaan A

2014-01-01

48

How to use diuretics in heart failure  

Microsoft Academic Search

Opinion statement  Systemic and pulmonary congestion is a central aspect of both acute and chronic heart failure and directly leads to many of\\u000a the clinical manifestations of these syndromes. Therefore, diuretic therapy to treat congestion plays a fundamental role in\\u000a heart failure management. However, although diuretics are the most common drugs prescribed for heart failure, there is limited\\u000a quality evidence to

Elizabeth M. Volz; G. Michael Felker

2009-01-01

49

“Playboy Bunny” Sign of Congestive Heart Failure  

PubMed Central

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

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

2011-01-01

50

"Playboy bunny" sign of congestive heart failure.  

PubMed

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

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

2011-11-01

51

The management of heart failure - an overview  

Microsoft Academic Search

National and international societies have issued guidelines on the management of heart failure: The European Society of Cardiology, WHO, ACC \\/ AHA Task Force Report, US Department of Health and Human Services, German Society of Cardiology. The therapeutic approaches to heart failure have undergone considerable changes during the last few years. The guidelines have to be updated almost yearly due

E. Erdmann

2000-01-01

52

Increased heteroscedasticity of heart rate in fatal heart failure  

NASA Astrophysics Data System (ADS)

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

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

2008-04-01

53

Neurohormonal therapy for congestive heart failure  

Microsoft Academic Search

Guidelines for heart failure management have been published by the American College of Cardiology and the American Heart Association\\u000a in 2001. These guidelines recommend the use of angiotensin-converting enzyme inhibitors and ß blockers to improve the symptoms\\u000a and prognosis of heart failure. Despite being advocated as the cornerstone of medical management, these agents remain underutilized.\\u000a Not only are these drugs

Allison M. Pritchett; Douglas L. Mann

2004-01-01

54

[Right heart failure in chronic pulmonary hypertension and acute pulmonary embolism].  

PubMed

Right-sided heart failure is a severe and often life-threatening complication of chronic pulmonary hypertension. The detection of trigger factors that induce right heart failure in previously stable patients is important to initiate a causal therapeutic strategy. Pulmonary embolism (PE) is a frequent cause of acute right heart failure and therapeutic strategies for PE are well documented in the current guidelines. Treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is surgical pulmonary endarterectomy (PEA) and patients with possible CTEPH should be referred to an experienced PEA surgeon without delay. Intensive care management for overt right heart failure is complex and includes the use of pulmonary vasodilators, individual adjustment of diuretic or volume therapy, augmentation of myocardial contractility and left ventricular afterload. Therapeutic regimens aim at optimized filling of the right ventricle, improvement of myocardial perfusion by avoiding tachycardia, elevating systemic pressure and reducing right ventricular afterload. Early communication with a specialized center for pulmonary hypertension is recommended. PMID:22527663

Voswinckel, R; Hoeper, M M; Kramm, T; Ghofrani, H A

2012-05-01

55

Hyponatremia in patients with heart failure  

PubMed Central

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

Filippatos, Theodosios D; Elisaf, Moses S

2013-01-01

56

Glucagonoma-induced acute heart failure  

PubMed Central

Summary Neuroendocrine tumours (NETs) represent a broad spectrum of tumours, of which the serotonin-producing carcinoid is the most common and has been shown to cause right ventricular heart failure. However, an association between heart failure and NETs other than carcinoid has not been established so far. In this case report, we describe a 51-year-old patient with a glucagon-producing NET of the pancreas who developed acute heart failure and even cardiogenic shock despite therapy. Heart failure eventually regressed after initialising i.v. treatment with the somatostatin analogue octreotide. Chromogranin A as a tumour marker was shown to be significantly elevated, and it decreased with clinical improvement of the patient. The effects of long-time stimulation of glucagon on the myocardium have not been studied yet; however, sarcoplasmic reticulum calcium leak can be discussed as a possible mechanism for glucagon-induced heart failure. Learning points Glucagonoma can be a cause for heart failure. i.v. infusion of octreotide can be successfully used to treat glucagonoma-induced acute heart failure. We suggest that cardiac function should be monitored in all NET patients. PMID:25520848

Lehner, Lukas J; Praeger, Damaris; Baumann, Gert; Knebel, Fabian; Quinkler, Marcus; Roepke, Torsten K

2014-01-01

57

Community management of heart failure.  

PubMed Central

OBJECTIVE: To review therapies for treating patients with heart failure (HF). QUALITY OF EVIDENCE: Recommendations in this paper are mainly based on the results of randomized controlled trials. To a lesser extent, data from smaller, more physiologic studies are included. Where appropriate, recommendations are based on the results of a consensus conference. MAIN MESSAGE: Although pharmacologic therapy is the main strategy for treating HF patients, general measures, such as counseling and advice about regular physical activity, are an important component of management. Use of angiotensin-converting enzyme inhibitors (ACE-I) is central to treating HF patients, because these agents decrease mortality and morbidity significantly. Digoxin does not reduce mortality but does reduce morbidity. Angiotensin II antagonists, although found to provide clinical benefit equal to ACE-I, have not been found as yet to have similar effects on mortality and morbidity. Diuretics and nitrates are useful for treating these patients' symptoms. Calcium channel blockers should generally be avoided. CONCLUSIONS: Angiotensin-converting enzyme inhibitors are the therapy of choice for HF patients and should be used in all cases unless there are contraindications or clear evidence of intolerance. All other therapies are used mainly for symptom relief. PMID:9870122

McKelvie, R. S.

1998-01-01

58

Ca2+ Cycling in Heart Failure  

PubMed Central

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

Luo, Min; Anderson, Mark E.

2013-01-01

59

Metabolic and Signaling Alterations in Dystrophin-Deficient Hearts Precede Overt Cardiomyopathy  

Technology Transfer Automated Retrieval System (TEKTRAN)

The cytoskeletal protein dystrophin has been implicated in hereditary and acquired forms of cardiomyopathy. However, much remains to be learned about the role of dystrophin in the heart. We hypothesized that the dystrophin-deficient heart displays early alterations in energy metabolism that precede ...

60

Advance Care Planning with Heart Failure  

MedlinePLUS

... as a health care power of attorney. Financial Planning Heart failure can be expensive to treat. You ... an Advance Care Plan As part of responsible planning for the future, everyone should make an advance ...

61

Significance of hyponatremia in heart failure  

Microsoft Academic Search

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

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

62

Oxidative stress in congestive heart failure  

Microsoft Academic Search

Heart failure is considered to be a complex clinical syndrome, with alterations in the multiple neurohumoral systems and subcellular\\u000a cardiac sites that correlate with abnormal cardiac function. Strong evidence for the role of oxidative stress in the pathogenesis\\u000a of heart failure has been provided by studies on experimental animals as well as humans. This concept is gaining more acceptance\\u000a due

Pawan K. Singal; Neelam Khaper; Firoozeh Farahmand; Adriane Belló-Klein

2000-01-01

63

Soluble Guanylate Cyclase Modulators in Heart Failure  

Microsoft Academic Search

This review summarizes the role of soluble guanylate cyclase (sGC)-cyclic guanosine 3?, 5?-monophosphate pathways in heart\\u000a failure and several new drugs that modify guanylate cyclase. The sGC activators and stimulators as modulators of sGC are promising\\u000a drugs in the therapy for decompensated heart failure and pulmonary hypertension. Cinaciguat is a nitric oxide (NO)–independent\\u000a direct activator of sGC, which also may

Veselin Mitrovic; Ana Jovanovic; Stefan Lehinant

2011-01-01

64

Diastolic heart failure in the community  

Microsoft Academic Search

Although it is now widely recognized that isolated diastolic dysfunction can lead to the classic signs and symptoms of congestive\\u000a heart failure (CHF), this disease process is poorly understood and remains of great interest and concern to cardiovascular\\u000a disease specialists, as well as to primary care physicians. Recent epidemiologic data have suggested that diastolic heart\\u000a failure is predominantly a disease

Chari Y. T. Hart; Margaret M. Redfield

2000-01-01

65

Heart Failure in Sub-Saharan Africa  

PubMed Central

The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs. PMID:23597299

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

2013-01-01

66

Influence of diabetes mellitus on heart failure risk and outcome  

Microsoft Academic Search

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

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

2003-01-01

67

[Transition of myocardial ischemia to heart failure].  

PubMed

Myocardial ischemia results in myocardial dysfunction. Recovery may be delayed ("stunning"), or persistent if perfusion remains reduced ("hibernation") and ischemia may go on to necrosis, thus, contributing to chronic heart failure. In addition, myocardium not directly affected by ischemia may undergo adaptive processes like hypertrophy and dilatation, which may result in chronic left heart failure. This process is characterized by hemodynamic, neurohumoral, and progressive morphologic changes of the heart which are closely interrelated. Hemodynamic changes basically consist of an increase in left ventricular filling pressure and a decrease in global ejection fraction, and, in most cases years after myocardial infarction, in an increase in systemic vascular resistance and right atrial pressure. Neurohumoral changes consist of an increase in plasma catecholamines, atrial natriuretic factor and vasopressin, and in an activation of the renin-angiotensin-system. Plasma endothelin-1 was recently reported to be increased in patients with heart failure, and prognosis was related to endothelin levels. Diminished response of vessels to endothelium (EDRF/NO) dependent vasodilatation suggests impairment of vascular endothelium in heart failure. Local changes of cardiac neurohumoral systems could contribute to structural changes of the heart, e.g., systemic activation to hemodynamic changes. Structural changes of the heart are characterized by an increase in volume and thickness of surviving myocardium and an expansion of ischemic and necrotic myocardium. Molecular control of these processes which include various cell types, such as cardiomyocytes and cardiofibroblasts, are currently an issue of intense research and could result in specific therapeutic importance. PMID:9816648

Ertl, G; Fraccarollo, D; Gaudron, P; Hu, K; Laser, A; Neubauer, S; Schorb, W

1998-09-01

68

What Are the Signs and Symptoms of Heart Failure?  

MedlinePLUS

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

69

Isolated diastolic heart failure--what is it?  

PubMed Central

Epidemiological evidence suggests that 20 to 40% of all patients with heart failure have normal systolic function. Isolated diastolic dysfunction may be the principle pathophysiological mechanism in these patients. The diagnosis of isolated diastolic heart failure is problematic and not merely based on demonstrating normal systolic function. The prognosis in isolated diastolic heart failure is more favourable than in systolic heart failure. At the present time, there is no licensed treatment for isolated diastolic heart failure and treatment is largely empirical. PMID:9926117

Shiels, P.; MacDonald, T. M.

1998-01-01

70

Early detection of myocardial dysfunction and heart failure.  

PubMed

The impact of cardiac dysfunction and heart failure is continuing to escalate in the developed world. Treatment of this heterogeneous condition has focused on the symptomatic stage, often after irreversible remodeling and functional impairment have occurred. Early identification of cardiac dysfunction would allow implementation of early intervention strategies to delay the progression or to prevent the onset of heart failure altogether. Although screening methods for asymptomatic cardiac dysfunction have yet to be optimized, a staged approach for patients with predisposing risk factors using serological biomarkers followed by noninvasive imaging techniques may be useful. Existing biomarkers for cardiac dysfunction include B-type natriuretic peptide, troponins, and C-reactive protein. Novel markers such as protein ST2, galectin-3, and various prohormones are emerging and may provide prognostic information that is incremental to conventional clinical evaluation. Monitoring myocardial mechanics and molecular processes through three-dimensional speckle tracking and hybrid imaging modalities, such as PET-CT, may provide insight into disease manifestation before overt structural and physiological abnormalities. PMID:20458341

de Couto, Geoffrey; Ouzounian, Maral; Liu, Peter P

2010-06-01

71

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

Microsoft Academic Search

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

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

72

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

Microsoft Academic Search

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

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

2004-01-01

73

Congestive Heart Failure in Women: Focus on Heart Failure due to Coronary Artery Disease and Diabetes  

Microsoft Academic Search

Congestive heart failure (CHF) is an important clinical syndrome. Evidence from several observational studies suggests sex-related differences in the incidence and prognosis of CHF, particularly in the setting of coronary artery disease. Women appear to be more prone than men to develop heart failure late after myocardial infarction as well as in the peri-infarction period. Additionally, diabetes mellitus appears to

Carey Kimmelstiel; Robert J. Goldberg

1990-01-01

74

Heart failure with preserved ejection fraction  

PubMed Central

Abstract Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies.

ElGuindy, Ahmed; Yacoub, Magdi H

2012-01-01

75

Left ventricular diastolic dysfunction in patients with congestive heart failure.  

PubMed Central

This study reviewed 372 male patients with congestive heart failure. Two hundred and eighty-three (77%) had congestive heart failure due to systolic dysfunction as demonstrated by radionuclide angiography. Eighty-seven (23%) with congestive heart failure were identified who had normal ejection fractions. All patients met the Framingham criteria for congestive heart failure. These 87 individuals had unrecognized diastolic heart failure. It is important to distinguish between systolic and diastolic heart failure because the pathophysiology, treatment, and prognosis differ significantly. The most frequent cause of diastolic heart failure in this study was hypertension. Diastolic dysfunction should be considered in patients with acute heart failure and severe uncontrolled hypertension, or in patients with ischemic heart disease who develop acute pulmonary edema. Patients who do not respond or deteriorate when treated for heart failure using conventional therapy may also have diastolic dysfunction. These patients warrant special recognition and tailored management. PMID:1994065

Cregler, L. L.; Georgiou, D.; Sosa, I.

1991-01-01

76

Pharmacogenomics and heart failure in congenital heart disease.  

PubMed

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

de Denus, Simon; Kantor, Paul F

2013-07-01

77

Sudden death prevention in heart failure.  

PubMed

Heart failure is one of the main clinical entities in modern society, with a prevalence of 0.4 to 2% in Europe. It has an adverse prognosis, with 5 to 20% annual mortality, even when properly medicated. Mortality in heart failure is frequently due to sudden death, which means preventive strategies should be adopted. Risk stratification is essential in order to identify which patients will benefit most. The main risk factor for sudden death is low ejection fraction. However, ECG data, Holter monitoring and electrophysiological studies are also useful. In primary prevention, all reversible conditions and precipitating factors should be identified and heart failure treatment optimized. The best preventive strategy, after appropriate patient selection, is ICD implantation. Recently, devices with both cardioversion-defibrillation and cardiac resynchronization have proved beneficial in terms of morbidity, quality of life and survival. PMID:17069438

Machado, Mariana; Falcão, L Menezes; Ravara, Luciano

2006-01-01

78

[Holistic therapy of chronic heart failure].  

PubMed

The rising prevalence and increasing disease-related costs render chronic heart failure a rapidly growing socioeconomic challenge. The concerted action of guideline-adjusted therapy and holistic patient care is essential to achieve improvements in mortality, morbidity, functional status and quality of life of patients with symptomatic heart failure. Holistic care strategies comprise consideration of comorbidities and individual needs, lifestyle recommendations and multidisciplinary management programs for high-risk symptomatic patients in addition to basic medication and surgical therapies. For optimal patient care and coaching, seamless interaction is required between in-hospital treatment and outpatient facilities. Moreover, the palliative needs of heart failure patients need to be considered, a topic that is currently not receiving enough attention. PMID:24806269

Feldmann, C; Ertl, G; Angermann, C E

2014-06-01

79

Vagus nerve stimulation in experimental heart failure  

Microsoft Academic Search

Chronic heart failure (HF) is associated with autonomic dysregulation characterized by a sustained increase in sympathetic\\u000a drive and by withdrawal of parasympathetic activity. Sympathetic overdrive and increased heart rate are predictors of poor\\u000a long-term outcome in patients with HF. Considerable evidence exists that supports the use of pharmacologic agents that partially\\u000a inhibit sympathetic activity as effective long-term therapy for patients

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

2011-01-01

80

From right to left heart failure: an unexpected transition.  

PubMed

Right and left heart failure are very common clinical syndromes with close correlation. Right-sided or right ventricular heart failure usually occurs as a result of left-sided failure. We report a very rare case of transition from right heart failure due to pulmonary embolism, followed by its resolution, to left heart failure due to Tako-tsubo syndrome within 48 h of hospitalization. PMID:24373339

Baydoun, Hassan; Khoueiry, George; Ghandour, Zahraa; Olkovsky, Yefim

2014-01-01

81

Pathomechanisms in heart failure: the contractile connection.  

PubMed

Heart failure is a multi-factorial progressive disease in which eventually the contractile performance of the heart is insufficient to meet the demands of the body, even at rest. A distinction can be made on the basis of the cause of the disease in genetic and acquired heart failure and at the functional level between systolic and diastolic heart failure. Here the basic determinants of contractile function of myocardial cells will be reviewed and an attempt will be made to elucidate their role in the development of heart failure. The following topics are addressed: the tension generating capacity, passive tension, the rate of tension development, the rate of ATP utilisation, calcium sensitivity of tension development, phosphorylation of contractile proteins, length dependent activation and stretch activation. The reduction in contractile performance during systole can be attributed predominantly to a loss of cardiomyocytes (necrosis), myocyte disarray and a decrease in myofibrillar density all resulting in a reduction in the tension generating capacity and likely also to a mismatch between energy supply and demand of the myocardium. This leads to a decline in the ejection fraction of the heart. Diastolic dysfunction can be attributed to fibrosis and an increase in titin stiffness which result in an increase in stiffness of the ventricular wall and hampers the filling of the heart with blood during diastole. A large number of post translation modifications of regulatory sarcomeric proteins influence myocardial function by altering calcium sensitivity of tension development. It is still unclear whether in concert these influences are adaptive or maladaptive during the disease process. PMID:25376563

Stienen, G J M

2014-11-01

82

Nurses's knowledge of heart failure education principles  

Microsoft Academic Search

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

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

2002-01-01

83

Aldosterone and Myocardial Fibrosis in Heart Failure  

Microsoft Academic Search

Cardiac fibroblasts are known to have high affinity corticoid receptors for aldosterone and account for the accumulation of collagen within the interstitium of the rat myocardium in acquired and genetic hypertension. This interstitial fibrosis is an important determinant of pathologic hypertrophy in chronic heart failure. To examine the relationship between aldosterone and myocardial fibrosis, collagen volume fraction of the left

Christian G. Brilla

2000-01-01

84

Combination stem cell therapy for heart failure  

PubMed Central

Patients with congestive heart failure (CHF) that are not eligible for transplantation have limited therapeutic options. Stem cell therapy such as autologous bone marrow, mobilized peripheral blood, or purified cells thereof has been used clinically since 2001. To date over 1000 patients have received cellular therapy as part of randomized trials, with the general consensus being that a moderate but statistically significant benefit occurs. Therefore, one of the important next steps in the field is optimization. In this paper we discuss three ways to approach this issue: a) increasing stem cell migration to the heart; b) augmenting stem cell activity; and c) combining existing stem cell therapies to recapitulate a "therapeutic niche". We conclude by describing a case report of a heart failure patient treated with a combination stem cell protocol in an attempt to augment beneficial aspects of cord blood CD34 cells and mesenchymal-like stem cells. PMID:20398245

2010-01-01

85

Combination stem cell therapy for heart failure.  

PubMed

Patients with congestive heart failure (CHF) that are not eligible for transplantation have limited therapeutic options. Stem cell therapy such as autologous bone marrow, mobilized peripheral blood, or purified cells thereof has been used clinically since 2001. To date over 1000 patients have received cellular therapy as part of randomized trials, with the general consensus being that a moderate but statistically significant benefit occurs. Therefore, one of the important next steps in the field is optimization. In this paper we discuss three ways to approach this issue: a) increasing stem cell migration to the heart; b) augmenting stem cell activity; and c) combining existing stem cell therapies to recapitulate a "therapeutic niche". We conclude by describing a case report of a heart failure patient treated with a combination stem cell protocol in an attempt to augment beneficial aspects of cord blood CD34 cells and mesenchymal-like stem cells. PMID:20398245

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

2010-01-01

86

Remote Monitoring of Heart Failure Patients  

PubMed Central

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

Bhimaraj, Arvind

2013-01-01

87

Mitochondria in cardiac hypertrophy and heart failure  

PubMed Central

Heart failure (HF) frequently is the unfavorable outcome of pathological heart hypertrophy. In contrast to physiological cardiac hypertrophy, which occurs in response to exercise and leads to full adaptation of contractility to the increased wall stress, pathological hypertrophy occurs in response to volume or pressure overload, ultimately leading to contractile dysfunction and HF. Because cardiac hypertrophy impairs the relationship between ATP demand and production, mitochondrial bioenergetics must keep up with the cardiac hypertrophic phenotype. We review data regarding the mitochondrial proteomic and energetic remodeling in cardiac hypertrophy, as well as the temporal and causal relationship between mitochondrial failure to match the increased energy demand and progression to cardiac decompensation. We suggest that the maladaptive effect of sustained neuroendocrine signals on mitochondria leads to bioenergetic fading which contributes to the progression from cardiac hypertrophy to failure. PMID:22982369

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

2013-01-01

88

EPIDEMIOLOGY OF HEART FAILURE AND FEASIBILITY OF HOME CARE IN PATIENTS WITH WORSENING CHRONIC HEART FAILURE  

Microsoft Academic Search

Aim: To investigate gender-specific trends in long-term mortality in patients hospitalised for ischaemic and non-ischaemic heart failure (HF) and explore temporal trends in the risk of HF complicating acute myocardial infarction (AMI). Another aim is to characterise patients with chronic heart failure (CHF) that seek an emergency department (ED) because of their deteriorating condition and evaluate the feasibility of home

Masoud Shafazand

89

End-of-life care in heart failure  

Microsoft Academic Search

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

Sarah J. Goodlin

2009-01-01

90

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

PubMed

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

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

1986-12-15

91

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

Microsoft Academic Search

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

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

2007-01-01

92

Altered Cardiac Myocyte Ca Regulation In Heart Failure  

NSDL National Science Digital Library

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

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

2006-12-01

93

Peak VO 2 in elderly patients with heart failure  

Microsoft Academic Search

The incidence and prevalence of heart failure increase with age. The cardinal manifestation of heart failure is exercise intolerance. The cardiopulmonary exercise test with determination of peak VO2 provides an integrated measure of both central and peripheral abnormalities in heart failure. It is used to predict prognosis, identify patients for cardiac transplantation and to distinguish cardiac from pulmonary causes of

Lars H. Lund; Donna M. Mancini

2008-01-01

94

Incidence of newly diagnosed heart failure in UK general practice  

Microsoft Academic Search

Aim: To estimate the incidence rate of heart failure in the general population and to assess risk factors associated with the occurrence of newly diagnosed heart failure. Methods: From the source population that was derived from the UK General Practice Research Database, we identified patients aged 40)84 years newly diagnosed with heart failure in 1996, and estimated . incidence rates.

Saga Johanssona; Mari-Ann Wallander; Ana Ruigomezd

95

Interventions for heart failure readmissions: successes and failures.  

PubMed

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

Fleming, Lisa M; Kociol, Robb D

2014-06-01

96

A personalized medicine target: heart failure in women  

PubMed Central

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

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

2011-01-01

97

Mechanisms of renal hyporesponsiveness to ANP in heart failure.  

PubMed

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

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

2003-09-01

98

Diastolic heart failure: The forgotten manifestation of hypertensive heart disease  

Microsoft Academic Search

Heart failure (HF) is a progressively debilitating disorder characterized by frequent hospital admissions and high annual\\u000a mortality rates. Coronary artery disease (CAD), hypertension, and aging are major risk factors for the development\\/ progression\\u000a of HF. For years, most of the attention has been focused on HF caused by reduced left ventricular (LV) systolic function,\\u000a largely attributable to CAD. It is

Rigobert Lapu-Bula; Elizabeth Ofili

2004-01-01

99

From Acute Decompensated to Chronic Heart Failure.  

PubMed

An acute decompensation of heart failure resulting in hospital admission represents a critical juncture in the natural history of the disease, as evidenced by poor mortality and readmission outcomes after hospital discharge. For this reason, a number of new short-term vasoactive therapies have been or are being tested in clinical trials. Furthermore, in response to unacceptable readmission rates, there has been intense interest in improving the transition from hospital discharge to the outpatient arena. Between these 2 areas of focus exists an often overlooked internal transition from acute vasoactive therapies to oral chronic heart failure medications. This transition from acute presentation to the rest of the hospital stay forms the basis of this review. PMID:25432154

Patel, Snehal R; Piña, Ileana L

2014-12-15

100

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

Microsoft Academic Search

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

Gloria J. Simuel

2010-01-01

101

Management of chronic heart failure in the community: role of a hospital based open access heart failure service  

Microsoft Academic Search

Objective: To evaluate the role of an open access heart failure service based at a teaching hospital for the diagnosis and treatment optimisation of patients with heart failure in the community and to identify measures that may further enhance the effectiveness of such a service.Subjects: 963 patients with suspected heart failure seen over an eight year period referred by their

S Shah; M K Davies; D Cartwright; P Nightingale

2004-01-01

102

Chronic Heart Failure: Contemporary Diagnosis and Management  

PubMed Central

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

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

2010-01-01

103

Isolated ultrafiltration in heart failure patients.  

PubMed

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

Costanzo, Maria Rosa; Ronco, Claudio

2012-06-01

104

Incretin-related drug therapy in heart failure.  

PubMed

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

Vest, Amanda R

2015-02-01

105

Electrocardiographic Predictors of Incident Congestive Heart Failure and All-Cause Mortality in Postmenopausal Women The Women's Health Initiative  

Microsoft Academic Search

Background—Information is limited about ECG predictors of the risk of incident congestive heart failure (CHF), particularly in women without overt manifestations of cardiovascular disease (CVD). Methods and Results—We evaluated hazard ratios for incident CHF and all-cause mortality using Cox regression in 38 283 participants of the Women's Health Initiative (WHI) during a 9-year follow-up. All risk models were adjusted for

Pentti M. Rautaharju; Charles Kooperberg; Joseph C. Larson; Andrea LaCroix

2010-01-01

106

Predictors of Heart Failure Among Women With Coronary Disease  

Microsoft Academic Search

Background—Although heart failure is common among women with coronary disease, the risk factors for developing heart failure have not been well studied. We determined the risk factors for developing heart failure among postmenopausal women with established coronary disease. Methods and Results—This is a prospective cohort study using data from the Heart and Estrogen\\/progestin Replacement Study (HERS), a randomized, blinded, placebo-controlled

Kirsten Bibbins-Domingo; Feng Lin; Eric Vittinghoff; Elizabeth Barrett-Connor; Stephen B. Hulley; Deborah Grady; Michael G. Shlipak

2010-01-01

107

[Occupational exposure and chronic heart failure severity].  

PubMed

Chronic heart failure (CHF) is characterized by the inability of the heart to supply the body with sufficient amount of blood for metabolic and circulatory needs. The main risk factors for CHF development are: hypertension, type 2 diabetes, obesity, smoking, chronic kidney diseases. Many occupational exposures, such as extremes of heat or cold temperatures, prolonged exposure to noise, vibrations, pesticides, can contribute to etiology of this disease. The aim of our study was to evaluate if work can affect CHF severity. We analyzed retrospectively the first 76 smokers aged over 65 years who presented to the outpatient Clinic of Chronic Heart Failure. The patients were divided in 4 groups based on their previous job: white-collars, farmers, steelworkers and subjects performing different occupational activities (hairdressers, firemen, masons). Our results showed that farmers had a reduced left ventricular ejection fraction compared with white-collars (p = 0.0045) although NYHA class and the presence/absence of CHF risk factors were not different between the two groups. This data suggests that the farmer job could be associated with the severity of CHF. PMID:18409765

Beltrame, D; Lo Cascio, N; Miotto, D; Mapp, C E; De Rosa, E; Boschetto, P

2007-01-01

108

Dilemmas in end-stage heart failure  

PubMed Central

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.

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

2015-01-01

109

Mechano-signaling in heart failure.  

PubMed

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

Buyandelger, Byambajav; Mansfield, Catherine; Knöll, Ralph

2014-06-01

110

Heart failure: TNM-like classification.  

PubMed

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

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

2014-05-20

111

The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease  

Microsoft Academic Search

Background: Although treatment of myocardial overload effectively reduces death from progression of heart failure, it is not known whether the retardation of progressive coronary artery disease obtained with lipid lowering treatment will prevent the onset and consequences of heart failure in patients without previous symptoms of heart failure.Methods and Results: In the Scandinavian Simvastatin Survival Study, 4444 patients with coronary

John Kjekshus; Terje R. Pedersen; Anders G. Olsson; Ole Færgeman; Kalevi Pyörälä

1997-01-01

112

Scientists Spot Mutation Behind Genetic Form of Heart Failure  

MedlinePLUS

... JavaScript. Scientists Spot Mutation Behind Genetic Form of Heart Failure Variant makes heart muscle less elastic, enlarges organ ... 2015 Related MedlinePlus Pages Genes and Gene Therapy Heart Failure WEDNESDAY, Jan. 14, 2015 (HealthDay News) -- Researchers have ...

113

Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency  

Microsoft Academic Search

BACKGROUND Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left ventricular ejection frac- tion, and iron deficiency, either with or without anemia. METHODS We enrolled 459 patients with chronic heart failure of New York Heart Association (NYHA) functional class II

Stefan D. Anker; Josep Comin Colet; Gerasimos Filippatos; Ronnie Willenheimer; Kenneth Dickstein; Helmut Drexler; Thomas F. Lüscher; Boris Bart; Waldemar Banasiak; Joanna Niegowska; Bridget-Anne Kirwan; Claudio Mori; Barbara von Eisenhart Rothe; Stuart J. Pocock; Philip A. Poole-Wilson; Piotr Ponikowski

2009-01-01

114

Exercise training in chronic heart failure: why, when and how  

Microsoft Academic Search

The management of patients with chronic congestive heart failure has changed considerably during the last decade. Until recently, restriction of physical activity was recommended for patients with chronic heart failure. However, the know- ledge that training influences largely the periphery rather than the heart itself has led to a dramatic change in the approach toward training in patients with chronic

Paul Dubach; Sebastian Sixt; Jonathan Myers

115

Cost-effectiveness of heart failure therapies.  

PubMed

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

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

2013-06-01

116

Concomitant diabetes mellitus and heart failure.  

PubMed

The prevalence of patients with concomitant diabetes mellitus (DM) and heart failure (HF) is growing exponentially. Patients with HF and DM show specific metabolic, neurohormonal, and structural heart abnormalities, which potentially contribute to worse HF outcomes than seen in patients without comorbid DM. Subgroup analysis of recent trials suggest that patients with HF and DM may respond differently to standard therapy, and data are emerging on the possible increase in the risk of hospitalizations for HF in patients with DM treated with specific class of antidiabetic agents, pointing to the need of developing specific medications to be tested in dedicated future studies to address the unique metabolic and hemodynamic alterations seen in these patients. PMID:25499908

Dei Cas, Alessandra; Fonarow, Gregg C; Gheorghiade, Mihai; Butler, Javed

2015-01-01

117

Mechanical support for postcardiotomy heart failure.  

PubMed

Cardiac failure remains a life-threatening complication for certain patients undergoing intracardiac repair. Despite improvements in surgical techniques, methods of myocardial protection, and postoperative care, patients are frequently at risk to develop postoperative low output syndrome. Approximately 1% of cardiac surgical patients cannot be weaned from extracorporeal circulation in spite of adequate volume loading, the use of inotropic support, and initiation of intraaortic balloon pumping. In these cases, ventricular assist devices (VAD) can mechanically aid the failing heart and reverse the low output state. The concept of mechanical support for the failing left ventricle was first proposed by Clauss et al. in 1961. By 1968, Kantrowitz and associates had developed and refined the first intraaortic balloon pump (IABP). Through the efforts of Moulopolous and others, this device evolved into the present-day intraaortic balloon pump (IABP). Clinical evidence for the efficacy of left ventricular assist devices (LVAD) remained questionable until 1980, when the National Heart, Blood and Lung Institute evaluated short-term LVADs by comparing various types of mechanical aids. This report focused attention primarily on the failing left ventricle (LV). As the use of inotropic support, intraaortic balloon pumping, and LVADs improved, a small group of patients emerged who could not be separated from extracorporeal circulation due to a failing right ventricle. The failing right ventricle emerged as a unique clinical entity similar to postcardiotomy left ventricular failure that also benefited from mechanical cardiac assistance. Current therapy at major centers incorporating mechanical assist devices is based on the premise that the low output state will allow the failing heart to recover from a reversible injury. The frequent occurrence of postcardiotomy ischemia may be due to several factors such as poor myocardial protection, overdistension of the LV, emboli, coronary spasm or technical problems. Whatever the etiology, the end product of cardiac failure is a demand for oxygen consumption that cannot be met, thus leading to cardiac demise. PMID:2980017

Campbell, C D; Tolitano, D J; Weber, K T; Statler, P M; Replogle, R L

1988-09-01

118

[Telemedicine and wireless devices in heart failure].  

PubMed

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

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

2014-05-01

119

Functional Assessment of Heart Failure Patients.  

PubMed

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

Kaminsky, Leonard A; Tuttle, Mary S

2015-01-01

120

Acute Heart Failure: Patient Characteristics and Pathophysiology  

PubMed Central

The number of hospitalizations for acute heart failure (HF) continues to increase and it remains the most common discharge diagnosis among Medicare beneficiaries. Prognosis after hospitalization for HF is poor, with high in-hospital mortality and even higher post-discharge mortality and rehospitalization rates. It is a complex clinical syndrome that varies widely with respect to clinical presentation and underlying pathophysiology. This paper reviews what is documented in the literature regarding the known pathophysiologic mechanisms reported in patients hospitalized for HF. PMID:23918642

Marti, Catherine N.; Georgiopoulou, Vasiliki V.; Kalogeropoulos, Andreas P.

2013-01-01

121

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

PubMed

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

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

2014-03-01

122

Spectrum of heart failure in older patients: Results from the national heart failure project  

Microsoft Academic Search

Background The elderly make up the majority of patients with heart failure (HF), but information on this segment of the HF population is lacking because clinical trials typically enroll younger patients and population-based studies lack clinical detail. We sought to describe a contemporary national sample of elderly patients with HF and to examine the sample for age-related trends in clinical

Edward P. Havranek; Frederick A. Masoudi; Kelly A. Westfall; Pam Wolfe; Diana L. Ordin; Harlan M. Krumholz

2002-01-01

123

Anemia in heart failure: an overview of current concepts.  

PubMed

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

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

2011-01-01

124

Stage A: can heart failure be prevented?  

PubMed

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

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

2015-01-01

125

Extracorporeal fluid removal in heart failure patients.  

PubMed

Ultrafiltration is the mechanical removal of fluid from the vasculature. Hydrostatic pressure is applied to blood across a semipermeable membrane to separate isotonic plasma water from blood. Because solutes in blood freely cross the semipermeable membrane, large amounts of fluid can be removed at the discretion of the treating physician without affecting any change in the serum concentration of electrolytes and other solutes. Ultrafiltration has been used to relieve congestion in patients with heart failure for almost four decades. In contrast to the adverse physiological consequences of loop diuretics, numerous studies have demonstrated favorable responses to ultrafiltration. Such studies have shown that removal of large amounts of isotonic fluid relieves symptoms of congestion, improves exercise capacity, improves cardiac filling pressures, restores diuretic responsiveness in patients with diuretic resistance, and has a favorable effect on pulmonary function, ventilatory efficiency, and neurohormonal activation. Ultrafiltration is the only fluid removal strategy shown to improve outcomes in randomized controlled trials of patients hospitalized with decompensated heart failure. PMID:20427974

Costanzo, Maria Rosa; Ronco, Claudio

2010-01-01

126

Management of refractory congestive heart failure—a nephrological challenge  

Microsoft Academic Search

filtration rate (GFR) was <50 ml\\/min\\/1.73 m2 (2). Conversely, congestive heart failure is present in at least 25% of patients with chronic renal disease (3,4). In this population, the prevalence of heart failure increases with the continuous deterioration in renal function, especially in elderly patients (5). A recent study evaluated the prevalence and clinical correlates of congestive heart failure using

Devora Rubinger

2005-01-01

127

Palliative care for end-stage heart failure  

Microsoft Academic Search

Heart failure is growing in prevalence. Despite an array of treatments targeting a complicated pathophysiology, heart failure\\u000a ultimately leads to death, and thus there is a clear need to provide palliative care to persons with end-stage heart failure.\\u000a Palliative care, or education and support of the patient and family and management of distressing symptoms, should be provided\\u000a throughout the course

Sarah J. Goodlin

2005-01-01

128

Does bnp testing aid diagnosis of heart failure?  

PubMed

Heart failure is common, causes major disability and often shortens life. Two UK guidelines advocate the measurement of plasma concentrations of B-type natriuretic peptide (BNP) in diagnosis of chronic heart failure, either in combination with, or as an alternative to, an ECG.1,2 Here we review the evidence for BNP testing in the diagnosis of chronic heart failure, and discuss the implications in terms of availability of the test. PMID:19809084

2009-10-01

129

Management of ACCF/AHA Stage C heart failure.  

PubMed

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

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

2014-02-01

130

Clinical service organisation for heart failure  

PubMed Central

Background Chronic heart failure (CHF) is a serious, common condition associated with frequent hospitalisation. Several different disease management interventions (clinical service organisation interventions) for patients with CHF have been proposed. Objectives To assess the effectiveness of disease management interventions for patients with CHF. Search methods We searched: Cochrane CENTRAL Register of Controlled Trials (to June 2003); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to July 2003); CINAHL (January 1982 to July 2003); AMED (January 1985 to July 2003); Science Citation Index Expanded (searched January 1981 to March 2001); SIGLE (January 1980 to July 2003); DARE (July 2003); National Research Register (July 2003); NHS Economic Evaluations Database (March 2001); reference lists of articles and asked experts in the field. Selection criteria Randomised controlled trials comparing disease management interventions specifically directed at patients with CHF to usual care. Data collection and analysis At least two reviewers independently extracted data information and assessed study quality. Study authors were contacted for further information where necessary. Main results Sixteen trials involving 1,627 people were included. We classified the interventions into three models: multidisciplinary interventions (a holistic approach bridging the gap between hospital admission and discharge home delivered by a team); case management interventions (intense monitoring of patients following discharge often involving telephone follow up and home visits); and clinic interventions (follow up in a CHF clinic). There was considerable overlap within these categories, however the components, intensity and duration of the interventions varied. Case management interventions tended to be associated with reduced all cause mortality but these findings were not statistically significant (odds ratio 0.86, 95% confidence interval 0.67 to 1.10, P = 0.23), although the evidence was stronger when analysis was limited to the better quality studies (odds ratio 0.68, 95% confidence interval 0.46 to 0.98, P = 0.04). There was weak evidence that case management interventions may be associated with a reduction in admissions for heart failure. It is unclear what the effective components of the case management interventions are. The single RCT of a multidisciplinary intervention showed reduced heart-failure related re-admissions in the short term. At present there is little available evidence to support clinic based interventions. Authors’ conclusions The data from this review are insufficient for forming recommendations. Further research should include adequately powered, multicentre studies. Future studies should also investigate the effect of interventions on patients’ and carers’ quality of life, their satisfaction with the interventions and cost effectiveness. PMID:15846638

Taylor, Stephanie JC; Bestall, Janine C; Cotter, Sarah; Falshaw, Margaret; Hood, Sonja G; Parsons, Suzanne; Wood, Lesley; Underwood, Martin

2014-01-01

131

The hibernating heart: reversible left ventricular dysfunction in chronic heart failure  

PubMed Central

A patient with severe heart failure secondary to coronary heart disease is presented. Following investigation he was thought to have significant areas of myocardial hibernation and was therefore treated with coronary revascularisation, with major clinical benefit.???Keywords: heart failure; myocardial hibernation PMID:10474727

Burn, S.; Walters, M.; Caplin, J.

1999-01-01

132

Cognitive impairment in heart failure patients.  

PubMed

Cognitive damage in heart failure (HF) involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many cerebral and functional changes were detected in brain imaging, involving areas of both grey and white matter deputed to cognition. Although various instruments are available to explore cognition, no consensus was obtained on better tools to be used in HF population. Reduction in cerebral blood flow, decreased cardiac output, alterations of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mechanisms of cognitive deficit. Several cardiac variables, laboratory parameters, demographic and clinical elements were studied for their possible relation with cognition and should be properly evaluated to define patients at increased risk of impairment. The present review gathers available data pointing out assured information and discussing possible areas of research development. PMID:25593581

Leto, Laura; Feola, Mauro

2014-12-01

133

Cognitive impairment in heart failure patients  

PubMed Central

Cognitive damage in heart failure (HF) involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many cerebral and functional changes were detected in brain imaging, involving areas of both grey and white matter deputed to cognition. Although various instruments are available to explore cognition, no consensus was obtained on better tools to be used in HF population. Reduction in cerebral blood flow, decreased cardiac output, alterations of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mechanisms of cognitive deficit. Several cardiac variables, laboratory parameters, demographic and clinical elements were studied for their possible relation with cognition and should be properly evaluated to define patients at increased risk of impairment. The present review gathers available data pointing out assured information and discussing possible areas of research development. PMID:25593581

Leto, Laura; Feola, Mauro

2014-01-01

134

Heart failure in the patients with chronic kidney disease  

Microsoft Academic Search

Heart failure is highly prevalent in the population with chronic kidney disease. Upon starting dialysis, 37% of patients will have had a previous episode of heart failure, doubling the risk of death. Both systolic and\\/or diastolic function may be impaired. 15% of patients starting dialysis therapy have systolic dysfunction of the left ventricle. The prevalence of diastolic dysfunction at dialysis

Lisowska A

2004-01-01

135

The prognostic importance of anemia in patients with heart failure  

Microsoft Academic Search

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

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

2003-01-01

136

Randomised controlled trial of specialist nurse intervention in heart failure  

Microsoft Academic Search

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

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

2001-01-01

137

Clinical Benefit and Approach of Ultrafiltration in Acute Heart Failure  

Microsoft Academic Search

Because of the increasing incidence of acute heart failure admissions to critical care units, nephrologists have been asked to become more involved in the management of these patients. Renal dysfunction is a major element in impeding clinical recovery. In acute heart failure, renal function is often abnormal. The judicious application of ultrafiltration techniques may represent an efficacious adjunct to present

Amit Sharma; Denise D. Hermann; Ravindra L. Mehta

2001-01-01

138

Are Too Many Heart Failure Patients Getting IV Fluids?  

MedlinePLUS

... this page, please enable JavaScript. Are Too Many Heart Failure Patients Getting IV Fluids? Since treatment usually aims ... Preidt Monday, February 2, 2015 Related MedlinePlus Page Heart Failure MONDAY, Feb. 2, 2015 (HealthDay News) -- Potentially harmful ...

139

Heart failure clinical trials: how do we define success?  

PubMed Central

The selection of end points for clinical trials of heart failure is challenging, with important implications for patients, the medical community, and regulatory agencies. The standards used in clinical research on patients with heart failure influence the effectiveness and value of future clinical trials, and the extent to which they can be translated into clinical practice. PMID:23917464

Ziaeian, Boback; Fonarow, Gregg C.

2015-01-01

140

Hyponatraemia as a marker for high renin heart failure  

Microsoft Academic Search

The factors that might activate the renin-angiotensin system in treated heart failure were explored. Serum Na+ correlated inversely with plasma renin activity. The degree of congestive heart failure measured by right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and systemic vascular resistance did not correlate with plasma renin activity. Similarly, renal function as measured by blood urea nitrogen, creatinine,

T B Levine; J A Franciosa; T Vrobel; J N Cohn

1982-01-01

141

Excess Weight May Help Heart Failure Patients, Study Contends  

MedlinePLUS

... page, please enable JavaScript. Excess Weight May Help Heart Failure Patients, Study Contends 'Paradoxical' finding suggests fat is ... December 22, 2014 Related MedlinePlus Pages Body Weight Heart Failure Obesity MONDAY, Dec. 22, 2014 (HealthDay News) -- Obese ...

142

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

PubMed

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

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

2015-01-01

143

A Palliative Care Approach to the Advanced Heart Failure Patient  

Microsoft Academic Search

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

Susan Quaglietti; Michael Pham; Victor Froelicher

2005-01-01

144

Animal models of human cardiovascular disease, heart failure and hypertrophy  

Microsoft Academic Search

The progress made in our understanding of the pathophysiology and treatment of congestive heart failure (CHF) would not have been possible without a number of animal models of heart failure and hypertrophy, each one having unique advantages as well as disadvantages. The species and interventions used to create CHF depends on the scientific question as well as on factors such

Gerd Hasenfuss

145

Diastolic and systolic heart failure: Different stages or distinct phenotypes of the heart failure syndrome?  

Microsoft Academic Search

It remains uncertain if diastolic heart failure (DHF) is a distinct HF phenotype or a precursor stage of systolic HF (SHF).\\u000a The unimodal distribution of left ventricular ejection fraction (LVEF) in HF, depressed LV long-axis shortening in DHF, and\\u000a progression to eccentric LV remodeling in hypertension favor DHF and SHF as successive stages. These arguments are countered\\u000a by the bimodal

Jean G. F. Bronzwaer; Walter J. Paulus

2009-01-01

146

Heart failure caused by congenital left-sided lesions.  

PubMed

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

Krieger, Eric V; Fernandes, Susan M

2014-01-01

147

Anemia associated with chronic heart failure: current concepts  

PubMed Central

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

Shah, Ravish; Agarwal, Anil K

2013-01-01

148

Heart failure in older people: causes, diagnosis and treatment  

Microsoft Academic Search

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

AHMED H. ABDELHAFIZ

2002-01-01

149

Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study  

Microsoft Academic Search

Background—Previous trials in the prevention of heart failure have been restricted to patients with low ejection fraction or hypertension. We assessed an angiotensin-converting enzyme (ACE) inhibitor, ramipril, to prevent the development of heart failure in high-risk patients without known low ejection fraction or heart failure. Methods and Results—We randomly assigned 9297 patients to receive double-blind ramipril (10 mg daily) or

J. Malcolm O. Arnold; Salim Yusuf; James Young; James Mathew; David Johnstone; Alvaro Avezum; Eva Lonn; Janice Pogue; Jackie Bosch

2010-01-01

150

Broken hearts and the heart broken: living with, and dying from, heart failure in Scotland   

E-print Network

Heart failure is a common and serious chronic condition, which can be as ‘malignant’ as most forms of cancer (Stewart, MacIntyre, Hole, Capewell, & McMurray, 2001). Recent estimates are that around 40,000 men and 45,000 ...

Pratt, Rebekah Janet

2012-11-30

151

Nutrient Intake in Heart Failure Patients  

PubMed Central

Background and Research Objective Approximately 50% of heart failure (HF) patients are thought to be malnourished, and macronutrient and micronutrient deficiencies may potentially aggravate HF symptoms. Thus, concerns have been raised about the overall nutrient composition of diets in HF populations. The purpose of this study was to examine the macronutrient and micronutrient intake by caloric adequacy among community-dwelling adults with HF. Participants and Methods A secondary analysis of baseline data of participants in an HF lifestyle intervention study was conducted. Participants (n = 45) were predominantly male (55.6%), white, and non-Hispanic (64.4%); had a mean age of 61 years (SD, 11 years) and mean body mass index of 31.2 kg/m2 (SD, 7.3 kg/m2); were of New York Heart Association functional classes II and III (77.8%); and had a mean ejection fraction of 31.9% (SD,13.2%); and 69% had a college or higher level of education. The Block Food Habits Questionnaire was used to assess the intake of macronutrients and micronutrients. Analysis included descriptive statistics and Mann-Whitney U tests. Results and Conclusions Individuals reporting inadequate daily caloric intake reported a lower intake of macronutrients and micronutrients as well as other differences in dietary patterns compared with individuals reporting adequate daily caloric intake. More than half of the individuals reporting adequate caloric intake did not meet the recommended dietary allowance for magnesium and vitamin E. Interventions aimed at increasing overall intake and nutrient density are suggested. Further research is needed to better understand the relationship between dietary factors and outcomes in HF. PMID:18596500

Grossniklaus, Daurice A.; O’Brien, Marian C.; Clark, Patricia C.; Dunbar, Sandra B.

2009-01-01

152

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

NASA Astrophysics Data System (ADS)

Heart Failure continues to be a major public health problem associated with high mortality and morbidity. Heart Failure is the leading cause of hospitalization for persons older than 65 years, has a poor prognosis and is associated with poor quality of life. More than 5.3 million American adults are living with heart failure. Despite maximum medical therapy and frequent hospitalizations to stabilize their condition, one in five heart failure patients die within the first year of diagnosis. Several disease-management programs have been proposed and tested to improve the quality of heart failure care. Studies have shown that hospital admissions and emergency room visits decrease with increased nursing interventions in the home and community setting. An alternative strategy for promoting self-management of heart failure is the use of electronic home monitoring. The purpose of this study was to examine what effects heart failure has on patient's quality of life that had been monitoring on an electronic home monitor longer than 2 months. Twenty-one questionnaires were given to patients utilizing an electronic home monitor by their home health agency nurse. Eleven patients completed the questionnaire. The findings showed that there is some deterioration in quality of life with more association with the physical aspects of life than with the emotional aspects of life, which probably was due to the small sample size. There was no significant difference in readmission rates in patients utilizing an electronic home monitor. Further research is needed with a larger population of patients with chronic heart failure and other chronic diseases which may provide more data, and address issues such as patient compliance with self-care, impact of heart failure on patient's quality of life, functional capacity, and heart failure patient's utilization of the emergency rooms and hospital. Telemonitoring holds promise for improving the self-care abilities of persons with HF.

Simuel, Gloria J.

153

Myocardial energetics and ubiquinol in diastolic heart failure.  

PubMed

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

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

2014-12-01

154

Frequency of low-risk hospital admissions for heart failure.  

PubMed

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

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

1998-01-01

155

Heart failure among Indigenous Australians: a systematic review  

PubMed Central

Background Cardiovascular diseases contribute substantially to the poor health and reduced life expectancy of Indigenous Australians. Heart failure is a common, disabling, progressive and costly complication of these disorders. The epidemiology of heart failure and the adequacy of relevant health service provision in Indigenous Australians are not well delineated. Methods A systematic search of the electronic databases PubMed, Embase, Web of Science, Cinahl Plus, Informit and Google Scholar was undertaken in April 2012 for peer-reviewed journal articles relevant to the topic of heart failure in Indigenous Australians. Additionally, a website search was done to identify other pertinent publications, particularly government reports. Results There was a paucity of relevant peer-reviewed research, and government reports dominated the results. Ten journal articles, 1 published conference abstract and 10 reports were eligible for inclusion. Indigenous Australians reportedly have higher morbidity and mortality from heart failure than their non-Indigenous counterparts (age-standardised prevalence ratio 1.7; age-standardised hospital separation ratio ?3; crude per capita hospital expenditure ratio 1.58; age-adjusted mortality ratio >2). Despite the evident disproportionate burden of heart failure in Indigenous Australians, the accuracy of estimation from administrative data is limited by poor indigenous identification, inadequate case ascertainment and exclusion of younger subjects from mortality statistics. A recent journal article specifically documented a high prevalence of heart failure in Central Australian Aboriginal adults (5.3%), noting frequent undiagnosed disease. One study examined barriers to health service provision for Indigenous Australians in the context of heart failure. Conclusions Despite the shortcomings of available published data, it is clear that Indigenous Australians have an excess burden of heart failure. Emerging data suggest that undiagnosed cases may be common in this population. In order to optimise management and to inform policy, high quality research on heart failure in Indigenous Australians is required to delineate accurate epidemiological indicators and to appraise health service provision. PMID:23116367

2012-01-01

156

Assessing Health Literacy in Heart Failure Patients?  

PubMed Central

Background Health literacy has important implications for health interventions and clinical outcomes. The Shortened-Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7 minutes limit and with no time limit (NTL). Methods and Results We enrolled 612 rural-dwelling adults with HF (mean age 66.0±13.0 years, 58.8% male). Characteristics affecting health literacy were identified by multiple regression. Percent correct scores improved from 71% to 86% (mean percent change = 15.1±18.1) between the 7-minute and NTL scores. Twenty-seven percent of patients improved at least one literacy level with NTL scores (p<.001). Demographic variables explained 24.2% and 11.1% of the variance in % correct scores in the 7-minute and the NTL scores respectively. Female gender, younger age, higher education, and higher income were related to higher scores. Conclusion Patients with HF may be inaccurately categorized as having low or marginal health literacy when the S-TOFHLA time limits are enforced. New ways to assess health literacy in older adults are needed. PMID:22041324

Robinson, Susan; Moser, Debra; Pelter, Michele M.; Nesbitt, Thomas; Paul, Steven M.; Dracup, Kathleen

2011-01-01

157

Imaging heart failure: current and future applications.  

PubMed

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

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

2013-03-01

158

MODELS OF INSULIN RESISTANCE AND HEART FAILURE  

PubMed Central

The incidence of heart failure (HF) and diabetes mellitus is rapidly increasing and is associated with poor prognosis. In spite of the advances in therapy, HF remains a major health problem with high morbidity and mortality. When HF and diabetes coexist, clinical outcomes are significantly worse. The relationship between these two conditions has been studied in various experimental models. However, the mechanisms for this interrelationship are complex, incompletely understood, and have become a matter of considerable clinical and research interest. There are only few animal models that manifest both HF and diabetes. However, the translation of results from these models to human disease is limited and new models are needed to expand our current understanding of this clinical interaction. In this review, we discuss mechanisms of insulin signaling and insulin resistance, the clinical association between insulin resistance and HF and its proposed pathophysiologic mechanisms. Finally, we discuss available animal models of insulin resistance and HF and propose requirements for future new models. PMID:23456447

Velez, Mauricio; Kohli, Smita; Sabbah, Hani N.

2013-01-01

159

Heart failure with preserved ejection fraction.  

PubMed

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

Pellicori, Pierpaolo; Cleland, John Gf

2014-12-01

160

Blood flow dynamics in heart failure  

NASA Technical Reports Server (NTRS)

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

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

1999-01-01

161

Gene Therapy in the Treatment of Heart Failure  

NSDL National Science Digital Library

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.

2007-04-01

162

Incorporating Common Biomarkers into the Clinical Management of Heart Failure  

PubMed Central

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

Halkar, Meghana

2013-01-01

163

B-vitamin deficiency in hospitalized patients with heart failure.  

PubMed

The impact of heart failure and its treatment on specific nutrient requirements is unknown. Furthermore, depletion of water-soluble B vitamins that play key roles in the production of cellular energy in patients with heart failure can contribute to depletion of energy reserves observed in the failing heart. A cross-sectional study recently reported that approximately one third of hospitalized patients with heart failure had tissue levels suggestive of thiamin deficiency (vitamin B-1). Riboflavin (vitamin B-2) and pyridoxine (vitamin B-6) are similar to thiamin in that they are water-soluble, subject to renal excretion, have limited tissue storage, and are dependent on intake. Therefore, it was hypothesized that the status of these B vitamins may also be adversely affected by heart failure. As a result, the prevalence of patients at risk of vitamin B-2 (erythrocyte glutathione reductase activity coefficient > or = 1.2) and B-6 deficiency (plasma B-6 < or = 20 nmol/L) was determined in a cross-section of 100 patients hospitalized with heart failure between April 2001 and June 2002 as well as in a group of volunteers without heart failure. Twenty-seven percent of patients with heart failure had biochemical evidence of vitamin B-2 deficiency, while 38% had evidence of B-6 deficiency. These prevalence rates were significantly higher than those observed in the volunteers without heart failure (2% and 19%, respectively; P < or = 0.02). Use of common B-vitamin-containing supplements by patients with heart failure did not significantly reduce deficiency rates in comparison with those who did not use supplements (B-2 P=0.38 or B-6 P=0.18)). Finally, while 80% of patients with heart failure took diuretics, neither the dose nor the duration of furosemide use was related to the presence of either B-2 or B-6 deficiency. Given the physiologic importance of these vitamins, further investigations aimed at determining the effect of heart failure on specific nutrient requirements as well as the safety and efficacy of B-vitamin supplementation are warranted. PMID:19631047

Keith, Mary E; Walsh, Natalie A; Darling, Pauline B; Hanninen, Stacy A; Thirugnanam, Subarna; Leong-Poi, Howard; Barr, Aiala; Sole, Michael J

2009-08-01

164

Optimized Treatment and Heart Rate Reduction in Chronic Heart Failure  

PubMed Central

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

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

2013-01-01

165

Implantable Cardiovascular Sensors and Computers: Interventional Heart Failure Strategies  

PubMed Central

Despite evidence-based medical and pharmacologic advances the management of heart failure remains challenging, whether in the ambulatory setting where daily weight monitoring has failed, or in the inpatient setting where readmission rates and morbidity remains high. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates for heart failure in general. There may be a shift in the paradigm with respect to the treatment of heart failure, which may usher in an era of invasive heart failure therapies and specialists. Experimental invasive devices and monitors have the potential to be game-changing therapies, and cardiac resynchronization therapy has evolved beyond just resynchronization and has the potential to provide important real-time hemodynamic feedback. PMID:22814631

Smith, Sakima A.; Abraham, William T.

2013-01-01

166

Conceptual model for heart failure disease management.  

PubMed

The objective of this review is to propose a conceptual model for heart failure (HF) disease management (HFDM) and to define the components of an efficient HFDM plan in reference to this model. Articles that evaluated 1 or more of the following aspects of HFDM were reviewed: (1) outpatient clinic follow-up; (2) self-care interventions to enhance patient skills; and (3) remote evaluation of worsening HF either using structured telephone support (STS) or by monitoring device data (telemonitoring). The success of programs in reducing readmissions and mortality were mixed. Outpatient follow-up programs generally resulted in improved outcomes, including decreased readmissions. Based on 1 meta-analysis, specialty clinics improved outcomes and nonspecialty clinics did not. Results from self-care programs were inconsistent and might have been affected by patient cognitive status and educational level, and intervention intensity. Telemonitoring, despite initially promising meta-analyses demonstrating a decrease in the number and duration of HF-related readmissions and all-cause mortality rates at follow-up, has not been shown in randomized trials to consistently reduce readmissions or mortality. However, evidence from device monitoring trials in particular might have been influenced by technology and design issues that might be rectified in future trials. Results from the literature suggest that the ideal HFDM plan would include outpatient follow-up at an HF specialty clinic and continuous education to improve patient self-care. The end result of this plan would lead to better understanding on the part of the patient and improved patient ability to recognize and respond to signs of decompensation. PMID:24565255

Andrikopoulou, Efstathia; Abbate, Kariann; Whellan, David J

2014-03-01

167

Extracorporeal fluid removal in heart failure patients.  

PubMed

More than one million hospitalizations occur annually in the US because of heart failure (HF) decompensation caused by fluid overload. Congestion contributes to HF progression and mortality. Apart from intrinsic renal insufficiency, venous congestion, rather than a reduced cardiac output, may be the primary hemodynamic factor driving worsening renal function in patients with acutely decompensated HF. According to data from large national registries, approximately 40% of hospitalized HF patients are discharged with unresolved congestion, which may contribute to unacceptably high rehospitalization rates. Although diuretics reduce the symptoms and signs of fluid overload, their effectiveness is reduced by excess salt intake, underlying chronic kidney disease, renal adaptation to their action and neurohormonal activation. In addition, the production of hypotonic urine limits the effectiveness of loop diuretics in reducing total body sodium. Ultrafiltration is the mechanical removal of fluid from the vasculature. Hydrostatic pressure is applied to blood across a semipermeable membrane to separate isotonic plasma water from blood. Because solutes in blood freely cross the semipermeable membrane, large amounts of fluid can be removed at the discretion of the treating physician without affecting any change in the serum concentration of electrolytes and other solutes. Ultrafiltration has been used to relieve congestion in patients with HF for almost four decades. In contrast to the adverse physiological consequences of loop diuretics, numerous studies have demonstrated favorable responses to ultrafiltration. Such studies have shown that removal of large amounts of isotonic fluid relieves symptoms of congestion, improves exercise capacity, improves cardiac filling pressures, restores diuretic responsiveness in patients with diuretic resistance, and has a favorable effect on pulmonary function, ventilatory efficiency, and neurohormonal activation. Ultrafiltration is the only fluid removal strategy shown to improve outcomes in randomized controlled trials of patients hospitalized with decompensated HF. PMID:20428003

Costanzo, Maria Rosa; Agostoni, Piergiuseppe; Marenzi, Giancarlo

2010-01-01

168

The epidemiology of heart failure in adults with congenital heart disease.  

PubMed

The impact of lifelong exposure to myocardial dysfunction in populations with congenital heart disease (CHD) is becoming increasingly recognized. Most children born with CHD now reach adulthood and the long-term sequelae of treatment are contributing to substantial comorbidity. The combination of structural changes present at birth with changes resulting from cardiac surgery can result in heart failure. This article reports on the current state of knowledge on the epidemiology of heart failure in this patient population. PMID:24275290

Rodriguez, Fred H; Marelli, Ariane J

2014-01-01

169

Lipid-Lowering Therapy and Outcomes in Heart Failure  

Microsoft Academic Search

Lipid-lowering therapy, particularly with statins, reduces the risk of cardiovascular mortality; however, there is uncertainty about their efficacy in patients with heart failure, including those without coronary artery stenosis. A clinical database was studied to determine whether lipid-lowering therapy is associated with improved survival in persons with heart failure—with or without concomitant coronary artery stenosis. During an 8-year period, 6060

Joel G. Ray; Colleen M. Norris; Jacob A. Udell; Ross T. Tsuyuki; Finlay A. McAlister; Merril L. Knudtson; William A. Ghali

2007-01-01

170

Social relationships and mortality in patients with congestive heart failure  

Microsoft Academic Search

The present study was undertaken to evaluate the possible effects of social relationships (perceived social support, and perceived social isolation) upon mortality risk among patients with congestive heart failure (CHF). Proportional hazard models were used to evaluate the effects of different social factors on mortality among 119 clinically stable patients (71.4% men; mean age 65.7±9.6 years) with symptomatic heart failure,

Terje A Murberg; Edvin Bru

2001-01-01

171

Sleep and Quality of Life in Heart Failure and Stroke  

Microsoft Academic Search

Congestive heart failure (CHF) because of left ventricular systolic dysfunction is a prevalent syndrome and associated with\\u000a morbidity, mortality, and huge economic cost. Hallmarks of CHF are exercise intolerance, poor prognosis, and poor quality\\u000a of life (QoL). According to reports from several laboratories, a large number of patients with heart failure also have sleep\\u000a apnea (SA). SAs cause arousals and

Erik C. Skobel; Christine Norra; Anil Martin Sinha; Winfried Randerath

172

Role of autophagy in heart failure associated with aging  

Microsoft Academic Search

Heart failure is a progressive disease, leading to reduced quality of life and premature death. Adverse ventricular remodeling\\u000a involves changes in the balance between cardiomyocyte protein synthesis and degradation, forcing these myocytes in equilibrium\\u000a between life and death. In this context, autophagy has been recognized to play a role in the pathophysiology of heart failure.\\u000a At basal levels, autophagy performs

Guido R. Y. De Meyer; Gilles W. De Keulenaer; Wim Martinet

2010-01-01

173

The impact of diabetes on heart failure: Opportunities for intervention  

Microsoft Academic Search

The pathophysiologic processes of diabetes mellitus and heart failure are likely interrelated. In particular, hyperglycemia\\u000a and insulin resistance can induce myocardial contractile systolic and diastolic abnormalities at the cellular level. Furthermore,\\u000a patients with heart failure and concomitant diabetes mellitus are more likely to have underlying comorbid conditions resulting\\u000a in greater vulnerability to adverse consequences. It is reassuring that the majority

Hadi N. Skouri; W. H. Wilson Tang

2007-01-01

174

[Epidemiology and risk factors for heart failure in the elderly].  

PubMed

Heart failure achieves particular relevance and different characteristics in the elderly population, especially for the clinical complexity related to the presence of comorbidity and chronicity, which are common conditions in these patients. Despite recent advances in clinical approach, diagnosis and therapeutic management of heart failure, the incidence and prevalence of this syndrome are still increasing, owing to the better control of the disease, and, largely, to the aging of the population. Epidemiologic data indicate that heart failure represents a crucial problem in the elderly population in terms of social, economic, and health burden. Despite their importance in the worsening of heart failure and prevention of the progression of this syndrome, the risks of hospital readmission and the causes of exacerbation have not been systematically evaluated in controlled trials. This explains why the precipitating factors of heart failure remain unknown in more than 40% of cases. For these reasons, prospective studies are needed in order to assess and clearly define the risk of hospital readmission and the causes related to heart failure exacerbation in the elderly population. PMID:15712508

Rengo, Franco; Leosco, Dario; Iacovoni, Attilio; Rengo, Giuseppe; Golino, Luca; Borgia, Francesco; De Lisa, Gabriella; Beneduce, Flora; Senni, Michele

2004-12-01

175

Angiotensin II, sympathetic nerve activity and chronic heart failure.  

PubMed

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

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

2014-03-01

176

Grading the severity of congestive heart failure in infants  

Microsoft Academic Search

To determine which variables most accurately define congestive heart failure (CHF) in infants, 41 patients (median age 2.5 months) were graded by four pediatric cardiologists for the presence and severity of CHF based on the following variables: amount of formula consumed per feeding, feeding time, history of diaphoresis or tachypnea, growth parameters, respiratory and heart rates, respiratory pattern, perfusion, presence

Robert D. Ross; Robert O. Bollinger; William W. Pinsky

1992-01-01

177

Effect of Cilazapril on Exercise Tolerance in Congestive Heart Failure  

Microsoft Academic Search

Cilazapril (C), an angiotensin-converting enzyme inhibitor with effective antihypertensive efficacy, was examined for its ability to alter exercise tolerance testing (ETT) and respiratory oxygen uptake in 33 patients with congestive heart failure (CHF). C was administered in capsules daily to patients with New York Heart Association Class II or Class III CHF for 12 weeks, in parallel double-blind treatment groups

Clinton N. Corder; Shirley Rubler; Linda F. Deere; Alan Puls; Alfredo Peguero-Rivera; Ravi N. Nagarajan; William Harwood

1993-01-01

178

The clinical implications of aldosterone escape in congestive heart failure  

Microsoft Academic Search

Angiotensin converting enzyme (ACE) inhibitor therapy does not reliably suppress aldosterone production, and 'aldosterone escape' occurs in up to 40% of patients with congestive heart failure (CHF). Aldosterone levels correlate with the risk of cardiovascular events. Aldosterone adversely affects the risk of cardiovascular events via mineralocorticoid receptors in the heart, blood vessels and other sites. Notably, aldosterone contributes to endothelial

Allan D. Struthers

2004-01-01

179

Oxygen free radicals in volume overload heart failure  

Microsoft Academic Search

It has been suggested that oxygen free radicals (OFR) depress the excitation-contraction coupling in cardiac muscle. It is possible that a decrease in the cardiac contractility in the failing heart may be due to an increased OFR producing activity of polymorphonuclear (PMN) leukocytes. We studied the OFR producing activity (chemiluminescence) of PMN leukocytes from blood in dogs with heart failure

K. Prasad; J. B. Gupta; J. Kalra; B. Bharadwaj

1992-01-01

180

Evidence for impaired vagus nerve activity in heart failure  

Microsoft Academic Search

Parasympathetic control of the heart via the vagus nerve is the primary mechanism that regulates beat-to-beat control of heart\\u000a rate. Additionally, the vagus nerve exerts significant effects at the AV node, as well as effects on both atrial and ventricular\\u000a myocardium. Vagal control is abnormal in heart failure, occurring at early stages of left ventricular dysfunction, and this\\u000a reduced vagal

Steve Bibevski; Mark E. Dunlap

2011-01-01

181

Calcification and fatigue failure in a polyurethane heart valve  

Microsoft Academic Search

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

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

1995-01-01

182

Percutaneous Mitral Valve Repair: Potential in Heart Failure Management  

Microsoft Academic Search

As a large portion of the US demographic advances into the later decades of life, the incidence of valvular heart disease\\u000a is expected to increase. Mitral regurgitation (MR) caused by primary valve abnormality (degenerative) or secondary to cardiomyopathy\\u000a (functional) is an important cause of heart failure. Management of valvular heart disease is expected to account for a large\\u000a segment of

Asma Hussaini; Saibal Kar

2010-01-01

183

Combination stem cell therapy for heart failure  

E-print Network

stem cells prolongs the survival of a semiallogeneic heart transplantstem cells: isolation, characterization, and differentiation. Cell Transplantstem cells from human umbilical cord blood. Cell Transplant

2010-01-01

184

Heart rate variability in left ventricular dysfunction and heart failure: effects and implications of drug treatment.  

PubMed Central

OBJECTIVE--To review the importance of heart rate variability analysis in left ventricular dysfunction and heart failure and to assess the effects of drug treatment. In patients with left ventricular dysfunction or heart failure, a low heart rate variability is a strong predictor of a low probability of survival. Because drug treatment in these patients has rapidly changed over the past two decades, the effect of these drugs on heart rate variability needs special attention. DESIGN--A study of published reports to give an overview of heart rate variability in patients with left ventricular dysfunction or heart failure and how it is affected by drug treatment. RESULTS--Analysis of heart rate variability provides an easily obtained early marker for progression of disease. It seems to be more closely related to the degree of neurohumoral activation than to haemodynamic variables. Cardiovascular drugs may either stimulate or inhibit the degree of neurohumoral activation, and the effects of pharmacological intervention can be closely monitored with this method. CONCLUSIONS--The analysis of heart rate variability, including spectral analysis, is a novel non-invasive way to obtain potentially useful clinical information in patients with reduced left ventricular function. The effects of drug treatment on heart rate variability are in general consistent with their long-term effects in left ventricular dysfunction and heart failure. PMID:7857731

Tuininga, Y S; van Veldhuisen, D J; Brouwer, J; Haaksma, J; Crijns, H J; Man in't Veld, A J; Lie, K I

1994-01-01

185

Pediatric Heart Failure: Current State and Future Possibilities  

PubMed Central

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

Jang, Gi Young

2015-01-01

186

Use of pimobendan in feline congenital heart failure  

PubMed Central

A 6-month-old domestic shorthair cat was referred for evaluation of sudden lethargy and tachypnea following ovariohysterectomy. Upon failure of improvement with supportive care, a cardiologist identified congenital tricuspid dysplasia with signs of heart failure. Furosemide, enalapril, and pimobendan were used to reduce clinical signs and improve length and quality of life. PMID:24293678

Wainberg, Shannon

2013-01-01

187

Characterisation of heart failure with normal ejection fraction in a tertiary hospital in Nigeria  

Microsoft Academic Search

BACKGROUND: The study aimed to determine the frequency and characteristics of heart failure with normal EF in a native African population with heart failure. METHODS: It was a hospital cohort study. Subjects were 177 consecutive individuals with heart failure and ninety apparently normal control subjects. All the subjects underwent transthoracic echocardiography. The group with heart failure was further subdivided into

Adedeji K Adebayo; Adewole A Adebiyi; Olulola O Oladapo; Okechukwu S Ogah; Akinyemi Aje; Dike B Ojji; Ayodele O Falase

2009-01-01

188

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

Microsoft Academic Search

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

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

2010-01-01

189

Blunted sympathetic response in diabetic patients with decompensated congestive heart failure  

Microsoft Academic Search

Background: The risk for congestive heart failure is strongly increased in diabetes, and the prognosis of diabetic patients with established heart failure is worse compared to nondiabetic patients. Heart failure entails complex alterations in autonomic and neurohormonal responses, which exert a direct deleterious effect on the heart and contribute to progressive circulatory failure. Altered neurohumoral physiology may underlie the poor

Andrew J Burger; Doron Aronson

2001-01-01

190

Ventricular arrhythmia in congestive heart failure.  

PubMed

The importance of ventricular arrhythmia is based on its association with sudden death. In certain groups of patients, ventricular arrhythmia--primarily runs of nonsustained ventricular tachycardia (NSVT)--is associated with an increased risk for sudden death. Although this relationship has been most often reported in patients with recent myocardial infarction, it has also been recognized in patients with dilated cardiomyopathy, regardless of etiology. Therefore, ventricular arrhythmia is common in patients with CHF due to cardiomyopathy. A number of studies have reported that 70-95% of patients with cardiomyopathy and congestive heart failure (CHF) have frequent ventricular premature beats, and 40-80% will manifest runs of NSVT. Many factors are responsible for ventricular arrhythmia in such patients, including structural abnormalities, electrolyte imbalance, hemodynamic impairment, activation of neurohormonal mechanisms, and pharmacologic therapy. Many studies have reported a high yearly mortality in patients with cardiomyopathy and CHF; greater than 40% of deaths are sudden, most often the result of sustained ventricular tachyarrhythmia. Most studies have noted an association between presence (and frequency) of NSVT and risk of sudden cardiac death in these patients. Unfortunately, other techniques--such as the signal-averaged electrocardiogram and electrophysiologic testing--are not helpful in identifying the individual at risk. Although several drug interventions will reduce mortality from progressive CHF, these drugs have not been shown to reduce sudden death and, indeed, have a variable effect on ventricular arrhythmia. Although NSVT is a marker for increased risk for sudden death, it is uncertain if antiarrhythmic drugs will prevent this outcome. Antiarrhythmic drugs have not been shown to be effective for preventing sudden death, although there are as yet no well-controlled randomized trials. Several studies suggest that amiodarone and beta blockers are beneficial, but this requires confirmation. For patients who have been resuscitated following an episode of sudden death due to a sustained ventricular tachyarrhythmia, antiarrhythmic therapy guided by invasive and noninvasive techniques appears to reduce risk of recurrent arrhythmia. However, the response rate to antiarrhythmic agents is low and side effects are common in patients with CHF. Especially important is the increased risk of precipitating CHF and aggravating the arrhythmia being treated. For many such patients who have had serious ventricular tachyarrhythmia, the automatic implantable cardioverter defibrillator may prove a better option. Other drugs used for management of CHF reduce overall mortality, but not risk of sudden death. PMID:1626494

Podrid, P J; Fogel, R I; Fuchs, T T

1992-06-01

191

Mitochondria as a Therapeutic Target in Heart Failure  

PubMed Central

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

Bayeva, Marina; Gheorghiade, Mihai; Ardehali, Hossein

2013-01-01

192

Hodgkin's lymphoma presenting with heart failure: a case report  

PubMed Central

Introduction Cardiac involvement in malignant lymphoma is one of the least investigated subjects in oncology. This article reports a case of cardiac involvement in Hodgkin's lymphoma which presented as heart failure. Case presentation We report the case of an 8-year-old Afghan girl with Hodgkin's lymphoma. The disease presented with systemic signs and symptoms, including abdominal distension, weakness, pallor, chills, fever, generalized edema, hepatosplenomegaly and generalized lymphadenopathy, as well as signs of heart failure. Test results showed a rare form of heart metastasis. Conclusion We report a case of Hodgkin's lymphoma with metastasis to the heart, detected premortem. Although the involvement of the heart in a malignancy is relatively common, premortem detection is unusual and only few studies have reported it in the literature. PMID:20205760

2010-01-01

193

Iron deficiency: an emerging therapeutic target in heart failure.  

PubMed

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

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

2014-09-15

194

Systems biology and biomechanical model of heart failure.  

PubMed

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

Louridas, George E; Lourida, Katerina G

2012-08-01

195

Diastolic dysfunction in persons with hypertensive heart failure.  

PubMed Central

Arterial hypertension is the commonest cause of heart failure in the Savannah region of Nigeria. The prevalence of diastolic dysfunction in patients with hypertensive heart failure in this region is unknown. This needs to be determined, since it may influence therapy. Left ventricular function of 95 patients with hypertensive heart failure and 92 age-/sex-matched, healthy normotensive control was determined by echocardiography using ALOKA SSD 1700 two-dimensional echocardiograph/ Doppler and color flow ultrasound machine. Compared to the controls, the hypertensive heart failure patients had increased left ventricular mass index (LVMI), p = 0.0001; cardiothoracic ratio (CTR), p = 0.0001; and electrocardiographic left ventricular hypertrophy (ECG-LVH), p = 0.0001. Isolated diastolic dysfunction, E/A ratio < 1.0, and EF > 50%, was seen in 12 patients (12.6%). Twenty-three patients (24.2%) had combined diastolic and systolic dysfunction (E/A ratio < 1.0 and EF < 50%). Six patients (6.3%) had pseudonormalization (E/A ratio 1.0-2.0 and deceleration time, DT, 150-200 msec), while restrictive pattern of diastolic dysfunction was seen in 25 patients (26.3%). This prevalence of 69.4% of diastolic dysfunction in Nigerians with hypertensive heart failure seen in this study emphasizes the need for Doppler echocardiographic evaluation and diagnosis where these facilities are available. This will aid the physician to prescribe appropriate treatment. Images Figure 1 Figure 2 Figure 3 PMID:15253329

Oyati, Imhogene Albert; Danbauchi, Sulei Solomon; Alhassan, Mohammed Ahmed; Isa, Mohammed S.

2004-01-01

196

Hemoconcentration-guided Diuresis in Heart Failure.  

PubMed

One quarter of patients hospitalized for heart failure are readmitted within 30 days, perhaps related to ineffective decongestion. Limited data exist guiding the extent and duration of diuresis in patients hospitalized for heart failure. The objective of this review was to determine the prognostic value of hemoconcentration, or the relative increase in the cellular elements in blood, in patients hospitalized for heart failure and to clarify its role in guiding inpatient diuretic practices. Six post hoc retrospective studies from 2010 to 2013 were available for review. Hemoconcentration was consistently associated with markers of aggressive fluid removal, including higher diuretic dosing and reduced body weight, but increased risk of in-hospital worsening renal function. Despite this, hemoconcentration was associated with improved short-term mortality and rehospitalization. Hemoconcentration is a practical, readily available, noninvasive, economically feasible strategy to help guide diuresis and monitor congestion relief in patients hospitalized for worsening heart failure. Clinicians should strongly consider using changes in hemoglobin and hematocrit as an adjunct to other available measures of decongestion and clinical acumen in inpatient heart failure care. PMID:24937157

Vaduganathan, Muthiah; Greene, Stephen J; Fonarow, Gregg C; Voors, Adriaan A; Butler, Javed; Gheorghiade, Mihai

2014-12-01

197

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

PubMed Central

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

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

2014-01-01

198

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

PubMed

Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heart failure. Diesel engine exhaust (DE) is a major air pollutant suspected to exacerbate preexisting cardiac conditions, in part, through autonomic and electrophysiologic disturbance of normal cardiac function. To explore this putative mechanism, we examined cardiophysiologic responses to DE inhalation in a model of aged heart failure-prone rats without signs or symptoms of overt heart failure. We hypothesized that acute DE exposure would alter heart rhythm, cardiac electrophysiology, and ventricular performance and dimensions consistent with autonomic imbalance while increasing biochemical markers of toxicity. Spontaneously hypertensive heart failure rats (16 months) were exposed once to whole DE (4h, target PM(2.5) concentration: 500 µg/m(3)) or filtered air. DE increased multiple heart rate variability (HRV) parameters during exposure. In the 4h after exposure, DE increased cardiac output, left ventricular volume (end diastolic and systolic), stroke volume, HRV, and atrioventricular block arrhythmias while increasing electrocardiographic measures of ventricular repolarization (i.e., ST and T amplitudes, ST area, T-peak to T-end duration). DE did not affect heart rate relative to air. Changes in HRV positively correlated with postexposure changes in bradyarrhythmia frequency, repolarization, and echocardiographic parameters. At 24h postexposure, DE-exposed rats had increased serum C-reactive protein and pulmonary eosinophils. This study demonstrates that cardiac effects of DE inhalation are likely to occur through changes in autonomic balance associated with modulation of cardiac electrophysiology and mechanical function and may offer insights into the adverse health effects of traffic-related air pollutants. PMID:23047911

Carll, Alex P; Lust, Robert M; Hazari, Mehdi S; Perez, Christina M; Krantz, Quentin Todd; King, Charly J; Winsett, Darrell W; Cascio, Wayne E; Costa, Daniel L; Farraj, Aimen K

2013-02-01

199

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

PubMed Central

Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heart failure. Diesel engine exhaust (DE) is a major air pollutant suspected to exacerbate preexisting cardiac conditions, in part, through autonomic and electrophysiologic disturbance of normal cardiac function. To explore this putative mechanism, we examined cardiophysiologic responses to DE inhalation in a model of aged heart failure–prone rats without signs or symptoms of overt heart failure. We hypothesized that acute DE exposure would alter heart rhythm, cardiac electrophysiology, and ventricular performance and dimensions consistent with autonomic imbalance while increasing biochemical markers of toxicity. Spontaneously hypertensive heart failure rats (16 months) were exposed once to whole DE (4h, target PM2.5 concentration: 500 µg/m3) or filtered air. DE increased multiple heart rate variability (HRV) parameters during exposure. In the 4h after exposure, DE increased cardiac output, left ventricular volume (end diastolic and systolic), stroke volume, HRV, and atrioventricular block arrhythmias while increasing electrocardiographic measures of ventricular repolarization (i.e., ST and T amplitudes, ST area, T-peak to T-end duration). DE did not affect heart rate relative to air. Changes in HRV positively correlated with postexposure changes in bradyarrhythmia frequency, repolarization, and echocardiographic parameters. At 24h postexposure, DE-exposed rats had increased serum C-reactive protein and pulmonary eosinophils. This study demonstrates that cardiac effects of DE inhalation are likely to occur through changes in autonomic balance associated with modulation of cardiac electrophysiology and mechanical function and may offer insights into the adverse health effects of traffic-related air pollutants. PMID:23047911

Farraj, Aimen K.

2013-01-01

200

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

PubMed Central

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

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

2014-01-01

201

The role of exercise in heart failure: a systematic review.  

PubMed

The objective of this study was to examine the long-term effects of exercise on physiological function, functional capacity, and quality of life (QOL) and health status in patients with heart failure. PubMed and CENTRAL were searched (March 2001 to March 2011) for randomized controlled trials for the keyword "exercise heart failure." Data were abstracted by a single author (B.D.R.) and reviewed by another author (R.A.). Fifteen studies were included. Results were mixed between studies for most measures of physiological function, functional capacity, and QOL and health status. In conclusion, compared with usual care, exercise increased a number of measures of functional capacity and QOL in patients with heart failure. Most of the measures of physiological function were not reported across multiple studies; therefore, no trend could be identified for these measures. PMID:23612059

Reiter, Brock D; Arora, Rohit R

2014-01-01

202

Vasodilator treatment for acute and chronic heart failure.  

PubMed Central

The current status of the use of vasodilator drugs in the treatment of acute and chronic heart failure has been reviewed. It is apparent that vasodilator treatment can be used effectively in some patients with heart failure with a beneficial haemodynamics response, and that vasodilator agents are likely to find an important place in the management of such patients. Vasodilator treatment may be associated with complications and must be used with care. Though several nonparenteral vasodilator agents have been investigated, no ideal drug is yet available for the treatment of chronic heart failure. Nevertheless, it is probable that suitable drugs will emerge and find an important place in the management of such patients. Images PMID:884021

Chatterjee, K; Parmley, W W

1977-01-01

203

Potential of resveratrol in the treatment of heart failure.  

PubMed

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

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

2014-01-30

204

Management of heart failure patients using telemedicine communication systems  

Microsoft Academic Search

Heart failure (HF) continues to place significant demands on health care resources because of the large number of hospital\\u000a admissions for HF, the growth of the elderly population with HF, and the improved survival of patients with chronic heart\\u000a disease who develop HF that requires continuous care. Because HF is best managed using a disease management approach, frequent\\u000a communication is

Abul Kashem; Robert C. Cross; William P. Santamore; Alfred A. Bove

2006-01-01

205

Current Status of Stem Cell Therapy in Heart Failure  

Microsoft Academic Search

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,

Marta Codina; Jeremy Elser; Kenneth B. Margulies

2010-01-01

206

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

Microsoft Academic Search

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

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

2010-01-01

207

Cognitive and psycholologic considerations in pediatric heart failure.  

PubMed

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

Hollander, Seth A; Callus, Edward

2014-10-01

208

Pulmonary arteriovenous malformations presenting as refractory heart failure  

PubMed Central

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

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

2014-01-01

209

Mitral Stenosis Reversed by Medical Treatment for Heart Failure  

PubMed Central

It is reported that functional mitral stenosis frequently develops after ring annuloplasty for ischemic mitral regurgitation. The mechanism is a combination of annular size reduction by surgery and diastolic mitral valve tethering, restricting the anterior leaflet opening due to posteriorly displaced papillary muscles with left ventricular dilatation. We report the case of a 57-year-old man who had a history of successful mitral valve plasty for degenerative mitral regurgitation. Four years later he developed heart failure, severe hypertension, mild mitral regurgitation, and significant mitral stenosis, which were reversed by aggressive medical treatment for heart failure. PMID:24182508

Yukawa, Sawami; Takeuchi, Masaaki; Nakazono, Akemi; Sakamoto, Kyoko; Araya, Kiyoshi; Eto, Masataka; Nishimura, Yosuke; Harada, Masaru; Levine, Robert A.; Otsuji, Yutaka

2014-01-01

210

The treatment of heart failure--what next?  

PubMed Central

1. Despite demonstrable benefits in terms of symptomatic relief and improvement in prognosis, even the best treatments of heart failure currently available fall short of being ideal. We review the basis for newer approaches to the treatment of heart failure and discuss some of the agents which capitalize on current understanding of the underlying patho-physiology. 2. Several drugs, old and new, are presently being investigated by major clinical trials. We also consider some of the difficulties related to the design and conduct of such trials and suggest how drugs might be better assessed in the future. PMID:8329279

Davies, R H; Sheridan, D J

1993-01-01

211

Leukocyte behavior in atherosclerosis, myocardial infarction, and heart failure  

PubMed Central

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

Swirski, Filip K.; Nahrendorf, Matthias

2013-01-01

212

Ion channels, transporters, and pumps as targets for heart failure  

PubMed Central

Congestive heart failure (CHF) is a leading cause of morbidity and mortality. CHF is marked by atrial and ventricular enlargement and reduced cardiac contractility, as well as an association with an increased incidence of atrial and ventricular arrhythmias and sudden cardiac death. Dysfunctional ion channel function is one of the major underlying mechanisms of the reduced contractility and arrhythmias. In this review, we explore the utility of ion channels, as well as transporters and pumps, as targets for treatment of heart failure, focusing predominantly on treatment for reduced contractility and arrhythmias. PMID:19365280

Doshi, Darshan; Marx, Steven O.

2009-01-01

213

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

PubMed Central

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

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

2014-01-01

214

Heart Failure Symposium: Promoting Knowledge and Self-Care: The Keys to  

E-print Network

Heart Failure Symposium: Promoting Knowledge and Self-Care: The Keys to a Woman's Healthy Heart This is the Fourth Annual UConn Health Center Heart Failure Symposium. This year we will focus on women and heart disease. The program will include presentations on heart disease and healthy living for women

Kim, Duck O.

215

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

PubMed Central

Diabetes and congestive heart failure (HF) commonly coexist in the same patient, and the presence of diabetes in HF patients is associated with increased adverse events compared to patients without diabetes. Recent guidelines regarding glycemic control stress individualization of glycemic therapy based on patient comorbid conditions and potential adverse effects of medical therapy. This balance in glycemic control may be particularly relevant in patients with diabetes and HF. In this review, we address data regarding the influence that certain HF medications may have on glycemic control. Despite potential modest changes in glycemic control, clinical benefits of proven pharmacologic HF therapies extend to patients with diabetes and HF. In addition, we review potential benefits and challenges associated with commonly used glycemic medications in HF patients. Finally, recent data and controversies on optimal glycemic targets in HF patients are discussed. Given the large number of patients with diabetes and HF and the health burden of these conditions, much needed future work is necessary to define the optimal glycemic treatment in HF patients with diabetes. PMID:23062568

Nasir, Saifullah; Aguilar, David

2012-01-01

216

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

PubMed Central

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

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

2014-01-01

217

Increased walking variability in elderly persons with congestive heart failure  

NASA Technical Reports Server (NTRS)

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

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

1994-01-01

218

NADPH Oxidases in Heart Failure: Poachers or Gamekeepers?  

PubMed Central

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

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

2013-01-01

219

Peritoneal ultrafiltration in patients with advanced decompensated heart failure.  

PubMed

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

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

2013-01-01

220

Causal Inference and Prediction in Health Studies: Environmental Exposures and Schistosomiasis, HIV-1 Genotypic Susceptibility Scores and Virologic Suppression, and Risk of Hospital Readmission for Heart Failure Patients  

E-print Network

Failure Ischemic Heart Disease Valvular Heart Disease DiabetesFailure Readmission African American Medicare Medicaid Idiopathic Cardiomyopathy Ischemic Heart Disease Valvular Heart Disease DiabetesFailure Readmission African American Medicare Medicaid Idiopathic Cardiomyopathy Ischemic Heart Disease Valvular Heart Disease Diabetes

Sudat, Sylvia

2012-01-01

221

Diastolic heart failure: progress, treatment challenges, and prevention.  

PubMed

Diastolic heart failure (DHF) is an important entity, the significance of which is increasingly recognized. This report examines the available evidence regarding the role, significance, and mechanisms of DHF. Epidemiologic studies have documented the rising burden of DHF, and experimental data are revealing the unique mechanisms distinguishing it from systolic heart failure. Despite controversies on the definition of DHF, or heart failure with preserved ejection fraction, standardized clinical criteria with supplementary imaging and structural data have identified DHF as a distinct pathophysiological entity. The mechanisms underlying DHF include abnormal matrix dynamics, altered myocyte cytoskeleton, and impaired active relaxation. The commonly held belief that survival of patients with DHF is better than that of patients with systolic heart failure has been challenged by updated data. The heterogeneous etiologies or risk factors for the condition include aging, diabetes, hypertension, and ischemia, making a common diagnostic or treatment pathway difficult. Novel therapeutic targets that address the pathophysiology of this disease are under consideration, although there are no proven therapies for DHF to date. Exacerbating factors include volume and sodium indiscretion, arrhythmias, ischemia, and comorbidities. Strategies to ameliorate or to obviate these precipitating factors are most effective in preventing DHF and its exacerbations. Meanwhile, prevention of DHF through appropriate and aggressive risk factor identification and management must remain the cornerstone of clinical intervention. PMID:21601770

Wood, Philip; Piran, Sanaz; Liu, Peter P

2011-01-01

222

MODELING CARDIOVASCULAR AND RESPIRATORY DYNAMICS IN CONGESTIVE HEART FAILURE  

E-print Network

pathophysiological links between sleep-related breathing disorders and cardiovascular diseases have recently receivedMODELING CARDIOVASCULAR AND RESPIRATORY DYNAMICS IN CONGESTIVE HEART FAILURE LAURA M. ELLWEIN1. This study develops a coupled cardiovascular-respiratory model that predicts cerebral blood flow velocity

Olufsen, Mette Sofie

223

Emerging role of nuclear cardiology in heart failure.  

PubMed

The management of patients with heart failure requires the integration of clinical skills and accurate complementary tests for the correct diagnosis, treatment and estimation of individual prognosis. Identification of those patients most at risk of death, and those most likely to benefit from currently available treatment technologies, remains a challenge. Although the basic characterization of patients with heart failure is supported primarily by the assessment of the left ventricular function, there are several nuclear cardiology techniques and tracers, either available or under development, which can provide important noninvasive imaging insights into the pathophysiology, prognosis and management of patients with heart failure. Nuclear techniques for molecular imaging of the myocardium such as those involved in the processes of myocardial perfusion, metabolism and viability, cellular injury, dyssynchrony, intersticial dysregulation and neurohormonal receptor function may facilitate better clinical outcomes for patients with heart failure. This review mainly focuses on cardiac sympathetic imaging, as other modalities of nuclear cardiology in the assessment of patients with HF are reviewed more extensively in other sections of this issue. PMID:20588214

Flotats, A; Carrió, I

2010-04-01

224

Congestive heart failure and outpatient risk of venous thromboembolism  

Microsoft Academic Search

Although CHF has been considered a risk factor for venous thromboembolism, this has not been directly studied. We hypothesized that congestive heart failure would increase the risk of venous thromboembolism in an outpatient population, and that this risk would increase as patients' ventricular function worsened. We conducted a case-control study to examine whether CHF due to left ventricular dysfunction was

M. D. Howell; J. M. Geraci; A. A. Knowlton

2001-01-01

225

Family caregiving and congestive heart failure. Review and analysis  

Microsoft Academic Search

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

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

226

The Oxidative Stress Hypothesis of Congestive Heart Failure* Radical Thoughts  

Microsoft Academic Search

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

Susanna Mak; Gary E. Newton

227

Plasma Profile of Urocortins in Acute Heart Failure Patients  

Microsoft Academic Search

Introduction: The growing number of evidence suggests cardioprotective effects of urocortin, a member of the corticotrophin releasing factor peptide family. Plasma levels of urocortins have been shown to increase in human systolic heart failure (HF), especially in the early state and decline with increasing HF severity. However, its role in acute HF is still unknown. In the present study, we

Phitsanu Boonprasert; Narissara Lailerd; Rungsrit Kanjanavanit; Nipon Chattipakorn

2009-01-01

228

Oxidative Stress in Heart Failure: Current Understanding and Prospective  

Microsoft Academic Search

Our knowledge of the pathophysiology of heart failure has advanced far beyond the classic concept of the hemodynamic overload model and associated neurohumoral changes. Current interest lies in understanding the fundamentals of cellular defects to identify new molecular targets for therapies. Some of the new target sites being explored are inflammatory cytokines, nitric oxide, oxidative stress and apoptosis during the

Pawan K. Singal; Neelam Khaper; Vince Palace; Dinender Kumar

1999-01-01

229

Endomyocardial nodular calcification as a cause of heart failure.  

PubMed

Massive cardiac calcification is rare, occurring in association with chronic diseases or more commonly with previous myocardial infarction. We present an intriguing case of massive myocardial calcification of the left ventricle in a young patient with restrictive cardiomyopathy and progressive heart failure who required transplantation. The patient's history and clinical presentation did not reveal the etiology of the myocardial calcification. PMID:20952214

Segura, Ana Maria; Radovancevic, Rajko; Connelly, John H; Loyalka, Pranav; Gregoric, Igor D; Buja, L Maximillian

2011-01-01

230

Assessment of Diastolic Function in Heart Failure and Atrial Fibrillation  

Microsoft Academic Search

In the past three decades, Doppler echocardiography has emerged as a noninvasive alternative to cardiac catheterisation for evaluating haemodynamic variables [1]. A well-performed Doppler examination is able to provide as accurate data as conventional cardiac catheterisation does. Diastolic function of the left ventricle (LV) plays a relevant role in producing the signs and symptoms of heart failure (HF) in cardiac

S. Carerj; S. Raffa; C. Zito

231

Body Fluid Distribution in Elderly Subjects with Congestive Heart Failure  

Microsoft Academic Search

The aims of this study were to investigate body fluid changes in elderly patients suffering from congestive heart failure (CHF) and to identify the fluid measurement that best characterizes fluid overload states in CHF patients by comparison with normal hydration in the elderly. In a case-controlled experimental design, 72 elderly subjects (65-98 yr), 38 healthy and 34 with CHF, were

Giuseppe Sergi; Lucia Lupoli; Stefania Volpato; Roberta Bertani; Alessandra Coin; Egle Perissinotto; Irene Calliari; Emine Meral Inelmen; Luca Busetto; Giuliano Enzi

232

Nebivolol in the treatment of chronic heart failure  

PubMed Central

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

Veverka, Angie; L Salinas, Jennifer

2007-01-01

233

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

Microsoft Academic Search

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

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

2006-01-01

234

Interdisciplinary Team-Based Disease Management of Heart Failure  

Microsoft Academic Search

Multidisciplinary team disease management has evolved into consensus `best practice' in the care of patients with chronic heart failure (CHF). The mission of disease management for patients with CHF is to shift care from the hospital to the clinic and to the home, optimize quality of care in concert with consensus guidelines, reduce admissions by 40% and improve functional status

Thomas G. Di Salvo; Lynne Warner Stevenson

2003-01-01

235

Teaching Congestive Heart Failure to Doctor of Pharmacy Students.  

ERIC Educational Resources Information Center

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

Parker, Robert B.

1992-01-01

236

Inotropes do not increase mortality in advanced heart failure  

PubMed Central

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

Guglin, Maya; Kaufman, Marc

2014-01-01

237

The Management of Acute Decompensated Heart Failure - 2003  

Microsoft Academic Search

SUMMARY The acute management of decompensated heart failure includes the initial stabilization of the patient, assessment of volume status, and tailored treatment, using a variety of therapeutic choices based upon the patient's clinical and hemodynamic status. Current parenteral therapies include the sympathomimetic amines dobutamine and dopamine, which have positive inotropic effects, the phosphodiesterase inhibitors amrinone and milrinone, which have both

José A. Tallaj; Robert C. Bourge

238

The Effects of Heart Failure on Renal Function  

PubMed Central

Summary Heart-kidney interactions have been increasingly recognized by clinicians and researchers involved in the study and treatment of heart failure and kidney disease. A classification system has been developed to categorize the different manifestations of cardiac and renal dysfunction. Recent work has highlighted the significant negative prognostic effect of worsening renal function on outcomes for individuals with heart failure. The etiology of the concomitant cardiac and renal dysfunction remains unclear; however, increasing evidence supports alternatives to the established theory of underfilling, including effects of venous congestion and changes in intra-abdominal pressure. Conventional therapy focuses on blockade of the renin-angiotensin-aldosterone system with expanding use of direct renin and aldosterone antagonists. Novel therapeutic interventions using extracorporeal therapy and antagonists of the adenosine pathway show promise and require further investigation. PMID:20621250

Udani, Suneel M; Koyner, Jay L

2010-01-01

239

Exercise Training Restores Cardiac Protein Quality Control in Heart Failure  

PubMed Central

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

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

2012-01-01

240

?-1 Protein evaluation to stratify heart failure patients.  

PubMed

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

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

2014-06-01

241

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

Microsoft Academic Search

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

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

2010-01-01

242

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

Microsoft Academic Search

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

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

243

Heart failure with preserved ejection fraction: echocardiographic VALVE protocol for emergency physicians.  

PubMed

Heart failure with preserved ejection fraction, previously called diastolic heart failure, has been recognized to account for heart failure in about half the total population of patients with heart failure. These patients can present with the signs and symptoms of acute heart failure. The emergency physician evaluating a patient for acute heart failure may find normal qualitative left ventricular systolic function on focused bedside echocardiogram and prematurely abandon heart failure as a differential diagnosis, when in fact signs of diastolic dysfunction could have been found on additional echo evaluation. This article discusses basic echocardiographic principles of diastolic dysfunction that can be learned and implemented in the emergency department. These findings can aid in the recognition of patients who present with heart failure with preserved ejection fraction. The authors will discuss a focused stepwise approach, namely the VALVE protocol, suitable for the fast-paced emergency department. PMID:24368405

Holst, John M; Kilker, Bret A; Wright, Sherieka; Hoffmann, Beatrice

2014-12-01

244

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

MedlinePLUS

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

245

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

PubMed Central

Although many obese individuals are normoglycemic and asymptomatic of cardiometabolic complications, this apparent healthy state may be a misnomer. Since heart failure is a major cause of mortality in obesity, we investigated the effects of heme-oxygenase (HO) on heart failure and cardiometabolic complications in obese normoglycemic Zucker-fatty rats (ZFs). Treatment with the HO-inducer, hemin, reduced markers of heart failure, such as osteopontin and osteoprotegerin, abated left-ventricular (LV) hypertrophy/fibrosis, extracellular matrix/profibrotic proteins including collagen IV, fibronectin, TGF-?1, and reduced cardiac lesions. Furthermore, hemin suppressed inflammation by abating macrophage chemoattractant protein-1, macrophage-inflammatory protein-1 alpha, TNF-?, IL-6, and IL-1? but enhanced adiponectin, atrial-natriuretic peptide (ANP), HO activity, insulin sensitivity, and glucose metabolism. Correspondingly, hemin improved several hemodynamic/echocardiographic parameters including LV-diastolic wall thickness, LV-systolic wall thickness, mean-arterial pressure, arterial-systolic pressure, arterial-diastolic pressure, LV-developed pressure, +dP/dt, and cardiac output. Contrarily, the HO-inhibitor, stannous mesoporphyrin nullified the hemin effect, exacerbating inflammatory/oxidative insults and aggravated insulin resistance (HOMA-index). We conclude that perturbations in insulin signaling and cardiac function may be forerunners to overt hyperglycemia and heart failure in obesity. Importantly, hemin improves cardiac function by suppressing markers of heart failure, LV hypertrophy, cardiac lesions, extracellular matrix/profibrotic proteins, and inflammatory/oxidative mediators, while concomitantly enhancing the HO-adiponectin-ANP axis. PMID:24454978

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

2013-01-01

246

Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) Trial  

PubMed Central

Aims Hawthorn's efficacy when added to contemporary evidence-based heart failure therapy is unknown. We aimed to determine whether hawthorn increases submaximal exercise capacity when added to standard medical therapy. Methods and results We performed a randomized, double-blind, placebo-controlled trial in 120 ambulatory patients aged ?18 years with New York Heart Association (NYHA) class II-III chronic heart failure. All patients received conventional medical therapy, as tolerated, and were randomized to either hawthorn 450 mg twice daily or placebo for 6 months. The primary outcome was change in 6 min walk distance at 6 months. Secondary outcomes included quality of life (QOL) measures, peak oxygen consumption, and anaerobic threshold during maximal treadmill exercise testing, NYHA classification, left ventricular ejection fraction (LVEF), neurohormones, and measures of oxidative stress and inflammation. There were no significant differences between groups in the change in 6 min walk distance (P = 0.61), or on measures of QOL, functional capacity, neurohormones, oxidative stress, or inflammation. A modest difference in LVEF favoured hawthorn (P = 0.04). There were significantly more adverse events reported in the hawthorn group (P = 0.02), although most were non-cardiac. Conclusion Hawthorn provides no symptomatic or functional benefit when given with standard medical therapy to patients with heart failure. This trial is registered in ClinicalTrials.gov ID: NCT00343902. PMID:19789403

Zick, Suzanna M.; Vautaw, Bonnie Motyka; Gillespie, Brenda; Aaronson, Keith D.

2009-01-01

247

Intravenous milrinone in treatment of advanced congestive heart failure.  

PubMed

Phosphodiesterase inhibitors such as milrinone can relieve symptoms and improve hemodynamics in patients with advanced congestive heart failure. We retrospectively evaluated the hemodynamic and clinical outcomes of long-term combination therapy with intravenous milrinone and oral beta-blockers in 65 patients with severe congestive heart failure (New York Heart Association class IV function and ejection fraction <25%) refractory to oral medical therapy. Fifty-one patients successfully began beta-blocker therapy while on intravenous milrinone. Oral medical therapy was maximized when possible. The mean duration of milrinone treatment in this combination-treatment group was 269 days (range, 14-1,026 days). Functional class improved from IV to II-III with milrinone therapy. Twenty-four such patients tolerated beta-blocker up-titration and were successfully weaned from milrinone. Sixteen patients (31%) died while receiving combination therapy; one died of sudden cardiac death (on treatment day 116); the other 15 died of progressive heart failure or other complications. Hospital admissions during the previous 6 months and admissions within 6 months after milrinone initiation stayed the same. Meanwhile, the total number of hospital days decreased from 450 to 380 (a 15.6% reduction), and the mean length of stay decreased by 1.4 days (a 14.7% reduction). We conclude that 1) milrinone plus beta-blocker combination therapy is an effective treatment for heart failure even with beta-blocker up-titration, 2) weaning from milrinone may be possible once medications are maximized, 3) patients' functional status improves on the combination regimen, and 4) treatment-related sudden death is relatively infrequent during the combination regimen. PMID:12809251

Zewail, Aly M; Nawar, Mohammad; Vrtovec, Bojan; Eastwood, Cathy; Kar, M N Biswajit; Delgado, Reynolds M

2003-01-01

248

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

Microsoft Academic Search

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

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

2011-01-01

249

Prediction of resting energy needs in older men with heart failure  

Microsoft Academic Search

Objectives: Patients with congestive heart failure are often undernourished. The measurement of resting energy expenditure has served as the basis upon which estimates of daily caloric needs have been developed. Resting energy needs, however, in heart failure patients are unknown. We have developed a new equation to predict resting energy needs in heart failure patients that takes into account easily

MJ Toth; ET Poehlman

1997-01-01

250

Edinburgh Research Explorer Global association of air pollution and heart failure  

E-print Network

Edinburgh Research Explorer Global association of air pollution and heart failure Citation & Mills, NL 2013, 'Global association of air pollution and heart failure: a systematic review and meta-6736(13)60898-3 1 Global association of air pollution and heart failure: a systematic review and meta-analysis Anoop

Edinburgh, University of

251

Lifestyle modification with diet and exercise in obese patients with heart failure - A pilot study  

Technology Transfer Automated Retrieval System (TEKTRAN)

There is a paucity of data regarding intentional weight loss in obese heart failure patients. This study sought to ascertain the safety and effectiveness of a lifestyle modification program in patients with systolic heart failure and metabolic syndrome. Patients (n=20) with systolic heart failure (e...

252

Appl Physiol Nutr Metab. Author manuscript Exercise training, energy metabolism, and heart failure  

E-print Network

, and heart failure Ventura-Clapier Ren eé * Signalisation et physiopathologie cardiaque INSERM : U769, IFR141 in many pathophysiological processes among which heart failure. Because endurance training improves recognized as a beneficial practice for heart failure patients. The mechanisms involved in the beneficial

Paris-Sud XI, Université de

253

Managing the patient with diabetes mellitus and heart failure: issues and considerations  

Microsoft Academic Search

Heart failure affects nearly 5 million Americans and is associated with high morbidity and mortality rates. It is now recognized that activation of multiple neurohormonal systems is intrinsic in the pathophysiology of heart failure. Patients with diabetes mellitus are at high risk for heart failure, and some of the complications of diabetes (e.g., insulin resistance) contribute to the development and

Gregg C Fonarow

2004-01-01

254

Approach to the management of diabetic patients with heart failure: Role of thiazolidinediones  

Microsoft Academic Search

Diabetes mellitus is a chronic, progressive disease that results in microvascular and macrovascular complications. Patients with diabetes are at high risk for developing heart failure, and the prevalence of diabetes in patients with heart failure ranges from 24% to 44%, with an estimated 1 to 2 million individuals in the United States having both diabetes and heart failure. Patients with

Gregg C. Fonarow

2004-01-01

255

Cardiovascular responses to heat stress in chronic heart failure.  

PubMed

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

Cui, Jian; Sinoway, Lawrence I

2014-06-01

256

Risks and Benefits of Weight Loss in Heart Failure.  

PubMed

Obesity adversely affects many cardiovascular disease (CVD) risk factors and increases the risk of most CVD, including heart failure (HF). HF is markedly increased in the setting of obesity. However, obese patients with HF have a better prognosis than lean patients with HF, which has been termed the obesity paradox. Therefore, the role of weight loss, which generally improves ventricular structure, systolic and diastolic ventricular function, and New York Heart Association functional class in HF, remains controversial. This article discusses the pros and cons of weight loss and differentiates purposeful (healthy) from nonpurposeful (unhealthy) weight loss. PMID:25432481

Lavie, Carl J; Alpert, Martin A; Ventura, Hector O

2015-01-01

257

Systems biology applied to heart failure with normal ejection fraction.  

PubMed

Heart failure with normal ejection fraction (HFNEF) is currently the most prevalent clinical phenotype of heart failure. However, the treatments available have shown no reduction in mortality so far. Advances in the omics sciences and techniques of high data processing used in molecular biology have enabled the development of an integrating approach to HFNEF based on systems biology. This study aimed at presenting a systems-biology-based HFNEF model using the bottom-up and top-down approaches. A literature search was conducted for studies published between 1991 and 2013 regarding HFNEF pathophysiology, its biomarkers and systems biology. A conceptual model was developed using bottom-up and top-down approaches of systems biology. The use of systems-biology approaches for HFNEF, a complex clinical syndrome, can be useful to better understand its pathophysiology and to discover new therapeutic targets. PMID:24918915

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

2014-05-01

258

Systems Biology Applied to Heart Failure With Normal Ejection Fraction  

PubMed Central

Heart failure with normal ejection fraction (HFNEF) is currently the most prevalent clinical phenotype of heart failure. However, the treatments available have shown no reduction in mortality so far. Advances in the omics sciences and techniques of high data processing used in molecular biology have enabled the development of an integrating approach to HFNEF based on systems biology. This study aimed at presenting a systems-biology-based HFNEF model using the bottom-up and top-down approaches. A literature search was conducted for studies published between 1991 and 2013 regarding HFNEF pathophysiology, its biomarkers and systems biology. A conceptual model was developed using bottom-up and top-down approaches of systems biology. The use of systems-biology approaches for HFNEF, a complex clinical syndrome, can be useful to better understand its pathophysiology and to discover new therapeutic targets. PMID:24918915

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

2014-01-01

259

Nitrosative stress and pharmacological modulation of heart failure  

PubMed Central

Dysregulation of nitric oxide (NO) and increased oxidative and nitrosative stress are implicated in the pathogenesis of heart failure. Peroxynitrite is a reactive oxidant that is produced from the reaction of nitric oxide with superoxide anion and impairs cardiovascular function through multiple mechanisms, including activation of matrix metalloproteinases (MMPs) and nuclear enzyme poly(ADP-ribose) polymerase (PARP). Recent studies suggest that the neutralization of peroxynitrite or pharmacological inhibition of MMPs and PARP are promising new approaches in the experimental therapy of various forms of myocardial injury. In this article, the role of nitrosative stress and downstream mechanisms, including activation of MMPs and PARP, in various forms of heart failure are discussed and novel emerging therapeutic strategies offered by neutralization of peroxynitrite and inhibition of MMPs and PARP in these pathophysiological conditions are reviewed. PMID:15925705

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

2008-01-01

260

Vasopressin receptor antagonists, heart failure, and polycystic kidney disease.  

PubMed

The synthesis of nonpeptide orally bioavailable vasopressin antagonists devoid of agonistic activity (vaptans) has made possible the selective blockade of vasopressin receptor subtypes for therapeutic purposes. Vaptans acting on the vasopressin V2 receptors (aquaretics) have attracted attention as a possible therapy for heart failure and polycystic kidney disease. Despite a solid rationale and encouraging preclinical testing, aquaretics have not improved clinical outcomes in randomized clinical trials for heart failure. Additional clinical trials with select population targets, more flexible dosing schedules, and possibly a different drug type or combination (balanced V1a/V2 receptor antagonism) may be warranted. Aquaretics are promising for the treatment of autosomal dominant polycystic kidney disease and have been approved in Japan for this indication. More studies are needed to better define their long-term safety and efficacy and optimize their utilization. PMID:25493947

Torres, Vicente E

2015-01-14

261

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

PubMed Central

Preclinical studies of animals with risk factors, and how those risk factors contribute to the development of cardiovascular disease and cardiac dysfunction, are clearly needed. One such approach is to feed mice a diet rich in fat (i.e. 60%). Here, we determined whether a high fat diet was sufficient to induce cardiac dysfunction in mice. We subjected mice to two different high fat diets (lard or milk as fat source) and followed them for over six months and found no significant decrement in cardiac function (via echocardiography), despite robust adiposity and impaired glucose disposal. We next determined whether antecedent and concomitant exposure to high fat diet (lard) altered the murine heart’s response to infarct-induced heart failure; high fat feeding during, or before and during, heart failure did not significantly exacerbate cardiac dysfunction. Given the lack of a robust effect on cardiac dysfunction with high fat feeding, we then examined a commonly used mouse model of overt diabetes, hyperglycemia, and obesity (db/db mice). db/db mice (or STZ treated wild-type mice) subjected to pressure overload exhibited no significant exacerbation of cardiac dysfunction; however, ischemia-reperfusion injury significantly depressed cardiac function in db/db mice compared to their non-diabetic littermates. Thus, we were able to document a negative influence of a risk factor in a relevant cardiovascular disease model; however, this did not involve exposure to a high fat diet. High fat diet, obesity, or hyperglycemia does not necessarily induce cardiac dysfunction in mice. Although many investigators use such diabetes/obesity models to understand cardiac defects related to risk factors, this study, along with those from several other groups, serves as a cautionary note regarding the use of murine models of diabetes and obesity in the context of heart failure. PMID:24367585

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

2013-01-01

262

Evidence-based Treatment of Chronic Heart Failure  

Microsoft Academic Search

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

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

2007-01-01

263

Sudden Death in Heart Failure: Risk Stratification and Treatment Strategies  

Microsoft Academic Search

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

M. Zecchin; G. Vitrella; G. Sinagra

264

Pharmacologic modulation of parasympathetic activity in heart failure  

Microsoft Academic Search

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

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

2011-01-01

265

The management of conditioned nutritional requirements in heart failure  

Microsoft Academic Search

Patients suffering from congestive heart failure exhibit impaired myocardial energy production, myocyte calcium overload and\\u000a increased oxidative stress. Nutritional factors known to be important for myocardial energy production, calcium homeostasis\\u000a and the reduction of oxidative stress, such as thiamine, riboflavin, pyridoxine, L-carnitine, coenzyme Q10, creatine and taurine\\u000a are reduced in this patient population. Furthermore, deficiencies of taurine, carnitine, and thiamine

Marc L. Allard; Khursheed N. Jeejeebhoy; Michael J. Sole

2006-01-01

266

Coping and mortality among patients with congestive heart failure  

Microsoft Academic Search

This study was undertaken to evaluate the effects of different coping styles on mortality risk among patients with symptomatic\\u000a congestive heart failure (CHF). Proportional hazard models were used to evaluate the effects of different coping styles on\\u000a mortality among 119 clinically stable patients (71.4% men, mean age 65.7 ± 9.6 years), recruited from an outpatient cardiology\\u000a practice. Twenty deaths were

Terje A. Murberg; Edvin Bru

2001-01-01

267

Breathing disorders in congestive heart failure: gender, etiology and mortality  

Microsoft Academic Search

We investigated the relationship between sleep-disordered breathing (SDB) and Cheyne-Stokes respiration (CSR) while awake as well as mortality. Eighty-nine consecutive outpatients (29 females) with congestive heart failure (CHF; left ventricular ejection fraction, LVEF <45%) were prospectively evaluated. The presence of SDB and of CSR while awake before sleep onset was investigated by polysomnography. SDB prevalence was 81 and 56%, using

R. S. Silva; A. C. Figueiredo; C. Mady; G. Lorenzi-Filho

2008-01-01

268

Endothelial Dysfunction in Congestive Heart Failure: Effects of Carvedilol  

Microsoft Academic Search

In this review, we have examined the role of oxidative stress and apoptosis in the continuum of molecular changes that accompanies congestive heart failure. Cytokine activation and tumor necrosis factor-a, in particular, may play a role in this continuum, favouring both oxidative stress and apoptosis. Carvedilol, a non selective ß- and a-blocker, exerts an anti-apoptotic effect on both the myocytes

R. Ferrari; L. Agnoletti; C. Ceconi; S. Curello; F. Nesta; R. Manfredini

1999-01-01

269

Blood Signature of Pre-Heart Failure: A Microarrays Study  

Microsoft Academic Search

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

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

2011-01-01

270

Biomarker guided therapy for heart failure: focus on natriuretic peptides  

Microsoft Academic Search

The management of heart failure remains challenging despite many therapeutic advances. Rigorous clinical trial evidence supports\\u000a administration of multiple therapies, but utilization of evidence-based treatment remains inconsistent and suboptimal. Disease\\u000a management programs appear effective, but remain costly and difficult to implement in today’s care system. Another approach\\u000a involves optimizing therapy based on serial monitoring of cardiac biomarkers. Emerging results suggest

Kirkwood F. Adams Jr; G. Michael Felker; Ghassan Fraij; J. Herbert Patterson; Christopher M. O’Connor

2010-01-01

271

A Juvenile Murine Heart Failure Model of Pressure Overload  

Microsoft Academic Search

Persistent pressure overload can cause cardiac hypertrophy and progressive heart failure (HF). The authors developed a pressure-overload\\u000a HF model of juvenile mice to study the cardiac response to pressure overload that may be applicable to clinical processes\\u000a in children. Severe thoracic aortic banding (sTAB) was performed using a 28-gauge needle for 40 juvenile (age, 3 weeks) and\\u000a 47 adult (age, 6 weeks)

Kristopher M. Cumbermack; Jun Cheng; Yibing Nong; William T. Mahle; Ronald W. Joyner; William L. Border; Mary B. Wagner; Derek A. Fyfe; Traci Leong; Yanggan Wang

2011-01-01

272

Targeting NOS as a therapeutic approach for heart failure.  

PubMed

Nitric oxide is a key signaling molecule in the heart and is produced endogenously by three isoforms of nitric oxide synthase, neuronal NOS (NOS1), endothelial NOS (NOS3), and inducible NOS (NOS2). Nitric oxide signals via cGMP-dependent or independent pathways to modulate downstream proteins via specific post translational modifications (i.e. cGMP-dependent protein kinase phosphorylation, S-nitrosylation, etc.). Dysfunction of NOS (i.e. altered expression, location, coupling, activity, etc.) exists in various cardiac disease conditions, such as heart failure, contributing to the contractile dysfunction, adverse remodeling, and hypertrophy. This review will focus on the signaling pathways of each NOS isoform during health and disease, and discuss current and potential therapeutic approaches targeting nitric oxide signaling to treat heart disease. PMID:24380841

Tang, Lifei; Wang, Honglan; Ziolo, Mark T

2014-06-01

273

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

PubMed Central

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

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

2014-01-01

274

Iron Deficiency in Heart Failure: A Practical Guide  

PubMed Central

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

Ebner, Nicole; von Haehling, Stephan

2013-01-01

275

Advanced therapies for end-stage heart failure.  

PubMed

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

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

2015-01-01

276

Electrocardiographic QRS Duration and the Risk of Congestive Heart Failure The Framingham Heart Study  

Microsoft Academic Search

Prolonged electrocardiographic QRS duration is frequently observed in congestive heart failure (CHF) patients. We hypothesized that CHF risk increases with longer QRS interval in individuals free of CHF. We evaluated 1759 Framingham Study participants (mean age, 69 years; 63% women) without prior myocardial infarction or CHF who attended a routine examination. QRS duration was analyzed as a continuous (log-transformed) and

Ravi Dhingra; Michael J. Pencina; Thomas J. Wang; Byung-Ho Nam; Emelia J. Benjamin; Daniel Levy; Martin G. Larson; William B. Kannel; Ralph B. D'Agostino; Ramachandran S. Vasan

277

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

PubMed Central

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

Cinca, Juan; Mendez, Ana; Puig, Teresa; Ferrero, Andreu; Roig, Eulalia; Vazquez, Rafael; Gonzalez-Juanatey, Jose R.; Alonso-Pulpon, Luis; Delgado, Juan; Brugada, Josep; Pascual-Figal, Domingo; Brugada, J.; Batlle, M.; Berruezo, A.; Hevia, S.; Mont, L.; 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

278

[Epidemiology of heart failure in mainland Portugal: new data from the EPICA study].  

PubMed

Heart failure (HF) is common, costly, disabling and lethal, and can be prevented. The progression of overt HF (CHF) can be slowed by correct management including precise diagnosis and appropriate therapy. Patients with CHF can be misdiagnosed, mainly in primary care, where patients are actually less symptomatic than those seen in hospitals. Accurate diagnosis requires objective evidence of cardiac dysfunction at rest by imaging techniques, according to the European Society of Cardiology (ESC) Guidelines. The EPICA Project (EPidemiologia da Insuficiência Cardiaca e Aprendizagem) was one of the first European studies designed to evaluate the prevalence of CHF according to those criteria. The estimated overall prevalence of CHF in Portugal was 4.36% in adults over 25 years. 1058 individuals were identified by the Boston questionnaire as possible or probable CHF cases; only 551 had objective evidence of cardiac dysfunction at rest by echocardiography. 264 patients in sinus rhythm had a Boston score > 3 and no echocardiographic abnormalities. These patients were predominantly older obese women; coronary artery disease was less prevalent than in patients with proved CHF. The ECG was normal in 40.9%, versus 20% in CHF patients. About one half of these patients were prescribed ACE inhibitors and diuretics; 17% were prescribed digoxin. According to these EPICA data concerning CHF, older obese women are more frequently misdiagnosed and incorrectly medicated. PMID:15526610

Ceia, Fátima; Fonseca, Cândida; Mota, Teresa; Morais, Humberto; Matias, Fernando; Costa, Catarina; Gouveia-Oliveira, Antonio

2004-09-01

279

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

PubMed Central

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

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

2010-01-01

280

Diabetes and heart failure in the post-myocardial infarction patient  

Microsoft Academic Search

Diabetes mellitus, a disease which is increasing in prevalence, is a major risk factor for coronary heart disease. In patients\\u000a following acute myocardial infarction, the presence of diabetes is a powerful risk factor for the development of heart failure,\\u000a and this intersection of heart failure and diabetes following myocardial infarction carries substantial risk. The poor prognosis\\u000a associated with heart failure

Jerry D. Estep; David Aguilar

2006-01-01

281

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

Microsoft Academic Search

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

Weiwei Li; Brian Olshansky

2011-01-01

282

Risk stratification in middle-aged patients with congestive heart failure: prospective comparison of the Heart Failure ž\\/ Survival Score HFSS and a simplified two-variable model  

Microsoft Academic Search

Ž. Aims: The performance of a US-American scoring system Heart Failure Survival Score, HFSS was prospectively evaluated Ž. in a sample of ambulatory patients with congestive heart failure CHF . Additionally, it was investigated whether the HFSS Ž. might be simplified by assessment of the distance ambulated during a 6-min walk test 6WT instead of determination of peak Ž. Ž

Christian Zugck; Carsten Kruger; Robert Kell; Sven Korber; Dieter Schellberg; Wolfgang Kubler; Markus Haass

283

Age-Dependent Prognostic Significance of Atrial Fibrillation in Outpatients with Chronic Heart Failure: Data from the Italian Network on Congestive Heart Failure Registry  

Microsoft Academic Search

Objectives: The role of atrial fibrillation (AF) in older patients with heart failure (HF) is controversial because many variables seem to influence their outcome. We investigated the predictivity of AF in 3 age groups of outpatients with HF. Methods: We analyzed 8,178 outpatients enrolled in the Italian Network on Congestive Heart Failure Registry with HF diagnosed according to the European

Samuele Baldasseroni; Francesco Orso; Gianna Fabbri; Alberto De Bernardi; Vincenzo Cirrincione; Lucio Gonzini; Stefano Fumagalli; Niccolò Marchionni; Paolo Midi; Aldo Pietro Maggioni; Y. Tan; J. Chen; G. Li; S. Emami

2010-01-01

284

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

PubMed Central

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

2014-01-01

285

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

PubMed

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

Maron, Bradley A

2014-12-01

286

Air Travel Considerations for the Patients With Heart Failure  

PubMed Central

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

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

2014-01-01

287

Original article Increased late sodium current in myocytes from a canine heart failure  

E-print Network

Original article Increased late sodium current in myocytes from a canine heart failure model and from failing human heart Carmen R. Valdivia, William W. Chu, Jielin Pu 1 , Jason D. Foell, Robert A December 2004 Abstract Electrophysiological remodeling of ion channels in heart failure causes action

Kamp, Tim

288

Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure  

Microsoft Academic Search

background We tested the hypothesis that prophylactic cardiac-resynchronization therapy in the form of biventricular stimulation with a pacemaker with or without a defibrillator would reduce the risk of death and hospitalization among patients with advanced chronic heart failure and intraventricular conduction delays. methods A total of 1520 patients who had advanced heart failure (New York Heart Association class III or

Michael R. Bristow; Leslie A. Saxon; John Boehmer; Steven Krueger; David A. Kass; Teresa De Marco; Peter Carson; Lorenzo DiCarlo; David DeMets; Bill G. White; Dale W. DeVries; Arthur M. Feldman

2010-01-01

289

Heart failure in sub-Saharan Africa: A literature review with emphasis on individuals with diabetes  

PubMed Central

Purpose Heart failure is the ultimate complication of cardiac involvements in diabetes. The purpose of this review was to summarize current literature on heart failure among people with diabetes mellitus in sub-Saharan Africa (SSA). Method Bibliographic search of published data on heart failure and diabetes in sub-Saharan Africa over the past 26 years. Results Heart failure remains largely unexplored in general population and among people with diabetes in Africa. Heart failure accounts for over 30% of hospital admission in specialized cardiovascular units and 3%–7% in general internal medicine. Over 11% of adults with heart failure have diabetes. Risk factors for heart failure among those with diabetes include classical cardiovascular risk factors, without evidence of diabetes distinctiveness for other predictors common in Africa. Prevention, management, and outcomes of heart failure are less well known; recent data suggest improvement in the management of risk factors in clinical settings. Conclusions Diabetes mellitus is growing in SSA. Related cardiovascular diseases are emerging as potential health problem. Heart failure as cardiovascular complication remains largely unexplored. Efforts are needed through research to improve our knowledge of heart failure at large in Africa. Multilevel preventive measures, building on evidences from other parts of the world must go along side. PMID:18629376

Kengne, Andre Pascal; Dzudie, Anastase; Sobngwi, Eugene

2008-01-01

290

The relationship between QT intervals and mortality in ambulant patients with chronic heart failure. The United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-HEART)  

Microsoft Academic Search

Aims Mortality in patients with heart failure remains high and is diYcult to predict. QT interval parameters on a 12-lead ECG have been shown to predict arrhythmic events in patients with a variety of myocardial diseases. There is some, but not consistent, evidence that QT interval par- ameters may act as predictors of mortality, in particular sudden death, in patients

P. Brooksby; P. D. Batin; J. Nolan; S. J. Lindsay; R. Andrews; M. Mullen; W. Baig; A. D. Flapan; R. J. Prescott; J. M. M. Neilson; A. J. Cowley; K. A. A. Fox

1999-01-01

291

Oxidative Stress and Heart Failure in Altered Thyroid States  

PubMed Central

Increased or reduced action of thyroid hormone on certain molecular pathways in the heart and vasculature causes relevant cardiovascular derangements. It is well established that hyperthyroidism induces a hyperdynamic cardiovascular state, which is associated with a faster heart rate, enhanced left ventricular systolic and diastolic function whereas hypothyroidism is characterized by the opposite changes. Hyperthyroidism and hypothyroidism represent opposite clinical conditions, albeit not mirror images. Recent experimental and clinical studies have suggested the involvement of ROS tissue damage under altered thyroid status. Altered-thyroid state-linked changes in heart modify their susceptibility to oxidants and the extent of the oxidative damage they suffer following oxidative challenge. Chronic increase in the cellular levels of ROS can lead to a catastrophic cycle of DNA damage, mitochondrial dysfunction, further ROS generation and cellular injury. Thus, these cellular events might play an important role in the development and progression of myocardial remodeling and heart failure in altered thyroid states (hypo- and hyper-thyroidism). The present review aims at elucidating the various signaling pathways mediated via ROS and their modulation under altered thyroid state and the possibility of antioxidant therapy. PMID:22649319

Mishra, Pallavi; Samanta, Luna

2012-01-01

292

Serum thioredoxin (TRX) levels in patients with heart failure.  

PubMed

An increase in oxidative stress is thought to be involved in the progression of heart disease, but the serum level of thioredoxin (TRX), which regulates the cellular redox state, has not been investigated in patients with heart diseases. The present study determined serum TRX levels with a sandwich enzyme-linked immunosorbent assay in a total of 39 patients with dilated cardiomyopathy (DCM) (n=5), acute coronary syndrome (ACS) (n=7) or stable angina (n=18), including effort angina (n=7) and vasospastic angina (n=11), and in control subjects (n=7). The serum TRX level in patients with New York Heart Association (NYHA) functional classes III and IV (n=8, 33.3+/-8.6 ng/ml) was significantly higher than in the control subjects (n=7, 14.0+/-4.6 ng/ml). In addition, the serum TRX levels correlated positively with the severity of NYHA class, and negatively with the left ventricular ejection fraction. The serum TRX levels were elevated in patients with ACS and DCM compared with the controls. These results indicate a possible association between TRX concentration and the severity of heart failure. PMID:11407728

Kishimoto, C; Shioji, K; Nakamura, H; Nakayama, Y; Yodoi, J; Sasayama, S

2001-06-01

293

[Cardiac resynchronization therapy in heart failure patients with atrial fibrillation].  

PubMed

Despite advances in treatment, heart failure (HF) remains a highly prevalent, worldwide problem with a high morbidity and mortality. Cardiac resynchronization therapy (CRT) has become an essential therapeutic tool in HF patients with significant dyssynchrony due to intrinsic conduction disease. Although the prevalence of atrial fibrillation (AF) in patients with advanced HF is high, those patients are excluded or underrepresented in most of the CRT trails. In randomized studies supporting the benefits and indications for CRT, only 2% of patients had AF. Observational studies, a randomized trial and several meta-analyses showed that HF patients with AF may experience benefits similar to patients with a sinus rhythm in terms of functional capacity and reverse remodeling, quality of life, and even survival. With this review, it was aimed to discuss the clinical issues related to CRT, efficacy, heart rate control strategies, and their effects on the therapy. PMID:24104984

Sanl? Ökmen, Arda; Erdinler, Izzet

2013-09-01

294

Remodeling of Calcium Handling in Human Heart Failure  

PubMed Central

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

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

2013-01-01

295

Prognosis: Does Exercise Training Reduce Adverse Events in Heart Failure?  

PubMed

Patients with heart failure (HF) were once discouraged from participating in exercise programs because of concerns regarding safety and the potential for harm to an already damaged myocardium. However, studies over the last 3 decades have provided extensive insights into both the health outcome benefits of exercise and the mechanisms underlying these benefits. Studies on the outcome benefits of exercise training, including mortality and hospitalization, have been convincing. This article reviews the physiologic benefits of exercise training in HF, studies on exercise training in women, results and implications of the HF-ACTION trial, and recent meta-analyses using the Cochrane data base. PMID:25432474

Myers, Jonathan; Brawner, Clinton A; Haykowsky, Mark J F; Taylor, Rod S

2015-01-01

296

Telemonitoring in heart failure: Big Brother watching over you.  

PubMed

Heart failure (HF) is a leading cause of hospitalisations in older people. Several strategies, supported by novel technologies, are now available to monitor patients' health from a distance. Although studies have suggested that remote monitoring may reduce HF hospitalisations and mortality, the study of different patient populations, the use of different monitoring technologies and the use of different endpoints limit the generalisability of the results of the clinical trials reported, so far. In this review, we discuss the existing home monitoring modalities, relevant trials and focus on future directions for telemonitoring. PMID:24972644

Dierckx, R; Pellicori, P; Cleland, J G F; Clark, A L

2015-01-01

297

Exercise Therapy for Heart Failure Patients in Canada.  

PubMed

Contemporary pharmacologic therapies have greatly improved outcomes in patients with heart failure (HF). Exercise therapy also has become increasingly recognized and utilized over the last decade. Patients with HF undergo significant central and peripheral deconditioning. Aerobic and resistance training in this patient population may improve quality of life, muscular strength, aerobic capacity, and potentially longevity. Those HF patients who are able to remain adherent to exercise training programs may improve their self-monitoring skills with respect to progressive volume overload, as well as their capacity for independent living, thereby reducing the likelihood of rehospitalization. PMID:25432476

Stone, James A; Hauer, Trina; Haykowsky, Mark; Aggarwal, Sandeep

2015-01-01

298

Breathing Exercises and Inspiratory Muscle Training in Heart Failure.  

PubMed

Breathing exercises (BE) and inspiratory muscle training (IMT) have been demonstrated to improve ventilation and ventilation-to-perfusion matching, and to improve exercise, functional performance, and many pathophysiologic manifestations of heart failure (HF). This article provides an extensive review of BE and IMT in patients with HF and identifies several key areas in need of further investigation, including the role of expiratory muscle training, IMT targeted at various locations of inspiration (early, mid, or late inspiration), and alteration of the ratio of inspiratory time to total breath time, all of which have substantial potential to improve many pathophysiologic manifestations of HF. PMID:25432483

Cahalin, Lawrence P; Arena, Ross A

2015-01-01

299

Defining the System: Contributors to Exercise Limitations in Heart Failure.  

PubMed

One of the primary hallmarks of patients diagnosed with heart failure (HF) is a reduced tolerance to exercise and compromised functional capacity. This limitation stems from poor pumping capacity but also major changes in functioning of the vasculature, skeletal muscle, and respiratory systems. Advances in the understanding of the central and peripheral mechanisms of exercise intolerance during HF are critical for the future design of therapeutic modalities devised to improve outcomes. The interrelatedness between systems cannot be discounted. This review summarizes the current literature related to the pathophysiology of HF contributing to poor exercise tolerance, and potential mechanisms involved. PMID:25432470

Phillips, Shane A; Vuckovic, Karen; Cahalin, Lawrence P; Baynard, Tracy

2015-01-01

300

PTH: Potential role in management of heart failure.  

PubMed

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

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

2014-06-10

301

Heart failure with preserved ejection fraction - unwinding the diagnosis mystique  

PubMed Central

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

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

2014-01-01

302

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

PubMed

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

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

2014-09-30

303

The role of oxidative stress in the development of congestive heart failure in a chicken genotype selected for rapid growth  

Microsoft Academic Search

The present study examined the possible role of reactive oxygen species in the pathogenesis of heart failure in broilers. Data were collected from three groups of birds at various risk of heart failure: Leghorn chickens (resistant to heart failure), slow-growing feed-restricted broilers (low risk of heart failure), fast-growing ad libitum fed broilers (high risk of heart failure), and broilers with

S. Nain; B. Ling; B. Bandy; J. Alcorn; C. Wojnarowicz; B. Laarveld; A. A. Olkowski

2008-01-01

304

Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure  

Microsoft Academic Search

OBJECTIVES. Many developed countries have seen declining mortality rates\\u000a for heart disease, together with an alleged decline in incidence and a\\u000a seemingly paradoxical increase in health care demands. This paper presents\\u000a a model for forecasting the plausible evolution of heart disease\\u000a morbidity. METHODS. The simulation model combines data from different\\u000a sources. It generates acute coronary event and mortality rates from

L. G. A. Bonneux; J. J. M. Barendregt; K. J. Meeter; G. J. Bonsel; Maas van der P. J

1994-01-01

305

Comparative pathology of heart and liver lesions of broiler chickens that died of ascites, heart failure, and others.  

PubMed

Pathologic changes of 120 dead broilers from a flock of 1000 birds were compared. Macroscopically, the changes were divided into three pathologic types: ascites (retention of ascitic fluid), heart failure (right heart dilation and/or hydropericardium without retention of ascitic fluid), and others (without ascites or heart failure). The rates of ascites, heart failure, and others were 55.8% (67/120), 33.3% (40/120), and 10.8% (13/120), respectively. Histologically, cardiac histologic changes (myocardial degeneration with calcification and epicardial fibrosis) were seen in 40 of 67 (59.7%) ascites cases. Hepatic histologic changes (hepatocytic degeneration/necrosis and hepatic capsule fibrosis) were seen in 64 of 67 (95.5%) ascites cases. Cardiac histologic changes were seen in 24 of 40 heart failure cases (60.0%). Hepatic histologic changes were seen in 36 of 40 (90.0%) heart failure cases. Six of 13 others had hepatic histologic changes, but the remaining seven birds had no significant histologic changes. Ascites and heart failure cases had almost the same percentages of hepatic and cardiac histologic changes. This study indicates that two pathologic types, ascites and heart failure, may be closely related conditions and that hepatic histologic changes may be common and fundamental lesions in the pathogenesis of these pathologic types. PMID:10494423

Nakamura, K; Ibaraki, Y; Mitarai, Z; Shibahara, T

1999-01-01

306

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

PubMed

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

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

2014-03-01

307

Stratification of the Risk of Sudden Death in Nonischemic Heart Failure  

PubMed Central

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

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

2014-01-01

308

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

PubMed

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

Fields, Anjali V; Kirkpatrick, James N

2012-01-01

309

Levosimendan reverses right-heart failure in a 51-year-old patient after heart transplantation.  

PubMed

Primary graft failure in the early postoperative period after heart transplantation, remains a main cause of a poor outcome. Current treatment options include pharmacological (catecholamines and phosphodiesterase inhibitors) and mechanical assist device support. Pharmacological support with catecholamines is related to elevated myocardial oxygen consumption and regional hypoperfusion leading to organ damage. On the other hand, levosimendan, as a calcium-sensitizing agent increases cardiac contractility without altering intracellular Ca(2+) levels and increase in oxygen demand. We present a case of a 51-year-old man, who was suffering from acute right-heart failure in the early postoperative period after heart transplantation. As a rescue therapy at the late stage of a low cardiac output state, levosimendan was started as continuous infusion at 0.1 ?g/kg/min for 12 h and thereafter, at 0.2 ?g/kg/min for the following 36 h. Levosimendan demonstrated an advanced pharmacological option as was portrayed in this case, where the right ventricle was under a prolonged severe depression and acutely overloaded after heart transplantation. PMID:24652017

Barisin, Stjepan; Djuzel, Viktor; Barisin, Ana; Rudez, Igor

2014-08-01

310

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

PubMed

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

Shah, Sachil

2012-01-01

311

Fatigue, Inflammation, and Projected Mortality in Heart Failure  

PubMed Central

Background Fatigue is a prominent and poorly understood symptom of heart failure with reduced ejection fraction (HFrEF). The purpose of this study was to determine whether fatigue correlated with immune biomarkers and prognosis. Methods/Results In patients with HFrEF (N = 59) and healthy controls (N = 25), we prospectively measured fatigue (Profile of Mood States), depressive symptoms (Patient Health Questionnaire-8), sleep quality (Pittsburgh Sleep Quality Index), and immune biomarkers (plasma C-reactive protein [CRP], tumor necrosis factor-? [TNF?], and interleukins [IL-6 and IL-10]). Seattle Heart Failure Model (SHFM) mortality risk scores were determined. Patients with HFrEF had significantly greater fatigue and depressive symptoms and poorer sleep quality compared to control subjects. When controlling for depressive symptoms, however, fatigue did not differ significantly between patients with HFrEF and controls. Patients with HFrEF had significantly lower levels of IL-10 compared to controls. Cytokines did not correlate significantly with fatigue, but fatigue was significantly associated with higher SHFM scores. Conclusions Depressive symptoms were an important covariate of fatigue in patients with HFrEF. Our study findings were the first to show a positive association between fatigue and the SHFM score, indicating that fatigue was associated with poorer prognosis. PMID:22939040

Fink, Anne M.; Gonzalez, Rosalia C.; Lisowski, Tadeusz; Pini, Maria; Fantuzzi, Giamila; Levy, Wayne C.; Piano, Mariann R.

2012-01-01

312

[Alternative approaches in the end-stage heart failure].  

PubMed

Cardiac transplantation has emerged as the therapeutic procedure of choice for patients with end-stage heart disease but the availability of donor organs remains major limiting factor allowing only 1% of the candidates actually become transplant recipients. New therapeutic strategies are under intensive research for patients who do not meet patient selection criteria for transplantation or who suffer from donor organ shortage. Even though there are significant developments in the medical treatment of cardiac failure, the prognosis of this condition continues to be poor. The 20-40% of the candidates for cardiac transplantation die while they are included in the waiting list. Twenty percent mortality has been reported within the first year of transplantation with additional yearly mortality of 5% following the first year. Financial constraints, complications of immunosuppression and functional failure of the transplanted hearts are other limiting factors. This has brought up the necessity to search for alternative surgical treatment methods besides increasing the waiting periods of transplant candidates. The aim of this report is to summarize other currently available therapeutic alternatives for patients with end-stage cardiac disease. PMID:12967894

Durdu, Serkan; Akar, Rüçhan; Cavolli, Raif; Eren, Neyyir Tuncay; Corapçio?lu, Tümer; Uçanok, Kemalettin; Ozyurda, Umit

2003-09-01

313

Outcomes in acute heart failure: 30-day readmission versus death.  

PubMed

For patients hospitalized with acute heart failure, health policy initiatives in the USA have drawn attention to 30-day mortality and readmission. Confusion around definitions, populations, and thus reported rates for these two outcomes is common. Among Medicare fee-for-service patients hospitalized with heart failure, all-cause mortality 30 days from the time of admission is 11.7 % and all-cause unplanned readmission 30 days from discharge is 23.0 %. Rates for Medicaid and commercially insured patients are lower. Mortality rates have been relatively stable, while readmission rates increased under the Diagnosis Related Group payment system then began decreasing under the Hospital Readmission Reductions Program. Risk models are reasonable at predicting mortality, whereas readmission has been harder to anticipate. The use of risk-standardized hospital rates as performance measures has generated considerable debate. Future work should clarify the interaction between the two measures, the optimal time window and factors influencing rates and trends-including socioeconomic status. PMID:25139630

McIlvennan, Colleen K; Allen, Larry A

2014-12-01

314

The Emerging Epidemic of Heart Failure with Preserved Ejection Fraction  

PubMed Central

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

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

2013-01-01

315

[Essential cardiac biomarkers in myocardial infarction and heart failure].  

PubMed

With the discovery of novel biomarkers in cardiovascular diseases, over the past decades considerable improvements in diagnosis, risk stratification and patient care could be achieved; however, despite extensive research, only few biomarkers have met the requirements of significantly improving diagnostic or prognostic approaches. Among the most established markers are cardiac troponins and natriuretic peptides, which are recommended in current guidelines for myocardial infarction or heart failure and are routinely used in clinical practice. Cardiac troponins T and I are the preferred biomarkers of choice for definition of myocardial infarction and proved to be prognostically relevant not only in acute coronary syndrome but also in non-cardiac diseases. The natriuretic peptides B-type natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) aid in diagnosis, risk stratification and monitoring of heart failure. In recent years several new promising markers have been proposed which might add incremental clinical information, most notably copeptin and growth differentiation factor (GDF) 15; however, larger studies are still required before recommendations for routine clinical use can be made. PMID:25091086

Mueller, M; Giannitsis, E; Katus, H A

2014-09-01

316

Experiences of air travel in patients with chronic heart failure  

PubMed Central

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

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

2012-01-01

317

Should aldosterone blockade be used beyond current indications in heart failure?  

Microsoft Academic Search

Aldosterone receptor antagonists (ARAs) are becoming important supplementary options in the pharmacologic treatment of congestive\\u000a heart failure (CHF), and the indication for ARAs continues to grow. Aldosterone is a stimulator of myocardial fibrosis, causing\\u000a progression of CHF and serving as an important factor in the pathogenesis of diastolic heart failure (ie, heart failure with\\u000a normal ejection fraction). The beneficial effects

Marcelle D. Smit; Isabelle C. van Gelder; Michael Böhm; Hans-Ruprecht Neuberger; Dirk J. van Veldhuisen

2009-01-01

318

Genetic Variation associated with Ischemic Heart Failure: A HuGE Review and Meta-Analysis  

Microsoft Academic Search

The ischemic etiology of heart failure is an independent prognostic factor associated with worse long-term outcome. Recent evidence indicates a role for genetic susceptibility to ischemic heart failure. The authors sys- tematically reviewed all known case-control studies that investigated the association between genetic variants and ischemic heart failure. Twenty-two articles, which examined 24 gene polymorphisms, were identified. In 22 poly-

Georgios Kitsios; Elias Zintzaras

2007-01-01

319

Implantable cardiac resynchronization therapy devices to monitor heart failure clinical status  

Microsoft Academic Search

Cardiac resynchronization therapy is a standard therapy for selected patients with heart failure. With advances in technology\\u000a and storage capacity, the device acts as a convenient platform to provide valuable information about heart failure status\\u000a in these high-risk patients. Unlike other modalities of investigation which may only allow one-off evaluation, heart failure\\u000a status can be monitored by device diagnostics including

Jeffrey Wing-Hong Fung; Cheuk-Man Yu

2007-01-01

320

The dietary quality of persons with heart failure in NHANES 1999-2006  

Microsoft Academic Search

BACKGROUND: Dietary quality may impact heart failure outcomes. However, the current status of the dietary quality of persons with heart failure has not been previously reported.\\u000aOBJECTIVE: To describe sodium intake, patient factors associated with sodium intake and overall dietary quality in a national sample of persons with heart failure.\\u000aDESIGN: Analysis of repeated cross-sectional probability sample surveys using data

Stephenie C. Lemon; Barbara C. Olendzki; Robert P. Magner; Wenjun Li; Annie L. Culver; Ira S. Ockene; Robert J. Goldberg

2009-01-01

321

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

Microsoft Academic Search

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

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

322

Disease-Specific Depression and Outcomes in Chronic Heart Failure: A Propensity Score Analysis  

Microsoft Academic Search

Depression is common in heart failure and is associated with increased mortality. Yet, it is often underdiagnosed and inadequately\\u000a treated. Lack of disease-specific and easy-to-administer screening tools is one of the reasons for underdiagnosis of depression\\u000a in heart failure. We examined the effect of depression, as diagnosed by a single question about depression caused by heart\\u000a failure symptoms and affecting

Ozioma C. Okonkwo; Xuemei Sui; Ali Ahmed

2007-01-01

323

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

Microsoft Academic Search

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

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

1989-01-01

324

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

Microsoft Academic Search

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

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

2006-01-01

325

?-Blocker Use for the Stages of Heart Failure  

PubMed Central

The 2005 American Heart Association/American College of Cardiology heart failure (HF) guidelines contributed to a renewed focus on “at-risk” patients and emphasized HF as a progressive disease. Patient categorization by stages focused attention on customization of therapy to achieve optimal, evidence-based treatments across the HF continuum. Therapy for risk factors that predispose patients to left ventricular dysfunction or other symptoms may help reduce HF development. ?-Blockers are valuable for treatment of HF; however, the class is heterogeneous, and proper ?-blocker selection for each HF stage is important. ?-Blockers have been used routinely to treat patients with stage A HF with hypertension. Recent controversy regarding the detrimental effects that some ?-blockers have on metabolic parameters has raised inappropriate concerns about the use of any ?-blocker for diabetes. ?-Blockade is standard therapy for the patient with stage B HF who has had a myocardial infarction, but few data are available concerning use in asymptomatic patients with left ventricular dysfunction. Additionally, ?-blockers are part of the core therapy for stage C HF and selected patients with stage D HF. This review examines the role and use of ?-blockers in each HF stage through an evidence-based approach to provide better understanding of their importance in this progressive disease. PubMed searches (1980-2008) identified large clinical trials that evaluated cardiovascular events and outcomes in any HF stage or hypertension. Search terms were heart failure, hypertension, ?-blocker, ACEI, ARB, and calcium channel blocker AND blood pressure coronary artery disease, diabetes, efficacy, left ventricular dysfunction, metabolism, mortality, myocardial infarction, or stroke. PMID:19648389

Klapholz, Marc

2009-01-01

326

Management of chronic heart failure in the older population  

PubMed Central

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

Azad, Nahid; Lemay, Genevieve

2014-01-01

327

Methods of failure and reliability assessment for mechanical heart pumps.  

PubMed

Artificial blood pumps are today's most promising bridge-to-recovery (BTR), bridge-to-transplant (BTT), and destination therapy solutions for patients suffering from intractable congestive heart failure (CHF). Due to an increased need for effective, reliable, and safe long-term artificial blood pumps, each new design must undergo failure and reliability testing, an important step prior to approval from the United States Food and Drug Administration (FDA), for clinical testing and commercial use. The FDA has established no specific standards or protocols for these testing procedures and there are only limited recommendations provided by the scientific community when testing an overall blood pump system and individual system components. Product development of any medical device must follow a systematic and logical approach. As the most critical aspects of the design phase, failure and reliability assessments aid in the successful evaluation and preparation of medical devices prior to clinical application. The extent of testing, associated costs, and lengthy time durations to execute these experiments justify the need for an early evaluation of failure and reliability. During the design stages of blood pump development, a failure modes and effects analysis (FMEA) should be completed to provide a concise evaluation of the occurrence and frequency of failures and their effects on the overall support system. Following this analysis, testing of any pump typically involves four sequential processes: performance and reliability testing in simple hydraulic or mock circulatory loops, acute and chronic animal experiments, human error analysis, and ultimately, clinical testing. This article presents recommendations for failure and reliability testing based on the National Institutes of Health (NIH), Society for Thoracic Surgeons (STS) and American Society for Artificial Internal Organs (ASAIO), American National Standards Institute (ANSI), the Association for Advancement of Medical Instrumentation (AAMI), and the Bethesda Conference. It further discusses studies that evaluate the failure, reliability, and safety of artificial blood pumps including in vitro and in vivo testing. A descriptive summary of mechanical and human error studies and methods of artificial blood pumps is detailed. PMID:15644079

Patel, Sonna M; Allaire, Paul E; Wood, Houston G; Throckmorton, Amy L; Tribble, Curt G; Olsen, Don B

2005-01-01

328

[Interest of NT-proBNP in chronic heart failure follow-up].  

PubMed

Reducing readmissions after hospitalisation for acute heart failure is the new challenge of these diseases, approaching 30% within 60 to 90 days of discharge. Congestion related to high ventricular filling pressures, reflected by the high levels of natriuretic peptides, is the main reason for heart failure readmission. Natriuretic peptide levels are a patent prognostic marker of cardiovascular event in chronic heart failure. Treshold values of BNP and NT-proBNP being respectively 125 and 1000 pg/mL. Optimizing treatment of heart failure by monitoring natriuretic peptides, including management of diuretic doses, remains matter of controversies. PMID:24235327

Galinier, Michel; Berry, Matthieu; Delmas, Clément; Fournier, Pauline

2013-11-01

329

Influence of sex on treatment and outcome in chronic heart failure.  

PubMed

The population is aging, the prevalence of heart failure increases with age, and on average women live longer than men. There is evidence for sex-specific effects of individual, guideline-recommended drugs used for treatment of chronic heart failure. Women are underrepresented in most clinical trials and only a minority of drug applications to regulatory authorities have included sex analyses. The present review focuses on the potential female survival benefit in heart failure, the influence of sex on medical treatment in a broader sense, and the potential benefit to be derived from guideline recommended treatment and common adjunctive heart failure medication. PMID:21599874

Frankenstein, Lutz; Clark, Andrew L; Ribeiro, Jorge P

2012-06-01

330

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

PubMed

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

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

2014-10-01

331

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

PubMed

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

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

332

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

PubMed

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

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

2014-04-01

333

Risk score model for predicting mortality in advanced heart failure patients followed in a heart failure clinic.  

PubMed

The prevalence of heart failure (HF) in the population is increasing, concomitant with high incidence of rehospitalizations and mortality. The aim of this study was to characterize a prognostic risk score model for patients with chronic HF. A total of 500 patients followed at the HF clinic were evaluated by clinical, functional, laboratory, imaging, and therapeutic variables that were correlated to mortality during a follow-up period of 25 months. Risk stratification was carried out by applying a risk score model based on multivariate analysis. Predictors correlated with mortality during follow-up were systolic blood pressure <110 mm Hg, male sex, age older than 70 years, 6-minute walk distance <300 m, lack of ?-blocker therapy, hyperuricemia (>7.5 mg/dL), hyponatremia, and prolonged QTc interval (>450 ms). Based on these variables, a risk score model (score 0-55) was established and included low risk, score <21 (9% mortality during 2-year follow-up); moderate risk, 21 to 29 (22%); high risk, 30 to 35 (35%), and very high risk: ?36 points (62% 2-year mortality). The risk model had good discrimination ability (concordance index 0.75), which was better than the performance of the Seattle Heart Failure Model on our cohort (0.69). Simple noninvasive characteristics examined during the initial admission to the HF clinic can serve as prognostic markers for mortality and may help in the process of therapeutic decision-making in patients with HF. PMID:22994439

Zafrir, Barak; Goren, Yaron; Paz, Hagar; Wolff, Rafael; Salman, Nabia; Merhavi, Dina; Lavi, Idit; Lewis, Basil S; Amir, Offer

2012-01-01

334

RNA-Seq identifies novel myocardial gene expression signatures of heart failure.  

PubMed

Heart failure is a complex clinical syndrome and has become the most common reason for adult hospitalization in developed countries. Two subtypes of heart failure, ischemic heart disease (ISCH) and dilated cardiomyopathy (DCM), have been studied using microarray platforms. However, microarray has limited resolution. Here we applied RNA sequencing (RNA-Seq) to identify gene signatures for heart failure from six individuals, including three controls, one ISCH and two DCM patients. Using genes identified from this small RNA-Seq dataset, we were able to accurately classify heart failure status in a much larger set of 313 individuals. The identified genes significantly overlapped with genes identified via genome-wide association studies for cardiometabolic traits and the promoters of those genes were enriched for binding sites for transcriptions factors. Our results indicate that it is possible to use RNA-Seq to classify disease status for complex diseases such as heart failure using an extremely small training dataset. PMID:25528681

Liu, Yichuan; Morley, Michael; Brandimarto, Jeffrey; Hannenhalli, Sridhar; Hu, Yu; Ashley, Euan A; Tang, W H Wilson; Moravec, Christine S; Margulies, Kenneth B; Cappola, Thomas P; Li, Mingyao

2015-02-01

335

Salt Intake Is Associated with Inflammation in Chronic Heart Failure  

PubMed Central

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

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

2014-01-01

336

Zebrafish Heart Failure Models for the Evaluation of Chemical Probes and Drugs  

PubMed Central

Abstract Heart failure is a complex disease that involves genetic, environmental, and physiological factors. As a result, current medication and treatment for heart failure produces limited efficacy, and better medication is in demand. Although mammalian models exist, simple and low-cost models will be more beneficial for drug discovery and mechanistic studies of heart failure. We previously reported that aristolochic acid (AA) caused cardiac defects in zebrafish embryos that resemble heart failure. Here, we showed that cardiac troponin T and atrial natriuretic peptide were expressed at significantly higher levels in AA-treated embryos, presumably due to cardiac hypertrophy. In addition, several human heart failure drugs could moderately attenuate the AA-induced heart failure by 10%–40%, further verifying the model for drug discovery. We then developed a drug screening assay using the AA-treated zebrafish embryos and identified three compounds. Mitogen-activated protein kinase kinase inhibitor (MEK-I), an inhibitor for the MEK-1/2 known to be involved in cardiac hypertrophy and heart failure, showed nearly 60% heart failure attenuation. C25, a chalcone derivative, and A11, a phenolic compound, showed around 80% and 90% attenuation, respectively. Time course experiments revealed that, to obtain 50% efficacy, these compounds were required within different hours of AA treatment. Furthermore, quantitative polymerase chain reaction showed that C25, not MEK-I or A11, strongly suppressed inflammation. Finally, C25 and MEK-I, but not A11, could also rescue the doxorubicin-induced heart failure in zebrafish embryos. In summary, we have established two tractable heart failure models for drug discovery and three potential drugs have been identified that seem to attenuate heart failure by different mechanisms. PMID:24351044

Monte, Aaron; Cook, James M.; Kabir, Mohd Shahjahan; Peterson, Karl P.

2013-01-01

337

Disparities in heart failure and other cardiovascular diseases among women  

PubMed Central

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

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

2012-01-01

338

Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives  

PubMed Central

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

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

2013-01-01

339

Can Cognitive Behaviour Therapy Be Beneficial for Heart Failure Patients?  

PubMed

This review aims to summarize the theory of cognitive behavioural therapy (CBT) as well as the current evidence for whether CBT can be beneficial for patients with heart failure (HF). Depression and/or anxiety are common in HF patients. However, participation in disease management programmes does not seem to be beneficial for these problems. CBT, which focuses on the identification and changing of dysfunctional beliefs and thoughts and on behaviour therapy, is a possible treatment option. The number of CBT studies on HF is small and they are often not designed as randomized controlled trials. However, the studies on HF indicate that CBT can decrease depression as well as anxiety and suggest that relaxation exercises with elements of CBT may decrease symptom burden. Before implementation in clinical practice, more knowledge is needed about how CBT programmes should be designed, where CBT should be delivered and who should deliver CBT. PMID:25475179

Lundgren, Johan; Andersson, Gerhard; Johansson, Peter

2014-12-01

340

Preprocedural Imaging for Patients with Atrial Fibrillation and Heart Failure  

PubMed Central

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

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

2012-01-01

341

Respiratory muscle function and exercise intolerance in heart failure.  

PubMed

Inspiratory muscle weakness (IMW) is prevalent in patients with chronic heart failure (CHF) caused by left ventricular systolic dysfunction, which contributes to reduced exercise capacity and the presence of dyspnea during daily activities. Inspiratory muscle strength (estimated by maximal inspiratory pressure) has independent prognostic value in CHF. Overall, the results of trials with inspiratory muscle training (IMT) indicate that this intervention improves exercise capacity and quality of life, particularly in patients with CHF and IMW. Some benefit from IMT may be accounted for by the attenuation of the inspiratory muscle metaboreflex. Moreover, IMT results in improved cardiovascular responses to exercise and to those obtained with standard aerobic training. These findings suggest that routine screening for IMW is advisable in patients with CHF, and specific IMT and/or aerobic training are of practical value in the management of these patients. PMID:19486593

Ribeiro, Jorge P; Chiappa, Gaspar R; Neder, J Alberto; Frankenstein, Lutz

2009-06-01

342

Emerging Biomarkers in Heart Failure and Cardiac Cachexia  

PubMed Central

Biomarkers are objective tools with an important role for diagnosis, prognosis and therapy optimization in patients with heart failure (HF). To date, natriuretic peptides are closest to optimal biomarker standards for clinical implications in HF. Therefore, the efforts to identify and test new biomarkers in HF are reasonable and justified. Along the natural history of HF, cardiac cachexia may develop, and once at this stage, patient performance and prognosis is particularly poor. For these reasons, numerous biomarkers reflecting hormonal, inflammatory and oxidative stress pathways have been investigated, but only a few convey relevant information. The complex pathophysiology of HF appears far too complex to be embraced by a single biomarker; thus, a combined approach appears reasonable. With these considerations, we have reviewed the recent developments in the field to highlight key candidates with diagnostic, prognostic and therapy optimization properties, either alone or in combination. PMID:25535078

Loncar, Goran; Omersa, Daniel; Cvetinovic, Natasa; Arandjelovic, Aleksandra; Lainscak, Mitja

2014-01-01

343

Treatment strategies for the prevention of heart failure.  

PubMed

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

Grodin, Justin L; Tang, W H Wilson

2013-12-01

344

Mammillary bodies and fornix fibers are injured in heart failure  

PubMed Central

Cognitive abnormalities, including memory deficits, are common in heart failure (HF). Brain structures, including the hippocampus, fornix, and thalamus participate in memory processing, and most show structural injury and functional deficits in HF. The mammillary bodies and fornix play essential roles in spatial and working memory processing, interact with other structures, and may also be injured in HF. We assessed mammillary body volumes and cross-sectional fornix areas in 17 HF and 50 control subjects using high-resolution T1-weighted magnetic resonance images. Mammillary body volumes and fornix cross-sectional areas were significantly reduced bilaterally in HF, and these differences remained after controlling age, gender, and intracranial volume. Mammillary body and fornix injury may contribute to the compromised spatial and working memory deficits in HF. Pathological processes eliciting the damage may include injury accompanying hypoxic/ischemic processes in pathologic HF perfusion and breathing, and thiamine deficiency accompanying diuretic use and nutritional malabsorption in the condition. PMID:19022386

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

2009-01-01

345

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

PubMed

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

von Haehling, S; Anker, S D

2014-04-01

346

Heart failure with preserved ejection fraction: Refocusing on diastole.  

PubMed

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

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

2015-01-20

347

Technology to Promote and Increase Physical Activity in Heart Failure.  

PubMed

Regular physical activity is firmly recommended as part of a multifaceted approach to heart failure (HF) self-management. Unfortunately, research indicates that most patients are less likely to engage in and adhere to such activities. The widespread use of information and communication technology tools and resources offers an innovative and potentially beneficial avenue for increasing physical activity levels in HF patients. This article presents specific ways in which advances in information and communication technologies, including Internet- and mobile-based communications, social media platforms, and self-monitoring health devices, can serve as a means to broadly promote increasing levels of physical activity to improve health outcomes in the HF population. PMID:25432484

Franklin, Nina C

2015-01-01

348

Pharmacogenetics in heart failure: how it will shape the future.  

PubMed

Pharmacogenomics is a growing field of research that focuses on how an individual's genetic background influences his or her response to therapy with a drug or device. Increasing evidence from clinical trials in patients with heart failure (HF) due to systolic dysfunction suggests that genetic variations can predict the occurrence of HF, influence the effects of standard therapies, and influence outcomes of HF patients. This article reviews the underlying principles of pharmacogenomics, discusses some of the complex variables that influence the investigational approach to pharmacogenomics, demonstrates how variations in genes encoding a variety of different proteins can influence the effects of pharmacologic agents, and describes the potential impact of pharmacogenomics on the treatment of patients with HF. PMID:19945055

Hamad, Eman; Feldman, Arthur M

2010-01-01

349

Understanding the epidemic of heart failure: past, present, and future.  

PubMed

Heart failure (HF) is a major public health problem affecting more than five million Americans and more than 23 million patients worldwide. The epidemiology of HF is evolving. Data suggests that the incidence of HF peaked in the mid-1990s and has since declined. Survival after HF diagnosis has improved, leading to an increase in prevalence. The case mix is also changing, as a rising proportion of patients with HF have preserved ejection fraction and multimorbidity is increasingly common. After diagnosis, HF can have a profound associated morbidity. Hospitalizations in HF remain both frequent and costly, though they may be declining as a result of preventive efforts. The need for skilled nursing facility care in HF has risen. The role of palliative medicine in the care of patients with advanced HF is evolving as we learn how to best care for this population with a large symptom burden. PMID:25182014

Dunlay, Shannon M; Roger, Véronique L

2014-12-01

350

Chronic systemic inflammation accompanies impaired ventricular diastolic function, detected by Doppler imaging, in patients with newly diagnosed systolic heart failure (Hellenic Heart Failure Study)  

Microsoft Academic Search

We sought to evaluate the relationship between plasma cytokine levels (sCD14, tumor necrosis factor [TNF]-?, and interleukin\\u000a [IL]-6) and tissue Doppler derived indices of left ventricular systolic and diastolic function in patients with newly diagnosed\\u000a heart failure. We enrolled 101 consecutive patients (mean age 65 ± 13 years) with newly diagnosed heart failure who were hospitalized\\u000a in our institute. Echocardiographic

Christina Chrysohoou; Christos Pitsavos; John Barbetseas; Iason Kotroyiannis; Stella Brili; Karmen Vasiliadou; Lambros Papadimitriou; Christodoulos Stefanadis

2009-01-01

351

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

PubMed

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

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

352

Cognitive impairment and self-care in heart failure  

PubMed Central

Background Heart failure (HF) is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization. Cognitive impairment may impact the ability to perform HF self-care activities. We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF. Design Prospective cohort study. Setting and participants A total of 577 patients (mean age = 71 years, 44% female) hospitalized for HF at five medical centers in the United States and Canada. Measurements and methods Participants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale. We assessed cognitive impairment in three domains (memory, processing speed, and executive function) using standardized measures. Patients’ demographic and clinical characteristics were obtained through medical record review. Multivariable linear regression was used to examine the association between cognitive impairment and self-care practices adjusting for demographic and clinical factors. Results A total of 453 patients (79%) were impaired in at least one cognitive domain. Average adherence to self-care activities among patients with global cognitive impairment did not differ significantly from those without cognitive impairment (30.5 versus 29.6; 45-point scale). However, impaired memory was associated with lower self-care scores (P = 0.006) in multivariable models. Conclusion Cognitive impairment is highly prevalent among older patients hospitalized for HF. Memory impairment is associated with poorer adherence to self-care practices. Screening for memory impairment in patients with HF may help to identify patients at risk for poor self-care who may benefit from tailored disease management programs. PMID:24187511

Hajduk, Alexandra M; Lemon, Stephenie C; McManus, David D; Lessard, Darleen M; Gurwitz, Jerry H; Spencer, Frederick A; Goldberg, Robert J; Saczynski, Jane S

2013-01-01

353

Cognitive Change in Heart Failure: A Systematic Review  

PubMed Central

Background Cognitive impairment (CI), highly prevalent in patients with heart failure (HF), increases risk for hospitalization, and mortality. However, the course of cognitive change in HF is not well characterized. The purpose of this systematic review was to examine the available evidence regarding longitudinal changes in cognitive function in patients with HF. Methods and Results A literature search of several electronic databases was performed. Studies published from January 1st, 1980 to September 30th, 2012 that used validated measures to diagnose HF and assess cognitive function two or more times in adults with HF were eligible for inclusion. Change in cognitive function was examined in the context of HF treatments applied (e.g., medication initiation, left ventricular assist device implantation), length of follow-up, and by comparison group. 15 studies met eligibility criteria. Significant decline in cognitive function was noted among patients with HF followed up for >1 year. Improvements in cognition were observed among patients with HF undergoing interventions to improve cardiac function (e.g., heart transplant) and among patients examined over short time periods (< 1 year). Studies comparing HF patient to their own baseline tended to report improvements while studies using a comparison group without HF tended to report declines or stability in cognition over time among patients with HF. Conclusions Patients with HF are at increased risk for cognitive decline but this risk appears to be modifiable with cardiac treatment. Further research is needed to identify the mechanisms that cause cognitive change in HF. PMID:23838109

Hajduk, Alexandra M.; Kiefe, Catarina I; Person, Sharina D.; Gore, Joel G.; Saczynski, Jane S.

2013-01-01

354

Therapeutic Strategies for Sleep Apnea in Hypertension and Heart Failure  

PubMed Central

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

Noda, Akiko; Miyata, Seiko; Yasuda, Yoshinari

2013-01-01

355

Genetics and epigenetics of arrhythmia and heart failure  

PubMed Central

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

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

2013-01-01

356

Congestive heart failure and treatment in thalassemia major.  

PubMed

The homozygous beta-thalassemias are a group of genetically inherited hemoglobin (Hb) disorders characterized by dyserythropoietic anemia. According to the degree of anemia, two main forms, sharing a common basic molecular mechanism, are distinguished: thalassemia major (TM) and thalassemia intermedia (TI). The severity of the clinical phenotype differentiates the two forms. Thalassemia major usually presents as a severe anemia requiring life-long transfusion therapy for survival. The dramatic improvement in life expectancy of beta-thalassemia (thal) patients achieved during the past few decades by virtue of therapeutic advances, has motivated investigators' interest in a better understanding of the clinical consequences of this genetic defect. Heart complications still represent the leading cause of mortality from the disease. The mechanisms of cardiac injury along with its treatment and prevention have attracted the main research efforts in this field. In this review, we present existing knowledge and our personal experience of 30 years of follow-up of over 1,000 thalassemic patients, regarding the basis of the cardiac injury, the clinical findings and the global strategy of the therapeutic intervention in TM patients who develop congestive heart failure (CHF). PMID:18274984

Aessopos, Athanassios; Kati, Maria; Tsironi, Maria

2008-01-01

357

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

PubMed

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

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

2014-03-01

358

Enalaprilat augments arterial and cardiopulmonary baroreflex control of sympathetic nerve activity in patients with heart failure  

Microsoft Academic Search

Objectives. This study sought to determine the effects of enalaprilat on reflex control of sympathetic nerve activity.Background. Angiotensin-converting enzyme inhibitors decrease mortality in patients with congestive heart failure. Their efficacy appears to be related importantly to antiadrenergic effects, the mechanism for which has not been determined. Because baroreflexes tonically inhibit sympathetic outflow, and baroreflexes are blunted in heart failure, we

Mark E. Dibner-Dunlap; Michael L. Smith; Toru Kinugawa; Marc D. Thames

1996-01-01

359

Decreased T-Cell Responses to Influenza Vaccination in Patients with Heart Failure  

E-print Network

Decreased T-Cell Responses to Influenza Vaccination in Patients with Heart Failure Orly Vardeny vaccination in patients with chronic heart failure (CHF) are less vigorous than the responses of healthy) influenza vaccine during October­December of 2006. Measurements and Main Results. Blood samples were taken

Wisconsin at Madison, University of

360

Bosentan improves renal regional blood flow in rats with experimental congestive heart failure  

Microsoft Academic Search

The effects of the mixed endothelin receptor antagonist bosentan on renal regional haemodynamics were investigated in rats with aorto-caval fistula, an experimental model of congestive heart failure. A matched group of normal rats served as control. Injection of bosentan (10 mg\\/kg i.v.) to the rats with decompensated congestive heart failure produced an increase in cortical (+ 20%) and medullary (+

Konstantin Gurbanov; Irith Rubinstein; Aaron Hoffman; Zaid Abassi; Ori S. Better; Joseph Winaver

1996-01-01

361

Discriminant properties of commonly used quality of life measures in heart failure  

Microsoft Academic Search

Health-related quality of life (HRQL) instruments have been used to measure HRQL in heart failure patients, but how different instruments compare in the same groups of patients is not known. The purpose of this study was to compare the reliability and validity of three HRQL measures in 211 heart failure patients recruited from clinics affiliated with an urban hospital. Two

Susan J. Bennett; Neil B. Oldridge; George J. Eckert; Jennifer L. Embree; Sherry Browning; Nan Hou; Melissa Deer; Michael D. Murray

2002-01-01

362

Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment  

Microsoft Academic Search

Background In patients with heart failure, biventricular pacing (BIV) improves left ventricular (LV) performance by counteracting LV unsynchronized contraction caused by the presence of left bundle branch block (LBBB). However, no data are yet available on regional long-axis function in patients with LBBB or on BIV effectiveness in improving such a function in patients with heart failure and LBBB. Methods

Gerardo Ansalone; Paride Giannantoni; Renato Ricci; Paolo Trambaiolo; Anna Laurenti; Francesco Fedele; Massimo Santini

2001-01-01

363

AntiThrombotic Strategies for Patients with Atrial Fibrillation and Heart Failure  

Microsoft Academic Search

Atrial fibrillation occurs commonly in the setting of congestive heart failure and, in fact can cause left ventricular dysfunction due to a rapid ventricular response over time, termed tachycardia-mediated cardiomyopathy. The combination of atrial fibrillation and congestive heart failure leads to a high risk of stroke for the patient and appropriate antithrombotic therapy can minimize this incidence of stroke. Stroke

Mary Norine Walsh; Eric N. Prystowsky

2002-01-01

364

Role of Paraventricular Nucleus in Mediating Sympathetic Outflow in Heart Failure  

Microsoft Academic Search

A number of neurohumoral processes are activated in heart failure, including an increase in the plasma concentration of norepinephrine. Few studies have been performed to examine the role of the central nervous system in the activation of sympathetic outflow during heart failure (HF). In this paper I review these limited studies, with particular emphasis on examining the role of the

Kaushik P. Patel

2000-01-01

365

Correlates of Early Hospital Readmission or Death in Patients With Congestive Heart Failure  

Microsoft Academic Search

Among patients with heart failure who survive an admission to the hospital, those who are readmitted or die soon after discharge may warrant special attention. Therefore, we prospectively followed 257 patients admitted nonelectively to an urban university hospital, with a complaint of shortness of breath or fatigue and evidence of congestive heart failure on admission chest radiograph, who were discharged

1997-01-01

366

[Educating patients about heart failure in community hospitals: it is possible...].  

PubMed

Prognosis for heart failure is linked to patient's compliance. Compliance is also dependent from patient education about his disease and treatment. Therapeutic education could be done in a community hospital but needs a lot of time. However, therapeutic education for heart failure patients becomes more and more essential in clinical practice and improves patient knowledge and implication and hospitalization duration. PMID:14714349

Jourdain, P; Funck, F; Bellorini, M; Neau, S; Mat, H; Abdelmoumene, N; Pege, C; Piccini, A; Astred, A; Thebault, B; Loiret, J; Guillard, N; Desnos, M

2003-11-01

367

Acetazolamide Improves Central Sleep Apnea in Heart Failure A Double-Blind, Prospective Study  

Microsoft Academic Search

Rationale: Acetazolamide is a mild diuretic and a respiratory stimu- lant. It is used to treat periodic breathing at high altitude. Objectives: To determine the therapeutic efficacy of acetazolamide on central sleep apnea associated with heart failure. Methods: Twelve male patients with stable systolic heart failure whose initial polysomnograms showed more than 15 episodes per hour of apnea and hypopnea

Shahrokh Javaheri

368

High Blood Sugar in Heart Failure Patients May Point to Risk of Early Death  

MedlinePLUS

... page, please enable JavaScript. High Blood Sugar in Heart Failure Patients May Point to Risk of Early Death ... 7, 2015 Related MedlinePlus Pages Blood Sugar Diabetes Heart Failure WEDNESDAY, Jan. 7, 2015 (HealthDay News) -- Checking the ...

369

Development and pilot testing of a disease management program for low literacy patients with heart failure  

Microsoft Academic Search

Development and pilot testing of a disease management program for low literacy patients with heart failure. Background: Randomized trials have shown that disease management programs can reduce hospitalizations and improve symptoms for patients with congestive heart failure. We sought to create and pilot test such a program for patients with low literacy skills. Methods: We used focus groups and individual

Darren A. DeWalt; Michael Pignone; Robb Malone; Cathy Rawls; Margaret C. Kosnar; Geeta George; Betsy Bryant; Russell L. Rothman; Bonnie Angel

2004-01-01

370

Chronic treatment with trimetazidine reduces the upregulation of atrial natriuretic peptide in heart failure  

Technology Transfer Automated Retrieval System (TEKTRAN)

Trimetazidine (TMZ) is effective for the treatment of ischemic cardiomyopathy; however, little is known about the effect of TMZ in established injury-induced heart failure. When rats with established infarct-induced heart failure were treated for 12 weeks with TMZ there was no effect on left ventric...

371

Current issues of managing anemia in patients with advanced heart failure: Is there a new pathway?  

Microsoft Academic Search

Anemia is a common co-morbid found in patients with chronic heart failure with incidence widely ranging from 4% to 70% due to lack of a consistent definition of anemia in HF setting. This prevalence is higher in heart failure (HF) patients with NYHA class III–IV or refractory HF, and some trials have showed that persistence of anemia in this population

Leonardo Paskah Suciadi; Bambang Budi Siswanto

372

Compliance by Referring Physicians With Recommendations on Heart Failure Therapy from a Tertiary Center  

Microsoft Academic Search

Background: We tested the assumption that general practitioners do not use medication as recommended and do not follow recommendations made by heart failure specialists.Methods: The study included 193 stable patients referred to and subsequently seen at our heart failure clinic between 1995 and 2001 with an ejection fraction of 40% or less. They had 1906 visits (1661 with structured follow-up).

Hans Peter Brunner-La Rocca; J. Capraro; W. Kiowski

2006-01-01

373

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...

374

Uptake of self-management strategies in a heart failure management programme  

Microsoft Academic Search

Background: Multidisciplinary heart failure programs including patient education and self-management strategies such as daily recording of body weight and use of a patient diary decrease hospital readmissions and improve quality of life. However, the degree of uptake of individual components of these programs and their contribution to patient benefit are uncertain. Methods: Patients with heart failure admitted to Auckland Hospital

S. P. Wright; H. Walsh; K. M. Ingley; S. A. Muncaster; G. D. Gamble; A. Pearl; G. A. Whalley; N. Sharpe; R. N. Doughty

2003-01-01

375

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

Microsoft Academic Search

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

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

1999-01-01

376

The patient with diabetes mellitus and heart failure: at-risk issues  

Microsoft Academic Search

The risk for cardiovascular disease, particularly congestive heart failure, is significantly higher in patients with type 2 diabetes mellitus than in individuals without diabetes. The presence of hyperglycemia has been associated with changes in the myocardium that are characteristic of diabetic cardiomyopathy and heart failure. Furthermore, insulin resistance may be associated with cardiomyopathy, even in the absence of hyperglycemia, and

Thomas D Giles

2003-01-01

377

______________________~~-www.lejacq.com ID:8430 SPOTLIGHT ON HEART FAILURE TRANSLATIONAL RESEARCH  

E-print Network

______________________~~-www.lejacq.com ID:8430 SPOTLIGHT ON HEART FAILURE TRANSLATIONAL RESEARCH in cardiovas cular disease states, such as hyperten sion, diabetes, chronic renal failure, and aging. Moreover of atherosclerotic plaque as well as infarct size associated with ischemic heart injury.2 An unexpected finding, how

Hammock, Bruce D.

378

The Comparative Clinical Effects of Valsartan and Ramipril in Patients With Heart Failure  

Microsoft Academic Search

Background and Objectives: Angiotensin II receptor blocker (ARB) has emerged as an alternative to angiotensin converting enzyme inhibitor (ACEI) for the treatment of heart failure. This study aimed at comparing the effecti- veness and safety of valsartan with ramipril in patients with heart failure, and these patients were hospitalized at Chonnam National University Hospital, Wonkwang University Hospital, Gunsan Medical Center,

Ki Hong Lee; Woo Seok Lee; Dae Ho Jung; Jeong Gwan Cho; Seok Kyu Oh; Kyung Ho Yun; Nam Jin Yoo; Ji Hyun Lim; Seong Hee Jeon; Nam Ho Kim; Yong Moon; Jay Young Rhew; Ok Young Park; Seung Uk Lee; Dong Goo Kang

2008-01-01

379

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

Microsoft Academic Search

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

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

2000-01-01

380

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

Microsoft Academic Search

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

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

1995-01-01

381

Measures of heart period variability as predictors of mortality in hospitalized patients with decompensated congestive heart failure  

Microsoft Academic Search

Depressed heart rate variability (HRV) is a powerful independent predictor of a poor outcome in patients with chronic and stable congestive heart failure (CHF). However, the prognostic value of HRV analysis in patients hospitalized for decompensated CHF is not known. The aim of this study was to investigate whether HRV parameters obtained during admission for decompensated CHF could predict survival

Doron Aronson; Murray A Mittleman; Andrew J Burger

2004-01-01

382

Abdominal aortic calcific deposits are associated with increased risk for congestive heart failure: The Framingham Heart Study  

Microsoft Academic Search

Objectives We sought to determine the association of aortic atherosclerosis, detected by calcific deposits in the abdominal aorta seen on lateral lumbar radiographs, with risk for congestive heart failure (CHF). Background Although the association between atherosclerotic coronary heart disease (CHD) and CHF has been extensively studied, there are limited prospective data regarding the association of extracoronary atherosclerosis with CHF. Methods

Craig R. Walsh; L. Adrienne Cupples; Daniel Levy; Douglas P. Kiel; Marian Hannan; Peter W. F. Wilson; Christopher J. O'Donnell

2002-01-01

383

Managing beyond an uncertain illness trajectory: palliative care in advanced heart failure.  

PubMed

A lack of comprehensive and effective palliative care is clearly evident in a number of studies describing the end of life for patients with advanced heart failure. These patients have been portrayed as experiencing a wide array of poorly managed symptoms. The primary rationale for the lack of care has been the uncertain illness trajectory that characterizes living with advanced heart failure. Nurses must manage care beyond the illness trajectory from an emphasis of palliative care as each of these patients may face significant illness burden and even sudden death. The purpose of this paper is to: discuss the current status of palliative care for patients with advanced heart failure; explain the basic pathophysiology and resulting signs and symptoms of advanced heart failure; describe pharmacological and non-pharmacological symptom management strategies for patients with advanced heart failure. PMID:17353842

Zambroski, Cheryl Hoyt

2006-12-01

384

Obesity and Heart Failure as a Mediator of the Cerebrorenal Interaction  

PubMed Central

The obesity epidemic is contributing substantially to the burden of cardiovascular disease including heart disease and congestive heart failure, in the United States and the rest of the world. Overnutrition as a driver of obesity, promotes alterations in fatty acid, lipid, and glucose metabolism that influence myocardial function and progression of heart failure from diastolic to systolic failure. The association of progressive heart failure and progressive chronic kidney disease is well documented and often referred to as the cardiorenal syndrome, as well as a prognosticator for cerebrovascular disease (e.g. stroke). Whether the relationship between obesity, heart disease/failure and risk for chronic kidney disease and stroke is direct or a confluence of risk factors is poorly understood. PMID:23652445

Jindal, Ankur; Whaley-Connell, Adam; Sowers, James R.

2015-01-01

385

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

PubMed

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

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

2015-02-01

386

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

PubMed Central

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

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

2013-01-01

387

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

PubMed

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. PMID:22244875

Roselló-Lletí, Esther; Rivera, Miguel; Cortés, Raquel; Azorín, Inmaculada; Sirera, Rafael; Martínez-Dolz, Luis; Hove, Leif; Cinca, Juan; Lago, Francisca; González-Juanatey, José R; Salvador, Antonio; Portolés, Manuel

2012-02-10

388

Role of Subcellular Remodeling in Cardiac Dysfunction due to Congestive Heart Failure  

Microsoft Academic Search

Although alterations in the size and shape of the heart (cardiac remodeling) are considered in explaining cardiac dysfunction during the development of congestive heart failure (CHF), there are several conditions including initial stages of cardiac hypertrophy, where cardiac remodeling has also been found to be associated with either an increased or no change in heart function. Extensive studies have indicated

Andrea P. Babick; Naranjan S. Dhalla

2007-01-01

389

Pathophysiology of heart failure in broiler chickens: structural, biochemical, and molecular characteristics.  

PubMed

Modern strains of fast-growing meat type poultry are highly susceptible to heart failure. Heart-related mortalities are observed predominantly in fast-growing broiler chickens, with ascites and sudden death syndrome being the most common heart-related conditions in modern broiler flocks. This paper examines the role of structural, molecular, and biochemical factors pertinent to the pathophysiology of heart failure in fast-growing broilers. Evidence explaining the pathogenesis of acute and chronic heart failure, in the context of the underlying molecular and biochemical changes in the cardiomyocytes, contractile apparatus, and extracellular matrix in the ventricular myocardium are critically evaluated and discussed with reference to the clinical signs associated with deterioration of heart pump function. The secondary pathophysiological effects on the cardiovascular system, resulting from hemodynamic changes associated with the failing heart pump, are also reviewed and critically discussed. PMID:17435038

Olkowski, A A

2007-05-01

390

Worldwide risk factors for heart failure: a systematic review and pooled analysis  

PubMed Central

Background Heart failure risk factors are diverse and likely to vary among world regions. Systematic review and pooled analysis were used describe contributions of major underlying risk factors for heart failure in six world regions. Methods Electronic databases were systematically searched, and 37 clinic-based studies representing 40 countries published 1980–2008 and reporting underlying risk factors for heart failure were included. Risk factors were classified as ischemic heart disease (IHD), hypertension, rheumatic/other valvular heart disease, cardiopulmonary disease, cardiomyopathy, and “other”. Crude and age- and sex-adjusted risk factor prevalence were estimated for each region using regression analysis, under specifications of overlapping as well as additive contributions. Results Many heart failure cases were assigned multiple underlying risk factors, leading to considerable overlap. Crude IHD prevalence among heart failure patients was >50% in Europe and North America, approximately 30–40% in East Asia and Latin America and the Caribbean, and <10% in sub-Saharan Africa. Age and sex adjustment attenuated regional differences in IHD-as-risk factor but IHD remained rare in sub-Saharan Africa. Hypertension prevalence was high in heart failure patients of all regions but highest in Eastern and Central Europe and sub-Saharan Africa (age- and sex-adjusted, 35.0% and 32.6%, respectively). Cardiomyopathy was most common in Latin American and the Caribbean and sub-Saharan Africa (age- and sex-adjusted, 19.8% and 25.7%). Conclusions Heart failure risk factors vary substantially among world regions. More detailed regional heart failure epidemiology studies are needed in order to quantify the global burden of heart failure and identify regional prevention and treatment strategies. PMID:23201083

Khatibzadeh, Shahab; Farzadfar, Farshad; Oliver, John; Ezzati, Majid; Moran, Andrew

2012-01-01

391

Leveraging cardiac resynchronization therapy devices to monitor patients with heart failure  

Microsoft Academic Search

Cardiac resynchronization therapy is a standard therapy for heart failure patients with cardiac dyssynchrony. The implantable\\u000a device provides a convenient and continuous platform for heart failure monitoring. Information such as heart rate variability\\u000a and activity status retrieved from the device allows physicians to more comprehensively evaluate these high-risk patients.\\u000a Several registries and prospective observational studies have evaluated the value of

Jeffrey Wing-Hong Fung; Cheuk-Man Yu

2008-01-01

392

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

Microsoft Academic Search

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

Satyam Sarma; Hossein Ardehali; Mihai Gheorghiade

393

In?Hospital Worsening Heart Failure and Associations With Mortality, Readmission, and Healthcare Utilization  

PubMed Central

Background A subset of patients hospitalized with acute heart failure experiences worsening clinical status and requires escalation of therapy. Worsening heart failure is an end point in many clinical trials, but little is known about its prevalence in clinical practice and its associated outcomes. Methods and Results We analyzed inpatient data from the Acute Decompensated Heart Failure National Registry linked to Medicare claims to examine the prevalence and outcomes of patients with worsening heart failure, defined as the need for escalation of therapy at least 12 hours after hospital presentation. We compared patients with worsening heart failure to patients with an uncomplicated hospital course and patients with a complicated presentation. Of 63 727 patients hospitalized with acute heart failure, 11% developed worsening heart failure. These patients had the highest observed rates of mortality, all?cause readmission, and Medicare payments at 30 days and 1 year after hospitalization (P < 0.001 for all comparisons). The adjusted hazards of 30?day mortality were 2.56 (99% CI, 2.34 to 2.80) compared with an uncomplicated course and 1.29 (99% CI, 1.17 to 1.42) compared with a complicated presentation. The adjusted cost ratios for postdischarge Medicare payments at 30 days were 1.35 (99% CI, 1.24 to 1.46) compared with an uncomplicated course and 1.11 (99% CI, 1.02 to 1.22) compared with a complicated presentation. Conclusions In?hospital worsening heart failure was common and was associated with higher rates of mortality, all?cause readmission, and postdischarge Medicare payments. Prevention and treatment of in?hospital worsening heart failure represents an important goal for patients hospitalized with acute heart failure. PMID:25015076

DeVore, Adam D.; Hammill, Bradley G.; Sharma, Puza P.; Qualls, Laura G.; Mentz, Robert J.; Waltman Johnson, Katherine; Fonarow, Gregg C.; Curtis, Lesley H.; Hernandez, Adrian F.

2014-01-01

394

Congestive heart failure induced by six of the newer antiarrhythmic drugs.  

PubMed

The incidence of drug-induced congestive heart failure with several newer antiarrhythmic agents including encainide, ethmozine, lorcainide, mexiletine, propafenone and tocainide was determined in a group of 407 patients who underwent 1,133 drug tests. The incidence rate ranged from 0.7% with lorcainide to 4.7% with propafenone. Congestive heart failure was present in 167 patients (41%) who underwent 491 drug trials. Congestive failure was induced in 15 (9%) of these 167 patients and involved 19 (3.9%) of the 491 tests. Left ventricular ejection fraction was 20 +/- 8% in patients who developed congestive failure, in contrast to 39 +/- 19% in those who did not (p less than 0.001). It is concluded that each of the six antiarrhythmic drugs examined has the potential to aggravate congestive heart failure in patients with reduced left ventricular ejection fraction or a history of congestive heart failure, but the incidence rate is low and its occurrence unpredictable. PMID:2509529

Ravid, S; Podrid, P J; Lampert, S; Lown, B

1989-11-01

395

Total artificial heart in the pediatric patient with biventricular heart failure.  

PubMed

Mechanical circulatory support emerged for the pediatric population in the late 1980s as a bridge to cardiac transplantation. The Total Artificial Heart (TAH-t) (SynCardia Systems Inc., Tuscon, AZ) has been approved for compassionate use by the Food and Drug Administration for patients with end-stage biventricular heart failure as a bridge to heart transplantation since 1985 and has had FDA approval since 2004. However, of the 1,061 patients placed on the TAH-t, only 21 (2%) were under the age 18. SynCardia Systems, Inc. recommends a minimum patient body surface area (BSA) of 1.7 m(2), thus, limiting pediatric application of this device. This unique case report shares this pediatric institution's first experience with the TAH-t. A 14-year-old male was admitted with dilated cardiomyopathy and severe biventricular heart failure. The patient rapidly decompensated, requiring extracorporeal life support. An echocardiogram revealed severe biventricular dysfunction and diffuse clot formation in the left ventricle and outflow tract. The decision was made to transition to biventricular assist device. The biventricular failure and clot formation helped guide the team to the TAH-t, in spite of a BSA (1.5 m(2)) below the recommendation of 1.7 m(2). A computed tomography (CT) scan of the thorax, in conjunction with a novel three-dimensional (3D) modeling system and team, assisted in determining appropriate fit. Chest CT and 3D modeling following implantation were utilized to determine all major vascular structures were unobstructed and the bronchi were open. The virtual 3D model confirmed appropriate device fit with no evidence of compression to the left pulmonary veins. The postoperative course was complicated by a left lung opacification. The left lung anomalies proved to be atelectasis and improved with aggressive recruitment maneuvers. The patient was supported for 11 days prior to transplantation. Chest CT and 3D modeling were crucial in assessing whether the device would fit, as well as postoperative complications in this smaller pediatric patient. PMID:23868320

Park, S S; Sanders, D B; Smith, B P; Ryan, J; Plasencia, J; Osborn, M B; Wellnitz, C M; Southard, R N; Pierce, C N; Arabia, F A; Lane, J; Frakes, D; Velez, D A; Pophal, S G; Nigro, J J

2014-01-01

396

Drug discovery for heart failure: a new era or the end of the pipeline?  

Microsoft Academic Search

Although there have been significant advances in the therapy of heart failure in recent decades, such as the introduction of beta-blockers and antagonists of the renin–angiotensin system, there is still a major unmet need for better therapies for many patients with heart failure. However, disappointment related to late-stage clinical failures of a number of novel agents, including endothelin antagonists and

Henry Krum; David M. Kaye

2007-01-01

397

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...

398

Iron status in patients with chronic heart failure  

PubMed Central

Aims The changes in iron status occurring during the course of heart failure (HF) and the underlying pathomechanisms are largely unknown. Hepcidin, the major regulatory protein for iron metabolism, may play a causative role. We investigated iron status in a broad spectrum of patients with systolic HF in order to determine the changes in iron status in parallel with disease progression, and to associate iron status with long-term prognosis. Methods and results Serum concentrations of ferritin, transferrin saturation (Tsat), soluble transferrin receptor (sTfR), and hepcidin were assessed as the biomarkers of iron status in 321 patients with chronic systolic HF [age: 61 ± 11 years, men: 84%, left ventricular ejection fraction: 31 ± 9%, New York Heart Association (NYHA) class: 72/144/87/18] at a tertiary cardiology centre and 66 age- and gender-matched healthy subjects. Compared with healthy subjects, asymptomatic HF patients had similar haematological status, but increased iron stores (evidenced by higher serum ferritin without distinct inflammation, P < 0.01) with markedly elevated serum hepcidin (P < 0.001). With increasing HF severity, patients in advanced NYHA classes had iron deficiency (ID) (reduced serum ferritin, low Tsat, high sTfR), iron-restricted erythropoiesis (reduced haemoglobin, high red cell distribution width), and inflammation (high serum high-sensitivity-C-reactive protein and interleukin 6), which was accompanied by decreased circulating hepcidin (all P < 0.001). In multivariable Cox models, low hepcidin was independently associated with increased 3-year mortality among HF patients (P < 0.001). Conclusions Increased level of circulating hepcidin characterizes an early stage of HF, and is not accompanied by either anaemia or inflammation. The progression of HF is associated with the decline in circulating hepcidin and the development of ID. Low hepcidin independently relates to unfavourable outcome. PMID:23178646

Jankowska, Ewa A.; Malyszko, Jolanta; Ardehali, Hossein; Koc-Zorawska, Ewa; Banasiak, Waldemar; von Haehling, Stephan; Macdougall, Iain C.; Weiss, Guenter; McMurray, John J.V.; Anker, Stefan D.; Gheorghiade, Mihai; Ponikowski, Piotr

2013-01-01

399

Prognostic Value of Resting Pulmonary Function in Heart Failure  

PubMed Central

Background The heart and lungs are intimately linked anatomically and physiologically, and, as a result, heart failure (HF) patients often develop changes in pulmonary function. This study examined the prognostic value of resting pulmonary function (PF) in HF. Methods and results In all, 134 HF patients (enrolled from January 1, 1999 Through December 31, 2005; ejection fraction (EF) = 29% ± 11%; mean age = 55 ± 12 years; 65% male) were followed for 67 ± 34 months with death/transplant confirmed via the Social Security Index and Mayo Clinic registry. PF included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), diffusing capacity of the lungs for carbon monoxide (DLCO), and alveolar volume (VA). Patients were divided in tertiles according to PF with survival analysis via log-rank Mantel-Cox test with chi-square analysis. Groups for FVC included (1) >96%, (2) 96% to 81%, and (3) <81% predicted (chi-square = 18.9, P < 0.001). Bonferroni correction for multiple comparisons (BC) suggested differences between groups 1 and 3 (P < 0.001) and 2 and 3 (P = 0.008). Groups for FEV1 included (1) >94%, (2) 94% to 77%, and (3) <77% predicted (chi-square = 17.3, P <0.001). BC suggested differences between groups 1 and 3 (P <0.001). Groups for DLCO included (1) >90%, (2) 90% to 75%, and (3) <75% predicted (chi-square = 11.9, P = 0.003). BC suggested differences between groups 1 and 3 (P < 0.001). Groups for VA included (1) >97%, (2) 97% to 87%, and (3) <87% predicted (Chi-square = 8.5, P = 0.01). BC suggested differences between groups 1 and 2 (P = 0.014) and 1 and 3 (P = 0.003). Conclusions In a well-defined cohort of HF patients, resting measures of PF are predictive of all-cause mortality. PMID:24058279

Olson, Thomas P.; Denzer, Dustin L.; Sinnett, William L.; Wilson, Ted; Johnson, Bruce D.

2013-01-01

400

Effects of Candesartan on the Development of a New Diagnosis of Diabetes Mellitus in Patients With Heart Failure  

Microsoft Academic Search

Background—Diabetes is a risk factor for heart failure, and both conditions are increasing. Identifying treatments that prevent both conditions will be clinically important. We previously reported that candesartan (an angiotensin receptor blocker) reduces cardiovascular mortality and heart failure hospitalizations in heart failure patients (CHARM: Candesartan in Heart Failure—Assessment of Reduction in Mortality and Morbidity Program). Methods and Results—We assessed the

Salim Yusuf; Jan B. Ostergren; Hertzel C. Gerstein; Marc A. Pfeffer; Karl Swedberg; Christopher B. Granger; Bertil Olofsson; Jeffrey Probstfield; John V. McMurray

2010-01-01

401

Remote Stab Wound Resulting in AV Fistula and High-Output Heart Failure.  

PubMed

A 54-year-old African American male with no medical history presented to an urgent care clinic with signs and symptoms of new-onset congestive heart failure. There was an initial concern for congestive heart failure secondary to an ischemic etiology as an echocardiogram revealed a depressed ejection fraction. However, a left heart cardiac catheterization did not demonstrate any significant coronary disease. As a loud bruit was auscultated over the right base of the patient's neck, he underwent a carotid duplex ultrasound revealing a fistula between the right common carotid artery (CCA) and the right internal jugular vein (IJV). A diagnosis of high-output heart failure secondary to a large arteriovenous (AV) fistula was made, and the patient underwent ligation and repair of the fistula with resolution of symptoms of congestive heart failure. PMID:24826298

Rymer, Jennifer A; Anderson, Lindsay L; Posenau, J Trevor; Jones, W Schuyler

2013-01-01

402

Prognostic Significance and Normal Values of 2D Strain to Assess Right Ventricular Systolic Function in Chronic Heart Failure  

E-print Network

Function in Chronic Heart Failure Short Title: RV dysfunction and prognosis in CHF Soulef Guendouz, MD1 Journal 2012;76(1):127-36" #12;2 ABSTRACT Aims: Chronic heart failure (CHF) has a poor prognosis. Our aims or emergent transplantation or emergent ventricular assist-device implantation or acute heart failure. RV-2D

Paris-Sud XI, Université de

403

The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size  

Microsoft Academic Search

Objectives. The purpose of this study was to quantify and characterize the regurgitant flow pattern and regurgitant orifice area in patients undergoing therapy for severe heart failure using contemporary echocardiographic techniques.Background. Mitral regurgitation may be dynamic in patients with heart failure and ultimately correlate with outcome in a group of patients.Methods. Fourteen patients with severe heart failure felt to require

Luis B. Rosario; Lynne W. Stevenson; Scott D. Solomon; Richard T. Lee; Sharon C. Reimold

1998-01-01

404

The Burden of Chronic Congestive Heart Failure in Older Persons: Magnitude and Implications for Policy and Research  

Microsoft Academic Search

Heart failure disproportionately affects the older population. Approximately 80% of all cases of heart failure in the United States occur in persons aged 65 years and older. It is associated with very poor long-term survival, with a minority surviving 5 years after diagnosis. In the older population, heart failure accounts for more hospital admissions than any other single condition. Following

Frederick A. Masoudi; Edward P. Havranek; Harlan M. Krumholz

2002-01-01

405

[Apathetic hyperthyroidism with heart failure in an elderly patient with Plummer's disease].  

PubMed

We report a case of apathetic hyperthyroidism associated with unrecognized slowly growing functional thyroid adenoma (Plummer's disease), atrial fibrillation and heart failure. An 81-year-old woman with worsening thyroid dysfunction was admitted to our hospital for the treatment of heart failure. The patient had developed heart failure associated with chronic atrial fibrillation at 76 years of age, and one year later was found to have asymptomatic hyperthyroidism. Anti-thyroid autoantibodies were negative, but thyroid echography showed a 32-mm tumor devoid of internal blood flow in the left lower lobe. Free thyroxine 4 (FT4) decreased from 3.30 to 2.60 ng/dl without treatment. The patient was diagnosed with transient thyroiditis and was followed-up without treatment. However, a repeat thyroid echography showed growth of the tumor to 41 mm in 4 years. Thyroid scintigraphy showed uptake that matched the thyroid mass. Based on these findings, the established diagnosis was Plummer's disease complicated with heart failure. The patient was treated with anti-thyroid drugs, which resulted in improvement of FT4 and reduced the severity of heart failure. In this rare case of an elderly patient, Plummer's disease was associated with a slowly-growing functional thyroid adenoma, apathetic hyperthyroidism, repeated episodes of atrial fibrillation and heart failure. Since symptoms of thyrotoxicosis are likely to be missed in the elderly, it is necessary to include hyperthyroidism in the pathoetiology of heart failure and atrial fibrillation in this population. PMID:25501760

Narisawa, Manabu; Okada, Yosuke; Arao, Tadashi; Kuno, Fumi; Tanaka, Yoshiya

2014-12-01

406

Influence of Life-Course Socioeconomic Position on Incident Heart Failure in Blacks and Whites  

PubMed Central

The influence of early-life socioeconomic position (SEP) on incident heart failure in blacks and whites is unknown. The authors examined the relation between early-life SEP and incident, hospitalized heart failure among middle-aged US participants (2,503 black and 8,519 white) in the Atherosclerosis Risk in Communities (ARIC) Study. Early-life SEP indicators assessed included parental education, occupation, and home ownership. From 1987 to 2004, 221 and 537 incident heart failure events were identified in blacks and whites, respectively. In Cox proportional hazards regression, early-life SEP was inversely related to incident heart failure after adjustment for age, gender, and study center (for blacks, hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.00, 1.95; for whites, HR = 1.32, 95% CI: 1.06, 1.64). Additional adjustment for young and mid-to-older adulthood SEP and established heart failure risk factors attenuated this association towards the null in both blacks and whites. Of the SEP measures, mid-to-older adulthood SEP showed the strongest association with incident heart failure in both blacks (HR = 1.32, 95% CI: 0.90, 1.96) and whites (HR = 1.39, 95% CI: 1.11, 1.75). SEP over the life course is related to the risk of incident heart failure, with SEP later in adulthood having a more prominent role than earlier SEP. PMID:20696652

Roberts, Calpurnyia B.; Couper, David J.; Chang, Patricia P.; James, Sherman A.; Rosamond, Wayne D.; Heiss, Gerardo

2010-01-01

407

Heart failure: a complex clinical process interpreted by systems biology approach and network medicine.  

PubMed

Systems biology is founded on the principles of integrative computational analysis and on the data from genetic and molecular components. The integration of biological components produces interacting networks, modules and phenotypes with remarkable applications in the field of clinical medicine. The evolving concept of network medicine gives a more precise picture of the intrinsic complexity of failing myocardium and its clinical consequences. The present review is focused on the impact of network cardiology in explaining the progressive nature of the clinical syndrome of heart failure. The failing myocardium and the subsequent clinical syndrome of heart failure disclose a dynamical and non-linear system with a progressive picture of clinical deterioration. The classical description of heart failure is based on tissue pathology and clinical presentation, and lately on specific genetic and molecular modifications. This characterization of heart failure has significant limitations to recognize preclinical disease features and to explain the progressive nature of the syndrome. Systems biology detects and evaluates specific networks from molecular, cellular and tissue elements, and assesses their influence on the appearance of clinical phenotypes. The classical reductive concept of heart failure is inadequate to provide data for molecular dysfunctions or defective coordination of the interconnected network components that are central to the genesis and clinical deterioration of heart failure. In heart failure, the recognition of molecular targets within the complex networks will increase the conceptual basis of pharmacology and the identification of novel biomarkers and at the same time will accelerate the discovery of new drugs. PMID:24566513

Louridas, George E; Lourida, Katerina G

2014-03-01

408

[Beta blockers in heart failure therapy with special reference to the COPERNICUS Study].  

PubMed

During the past 15 years, the pathophysiological concept of heart failure as a neurohormonal disease has influenced heart failure therapy substantially. ACE-inhibitors have become the mainstay of heart failure therapy. In addition, beta blocker evolved to be effective in improving survival in this disease. Recently, the COPERNICUS study established the efficacy of carvedilol in severe heart failure and extended the benefits of this drug first observed in patients with mild and moderate symptoms to those with advanced disease. In this study, carvedilol resulted in a significant reduction of all-cause mortality and combined mortality and hospitalization, the frequency of hospitalizations, the risk of repeated hospitalizations, the number of days in hospital, the average duration of each admission and the utilization of treatments and procedures for heart failure. Carvedilol was well tolerated, improved the sense of well-being, was associated with a lower risk of a serious adverse event, particularly one related to the progression of heart failure and fewer patients requiring withdrawal of treatment for an adverse event. These favourable results were equally seen in all subgroups. Carvedilol treatment was even cost-effective in severe disease. Therefore, this new therapeutic option should be available to all patients with symptomatic systolic heart failure. PMID:12229256

Hartmann, Franz; Katus, Hugo A

2002-08-01

409

Heart and combined heart-kidney transplantation in patients with concomitant renal insufficiency and end-stage heart failure.  

PubMed

In patients with end-stage heart failure (ESHF) who are candidates for isolated heart transplant (HRT), dialysis dependence (DD) is considered an indication for combined heart-kidney transplantation (HKT). HKT remains controversial in ESHF transplant candidates with nondialysis-dependent renal insufficiency (NDDRI). Using United Network for Organ Sharing data, we examined the cumulative incidences of transplant and mortality in patients with DD and NDDRI waitlisted for HKT or HRT. In all groups, 3-month waitlist mortality was dismal: 31% and 21% for HRT- and HKT-listed patients with DD and 12% and 7% for HRT- and HKT-listed patients with NDDRI. Five-year posttransplant survival was improved in HKT recipients compared with HRT recipients for both patients with DD (73% vs. 51%, p<0.001) and NDDRI (80% vs. 69%, p<0.001). Likewise, multivariable analysis associated HKT with better outcomes than HRT in HKT-listed patients, although both improved survival. These data argue strongly for HKT in ESHF transplant candidates with DD. However, in patients with NDDRI, HKT must be weighed against the possibility of renal recovery with isolated HRT. Whether HRT (followed by a staged kidney transplant in patients who do not recover renal function after HRT), as opposed to HKT, maximizes organ benefit for patients with NDDRI and ESHF requires assessment. Nevertheless, given their dismal waitlist outcomes and excellent posttransplant results, we suggest that patients with DD and NDDRI with ESHF be considered for early listing and transplant. PMID:24279876

Schaffer, J M; Chiu, P; Singh, S K; Oyer, P E; Reitz, B A; Mallidi, H R

2014-02-01

410

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

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

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

411

Echocardiographic features and brain natriuretic peptides in patients presenting with heart failure and preserved systolic function  

PubMed Central

Objective To characterise patients who appear to fulfil the diagnosis of heart failure with preserved systolic function clinically, echocardiographically, and by concentrations of brain?type natriuretic peptide (BNP). Methods 102 new cases of heart failure were identified over 24 months in 213 patients referred to a rapid access heart failure clinic. Patients with heart failure and preserved systolic function with contemporary markers of diastolic function were assessed to evaluate their cardiac status further. Results Forty patients (39%) had an ejection fraction (EF) heart failure. The remaining 32 (52%) had neither an EF heart failure. Conclusion Among ambulatory patients presenting with suspected heart failure in the community 19% have systolic dysfunction, 14% have diastolic dysfunction, and 15% seemingly have heart failure with neither systolic nor diastolic dysfunction. A new understanding, including alternative parameters of diastolic function, seems to be necessary to classify patients with heart failure and preserved systolic function. PMID:16159966

Thomas, M D; Fox, K F; Wood, D A; Gibbs, J S R; Coats, A J S; Henein, M Y; Poole?Wilson, P A; Sutton, G C

2006-01-01

412

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

PubMed Central

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

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

2014-01-01

413

Brain metabolites in autonomic regulatory insular sites in heart failure.  

PubMed

Autonomic, pain, and neuropsychologic comorbidities appear in heart failure (HF), likely resulting from brain changes, indicated as loss of structural integrity and functional deficits. Among affected brain sites, the anterior insulae are prominent in serving major regulatory roles in many of the disrupted functions commonly seen in HF. Metabolite levels, including N-acetylaspartate (NAA), creatine (Cr), choline (Cho), and myo-inositol (MI), could indicate the nature of anterior insula tissue injury in HF. The study aim was to assess anterior insular metabolites to determine processes mediating autonomic, pain, and neuropsychologic disruptions in HF. We performed magnetic resonance spectroscopy in bilateral anterior insulae in 11 HF and 53 controls, using a 3.0-Tesla magnetic resonance imaging scanner. Peaks for NAA at 2.02ppm, Cr at 3.02ppm, Cho at 3.2ppm, and MI at 3.56ppm were assigned, peak areas were calculated, and metabolites were expressed as ratios, including NAA/Cr, Cho/Cr, and MI/Cr. HF patients showed significantly increased Cho/Cr ratios, indicative of glial proliferation or injury, on the left anterior insula, and reduced NAA/Cr levels, suggesting neuronal loss/dysfunction, on the right anterior insula over controls. No differences in MI/Cr ratios appeared between groups. Right anterior insular neuronal loss and left glial alterations may contribute to distorted autonomic, pain, and neuropsychologic functions found in HF. PMID:25248953

Woo, Mary A; Yadav, Santosh K; Macey, Paul M; Fonarow, Gregg C; Harper, Ronald M; Kumar, Rajesh

2014-11-15

414

Intact systolic left ventricular function in clinical congestive heart failure.  

PubMed

Clinical congestive heart failure (CHF) is traditionally associated wtih significant left ventricular (LV) systolic dysfunction. Over a 1-year period, 58 patients with CHF and intact systolic function (LV ejection fraction [EF] 62 +/- 11%) were identified. An objective clinical-radiographic CHF score was used to document the clinical impression. Based on radionuclide evaluation of peak filling rate, 38% of these patients were found to have a significant abnormality in diastolic function as measured by peak filling rate (less than 2.50 end-diastolic volume/s). An additional 24% of the patients had probable diastolic dysfunction with borderline abnormal peak filling rate measurements (2.5 to 3.0 end-diastolic volume/s). The disease states most frequently associated with CHF and intact systolic function were coronary artery disease and systemic hypertension. During a 3-month sampling period 42% of patients with clinical diagnosis of CHF referred to the nuclear cardiology laboratory were found to have intact systolic function; thus, intact systolic function is not uncommon in patients with clinical CHF. Abnormal diastolic function is the most frequently encountered mechanism for the occurrence of CHF. Definition of systolic and diastolic function appears relevant for development of optimal therapeutic strategies for the treatment of patients with CHF. PMID:3984863

Soufer, R; Wohlgelernter, D; Vita, N A; Amuchestegui, M; Sostman, H D; Berger, H J; Zaret, B L

1985-04-01

415

Atrial fibrillation and heart failure in the elderly.  

PubMed

Atrial fibrillation (AF) is a common clinical problem in elderly patients and especially in those with heart failure (HF). It is a major risk factor for serious cardiovascular events, such as stroke, HF and premature death. Both the prevalence and incidence of AF increase with age and its prevalence in the United States are estimated at more than 2.2 million, with nearly 75% of patients aged >65 years. Aging-related atrial remodeling with fibrosis, dilation and mitochondrial DNA mutations predispose elderly patients to AF. Current management options for AF, including rate control and anticoagulation therapy, can be successfully applied to the elderly population. New antiarrhythmic and anticoagulation medications such as dronedarone and dabigatran, respectively, can impact the approach to therapy in the elderly. Non-pharmacological options such as catheter-based ablation have also gained prominence and have been incorporated into the guidelines for management of AF. However, more trials in the elderly and very elderly segments are needed to clarify the safety and long-term efficacy of the new treatment options. PMID:22052471

Kazemian, Pedram; Oudit, Gavin; Jugdutt, Bodh I

2012-09-01

416

Atrial fibrillation in heart failure: The sword of Damocles revisited  

PubMed Central

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

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

2013-01-01

417

Devices in the management of advanced, chronic heart failure  

PubMed Central

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

Abraham, William T.; Smith, Sakima A.

2013-01-01

418

Therapeutic adjustments in stage d heart failure: challenges and strategies.  

PubMed

The morbidity and mortality associated with heart failure (HF) represents a significant public health challenge. Stage D HF identifies a distinct subgroup of advanced HF patients characterized by adverse clinical and hemodynamic factors which warrant evaluation for specialized advanced management strategies and/or consideration of palliative care in tandem with the same recommendations for goal-directed optimal medical therapy as earlier stages of HF. In fact, one of the inherent markers of progression to stage D disease is the need to withdraw previously tolerated neurohormonal agents in the setting of systemic circulatory limitations or renal dysfunction. Furthermore, the requirement for aggressive diuresis in the setting of borderline blood pressures and renal insufficiency is often complicated by worsening renal impairment. Assessment of the appropriate need for inotropic support, given the significant complications associated with their use, is also a frequently encountered challenge complicating the medical management of Stage D HF. This review outlines some of the most relevant challenges of pharmacological therapy in stage D HF and describes current and future strategies that may be employed to overcome some of these obstacles. PMID:25391351

Joyce, Emer; Nohria, Anju

2015-02-01

419

Effect of renal function on prognosis in chronic heart failure.  

PubMed

Renal dysfunction (RD) is associated with increased mortality in heart failure (HF). The aim of this study was to identify whether worsened or improved renal function during mid-term follow-up is associated with worsened outcomes in patients with chronic HF. A total of 892 participants from a multicenter cohort study of chronic HF were followed over 3.1 ± 1.9 years of enrollment. Worsened and improved renal functions were tested with multivariate models as independent predictors of HF hospitalization and mortality. Although 12% of subjects experienced a ?25% decrease in estimated glomerular filtration rate (eGFR), 17% experienced a ?25% increase in eGFR, and there was stability of kidney function observed in the cohort as a whole. The quartile with the worst RD at any point in time had increased risk of HF hospitalization and mortality. Worsened eGFR was associated with HF outcomes in the unadjusted (hazard ratio = 1.71, 95% confidence interval 1.04 to 2.81, p = 0.035), but not the adjusted analysis. Improvement in eGFR was not associated with outcome (p = 0.453). In chronic HF, the severity of RD predicts risk of poor outcome better than changes in renal function during mid-term follow-up. This suggests that in patients with appropriately treated chronic HF, worsening renal function in itself does not yield useful prognostic information and may not reflect poor outcome. PMID:25465925

Löffler, Adrián Ignacio; Cappola, Thomas P; Fang, James; Hetzel, Scott J; Kadlec, Andrew; Astor, Brad; Sweitzer, Nancy K

2015-01-01

420

Body fluid distribution in elderly subjects with congestive heart failure.  

PubMed

The aims of this study were to investigate body fluid changes in elderly patients suffering from congestive heart failure (CHF) and to identify the fluid measurement that best characterizes fluid overload states in CHF patients by comparison with normal hydration in the elderly. In a case-controlled experimental design, 72 elderly subjects (65-98 yr), 38 healthy and 34 with CHF, were studied. Total body water (TBW) and extracellular water (ECW) were determined by dilution methods; fat-free mass (FFM) and fat mass (FM) were determined by dual-energy X-ray absorptiometry (DEXA). In healthy subjects, the FFM hydration expressed as TBW% FFM (males 72.0 +/- 4.3 vs females 72.4 +/- 5.0%) and ECW% TBW (males 47.3 +/- 3.4 vs females 47.8 +/- 5.1) were similar in both genders. ECW in liters for FFM and for TBW (ECW% TBW), corrected for body weight, was greater in the group with CHF than in the control group, in both sexes. Among the relative fluid measures, only ECW% TBW [odds ratio (OR) 1.5] independently predicted fluid retention. Having an ECW% TBW greater than 50% corresponded to an OR of about 10. In conclusion, elderly patients suffering from CHF have a characteristic increase in body fluid levels, mainly affecting the extracellular compartment, and ECW% TBW is a useful indicator of fluid retention. PMID:15648783

Sergi, Giuseppe; Lupoli, Lucia; Volpato, Stefania; Bertani, Roberta; Coin, Alessandra; Perissinotto, Egle; Calliari, Irene; Inelmen, Emine Meral; Busetto, Luca; Enzi, Giuliano

2004-01-01

421

Anemia, Heart Failure and Evidence-Based Clinical management  

PubMed Central

Anemia is a prevalent comorbidity and marker of a poorer prognosis in patients with heart failure (HF). Its clinical relevance, as well as its pathophysiology and the clinical management of these patients are important subjects in the specialized literature. In the present review, we describe the current concepts on the pathophysiology of anemia in HF, its diagnostic criteria, and the recommendations for iron supplementation. Also, we make a critical analysis of the major studies showing evidences on the benefits of this supplementation. The four main components of anemia are addressed: chronic disease, dilutional, "renal" and malabsorption. In patients with HF, the diagnostic criteria are the same as those used in the general population: serum ferritin levels lower than 30 mcg/L in patients without kidney diseases and lower than 100 mcg/L or serum ferritin levels between 100-299 mcg/L with transferring saturation lower than 20% in patients with chronic kidney diseases. Finally, the therapeutic possibilities for anemia in this specific patient population are discussed. PMID:23917508

Pereira, Camila Alves; Roscani, Meliza Goi; Zanati, Silméia Garcia; Matsubara, Beatriz Bojikian

2013-01-01

422

A machine learning system to improve heart failure patient assistance.  

PubMed

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

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

2014-11-01

423

Cardiac Rehabilitation Exercise and Self Care for Chronic Heart Failure  

PubMed Central

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

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

2014-01-01

424

Diuretic therapy and resistance in congestive heart failure.  

PubMed

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 low-dose combination therapy and may prove superior to traditional approaches that rely exclusively on loop diuretics. Such approaches aim to prevent adverse compensatory processes that appear to result from chronic diuretic treatment. These include acute and chronic increases in plasma renin activity and stimulation of the sympathetic nervous system, both of which increase afterload and may tend to increase mortality. They also include adaptive changes in nephron structure and function resulting from diuretic-induced increases in distal sodium load and diuretic-induced neurohormonal stimulation. These adaptations blunt the effectiveness of diuretic therapy. Diuretic strategies that rely on combinations of diuretics are emphasized as a method to prevent resistance. If diuretic resistance does develop, higher-dose combination regimens, continuous diuretic infusions and mechanical ultrafiltration can be used to overcome diuretic adaptations and restore diuretic efficacy. The goal of reducing the extracellular fluid volume with the least stimulation of the RAA axis and minimal changes in nephron architecture can be achieved in many patients. PMID:11805380

Ellison, D H

2001-01-01

425

BNP in the diagnosis and risk stratification of heart failure.  

PubMed

Heart failure (HF) is a common disorder that is associated with significant mortality and morbidity. However, the diagnosis of HF may at times be difficult when using conventional tools. The cardiac natriuretic peptides, particularly brain (B-type) natriuretic peptide (BNP), have evolved to be useful biomarkers of cardiac function and prognosis in HF and other cardiovascular disorders. Multiple observational studies have established the close association between plasma BNP as well as the N-terminal fragment of the BNP prohormone (NT-proBNP) with the diagnosis of HF and an independent prediction of mortality and HF events. Although there are confounding variables to consider, when used in the correct clinical settings, BNP or NT-proBNP testing can be extremely useful. Furthermore, preliminary data from randomized controlled trials suggest that knowledge of BNP and/or NT-proBNP level may optimize the management of patients with HF. Large-scale randomized controlled trials that evaluate BNP/NT-proBNP-guided therapy are ongoing. PMID:16234898

Moe, Gordon W

2005-01-01

426

Epidemiology of heart failure with preserved ejection fraction.  

PubMed

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

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

2014-12-01

427

The Dietary Quality of Persons with Heart Failure in NHANES 1999–2006  

Microsoft Academic Search

Background  Dietary quality may impact heart failure outcomes. However, the current status of the dietary quality of persons with heart\\u000a failure has not been previously reported.\\u000a \\u000a \\u000a \\u000a \\u000a Objective  To describe sodium intake, patient factors associated with sodium intake and overall dietary quality in a national sample\\u000a of persons with heart failure.\\u000a \\u000a \\u000a \\u000a \\u000a Design  Analysis of repeated cross-sectional probability sample surveys using data from National Health

Stephenie C. Lemon; Barbara Olendzki; Robert Magner; Wenjun Li; Annie L. Culver; Ira Ockene; Robert J. Goldberg

2010-01-01

428

Erratum to: The Dietary Quality of Persons with Heart Failure in NHANES 1999–2006  

Microsoft Academic Search

BACKGROUND  Dietary quality may impact heart failure outcomes. However, the current status of the dietary quality of persons with heart\\u000a failure has not been previously reported.\\u000a \\u000a \\u000a \\u000a \\u000a OBJECTIVE  To describe sodium intake, patient factors associated with sodium intake and overall dietary quality in a national sample\\u000a of persons with heart failure.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN  Analysis of repeated cross-sectional probability sample surveys using data from National Health

Stephenie C. Lemon; Barbara Olendzki; Robert Magner; Wenjun Li; Annie L. Culver; Ira Ockene; Robert J. Goldberg

2010-01-01

429

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

PubMed Central

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

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

2013-01-01

430

Resolution of Right-Sided Heart Failure Symptoms after Resection of a Primary Ovarian Carcinoid Tumor  

PubMed Central

Carcinoid tumors are rare neuroendocrine malignancies that typically originate from the gastrointestinal tract. Patients who are diagnosed with carcinoid heart disease generally have poor prognoses because of advanced metastases during staging and few therapeutic options. We present the case of a 61-year-old woman with right-sided heart failure, secondary to carcinoid heart disease caused by a primary ovarian carcinoid tumor. After undergoing surgical resection of the left ovary and fallopian tube, the patient experienced complete resolution of her heart failure symptoms. In addition to the patient's case, we discuss the diagnosis, nature, and treatment of this rare condition. PMID:25425990

Adamson, Kathi; Yang, Eugene

2014-01-01

431

Mechanisms of the beneficial effects of beta-adrenoceptor antagonists in congestive heart failure  

PubMed Central

Many clinical studies have documented favourable effects (reduced morbidity and mortality) of beta-adrenoceptor (?-AR) antagonists, such as carvedilol, metoprolol, propranolol, atenolol and bisoprolol, in congestive heart failure. These agents attenuate the effects of sympathetic activation during the development of heart failure, prevent ventricular remodelling and improve cardiac function. Because ?-AR blockers are known to exert negative inotropic action, the mechanisms responsible for their beneficial effects in heart failure have been a subject of debate. While attenuation of changes in ?-AR cyclic AMP-mediated signal transduction in heart failure is considered to be responsible for the beneficial effects of ?-AR antagonists, other mechanisms such as the effects of these agents on subcellular remodelling, oxidative stress, apoptosis and defect in calcium handling, are equally important in preventing cardiac alterations in the failing heart. Moreover, ?-AR antagonists are not a homogeneous group of drugs because they differ in their pharmacokinetics and pharmacodynamics, in addition to the selective and nonselective nature of their actions on ?-AR. Various ?-AR blocking agents have been shown to possess different ancillary properties and produce effects that are independent of ?-AR. In fact, different ?-AR antagonists have been observed to lower the elevated levels of plasma catecholamines in heart failure. Thus, the beneficial effects of ?-AR antagonists are not only elicited through their interaction with mediated ?-AR signal transduction sites in the myocardium, but other mechanisms may also contribute to their favourable actions in heart failure. PMID:21264074

Rehsia, Navneet S; Dhalla, Naranjan S

2010-01-01

432

Early and Sustained Benefit on Event-Free Survival and Heart Failure Hospitalization From Fixed-Dose Combination of Isosorbide Dinitrate\\/Hydralazine Consistency Across Subgroups in the African-American Heart Failure Trial  

Microsoft Academic Search

Background—We previously reported that the fixed-dose combination of isosorbide dinitrate and hydralazine hydrochlo- ride (FDC I\\/H) significantly decreased the risk of all-cause death and first hospitalization for heart failure (HF) and improved quality of life in patients with New York Heart Association class III or IV heart failure in the African-American Heart Failure Trial (A-HeFT). The current analyses further define

Anne L. Taylor; Susan Ziesche; Clyde W. Yancy; Peter Carson; Keith Ferdinand; Malcolm Taylor; Kirkwood Adams; Adeoye Y. Olukotun; Elizabeth Ofili; S. William Tam; Michael L. Sabolinski; Manuel Worcel; Jay N. Cohn

2010-01-01

433

The utility of novel non-invasive technologies for remote hemodynamic monitoring in chronic heart failure.  

PubMed

Monitoring a patient's hemodynamic status may be a revolutionary way to aid a 'health maintenance' strategy in which the physician strives to therapeutically keep the patient in an ideal hemodynamic range. Currently, home telemonitoring employs a 'crisis-prevention' approach. This strategy is still based on easily acquired measures such as heart rate, weight and blood pressure--measurements that are useful to help implement guideline-directed therapy but provide little information about impending decompensation or the risk of hospitalisation. Current systems provide limited information to personalize and adapt medication therapy for heart failure. Several innovative technologies that can remotely monitor estimates of cardiovascular hemodynamics, such as cardiac index, systemic vascular resistance, augmentation index and added heart sounds may enable earlier detection of heart failure decompensation. This editorial presents an overview of the innovative technologies that are available for non-invasive hemodynamic monitoring and maybe adapted for home telemonitoring for chronic heart failure. PMID:25026973

Mabote, Thato; Wong, Kenneth; Cleland, John G F

2014-08-01

434

Home health care with telemonitoring improves health status for older adults with heart failure.  

PubMed

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 rehospitalization or emergency visit between those who received telemonitoring versus 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 an important adjunct to home health care services to improve health status. PMID:23438509

Madigan, Elizabeth; Schmotzer, Brian J; Struk, Cynthia J; DiCarlo, Christina M; Kikano, George; Piña, Ileana L; Boxer, Rebecca S

2013-01-01

435

Home Health Care With Telemonitoring Improves Health Status for Older Adults with Heart Failure  

PubMed Central

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

Madigan, Elizabeth; Schmotzer, Brian J.; Struk, Cynthia J.; DiCarlo, Christina M.; Kikano, George; Piña, Ileana L.; Boxer, Rebecca S.

2014-01-01

436

Brain (B-type) natriuretic peptide: implications for heart failure management.  

PubMed

Heart failure is the leading cause for hospitalization in the United States, resulting in over $8 billion in costs annually. Over 4.8 million Americans are afflicted with the disease and the number is increasing as the baby boomer generation continues to age. It is imperative that new and innovative modalities of therapy and diagnosis evolve as we continue to redefine the nature of heart failure and discover more about this debilitating disease. This article addresses the implications for endogenous brain (B-type) natriuretic peptide (BNP) testing in patients diagnosed with heart failure as well as the implications for the first available form of exogenous BNP, nesiritide. In addition, the pathophysiology of heart failure and traditional treatment modalities are discussed. PMID:14595212

Gordon, Conrad; Rempher, Kenneth J

2003-11-01

437

Pharmacologic strategies to preserve renal function in acute decompensated heart failure.  

PubMed

Over a million patients get hospitalized with the diagnosis of acute decompensated heart failure which poses an insurmountable financial burden on the health care system. Heart failure alone incurs over 30 billion dollars with half the cost spent towards acute hospitalizations. Majority of the treatment strategies have focused towards decongesting patients which often comes with the cost of worsening renal function. Renal dysfunction in the setting of acute decompensated heart failure portends worse morbidity and mortality. Recently, there has been a change in the focus with shift towards therapies attempting to conserve renal function. In the past decade, we have witnessed several large randomized controlled trials testing the established as well as emerging therapies in this subset of population with mixed results. This review intends to provide a comprehensive overview of the pharmacologic therapies commonly utilized in the management of acute decompensated heart failure and the body of evidence supporting these strategies. PMID:25417180

Kumar, Sachin; Taylor, David O

2015-02-01

438

Could a Drink a Day Lower Your Risk for Heart Failure?  

MedlinePLUS

... page, please enable JavaScript. Could a Drink a Day Lower Your Risk for Heart Failure? Study found ... 19, 2015 (HealthDay News) -- Having a drink each day might help lower a middle-aged person's odds ...

439

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...

440

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

MedlinePLUS

... required looked for elevated levels of the hormone BNP, which is associated with more severe heart failure. ... The study showed that participants enrolled via elevated BNP measurements who received spironolactone fared better in the ...

441

Exercise training improves peripheral chemoreflex function in heart failure rabbits  

PubMed Central

An enhancement of peripheral chemoreflex sensitivity contributes to sympathetic hyperactivity in chronic heart failure (CHF) rabbits. The enhanced chemoreflex function in CHF involves augmented carotid body (CB) chemoreceptor activity via upregulation of the angiotensin II (ANG II) type 1 (AT1)-receptor pathway and downregulation of the neuronal nitric oxide synthase (nNOS)-nitric oxide (NO) pathway in the CB. Here we investigated whether exercise training (EXT) normalizes the enhanced peripheral chemoreflex function in CHF rabbits and possible mechanisms mediating this effect. EXT partially, but not fully, normalized the exaggerated baseline renal sympathetic nerve activity (RSNA) and the response of RSNA to hypoxia in CHF rabbits. EXT also decreased the baseline CB nerve single-fiber discharge (4.9 ± 0.4 vs. 7.7 ± 0.4 imp/s at Po2 = 103 ± 2.3 Torr) and the response to hypoxia (20.6 ± 1.1 vs. 36.3 ± 1.3 imp/s at Po2 = 41 ± 2.2 Torr) from CB chemoreceptors in CHF rabbits, which could be reversed by treatment of the CB with ANG II or a nNOS inhibitor. Our results also showed that NO concentration and protein expression of nNOS were increased in the CBs from EXT + CHF rabbits, compared with that in CHF rabbits. On the other hand, elevated ANG II concentration and AT1-receptor overexpression of the CBs in CHF state were blunted by EXT. These results indicate that EXT normalizes the CB chemoreflex in CHF by preventing an increase in afferent CB chemoreceptor activity. EXT reverses the alterations in the nNOS-NO and ANG II-AT1-receptor pathways in the CB responsible for chemoreceptor sensitization in CHF. PMID:18583379

Li, Yu-Long; Ding, Yanfeng; Agnew, Chad; Schultz, Harold D.

2008-01-01

442

Self?Rated Health Predicts Healthcare Utilization in Heart Failure  

PubMed Central

Background Heart failure (HF) patients experience impaired functional status, diminished quality of life, high utilization of healthcare resources, and poor survival. Yet, the identification of patient?centered factors that influence prognosis is lacking. Methods and Results We determined the association of 2 measures of self?rated health with healthcare utilization and skilled nursing facility (SNF) admission in a community cohort of 417 HF patients prospectively enrolled between October 2007 and December 2010 from Olmsted County, MN. Patients completed a 12?item Short Form Health Survey (SF?12). Low self?reported physical functioning was defined as a score ?25 on the SF?12 physical component. The first question of the SF?12 was used as a measure of self?rated general health. After 2 years, 1033 hospitalizations, 1407 emergency department (ED) visits, and 19,780 outpatient office visits were observed; 87 patients were admitted to a SNF. After adjustment for confounding factors, an increased risk of hospitalizations (1.52 [1.17 to 1.99]) and ED visits (1.48 [1.04 to 2.11]) was observed for those with low versus moderate?high self?reported physical functioning. Patients with poor and fair self?rated general health also experienced an increased risk of hospitalizations (poor: 1.73 [1.29 to 2.32]; fair: 1.46 [1.14 to 1.87]) and ED visits (poor: 1.73 [1.16 to 2.56]; fair: 1.48 [1.13 to 1.93]) compared with good?excellent self?rated general health. No association between self?reported physical functioning or self?rated general health with outpatient visits and SNF admission was observed. Conclusion In community HF patients, self?reported measures of physical functioning predict hospitalizations and ED visits, indicating that these patient?reported measures may be useful in risk stratification and management in HF. PMID:24870937

Chamberlain, Alanna M.; Manemann, Sheila M.; Dunlay, Shannon M.; Spertus, John A.; Moser, Debra K.; Berardi, Cecilia; Kane, Robert L.; Weston, Susan A.; Redfield, Margaret M.; Roger, Véronique L.

2014-01-01

443

Effects of compensated heart failure on digoxin pharmacokinetics in cats.  

PubMed

To evaluate the effects of compensated heart failure (HF) on digoxin pharmacokinetic properties in cats, 6 cats with dilated cardiomyopathy were compared with 6 clinically normal (control) cats. Digoxin tablets were administered at a dosage of 0.01 mg/kg of body weight, q 48 h for approximately 10 days, until presumed steady state was reached. Both groups were treated concomitantly with aspirin, furosemide, and a commercial low-salt diet. Retrospectively, control and HF cats were calculated to be at 95% and 97% steady state, respectively. At the time blood samples were collected, HF cats were clinically compensated. Serum digoxin concentration [( DXN]) was determined by radioimmunoassay on samples drawn immediately before and 1, 2, 4, 8, 12, 24, 34, and 48 hours after digoxin administration. Measured and calculated values (peak, 8-hour, and mean [DXN]; elimination half-life [t1/2]; oral clearance; and hours during which [DXN] was in the toxic range) were not significantly different between control and HF cats. To predict individual propensity for digoxin intoxication, serum creatinine and urea concentrations and sulfobromophthalein dye retention were measured in control and HF cats prior to the onset of treatment with digoxin. There was no statistically significant correlation between serum creatinine and urea concentrations when compared with sulfobromophthalein dye retention nor between any of these values and digoxin peak, 8-hour, and mean concentrations or t1/2, oral clearance, or hours during which [DXN] was in the toxic range. Mean serum creatinine and urea nitrogen concentrations were significantly greater (P less than 0.01) and sulfobromophthalein dye retention approached significant prolongation (P less than 0.06) in HF cats, compared with that in control cats.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2793576

Atkins, C E; Snyder, P S; Keene, B W; Rush, J E

1989-10-01

444

Hypoalbuminaemia and incident heart failure in older adults  

PubMed Central

Aims To test the hypothesis that baseline hypoalbuminaemia is associated with incident heart failure (HF) in community-dwelling older adults. Methods and results Of the 5795 community-dwelling adults aged ?65 years in the Cardiovascular Health Study, 5450 were free of centrally adjudicated prevalent HF at baseline, and also had data on baseline serum albumin. Of these, 599 (11%) had hypoalbuminaemia, defined as baseline serum albumin levels ?3.5 mg/dL. Propensity scores for hypoalbuminaemia were calculated for each patient and used to assemble a matched cohort of 582 pairs of participants with and without hypoalbuminaemia, who were well balanced on 58 baseline characteristics. Using Cox regression models, we estimated the association of hypoalbuminaemia with centrally adjudicated incident HF during 9.6 years of median follow-up. Matched participants had a mean (±SD) age of 74 (±6) years, 62% were women, and 16% were African Americans. Incident HF occurred in 25 and 20% of matched participants with and without hypoalbuminaemia, respectively [hazard ratio when hypoalbuminaemia was compared with normoalbuminaemia, 1.40; 95% confidence interval, 1.05–1.85; P = 0.020]. Pre-match unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios (95% confidence intervals) for incident HF associated with hypoalbuminaemia were 1.33 (1.12–1.58; P = 0.001), 1.33 (1.11–1.60; P = 0.002), and 1.25 (1.04–1.50; P= 0.016), respectively. The combined endpoint of incident HF or all-cause mortality occurred in 59 and 50% of matched participants with and without hypoalbuminaemia, respectively (hazard ratio, 1.33; 95% confidence interval, 1.11–1.61; P= 0.002). Conclusions Among community-dwelling older adults without HF, baseline hypoalbuminaemia was associated with increased risk of incident HF during 10 years of follow-up. PMID:21807662

Filippatos, Gerasimos S.; Desai, Ravi V.; Ahmed, Mustafa I.; Fonarow, Gregg C.; Love, Thomas E.; Aban, Inmaculada B.; Iskandrian, Ami E.; Konstam, Marvin A.; Ahmed, Ali

2011-01-01

445

BACE1 levels are elevated in congestive heart failure.  

PubMed

Cardiovascular (CV) diseases are known to have a negative impact on the brain and neurocognition, and contribute to the development of vascular dementia and neurodegenerative diseases such as Alzheimer's disease (AD). Among CV diseases, congestive heart failure (CHF) after myocardial infarction (MI) is a condition where the ability of the left ventricle to eject blood to the circulation is impaired. As a consequence, CHF triggers inflammation and results in reduced cerebral blood flow which are considered among the risk factors for development of AD. However, biochemical alterations in the brain following MI and CHF remain unknown. To address this issue, we investigated microglia activation; levels of BACE1, the key rate-limiting enzyme involved in the pathogenesis of AD; and VEGF levels in the hippocampus and cortex following MI. We created MI by the ligation of the left anterior descending coronary artery in Sprague-Dawley male rats and collected brains either 3 days after MI (AMI) or 21 days after MI (CHF). We investigated microglia activation in AMI and CHF brains by immunohistochemistry and immunoblotting using macrophage/microglia marker Ionized calcium binding adaptor molecule 1 (Iba-1), and observed activated morphology of microglia in the cortex of rats in both AMI and CHF. We also showed the levels of BACE1 were increased in the cortex and hippocampus of CHF rats. To determine whether hypoxia occurs in the CHF brain, we assessed levels of VEGF in the hippocampus and cortex. Western blotting analysis showed up-regulation of VEGF in the hippocampus of CHF brains. These results suggest that neuroinflammation takes place secondary to myocardial infarction. In addition, CHF-induced hypoxia might play a role in the elevation of BACE1 and VEGF levels. PMID:23127855

Nural-Guvener, Hikmet F; Mutlu, Nezahet; Gaballa, Mohamed A

2013-01-01

446

Altered intracellular Ca2+ regulation in chronic rat heart failure.  

PubMed

intracellular Ca(2+) handling by the sarcoplasmic reticulum (SR) plays a crucial role in the pathogenesis of heart failure (HF). Despite extensive effort, the underlying causes of abnormal SR Ca(2+) handling in HF have not been clarified. To determine whether the diastolic SR Ca(2+) leak along with reduced Ca(2+) reuptake is required for decreased contractility, we investigated the cytosolic Ca(2+) transients and SR Ca(2+) content and assessed the expression of ryanodine receptor (RyR2), FK506 binding protein (FKBP12.6), SR-Ca(2+) ATPase (SERCA2a), and L-type Ca(2+) channel (LTCC) using an SD-rat model of chronic HF. We found that the cytosolic Ca(2+) transients were markedly reduced in amplitude in HF myocytes (DeltaF/F(0) = 12.3 +/- 0.8) compared with control myocytes (DeltaF/F(0) = 17.7 +/- 1.2, P < 0.01), changes paralleled