WorldWideScience

Sample records for advanced heart failure

  1. Planning Ahead: Advanced Heart Failure

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Planning Ahead: Advanced Heart Failure Updated:Jul 7,2016 ... making your preferences known is called advance care planning. It allows you to speak for yourself, even ...

  2. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Vase, Henrik; Gjedsted, Jakob;

    2016-01-01

    Heart failure is one of the most common causes of morbidity and mortality worldwide. When patients cease to respond adequately to optimal medical therapy mechanical circulatory support has been promising. The advent of mechanical circulatory support devices has allowed significant improvements in...... patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support....

  3. Advanced glycation endproducts in chronic heart failure

    NARCIS (Netherlands)

    Smit, Andries J.; Hartog, Jasper W. L.; Voors, Adriaan A.; van Veldhuisen, Dirk J.; Schleicher, E; Somoza,; Shieberle, P

    2008-01-01

    Advanced glycation endproducts (AGEs) have been proposed as factors involved in the development and progression of chronic heart failure (CHF). Cross-linking by AGEs results in vascular and myocardial stiffening, which are hallmarks in the pathogenesis of CHE Additionally, stimulation of receptors b

  4. Diabetes Drug Victoza Might Not Help Advanced Heart Failure Patients

    Science.gov (United States)

    ... liraglutide (Victoza) doesn't appear to improve heart function in patients with advanced heart failure, a new study finds. The theory ... even been slightly harmful in some patients with advanced heart failure, ... function. But, patients using Victoza who develop heart failure ...

  5. Exercise And Heart Failure: Advancing Knowledge And Improving Care

    Science.gov (United States)

    Alvarez, Paulino; Hannawi, Bashar; Guha, Ashrith

    2016-01-01

    Exercise limitation is the hallmark of heart failure, and an increasing degree of intolerance is associated with poor prognosis. Objective evaluation of functional class (e.g., cardiopulmonary exercise testing) is essential for adequate prognostication in patients with advanced heart failure and for implementing an appropriate exercise training program. A graded exercise program has been shown to be beneficial in patients with heart failure and has become an essential component of comprehensive cardiac rehabilitation in these patients. An exercise program tailored to the patient's preferences, possibilities, and physiologic reserve has the greatest chance of being successful. Despite being safe, effective, and a guideline-recommended treatment to improve quality of life, exercise training remains grossly underutilized. Patient, physician, insurance and practice barriers need to be addressed to improve this quality gap. PMID:27486494

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

    NARCIS (Netherlands)

    Metra, Marco; Ponikowski, Piotr; Dickstein, Kenneth; McMurray, John J. V.; Gavazzi, Antonello; Bergh, Claes-Hakan; Fraser, Alan G.; Jaarsma, Tiny; Pitsis, Antonis; Mohacsi, Paul; Boehm, Michael; Anker, Stefan; Dargie, Henry; Brutsaert, Dirk; Komajda, Michel

    2007-01-01

    Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition. Patients that are generally recognised as ACHF often exhibit the following c

  7. Heart Failure

    Science.gov (United States)

    ... blood. In other cases, the heart can't pump blood to the rest of the body with enough ... failure affects the right side, the heart cannot pump enough blood to the lungs, where it picks up oxygen. ...

  8. Heart Failure: Advanced Development in Genetics and Epigenetics

    OpenAIRE

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

    2015-01-01

    Heart failure (HF) is a complex pathophysiological syndrome that arises from a primary defect in the ability of the heart to take in and/or eject sufficient blood. Genetic mutations associated with familial dilated cardiomyopathy, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy can contribute to the various pathologies of HF. Therefore, genetic screening could be an approach for guiding individualized therapies and surveillance. In addition, epigenetic regulat...

  9. Heart Failure

    Science.gov (United States)

    ... together. About Rise Above HF Rise Above Heart Failure seeks to increase the dialogue about HF and improve the lives of people affected by the condition through awareness, education and support. Through the initiative, AHA strives to ...

  10. Heart failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970284 Effects of enalapril on heart rate variabilityin patients with congestive heart failure. ZHANGYouhua(章友华), et a1. Dept Cardiol, Cardiovasc Instit& Fuwai Hosp, CAMS & PUMC, Beijing, 100037. ChinCir J 1996; 11(2): 729-732.

  11. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009170 Curcumin attenuates left ventricular dysfunction and remodeling in rabbits with chronic heart failure. TANG Yanhong(唐艳红),et al.Dept Cardiol,Renmin Hosp,Wuhan Univ,Wuhan 430060.Chin J Cardiol,2009;37(3):262-267.

  12. Paradox of circulating advanced glycation end product concentrations in patients with congestive heart failure and after heart transplantation

    OpenAIRE

    A. Heidland; Šebeková, K.; Frangiosa, A; De Santo, L S; Cirillo, M.; Rossi, F.; Cotrufo, M.; Perna, A; Klassen, A; Schinzel, R; De Santo, N G

    2004-01-01

    Objectives: To analyse circulating concentrations of advanced glycation end products (AGEs) in patients with severe congestive heart failure (CHF) and after heart transplantation; to identify the potential contribution of kidney function to plasma AGE concentrations; and to determine whether AGE concentrations and parameters of oxidative stress are interrelated.

  13. LVAD as a Bridge to Heart Transplantation in a Patient with Left Ventricular Noncompaction Cardiomyopathy and Advanced Heart Failure.

    Science.gov (United States)

    Cerar, Andraž; Kšela, Juš; Poglajen, Gregor; Vrtovec, Bojan; Kneževič, Ivan

    2016-01-01

    Left ventricular noncompaction cardiomyopathy (LVNC) is a rare hereditary cardiomyopathy characterized by the formation of an outer compacted and inner noncompacted layer of the myocardium. The latter is characterized by prominent trabeculations and deep intertrabecular recesses and is functionally inferior to the compacted myocardium. As there is no specific treatment for patients with LVNC who develop heart failure, the management of these patients is limited and many patients progress to advanced stages of the disease. For LVNC patients with advanced heart failure, the data regarding the use of mechanical circulatory support are scarce. We report a case of a 29-year-old patient with LVNC and advanced refractory heart failure, who was successfully bridged to heart transplantation using a long-term continuous-flow left ventricular assist device. PMID:27355148

  14. Living with an unfixable heart: a qualitative study exploring the experience of living with advanced heart failure.

    LENUS (Irish Health Repository)

    Ryan, Marie

    2012-02-01

    BACKGROUND: Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person\\'s point of view as its central focus. AIM: The aim of this study was to describe patients\\' experiences of living with advanced heart failure. METHODS: The study sample (N=9) consisted of male (N=6) and female (N=3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006. RESULTS: Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence. CONCLUSIONS: The findings suggest that there may be an illogical but enduring ethos of \\'cure\\' pervading health care worker\\'s attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.

  15. Recognizing Advanced Heart Failure and Knowing Your Options

    Science.gov (United States)

    ... different procedures for different types of valve defects. Percutaneous coronary intervention: A blocked heart artery can be opened using ... placed in the artery to keep it open. Percutaneous coronary intervention, or PCI, is also known as coronary angioplasty. ...

  16. Electrophysiological Remodeling in Heart Failure

    OpenAIRE

    Wang, Yanggan; Hill, Joseph A.

    2010-01-01

    Heart failure affects nearly 6 million Americans, with a half-million new cases emerging each year. Whereas up to 50% of heart failure patients die of arrhythmia, the diverse mechanisms underlying heart failure-associated arrhythmia are poorly understood. As a consequence, effectiveness of antiarrhythmic pharmacotherapy remains elusive. Here, we review recent advances in our understanding of heart failure-associated molecular events impacting the electrical function of the myocardium. We appr...

  17. Estrogen Therapy Rescues Advanced Heart Failure via Estrogen Receptor Beta

    OpenAIRE

    Iorga, Andrea

    2015-01-01

    Cardiac hypertrophy, defined as an enlargement of the ventricles, is often triggered when the heart is subjected to hemodynamic stress from physiological stimuli such as pregnancy, or from pathological stimuli such as pressure overload-induced left ventricular hypertrophy or pulmonary hypertension-induced right ventricular hypertrophy. Physiological hypertrophy is beneficial and adaptive, while pathological hypertrophy is maladaptive and detrimental. Estrogen treatment prior to the onset of p...

  18. Advanced strategies for end-stage heart failure: combining regenerative approaches with LVAD, a new horizon?

    Directory of Open Access Journals (Sweden)

    Cheyenne eTseng

    2015-04-01

    Full Text Available Despite the improved treatment of cardiovascular diseases the population with end-stage heart failure is progressively growing. The scarcity of the gold standard therapy, heart transplantation, demands novel therapeutic approaches. For patients awaiting transplantation ventricular assist devices have been of great benefit on survival. To allow explantation of the assist device and obviate heart transplantation, sufficient and durable myocardial recovery is necessary. However, explant rates so far are low. Combining mechanical circulatory support with regenerative therapies such as cell(-based therapy and biomaterials might give rise to improved long-term results. Although synergistic effects are suggested with mechanical support and stem cell therapy, evidence in both preclinical and clinical setting is lacking. This review focuses on advanced and innovative strategies for the treatment of end-stage heart failure and furthermore appraises clinical experience with combined strategies.

  19. Heart failure - medicines

    Science.gov (United States)

    CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines ... You will need to take most of your heart failure medicines every day. Some medicines are taken ...

  20. Heart failure

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920647 Comparative effects of commonvasodilators on experimental cardiac fai-lure. LI Zhijian (李志坚), et al. Dept Cardiol,2nd Hosp, Tianjin Med Coll. Tianjin Med J1992; 20(8): 456-458. A 9×9 latin square design was employed forcomparing the effects of (1) placebo, (2) nitr-oprusside, (3) phentolamine, (4) isosorbide dini-trate. (5) captopril, (6) captopril-isosorbide

  1. Durable mechanical circulatory support in advanced heart failure: a critical care cardiology perspective.

    Science.gov (United States)

    Lala, Anuradha; Mehra, Mandeep R

    2013-11-01

    Though cardiac transplantation for advanced heart disease patients remains definitive therapy for patients with advanced heart failure, it is challenged by inadequate donor supply, causing durable mechanical circulatory support (MCS) to slowly become a new primary standard. Selecting appropriate patients for MCS involves meeting a number of prespecifications as is required in evaluation for cardiac transplant candidacy. As technology evolves to bring forth more durable smaller devices, selection criteria for appropriate MCS recipients will likely expand to encompass a broader, less sick population. The "Holy Grail" for MCS will be a focus on clinical recovery and explantation of devices rather than the currently more narrowly defined indications of bridge to transplantation or lifetime device therapy. PMID:24188222

  2. Haemostatic and inflammatory biomarkers in advanced chronic heart failure: role of oral anticoagulants and successful heart transplantation.

    Science.gov (United States)

    Cugno, Massimo; Mari, Daniela; Meroni, Pier Luigi; Gronda, Edoardo; Vicari, Francesco; Frigerio, Maria; Coppola, Raffaella; Bottasso, Bianca; Borghi, Maria Orietta; Gregorini, Luisa

    2004-07-01

    Advanced chronic heart failure (CHF) is associated with abnormal haemostasis and inflammation, but it is not known how these abnormalities are related, whether they are modified by oral anticoagulants (OAT), or if they persist after successful heart transplantation. We studied 25 patients with CHF (New York Heart Association class IV, 10 of whom underwent heart transplantation) and 25 age- and sex-matched healthy controls by measuring their plasma levels of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin (TAT) complexes, tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), D-dimer, factor VII (FVII), fibrinogen, von Willebrand factor (VWF), tumour necrosis factor (TNF), soluble TNF receptor II (sTNFRII), interleukin 6 (IL-6), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), endothelial-selectin (E-selectin) and thrombomodulin. CHF patients had higher plasma levels of TAT, D-dimer, t-PA, fibrinogen, VWF, TNF, IL-6, sTNFRII, sVCAM-1 (P = 0.0001), sICAM-1 (P = 0.003) and thrombomodulin (P = 0.007) than controls. There were significant correlations (r = 0.414-0.595) between coagulation, fibrinolysis, endothelial dysfunction and inflammation parameters, which were lower in those patients treated with OATs. Heart transplantation led to reductions in fibrinogen (P = 0.001), VWF (P = 0.05), D-dimer (P = 0.05) and IL-6 levels (P = 0.05), but all the parameters remained significantly higher (P = 0.01-0.0001) than in the controls. Advanced CHF is associated with coagulation activation, endothelial dysfunction and increased proinflammatory cytokine levels. Most of these abnormalities parallel each other, tend to normalize in patients treated with OATs and, although reduced, persist in patients undergoing successful heart transplantation, despite the absence of clinical signs of CHF. PMID:15198737

  3. Types of Heart Failure

    Science.gov (United States)

    ... failure. Drug treatments are different for the two types. Systolic failure: The left ventricle loses its ability to contract normally. The heart can't pump with enough force to push enough blood into circulation. Diastolic failure ( ...

  4. Cardiomyocytic apoptosis and heart failure

    Institute of Scientific and Technical Information of China (English)

    Quanzhou Feng

    2008-01-01

    Heart failure is a major disease seriously threatening human health.Once left ventricular dysfunction develops,cardiac function usually deteriorates and progresses to congestive heart failure in several months or years even if no factors which accelerate the deterioration repeatedly exist.Mechanism through which cardiac function continually deteriorates is still unclear.Cardiomyocytic apoptosis can occur in acute stage of ischemic heart diseases and the compensated stage of cardiac dysfunction.In this review,we summarize recent advances in understanding the role of cardiomyocytic apoptosis in heart failure.

  5. Lungs in Heart Failure

    OpenAIRE

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

    2012-01-01

    Lung function abnormalities both at rest and during exercise are frequently observed in patients with chronic heart failure, also in the absence of respiratory disease. Alterations of respiratory mechanics and of gas exchange capacity are strictly related to heart failure. Severe heart failure patients often show a restrictive respiratory pattern, secondary to heart enlargement and increased lung fluids, and impairment of alveolar-capillary gas diffusion, mainly due to an increased resistance...

  6. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    Science.gov (United States)

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions. PMID:27568873

  7. Heart failure - medicines

    Science.gov (United States)

    ... are working and to measure your potassium levels. Beta Blockers Beta blockers slow your heart rate and decrease the strength ... muscle contracts in the short term. Long term beta blockers help keep your heart failure from becoming worse. ...

  8. Antithrombotics in heart failure.

    OpenAIRE

    Miličić, Davor; Samardžić, Jure; Petričević, Mate

    2014-01-01

    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...

  9. Impact of advance care planning on the care of patients with heart failure: study protocol for a randomized controlled trial

    OpenAIRE

    Malhotra, Chetna; Sim, David Kheng Leng; Jaufeerally, Fazlur; Vikas, Nivedita Nadkarni; Sim, Genevieve Wong Cheng; Tan, Boon Cheng; Ng, Clarice Shu Hwa; Tho, Pei Leng; Lim, Jingfen; Chuang, Claire Ya-Ting; Fong, Florence Hui Mei; Liu, Joy; Finkelstein, Eric A.

    2016-01-01

    Background Despite the promise and popularity of advance care planning, there is insufficient evidence that advance care planning helps patients to meet their end-of-life care preferences, especially in Asian settings. Thus, the proposed study aims to assess whether patients with advanced heart failure who are receiving advance care planning have a greater likelihood of receiving end-of-life care consistent with their preferences compared to patients receiving usual care. Secondary objectives...

  10. Life disruption, life continuation: contrasting themes in the lives of African-American elders with advanced heart failure.

    Science.gov (United States)

    Hopp, Faith Pratt; Thornton, Nancy; Martin, Lindsey; Zalenski, Robert

    2012-01-01

    This study addresses the need for more information about how urban African-American elders experience advanced heart failure. Participants included 35 African Americans aged 60 and over with advanced heart failure, identified through records from a community hospital in Detroit, Michigan. Four focus groups (n = 13) and 22 individual interviews were conducted. We used thematic analysis to examine qualitative focus groups and interviews. Themes identified included life disruption, which encompassed the sub-themes of living scared, making sense of heart failure, and limiting activities. Resuming life was a contrasting theme involving culturally relevant coping strategies, and included the sub-themes of resiliency, spirituality, and self-care that helped patients regain and maintain a sense of self amid serious illness. Participants faced numerous challenges and invoked a variety of strategies to cope with their illness, and their stories of struggles, hardship, and resilience can serve as a model for others struggling with advanced illness. PMID:22352363

  11. Heart failure in North America.

    Science.gov (United States)

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

    2013-05-01

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

  12. Heart Failure in North America

    OpenAIRE

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

    2013-01-01

    Heart failure is a major health problem that affects patients and healthcare systems worldwide. Within the continent of North America, differences in economic development, genetic susceptibility, cultural practices, and trends in risk factors and treatment all contribute to both inter-continental and within-continent differences in heart failure. The United States and Canada represent industrialized countries with similar culture, geography, and advanced economies and infrastructure. During t...

  13. Recent advances in treatment of heart failure [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Takeshi Kitai

    2015-12-01

    Full Text Available With the total cases and economic burden of heart failure continuing to rise, there is an overwhelming need for novel therapies. Several drugs for heart failure have succeeded in preclinical and early-phase clinical trials, but most of them failed to show the real benefit in pivotal clinical trials. Meanwhile, the US Food and Drug Administration recently approved two promising new drugs to treat heart failure: ivabradine and sacubitril/valsartan. Furthermore, some of the newer agents in testing offer the potential for significant progress in addition to these drugs. Patiromer and zirconium cyclosilicate are attractive agents that are expected to prevent hyperkalemia during renin-angiotensin-aldosterone system inhibition, and serelaxin and urodilatin are promising drugs in the treatment of acute heart failure. Future clinical trials with more appropriate study designs, optimal clinical endpoints, and proper patient selection are mandatory to assess the true efficacy of these attractive compounds in clinical practice.

  14. Nutrition in Heart Failure

    OpenAIRE

    Reci Meseri

    2013-01-01

    Heart failure is defined as decreased ability of heart due to various reasons. It%u2019s seen 2-3% but the prevalence increases sharply after the age of seventy. The objectives of nutrition therapy in heart failure are to prevent from water retention and edema, to avoid from hard digestion and to offer a balanced diet. In order to avoid fluid retention and edema, daily sodium and fluid intake must be monitored carefully. Main dilemma of the heart failure patients is the obesity-cachexia dilem...

  15. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    Science.gov (United States)

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care. PMID:26836596

  16. Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure.

    Directory of Open Access Journals (Sweden)

    Susan Browne

    Full Text Available BACKGROUND: Those with advanced heart failure (HF experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care. METHODS: Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30, carers (n = 20, and professionals (n = 65. Data analysed using Normalisation Process Theory (NPT as the underpinning conceptual framework. FINDINGS: Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom. CONCLUSIONS: Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor

  17. Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction.

    Science.gov (United States)

    Omar, Alaa Mabrouk Salem; Bansal, Manish; Sengupta, Partho P

    2016-07-01

    Echocardiography, given its safety, easy availability, and the ability to permit a comprehensive assessment of cardiac structure and function, is an indispensable tool in the evaluation and management of patients with heart failure (HF). From initial phenotyping and risk stratification to providing vital data for guiding therapeutic decision-making and monitoring, echocardiography plays a pivotal role in the care of HF patients. The recent advent of multiparametric approaches for myocardial deformation imaging has provided valuable insights in the pathogenesis of HF, elucidating distinct patterns of myocardial dysfunction and events that are associated with progression from subclinical stage to overt HF. At the same time, miniaturization of echocardiography has further expanded clinical application of echocardiography, with the use of pocket cardiac ultrasound as an adjunct to physical examination demonstrated to improve diagnostic accuracy and risk stratification. Furthermore, ongoing advances in the field of big data analytics promise to create an exciting opportunity to operationalize precision medicine as the new approach to healthcare delivery that aims to individualize patient care by integrating data extracted from clinical, laboratory, echocardiographic, and genetic assessments. The present review summarizes the recent advances in the field of echocardiography, with emphasis on their role in HF phenotyping, risk stratification, and optimizing clinical outcomes. PMID:27390337

  18. Lungs in Heart Failure

    Directory of Open Access Journals (Sweden)

    Anna Apostolo

    2012-01-01

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

  19. Advanced research on the microRNA mechanism in heart failure.

    Science.gov (United States)

    Deng, Jianying; Zhong, Qianjin

    2016-10-01

    Heart failure is the end stage of most cardiac diseases and also an important cardiovascular disease. Ventricular remodeling, a complicated pathophysiological process involving multiple molecular pathways, is a crucial mechanism for the occurrence and development of heart failure. A microRNA (miRNA) is a highly conservative noncoding molecule containing 18-25 nucleotides. miRNA is different from other RNAs. It mainly serves as an endogenous gene-regulating factor, and is a member of the complex regulatory network. It induces gene repression of target transcripts by affecting mRNA at the post-transcriptional level Vasudevan et al. (2007) . This study aimed at determining the mechanism of miRNA action in heart failure. PMID:27372044

  20. Heart failure - palliative care

    Science.gov (United States)

    ... et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College ... MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, ...

  1. Chronic beta-blocker treatment in patients with advanced heart failure - Effects on neurohormones

    NARCIS (Netherlands)

    Teisman, ACH; van Veldhuisen, DJ; Boomsma, F; de Kam, PJ; Pinto, YM; de Zeeuw, D; van Gilst, WH

    2000-01-01

    Background: To date, the use of beta-blockers in treating patients with chronic heart failure gains support, this since several large clinical trials reported reduced mortality after chronic beta-blockade. Part of these beneficial effects may result from inhibition of deleterious neurohormone activa

  2. Nutrition in Heart Failure

    Directory of Open Access Journals (Sweden)

    Reci Meseri

    2013-10-01

    Full Text Available Heart failure is defined as decreased ability of heart due to various reasons. It%u2019s seen 2-3% but the prevalence increases sharply after the age of seventy. The objectives of nutrition therapy in heart failure are to prevent from water retention and edema, to avoid from hard digestion and to offer a balanced diet. In order to avoid fluid retention and edema, daily sodium and fluid intake must be monitored carefully. Main dilemma of the heart failure patients is the obesity-cachexia dilemma. Since one of the main reasons of heart failure is cardiovascular diseases, in first phase, the patient may be obese. In the later phases, cachexia may show up. It was shown that cachexia is associated with mortality. Within this period, patients should not be over-fed and the patient should pass from catabolic state to anabolic state slowly. If the gastrointestinal track is functional oral/enteral feeding must be preferred. Multi vitamin and mineral supportsmay be beneficial, which may replace the increased loss, increase anti-inflammatory response and be anti-oxidants. Large, controlled and well-designed studies must be conducted in order to evaluate the benefits of nutritional practices such as nutritional assessment, enteral feeding and nutrient supports in heart failure patients.

  3. Advances in the management of atrial fibrillation in congestive heart failure

    OpenAIRE

    Gopinathannair, Rakesh; Olshansky, Brian

    2009-01-01

    Atrial fibrillation, a common problem in patients with heart failure, is associated with increased mortality and morbidity. Pharmacological as well as invasive management and the endpoints of such management are complex. Recent randomized trials indicate that a rate-control strategy, along with anticoagulation treatment with warfarin, when appropriate, has a similar outcome in terms of mortality and morbidity as rhythm control, and could, therefore, be considered as the primary management str...

  4. Relationship between advanced glycation end-products with the severity of chronic heart failure in 85 patients

    Directory of Open Access Journals (Sweden)

    Amir Farhang Zand Parsa

    2013-12-01

    Full Text Available Background: Advanced glycation end-products (AGEs came up with the recent researches regarding new biomarkers for the diagnosis of heart failure. AGEs are the end products of non-enzymatic glycation and oxidation of proteins, lipids and nucleotides during Maillard biochemical reaction. Although it has been known that AGEs have a role in the pathogenesis of chronic heart failure (CHF, information regarding its role and its pathogenetic mechanism is very limited. The aim of this study was to find any relationship between AGEs with the etiology and severity of chronic heart failure.Methods: This study is a prospective cross sectional study that enrolled 85 patients with chronic heart failure. Measurement of left ventricle ejection fraction (LVEF was done by echocardiography. Blood samples were collected for measuring AGEs just before or after echocardiography assessment (in the same session. Measurement of AGEs was done by the enzyme-linked immunosorbent assay (ELISA method. The relationship between AGEs with the severity of CHF and as well as the etiology of CHF were evaluated via SPSS-15.Results: Of 85 patients 48 (56.5% patients were male and 37 (43.5% were female; Mean±SD of their ages was 55.8±13.4 years old (ranges from 27 to 84 years. Correlation coefficient between LVEF and AGEs was 0.269 (P=0.013. Mean of AGEs in patients with and without ischemic etiology of their heart failure were 16.8±9.8µg/ml and 11.6±7.3 µg/ml, respectively. Although trend was in favor of ischemic heart failure, the difference between two groups was not statistically significant (P= 0.141.Conclusion: According to this study the rate of AGES could be helpful in the diagnosis and assessment of severity of CHF. Based on our findings, higher blood levels of AGEs in the ischemic CHF cases, also it could be concluded that in the future this marker may be used for etiologic differentiation of heart failure syndrome.

  5. Qt dispersion has no prognostic information for patients with advanced congestive heart failure and reduced left ventricular systolic function

    DEFF Research Database (Denmark)

    Brendorp, B; Elming, H; Jun, L;

    2001-01-01

    .55), or cardiac arrhythmic mortality (risk ratio 1.00, 95% CI 0.99 to 1.01; P=0.38). CONCLUSIONS: QT dispersion has no prognostic value regarding all-cause mortality, cardiac mortality, or cardiac arrhythmic mortality for patients with advanced CHF and reduced left ventricular systolic function.......BACKGROUND: QT dispersion is a potential prognostic marker of tachyarrhythmic events and death, but it is unclear whether this applies to patients with congestive heart failure (CHF). METHODS AND RESULTS: Of the 1518 patients with advanced CHF and left ventricular dysfunction enrolled in the Danish...

  6. Overcoming the challenges of conducting research with people who have advanced heart failure and palliative care needs.

    Science.gov (United States)

    Fitzsimons, Donna; Strachan, Patricia H

    2012-06-01

    Research on the palliative care needs of heart failure patients is scant and requires development to provide a sound evidence base for improved care; but there are distinct practical and ethical challenges in conducting research with this population. This paper presents an integrative review of the literature that aims to describe these challenges and discuss potential strategies by which they may be addressed. It is recognised that heart failure is a volatile condition making identification of the end of the life phase difficult. This leads to an array of other issues; firstly clinical teams tend to use this as a rationale for their failure to discuss palliative care issues with patients and families, making identification of the population difficult and research related communication challenging. Symptom volatility also creates methodological problems for researchers in deciding patients' eligibility, securing user involvement and contributes to sample attrition in research. There are also substantial ethical challenges for researchers in terms of gaining access and ensuring patient autonomy in this population. Acknowledgement of these issues and discussion of strategies by which they can be addressed has the potential to augment clinical research, develop practice and ultimately produce the much needed improvements in patient care required for those with advanced heart failure. PMID:21330214

  7. Malnutrition and Cachexia in Heart Failure.

    Science.gov (United States)

    Rahman, Adam; Jafry, Syed; Jeejeebhoy, Khursheed; Nagpal, A Dave; Pisani, Barbara; Agarwala, Ravi

    2016-05-01

    Heart failure is a growing public health concern. Advanced heart failure is frequently associated with severe muscle wasting, termed cardiac cachexia This process is driven by systemic inflammation and tumor necrosis factor in a manner common to other forms of disease-related wasting seen with cancer or human immunodeficiency virus. A variable degree of malnutrition is often superimposed from poor nutrient intake. Cardiac cachexia significantly decreases quality of life and survival in patients with heart failure. This review outlines the evaluation of nutrition status in heart failure, explores the pathophysiology of cardiac cachexia, and discusses therapeutic interventions targeting wasting in these patients. PMID:25634161

  8. After Heart Attack, New Threat: Heart Failure

    Science.gov (United States)

    ... nih.gov/medlineplus/news/fullstory_159007.html After Heart Attack, New Threat: Heart Failure 1 in 4 survivors develops this serious ... TUESDAY, May 24, 2016 (HealthDay News) -- Risk of heart failure appears high within a few years of ...

  9. Heart Failure Society of America

    Science.gov (United States)

    ... Site Terms and Conditions Copyright © 2016 Heart Failure Society of America. All Rights Reserved 2016 Board Review ... Membership Membership Information Membership in the Heart Failure Society is open to all health care professionals with ...

  10. Your Heart Failure Healthcare Team

    Science.gov (United States)

    ... Tools & Resources Stroke More Your Heart Failure Healthcare Team Updated:Mar 25,2016 Patients with heart failure ... good relationships with all the members of this team. Learn to talk to them openly and honestly ...

  11. Acute electromyostimulation decreases muscle sympathetic nerve activity in patients with advanced chronic heart failure (EMSICA Study.

    Directory of Open Access Journals (Sweden)

    Marc Labrunée

    Full Text Available BACKGROUND: Muscle passive contraction of lower limb by neuromuscular electrostimulation (NMES is frequently used in chronic heart failure (CHF patients but no data are available concerning its action on sympathetic activity. However, Transcutaneous Electrical Nerve Stimulation (TENS is able to improve baroreflex in CHF. The primary aim of the present study was to investigate the acute effect of TENS and NMES compared to Sham stimulation on sympathetic overactivity as assessed by Muscle Sympathetic Nerve Activity (MSNA. METHODS: We performed a serie of two parallel, randomized, double blinded and sham controlled protocols in twenty-two CHF patients in New York Heart Association (NYHA Class III. Half of them performed stimulation by TENS, and the others tested NMES. RESULTS: Compare to Sham stimulation, both TENS and NMES are able to reduce MSNA (63.5 ± 3.5 vs 69.7 ± 3.1 bursts / min, p < 0.01 after TENS and 51.6 ± 3.3 vs 56.7 ± 3.3 bursts / min, p < 0, 01 after NMES. No variation of blood pressure, heart rate or respiratory parameters was observed after stimulation. CONCLUSION: The results suggest that sensory stimulation of lower limbs by electrical device, either TENS or NMES, could inhibit sympathetic outflow directed to legs in CHF patients. These properties could benefits CHF patients and pave the way for a new non-pharmacological approach of CHF.

  12. Copeptin in heart failure

    Directory of Open Access Journals (Sweden)

    Lasota B

    2014-07-01

    Full Text Available Bartosz Lasota,1 Katarzyna Mizia-Stec212nd Department of Cardiology, Medical University of Silesia, Katowice, Poland; 21st Department of Cardiology, Medical University of Silesia, Katowice, PolandAbstract: Copeptin is a novel indicator of arginine–vasopressin activation in the body. Its value has primarily been documented in acute life-threatening conditions mediated by the stress response system. Recently, some studies have revealed copeptin's promising role as a marker in cardiovascular diseases. In our review, we summarize the current knowledge on copeptin in pathophysiology, as well as in risk assessment in different clinical settings involving the cardiovascular system with a special focus on heart failure.Keywords: copeptin, heart failure, arginine–vasopressin

  13. Mitophagy and heart failure

    OpenAIRE

    Shires, Sarah E.; Gustafsson, Åsa B.

    2015-01-01

    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 a...

  14. Recent advances in point-of-care testing for natriuretic peptides: potential impact on heart failure diagnosis and management.

    Science.gov (United States)

    Iwaz, James A; Maisel, Alan S

    2016-06-01

    Heart failure is a leading cause of morbidity and mortality worldwide. The presenting symptoms of heart failure are often nonspecific. The diagnosis of heart failure has traditionally relied heavily upon clinical exam findings, which are often subjective and have low sensitivity. Efficient and rapid diagnosis of heart failure in the emergency room setting can reduce health care costs, hospital admission and ER visits, and improve patient care. Natriuretic peptides are objective biomarkers that can help with diagnosis, prognosis and management of heart failure. The most extensively studied and clinically utilized natriuretic peptides include brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP). Point-of-care testing in the emergency room setting can result in faster triage times. Point-of-care testing can also be utilized in the outpatient setting for real-time management of patients with heart failure. PMID:26919295

  15. Reduction of complex ventricular arrhythmias after enalapril treatment in patients with advanced stable heart failure.

    Science.gov (United States)

    Pomini, G; Gribaldo, R; Rugna, A; Lupia, M; Molfese, G; Carenza, P

    1991-01-01

    We studied, by 48-hour Holter monitoring, 33 patients with chronic stable heart failure (radionuclide ejection fraction less than 35%), complex ventricular arrhythmias and no electrolyte abnormalities, after a period during which they were treated with digoxin and diuretics. Before Holter monitoring blood samples were analyzed for serum concentration of sodium, potassium, magnesium, urea, creatinine, digoxin, aldosterone and for plasmatic renin activity in addition to urinary aldosterone and catecholamines determination. After these investigations in 23 patients, 5-20 mg of enalapril were progressively added to the conventional therapy, while 10 patients continued the previous therapy. After 8 weeks 30 patients were subjected to a second 48-hour Holter monitoring and to the same biochemical and hormonal tests. One patient died and 2 were lost to follow up. Only the enalapril group showed a significant decrease in the number of premature ventricular complexes (PVC) (p less than 0.01), and the frequency of couplets and episodes of ventricular tachycardia (VT) declined significantly (P less than 0.01). In the two groups there were no significant changes in digoxin, sodium, or magnesium, while potassium concentration increased in both groups (p less than 0.01). In the enalapril group heart rate and systolic and diastolic pressure declined significantly (p less than 0.01), and New York Heart Association class (NYHA) improved (p less than 0.001). In the other group there were no significant changes in these parameters. Enalapril caused a significant increase in the plasmatic renin activity (p less than 0.01) and a significant fall of plasma and urinary aldosterone (p less than 0.01; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2055378

  16. Human Cardiosphere-Derived Cells From Advanced Heart Failure Patients Exhibit Augmented Functional Potency in Myocardial Repair

    Science.gov (United States)

    Shen, Deliang; Sun, Baiming; Blusztajn, Agnieszka; Xie, Yucai; Ibrahim, Ahmed; Aminzadeh, Mohammad Amin; Liu, Weixin; Li, Tao-Sheng; De Robertis, Michele A.; Marbán, Linda; Czer, Lawrence S. C.; Trento, Alfredo; Marbán, Eduardo

    2014-01-01

    Objectives This study sought to compare the regenerative potency of cells derived from healthy and diseased human hearts. Background Results from pre-clinical studies and the CADUCEUS (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction) trial support the notion that cardiosphere-derived cells (CDCs) from normal and recently infarcted hearts are capable of regenerating healthy heart tissue after myocardial infarction (MI). It is unknown whether CDCs derived from advanced heart failure (HF) patients retain the same regenerative potency. Methods In a mouse model of acute MI, we compared the regenerative potential and functional benefits of CDCs derived from 3 groups: 1) non-failing (NF) donor: healthy donor hearts post-transplantation; 2) MI: patients who had an MI 9 to 35 days before biopsy; and 3) HF: advanced cardiomyopathy tissue explanted at cardiac transplantation. Results Cell growth and phenotype were identical in all 3 groups. Injection of HF CDCs led to the greatest therapeutic benefit in mice, with the highest left ventricular ejection fraction, thickest infarct wall, most viable tissue, and least scar 3 weeks after treatment. In vitro assays revealed that HF CDCs secreted higher levels of stromal cell-derived factor 1 (SDF-1), which may contribute to the cells’ augmented resistance to oxidative stress, enhanced angiogenesis, and improved myocyte survival. Histological analysis indicated that HF CDCs engrafted better, recruited more endogenous stem cells, and induced greater angiogenesis and cardiomyocyte cell-cycle re-entry. CDC-secreted SDF-1 levels correlated with decreases in scar mass over time in CADUCEUS patients treated with autologous CDCs. Conclusions CDCs from advanced HF patients exhibit augmented potency in ameliorating ventricular dysfunction post-MI, possibly through SDF-1–mediated mechanisms. PMID:24511463

  17. Analysis of Skeletal Muscle Torque Capacity and Circulating Ceramides in Patients with Advanced Heart Failure

    Science.gov (United States)

    Brunjes, Danielle L.; Dunlop, Mark; Wu, Christina; Jones, Meaghan; Kato, Tomoko S.; Kennel, Peter J.; Armstrong, Hilary F.; Choo, Tse-Hwei; Bartels, Matthew N.; Forman, Daniel E.; Mancini, Donna M.; Schulze, P. Christian

    2016-01-01

    Background Heart failure (HF)-related exercise intolerance is thought to be perpetuated by peripheral skeletal muscle functional, structural, and metabolic abnormalities. We analyzed specific dynamics of muscle contraction in patients with HF compared with healthy, sedentary controls. Methods Isometric and isokinetic muscle parameters were measured in the dominant upper and lower limbs of 45 HF patients and 15 healthy age-matched controls. Measurements included peak torque normalized to body weight, work normalized to body weight, power, time to peak torque, and acceleration and deceleration to maximum strength times. Body morphometry (dual energy X-ray absorptiometry scan) and circulating fatty acids and ceramides (lipodomics) were analyzed in a subset of subjects (18 HF and 9 controls). Results Extension and flexion time-to-peak torque was longer in the lower limbs of HF patients. Furthermore, acceleration and deceleration times in the lower limbs were also prolonged in HF subjects. HF subjects had increased adiposity and decreased lean muscle mass compared with controls. Decreased circulating unsaturated fatty acids and increased ceramides were found in subjects with HF. Conclusions Delayed torque development suggests skeletal muscle impairments that may reflect abnormal neuromuscular functional coupling. These impairments may be further compounded by increased adiposity and inflammation associated with increased ceramides. PMID:26879888

  18. Ejection Fraction Heart Failure Measurement

    Science.gov (United States)

    ... Tools & Resources Stroke More Ejection Fraction Heart Failure Measurement Updated:May 31,2016 The ejection fraction (EF) is an important measurement in determining how well your heart is pumping ...

  19. Insomnia Self-Management in Heart Failure

    Science.gov (United States)

    2016-05-11

    Cardiac Failure; Heart Failure; Congestive Heart Failure; Heart Failure, Congestive; Sleep Initiation and Maintenance Disorders; Chronic Insomnia; Disorders of Initiating and Maintaining Sleep; Fatigue; Pain; Depressive Symptoms; Sleep Disorders; Anxiety

  20. Nuclear cardiology and heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Giubbini, Raffaele; Bertagna, Francesco [University of Brescia, Department of Nuclear Medicine, Brescia (Italy); Milan, Elisa [Ospedale Di Castelfranco Veneto, Nuclear Medicine Unit, Castelfranco Veneto (Italy); Mut, Fernando; Dondi, Maurizio [International Atomic Energy Agency, Nuclear Medicine Section, Division of Human Health, Vienna (Austria); Metra, Marco [University of Brescia, Department of Cardiology, Brescia (Italy); Rodella, Carlo [Health Physics Department, Spedali Civili di Brescia, Brescia (Italy)

    2009-12-15

    The prevalence of heart failure in the adult population is increasing. It varies between 1% and 2%, although it mainly affects elderly people (6-10% of people over the age of 65 years will develop heart failure). The syndrome of heart failure arises as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction. Coronary artery disease is the leading cause of heart failure and it accounts for this disorder in 60-70% of all patients affected. Nuclear techniques provide unique information on left ventricular function and perfusion by gated-single photon emission tomography (SPECT). Myocardial viability can be assessed by both SPECT and PET imaging. Finally, autonomic dysfunction has been shown to increase the risk of death in patients with heart disease and this may be applicable to all patients with cardiac disease regardless of aetiology. MIBG scanning has a very promising prognostic value in patients with heart failure. (orig.)

  1. Nuclear cardiology and heart failure

    International Nuclear Information System (INIS)

    The prevalence of heart failure in the adult population is increasing. It varies between 1% and 2%, although it mainly affects elderly people (6-10% of people over the age of 65 years will develop heart failure). The syndrome of heart failure arises as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction. Coronary artery disease is the leading cause of heart failure and it accounts for this disorder in 60-70% of all patients affected. Nuclear techniques provide unique information on left ventricular function and perfusion by gated-single photon emission tomography (SPECT). Myocardial viability can be assessed by both SPECT and PET imaging. Finally, autonomic dysfunction has been shown to increase the risk of death in patients with heart disease and this may be applicable to all patients with cardiac disease regardless of aetiology. MIBG scanning has a very promising prognostic value in patients with heart failure. (orig.)

  2. Copeptin in Heart Failure.

    Science.gov (United States)

    Balling, Louise; Gustafsson, Finn

    2016-01-01

    Heart failure (HF) is one of the most common causes of hospitalization and mortality in the modern Western world and an increasing proportion of the population will be affected by HF in the future. Although HF management has improved quality of life and prognosis, mortality remains very high despite therapeutic options. Medical management consists of a neurohormonal blockade of an overly activated neurohormonal axis. No single marker has been able to predict or monitor HF with respect to disease progression, hospitalization, or mortality. New methods for diagnosis, monitoring therapy, and prognosis are warranted. Copeptin, a precursor of pre-provasopressin, is a new biomarker in HF with promising potential. Copeptin has been found to be elevated in both acute and chronic HF and is associated with prognosis. Copeptin, in combination with other biomarkers, could be a useful marker in the monitoring of disease severity and as a predictor of prognosis and survival in HF. PMID:26975969

  3. Chronic Heart Failure: Contemporary Diagnosis and Management

    OpenAIRE

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

    2010-01-01

    Chronic heart failure (CHF) remains the only cardiovascular disease with an increasing hospitalization burden and an ongoing drain on health care expenditures. The prevalence of CHF increases with advancing life span, with diastolic heart failure predominating in the elderly population. Primary prevention of coronary artery disease and risk factor management via aggressive blood pressure control are central in preventing new occurrences of left ventricular dysfunction. Optimal therapy for CHF...

  4. After Heart Attack, New Threat: Heart Failure

    Science.gov (United States)

    ... poorest patients had a 27 percent increased risk. Atrial fibrillation -- a condition characterized by an abnormal heartbeat -- and diabetes also significantly increased the risk of heart failure, by 63 percent and 44 percent, respectively. Other ...

  5. New medications for heart failure.

    Science.gov (United States)

    Gordin, Jonathan S; Fonarow, Gregg C

    2016-08-01

    Heart failure is common and results in substantial morbidity and mortality. Current guideline-based therapies for heart failure with reduced ejection fraction, including beta blockers, angiotensin converting enzyme (ACE) inhibitors, and aldosterone antagonists aim to interrupt deleterious neurohormonal pathways and have shown significant success in reducing morbidity and mortality associated with heart failure. Continued efforts to further improve outcomes in patients with heart failure with reduced ejection fraction have led to the first new-in-class medications approved for heart failure since 2005, ivabradine and sacubitril/valsartan. Ivabradine targets the If channels in the sinoatrial node of the heart, decreasing heart rate. Sacubitril/valsartan combines a neprilysin inhibitor that increases levels of beneficial vasodilatory peptides with an angiotensin receptor antagonist. On a background of previously approved, guideline-directed medical therapies for heart failure, these medications have shown improved clinical outcomes ranging from decreased hospitalizations in a select group of patients to a reduction in all-cause mortality across all pre-specified subgroups. In this review, we will discuss the previously established guideline-directed medical therapies for heart failure with reduced ejection fraction, the translational research that led to the development of these new therapies, and the results from the major clinical trials of ivabradine and sacubitril/valsartan. PMID:27038558

  6. Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

    Directory of Open Access Journals (Sweden)

    Keith M. Swetz

    2012-01-01

    Full Text Available Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS. Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein.

  7. Management of advanced heart failure in the elderly: ethics, economics, and resource allocation in the technological era.

    Science.gov (United States)

    Swetz, Keith M; Stulak, John M; Dunlay, Shannon M; Gafford, Ellin F

    2012-01-01

    Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS). Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT) for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL) and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein. PMID:23259150

  8. Getting Pumped About Heart Failure

    OpenAIRE

    Mann, Douglas L.

    2014-01-01

    Heart failure is a clinical syndrome caused by dysregulated calcium handling and abnormal cardiac pumping capacity. Whalquist et al. (2014) show that upregulation of micro-RNA25 impairs calcium handling leading to pump dysfunction, and that targeting micro-RNA25 using antisense oligonucleotides reverses pump dysfunction and improves survival in mice with heart failure.

  9. Bisoprolol for congestive heart failure

    DEFF Research Database (Denmark)

    Rosenberg, J.; Gustafsson, F.

    2008-01-01

    Background: beta-Blockers are a cornerstone in the treatment of systolic heart failure treatment, but not all beta-blockers are effective or in this setting. Objective: To define the role of bisoprolol, a highly selective beta(1)-antagonist in congestive heart failure due to systolic dysfunction....... Methods: Using the keywords 'bisoprolol' and 'heart failure' PubMed and BIOSIS databases were searched for information regarding pharmacology and relevant randomised clinical trials. Supplementary publications were acquired by scrutinising reference lists of relevant papers. Additional information was...... obtained from the FDA website. Conclusion: Bisoprolol is an effective and well-tolerated first-line beta-blocker for patients with systolic heart failure. The knowledge is primarily based on study patients with moderate-to-severe heart failure from the three CIBIS trials Udgivelsesdato: 2008/2...

  10. Parallel paths to improve heart failure outcomes

    DEFF Research Database (Denmark)

    Albert, Nancy M.

    2013-01-01

    Gaps and disparities in delivery of heart failure education by nurses and performance in accomplishing self-care behaviors by patients with advanced heart failure may be factors in clinical decompensation and unplanned consumption of health care. Is nurse-led education effectively delivered before...... hospital discharge? Nurse leaders must understand the strength of nurses’ knowledge base related to self-care principles and important barriers to best practice. Nurses may not be comfortable teaching patients about dry weight, meal planning, heart failure medications, or progressive steps of activity and...... exercise. Further, clinical nurses may not have time to provide in-depth education to patients before discharge. Equally important, research is needed to learn about factors that enhance patients’ adherence to heart failure self-care behaviors, because adherence to recommendations of national, evidence...

  11. Periodontitis in Chronic Heart Failure.

    Science.gov (United States)

    Fröhlich, Hanna; Herrmann, Kristina; Franke, Jennifer; Karimi, Alamara; Täger, Tobias; Cebola, Rita; Katus, Hugo A; Zugck, Christian; Frankenstein, Lutz

    2016-08-01

    Periodontal disease has been associated with an increased risk of cardiovascular events. The purpose of our study was to investigate whether a correlation between periodontitis and chronic heart failure exists, as well as the nature of the underlying cause. We enrolled 71 patients (mean age, 54 ± 13 yr; 56 men) who had stable chronic heart failure; all underwent complete cardiologic and dental evaluations. The periodontal screening index was used to quantify the degree of periodontal disease. We compared the findings to those in the general population with use of data from the 4th German Dental Health Survey. Gingivitis, moderate periodontitis, and severe periodontitis were present in 17 (24%), 17 (24%), and 37 (52%) patients, respectively. Severe periodontitis was more prevalent among chronic heart failure patients than in the general population. In contrast, moderate periodontitis was more prevalent in the general population (P <0.00001). The severity of periodontal disease was not associated with the cause of chronic heart failure or the severity of heart failure symptoms. Six-minute walking distance was the only independent predictor of severe periodontitis. Periodontal disease is highly prevalent in chronic heart failure patients regardless of the cause of heart failure. Prospective trials are warranted to clarify the causal relationship between both diseases. PMID:27547136

  12. Periodontitis in Chronic Heart Failure

    Science.gov (United States)

    Fröhlich, Hanna; Herrmann, Kristina; Franke, Jennifer; Karimi, Alamara; Täger, Tobias; Cebola, Rita; Katus, Hugo A.; Zugck, Christian

    2016-01-01

    Periodontal disease has been associated with an increased risk of cardiovascular events. The purpose of our study was to investigate whether a correlation between periodontitis and chronic heart failure exists, as well as the nature of the underlying cause. We enrolled 71 patients (mean age, 54 ± 13 yr; 56 men) who had stable chronic heart failure; all underwent complete cardiologic and dental evaluations. The periodontal screening index was used to quantify the degree of periodontal disease. We compared the findings to those in the general population with use of data from the 4th German Dental Health Survey. Gingivitis, moderate periodontitis, and severe periodontitis were present in 17 (24%), 17 (24%), and 37 (52%) patients, respectively. Severe periodontitis was more prevalent among chronic heart failure patients than in the general population. In contrast, moderate periodontitis was more prevalent in the general population (P periodontal disease was not associated with the cause of chronic heart failure or the severity of heart failure symptoms. Six-minute walking distance was the only independent predictor of severe periodontitis. Periodontal disease is highly prevalent in chronic heart failure patients regardless of the cause of heart failure. Prospective trials are warranted to clarify the causal relationship between both diseases. PMID:27547136

  13. Heart failure - overview

    Science.gov (United States)

    ... Left or right ventricular assist device (LVAD) Total artificial heart At a certain point, the provider will ... American Heart Association Task Force on Practice Guidelines. Circulation . 2013;128:e240-e327. PMID: 23741058 www.ncbi. ...

  14. Progenitor Hematopoietic Cells Implantation Improves Functional Capacity of End Stage Coronary Artery Disease Patients with Advanced Heart Failure

    Directory of Open Access Journals (Sweden)

    Yoga Yuniadi

    2016-01-01

    Full Text Available Background. Proangiogenic Hematopoietic Cells (PHC which comprise diverse mixture of cell types are able to secrete proangiogenic factors and interesting candidate for cell therapy. The aim of this study was to seek for benefit in implantation of PHC on functional improvement in end stage coronary artery disease patients with advanced heart failure. Methods. Patients with symptomatic heart failure despite guideline directed medical therapy and LVEF less than 35% were included. Peripheral blood mononuclear cells were isolated, cultivated for 5 days, and then harvested. Flow cytometry and cell surface markers were used to characterize PHC. The PHC were delivered retrogradely via sinus coronarius. Echocardiography, myocardial perfusion, and clinical and functional data were analyzed up to 1-year observation. Results. Of 30 patients (56.4±7.40 yo preimplant NT proBNP level is 5124.5±4682.50 pmol/L. Harvested cells characterized with CD133, CD34, CD45, and KDR showed 0.87±0.41, 0.63±0.66, 99.00±2.60, and 3.22±3.79%, respectively. LVEF was improved (22±5.68 versus 26.8±7.93, p<0.001 during short and long term observation. Myocardial perfusion significantly improved 6 months after treatment. NYHA Class and six-minute walk test are improved during short term and long term follow-up. Conclusion. Expanded peripheral blood PHC implantation using retrograde delivery approach improved LV systolic function, myocardial perfusion, and functional capacity.

  15. Heart failure etiology impacts survival of patients with heart failure

    DEFF Research Database (Denmark)

    Pecini, Redi; Møller, Daniel Vega; Torp-Pedersen, Christian;

    2010-01-01

    BACKGROUND: The impact of heart failure (HF) etiology on prognosis of HF is not well known. METHODS: 3078 patients (median age 75years, 61% male) hospitalized with HF were studied. Patients were classified into six etiology groups: hypertension (HTN, 13.9%), ischemic heart disease (IHD, 42...

  16. [Metabolic therapy for heart failure].

    Science.gov (United States)

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

    2014-01-01

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

  17. Palliative care in patients with heart failure.

    Science.gov (United States)

    McIlvennan, Colleen K; Allen, Larry A

    2016-01-01

    Despite advances in cardiac therapy, heart failure (HF) remains a progressive, highly symptomatic, and deadly disease that places great demands on patients, caregivers, and healthcare systems. Palliative care is a multidisciplinary approach to care that focuses on communication, shared decision making, and advance care planning; provides relief from pain and other distressing symptoms; integrates psychological and spiritual aspects of care; and offers a support system to help families cope during illness and bereavement. Palliative care has applications across the stages of heart failure, including early in the course of illness, often in conjunction with other therapies that are intended to prolong life. However, the incorporation of palliative care into the management of heart failure has been suboptimal for several reasons: uncertainty in the disease trajectory, failure to reward communication between healthcare providers and patients, siloed care, lack of knowledge, overlay of comorbidity and frailty, life saving devices with complex trade-offs, and a limited evidence base. This review will summarize the current literature on the emerging role of palliative care in patients with heart failure and the challenges and opportunities for its integration into routine care. It will discuss current initiatives and future directions of the collaborative relationship between the palliative care and heart failure disciplines. PMID:27079896

  18. [Competence Network Heart Failure (CNHF). Together against heart failure].

    Science.gov (United States)

    Ertl, Georg; Störk, Stefan; Börste, Rita

    2016-04-01

    Heart failure is one of the most urgent medical and socio-economic challenges of the 21(st) century. Up to three million people are affected in Germany; this means one in ten people over the age of 65  live with heart failure. The current demographic changes will accentuate the importance of this grave health problem. The care of patients with heart failure, as well as the associated research mandates a comprehensive, multidisciplinary approach. The Competence Network Heart Failure (CNHF) pursues this objective. CNHF is a research alliance with 11 sites in Germany and was funded by the Federal Ministry of Research (BMBF) from 2003 through 2014. Since January 2015, the network has been an associate cooperating partner of the German Centre for Cardiovascular Research (DZHK). During the 12-year funding period by the BMBF, scientists in the field of heart failure from 30 university hospitals, 5 research institutes, 7 heart centers, 17 cardiovascular clinics, over 200 general practitioners, 4 rehabilitation clinics, as well as numerous organizations and associations were involved in cooperative CNHF research. In the context of 22 projects, the CNHF covered basic, clinical, and health care research, and generated numerous groundbreaking insights into disease mechanisms, as well as diagnosis and treatment of heart failure, which are documented in more than 350 publications. With its central study database and bank of biomaterials, the network has set up a Europe-wide unique research resource, which can be used in the future for national and international cooperations with the DZHK and other partners. Furthermore, the CNHF strongly promotes nation- and Europe-wide public relations and heart failure awareness activities. PMID:26979718

  19. Lifestyle Changes for Heart Failure

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Lifestyle Changes for Heart Failure Updated:May 4,2016 ... so it becomes a regular part of your lifestyle. Managing stress Take 15 to 20 minutes a ...

  20. Managing Feelings about Heart Failure

    Science.gov (United States)

    ... time. Although people with heart failure commonly experience depression or anxiety, that does not mean you have to accept ... them to get better on their own. Recognizing Depression and Anxiety Everyone feels anxious or blue some of the ...

  1. Tachycardia-Induced Heart Failure

    OpenAIRE

    Patel, Jitenbhai J; Whittaker, Charles T

    2007-01-01

    Heart failure associated with tachyarrhythmias can very often be reversed by dealing with the underlying tachyarrhythmia. Typically characterized by left ventricular dilation and subsequent systolic dysfunction, this disorder can be caused by both atrial and ventricular arrhythmias, most commonly chronic atrial fibrillation. Whereas for most cardiomyopathies there is little that can be done to reverse the progression of the disease, in tachycardia-induced heart failure the patient's often deb...

  2. Serum From Advanced Heart Failure Patients Promotes Angiogenic Sprouting and Affects the Notch Pathway in Human Endothelial Cells.

    Science.gov (United States)

    Pannella, Micaela; Caliceti, Cristiana; Fortini, Francesca; Aquila, Giorgio; Vieceli Dalla Sega, Francesco; Pannuti, Antonio; Fortini, Cinzia; Morelli, Marco Bruno; Fucili, Alessandro; Francolini, Gloria; Voltan, Rebecca; Secchiero, Paola; Dinelli, Giovanni; Leoncini, Emanuela; Ferracin, Manuela; Hrelia, Silvana; Miele, Lucio; Rizzo, Paola

    2016-12-01

    It is unknown whether components present in heart failure (HF) patients' serum provide an angiogenic stimulus. We sought to determine whether serum from HF patients affects angiogenesis and its major modulator, the Notch pathway, in human umbilical vein endothelial cells (HUVECs). In cells treated with serum from healthy subjects or from patients at different HF stage we determined: (1) Sprouting angiogenesis, by measuring cells network (closed tubes) in collagen gel. (2) Protein levels of Notch receptors 1, 2, 4, and ligands Jagged1, Delta-like4. We found a higher number of closed tubes in HUVECs treated with advanced HF patients serum in comparison with cells treated with serum from mild HF patients or controls. Furthermore, as indicated by the reduction of the active form of Notch4 (N4IC) and of Jagged1, advanced HF patients serum inhibited Notch signalling in HUVECs in comparison with mild HF patients' serum and controls. The circulating levels of NT-proBNP (N-terminal of the pro-hormone brain natriuretic peptide), a marker for the detection and evalutation of HF, were positively correlated with the number of closed tubes (r = 0.485) and negatively with Notch4IC and Jagged1 levels in sera-treated cells (r = -0.526 and r = -0.604, respectively). In conclusion, we found that sera from advanced HF patients promote sprouting angiogenesis and dysregulate Notch signaling in HUVECs. Our study provides in vitro evidence of an angiogenic stimulus arising during HF progression and suggests a role for the Notch pathway in it. J. Cell. Physiol. 231: 2700-2710, 2016. © 2016 Wiley Periodicals, Inc. PMID:26987674

  3. Modulating fatty acid oxidation in heart failure

    OpenAIRE

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

    2011-01-01

    In the advanced stages of heart failure, many key enzymes involved in myocardial energy substrate metabolism display various degrees of down-regulation. The net effect of the altered metabolic phenotype consists of reduced cardiac fatty oxidation, increased glycolysis and glucose oxidation, and rigidity of the metabolic response to changes in workload. Is this metabolic shift an adaptive mechanism that protects the heart or a maladaptive process that accelerates structural and functional dera...

  4. The pathophysiology of heart failure.

    Science.gov (United States)

    Kemp, Clinton D; Conte, John V

    2012-01-01

    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

  5. Heart failure - discharge

    Science.gov (United States)

    ... health care provider may refer you to cardiac rehabilitation program. There, you will learn how to slowly ... al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2014: ...

  6. Heart failure overview

    Science.gov (United States)

    ... smoke . Stay active. Walk or ride a stationary bicycle. Your provider can provide a safe and effective ... at the same time. A defibrillator sends an electrical pulse to stop life-threatening abnormal heart rhythms. ...

  7. Heart Failure Association of the European Society of Cardiology Specialist Heart Failure Curriculum

    DEFF Research Database (Denmark)

    McDonagh, Theresa A; Gardner, Roy S; Lainscak, Mitja;

    2014-01-01

    . The second year allows completion of the optional modules of advanced imaging, device therapy for implanters, cardiac transplantation, and mechanical circulatory support. The second year can also be devoted to continuation of specialist heart failure training and/or research for those not wishing to......It is well established that organized care of heart failure patients, including specialist management by cardiologists, improves patient outcomes. In response to this, other national training bodies (the UK and the USA) have developed heart failure subspecialty curricula within their Cardiology...... Training Curricula. In addition, European Society of Cardiology (ESC) subspecialty curricula exist for Interventional Cardiology and Heart Rhythm Management. The purpose of this heart failure curriculum is to provide a framework which can be used as a blueprint for training across Europe. This blueprint...

  8. Dynamics and prognostic role of galectin-3 in patients with advanced heart failure, during left ventricular assist device support and following heart transplantation

    OpenAIRE

    Coromilas, Ellie; Que-Xu, Em-Claire; Moore, D’Vesharronne; Kato, Tomoko S.; Wu, Christina; Ji, Ruiping; Givens, Raymond; Jorde, Ulrich P.; Takayama, Hiroo; NAKA, YOSHIFUMI; George, Isaac; Mancini, Donna; Schulze, P. Christian

    2016-01-01

    Background Galectin-3 is a marker of myocardial inflammation and fibrosis shown to correlate with morbidity and mortality in heart failure (HF). We examined the utility of galectin-3 as a marker of the severity of HF, the response of galectin-3 levels to ventricular assist device (LVAD) implantation or heart transplantation (HTx), and its use as a prognostic indicator. Methods Plasma galectin-3 was measured using a commercially available ELISA assay in patients with stable HF (n = 55), severe...

  9. Heart failure: Epidemiology and prevention in India

    OpenAIRE

    Huffman, Mark D; Prabhakaran, Dorairaj

    2010-01-01

    Reliable estimates of heart failure are lacking in India because of the absence of a surveillance programme to track incidence, prevalence, outcomes and key causes of heart failure. Nevertheless, we propose that the incidence and prevalence rates of heart failure are rising due to population, epidemiological and health transitions. Based on disease-specific estimates of prevalence and incidence rates of heart failure, we conservatively estimate the prevalence of heart failure in India due to ...

  10. Heart failure: SGLT2 inhibitors and heart failure -- clinical implications.

    Science.gov (United States)

    Raz, Itamar; Cahn, Avivit

    2016-04-01

    The latest findings from the EMPA-REG OUTCOME trial show a 34% reduction in hospitalization for heart failure or cardiovascular death in patients receiving empagliflozin, a sodium/glucose cotransporter 2 (SGLT2) inhibitor, compared with placebo. These outstanding results call for discussion of the clinical implications, and in-depth studies of the mechanisms of action of SGLT2 inhibitors. PMID:26961066

  11. Translocation and cleavage of myocardial dystrophin as a common pathway to advanced heart failure: A scheme for the progression of cardiac dysfunction

    OpenAIRE

    Toyo-Oka, Teruhiko; Kawada, Tomie; Nakata, Jumi; Xie, Han; Urabe, Masashi; Masui, Fujiko; Ebisawa, Takashi; Tezuka, Asaki; Iwasawa, Kuniaki; Nakajima, Toshiaki; Uehara, Yoshio; Kumagai, Hiroyuki; Kostin, Sawa; Schaper, Jutta; Nakazawa, Mikio

    2004-01-01

    Advanced heart failure (HF) is the leading cause of death in developed countries. The mechanism underlying the progression of cardiac dysfunction needs to be clarified to establish approaches to prevention or treatment. Here, using TO-2 hamsters with hereditary dilated cardiomyopathy, we show age-dependent cleavage and translocation of myocardial dystrophin (Dys) from the sarcolemma (SL) to the myoplasm, increased SL permeability in situ, and a close relationship between the loss of Dys and h...

  12. Advances of metabolic therapy for heart failure%心力衰竭的代谢治疗进展

    Institute of Scientific and Technical Information of China (English)

    黄震华

    2011-01-01

    The hyperadrenergic state of heart failure can cause the increase of plasma free fatty acid,insulin resistance and decrease of glucose oxidation, result in the decrease of energy production, increase of free radical generation and inflammatory markers, and thereby, make heart failure worse.Adrenergic beta receptor antagonists, trimetazidine, ranolazine, perhexiline and metformin were currently paid more attention in the study of metabolic therapy for heart failure.%心力衰竭时交感神经兴奋性增加,使血浆游离脂肪酸浓度增高,引起胰岛素抵抗、葡萄糖氧化减少、游离脂肪酸氧化增加,导致能量产生减少、氧自由基和炎症介质产生增加,均加剧心力衰竭.肾上腺素β受体拮抗药、曲美他嗪、雷诺嗪、哌克昔林、二甲双呱等是目前心力衰竭代谢治疗中研究最多的药物.

  13. Advanced Heart Failure

    Science.gov (United States)

    ... about major side effects of treatment, quality of life, loss of independence, impact of worsening symptoms, and increased commitment by caregivers and families. Considering palliative care , ... a care plan for the end of life that ensures your needs and wishes are met. ...

  14. Heart failure and galectin 3.

    Science.gov (United States)

    Suarez, Gabriela; Meyerrose, Gary

    2014-09-01

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

  15. Predicting survival in heart failure

    DEFF Research Database (Denmark)

    Pocock, Stuart J; Ariti, Cono A; McMurray, John J V;

    2012-01-01

    AimsUsing a large international database from multiple cohort studies, the aim is to create a generalizable easily used risk score for mortality in patients with heart failure (HF).Methods and resultsThe MAGGIC meta-analysis includes individual data on 39 372 patients with HF, both reduced and...

  16. 10.3.Heart failure

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920271 The relationship between plasmacatecholamines and cardiac function in pa-tients with congestive heart failure.ZHAOShuyuan (赵树元),et al.Dept Intern Med,HebeiProv Hosp.Chin Cir J 1991;6(6):484-486.

  17. Heart failure etiology impacts survival of patients with heart failure

    DEFF Research Database (Denmark)

    Pecini, Redi; Møller, Daniel Vega; Torp-Pedersen, Christian;

    2010-01-01

    BACKGROUND: The impact of heart failure (HF) etiology on prognosis of HF is not well known. METHODS: 3078 patients (median age 75years, 61% male) hospitalized with HF were studied. Patients were classified into six etiology groups: hypertension (HTN, 13.9%), ischemic heart disease (IHD, 42.......4%), valvular disease (VHD, 9.5%), dilated cardiomyopathy (DCM, 7.9%), other (11.5%), and unknown etiology (14.8%). Patients with normal left ventricular ejection fraction (LVEF) were also included. Follow-up was up to 5years. RESULTS: In multivariable analysis, with HTN as the reference, VHD showed the highest...

  18. Anemia in chronic heart failure : etiology and treatment options

    NARCIS (Netherlands)

    Westenbrink, B. Daan; de Boer, Rudolf A.; Voors, Adriaan A.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    2008-01-01

    Purpose of review Anemia is common in patients with chronic heart failure, and is related to increased morbidity and mortality. The etiology of anemia in heart failure is complex and still not fully resolved. The review will describe current advances in the understanding of the pathophysiology of an

  19. Regulated Inositol‐Requiring Protein 1‐Dependent Decay as a Mechanism of Corin RNA and Protein Deficiency in Advanced Human Systolic Heart Failure

    Science.gov (United States)

    Lee, Rebecca; Xu, Bin; Rame, J. Eduardo; Felkin, Leanne E.; Barton, Paul; Dries, Daniel L.

    2014-01-01

    Background The compensatory actions of the endogenous natriuretic peptide system require adequate processing of natriuretic peptide pro‐hormones into biologically active, carboxyl‐terminal fragments. Natriuretic peptide pro‐peptide processing is accomplished by corin, a transmembrane serine protease expressed by cardiomyocytes. Brain natriuretic peptide (BNP) processing is inadequate in advanced heart failure and is independently associated with adverse outcomes; however, the molecular mechanisms causing impaired BNP processing are not understood. We hypothesized that the development of endoplasmic reticulum stress in cardiomyocytes in advanced heart failure triggers inositol‐requiring protein 1 (IRE1)‐dependent corin mRNA decay, which would favor a molecular substrate favoring impaired natriuretic peptide pro‐peptide processing. Methods and Results Two independent samples of hearts obtained from patients with advanced heart failure at transplant demonstrated that corin RNA was reduced as Atrial natriuretic peptide (ANP)/BNP RNA increased. Increases in spliced X‐box protein 1, a marker for IRE1‐endoribonuclease activity, were associated with decreased corin RNA. Moreover, ≈50% of the hearts demonstrated significant reductions in corin RNA and protein as compared to the nonfailing control sample. In vitro experiments demonstrated that induction of endoplasmic reticulum stress in cultured cardiomyocytes with thapsigargin activated IRE1's endoribonuclease activity and time‐dependent reductions in corin mRNA. In HL‐1 cells, overexpression of IRE1 activated IRE1 endoribonuclease activity and caused corin mRNA decay, whereas IRE1‐RNA interference with shRNA attenuated corin mRNA decay after induction of endoplasmic reticulum stress with thapsigargin. Pre‐treatment of cells with Actinomycin D to inhibit transcription did not alter the magnitude or time course of thapsigargin‐induced corin mRNA decline, supporting the hypothesis that this was

  20. Heart failure in patients treated with bisphosphonates

    DEFF Research Database (Denmark)

    Grove, Erik; Abrahamsen, B; Vestergaard, P

    2013-01-01

    The aim of this study was to investigate the occurrence of heart failure in patients treated with bisphosphonates.......The aim of this study was to investigate the occurrence of heart failure in patients treated with bisphosphonates....

  1. Message for Heart Failure Patients: Exercise

    Science.gov (United States)

    ... fullstory_159059.html Message for Heart Failure Patients: Exercise You'll feel better and maybe even live ... with heart failure should not be scared of exercise damaging them or killing them," said principal investigator ...

  2. NEW HORIZONS IN THE MANAGEMENT OF HEART FAILURE

    Directory of Open Access Journals (Sweden)

    Puneeta

    2016-04-01

    Full Text Available INTRODUCTION Heart failure (HF is a global problem with an estimated prevalence of 38 million people worldwide; a number that is increasing with the ageing of the population. The heart failure is associated with high health expenditure, mostly because of cost of hospitalisations. The five year survival for individuals with heart failure is about 50%, and in advanced heart failure, the one year survival is as low as 22%, regardless of therapy. The modern history of therapy for heart failure with reduced ejection fraction began with the introduction of vasodilatation with hydralazine plus isosorbide dinitrate. Research about heart failure is now quite active worldwide and many areas are being explored e.g. gene therapy, modification of function of micro RNAs by antagomirs, stem cell therapy besides development of new pharmacological therapeutic agents.

  3. Effects of heart failure management programmes

    NARCIS (Netherlands)

    Bruggink-André de la Porte, P.W.F.

    2009-01-01

    Abstract of the thesis “Effects of heart failure management programmes” The main purpose of the studies presented in this thesis, was to assess whether an intensive 1-year intervention at a heart failure clinic for patients with heart failure, NYHA classification III or IV, reduces the incidence of

  4. Atrial Fibrillation and Heart Failure

    Directory of Open Access Journals (Sweden)

    William G. Stevenson, M.D

    2008-07-01

    Full Text Available Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy. Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking. Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases. Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing. Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.

  5. Adrenal adrenoceptors in heart failure

    Directory of Open Access Journals (Sweden)

    Claudio ede Lucia

    2014-07-01

    Full Text Available Heart failure (HF is a chronic clinical syndrome characterized by the reduction in left ventricular (LV function and it represents one of the most important causes of morbidity and mortality worldwide. Despite considerable advances in pharmacological treatment, HF represents a severe clinical and social burden. Sympathetic outflow, characterized by increased circulating catecholamines (CAs biosynthesis and secretion, is peculiar in HF and sympatholytic treatments (as β-blockers are presently being investigated for the treatment of this disease. Adrenal gland secretes Epinephrine (80% and Norepinephrine (20% in response to acetylcholine stimulation of nicotinic cholinergic receptors on the chromaffin cell membranes. This process is regulated by adrenergic receptors (ARs: α2ARs inhibit CA release through coupling to inhibitory Gi-proteins, and βARs (mainly β2ARs stimulate CA release through coupling to stimulatory Gs-proteins. All ARs are G-protein-coupled receptors (GPCRs and GPCR kinases (GRKs regulate their signaling and function. Adrenal GRK2-mediated α2AR desensitization and downregulation are increased in HF and seem to be a fundamental regulator of CA secretion from the adrenal gland. Consequently, restoration of adrenal a2AR signaling through the inhibition of GRK2 is a fascinating sympatholytic therapeutic strategy for chronic HF. This strategy could have several significant advantages over existing HF pharmacotherapies (antiadrenergic, such as bAR-blockers minimizing side-effects on extra-cardiac tissues and reducing the chronic activation of the renin–angiotensin–aldosterone and endothelin systems.The role of adrenal ARs in regulation of sympathetic hyperactivity opens interesting perspectives in understanding pathophysiology of HF and identifying new potential therapeutic targets.

  6. Atrial Fibrillation and Heart Failure

    OpenAIRE

    Jens Seiler; Tedrow, Usha B.; Stevenson, William G

    2008-01-01

    Atrial fibrillation is common in heart failure patients and is associated with increased mortality.  Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy.  It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect.  Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of a...

  7. Atrial Fibrillation and Heart Failure

    OpenAIRE

    William G. Stevenson, M.D; Usha B. Tedrow, M.D; Jens Seiler, M.D

    2008-01-01

    Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic dru...

  8. Is Heart Rate a Norepiphenomenon in Heart Failure?

    Science.gov (United States)

    Hensey, Mark; O'Neill, James

    2016-09-01

    There has been an increased focus on heart rate as a target in the management of cardiovascular disease and more specifically in heart failure with preserved ejection fraction in recent years with several studies showing the benefit of a lower resting heart rate on outcomes. This review paper examines the pathophysiology behind the benefits of lowering heart rate in heart failure and also the evidence for and against the pharmacological agents available to achieve this. PMID:27457085

  9. Neural modulation for hypertension and heart failure.

    Science.gov (United States)

    Smith, S; Rossignol, P; Willis, S; Zannad, F; Mentz, R; Pocock, S; Bisognano, J; Nadim, Y; Geller, N; Ruble, S; Linde, C

    2016-07-01

    Hypertension (HTN) and heart failure (HF) have a significant global impact on health, and lead to increased morbidity and mortality. Despite recent advances in pharmacologic and device therapy for these conditions, there is a need for additional treatment modalities. Patients with sub-optimally treated HTN have increased risk for stroke, renal failure and heart failure. The outcome of HF patients remains poor despite modern pharmacological therapy and with established device therapies such as CRT and ICDs. Therefore, the potential role of neuromodulation via renal denervation, baro-reflex modulation and vagal stimulation for the treatment of resistant HTN and HF is being explored. In this manuscript, we review current evidence for neuromodulation in relation to established drug and device therapies and how these therapies may be synergistic in achieving therapy goals in patients with treatment resistant HTN and heart failure. We describe lessons learned from recent neuromodulation trials and outline strategies to improve the potential for success in future trials. This review is based on discussions between scientists, clinical trialists, and regulatory representatives at the 11th annual CardioVascular Clinical Trialist Forum in Washington, DC on December 5-7, 2014. PMID:27085120

  10. Emerging Novel Therapies for Heart Failure

    OpenAIRE

    Szema, Anthony M; Sophia Dang; Li, Jonathan C

    2015-01-01

    Heart function fails when the organ is unable to pump blood at a rate proportional to the body’s need for oxygen or when this function leads to elevated cardiac chamber filling pressures (cardiogenic pulmonary edema). Despite our sophisticated knowledge of heart failure, even so-called ejection fraction-preserved heart failure has high rates of mortality and morbidity. So, novel therapies are sorely needed. This review discusses current standard therapies for heart failure and launches an exp...

  11. Glucagonoma-induced acute heart failure

    OpenAIRE

    Zhang, K.; Lehner, L.J.; Praeger, D.; Baumann, G.; Knebel, F.; Quinkler, M.; Roepke, T.K.

    2014-01-01

    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 fai...

  12. A Comparison of three diuretic Regimens in Heart Failure

    DEFF Research Database (Denmark)

    Andreasen, F.; Eriksen, U.H.; Guul, S.-J.; Nielsen, L.P.; Bech, O.M.; Diamant, Bertil; Kahr, O.; Bruun, P.; Hartling, O.J.; Hvidt, S.

    Farmakologi, bendroflumethiazide, diuretics, heart failure, bumethanide, ergometry plasma lactate......Farmakologi, bendroflumethiazide, diuretics, heart failure, bumethanide, ergometry plasma lactate...

  13. Right heart failure: toward a common language.

    Science.gov (United States)

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

    2014-02-01

    In this perspective, the International Right Heart Foundation Working Group moves a step forward to develop a common language to describe the development and defects that exemplify the common syndrome of right heart failure. We first propose fundamental definitions of the distinctive components of the right heart circulation and provide consensus on a universal definition of right heart failure. These definitions will form the foundation for describing a uniform nomenclature for right heart circulatory failure with a view to foster collaborative research initiatives and conjoint education in an effort to provide insight into echanisms of disease unique to the right heart. PMID:24268184

  14. CONGESTIVE HEART FAILURE: EXPERIMENTAL MODEL

    Directory of Open Access Journals (Sweden)

    Antonio Francesco Corno

    2013-10-01

    Full Text Available INTRODUCTION.Surgically induced, combined volume and pressure overload has been used in rabbits to create a simplified and reproducible model of acute left ventricular (LV failure.MATERIALS AND METHODS.New Zealand white male rabbits (n=24, mean weight 3.1±0.2kg were randomly assigned to either the Control group (n=10 or to the Heart Failure group (HF, n=14. Animals in the Control group underwent sham procedures. Animals in the HF group underwent procedures to induce LV volume overload by inducing severe aortic valve regurgitation with aortic cusp disruption and pressure overload using an occlusive silver clip positioned around the pre-renal abdominal aorta.RESULTS.Following Procedure-1 (volume overload echocardiography confirmed severe aortic regurgitation in all animals in the HF group, with increased mean pulse pressure difference from 18±3mmHg to 38±3mmHg (P

  15. Insomnia and chronic heart failure.

    Science.gov (United States)

    Hayes, Don; Anstead, Michael I; Ho, Julia; Phillips, Barbara A

    2009-09-01

    Insomnia is highly prevalent in patients with chronic disease including chronic heart failure (CHF) and is a significant contributing factor to fatigue and poor quality of life. The pathophysiology of CHF often leads to fatigue, due to nocturnal symptoms causing sleep disruption, including cough, orthopnea, paroxysmal nocturnal dyspnea, and nocturia. Inadequate cardiac function may lead to hypoxemia or poor perfusion of the cerebrum, skeletal muscle, or visceral body organs, which result in organ dysfunction or failure and may contribute to fatigue. Sleep disturbances negatively affect all dimensions of quality of life and is related to increased risk of comorbidities, including depression. This article reviews insomnia in CHF, cardiac medication side-effects related to sleep disturbances, and treatment options. PMID:18758945

  16. Co-morbidities in heart failure

    NARCIS (Netherlands)

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

    2014-01-01

    Heart failure is a clinical syndrome characterized by poor quality of life and high morbidity and mortality. Co-morbidities frequently accompany heart failure and further decrease in both quality of life and clinical outcome. We describe that the prevalence of co-morbidities in patients with heart f

  17. Brain natriuretic peptide and optimal management of heart failure

    Institute of Scientific and Technical Information of China (English)

    LI Nan; WANG Jian-an

    2005-01-01

    Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization and death of the fatal disease.Several randomized clinical trials demonstrated that drugs such as beta blocker, angiotensin converting enzyme inhibitor, spironolactone and amiodarone have beneficial effects in decreasing circulating BNP level during the management of chronic heart failure. The optimization of clinical decision-making appeals for a representative surrogate marker for heart failure prognosis. The serial point-of-care assessments of BNP concentration provide a therapeutic goal of clinical multi-therapy and an objective guidance for optimal treatment of heart failure. Nevertheless new questions and problems in this area remain to be clarified. On the basis of current research advances, this article gives an overview of BNP peptide and its property and role in the management of heart failure.

  18. Heart failure and sleep disorders.

    Science.gov (United States)

    Parati, Gianfranco; Lombardi, Carolina; Castagna, Francesco; Mattaliano, Paola; Filardi, Pasquale Perrone; Agostoni, Piergiuseppe

    2016-07-01

    Awareness of the importance of sleep-related disorders in patients with cardiovascular diseases is growing. In particular, sleep-disordered breathing, short sleep time, and low sleep quality are frequently reported by patients with heart failure (HF). Sleep-disordered breathing, which includes obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is common in patients with HF and has been suggested to increase the morbidity and mortality in these patients. Both OSA and CSA are associated with increased sympathetic activation, vagal withdrawal, altered haemodynamic loading conditions, and hypoxaemia. Moreover, OSA is strongly associated with arterial hypertension, the most common risk factor for cardiac hypertrophy and failure. Intrathoracic pressure changes are also associated with OSA, contributing to haemodynamic alterations and potentially affecting overexpression of genes involved in ventricular remodelling. HF treatment can decrease the severity of both OSA and CSA. Indeed, furosemide and spironolactone administration, exercise training, cardiac resynchronization therapy, and eventually heart transplantation have shown a positive effect on OSA and CSA in patients with HF. At present, whether CSA should be treated and, if so, which is the optimal therapy is still debated. By contrast, more evidence is available on the beneficial effects of OSA treatment in patients with HF. PMID:27173772

  19. Atrial Fibrillation and Heart Failure

    Directory of Open Access Journals (Sweden)

    Jens Seiler

    2008-07-01

    Full Text Available Atrial fibrillation is common in heart failure patients and is associated with increased mortality.  Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy.  It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect.  Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy.  Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking.  Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases.  Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing.  Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed. 

  20. Psychosocial risk factors and heart failure hospitalization

    DEFF Research Database (Denmark)

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

    2011-01-01

    Prospective studies on the role of psychosocial factors in heart failure development are virtually nonexistent. The authors aimed to address the effect of psychosocial factors on the risk of heart failure hospitalization in men and women free of cardiovascular disease. In 1991-1993, the 8...... population reported some degree of vital exhaustion. The vital exhaustion score was associated with a higher risk of heart failure in a dose-response manner (P <0.002), with high vital exhaustion being associated with a 2-fold higher risk of heart failure in both men (hazard ratio = 1.93, 95% confidence...... population, even a modestly higher risk of heart failure associated with vital exhaustion may be of importance in the planning of future preventive strategies for heart failure....

  1. Acute Decompensated Heart Failure: Contemporary Medical Management

    OpenAIRE

    Joseph, Susan M.; Cedars, Ari M.; Ewald, Gregory A.; Geltman, Edward M.; Mann, Douglas L.

    2009-01-01

    Hospitalizations for acute decompensated heart failure are increasing in the United States. Moreover, the prevalence of heart failure is increasing consequent to an increased number of older individuals, as well as to improvement in therapies for coronary artery disease and sudden cardiac death that have enabled patients to live longer with cardiovascular disease. The main treatment goals in the hospitalized patient with heart failure are to restore euvolemia and to minimize adverse events. C...

  2. Right heart failure: toward a common language

    OpenAIRE

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

    2013-01-01

    Abstract In this guideline, the International Right Heart Foundation Working Group moves a step forward to develop a common language to describe the development and defects that exemplify the common syndrome of right heart failure. We first propose fundamental definitions of the distinctive components of the right heart circulation and provide consensus on a universal definition of right heart failure. These definitions will form the foundation for describing a uniform nomenclature for right ...

  3. Epigenetics in heart failure phenotypes.

    Science.gov (United States)

    Berezin, Alexander

    2016-12-01

    Chronic heart failure (HF) is a leading clinical and public problem posing a higher risk of morbidity and mortality in different populations. HF appears to be in both phenotypic forms: HF with reduced left ventricular ejection fraction (HFrEF) and HF with preserved left ventricular ejection fraction (HFpEF). Although both HF phenotypes can be distinguished through clinical features, co-morbidity status, prediction score, and treatment, the clinical outcomes in patients with HFrEF and HFpEF are similar. In this context, investigation of various molecular and cellular mechanisms leading to the development and progression of both HF phenotypes is very important. There is emerging evidence that epigenetic regulation may have a clue in the pathogenesis of HF. This review represents current available evidence regarding the implication of epigenetic modifications in the development of different HF phenotypes and perspectives of epigenetic-based therapies of HF. PMID:27335803

  4. Heart Failure Update: Inpatient Management.

    Science.gov (United States)

    Korabathina, Ravi

    2016-03-01

    Acute decompensated heart failure (HF) is one of most common reasons for hospitalization among individuals older than 65 years. A thorough evaluation, including history, physical examination, and laboratory assessment, is required to optimize care of these patients. In uncertain cases, serum brain-type natriuretic peptide (BNP) or N-terminal proBNP level, stress testing, and/or invasive coronary angiography may be helpful in establishing the diagnosis. The hospital setting provides an opportunity to identify etiologies and stabilize the patient. The primary goal of inpatient HF therapy is systemic and pulmonary decongestion, achieved most effectively using intravenous diuretic therapy. Rate and rhythm control may be needed for patients with concurrent atrial fibrillation and, in American College of Cardiology/American Heart Association stage D HF, intravenous inotropes may become necessary. New pharmacologic or device therapies also are considered as a means of transitioning patients, especially those with severe disease, to the outpatient setting. Patients hospitalized for acute decompensated HF have high postdischarge mortality and rehospitalization rates and, thus, should be monitored carefully. PMID:26974002

  5. Mutations of Presenilin Genes in Dilated Cardiomyopathy and Heart Failure

    OpenAIRE

    Li, Duanxiang ; Parks, Sharie B. ; Kushner, Jessica D. ; Nauman, Deirdre ; Burgess, Donna ; Ludwigsen, Susan ; Partain, Julie ; Nixon, Randal R. ; Allen, Charles N. ; Irwin, Robert P. ; Jakobs, Petra M. ; Litt, Michael ; Hershberger, Ray E. 

    2006-01-01

    Two common disorders of the elderly are heart failure and Alzheimer disease (AD). Heart failure usually results from dilated cardiomyopathy (DCM). DCM of unknown cause in families has recently been shown to result from genetic disease, highlighting newly discovered disease mechanisms. AD is the most frequent neurodegenerative disease of older Americans. Familial AD is caused most commonly by presenilin 1 (PSEN1) or presenilin 2 (PSEN2) mutations, a discovery that has greatly advanced the fiel...

  6. NADPH Oxidases in Heart Failure: Poachers or Gamekeepers?

    OpenAIRE

    Zhang, Min; Perino, Alessia; Ghigo, Alessandra; Hirsch, Emilio; Shah, Ajay M.

    2013-01-01

    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 ...

  7. Heart failure - surgeries and devices

    Science.gov (United States)

    ... right ventricular assist devices (RVAD) or a total artificial hearts. They are considered for use if you have ... be on a heart-lung bypass machine. Total artificial hearts are being developed, but are not yet in ...

  8. Congestive heart failure in the elderly.

    Science.gov (United States)

    Rengo, F; Acanfora, D; Trojano, L; Furgi, G; Picone, C; Iannuzzi, G L; Vitale, D F; Rengo, C; Ferrara, N

    1996-01-01

    Several aspects of congestive heart failure are discussed in the light of international literature and of recent findings of our group. The annual incidence of heart failure in elderly subjects, aged >or=75y, is 13 to 50/1000, while it is 1.6/1000 in people aged 45-54 y. The prevalence of heart failure is about 3% in subjects aged 45-64% in subjects aged more than 65 y and 10% in subjects aged more than 75 y. These data are confirmed by our population based study in elderly subjects. The etiology of congestive heart failure is similar in elderly and middle-aged patients. However, several anatomo-functional, hormonal and autonomic nervous system changes, typical of congestive heart failure, occur during physiologic ageing processes also. These findings may explain the dramatic evolution of congestive heart failure in elderly patients. Moreover, some features of the elderly - e.g. comorbidity, atypical clinical presentations, loss of autonomy, increased iatrogen risk should be considered. No specific drugs exist for the pharmacologic treatment of heart failure in the elderly, so that the geriatric specificity in the treatment of heart failure can be recognized in the art of drug choice and dosage, to obtain the best results with the least side effects. The multiple etiology of congestive heart failure, the comorbidity, the loss of autonomy and the deterioration of cognitive functions suggest the need for multidimensional approach and continuative intervention in elderly patients with heart disease, and in particular with congestive heart failure. Further studies on disease- and age-related changes are necessary to develop new and more potent strategies to secure 'successful ageing'. PMID:15374141

  9. Efficacy of carvedilol in pediatric heart failure

    DEFF Research Database (Denmark)

    Christensen, Alex Hørby; Fatkin, Diane

    2013-01-01

    Evaluation of: Huang M, Zhang X, Chen S et al. The effect of carvedilol treatment on chronic heart failure in pediatric patients with dilated cardiomyopathy: a prospective, randomized-controlled study. Pediatr. Cardiol. 34, 680-685 (2013). A role for β-blockers in children with heart failure has...

  10. Modeling Pathologies of Diastolic and Systolic Heart Failure

    OpenAIRE

    Genet, M.; Lee, L. C.; Baillargeon, B; Guccione, J.M.; Kuhl, E.

    2015-01-01

    Chronic heart failure is a medical condition that involves structural and functional changes of the heart and a progressive reduction in cardiac output. Heart failure is classified into two categories: diastolic heart failure, a thickening of the ventricular wall associated with impaired filling; and systolic heart failure, a dilation of the ventricles associated with reduced pump function. In theory, the pathophysiology of heart failure is well understood. In practice, however, heart failure...

  11. Heart Failure: Unique to Older Adults

    Science.gov (United States)

    ... provider may suggest other ways to help your body reduce the extra fluid. Depression and Heart Failure If you have chronic heart ... more often, tell your healthcare professional right away. Depression in ... and other chemicals in your body that can be damaging to your heart and ...

  12. Heart Failure: Gaps in Knowledge and Failures in Treatment

    OpenAIRE

    Callender, Thomas; Woodward, Mark; Roth, Gregory; Farzadfar, Farshad; Lemarie, Jean-Christophe; Gicquel, Stéphanie; Atherton, John; Rahimzadeh, Shadi; Ghaziani, Mehdi; Shaikh, Maaz; Bennett, Derrick; Patel, Anushka; Lam, Carolyn S.P.; Sliwa, Karen; Barretto, Antonio

    2014-01-01

    Editors' Summary Background A healthy heart pumps about 23,000 liters of blood around the body every day. This blood delivers oxygen and nutrients to the rest of the body and carries carbon dioxide and waste products away from the tissues and organs. A healthy heart is therefore essential for life. Unfortunately, many people (particularly elderly people) develop heart failure, a life-threatening condition in which the heart no longer pumps enough blood to meet all the body's needs because it ...

  13. Heart Failure in the Middle East

    OpenAIRE

    Al-Shamiri, Mostafa Q

    2013-01-01

    The clinical syndrome of heart failure is the final pathway for a myriad of diseases that affect the heart, and is a leading and growing cause of morbidity and mortality worldwide. Evidence-based guidelines have provided clinicians with valuable data for better applying diagnostic and therapeutic tools, particularly the overwhelming new imaging technology and other, often expensive, therapies and devices, in heart failure patients. In the Middle East, progress has recently been made with the ...

  14. The systemic inflammatory response in heart failure.

    Science.gov (United States)

    Anderson

    2000-09-01

    The physiologic diagnosis of heart failure has changed very little over the past several decades: heart failure is the inability of the cardiac output to meet the metabolic demands of the organism. The clinical definition of heart failure (also relatively unchanged) describes it as ventricular dysfunction that is accompanied by reduced exercise tolerance. Our understanding of the true pathophysiologic processes involved in heart failure have, however, changed. We have moved from thinking of heart failure as primarily a circulatory phenomenon to seeing it as a pathophysiologic state under the control of multiple complex systems. Over the past several years the dramatic explosion of research in the fields of immunology and immunopathology have added an additional piece to the puzzle that defines heart failure and have lead to an understanding of heart failure, at least in some part, as an 'inflammatory disease'. In this review we will examine several of the key inflammatory mediators as they relate to heart failure while at the same time attempting to define the source(s) of these mediators. We will examine key elements of the inflammatory cascade as they relate to heart failure such as: cytokines, 'proximal mediators' (e.g. NF-kappaB), and distal mediators (e.g. nitric oxide). We will end with a discussion of the potential therapeutic role of anti-inflammatory strategies in the future treatment of heart failure. Also, throughout the review we will examine the potential pitfalls encountered in applying bench discoveries to the bedside as have been learned in the field of septic shock research. PMID:10978715

  15. Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction

    Science.gov (United States)

    Farr, Maryjane; Mitchell, James; Lippel, Matthew; Kato, Tomoko S.; Jin, Zhezhen; Ippolito, Paul; Dove, Lorna; Jorde, Ulrich P.; Takayama, Hiroo; Emond, Jean; Naka, Yoshifumi; Mancini, Donna; Lefkowitch, Jay H.; Schulze, P. Christian

    2016-01-01

    BACKGROUND Functional and structural liver abnormalities may be found in patients with advanced heart failure (HF). The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score allows functional risk stratification of HF patients on and off anti-coagulation awaiting heart transplantation (HTx), but these scores may improve or worsen depending on bridging therapies and during time on the waiting list. Liver biopsy is sometimes performed to assess for severity of fibrosis. Uncertainty remains whether biopsy in addition to MELD-XI improves prediction of adverse outcomes in patients evaluated for HTx. METHODS Sixty-eight patients suspected of advanced liver disease underwent liver biopsy as part of their HTx evaluation. A liver risk score (fibrosis-on-biopsy + 1) × MELD-XI was generated for each patient. RESULTS Fifty-two patients were listed, of whom 14 had mechanical circulatory support (MCS). Thirty-six patients underwent transplantation and 27 patients survived ≥1 year post-HTx (74%, as compared with 88% average 1-year survival in HTx patients without suspected liver disease; p ventilation times (55.6% vs 11.1%, p = 0.013) and severe bleeding events (44.4% vs 11.1%, p = 0.049). The liver risk score at evaluation for HTx also predicted 1-year mortality after HTx listing (p < 0.001). CONCLUSIONS Patients with HF and advanced liver dysfunction are high-risk HTx candidates. Liver biopsy in addition to MELD-XI improves risk stratification of patients with advanced HF and suspected irreversible liver dysfunction. PMID:25851466

  16. Cellular Therapy for Heart Failure.

    Science.gov (United States)

    Psaltis, Peter J; Schwarz, Nisha; Toledo-Flores, Deborah; Nicholls, Stephen J

    2016-01-01

    The pathogenesis of cardiomyopathy and heart failure (HF) is underpinned by complex changes at subcellular, cellular and extracellular levels in the ventricular myocardium. For all of the gains that conventional treatments for HF have brought to mortality and morbidity, they do not adequately address the loss of cardiomyocyte numbers in the remodeling ventricle. Originally conceived to address this problem, cellular transplantation for HF has already gone through several stages of evolution over the past two decades. Various cell types and delivery routes have been implemented to positive effect in preclinical models of ischemic and nonischemic cardiomyopathy, with pleiotropic benefits observed in terms of myocardial remodeling, systolic and diastolic performance, perfusion, fibrosis, inflammation, metabolism and electrophysiology. To a large extent, these salubrious effects are now attributed to the indirect, paracrine capacity of transplanted stem cells to facilitate endogenous cardiac repair processes. Promising results have also followed in early phase human studies, although these have been relatively modest and somewhat inconsistent. This review details the preclinical and clinical evidence currently available regarding the use of pluripotent stem cells and adult-derived progenitor cells for cardiomyopathy and HF. It outlines the important lessons that have been learned to this point in time, and balances the promise of this exciting field against the key challenges and questions that still need to be addressed at all levels of research, to ensure that cell therapy realizes its full potential by adding to the armamentarium of HF management. PMID:27280304

  17. CPAP in chronic heart failure

    Directory of Open Access Journals (Sweden)

    F. Lari

    2013-05-01

    Full Text Available BACKGROUND Chronic Heart Failure (CHF represents worldwide a clinical condition with increasing prevalence, high social, economical and epidemiological impact. Even if new pharmacological and non-pharmacological approachs have been recently used, mortality remains high in general population and quality of life is poor in these patients. DISCUSSION The association between CHF and sleep disorders is frequent but still undervalued: sleep apnoeas in CHF produce negative effects on cardiovascular system and an aggravation of prognosis. CPAP (Continuous Positive Airway Pressure is commonly used to treat sleep apnoeas in patients without cardiac involvement and it is also used in first line treatment of acute cardiogenic pulmonary oedema thanks to its hemodynamic and ventilatory effects. The addition of nightly CPAP to standard aggressive medical therapy in patients with CHF and sleep apnoeas reduces the number of apnoeas, reduces the blood pressure, and the respiratory and cardiac rate, reduces the activation of sympathetic nervous system, the left ventricular volume and the hospitalization rate; besides CPAP increases the left ventricular ejection fraction, amd the oxygenation, it improves quality of life, tolerance to exercise and seems to reduce mortality in patients with a higher apnoeas suppression. CONCLUSIONS These implications suggest to investigate sleep apnoeas in patients with CHF in order to consider a possible treatment with CPAP. Further studies need to be developed to confirm the use of CPAP in patients with CHF without sleep disorders.

  18. Heart failure - surgeries and devices

    Science.gov (United States)

    ... is weakened, gets too large, and does not pump blood very well, you are at high risk for ... pacemaker. Ventricular assist devices (VAD) help your heart pump blood from the pumping chambers of your heart to ...

  19. How Is Heart Failure Treated?

    Science.gov (United States)

    ... your heart doesn’t work as hard to pump blood. Studies have shown that this medicine can reduce ... a left ventricular assist device . This device helps pump blood from the heart to the rest of the ...

  20. How Is Heart Failure Diagnosed?

    Science.gov (United States)

    ... and echo, often are done during stress testing. Cardiac MRI Cardiac MRI (magnetic resonance imaging) uses radio waves, magnets, and ... of your heart and major blood vessels. A cardiac MRI can show whether parts of your heart are ...

  1. Data and Statistics: Heart Failure

    Science.gov (United States)

    ... Program Funded States History of PCNASP PCNASP Metrics/Data Elements PCNASP Logic Model 2015 PCNASP FOA DP15- ... Insurance Million Hearts® Clinical Quality Measures (CQM) Dashboard Data Trends & Maps Printed Atlases Heart Disease Hospitalizations Among ...

  2. Warning Signs of Heart Failure

    Science.gov (United States)

    ... heart palpitations, which feel like your heart is racing or throbbing. To "make up for" the loss ... Blood Pressure Tracker Find additional helpful resources here Popular Articles 1 Understanding Blood Pressure Readings 2 Target ...

  3. Heart Failure: Diagnosis, Management and Utilization

    Directory of Open Access Journals (Sweden)

    Arati A. Inamdar

    2016-06-01

    Full Text Available Despite the advancement in medicine, management of heart failure (HF, which usually presents as a disease syndrome, has been a challenge to healthcare providers. This is reflected by the relatively higher rate of readmissions along with increased mortality and morbidity associated with HF. In this review article, we first provide a general overview of types of HF pathogenesis and diagnostic features of HF including the crucial role of exercise in determining the severity of heart failure, the efficacy of therapeutic strategies and the morbidity/mortality of HF. We then discuss the quality control measures to prevent the growing readmission rates for HF. We also attempt to elucidate published and ongoing clinical trials for HF in an effort to evaluate the standard and novel therapeutic approaches, including stem cell and gene therapies, to reduce the morbidity and mortality. Finally, we discuss the appropriate utilization/documentation and medical coding based on the severity of the HF alone and with minor and major co-morbidities. We consider that this review provides an extensive overview of the HF in terms of disease pathophysiology, management and documentation for the general readers, as well as for the clinicians/physicians/hospitalists.

  4. Interventional heart failure: a new field.

    Science.gov (United States)

    Shah, Sanjiv J

    2016-05-17

    With the rapid expansion of interventional therapies for structural heart disease, it is no surprise that the field of interventional heart failure (HF) is now an established reality. Why is there a need for interventional treatment of HF? Despite critical advances in the treatment of some forms of HF, there are still major unmet needs in the HF field (e.g., HF with preserved ejection fraction and right ventricular failure), and HF-related morbidity and mortality remain high. Furthermore, there are several advantages to device-based therapies for HF: they may help reduce polypharmacy and the need for patient compliance with pharmacotherapies, both of which continue to plague the treatment of HF. For these reasons and others, there has been a plethora of development within the interventional HF field, with therapies ranging from interatrial shunt devices to left ventricular partition devices. Here we discuss the current unmet need for interventional HF therapies, lessons learned from prior successes and challenges in the development of device-based HF therapeutics, novel interventional therapies on the horizon for HF patients, and future challenges that will be critical for all those in the field to consider when developing interventional therapies for HF. PMID:27174120

  5. Ivabradine, heart failure and chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Luca Di Lullo

    2015-12-01

    Full Text Available The incidence and prevalence of congestive heart failure are actually increasing worldwide, especially in Western countries. In Europe and the United States, congestive heart failure represents a disabling clinical disease, accountable for increased hospitalization and health care costs. European guidelines have underlined the importance of pharmacological treatment to improve both patients’ outcomes and quality of life. The latest clinical trials to evaluate ivabradine’s efficacy have underlined its usefulness as a stand-alone medication and in combination with conventional congestive heart failure therapy, including in chronic kidney disease patients.

  6. Heart failure and orthostatic hypotension.

    Science.gov (United States)

    Gorelik, Oleg; Feldman, Leonid; Cohen, Natan

    2016-09-01

    Orthostatic hypotension (OH) is traditionally defined as a fall of ≥20 mmHg in systolic and/or ≥10 mmHg in diastolic blood pressure within 3 min of active standing. OH is a common comorbidity among patients with heart failure (HF). A comprehensive review regarding the relationship between OH and HF has not been published in the English literature. Here we provide current information about concomitant HF and OH, including: pathophysiology, methods of evaluation, prevalence, risk factors, prognosis and management of OH in HF patients, as well as the incidence of HF among patients with OH. The prevalence of OH in HF ranges from 8 % among community-living individuals to 83 % in elderly hospitalized patients. Dizziness and palpitations are the most frequent OH symptoms. Main predisposing factors for OH are HF severity, non-ischemic HF etiology, prolonged bed rest, hypertension and polypharmacy. OH in HF is generally managed according to recommendations for treatment of OH in the non-HF population. However, since acceptable pharmacotherapy with fludrocortisone and midodrine is problematic in HF due to adverse effects, the management of OH is based mainly on non-pharmacologic interventions. Several prospective epidemiological studies reported that OH is independently associated with an increased risk of developing HF. Since OH is a common and frequently symptomatic condition in HF patients, its clinical implications should be emphasized. Longitudinal studies should be conducted to investigate the prognostic significance and optimal management of OH in the HF population. PMID:26880254

  7. Cardiopulmonary Exercise Testing in Heart Failure.

    Science.gov (United States)

    Malhotra, Rajeev; Bakken, Kristian; D'Elia, Emilia; Lewis, Gregory D

    2016-08-01

    Exercise intolerance, indicated by dyspnea and fatigue during exertion, is a cardinal manifestation of heart failure (HF). Cardiopulmonary exercise testing (CPET) precisely defines maximum exercise capacity through measurement of peak oxygen uptake (VO2). Peak VO2 values have a critical role in informing patient selection for advanced HF interventions such as heart transplantation and ventricular assist devices. Oxygen uptake and ventilatory patterns obtained during the submaximal portion of CPET are also valuable to recognize because of their ease of ascertainment during low-level exercise, relevance to ability to perform activities of daily living, independence from volitional effort, and strong relationship to prognosis in HF. The ability of peak VO2 and other CPET variables to be measured reproducibly and to accurately reflect HF severity is increasingly recognized and endorsed by scientific statements. Integration of CPET with invasive hemodynamic monitoring and cardiac imaging during exercise provides comprehensive characterization of multisystem reserve capacity that can inform prognosis and the need for cardiac interventions. Here, we review both practical aspects of conducting CPETs in patients with HF for clinical and research purposes as well as interpretation of gas exchange patterns across the spectrum of preclinical HF to advanced HF. PMID:27289406

  8. Remote patient monitoring in chronic heart failure.

    Science.gov (United States)

    Palaniswamy, Chandrasekar; Mishkin, Aaron; Aronow, Wilbert S; Kalra, Ankur; Frishman, William H

    2013-01-01

    Heart failure (HF) poses a significant economic burden on our health-care resources with very high readmission rates. Remote monitoring has a substantial potential to improve the management and outcome of patients with HF. Readmission for decompensated HF is often preceded by a stage of subclinical hemodynamic decompensation, where therapeutic interventions would prevent subsequent clinical decompensation and hospitalization. Various methods of remote patient monitoring include structured telephone support, advanced telemonitoring technologies, remote monitoring of patients with implanted cardiac devices such as pacemakers and defibrillators, and implantable hemodynamic monitors. Current data examining the efficacy of remote monitoring technologies in improving outcomes have shown inconsistent results. Various medicolegal and financial issues need to be addressed before widespread implementation of this exciting technology can take place. PMID:23018667

  9. Message for Heart Failure Patients: Exercise

    Science.gov (United States)

    ... they can't prove a direct cause-and-effect relationship between exercise and survival, the researchers said benefits were seen in both men and women and regardless of heart failure severity or age. ...

  10. Heart Failure Questions to Ask Your Doctor

    Science.gov (United States)

    ... Stroke More Heart Failure Questions to Ask Your Doctor Updated:Mar 25,2016 These are concerns that ... draw up a list of questions for your physician or healthcare team. Download Partnering in Your HF ...

  11. Patient Experiences of Structured Heart Failure Programmes

    Directory of Open Access Journals (Sweden)

    Nuala E. Tully

    2010-01-01

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

  12. Systolic heart failure: a prothrombotic state

    DEFF Research Database (Denmark)

    de Peuter, Olav R; Kok, Wouter E M; Torp-Pedersen, Christian; Büller, Harry R; Kamphuisen, Pieter W

    2009-01-01

    Systolic heart failure is a common syndrome whose incidence is expected to increase. Several treatment modalities, such as beta-blockers and angiotensin-converting enzyme inhibitors, improve survival. Whether antithrombotic treatment is effective remains to be elucidated, although observations...... suggest a prothrombotic state in heart failure. This article focuses on this prothrombotic state and discusses the risk of thromboembolic events, pathophysiological mechanisms, and the potential role of anticoagulant treatment....

  13. Genetic causes of human heart failure

    OpenAIRE

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

    2005-01-01

    Factors that render patients with cardiovascular disease at high risk for heart failure remain incompletely defined. Recent insights into molecular genetic causes of myocardial diseases have highlighted the importance of single-gene defects in the pathogenesis of heart failure. Through analyses of the mechanisms by which a mutation selectively perturbs one component of cardiac physiology and triggers cell and molecular responses, studies of human gene mutations provide a window into the compl...

  14. Atrial Fibrillation in Congestive Heart Failure

    OpenAIRE

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

    2010-01-01

    Atrial fibrillation and congestive heart failure are morbid conditions that share common risk factors and frequently coexist. Each condition predisposes to the other, and the concomitant presence of the two identifies individuals at increased risk for mortality. Recent data have emerged which help elucidate the complex genetic and non-genetic pathophysiological mechanisms that contribute to the development of atrial fibrillation in individuals with congestive heart failure. Clinical trial res...

  15. Heart failure - fluids and diuretics

    Science.gov (United States)

    ... Remember, some foods, such as soups, puddings, gelatin, ice cream, popsicles and others contain fluids. When you eat ... and Metabolism; American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research. State of the ...

  16. Optimization of cardiac metabolism in heart failure.

    Science.gov (United States)

    Nagoshi, Tomohisa; Yoshimura, Michihiro; Rosano, Giuseppe M C; Lopaschuk, Gary D; Mochizuki, Seibu

    2011-12-01

    The derangement of the cardiac energy substrate metabolism plays a key role in the pathogenesis of heart failure. The utilization of non-carbohydrate substrates, such as fatty acids, is the predominant metabolic pathway in the normal heart, because this provides the highest energy yield per molecule of substrate metabolized. In contrast, glucose becomes an important preferential substrate for metabolism and ATP generation under specific pathological conditions, because it can provide greater efficiency in producing high energy products per oxygen consumed compared to fatty acids. Manipulations that shift energy substrate utilization away from fatty acids toward glucose can improve the cardiac function and slow the progression of heart failure. However, insulin resistance, which is highly prevalent in the heart failure population, impedes this adaptive metabolic shift. Therefore, the acceleration of the glucose metabolism, along with the restoration of insulin sensitivity, would be the ideal metabolic therapy for heart failure. This review discusses the therapeutic potential of modifying substrate utilization to optimize cardiac metabolism in heart failure. PMID:21933140

  17. Heart Failure After Heart Attack Tied to Cancer Risk in Study

    Science.gov (United States)

    ... gov/news/fullstory_159804.html Heart Failure After Heart Attack Tied to Cancer Risk in Study Preliminary finding ... News) -- People who develop heart failure after a heart attack may also face a higher risk of cancer, ...

  18. Anticoagulation in heart failure : current status and future direction

    NARCIS (Netherlands)

    Gheorghiade, Mihai; Vaduganathan, Muthiah; Fonarow, Gregg C.; Greene, Stephen J.; Greenberg, Barry H.; Liu, Peter P.; Massie, Barry M.; Mehra, Mandeep R.; Metra, Marco; Zannad, Faiez; Cleland, John G. F.; van Veldhuisen, Dirk J.; Shah, Ami N.; Butler, Javed

    2013-01-01

    Despite therapeutic advances, patients with worsening heart failure (HF) requiring hospitalization have unacceptably high post-discharge mortality and re-admission rates soon after discharge. Evidence suggests a hypercoagulable state is present in patients with HF. Although thromboembolism as a dire

  19. Comparison of whole blood and peripheral blood mononuclear cell gene expression for evaluation of the perioperative inflammatory response in patients with advanced heart failure.

    Directory of Open Access Journals (Sweden)

    Galyna Bondar

    Full Text Available BACKGROUND: Heart failure (HF prevalence is increasing in the United States. Mechanical Circulatory Support (MCS therapy is an option for Advanced HF (AdHF patients. Perioperatively, multiorgan dysfunction (MOD is linked to the effects of device implantation, augmented by preexisting HF. Early recognition of MOD allows for better diagnosis, treatment, and risk prediction. Gene expression profiling (GEP was used to evaluate clinical phenotypes of peripheral blood mononuclear cells (PBMC transcriptomes obtained from patients' blood samples. Whole blood (WB samples are clinically more feasible, but their performance in comparison to PBMC samples has not been determined. METHODS: We collected blood samples from 31 HF patients (57±15 years old undergoing cardiothoracic surgery and 7 healthy age-matched controls, between 2010 and 2011, at a single institution. WB and PBMC samples were collected at a single timepoint postoperatively (median day 8 postoperatively (25-75% IQR 7-14 days and subjected to Illumina single color Human BeadChip HT12 v4 whole genome expression array analysis. The Sequential Organ Failure Assessment (SOFA score was used to characterize the severity of MOD into low (≤ 4 points, intermediate (5-11, and high (≥ 12 risk categories correlating with GEP. RESULTS: Results indicate that the direction of change in GEP of individuals with MOD as compared to controls is similar when determined from PBMC versus WB. The main enriched terms by Gene Ontology (GO analysis included those involved in the inflammatory response, apoptosis, and other stress response related pathways. The data revealed 35 significant GO categories and 26 pathways overlapping between PBMC and WB. Additionally, class prediction using machine learning tools demonstrated that the subset of significant genes shared by PBMC and WB are sufficient to train as a predictor separating the SOFA groups. CONCLUSION: GEP analysis of WB has the potential to become a clinical

  20. Heart rate reduction in coronary artery disease and heart failure.

    Science.gov (United States)

    Ferrari, Roberto; Fox, Kim

    2016-08-01

    Elevated heart rate is known to induce myocardial ischaemia in patients with coronary artery disease (CAD), and heart rate reduction is a recognized strategy to prevent ischaemic episodes. In addition, clinical evidence shows that slowing the heart rate reduces the symptoms of angina by improving microcirculation and coronary flow. Elevated heart rate is an established risk factor for cardiovascular events in patients with CAD and in those with chronic heart failure (HF). Accordingly, reducing heart rate improves prognosis in patients with HF, as demonstrated in SHIFT. By contrast, data from SIGNIFY indicate that heart rate is not a modifiable risk factor in patients with CAD who do not also have HF. Heart rate is also an important determinant of cardiac arrhythmias; low heart rate can be associated with atrial fibrillation, and high heart rate after exercise can be associated with sudden cardiac death. In this Review, we critically assess these clinical findings, and propose hypotheses for the variable effect of heart rate reduction in cardiovascular disease. PMID:27226153

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

    OpenAIRE

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

    2004-01-01

    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.

  2. End-of-life matters in chronic heart failure patients

    OpenAIRE

    Sobanski, Piotr; Jaarsma, Tiny; Krajnik, Malgorzata

    2014-01-01

    Purpose of review Until recently, concepts of care for people with heart failure had rarely included preparation for unavoidable imminent death or caring for the dying. The purpose of this review is to provide an update on current end-of-life issues specific to heart failure patients. Recent findings Mortality in the heart failure population remains high, especially shortly after the first acute heart failure hospitalization. Patients with systolic heart failure die more frequently from progr...

  3. A case of peripartum heart failure

    Directory of Open Access Journals (Sweden)

    Annalisa Vinci

    2008-03-01

    Full Text Available A 32-year-old woman was admitted in congestive heart failure (CHF 3 days after delivery. She had no history of cardiovascular disease and impaired left ventricular Ejection Fraction (EF 35%. She underwent complete heart catheterisation, selective coronary angiography and right ventricular endomyocardial biopsy (EMB.Coronary arteries were normal and EMB revealed active virus negative myocarditis. Serum was positive for anti-heart autoantibodies (AHA. Thus myocarditis was classified as autoimmune and the patient was treated with immunosuppressive therapy, with clinical and hemodynamic improvement. At 27 months follow-up EMB showed healed myocarditis. Peripartum cardiomyopathy (PPCM is a rare disorder in which left ventricular dysfunction and heart failure occur in the peripartum period in previously healthy women. The etiology is still unknown but a sizable proportion of patients may have an underlying organ-specific autoimmune myocarditis.

  4. Pathways to embryonic heart failure

    Czech Academy of Sciences Publication Activity Database

    Sedmera, David

    2009-01-01

    Roč. 297, č. 5 (2009), H1578-H1579. ISSN 0363-6135 R&D Projects: GA ČR GA304/08/0615 Institutional research plan: CEZ:AV0Z50110509 Keywords : embryo * ultrasound * cardiac failure Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 3.712, year: 2009

  5. Mitochondria in cardiac hypertrophy and heart failure

    OpenAIRE

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

    2012-01-01

    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 bioenerget...

  6. Metaiodobenzylguanidine and heart rate variability in heart failure

    International Nuclear Information System (INIS)

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

  7. Congestive Heart Failure and Central Sleep Apnea.

    Science.gov (United States)

    Sands, Scott A; Owens, Robert L

    2016-03-01

    Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation. PMID:26972039

  8. Intercellular communication lessons in heart failure.

    Science.gov (United States)

    Bang, Claudia; Antoniades, Charalambos; Antonopoulos, Alexios S; Eriksson, Ulf; Franssen, Constantijn; Hamdani, Nazha; Lehmann, Lorenz; Moessinger, Christine; Mongillo, Marco; Muhl, Lars; Speer, Thimoteus; Thum, Thomas

    2015-11-01

    Cell-cell or inter-organ communication allows the exchange of information and messages, which is essential for the coordination of cell/organ functions and the maintenance of homeostasis. It has become evident that dynamic interactions of different cell types play a major role in the heart, in particular during the progression of heart failure, a leading cause of mortality worldwide. Heart failure is associated with compensatory structural and functional changes mostly in cardiomyocytes and cardiac fibroblasts, which finally lead to cardiomyocyte hypertrophy and fibrosis. Intercellular communication within the heart is mediated mostly via direct cell-cell interaction or the release of paracrine signalling mediators such as cytokines and chemokines. However, recent studies have focused on the exchange of genetic information via the packaging into vesicles as well as the crosstalk of lipids and other paracrine molecules within the heart and distant organs, such as kidney and adipose tissue, which might all contribute to the pathogenesis of heart failure. In this review, we discuss emerging communication networks and respective underlying mechanisms which could be involved in cardiovascular disease conditions and further emphasize promising therapeutic targets for drug development. PMID:26398116

  9. Xamoterol in severe congestive heart failure

    DEFF Research Database (Denmark)

    Tangø, M; Lyngborg, K; Mehlsen, J;

    1992-01-01

    Twelve patients in severe congestive heart failure were given placebo, 100 mg xamoterol (Corwin) twice daily and 200 mg xamoterol twice daily, respectively, in 3 two-week periods in a double-blind randomised study. At the end of each treatment period the patients were evaluated. No differences were...... found between placebo and xamoterol in the following parameters: New York Heart Association function group index, heart volume, body weight, exercise duration on bicycle and treadmill, heart rate and systolic and diastolic blood pressure at rest. However, during exercise we found significantly lower...... heart rate and rate-pressure product during xamoterol treatment. This reduction is probably indicating occupation of beta-adrenoreceptors with concomitant reduced oxygen consumption during exercise....

  10. Research advancement in atrial fibrillation associated with heart failure%心房颤动合并心力衰竭研究进展

    Institute of Scientific and Technical Information of China (English)

    汪莉; 汪海娅

    2009-01-01

    @@ 心房颤动(atrial fibrillation,Af)和心力衰竭(heart failure,Hf)目前已经成为心血管领域日渐突出的两大问题.Af是异常心电活动所致的一种最常见的持续性心律失常疾病,约占心律失常住院患者的三分之一.

  11. Erythropoietin in heart failure : pathology and protection

    NARCIS (Netherlands)

    Westenbrink, Berend Daan

    2008-01-01

    Anemia is common in chronic heart failure (CHF) patients and related to impaired survival. The etiology of anemia in CHF-patients is often unknown. We hypothesized that dysregulation of erythropoietin (EPO) synthesis by the kidney or an altered sensitivity of the bone marrow to EPO might represent c

  12. Update in cardiomyopathies and congestive heart failure

    Directory of Open Access Journals (Sweden)

    The Heart Hospital, London, UK and Monaldi Hospital, Naples, Italy

    2012-05-01

    Full Text Available This abstract book contains four reports and all abstracts presented to the Joint Meeting: Update in cardiomyopathies and congestive heart failure, 22-23 September 2011 - Naples, Italy, endorsed by the Working Group on Myocardial and Pericardial Diseases (WG 21 of the European Society of Cardiology (ESC.

  13. Copeptin as a biomarker in heart failure

    DEFF Research Database (Denmark)

    Balling, Louise; Gustafsson, Finn

    2014-01-01

    Increased neurohormonal activation is a key feature of heart failure (HF). Copeptin is a surrogate marker for proarginine vasopressin and the prognostic value of copeptin has been reported for multiple disease states of both nonvascular and cardiovascular etiology. Elevated plasma copeptin in HF...

  14. Body mass index in chronic heart failure

    DEFF Research Database (Denmark)

    Christensen, Heidi M; Schou, Morten; Goetze, Jens P; Faber, Jens; Frystyk, Jan; Flyvbjerg, Allan; Kistorp, Caroline

    2013-01-01

    Low body mass index (BMI) is associated with a poor outcome in chronic heart failure (CHF). An inverse association between BMI and adiponectin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been reported. The aim of the present study was to investigate whether novel markers of...

  15. Cell therapy in congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Congestive heart failure (CHF) has emerged as a major worldwide epidemic and its main causes seem to be the aging of the population and the survival of patients with post-myocardial infarction. Cardiomyocyte dropout (necrosis and apoptosis) plays a critical role in the progress of CHF; thus treatment of CHF by exogenous cell implantation will be a promising medical approach. In the acute phase of cardiac damage cardiac stem cells (CSCs) within the heart divide symmetrically and/or asymmetrically in response to the change of heart homeostasis, and at the same time homing of bone marrow stem cells (BMCs) to injured area is thought to occur, which not only reconstitutes CSC population to normal levels but also repairs the heart by differentiation into cardiac tissue. So far, basic studies by using potential sources such as BMCs and CSCs to treat animal CHF have shown improved ventricular remodelling and heart function. Recently, however, a few of randomized, double-blind, placebo-controlled clinical trials demonstrated mixed results in heart failure with BMC therapy during acute myocardial infarction.

  16. Self-care in heart failure patients

    Directory of Open Access Journals (Sweden)

    Ana Paula da Conceição

    2015-08-01

    Full Text Available AbstractObjective: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients.Method: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care. Association tests were applied, considering a descriptive level of 0.05.Results: the mean age of participants was 57.7 (SD =11.3 years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0 years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3, selfcare management: 50.0 (SD = 20.3 and self-care confidence: 52.6 (SD=22.7 and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%, self-care management (14.7% and self-care confidence (19%. Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001, longer time of experience with the disease (p=0.05 and joint monitoring by physician and nurse (p=0.007.Conclusion: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement.

  17. The renin–angiotensin–aldosterone-system and right heart failure in congenital heart disease

    OpenAIRE

    Stine Andersen; Asger Andersen; Jens Erik Nielsen-Kudsk

    2016-01-01

    Adults with congenital heart disease represent a rapidly growing patient group. Dysfunction of the right ventricle is often present, and right heart failure constitutes the main cause of death. Heart failure therapies used in acquired left heart failure are often initiated in adults with right heart failure due to congenital heart disease, but the right ventricle differs substantially from the left ventricle, and the clinical evidence for this treatment strategy is lacking. In this review,...

  18. Antidepressant No Help to Heart Failure Patients: Study

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_159604.html Antidepressant No Help to Heart Failure Patients: Study Depression ... 2016 TUESDAY, June 28, 2016 (HealthDay News) -- The antidepressant Lexapro may not help heart failure patients suffering ...

  19. Stem Cell Therapy Shows Promise Against Heart Failure

    Science.gov (United States)

    ... nlm.nih.gov/medlineplus/news/fullstory_158122.html Stem Cell Therapy Shows Promise Against Heart Failure A second ... 4, 2016 MONDAY, April 4, 2016 (HealthDay News) -- Stem cell therapy shows promise for people battling heart failure, ...

  20. Gene Therapy Shows Early Promise Against Heart Failure

    Science.gov (United States)

    ... nlm.nih.gov/medlineplus/news/fullstory_158046.html Gene Therapy Shows Early Promise Against Heart Failure Inserting ... who suffer from heart failure: A trial using gene therapy appears to have boosted patients' cardiac function. " ...

  1. Stratification of the Risk of Sudden Death in Nonischemic Heart Failure

    Directory of Open Access Journals (Sweden)

    Maurício Pimentel

    2014-10-01

    Full Text Available 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.

  2. Key role of congestion in natural history of heart failure

    OpenAIRE

    Guglin M

    2011-01-01

    Maya GuglinUniversity of South Florida, Tampa, FL, USAAbstract: The natural course of heart failure with decreased and preserved systolic function is almost identical. The current concept of heart failure where decreased cardiac output plays the major role does not explain this similarity. We suggest a revised concept of heart failure where congestion plays the leading role. While congestion is almost invariably present in heart failure with normal and with reduced systolic function, the low ...

  3. Treatment of anemia with darbepoetin alfa in systolic heart failure

    DEFF Research Database (Denmark)

    Swedberg, Karl; Young, James B; Anand, Inder S;

    2013-01-01

    Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia.......Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia....

  4. Heart failure and atrial fibrillation: current concepts and controversies

    OpenAIRE

    Berg, van den, T.J.T.P.; Tuinenburg, A. E.; Crijns, H. J. G. M.; Gelder, De; Gosselink, A. T.; Lie, K. I.

    1997-01-01

    Heart failure and atrial fibrillation are very common, particularly in the elderly. Owing to common risk factors both disorders are often present in the same patient. In addition, there is increasing evidence of a complex, reciprocal relation between heart failure and atrial fibrillation. Thus heart failure may cause atrial fibrillation, with electromechanical feedback and neurohumoral activation playing an important mediating role. In addition, atrial fibrillation may promote heart failure; ...

  5. Risk following hospitalization in stable chronic systolic heart failure

    DEFF Research Database (Denmark)

    Abrahamsson, Putte; Swedberg, Karl; Borer, Jeffrey S; Böhm, Michael; Kober, Lars; Komajda, Michel; Lloyd, Suzanne M; Metra, Marco; Tavazzi, Luigi; Ford, Ian

    2013-01-01

    We explored the impact of being hospitalized due to worsening heart failure (WHF) or a myocardial infarction (MI) on subsequent mortality in a large contemporary data set of patients with stable chronic systolic heart failure (HF).......We explored the impact of being hospitalized due to worsening heart failure (WHF) or a myocardial infarction (MI) on subsequent mortality in a large contemporary data set of patients with stable chronic systolic heart failure (HF)....

  6. Sexual dysfunction in heart failure patients.

    Science.gov (United States)

    Jaarsma, Tiny; Fridlund, Bengt; Mårtensson, Jan

    2014-09-01

    Heart failure has a severe impact on different aspects of a patient's life, including sexual function. Sexual problems are common in heart failure (HF) patients, both in men and women, and are not always adequately addressed and treated in the current health care system. Several factors have been described to be related to sexual problems, such as activity intolerance, psychological factors, physiological factors, cardiac medications, recreational habits and co-morbidity. The current review summarizes knowledge that can help clinicians treat sexual dysfunction in HF patients. After a good assessment, several steps are advised, including improving HF and co-morbid conditions, discussing psychosocial problems, worries and misunderstandings, managing risk factors and considering PDE-5 inhibitors or other libido enhancing agents. PMID:24800993

  7. Heart failure due to severe myocardial calcification

    International Nuclear Information System (INIS)

    A 28-year-old female who had had irradiation on the chest wall at the age of 5 as a remedy for keloid granulation after burn, recently developed congestive heart failure. Severe tricuspid regurgitation was demonstrated by echocardiography with a certain calcification in the cardiac shadow on chest radiogram. Calcified right ventricle and ventricular septum were noticed operatively, which disturbed ventricular motion and also caused tricuspid valve deformity. These calcified myocardium apparently corresponded with the irradiation field. After tricuspid valve replacement, she regained physical activity satisfactorily without congestive heart failure. Because she had no other known causes of cardiac calcification such as hypercalcemia, myocarditis, myocardial infarction or renal diseases, irradiation on the chest wall could be responsible for the severe myocardial calcification. (author)

  8. MicroRNA and Heart Failure

    OpenAIRE

    Lee Lee Wong; Juan Wang; Oi Wah Liew; Arthur Mark Richards; Yei-Tsung Chen

    2016-01-01

    Heart failure (HF) imposes significant economic and public health burdens upon modern society. It is known that disturbances in neurohormonal status play an important role in the pathogenesis of HF. Therapeutics that antagonize selected neurohormonal pathways, specifically the renin-angiotensin-aldosterone and sympathetic nervous systems, have significantly improved patient outcomes in HF. Nevertheless, mortality remains high with about 50% of HF patients dying within five years of diagnosis ...

  9. Cardiac Rehabilitation in Patients with Heart Failure

    OpenAIRE

    Fu, Tieh-Cheng; Huang, Shu-Chun; Hsu, Chih-Chin; Wang, Chao-Hung; Wang, Jong-Shyan

    2014-01-01

    Reduced exercise capacity negatively affects the ability of patients with heart failure (HF) to perform activities required for daily life, further decreasing their independence and quality of life (QoL). Cardiac rehabilitation (CR) can effectively improve aerobic fitness and overall health status in patients with HF. Low referral rate is an important limitation that may impede successful CR, whereas the automatic referral and liaison strategies performed by some healthcare providers manifest...

  10. Prospective memory and chronic heart failure

    OpenAIRE

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

    2013-01-01

    Background Patients with chronic heart failure (CHF) experience a number of debilitating symptoms, which impact on activities of daily living and result in poor quality of life. Prospective memory, which is defined as memory to carry out future intentions, has not been investigated in this group. However, emerging evidence suggests CHF patients have difficulties with cognitive processes related to prospective memory. Self-care, which partly relies on prospective memory, is essential in sympto...

  11. Cell death signalling mechanisms in heart failure

    OpenAIRE

    Mughal, Wajihah; Kirshenbaum, Lorrie A.

    2011-01-01

    In 2003, cardiovascular disease was the most costly disease in Canada, and it is still on the rise. The loss of properly functioning cardiomyocytes leads to cardiac impairment, which is a consequence of heart failure. Therefore, understanding the pathways of cell death (necrosis and apoptosis) has potential implications for the development of therapeutic strategies. In addition, the role of B-cell lymphoma-2 family members is discussed and the importance of mitochondria in directing cell deat...

  12. Targeting Iron Deficiency Anemia in Heart Failure.

    Science.gov (United States)

    Saraon, Tajinderpal; Katz, Stuart D

    2016-01-01

    Iron deficiency is common in heart failure (HF) patients, and is associated with increased risk of adverse clinical outcomes. Clinical trials of intravenous iron supplementation in iron-deficient HF patients have demonstrated short-term improvement in functional capacity and quality of life. In some trials, the benefits of iron supplementation were independent of the hemoglobin levels. Additional investigations of iron supplementation are needed to characterize the mechanisms contributing to clinical benefit and long-term safety in HF. PMID:26657161

  13. CARDIORENAL INTERACTION IN DECOMPENSATED CHRONIC HEART FAILURE

    OpenAIRE

    Zh. D. Kobalava; S. V. Villevalde; M. A. Efremovtseva

    2016-01-01

    Aim. To investigate the prevalence of cardiorenal interactions, predictors of development, variants of clinical course, and outcomes of acute kidney injury (AKI) in patients with acute decompensation of chronic heart failure (ADCHF).Material and methods. Patients (n=278) with clinical manifestations of ADCHF were included into the study. All patients underwent clinical, laboratory and instrumental investigation. Renal function was assessed using the CKD-EPI formula to calculate glomerular fil...

  14. An intriguing association between congestive heart failure and An intriguing association between congestive heart failure and diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2010-01-01

    @@ The prevalence of type 2 diabetes is rising at an alarming rate in China due to aging of the population,increased frequency of obesity, and suboptimal nutritional habits.~1 Although many diabetic Patients now survive severe coronary lesions or myocardial infarction as a result of dramatic advances in the management of ischemic heart disease in general and acute myocardial infarction specifically,~(2,3) they are subsequently succumbing to the consequences of myocardial damage, with an increased incidence of congestive heart failure (CHF).~4

  15. Myocardial disease,anemia and heart failure

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

    Abstract Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, very poor quality of life, end stage renal failure, or die of cardiovascular complications within a short time. One factor that has generally been ignored in many of these patients is the fact that they are often anemic.The anemia is due mainly to renal failure but also to the inhibitory effects of cytokines on the bone marrow. Anemia itself may further worsen the cardiac function and make the patients resistant to standard CHF therapies. Indeed anemia has been associated with increased severity of CHF, increased hospitalization, worse cardiac function and functional class, higher doses of diuretics,worsening of renal function and reduced quality of life. In both controlled and uncontrolled studies the correction of the anemia with erythropoietin (EPO) and oral or Ⅳ iron is associated with improvement in all these parameters. EPO itself may also play a direct role in improving the heart unrelated to the improvement of the anemia. Anemia may also play a role in the worsening of coronary heart disease even without CHF.

  16. Are there long-term benefits in following stable heart failure patients in a heart failure clinic?

    DEFF Research Database (Denmark)

    Leetmaa, Tina; Villadsen, Henrik; Mikkelsen, Kirsten; Davidsen, Flemming; Haghfelt, Torben; Videbæk, Lars

    Objectives and Design. This study describes the long-term outcome of 163 patients with stable mild to moderate heart failure (NYHA II-III), who already were enrolled in a heart failure clinic and now were randomized to continued follow-up in the heart failure (HF) clinic or else to usual care (UC...

  17. Home monitoring of chronic heart failure

    Directory of Open Access Journals (Sweden)

    Bockeria O. L.

    2012-06-01

    Full Text Available Being a common syndrome chronic heart failure (CHF results in high mortality among cardiosurgical patients and requires very high expenditures for the treatment. All over the world the number of patients with CHF syndrome is about 22 millions. Heart failure is difficult to treat because of high level of hospitalization due to decompensation. Care aimed at constant home observation of patients could have been more efficient and not only symptomatic and as a response to complications induced. There are methods controlling CHF patients at home. These methods vary from increase of self-care and telephone support to telemonitoring and remote monitoring of implantable devices. Self-care includes such components as maintenance of drug intake, keeping to a diet, physical exercises and active control over edemas. Telephone calls are also a source of monitoring and treatment of heart failure at home. Meta-analysis of programs for structured phone support showed that telephone support could reduce the level of readmission of HF patients approximately by 25%. Telemonitoring implies transmission of such physiological data as blood pressure, body weight, electrocardiographic signals or oxygen saturation using phone lines, broadband and satellite or wireless networks. Having cardiac pacemakers, implantable cardioverter defibrillators and cardiac resynchronization therapy devices that are placed in HF patients, it is possible to use their opportunities for the further evaluation of the patient. Some regularly controlled parameters can show the clinical state of the patient and predict the following heart failure. For example, atrial fibrillation, decrease of cardiac rhythm variability and decrease of the level of the patient`s activity (according to integrated accelerometer can predict clinical decompensation. Also, implantable hemodynamic monitors for immediate pressure measuring in the left atrium, sensor system of pressure measuring in the right atrium are

  18. Right ventricular failure in congenital heart disease

    Directory of Open Access Journals (Sweden)

    Young Kuk Cho

    2013-03-01

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

  19. Mechano-signaling in heart failure.

    Science.gov (United States)

    Buyandelger, Byambajav; Mansfield, Catherine; Knöll, Ralph

    2014-06-01

    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

  20. Heart failure as an endpoint in heart failure and non-heart failure cardiovascular clinical trials: the need for a consensus definition

    DEFF Research Database (Denmark)

    Zannad, F.; Stough, W.G.; Pitt, B.;

    2008-01-01

    Specific criteria have been established to define the occurrence of myocardial infarction (MI) and stroke in cardiovascular clinical trials, but there is not a consistent definition for heart failure. Heart failure events appear to occur at a rate that is similar to stroke and MI in trials...... of hypertension, hyperlipidaemia, diabetes, and coronary heart disease, yet a consistent approach to defining heart failure events has not yet been realized. The wide range of definitions used in clinical trials makes it difficult to interpret new data in the context of existing literature. This inconsistency has...... led to challenges in determining the incidence of heart failure in cardiovascular studies and the effects of interventions on these endpoints. This paper examines issues related to defining heart failure events in cardiovascular clinical trials and presents a definition to formally address this issue...

  1. Validation of the Seattle Heart Failure Model (SHFM) in Heart Failure Population

    International Nuclear Information System (INIS)

    Objective: To determine the effectiveness of Seattle Heart Failure Model (SHFM) in a Pakistani systolic heart failure cohort in predicting mortality in this population. Study Design: Cohort study. Place and Duration of Study: The Armed Forces Institute of Cardiology - National Institute of Heart Diseases, Rawalpindi, from March 2011 to March 2012. Methodology: One hundred and eighteen patients with heart failure (HF) from the registry were followed for one year. Their 1-year mortality was calculated using the SHFM software on their enrollment into the registry. After 1-year predicted 1-year mortality was compared with the actual 1-year mortality of these patients. Results: The mean age was 41.6 +- 14.9 years (16 - 78 years). There were 73.7% males and 26.3% females. One hundred and fifteen patients were in NYHA class III or IV. Mean ejection fraction in these patients was 23 +- 9.3%. Mean brain natriuretic peptide levels were 1230 A+- 1214 pg/mL. Sensitivity of the model was 89.3% with 71.1% specificity, 49% positive predictive value and 95.5% negative predictive value. The accuracy of the model was 75.4%. In Roc analysis, AUC for the SHFM was 0.802 (p<0.001). conclusion: SHFM was found to be reliable in predicting one year mortality among patients with heart failure in the pakistan patients. (author)

  2. Adults living with heart failure and fatigue

    DEFF Research Database (Denmark)

    Schjødt, Inge; Sommer, Irene; Bjerrum, Merete

    studies have been performed to develop more coherent and effective interventions to support self-care among heart failure patients experiencing fatigue. The findings of qualitative research should be synthesised to optimise nurses' understanding of fatigue and develop recommendations for practice. Aim To...... describe their experiences of fatigue? • How do patients with HF perceive the impact of fatigue in everyday life? • How do patients with HF manage fatigue and its consequences in everyday life? Methods A systematic literature search for published and unpublished studies 1995-2012 was carried out from...... October 2012 - ????. Search terms were “heart failure”, “fatigue” and “experience”. Studies were included if they explored the experiences and management of fatigue in everyday life among adult patients with HF, included non-hospitalised adult patients with confirmed HF or outpatients in a HF clinic. The...

  3. Diagnosis and management of acute heart failure.

    Science.gov (United States)

    Ural, Dilek; Çavuşoğlu, Yüksel; Eren, Mehmet; Karaüzüm, Kurtuluş; Temizhan, Ahmet; Yılmaz, Mehmet Birhan; Zoghi, Mehdi; Ramassubu, Kumudha; Bozkurt, Biykem

    2015-11-01

    Acute heart failure (AHF) is a life threatening clinical syndrome with a progressively increasing incidence in general population. Turkey is a country with a high cardiovascular mortality and recent national statistics show that the population structure has turned to an 'aged' population.As a consequence, AHF has become one of the main reasons of admission to cardiology clinics. This consensus report summarizes clinical and prognostic classification of AHF, its worldwide and national epidemiology, diagnostic work-up, principles of approach in emergency department,intensive care unit and ward, treatment in different clinical scenarios and approach in special conditions and how to plan hospital discharge. PMID:26574757

  4. Targeting microRNAs in heart failure.

    Science.gov (United States)

    Duygu, Burcu; de Windt, Leon J; da Costa Martins, Paula A

    2016-02-01

    MicroRNAs play pivotal roles in cardiac disease, and their therapeutic modulation raises exciting and unique opportunities, as well as challenges in the path toward clinical development and implementation. In this review, we provide a detailed overview of recent studies highlighting the important role of microRNAs in heart failure (HF) and the potential use of microRNA-based technology for diagnosis, prevention, and treatment of HF. We will focus on the strategies presently used for microRNA-based therapy by discussing their use and drawbacks, as well as the challenges and future directions for their development in the context of human HF. PMID:26119078

  5. Mechanisms of Cardiotoxicity and the Development of Heart Failure.

    Science.gov (United States)

    Lee, Christopher S

    2015-12-01

    Cardiotoxicity is a broad term that refers to the negative effects of toxic substances on the heart. Cancer drugs can cause cardiotoxicity by effects on heart cells, thromboembolic events, and/or hypertension that can lead to heart failure. Rheumatoid arthritis biologics may interfere with ischemic preconditioning and cause/worsen heart failure. Long-term and heavy alcohol use can result in oxidative stress, apoptosis, and decreased contractile protein function. Cocaine use results in sympathetic nervous system stimulation of heart and smooth muscle cells and leads to cardiotoxicity and evolution of heart failure. The definition of cardiotoxicity is likely to evolve along with knowledge about detecting subclinical myocardial injury. PMID:26567492

  6. Targeting Inflammation in Heart Failure with Histone Deacetylase Inhibitors

    OpenAIRE

    McKinsey, Timothy A.

    2011-01-01

    Cardiovascular insults such as myocardial infarction and chronic hypertension can trigger the heart to undergo a remodeling process characterized by myocyte hypertrophy, myocyte death and fibrosis, often resulting in impaired cardiac function and heart failure. Pathological cardiac remodeling is associated with inflammation, and therapeutic approaches targeting inflammatory cascades have shown promise in patients with heart failure. Small molecule histone deacetylase (HDAC) inhibitors block a...

  7. Stem Cell Therapy for Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Gunduz E

    2011-01-01

    Full Text Available IntroductionHeart failure is a major cardiovascular health problem. Coronary artery disease is the leading cause of congestive heart failure (CHF [1]. Cardiac transplantation remains the most effective long-term treatment option, however is limited primarily by donor availability, rejection and infections. Mechanical circulatory support has its own indications and limitations [2]. Therefore, there is a need to develop more effective therapeutic strategies.Recently, regenerative medicine has received considerable scientific attention in the cardiovascular arena. We report here our experience demonstrating the beneficial effects of cardiac stem cell therapy on left ventricular functions in a patient with Hodgkin’s lymphoma (HL who developed CHF due to ischemic heart disease during the course of lymphoma treatment. Case reportA 58-year-old male with relapsed HL was referred to our bone marrow transplantation unit in October 2009. He was given 8 courses of combination chemotherapy with doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD between June 2008 and February 2009 and achieved complete remission. However, his disease relapsed 3 months after completing the last cycle of ABVD and he was decided to be treated with DHAP (cisplatin, cytarabine, dexamethasone followed autologous stem cell transplantation (SCT. After the completion of first course of DHAP regimen, he developed acute myocardial infarction (AMI and coronary artery bypass grafting (CABG was performed. After his cardiac function stabilized, 3 additional courses of DHAP were given and he was referred to our centre for consideration of autologous SCT. Computed tomography scans obtained after chemotherapy confirmed complete remission. Stem cells were collected from peripheral blood after mobilization with 10 µg/kg/day granulocyte colony-stimulating factor (G-CSF subcutaneously. Collection was started on the fifth day of G-CSF and performed for 3 consecutive days. Flow cytometric

  8. European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

    NARCIS (Netherlands)

    McDonagh, Theresa A.; Blue, Lynda; Clark, Andrew L.; Dahlstroem, Ulf; Ekman, Inger; Lainscak, Mitja; McDonald, Kenneth; Ryder, Mary; Stroemberg, Anna; Jaarsma, Tiny

    2011-01-01

    The management of heart failure (HF) is complex. As a consequence, most cardiology society guidelines now state that HF care should be delivered in a multiprofessional manner. The evidence base for this approach now means that the establishment of HF management programmes is a priority. This documen

  9. Congestive heart failure in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Poskurica Mileta

    2014-01-01

    Full Text Available Cardiovascular disorders are the most frequent cause of death (46-60% among patients with advanced chronic renal failure (CRF, and on dialysis treatment. Uremic cardiomyopathy is the basic pathophysiologic substrate, whereas ischemic heart disease (IHD and anemia are the most important contributing factors. Associated with well-know risk factors and specific disorders for terminal kidney failure and dialysis, the aforementioned factors instigate congestive heart failure (CHF. Suspected CHF is based on the anamnesis, clinical examination and ECG, while it is confirmed and defined more precisely on the basis of echocardiography and radiology examination. Biohumoral data (BNP, NT-proBNP are not sufficiently reliable because of specific volemic fluctuation and reduced natural clearance. Therapy approach is similar to the one for the general population: ACEI, ARBs, β-blockers, inotropic drugs and diuretics. Hypervolemia and most of the related symptoms can be kept under control effectively by the isolated or ultrafiltation, in conjunction with dialysis, during the standard bicarbonate hemodialysis or hemodiafiltration. In the same respect peritoneal dialysis is efficient for the control of hypervolemia symptoms, mainly during the first years of its application and in case of the lower NYHA class (II°/III°. In general, heart support therapy, surgical interventions of the myocardium and valve replacement are rarely used in patients on dialysis, whereas revascularization procedures are beneficial for associated IHD. In selected cases the application of cardiac resynchronization and/or implantation of a cardioverter defibrillator are advisable.

  10. Chronic heart failure in Japan: Implications of the CHART studies

    Directory of Open Access Journals (Sweden)

    Nobuyuki Shiba

    2008-03-01

    Full Text Available Nobuyuki Shiba, Hiroaki ShimokawaDepartment of Cardiovascular Medicine, Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai City, JapanAbstract: The prognosis of patients with chronic heart failure (CHF still remains poor, despite the recent advances in medical and surgical treatment. Furthermore, CHF is a major public health problem in most industrialized countries where the elderly population is rapidly increasing. Although the prevalence and mortality of CHF used to be relatively low in Japan, the disorder has been markedly increasing due to the rapid aging of the society and the Westernization of lifestyle that facilitates the development of coronary artery disease. The Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART-1 study was one of the largest cohorts in Japan. The study has clarified the characteristics and prognosis of Japanese patients with CHF, demonstrating that their prognosis was similarly poor compared with those in Western countries. However, we still need evidence for the prevention and treatment of CHF based on the large cohort studies or randomized treatment trials in the Japanese population. Since the strategy for CHF management is now changing from treatment to prevention, a larger-size prospective cohort, called the CHART-2 study, has been initiated to evaluate the risk factors of CHF in Japan. This review summarizes the current status of CHF studies in Japan and discusses their future perspectives.Keywords: heart failure, aging, Japanese

  11. [Congestive heart failure in patients with chronic kidney disease].

    Science.gov (United States)

    Poskurica, Mileta; Petrović, Dejan

    2014-01-01

    Cardiovascular disorders are the most frequent cause of death (46-60%) among patients with advanced chronic renal failure (CRF), and on dialysis treatment. Uremic cardiomyopathy is the basic pathophysiologic substrate, whereas ischemic heart disease (IHD) and anemia are the most important contributing factors. Associated with well-know risk factors and specific disorders for terminal kidney failure and dialysis, the aforementioned factors instigate congestive heart failure (CHF). Suspected CHF is based on the anamnesis, clinical examination and ECG, while it is confirmed and defined more precisely on the basis of echocardiography and radiology examination. Biohumoral data (BNP, NT-proBNP) are not sufficiently reliable because of specific volemic fluctuation and reduced natural clearance. Therapy approach is similar to the one for the general population: ACEI, ARBs, β-blockers, inotropic drugs and diuretics. Hypervolemia and most of the related symptoms can be kept under control effectively by the isolated or ultrafiltation, in conjunction with dialysis, during the standard bicarbonate hemodialysis or hemodiafiltration. In the same respect peritoneal dialysis is efficient for the control of hypervolemia symptoms, mainly during the first years of its application and in case of the lower NYHA class (II°/III°). In general, heart support therapy, surgical interventions of the myocardium and valve replacement are rarely used in patients on dialysis, whereas revascularization procedures are beneficial for associated IHD. In selected cases the application of cardiac resynchronization and/or implantation of a cardioverter defibrillator are advisable. PMID:25731010

  12. Epidemiology of central sleep apnoea in heart failure.

    Science.gov (United States)

    Naughton, Matthew T

    2016-03-01

    Central sleep apnoea occurs in about a third of patients with reduced systolic heart failure and is a marker of increased mortality. Such patients usually are older males with advanced heart failure (i.e., high pulmonary wedge pressure), often in atrial fibrillation, with evidence of hyperventilation (i.e., low PaCO2) in the absence of hypoxemia. Characteristically, ventilation waxes and wanes in a sinusoidal pattern, with mild hypoxemia, occurring in the lighter levels of sleep usually when supine. Snoring may also occur in central sleep apnoea, often at the peak of hyperventilation, sometimes contributing to the confusion or overlap with obstructive sleep apnoea. Central sleep apnoea is associated with orthopnoea, paroxysmal nocturnal dyspnoea and an oscillatory respiratory pattern with an incremental cardiopulmonary exercise study. Importantly, heart failure therapies (e.g., afterload reduction, diuresis, pacemakers, transplantation) attenuate central sleep apnoea. Night to night variability in severity of central sleep apnoea may occur with changes in patients' posture during sleep (less severe when sleeping on-side or upright). PMID:26948168

  13. [The best in 2000 on heart failure].

    Science.gov (United States)

    Juillière, Y

    2001-01-01

    The advances in cardiac failure are permanent. In 2000, once again, they concerned all fields of pathology. Complementary information of the epidemiology of the disease in France and Europe has been published. The prevention of sudden death by the implantable defibrillator in hypertrophic cardiomyopathy has been confirmed. The prognostic role of the aetiology of dilated cardiomyopathy has been demonstrated and the distinct clinical entity of acute fulminating viral myocarditis with an excellent long-term prognosis has been identified. New genetic abnormalities have been found in different forms of dilated cardiomyopathy. One of the most important advances concerns the neurohormones and the rise of interest in type B natriuretic peptide, for diagnosis, prognosis, as well as treatment (nesiritide). From the therapeutic point of view, the importance of betablockers has been confirmed, including in severe cardiac failure. The therapeutic value of biventricular stimulation resynchronising the two ventricles seem to be an additional therapeutic opportunity for patients with advanced cardiac failure. The summit of 2000 remains the first cellular transplantation carried out by a Parisian French team. PMID:11260834

  14. Association of heart failure severity with risk of diabetes

    DEFF Research Database (Denmark)

    Demant, Malene N.; Gislason, Gunnar H.; Køber, Lars; Vaag, Allan; Torp-Pedersen, Christian; Andersson, Charlotte

    2014-01-01

    AIMS/HYPOTHESIS: Heart failure has been suggested to increase the risk of developing diabetes. We investigated the relation between heart failure severity, defined by loop-diuretic dosage, and the risk of developing diabetes in a nationwide cohort of patients with heart failure. METHODS: We...... followed all Danish patients discharged from hospitalisation for first-time heart failure in 1997-2010, without prior use of hypoglycaemic agents, until a claimed prescription for hypoglycaemic agents, death or 31 December 2010. The association of loop-diuretic dosage (furosemide equivalents) 90 days after.......32), 2.28 (2.01, 2.59), 2.88 (2.52, 3.30) and 3.02 (2.66, 3.43) without RASi treatment. CONCLUSIONS/INTERPRETATION: In a nationwide cohort of patients with heart failure, severity of heart failure was associated with a stepwise increased risk of developing diabetes. Increased awareness of risk of...

  15. Evaluation of Illness Related Worries in Heart Failure Patients

    OpenAIRE

    Hossein Bagheri; Farideh Yaghmaei; Tahere Ashktorab; Farid Zayeri

    2014-01-01

    Introduction: Heart failure is a major growing problem that affects not only patients but also their families and social networks and reduces the functional capacity of patients and impaires their social life. This study was conducted to investigate the illness related worries in heart failure patients. Methods: In this descriptive, cross-sectional study, 130 patients with class II to IV heart failure were selected upon to researcher characteristics and in non randomized sampling from pati...

  16. The gene expression fingerprint of human heart failure

    OpenAIRE

    Tan, Fen-Lai; Moravec, Christine S.; Li, Jianbo; Apperson-Hansen, Carolyn; McCarthy, Patrick M; Young, James B.; Bond, Meredith

    2002-01-01

    Multiple pathways are responsible for transducing mechanical and hormonal stimuli into changes in gene expression during heart failure. In this study our goals were (i) to develop a sound statistical method to establish a comprehensive cutoff point for identification of differentially expressed genes, (ii) to identify a gene expression fingerprint for heart failure, (iii) to attempt to distinguish different etiologies of heart failure by their gene expression fingerprint, and (iv) to identify...

  17. Optimizing therapy in patients with atrial fibrillation and heart failure

    OpenAIRE

    Mulder, Bart Antonius

    2015-01-01

    Atrial fibrillation is the most common cardiac arrhythmia and the prevalence is expected to increase in the coming years. The same is true for heart failure. Atrial fibrillation may result in heart failure, and vice versa, but they can also exacerbate each other. The combination of atrial fibrillation and heart failure has important therapeutic implications to treat both diseases and create optimal outcomes for these patients. We started with patients with permanent atrial fibrillation. These...

  18. Novel Strategies for the Treatment of Heart Failure

    OpenAIRE

    Izhak Kehat

    2012-01-01

    Heart failure is a leading cause of morbidity and mortality with a prevalence that is rising throughout the world. Currently the pharmaceutical therapy of heart failure is mainly based on inhibition of the neurohumoral pathways that are activated secondary to the deterioration of cardiac function, and diuretics to alleviate the salt and water overload. With our increasing understanding of the pathophysiology of heart failure, it is now clear that the macroscopic and functional changes in the ...

  19. Palliative care in medical outliers with heart failure

    OpenAIRE

    Jammula Prabhakar Patro; Pavani Priyadarsini

    2016-01-01

    Medical outliers are the patients who present to medical practices without health insurance or with serious co-morbidities needing prolonged hospital stay. Palliative care is part of standard guidelines for management of heart failure. But in medical outliers suffering from heart failure, palliative care should begin more early than it is recommended in standard guidelines because of financial reasons. It is suggested that guidelines be framed also for medical outliers with heart failure. It ...

  20. Challenges Facing Nurse-Led Disease Management for Heart Failure

    OpenAIRE

    Hebert, Paul L; Sisk, Jane E.

    2008-01-01

    The positive results of several randomized controlled trials of nurse-led disease management (DM) for heart failure have led to considerable growth in the use of DM programs in such patients. However, many aspects of the protocols used in randomized trials of DM for heart failure have differed, and there are still significant gaps in our knowledge of what makes DM work and for whom. Four important unresolved issues are: (i) what components of multifaceted DM protocols for heart failure are ef...

  1. Practical guide on home health in heart failure patients

    OpenAIRE

    Jaarsma, Tiny; Strömberg, Anna; Larsen, Torben

    2013-01-01

    Introduction: Chronic heart failure is a common condition affecting up to 15 million people in the extended Europe. Heart failure is burdensome and costly for patients in terms of decreased quality of life and poor prognosis and it is also costly for society. Better integrated care is warranted in this population and specialized heart failure care can save costs and improve the quality of care. However, only a few European countries have implemented specialized home care and offered this to a...

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

    OpenAIRE

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

    2008-01-01

    Many patient education guidelines for teaching heart failure patients recommend inclusion of the family; however, family-focused interventions to promote self-care in heart failure are few. This article reviews the state of the science regarding family influences on heart failure self-care and outcomes. The literature and current studies suggest that family functioning, family support, problem solving, communication, self-efficacy, and caregiver burden are important areas to target for future...

  3. Diagnosis and management of heart failure in the elderly.

    OpenAIRE

    King, D

    1996-01-01

    Heart failure is common in the elderly and is associated with a significant morbidity and mortality. It accounts for about 5% of adult medical admissions and the expenditure of 1% of the total National Health Service budget. Clinical presentation in old age may be with the classical symptoms of heart failure but often, due to multiple pathology and low functional ability, presentation is atypical. Both nonspecific symptoms and signs of heart failure, are often a delayed presentation in this p...

  4. Arrhythmias and electrocardiographic changes in systolic heart failure

    OpenAIRE

    Ashok Devkota; Ahmed Bakhit; Alix Dufresne; Aung Naing Oo; Premraj Parajuli; Saveena Manhas

    2016-01-01

    Background: Heart failure is a common condition that that leads to hospitalization. It is associated with various atrial and ventricular arrhythmias. Aim: The aim of this study is to find common arrhythmias and electrocardiographic changes in hospitalized patients who have systolic heart failure. Materials and Methods: This is a retrospective study of medical records, and electrocardiograms (EKGs) of 157 patients admitted to our hospital who had systolic heart failure with ejection fraction (...

  5. Characteristics and outcome of patients with heart failure due to anabolic-androgenic steroids

    DEFF Research Database (Denmark)

    Søndergaard, Eva Bjerre; Thune, Jens Jakob; Gustafsson, Finn

    2014-01-01

    OBJECTIVES: The objective of the study was to analyse the outcome of patients with advanced heart failure due to abuse of anabolic-androgenic steroids. DESIGN: A retrospective chart review of patients admitted or referred for advanced heart failure, due to anabolic-androgenic steroid abuse...... with angiotensin-converting enzyme inhibitors and beta-blockers. The remaining 3 patients required implantation of a LV assist device (LVAD) and were listed for heart transplantation. No recovery of LV function in the patients treated with assist device was seen. CONCLUSION: Anabolic-androgenic steroid...

  6. Non-transplant surgical alternatives for heart failure

    Institute of Scientific and Technical Information of China (English)

    Robroy H. MacIver; Edwin C. McGee

    2006-01-01

    Although surgical options exist, treatment for heart failure remains dominated by medical therapy. Even with optimal medical therapy, the mortality of heart failure continues to be high. Conventional wisdom in heart failure treatment leads many practitioners to believe that the patient is "too sick" for further operative procedures such as revascularization, valve repair or replacement and ventricular reconstruction. Improvements in intra and peri-operative care over the last 20 years have allowed for more complex procedures to be performed, and have improved the mortality rates of the more traditional surgeries. As the complexity of the operative procedure and morbidity of the patient has elevated so has the importance of a multidisciplinary approach in choosing treatment plans for patients. As the age of the population increases and acute management of ischemic heart disease improves, the prevalence of heart failure will likely increase. Improving access and changing treatment algorithms to include operative procedures can improve the treatment of heart failure patients.

  7. Practical guide on home health in heart failure patients

    DEFF Research Database (Denmark)

    Jaarsma, T.; Larsen, Torben; Stromberg, A.

    2013-01-01

    following components: integrated multidisciplinary care, patient and partner participation, care plans with clear goals of care, patient education, self-care management, appropriate access to care and optimised treatment. Discussion: We summarised the state of the art of home-based care for heart failure......Introduction: Chronic heart failure is a common condition affecting up to 15 million people in the extended Europe. Heart failure is burdensome and costly for patients in terms of decreased quality of life and poor prognosis, and it is also costly for society. Better integrated care is warranted in...... this population and specialised heart failure care can save costs and improve the quality of care. However, only a few European countries have implemented specialised home care and offered this to a larger number of patients with heart failure. Method: We developed a guide on Home Health in Heart...

  8. Exercise oscillatory ventilation in heart failure.

    Science.gov (United States)

    Corrà, Ugo

    2016-03-01

    Ventilation inefficiency has become a matter of interest for heart failure (HF) specialists, the most remarkable being exertional oscillatory ventilation (EOV). EOV is an abnormal ventilatory phenomenon, originally described as anecdotal, but now considered a marker of disease severity and worst prognosis in HF. EOV is a cyclic fluctuation of minute ventilation (VE) and expired gas kinetics occurring during exercise: it is a slow, prominent, consistent rather than random, fluctuation in VE that may be evanescent or transient and can follow several distinct patterns. In contrast to the periodic breathing observed in Cheyne-Stokes respiration and central sleep apnea, the gradual increase and decrease in minute ventilation (VE) are not spaced by periods of apnea. This review will discuss EOV in HF and the overlap with Cheyne-Stokes respiration. PMID:26935880

  9. Cognitive impairment in heart failure patients

    Institute of Scientific and Technical Information of China (English)

    Laura Leto; Mauro Feola

    2014-01-01

    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, altera-tions of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mecha-nisms 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 avail-able data pointing out assured information and discussing possible areas of research development.

  10. Computer assisted optimisation on non-pharmacological treatment of congestive heart failure and supraventricular arrhythmia

    OpenAIRE

    Reumann, Matthias

    2007-01-01

    Heart Failure is the most common cardiac disease worldwide; supraventricular arrhythmia the most common cardiac arrhythmia. The understanding of these diseases advances treatment options. Ablation therapy and atrial antitachycardial pacing are non-pharmacological options in the treatment of atrial fibrillation. Cardiac resynchronization therapy with biventricular pacing devices has been shown successful in patients with severe heart failure. However, an optimization or even individual therapy...

  11. Atrial fibrillation in heart failure: new directions in diagnosis, risk assessment and risk reduction.

    OpenAIRE

    Dr Richard Till; Prof artin Cowie

    2014-01-01

    Heart failure and atrial fibrillation are common conditions which frequently co-exist. In patients with established systolic and diastolic dysfunction, atrial fibrillation increases the risk of stroke, mortality and reduces quality of life. Recent advances in implantable device technology have improved the detection of atrial fibrillation and reduced the time to intervention. Rate control remains the mainstay of treatment to improve symptoms in patients with heart failure. Currently evidence ...

  12. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

    OpenAIRE

    Arnold, J. Malcolm O.; Liu, Peter; Demers, Catherine; Dorian, Paul; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Howlett, Jonathan G; Ignaszewski, Andrew; Johnstone, David E; Jong, Philip; Robert S. McKelvie; Moe, Gordon W; John D. Parker; Rao, Vivek

    2006-01-01

    Heart failure remains a common diagnosis, especially in older individuals. It continues to be associated with significant morbidity and mortality, but major advances in both diagnosis and management have occurred and will continue to improve symptoms and other outcomes in patients. The Canadian Cardiovascular Society published its first consensus conference recommendations on the diagnosis and management of heart failure in 1994, followed by two brief updates, and reconvened this consensus co...

  13. Influence of diabetes mellitus on heart failure risk and outcome

    Directory of Open Access Journals (Sweden)

    Van Belle Eric

    2003-01-01

    Full Text Available Abstract 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 control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy. Treatment of heart failure in diabetic patients The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients.

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

    OpenAIRE

    Knocke, Ann

    2012-01-01

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

  15. [Congestive heart failure with frequent hospital readmissions in the elderly].

    Science.gov (United States)

    Pentimone, F; Del Corso, L

    1993-03-01

    Ten elderly patients with heart failure and frequent hospital readmission within 12 months before the study, were submitted to clinical radiologic, electrocardiographic and echocardiographic evaluation in order to find the causes of readmission. The most frequent factors were found to be non compliance with drug prescriptions and therapy inadequate for the etiology of the heart failure and the kind of cardiac dysfunction. PMID:8482059

  16. Accuracy of a heart failure diagnosis in administrative registers

    DEFF Research Database (Denmark)

    Kümler, Thomas; Gislason, Gunnar Hilmar; Kirk, Vibeke;

    2008-01-01

    BACKGROUND: The incidence of heart failure is frequently reported using hospital discharge diagnoses. The specificity of a diagnosis has been shown to be high but the sensitivity of a reported diagnosis is unknown. PURPOSE: To study the accuracy of a heart failure diagnosis reported to the Danish...

  17. Exercise training in older patients with systolic heart failure

    DEFF Research Database (Denmark)

    Prescott, Eva; Hjardem-Hansen, Rasmus; Dela, Flemming; Teisner, Ane S; Nielsen, Henrik

    2009-01-01

    Training improves exercise capacity in patients with heart failure (CHF) but most evidence is on selected younger patients with systolic CHF.......Training improves exercise capacity in patients with heart failure (CHF) but most evidence is on selected younger patients with systolic CHF....

  18. High mortality among heart failure patients treated with antidepressants

    DEFF Research Database (Denmark)

    Veien, Karsten Tang; Videbæk, Lars; Schou, Morten; Gustafsson, Finn; Hald-Steffensen, Flemming; Hildebrandt, Per R

    2011-01-01

    This study was designed to assess whether pharmacologically treated depression was associated with increased mortality risk in systolic heart failure (SHF) patients.......This study was designed to assess whether pharmacologically treated depression was associated with increased mortality risk in systolic heart failure (SHF) patients....

  19. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure

    DEFF Research Database (Denmark)

    Køber, Lars; Thune, Jens J; Nielsen, Jens C;

    2016-01-01

    Background The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due...

  20. Health care professionals in a heart failure team

    NARCIS (Netherlands)

    Jaarsma, T

    2005-01-01

    A heart failure team that treats heart failure patients often faces the challenge of managing multiple conditions requiring multiple medications and life style changes in an older patient group. A multidisciplinary team approach can optimally diagnose, carefully review and prescribe treatment, and e

  1. Diastolic heart failure in the elderly and the potential role of aldosterone antagonists.

    Science.gov (United States)

    Kumar, Ashwani; Meyerrose, Gary; Sood, Vineeta; Roongsritong, Chanwit

    2006-01-01

    The overall incidence of heart failure increases with age, affecting up to 10% of people >65 years of age. Diastolic heart failure is also age-dependent, increasing from 40% in patients > or =70 years of age. Elderly patients usually have other co-morbid conditions such as hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation that can adversely affect the diastolic properties of the heart. The clinical manifestations of diastolic heart failure are similar to those of systolic heart failure. In practice, the diagnosis is generally based on the finding of typical symptoms and signs of heart failure with preserved left ventricular ejection fraction and no valvular abnormalities on echocardiography. Altered ventricular relaxation and abnormal ventricular filling are the hallmarks of diastolic heart failure. Cardiac fibrosis and cellular disarray lead to the alterations in the diastolic properties of the heart. Diffuse foci of fibrosis in the myocardium have been reported with advancing age. Aldosterone has been shown to play a crucial role in the development of cardiac fibrosis via a direct effect on the mineralocorticoid receptors within the myocardium. Unlike the situation with treatment of systolic heart failure, few clinical trials are available to guide the management of patients with diastolic heart failure. In the absence of controlled clinical trials, patient management is based on control of the physiological factors (blood pressure, heart rate, blood volume and myocardial ischaemia) that are known to exert important effects on ventricular relaxation. Aldosterone antagonists inhibit the deposition of collagen matrix in the myocardium, thereby targeting the basic pathophysiological mechanism of diastolic dysfunction. Thus, they appear to represent a promising therapeutic approach for this condition. Currently, only small clinical trials supporting this therapy are available and large clinical trials evaluating long-term outcomes in

  2. Potential Autonomic Nervous System Effects of Statins in Heart Failure

    OpenAIRE

    Horwich, Tamara; Middlekauff, Holly

    2008-01-01

    Sympathetic nervous system activation in heart failure, as indexed by elevated norepinephrine levels, higher muscle sympathetic nerve activity and reduced heart rate variability, is associated with pathologic ventricular remodeling, increased arrhythmias, sudden death, and increased mortality. Recent evidence suggests that HMG-CoA reductase inhibitor (statin) therapy may provide survival benefit in heart failure of both ischemic and non-ischemic etiology, and one potential mechanism of benefi...

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

    OpenAIRE

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

    2004-01-01

    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.

  4. Health-related quality of life in children with heart failure as perceived by children and parents.

    Science.gov (United States)

    Wilmot, Ivan; Cephus, Constance E; Cassedy, Amy; Kudel, Ian; Marino, Bradley S; Jefferies, John L

    2016-06-01

    Advancements in paediatric heart failure management have resulted in improved survival and a focus on long-term outcomes including health-related quality of life. We compared health-related quality of life in children with heart failure with healthy patients, children with chronic conditions, and children with cardiovascular disease. Families (n=63) and children (n=73) aged 2-20 years with heart failure were enrolled and compared with data previously published for healthy patients (n=5480), those with chronic conditions (n=247), and those with cardiovascular disease (n=347). Patients and parents completed the PedsQL 4.0 and the Cardiac 3.0 Module health-related quality-of-life questionnaires. PedsQL scores including Total, Psychosocial Health Summary, and Physical were compared between groups. In general, patients with heart failure had lower scores than the healthy population (p=0.001), and comparable scores with those with chronic conditions. Parents perceived no difference in physical scores for children with heart failure when compared with healthy children, and perceived higher scores for children with heart failure when compared with those with chronic conditions (p⩽0.003). Furthermore, children with heart failure had decremental health-related quality-of-life scores as the American Heart Association stage of heart failure increased, such that patients with stage C heart failure had scores similar to children with severe cardiovascular disease. Children with heart failure reported significantly impaired health-related quality of life compared with healthy children and similar scores compared with children with chronic conditions. Parental perceptions appear to underestimate these impairments. Children with heart failure appear to have progressive impairment of health-related quality of life with advancing stage of heart failure. PMID:26277874

  5. How can we cure a heart "in flame"? A translational view on inflammation in heart failure

    OpenAIRE

    Hofmann, Ulrich; Frantz, Stefan

    2016-01-01

    The prevalence of chronic heart failure is still increasing making it a major health issue in the 21st century. Tremendous evidence has emerged over the past decades that heart failure is associated with a wide array of mechanisms subsumed under the term "inflammation". Based on the great success of immuno-suppressive treatments in auto-immunity and transplantation, clinical trials were launched targeting inflammatory mediators in patients with chronic heart failure. However, they widely lack...

  6. A new approach to treatment of acute heart failure.

    Science.gov (United States)

    Goldsmith, Steven R

    2016-05-01

    Conventional therapies for acute decongestion have yielded uniformly poor results in patients with acute heart failure (AHF). The failure of current strategies may be due to advanced disease in hospitalized patients, incomplete therapy, inherent limitations to existing therapy, or some combination of all three factors. Loop diuretics are the mainstay of current therapy and are in theory not ideal since while producing immediate intravascular volume reduction and relief of symptoms they activate neurohormonal forces that are deleterious to both the heart and the kidney. Ultrafiltration is an alternative to loop diuretics but has not proved advantageous in the setting of renal dysfunction, and if not carefully applied may also aggravate neurohormonal imbalance. In theory decongestive therapy for AHF should remove large volumes of fluid quickly and safely and improve symptoms, particularly dyspnea, without aggravating renal dysfunction or causing neurohormonal activation. Several studies have now suggested that the use of aquaretics such as antagonists to the V2 receptor for arginine vasopressin may be useful as adjunctive therapy in AHF, particularly when renal dysfunction and/or hyponatremia are present. These agents leverage osmotic forces to produce tissue decongestion while causing a water diuresis. They do not adversely affect renal function or neurohormonal balance. Building on the current base of knowledge about outcomes in AHF together with the only study of vasopressin antagonists as short-term monotherapy in chronic heart failure, it would be reasonable to design a trial in AHF in which the use of loop diuretics was minimized in favor of these agents. PMID:26946929

  7. Plasma Concentration of the Novel Peptide Apelin is Regularly Changed in Patients With Heart Failure

    Institute of Scientific and Technical Information of China (English)

    Yuan Yanju; Li Tianchang; Yan Jun; Bian Hong; Yao Daokuo; Xu Shiying; Zheng Jianyong

    2006-01-01

    Objectives Apelin, the novel endogenous ligand for the G-protein-coupled receptor APJ, has been observed in many animals and humans studies. It is concluded that it has inotropic effects,hypotension and diuretic properties. The change of apelin in relation to heart failure is still controversial.Our goal was to observe the change of apelin-12 in patients with heart failure (HF). Methods From 2005 to 2006, 81 consecutive patients (46 male and 35 female, mean age 68.5±12.1 years) with heart failure resulting from variable etiologies and 15 healthy controls were included in this study. Plasma concentration of apelin-12 was measured through ELISA on admission. All patients received conventional therapy and recorded detailed the clinical conditions. Results (1) Plasma concentration of apelin of the controls is lower than the ones of heart failure patients. (2) Plasma concentration of apelin is increased in the early stage and decreased in the advanced period. (3) Apelin is related with variable indexes in the Pearson's association analysis. Apelin is also changed with the atrium and ventricular's diameter. Conclusions Plasma concentration of apelin is increased in early stage and decreased in advanced period. The apelin-APJ system might be important in the pathophysiological process of heart failure. And it might be valuable in diagnosis and therapeutic implications in heart failure.

  8. Cardiac arrhythmia and heart failure: From bench to bedside

    Institute of Scientific and Technical Information of China (English)

    Yong-Fu Xiao

    2011-01-01

    @@ Cardiac arrhythmia is an abnormal rate and/or rhythm of a heart due to its abnormal electrical impulse origination and/or propagation.Various etiologies can cause arrhythnuas.Heart failure(HF)is a clinical syndrome due to an impaired heart that can not pump sufficient blood to meet the systemic metabolic needs.The common causes of HF include myocardial infarction,hypertension,valvular heart disease,and cardiomyopathy.

  9. Epidemiology and aetiology of heart failure.

    Science.gov (United States)

    Ziaeian, Boback; Fonarow, Gregg C

    2016-06-01

    Heart failure (HF) is a rapidly growing public health issue with an estimated prevalence of >37.7 million individuals globally. HF is a shared chronic phase of cardiac functional impairment secondary to many aetiologies, and patients with HF experience numerous symptoms that affect their quality of life, including dyspnoea, fatigue, poor exercise tolerance, and fluid retention. Although the underlying causes of HF vary according to sex, age, ethnicity, comorbidities, and environment, the majority of cases remain preventable. HF is associated with increased morbidity and mortality, and confers a substantial burden to the health-care system. HF is a leading cause of hospitalization among adults and the elderly. In the USA, the total medical costs for patients with HF are expected to rise from US$20.9 billion in 2012 to $53.1 billion by 2030. Improvements in the medical management of risk factors and HF have stabilized the incidence of this disease in many countries. In this Review, we provide an overview of the latest epidemiological data on HF, and propose future directions for reducing the ever-increasing HF burden. PMID:26935038

  10. MicroRNA and Heart Failure

    Directory of Open Access Journals (Sweden)

    Lee Lee Wong

    2016-04-01

    Full Text Available Heart failure (HF imposes significant economic and public health burdens upon modern society. It is known that disturbances in neurohormonal status play an important role in the pathogenesis of HF. Therapeutics that antagonize selected neurohormonal pathways, specifically the renin-angiotensin-aldosterone and sympathetic nervous systems, have significantly improved patient outcomes in HF. Nevertheless, mortality remains high with about 50% of HF patients dying within five years of diagnosis thus mandating ongoing efforts to improve HF management. The discovery of short noncoding microRNAs (miRNAs and our increasing understanding of their functions, has presented potential therapeutic applications in complex diseases, including HF. Results from several genome-wide miRNA studies have identified miRNAs differentially expressed in HF cohorts suggesting their possible involvement in the pathogenesis of HF and their potential as both biomarkers and as therapeutic targets. Unravelling the functional relevance of miRNAs within pathogenic pathways is a major challenge in cardiovascular research. In this article, we provide an overview of the role of miRNAs in the cardiovascular system. We highlight several HF-related miRNAs reported from selected cohorts and review their putative roles in neurohormonal signaling.

  11. Blood flow dynamics in heart failure

    Science.gov (United States)

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

    1999-01-01

    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 (Pblood 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.

  12. Comorbidity of atrial fibrillation and heart failure.

    Science.gov (United States)

    Ling, Liang-Han; Kistler, Peter M; Kalman, Jonathan M; Schilling, Richard J; Hunter, Ross J

    2016-03-01

    Atrial fibrillation (AF) and heart failure (HF) are evolving epidemics, together responsible for substantial human suffering and health-care expenditure. Ageing, improved cardiovascular survival, and epidemiological transition form the basis for their increasing global prevalence. Although we now have a clear picture of how HF promotes AF, gaps remain in our knowledge of how AF exacerbates or even causes HF, and how the development of HF affects the outcome of patients with AF. New data regarding HF with preserved ejection fraction and its unique relationship with AF suggest a possible role for AF in its aetiology, possibly as a trigger for ventricular fibrosis. Deciding on optimal treatment strategies for patients with both AF and HF is increasingly difficult, given that results from trials of pharmacological rhythm control are arguably obsolete in the age of catheter ablation. Restoring sinus rhythm by catheter ablation seems successful in the medium term and improves HF symptoms, functional capacity, and left ventricular function. Long-term studies to examine the effect on rates of stroke and death are ongoing. Guidelines continue to evolve to keep pace with this rapidly changing field. PMID:26658575

  13. MicroRNA and Heart Failure

    Science.gov (United States)

    Wong, Lee Lee; Wang, Juan; Liew, Oi Wah; Richards, Arthur Mark; Chen, Yei-Tsung

    2016-01-01

    Heart failure (HF) imposes significant economic and public health burdens upon modern society. It is known that disturbances in neurohormonal status play an important role in the pathogenesis of HF. Therapeutics that antagonize selected neurohormonal pathways, specifically the renin-angiotensin-aldosterone and sympathetic nervous systems, have significantly improved patient outcomes in HF. Nevertheless, mortality remains high with about 50% of HF patients dying within five years of diagnosis thus mandating ongoing efforts to improve HF management. The discovery of short noncoding microRNAs (miRNAs) and our increasing understanding of their functions, has presented potential therapeutic applications in complex diseases, including HF. Results from several genome-wide miRNA studies have identified miRNAs differentially expressed in HF cohorts suggesting their possible involvement in the pathogenesis of HF and their potential as both biomarkers and as therapeutic targets. Unravelling the functional relevance of miRNAs within pathogenic pathways is a major challenge in cardiovascular research. In this article, we provide an overview of the role of miRNAs in the cardiovascular system. We highlight several HF-related miRNAs reported from selected cohorts and review their putative roles in neurohormonal signaling. PMID:27058529

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

    Science.gov (United States)

    Simuel, Gloria J.

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

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

    International Nuclear Information System (INIS)

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

  16. Neprilysin Inhibition as a PARADIGM Shift in Heart Failure Therapy.

    Science.gov (United States)

    Hsiao, Ruth; Greenberg, Barry

    2016-08-01

    Heart failure is a growing global public health problem. With the aging population, increased risk factors for heart failure development, and better survival after myocardial infarction, the prevalence is only expected to increase in the coming years. Although existing therapies have improved the clinical course of heart failure patients, new approaches are urgently needed to enhance quality of life and reduce morbidity and mortality. However, there has been little progress in the treatment of chronic heart failure in the past decade with only two new drugs approved by the US FDA over this time. Better understanding of the neurohormonal axis of heart failure has lead to the development of LCZ696, a first-in-class novel agent that acts as an angiotensin receptor blocker and neprilysin inhibitor. In the PARADIGM-HF study, LCZ696 was superior to an angiotensin-converting enzyme inhibitor in reducing mortality and HF hospitalizations and improving quality of life across a broad spectrum of symptomatic patients with heart failure with reduced ejection fraction. While evaluation of long-term effects is still needed, the completed trials on LCZ696 demonstrate that the drug is generally well-tolerated with a safe side effect profile. LCZ696 should be strongly considered as a favorable alternative to angiotensin converting enzyme inhibitors and angiotensin receptor blockers in appropriate heart failure patients. PMID:27271564

  17. Heart Failure in Children and Adolescents

    Science.gov (United States)

    ... of the heart. It's then pumped into the aorta, which distributes it throughout the body to provide ... due to effects of smoking, high blood pressure, diabetes, coronary artery disease and bad heart valves. It ...

  18. Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Søndergaard, Peter; Nielsen, Tonny;

    2006-01-01

    AIMS: Atrial fibrillation (AF) is a risk factor for death in patients with a myocardial infarction, but highly variable results are reported in patients with heart failure. We studied the prognostic impact of AF in heart failure patients with and without ischaemic heart disease. METHODS AND RESULTS......: During a period of 2 years, 3587 patients admitted to hospital because of heart failure were included in this study. All patients were examined by echocardiography and the presence of AF was recorded. Follow-up was available for 8 years. Twenty four percent of those discharged alive from hospital had AF...... without ischaemic heart disease, HR was 1.01 (95% CI: 0.88-1.16) and P=0.88. CONCLUSION: AF is associated with increased risk of death only in patients with ischaemic heart disease. This finding may explain the variable results of studies of the prognosis associated with AF in heart failure....

  19. Heart failure among Indigenous Australians: a systematic review

    Directory of Open Access Journals (Sweden)

    Woods John A

    2012-11-01

    Full Text Available Abstract 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

  20. Cardiovascular Simulation of Heart Failure Pathophysiology and Therapeutics.

    Science.gov (United States)

    Doshi, Darshan; Burkhoff, Daniel

    2016-04-01

    Mathematical modeling and simulation allows for an in-depth examination of the cardiovascular system and provides the opportunity to develop deeper understanding. This review summarizes recent efforts at modeling the cardiovascular system and how these models have been useful in providing greater comprehension of the pathophysiology of heart failure, explaining the hemodynamic impact of various heart failure devices, predicting the hemodynamic effects and clinical outcomes of certain heart failure clinical trials, and perhaps aiding in patient selection for new therapies. The potential future use of these models in clinical research and clinical practice are also discussed. PMID:26703246

  1. 3D Printing to Guide Ventricular Assist Device Placement in Adults With Congenital Heart Disease and Heart Failure.

    Science.gov (United States)

    Farooqi, Kanwal M; Saeed, Omar; Zaidi, Ali; Sanz, Javier; Nielsen, James C; Hsu, Daphne T; Jorde, Ulrich P

    2016-04-01

    As the population of adults with congenital heart disease continues to grow, so does the number of these patients with heart failure. Ventricular assist devices are underutilized in adults with congenital heart disease due to their complex anatomic arrangements and physiology. Advanced imaging techniques that may increase the utilization of mechanical circulatory support in this population must be explored. Three-dimensional printing offers individualized structural models that would enable pre-surgical planning of cannula and device placement in adults with congenital cardiac disease and heart failure who are candidates for such therapies. We present a review of relevant cardiac anomalies, cases in which such models could be utilized, and some background on the cost and procedure associated with this process. PMID:27033018

  2. Influence of levocarnitine on heart function and endocrine among patients with heart failure

    Institute of Scientific and Technical Information of China (English)

    程磊

    2013-01-01

    Objective To observe the efficacy of levocarnitine in treating elderly patients with chronic heart failure and to explore its impact on cardiac function and endocrine.Methods 120 elderly patients with chronic heart failure were randomly divided into observation and control groups,with 60 cases of each.Patients in the control

  3. Successful treatment of fetal atrial flutter and congestive heart failure.

    OpenAIRE

    Hirata, K.; Kato, H.; Yoshioka, F; Matsunaga, T

    1985-01-01

    Fetal supraventricular tachycardia may cause congestive heart failure, hydrops fetalis, and intrauterine death. Tachycardia in a fetus of 34 weeks' gestation was diagnosed as atrial flutter by echocardiography, and was successfully treated by giving the mother digoxin.

  4. Hospital Value-Based Purchasing (HVBP) – Heart Failure Scores

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospitals participating in the Hospital VBP Program and their performance rates and scores for the Clinical Process of Care Heart Failure measures.

  5. High mortality among heart failure patients treated with antidepressants

    DEFF Research Database (Denmark)

    Veien, Karsten T; Videbæk, Lars; Schou, Morten;

    2011-01-01

    BACKGROUND: This study was designed to assess whether pharmacologically treated depression was associated with increased mortality risk in systolic heart failure (SHF) patients. METHODS: Patients (n=3346) with SHF (left ventricular ejection fraction...

  6. Indicators psychological status in patients with chronic heart failure

    OpenAIRE

    KADIROVA SHAHLO; KAMILOVA UMIDA KABIROVNA

    2016-01-01

    In patients with heart failure to study the psychological status of the relationship between indicators of psychological status and progression of the disease: patients with FC III identified more often more severe disorders with revalence of depressive disorders.

  7. Prognostic importance of pulmonary hypertension in patients with heart failure

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Akkan, Dilek; Iversen, Kasper Karmark;

    2007-01-01

    Pulmonary hypertension is a well-known complication in heart failure, but its prognostic importance is less well established. This study assessed the risk associated with pulmonary hypertension in patients with heart failure with preserved or reduced left ventricular (LV) ejection fractions....... Patients with known or presumed heart failure (n = 388) underwent the echocardiographic assessment of pulmonary systolic pressure and LV ejection fraction. Patients were followed for up to 5.5 years. Increased pulmonary pressure was associated with increased short- and long-term mortality (p <0.0001 and p...... obstructive lung disease, heart failure, and impaired renal function. In conclusion, pulmonary hypertension is associated with increased short- and long-term mortality in patients with reduced LV ejection fractions and also in patients with preserved LV ejection fractions....

  8. Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors.

    Science.gov (United States)

    Dubé, Bruno-Pierre; Agostoni, Piergiuseppe; Laveneziana, Pierantonio

    2016-09-01

    Exertional dyspnoea is among the dominant symptoms in patients with chronic heart failure and progresses relentlessly as the disease advances, leading to reduced ability to function and engage in activities of daily living. Effective management of this disabling symptom awaits a better understanding of its underlying physiology.Cardiovascular factors are believed to play a major role in dyspnoea in heart failure patients. However, despite pharmacological interventions, such as vasodilators or inotropes that improve central haemodynamics, patients with heart failure still complain of exertional dyspnoea. Clearly, dyspnoea is not determined by cardiac factors alone, but likely depends on complex, integrated cardio-pulmonary interactions.A growing body of evidence suggests that excessively increased ventilatory demand and abnormal "restrictive" constraints on tidal volume expansion with development of critical mechanical limitation of ventilation, contribute to exertional dyspnoea in heart failure. This article will offer new insights into the pathophysiological mechanisms of exertional dyspnoea in patients with chronic heart failure by exploring the potential role of the various constituents of the physiological response to exercise and particularly the role of abnormal ventilatory and respiratory mechanics responses to exercise in the perception of dyspnoea in patients with heart failure. PMID:27581831

  9. Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study.

    LENUS (Irish Health Repository)

    Moran, D

    2014-08-23

    We assessed adherence to European Society of Cardiology heart rate guidelines (i.e. heart rates less than 70bpm) in patients with chronic stable heart failure. We also investigated the percent of patients on target doses of rate controlling drugs.

  10. Long noncoding RNA dysregulation in ischemic heart failure

    OpenAIRE

    Greco, Simona; Zaccagnini, Germana; Perfetti, Alessandra; Fuschi, Paola; Valaperta, Rea; Voellenkle, Christine; Castelvecchio, Serenella; Gaetano, Carlo; Finato, Nicoletta; Beltrami, Antonio Paolo; Menicanti, Lorenzo; Martelli, Fabio

    2016-01-01

    Background Long noncoding RNAs (lncRNAs) are non-protein coding transcripts regulating a variety of physiological and pathological functions. However, their implication in heart failure is still largely unknown. The aim of this study is to identify and characterize lncRNAs deregulated in patients affected by ischemic heart failure. Methods LncRNAs were profiled and validated in left ventricle biopsies of 18 patients affected by non end-stage dilated ischemic cardiomyopathy and 17 matched cont...

  11. Genomics, proteomics and bioinformatics of human heart failure

    OpenAIRE

    dos Remedios, C. G.; Liew, C C; Allen, P. D.; Winslow, R. L.; Van Eyk, J. E.; Dunn, M J

    2003-01-01

    Unraveling the molecular complexities of human heart failure, particularly end-stage failure, can be achieved by combining multiple investigative approaches. There are several parts to the problem. Each patient is the product of a complex set of genetic variations, different degrees of influence of diets and lifestyles, and usually heart transplantation patients are treated with multiple drugs. The genomic status of the myocardium of any one transplant patient can be analysed using gene array...

  12. Management of Atrial Fibrillation in Patients with Heart Failure

    OpenAIRE

    Dr. Andrew E. Darby

    2014-01-01

    Atrial fibrillation (AF) and heart failure (HF) are common conditions that frequently coexist. Both conditions share risk factors, are associated with increased morbidity and mortality, and may worsen the other. The presence of heart failure and symptoms associated with it may influence both the approach to management (i.e., rate versus rhythm control) and the treatment options available for AF patients. The presence of HF increases the stroke risk with atrial fibrillation, and thromboembo...

  13. Psychobiology of depression/distress in congestive heart failure

    OpenAIRE

    York, Kaki M.; Hassan, Mustafa; Sheps, David S.

    2008-01-01

    Heart failure affects millions of Americans and new diagnosis rates are expected to almost triple over the next 30 years as our population ages. Affective disorders including clinical depression and anxiety are common in patients with congestive heart failure. Furthermore, the presence of these disorders significantly impacts quality of life, medical outcomes, and healthcare service utilization. In recent years, the literature has attempted to describe potential pathophysiologic mechanisms re...

  14. Heart failure among Indigenous Australians: a systematic review

    OpenAIRE

    Woods John A; Katzenellenbogen Judith M; Davidson Patricia M; Thompson Sandra C

    2012-01-01

    Abstract 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 ...

  15. Insulin resistance and exercise tolerance in heart failure patients

    DEFF Research Database (Denmark)

    Snoer, Martin; Monk-Hansen, Tea; Olsen, Rasmus Huan;

    2012-01-01

    Insulin resistance has been linked to exercise intolerance in heart failure patients. The aim of this study was to assess the potential role of coronary flow reserve (CFR), endothelial function and arterial stiffness in explaining this linkage.......Insulin resistance has been linked to exercise intolerance in heart failure patients. The aim of this study was to assess the potential role of coronary flow reserve (CFR), endothelial function and arterial stiffness in explaining this linkage....

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

    OpenAIRE

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

    2014-01-01

    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·...

  17. Psychological distress and mortality in systolic heart failure

    DEFF Research Database (Denmark)

    Pelle, Aline J; Pedersen, Susanne S.; Schiffer, Angélique A;

    2010-01-01

    Depression, anxiety, and type D ("distressed") personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but little is known about their role in chronic heart failure. Therefore, we investigated whether...

  18. Imaging of Myocardial Oxidative Metabolism in Heart Failure

    OpenAIRE

    Naya, Masanao; Tamaki, Nagara

    2013-01-01

    Metabolic imaging has a potential for better understanding of pathophysiology of heart failure. C-11 acetate is taken up by the heart, rapidly converted to acetylCoA and readily metabolized to C-11 CO2 through TCA cycle with oxidative phosphorylation. Thus, the myocardial turnover rate of this tracer is tightly correlated with its clearance of C-11 CO2, reflecting overall oxidative metabolism. The heart relies on aerobic oxidative substrate for the generation of ATP, which is required to main...

  19. Telomere attrition and Chk2 activation in human heart failure

    OpenAIRE

    Oh, Hidemasa; Wang, Sam C.; Prahash, Arun; Sano, Motoaki; Moravec, Christine S.; Taffet, George E.; Michael, Lloyd H.; Youker, Keith A.; Entman, Mark L.; Schneider, Michael D.

    2003-01-01

    The “postmitotic” phenotype in adult cardiac muscle exhibits similarities to replicative senescence more generally and constitutes a barrier to effective restorative growth in heart disease. Telomere dysfunction is implicated in senescence and apoptotic signaling but its potential role in heart disorders is unknown. Here, we report that cardiac apoptosis in human heart failure is associated specifically with defective expression of the telomere repeat- binding factor TRF2, telomere shortening...

  20. Left atrial leiomyosarcoma as cause of heart failure

    International Nuclear Information System (INIS)

    The case of a 26 year-old patient with diagnosis of heart failure and presence of a mobile echogenic mass without calcification attached to the posterolateral area of the left atrium was reported. She underwent surgery and tissue examination evidenced a high-grade heart leiomyosarcoma. Postoperative course was satisfactory and her clinical state was rigorously monitored by oncology and heart specialists in the institution

  1. Accurate diagnoses, evidence based drugs, and new devices (3 Ds) in heart failure

    OpenAIRE

    Bambang B. Siswanto

    2012-01-01

    Heart failure becomes main problem in cardiology because of increasing of heart failure patients, rehospitalization rate, morbidity, and mortality rate. The main causes of increasing heart failure problems are: (1) Successful treatment of acute myocardial infarction can be life saving, but its sequelae can cause heart failure. (2) Increasing life expectancy rate grows along with incidences of ageing related heart failure. (3) High prevalence of infection in Indonesia can cause rheumatic heart...

  2. 61. The effect of depression on medication adherence in patients with heart failure

    OpenAIRE

    Zeineddine, M.; Farah, I.; S. Alanzi; A. Alsaud; B. Bdeir

    2016-01-01

    Heart failure is a major and growing public health problem; approximately 5 million patients in the USA have heart failure. Depression is a serious mental illness that interferes with daily life activities and quality of life of Heart Failure Patients. Aim: To determine the association between depression and the medication adherence in patients with heart failure. Depression will reduce adherence to medication in patients with heart failure Quality project involving 50 patients with heart fai...

  3. Ivabradine in stable coronary artery disease without clinical heart failure

    DEFF Research Database (Denmark)

    Fox, Kim; Ford, Ian; Steg, Philippe Gabriel; Tardif, Jean-Claude; Tendera, Michal; Ferrari, Roberto; Jeppesen, Jørgen Lykke

    2014-01-01

    minute or more. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of ivabradine, added to standard background therapy, in 19,102 patients who had both stable coronary artery disease without clinical heart failure and a heart rate of 70 beats per minute or more (including 12...... those without activity-limiting angina (P=0.02 for interaction). The incidence of bradycardia was higher with ivabradine than with placebo (18.0% vs. 2.3%, P<0.001). CONCLUSIONS: Among patients who had stable coronary artery disease without clinical heart failure, the addition of ivabradine to standard...

  4. Failure and damage analysis of advanced materials

    CERN Document Server

    Sadowski, Tomasz

    2015-01-01

    The papers in this volume present basic concepts and new developments in failure and damage analysis with focus on advanced materials such as composites, laminates, sandwiches and foams, and also new metallic materials. Starting from some mathematical foundations (limit surfaces, symmetry considerations, invariants) new experimental results and their analysis are shown. Finally, new concepts for failure prediction and analysis will be introduced and discussed as well as new methods of failure and damage prediction for advanced metallic and non-metallic materials. Based on experimental results the traditional methods will be revised.

  5. A reappraisal of loop diuretic choice in heart failure patients

    Science.gov (United States)

    Buggey, Jonathan; Mentz, Robert J.; Pitt, Bertram; Eisenstein, Eric L.; Anstrom, Kevin J.; Velazquez, Eric J.; O’Connor, Christopher M.

    2015-01-01

    The health and economic burden of heart failure is significant, and continues to grow each year. Loop diuretics are an integral part of symptom management in heart failure. Furosemide is used disproportionately compared to other loop diuretics and there is currently no guidance for physicians regarding which agent to choose. However, there exist pharmacologic differences as well as other mechanistic differences that appear to favor torsemide use over furosemide. Compared to furosemide, torsemide improves surrogate markers of heart failure severity such as left ventricular function, plasma brain natriuretic peptide levels, and New York Heart Association functional class and may also reduce hospitalizations, readmissions, and mortality. Data suggest these benefits could be mediated through torsemide’s ability to positively affect the renin-angiotensin-aldosterone system. Specifically, torsemide has been shown to inhibit aldosterone secretion, synthesis, and receptor binding in vitro, as well as decrease transcardiac extraction of aldosterone, myocardial collagen production and cardiac fibrosis in patients with heart failure. We identified pertinent literature using keyword MEDLINE searches and cross-referencing prior bibliographies. We summarize the available data suggesting potential benefits with torsemide over furosemide, and call attention to the need for a reappraisal of diuretic use in heart failure patients and also for a well powered, randomized control trial assessing torsemide versus furosemide use. PMID:25728721

  6. [Disease management for heart failure patients: role of wireless technologies for telemedicine. The ICAROS project].

    Science.gov (United States)

    Villani, Alessandra; Malfatto, Gabriella; Della Rosa, Francesco; Branzi, Giovanna; Boarin, Simona; Borghi, Claudio; Cosentino, Eugenio; Gualerzi, Massimo; Coruzzi, Paolo; Molinari, Enrico; Compare, Angelo; Cassi, Maurizio; Collatina, Stefano; Parati, Gianfranco

    2007-02-01

    Healthcare costs for heart failure are increasing. The need for a better care, however, has to be matched with a policy of cost containment. A way to improve the cost-effectiveness of heart failure care is the disease management approach, in which therapy, education and follow-up are tailored for each patient by a multidisciplinary team. Such a complex intervention can be facilitated by the use of telemedicine, which allows the remote control of considerable amounts of clinical data. In Italy, a few studies with telemedicine have been reported. A recent development in this field is represented by the ICAROS project (Integrated Care vs Conventional Intervention in Cardiac Failure Patients: Randomized Open Label Study), whose aim is to improve the clinical and psychological care of heart failure patients employing advanced wireless telecommunication technology. So far, we randomized 60 patients: 30 in usual ambulatory care, 30 in an intensive treatment group. The latter patients were instructed to use a portable computer to get in touch daily with the heart failure clinic and receive feedback instruction for the management of drug therapy and daily problems. At the first year of follow-up, the treatment group showed good compliance to drug prescriptions, and could easily handle the portable computer. The preliminary results of this ongoing study support the feasibility and appropriateness of new technologies for the management of heart failure, even in elderly patients in whom a limited expertise with these appliances could have been anticipated. PMID:17402355

  7. Arrhythmias and electrocardiographic changes in systolic heart failure

    Directory of Open Access Journals (Sweden)

    Ashok Devkota

    2016-01-01

    Full Text Available Background: Heart failure is a common condition that that leads to hospitalization. It is associated with various atrial and ventricular arrhythmias. Aim: The aim of this study is to find common arrhythmias and electrocardiographic changes in hospitalized patients who have systolic heart failure. Materials and Methods: This is a retrospective study of medical records, and electrocardiograms (EKGs of 157 patients admitted to our hospital who had systolic heart failure with ejection fraction (EF 35%. Twelve-lead EKG of these patients was studied to identify common arrhythmia and demographic variables; laboratory results were compared to identify the differences. Results: A total of 157 patients with systolic heart failure, 63.7% had an EF ≤ 35%. Hypertension 82.8%, diabetes 49%, coronary artery disease 40.8%, chronic obstructive pulmonary disease or bronchial asthma 22.3%, and stroke 12.1% were common associated co-morbidities. On analysis of EKG, 28.6% had tachycardia, 21.9% had prolonged PR > 200 ms, 16.3% had wide QRS > 120 ms, 70.7% had prolonged corrected QT (QTc, and 42.2% had left axis deviation. The most common arrhythmias were sinus tachycardia and atrial fibrillation/flutter which were found in 14.6% and 13.4%, respectively. The left ventricular hypertrophy was a common abnormality found in 22.4% followed by ventricular premature contractions 18.4%, atrial premature contractions 9.5%, and left bundle branch block 6.1%. Patients with severe systolic heart failure had prolonged QRS (P = 0.02 and prolonged QTc (P = 0.01 as compared to the other group. Conclusions: Sinus tachycardia and atrial fibrillation/flutter were common arrhythmias in patients with systolic heart failure. Patients with severe systolic heart failure had statistically significant prolongation of the QRS duration and QTc interval.

  8. Adiponectin, diabetes and ischemic heart failure: a challenging relationship

    Directory of Open Access Journals (Sweden)

    Baldasseroni Samuele

    2012-12-01

    Full Text Available Abstract Background Several peptides, named adipokines, are produced by the adipose tissue. Among those, adiponectin (AD is the most abundant. AD promotes peripheral insulin sensitivity, inhibits liver gluconeogenesis and displays anti-atherogenic and anti-inflammatory properties. Lower levels of AD are related to a higher risk of myocardial infarction and a worse prognosis in patients with coronary artery disease. However, despite a favorable clinical profile, AD increases in relation to worsening heart failure (HF; in this context, higher adiponectinemia is reliably related to poor prognosis. There is still little knowledge about how certain metabolic conditions, such as diabetes mellitus, modulate the relationship between AD and HF. We evaluated the level of adiponectin in patients with ischemic HF, with and without type 2 diabetes, to elucidate whether the metabolic syndrome was able to influence the relationship between AD and HF. Results We demonstrated that AD rises in patients with advanced HF, but to a lesser extent in diabetics than in non-diabetics. Diabetic patients with reduced systolic performance orchestrated a slower rise of AD which began only in face of overt HF. The different behavior of AD in the presence of diabetes was not entirely explained by differences in body mass index. In addition, NT-proBNP, the second strongest predictor of AD, did not differ significantly between diabetic and non-diabetic patients. These data indicate that some other mechanisms are involved in the regulation of AD in patients with type 2 diabetes and coronary artery disease. Conclusions AD rises across chronic heart failure stages but this phenomenon is less evident in type 2 diabetic patients. In the presence of diabetes, the progressive increase of AD in relation to the severity of LV dysfunction is hampered and becomes evident only in overt HF.

  9. Heart failure and cardiorenal syndrome in the elderly.

    Science.gov (United States)

    Santoro, Antonio

    2012-01-01

    In the view of the aging of the general population and particularly the aging of the dialysis population, it is of considerable interest to examine the combined effects of age and uremia on cardiovascular status. The effects of uremia per se interact with the effects of aging in cardiovascular end-organ damage and in the genesis of heart failure (HF) and cardiorenal syndrome (CRS). Structural abnormalities with fibrosis and calcification of the heart and central arteries, along with autonomic nervous system dysfunction, underlie reduced cardiac performance leading to cardiac decompensation and HF. HF in the elderly is characterized by the heart's inability to maintain an adequate cardiac output and may be the result of systolic dysfunction or reduced compliance and diastolic dysfunction. In the elderly, HF symptoms are generally light, upon admission to the hospital, while HF is sometimes in an advanced stage. The pathophysiology of CRS involves interrelated hemodynamic and neurohormonal mechanisms that in the elderly are often increased/emphasized because there is no compensatory response. The therapy of HF and CRS in the elderly with chronic kidney disease is almost entirely empirical since there are no large trials of drugs to reduce mortality and morbidity in this setting. This may lead nephrologists and cardiologists managing these patients toward a sort of "therapeutic nihilism." But this is not the attitude we should adopt in the elderly. Instead we should make a rather careful assessment of each patient and use a personalized treatment that takes into consideration the characteristics of the individual patient and his or her cardiac and renal history as well as social context. PMID:23032915

  10. Impact of chemical elements on heart failure progression in coronary heart disease patients

    Directory of Open Access Journals (Sweden)

    Cherniavsky Aleksander

    2011-05-01

    Full Text Available Background. The high prevalence, poor prog-nosis of patients with coronary heart disease with chronic heart failure determine the relevance of the study pathophysiological and molecular mechanisms of this pathology. Researches of the trace element metabolism in the myocardium are scarce. With this in mind, an attempt was made to analyze the relationship of macro and trace elements metabolism with the functional state of the myocardium in coronary heart disease patients against the background of chronic heart failure progression. Methods and Results. To study the content of the chemical elements (S, K, Ca, Cr, Fe, Ni, Cu, Zn, Se, Rb, Sr in the myocardium of 43 patients with coronary heart disease, use was made of X-ray fluorescence with synchrotron radiation. While doing autopsy, 43 samples of left ventricle myocardium were taken off the cardiac callosity. Myocardium samples were subjected to histological examination. Dynamics of macro and trace elements content in the myocardium reflects the development of energy deficiency and disorders of myocardial microcirculation with a decrease of systolic myocardial function. Structural/functional disorders in the myocardium of the left ventricle of patients with coronary heart disease that accompany the progression of chronic heart failure are associated with profound changes of metabolic processes in heart muscle. Conclusions. The structural/ functional changes accompanying chronic heart failure progression are associated with wide variations of metabolic processes in the myocardium, which could be evaluated by the content of chemical elements in tissue.

  11. The cardiac enigma: current conundrums in heart failure research [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Michael S. Kapiloff

    2016-01-01

    Full Text Available The prevalence of heart failure is expected to increase almost 50% in the next 15 years because of aging of the general population, an increased frequency of comorbidities, and an improved survival following cardiac events. Conventional treatments for heart failure have remained largely static over the past 20 years, illustrating the pressing need for the discovery of novel therapeutic agents for this patient population. Given the heterogeneous nature of heart failure, it is important to specifically define the cellular mechanisms in the heart that drive the patient’s symptoms, particularly when considering new treatment strategies. This report highlights the latest research efforts, as well as the possible pitfalls, in cardiac disease translational research and discusses future questions and considerations needed to advance the development of new heart failure therapies. In particular, we discuss cardiac remodeling and the translation of animal work to humans and how advancements in our understanding of these concepts relative to disease are central to new discoveries that can improve cardiovascular health.

  12. DETECTING CONGESTIVE HEART FAILURE USING HEART RATE SEQUENTIAL TREND ANALYSIS PLOT

    Directory of Open Access Journals (Sweden)

    SRINIVAS KUNTAMALLA,

    2010-12-01

    Full Text Available Heart rate variability analysis is gaining acceptance as a potential non-invasive means of autonomic nervous system assessment in research as well as clinical domains. In this study, a nonlinear analysis method is developed to detect congestive heart failure. The data obtained from an online and widely used public database (i.e., MIT/BIH physionet database, is used for testing the performance of the method. The method developed is based on the sequential trend analysis plot of heart rate variability and correlates well with the characteristic autonomic nervous system regulations in congestive heart failure. The proposed method can be used for screening as well as diagnosing the heart failure patients. The algorithm is computationally simple and can be implemented in a real time processing hardware. This method classifies 31 out of 32 subjects and has the highest discrimination power in terms of sensitivity, specificity and accuracy.

  13. Palliative care in heart failure : a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology

    NARCIS (Netherlands)

    Jaarsma, Tiny; Beattie, James M.; Ryder, Mary; Rutten, Frans H.; McDonagh, Theresa; Mohacsi, Paul; Murray, Scott A.; Grodzicki, Thomas; Bergh, Ingrid; Metra, Marco; Ekman, Inger; Angermann, Christiane; Leventhal, Marcia; Pitsis, Antonis; Anker, Stefan D.; Gavazzi, Antonello; Ponikowski, Piotr; Dickstein, Kenneth; Delacretaz, Etienne; Blue, Lynda; Strasser, Florian; McMurray, John

    2009-01-01

    Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as ref

  14. Evolution of biomarker guided therapy for heart failure: current concepts and trial evidence.

    Science.gov (United States)

    Pruett, Amanda E; Lee, Amanda K; Patterson, J Herbert; Schwartz, Todd A; Glotzer, Jana M; Adams, Kirkwood F

    2015-01-01

    Optimizing management of patients with heart failure remains quite challenging despite many significant advances in drug and device therapy for this syndrome. Although a large body of evidence from robust clinical trials supports multiple therapies, utilization of these well-established treatments remains inconsistent and outcomes suboptimal in "real-world" patients with heart failure. Disease management programs may be effective, but are difficult to implement due to cost and logistical issues. Another approach to optimizing therapy is to utilize biomarkers to guide therapeutic choices. Natriuretic peptides provide additional information of significant clinical value in the diagnosis and estimation of risk inpatients with heart failure. Ongoing research suggests a potential important added role for natriuretic peptides in heart failure. Guiding therapy based on serial changes in these biomarkers may be an effective strategy to optimize treatment and achieve better outcomes in this syndrome. Initial, innovative, proof-of-concept studies have provided encouraging results and important insights into key aspects of this strategy, but well designed, large-scale, multicenter, randomized, outcome trials are needed to definitively establish this novel approach to management. Given the immense and growing public health burden of heart failure, identification of cost-effective ways to decrease the morbidity and mortality due to this syndrome is critical. PMID:24251462

  15. Study of adherence to exercise in heart failure: the HEART camp trial protocol

    OpenAIRE

    Pozehl, Bunny J; Duncan, Kathleen; Hertzog, Melody; McGuire, Rita; Norman, Joseph F.; Artinian, Nancy T.; Keteyian, Steven J.

    2014-01-01

    Background Adherence to the Heart Failure Society of America (HFSA) 2010 guidelines recommending 30 minutes of supervised moderate intensity exercise five days per week is difficult for patients with heart failure (HF). Innovative programs are needed to assist HF patients to adhere to long-term exercise. The objective of this prospective randomized two-group repeated measures experimental design is to determine the efficacy of a behavioral exercise training intervention on long-term adherence...

  16. Neprilysin and Natriuretic Peptide Regulation in Heart Failure.

    Science.gov (United States)

    Bayes-Genis, Antoni; Morant-Talamante, Nuria; Lupón, Josep

    2016-08-01

    Neprilysin is acknowledged as a key player in neurohormonal regulation, a cornerstone of modern drug therapy in chronic heart failure. In the cardiovascular system, neprilysin cleaves numerous vasoactive peptides, some with mainly vasodilating effects (natriuretic peptides, adrenomedullin, bradykinin) and other with mainly vasoconstrictor effects (angiotensin I and II, endothelin-1). For decades, neprilysin has been an important biotarget. Academia and industry have combined active efforts to search for neprilysin inhibitors (NEPIs) that might be useful in clinical practice. NEPI monotherapy was initially tested with little success due to efficacy issues. Next, combination of NEPI and ACE-inhibiting activity agents were abandoned due to safety concerns. Recently, the combination of NEPI and ARB, also known as ARNI, has shown better than expected results in heart failure with reduced ejection fraction, and multitude of ongoing studies are set to prove its value across the heart failure spectrum. PMID:27260315

  17. Increased mortality after dronedarone therapy for severe heart failure

    DEFF Research Database (Denmark)

    Køber, Lars; Torp-Pedersen, Christian; McMurray, John J V; Gøtzsche, Ole; Lévy, Samuel; Crijns, Harry; Amlie, Jan; Carlsen, Jan

    2008-01-01

    BACKGROUND: Dronedarone is a novel antiarrhythmic drug with electrophysiological properties that are similar to those of amiodarone, but it does not contain iodine and thus does not cause iodine-related adverse reactions. Therefore, it may be of value in the treatment of patients with heart failure....... METHODS: In a multicenter study with a double-blind design, we planned to randomly assign 1000 patients who were hospitalized with symptomatic heart failure and severe left ventricular systolic dysfunction to receive 400 mg of dronedarone twice a day or placebo. The primary end point was the composite of...... death from any cause or hospitalization for heart failure. RESULTS: After inclusion of 627 patients (310 in the dronedarone group and 317 in the placebo group), the trial was prematurely terminated for safety reasons, at the recommendation of the data and safety monitoring board, in accordance with the...

  18. Telerehabilitation in heart failure patients: The evidence and the pitfalls.

    Science.gov (United States)

    Piotrowicz, Ewa; Piepoli, Massimo F; Jaarsma, Tiny; Lambrinou, Ekaterini; Coats, Andrew J S; Schmid, Jean-Paul; Corrà, Ugo; Agostoni, Piergiuseppe; Dickstein, Kenneth; Seferović, Petar M; Adamopoulos, Stamatis; Ponikowski, Piotr P

    2016-10-01

    Accessibility to the available traditional forms of cardiac rehabilitation programs in heart failure patients is not adequate and adherence to the programs remains unsatisfactory. The home-based telerehabilitation model has been proposed as a promising new option to improve this situation. This paper's aims are to discuss the tools available for telemonitoring, and describing their characteristics, applicability, and effectiveness in providing optimal long term management for heart failure patients who are unable to attend traditional cardiac rehabilitation programs. The critical issues of psychological support and adherence to the telerehabilitation programs are outlined. The advantages and limitations of this long term management modality are presented and compared with alternatives. Finally, the importance of further research, multicenter studies of telerehabilitation for heart failure patients and the technological development needs are outlined, in particular interactive remotely controlled intelligent telemedicine systems with increased inter-device compatibility. PMID:27390963

  19. Ventricular assist devices for heart failure: a focus on patient selection and complications

    Directory of Open Access Journals (Sweden)

    Cipriani M

    2014-09-01

    Full Text Available Manlio Cipriani, Vincenzo De Simone, Luciana D'Angelo, Enrico Perna, Marzia Lilliu, Virginia Bovolo, Fabrizio Oliva, Maria Frigerio Cardiovascular and Thoracic Department, A De Gasperis Niguarda Ca' Granda Hospital, Milan, Italy Abstract: Heart transplantation represents the “gold standard” for the treatment of patients with end-stage heart failure, but remains challenged by inadequate donor supply, finite graft survival, and long-term complications arising from immunosuppressive therapy. In addition, a lot of patients waiting for a heart transplant experience clinical deterioration, and other patients become ineligible to undergo this treatment due to their age or relevant comorbidities. Left ventricular assist devices have emerged as a valid therapeutic option for advanced heart failure. In recent years, we have seen significant advances not only in the technologies available, but also in patient selection, indications for use, and management after implantation. Consequently, there has been an increase in the number of implants and an improvement in the survival rate and quality of life for these patients. At the same time, there are new challenges on the horizon. Patient selection is a difficult process, based on clinical and imaging parameters and risk scores, and more data are needed to refine patient selection criteria and the timing of the implant. Left ventricular assist device-related complications are still a serious problem, causing adverse events and hospital readmissions. Continuous progress in the development of these implantable devices, such as a further reduction in size and hopefully the abolition of the external driveline, will probably make ventricular assist devices an option also for less advanced stages of heart failure. Here, we discuss the current indications for left ventricular assist device implantation, patient selection criteria, and the most frequent complications associated with these devices. Keywords

  20. The ubiquitin proteasome system in human cardiomyopathies and heart failure

    OpenAIRE

    Day, Sharlene M.

    2013-01-01

    Maintenance of protein quality control is a critical function of the ubiquitin proteasome system (UPS). Evidence is rapidly mounting to link proteasome dysfunction with a multitude of cardiac diseases, including ischemia, reperfusion, atherosclerosis, hypertrophy, heart failure, and cardiomyopathies. Recent studies have demonstrated a remarkable level of complexity in the regulation of the UPS in the heart and suggest that our understanding of how UPS dysfunction might contribute to the patho...

  1. Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure.

    Science.gov (United States)

    McDougall, A; Goldszmidt, M; Kinsella, E A; Smith, S; Lingard, L

    2016-09-01

    Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 "Team Sampling Units" (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams 'disentangled' fluid in order to focus on its physiological function and mobilisation. Teams also used distinct 'framings' of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease. PMID:27490299

  2. Prevalence, prognostic significance, and treatment of atrial fibrillation in congestive heart failure with particular reference to the DIAMOND-CHF study

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Brendorp, Bente; Køber, Lars;

    2003-01-01

    failure and the prevalence increases with the severity of the disease. These two conditions seem to be linked together, and congestive heart failure may either be the cause or the consequence of atrial fibrillation. The prognosis of atrial fibrillation is controversial, but studies indicate that atrial...... fibrillation is a risk factor in congestive heart failure patients. In the last 10-15 years, significant advances in the treatment of heart failure have improved survival, whereas effective management of atrial fibrillation in heart failure patients still awaits similar progress. Empirically, two strategies...

  3. Cognitive and psycholologic considerations in pediatric heart failure.

    Science.gov (United States)

    Hollander, Seth A; Callus, Edward

    2014-10-01

    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

  4. Epidemiology of heart failure with preserved ejection fraction

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Vasan, Ramachandran S

    2014-01-01

    Heart failure with preserved ejection fraction (HFPEF) is a common condition, and the prevalence is projected to increase further. Studies differ in the reported incidence and mortality associated with this condition, although there is agreement that between a third and one-half of all patients...... with heart failure have HFPEF. Although several consensus statements and guidelines have been published, some recent randomized clinical trials have reported low mortality, raising doubts about whether all patients diagnosed with HFPEF have HFPEF or whether the condition is heterogeneous in its cause...

  5. Exercise Intolerance In Heart Failure With Preserved Ejection Fraction

    Science.gov (United States)

    Gupte, Anisha A.; Hamilton, Dale J.

    2016-01-01

    More than 50% of Americans with heart failure have preserved ejection fraction (HFpEF). Exercise intolerance is a hallmark of HFpEF, but the pathophysiology is not well understood. Diverse etiologies and incomplete mechanistic understanding have resulted in ineffective management strategies to improve the outcomes of HFpEF. Traditional therapies that have been beneficial in the treatment of heart failure with reduced ejection fraction (HFrEF), neurohormonal blockade in particular, have not been effective in treating HFpEF. In this review, we address underlying mechanisms of HFpEF and present the rationale supporting exercise as a component of comprehensive management.

  6. Distribution side of pleural effusion in heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Park, Cheol Kyu; Park, Young Ha; Jung, Se Young; Park, Seog Hee; Bahk, Yong Whee [Catholic University Medical College, Seoul (Korea, Republic of)

    1988-02-15

    The interrelationship between the etiology of pleural effusion and the side of its occurrence has been a subject of clinical interest for many years. It has often been stated that pleural effusion caused by congestive heart failure tends to occur on the right side. However, some authors contended that such a side proclivity is not reliable. In the present study, the authors investigated the laterally of effusion caused by various cardiovascular diseases complicated by heart failure. We reviewed the chest X-ray films and clinical records of 68 patients with proven pleural effusion resulted from heart failure. 1. There were 34 men and 34 women with the age ranging from 10 to 84 years with the mean of 59. 2. The diagnoses were rheumatic heart disease (2 patients), coronary heart disease (10 patients), hypertensive heart disease (8 patients), mitral valvular disease (18 patients), aortic valvular disease (3 patients), and miscellaneous (27 patients). 3. 34 patients had unilateral pleural effusion, 25 and 9, right and left, respectively. Of the 34 patients with bilateral effusion, 13 patients had predominantly right-sided effusion, 5 patients had predominantly left-sided effusion and 16 patients had evenly distributed bilateral effusion. Thus, 55.8% of effusion was right-sided.

  7. Heart failure re-admission: measuring the ever shortening gap between repeat heart failure hospitalizations.

    Directory of Open Access Journals (Sweden)

    Jeffrey A Bakal

    Full Text Available 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Gaui, Eduardo Nagib, E-mail: engaui@cardiol.br; Oliveira, Gláucia Maria Moraes de [Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Klein, Carlos Henrique [Escola Nacional de Saúde Pública Sérgio Arouca da Fundação Oswaldo Cruz, Rio de Janeiro, RJ (Brazil)

    2014-06-15

    Circulatory system diseases are the first cause of death in Brazil. 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. 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. 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. 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.

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

    International Nuclear Information System (INIS)

    Circulatory system diseases are the first cause of death in Brazil. 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. 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. 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. 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

  10. Heart failure in very elderly population- a profile of heart failure in patients over the age of eighty

    Institute of Scientific and Technical Information of China (English)

    Christopher V.Chien; Dani Hackner; Ernst R. Schwarz

    2007-01-01

    Objective Heart failure is an epidemic in the elderly, but there is a striking lack of data in this clinically important patient population. We investigated the demographics, cardiac performance, and medication management of a segment of the hospital population in at least their eighth decade of life. Methods We retrospectively reviewed 75 records of heart failure patients who were 80 years of age or older. Records were reviewed for demographic information, presence or absence of diastolic dysfunction, evaluation of ejection fraction, and medication usage including angiotensin-concerting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBs),beta-adrenergic blockers, digoxin, and aldosterone antagonists. Assessment for contra-indications to ACE inhibitor or ARBs use was also performed to assess co-morbidities that limit treatment of heart failure. Results The population of very elderly with heart failure is heterogeneous. We found a higher proportion of females as well as higher rates of diastolic dysfunction in patients aged ≥ 90 years compared to patients between the ages of 80-89 years. Usage of ACE inhibitors, ARBs and beta-adrenergic blockers was strikingly low throughout the very elderly population. While co-morbid conditions limited use of agents in many cases, there was a lack of explicit contra-indication in most patients not on an ACE inhibitor or an ARB. Conclusions Heart failure is not a single disease processes, but a continuum of disease processes that vary with age. The elderly with heart failure are an undertreated population, in part due to the multitude of co-morbidities that affect them. Further prospective studies are needed to better understand the physiology and ideal treatment regiment in this growing population.

  11. Optimal medical therapy in chronic heart failure-an audit

    International Nuclear Information System (INIS)

    Objective: Systolic heart failure is a chronic condition with significant morbidity and mortality. Evidence based optimal medical therapy (OMT) has been shown to reduce mortality. Underuse of OMT due to multiple reasons has been a consistent problem. The study objective was to audit the use of OMT in patients with heart Failure. Study Design: Descriptive study. Place and Duration of study: This audit was carried out in AFIC-NIHD from April 2011- February 2012. Material and Methods: Seventy consecutive stage D heart failure patients were included in the study. The patients were assessed clinically by a cardiologist and all previous documentations, referral letters, prescriptions, and purchase receipts were reviewed. To identify any other medication patients might have been taking (which did not appear on the prescriptions) patients were asked to identify common medicine packs. The patients underwent a detailed clinical evaluation including history, physical examination. Relevant investigations were done. ACCF/AHA (American College of Cardiology Foundation / American Heart Association) and ESC (European Society of Cardiology) guidelines for the diagnosis and treatment of acute and chronic heart failure were taken as standard of care. Results: In our audit we found that a large proportion of patients who were at high risk as per the Seattle Heart Failure Model (SHFM) were not on OMT, only 4.3% of the patients were on beta blockers that have been shown to improve mortality in the large randomized clinical trials, 64.3% were not taking any beta blockers where as 55.7% were not on ACE inhibitors and adding the OMT greatly reduced their mortality risk. Conclusions: We concluded that a large proportion of patients were not on OMT despite not having any contraindication to such therapy. This deprives them of significant survival benefit. (author)

  12. Heart failure: when form fails to follow function.

    Science.gov (United States)

    Katz, Arnold M; Rolett, Ellis L

    2016-02-01

    Cardiac performance is normally determined by architectural, cellular, and molecular structures that determine the heart's form, and by physiological and biochemical mechanisms that regulate the function of these structures. Impaired adaptation of form to function in failing hearts contributes to two syndromes initially called systolic heart failure (SHF) and diastolic heart failure (DHF). In SHF, characterized by high end-diastolic volume (EDV), the left ventricle (LV) cannot eject a normal stroke volume (SV); in DHF, with normal or low EDV, the LV cannot accept a normal venous return. These syndromes are now generally defined in terms of ejection fraction (EF): SHF became 'heart failure with reduced ejection fraction' (HFrEF) while DHF became 'heart failure with normal or preserved ejection fraction' (HFnEF or HFpEF). However, EF is a chimeric index because it is the ratio between SV - which measures function, and EDV - which measures form. In SHF the LV dilates when sarcomere addition in series increases cardiac myocyte length, whereas sarcomere addition in parallel can cause concentric hypertrophy in DHF by increasing myocyte thickness. Although dilatation in SHF allows the LV to accept a greater venous return, it increases the energy cost of ejection and initiates a vicious cycle that contributes to progressive dilatation. In contrast, concentric hypertrophy in DHF facilitates ejection but impairs filling and can cause heart muscle to deteriorate. Differences in the molecular signals that initiate dilatation and concentric hypertrophy can explain why many drugs that improve prognosis in SHF have little if any benefit in DHF. PMID:26497163

  13. Severe tricuspid regurgitation and isolated right heart failure due to thyrotoxicosis

    OpenAIRE

    Bonou, Maria; Lampropoulos, Konstantinos M; Andriopoulou, Maria; Kotsas, Dimitrios; Lakoumentas, John; Barbetseas, John

    2012-01-01

    We describe the case of a patient presented with isolated right heart failure with atrial fibrillation and severe tricuspid regurgitation due to hyperthyroidism. Treatment of the thyroid disease resulted in the disappearance of signs of right heart failure and resolution of the valve incompetence and normalization of the heart rhythm. Although thyrotoxicosis may be associated with congestive heart failure, isolated right heart failure with marked tricuspid regurgitation is rarely seen.

  14. AAV-mediated gene therapy for heart failure: enhancing contractility and calcium handling

    OpenAIRE

    Zouein, Fouad A.; Booz, George W.

    2013-01-01

    Heart failure is a progressive, debilitating disease that is characterized by inadequate contractility of the heart. With an aging population, the incidence and economic burden of managing heart failure are anticipated to increase substantially. Drugs for heart failure only slow its progression and offer no cure. However, results of recent clinical trials using recombinant adeno-associated virus (AAV) gene delivery offer the promise, for the first time, that heart failure can be reversed. The...

  15. Demographics, Clinical Characteristics, Management, and Outcomes of Acute Heart Failure Patients: Observations from the Oman Acute Heart Failure Registry

    OpenAIRE

    Prashanth Panduranga; Kadhim Sulaiman; Ibrahim Al-Zakwani; Aouf AbdlRahman Alazzawi; Abraham Abraham; Prit Pal Singh; Narayan Anantha Narayan; Mamatha Punjee Rajarao; Mohammed Ahmed Khdir; Mohamad Abdlraheem; Aftab Ahmed Siddiqui; Hisham Soliman; Osama Abdellatif Elkadi; Ruchir Kumar Bichu; Kumayl Hasan Al Lawati

    2016-01-01

    Objectives: We sought to describe the demographics, clinical characteristics, management and outcomes of patients in Oman with acute heart failure (AHF) as part of the Gulf aCute heArt failuRe rEgistry (CARE) project. Methods: Data were analyzed from 988 consecutive patients admitted with AHF to 12 hospitals in Oman between 14 February and 14 November 2012. Results: The mean age of our patients was 63±12 years. Over half (57%) were male and 95% were Omani citizens. Fifty-seven percent...

  16. Newer treatments for decompensated heart failure: focus on levosimendan

    Directory of Open Access Journals (Sweden)

    Ferenc Follath

    2009-03-01

    Full Text Available Ferenc FollathUniversity Hospital Zürich, Steering Group Drug Therapy, Zürich, SwitzerlandAbstract: Acute heart failure (AHF is a major cause of hospitalizations. Severe dyspnea, pulmonary congestion and low cardiac output with peripheral vasoconstriction and renal hypoperfusion is a main form of clinical presentation. Most patients with acute worsening have a pre-existing decompensated chronic heart failure (ADCHF, but AHF may also occur as a first manifestation of a previously unknown heart disease. Myocardial ischemia, cardiac arrhythmias, non-compliance with medication and infections are frequent precipitating factors. Management of AHF depends on the underlying heart disease and cause of decompensation. In patients with ADCHF vasodilators and iv diuretics are first-line drugs for rapid reduction of dyspnea and congestion. In patients with signs of low cardiac output and oliguria, inotropic agents are also often administered to prevent further deterioration. Beta-adrenergic agents and phosphodiesterase inhibitors correct the hemodynamic disturbance, but may also induce arrhythmias and worsen myocardial ischemia. Inotropic therapy therefore remains controversial. A novel class of drugs, the calcium sensitizers, represent a new therapeutic option. Levosimendan was shown to improve myocardial contractility without increasing oxygen requirements and to produce peripheral and coronary vasodilation. Its therapeutic effects and tolerance have been tested in several trials. The present review focuses on the clinical pharmacology and therapeutic utility of levosimendan in patients with ADCHF.Keywords: acute heart failure, inotropic agents, calcium sensitizers, levosimendan

  17. Hypochloremia and Diuretic Resistance in Heart Failure : Mechanistic Insights

    NARCIS (Netherlands)

    Hanberg, Jennifer S; Rao, Veena; Ter Maaten, Jozine M; Laur, Olga; Brisco, Meredith A; Perry Wilson, F; Grodin, Justin L; Assefa, Mahlet; Samuel Broughton, J; Planavsky, Noah J; Ahmad, Tariq; Bellumkonda, Lavanya; Tang, W H Wilson; Parikh, Chirag R; Testani, Jeffrey M

    2016-01-01

    BACKGROUND: Recent epidemiological studies have implicated chloride, rather than sodium, as the driver of poor survival previously attributed to hyponatremia in heart failure. Accumulating basic science evidence has identified chloride as a critical factor in renal salt sensing. Our goal was to prob

  18. Chronic obstructive pulmonary disease in patients admitted with heart failure

    DEFF Research Database (Denmark)

    Iversen, K K; Kjaergaard, J; Akkan, D;

    2008-01-01

    OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is an important differential diagnosis in patients with heart failure (HF). The primary aims were to determine the prevalence of COPD and to test the accuracy of self-reported COPD in patients admitted with HF. Secondary aims were to study a...

  19. Dronedarone in patients with congestive heart failure: insights from ATHENA

    DEFF Research Database (Denmark)

    Hohnloser, Stefan H; Crijns, Harry J G M; van Eickels, Martin;

    2010-01-01

    Dronedarone is a new multichannel blocking antiarrhythmic drug for treatment of atrial fibrillation (AF). In patients with recently decompensated congestive heart failure (CHF) and depressed LV function, the drug was associated with excess mortality compared with a placebo group. The present study...

  20. Hemostatic biomarkers in dogs with chronic congestive heart failure

    DEFF Research Database (Denmark)

    Tarnow, Inge; Falk, Torkel; Tidholm, Anna;

    2007-01-01

    Background: Chronic congestive heart failure (CHF) in humans is associated with abnormal hemostasis, and abnormalities in hemostatic biomarkers carry a poor prognosis. Alterations in hemostatic pathways can be involved in the pathogenesis of CHF in dogs, and microthrombosis in the myocardium could...

  1. Management of atrial fibrillation in patients with heart failure

    NARCIS (Netherlands)

    Neuberger, Hans-Ruprecht; Mewis, Christian; van Veldhuisen, Dirk J.; Schotten, Ulrich; van Gelder, Isabelle C.; Allessie, Maurits A.; Boehm, Michael

    2007-01-01

    Atrial. fibrillation (AF) and chronic heart failure (CHF) are two major and even growing cardiovascular conditions that often coexist. However, few data are available to guide treatment of AF in patients with CHF. This review summarizes current literature concerning the following topics: (i) prognos

  2. The case for statin therapy in chronic heart failure

    NARCIS (Netherlands)

    van der Harst, Pim; Boehm, Michael; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    2008-01-01

    Both primary and secondary prevention studies have provided a wealth of evidence that statin therapy effectively reduces cardiovascular events. However, this general statement on the efficacy and safety of statin treatment has not been validated in patients with chronic heart failure (CHF). Recently

  3. Sleep apnoea, heart failure, and atrial fibrillation—quo vadis?

    OpenAIRE

    Chahal, C. Anwar A.; Somers, Virend K.

    2015-01-01

    Strong associations exist between sleep disordered breathing (SDB) and both heart failure (HF) and atrial fibrillation (AF). Burgeoning epidemics of obesity, SDB, HF, and AF make these conditions priorities for health-care policymakers. Two observational studies now suggest outcome benefits from screening and treating for SDB in AF and HF.

  4. Neurohormonal and clinical sex differences in heart failure

    NARCIS (Netherlands)

    Meyer, Sven; van der Meer, Peter; van Deursen, Vincent M.; Jaarsma, Tiny; van Veldhuisen, Dirk J.; van der Wal, Martje H. L.; Hillege, Hans L.; Voors, Adriaan A.

    2013-01-01

    Despite disparities in pathophysiology and disease manifestation between male and female patients with heart failure, studies focusing on sex differences in biomarkers are scarce. The purpose of this study was to assess sex-specific variation in clinical characteristics and biomarker levels to gain

  5. Unraveling the mechanisms for heart failure patients' beliefs about compliance

    NARCIS (Netherlands)

    van der Wal, Martje H. L.; Jaarsma, Tiny; Moser, Debra K.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    2007-01-01

    BACKGROUND: Compliance with medication, diet, and monitoring symptoms is a problem in heart failure (HF) patients. Noncompliance can lead to worsening symptoms and is associated with personal beliefs about compliance. To intervene effectively, knowledge of factors related to patients' beliefs about

  6. Exercise-based cardiac rehabilitation in patients with heart failure

    DEFF Research Database (Denmark)

    Lewinter, Christian; Doherty, Patrick; Gale, Christopher P;

    2015-01-01

    BACKGROUND: Guidelines recommend exercise-based cardiac rehabilitation (EBCR) for patients with heart failure (HF). However, established research has not investigated the longer-term outcomes including mortality and hospitalisation in light of the contemporary management of HF. METHODS: This was a...

  7. Vitamin B-12 and folate deficiency in chronic heart failure

    NARCIS (Netherlands)

    van der Wal, Haye H.; Comin-Colet, Josep; Klip, Ijsbrand T.; Enjuanes, Cristina; Grote Beverborg, Niels; Voors, Adriaan A.; Banasiak, Waldemar; van Veldhuisen, Dirk J.; Bruguera, Jordi; Ponikowski, Piotr; Jankowska, Ewa A.; van der Meer, Peter

    2015-01-01

    Objective To determine the prevalence, clinical correlates and the effects on outcome of vitamin B-12 and folic acid levels in patients with chronic heart failure (HF). Methods We studied an international pooled cohort comprising 610 patients with chronic HF. The main outcome measure was all-cause m

  8. Heart failure in the elderly: a U.S. Perspective

    Institute of Scientific and Technical Information of China (English)

    Michael W. Rich

    2006-01-01

    @@ Heart failure (HF) affects 5 million Americans, of whom three-fourths are over age 65 and half are over age 75.1 HF is currently the leading cause of hospitalization among older adults in the U.S., and it is the most costly medical illness by a factor of almost two.

  9. Gender and survival in patients with heart failure

    DEFF Research Database (Denmark)

    Martínez-Sellés, Manuel; Doughty, Robert N; Poppe, Katrina; Whalley, Gillian A; Earle, Nikki; Tribouilloy, Christophe; McMurray, John J V; Swedberg, Karl; Køber, Lars; Berry, Colin; Squire, Iain; Boesgaard, Søren; Wendelboe Nielsen, Olav; Torp-Pedersen, Christian Tobias

    2012-01-01

    The aim of this study was to investigate the relationship between gender and survival of patients with heart failure, using data from both randomized trials and observational studies, and the relative contribution of age, left ventricular systolic function, aetiology, and diabetes to differences in...

  10. TREATMENT OF CHRONIC HEART FAILURE: FOCUS ON METOPROLOL SUCCINATE

    OpenAIRE

    2015-01-01

    Advantages of metoprolol succinate in patients with chronic heart failure (CHF) are covered. Results of MERIT-HF study are taken as the main evidences. Patterns of the metoprolol succinate use in the treatment of different categories of patients with CHF (women, the elderly , severe CHF forms, CHF with concomitant hypertension or diabetes) are considered.

  11. TREATMENT OF CHRONIC HEART FAILURE: FOCUS ON METOPROLOL SUCCINATE

    Directory of Open Access Journals (Sweden)

    O. D. Ostroumova

    2015-12-01

    Full Text Available Advantages of metoprolol succinate in patients with chronic heart failure (CHF are covered. Results of MERIT-HF study are taken as the main evidences. Patterns of the metoprolol succinate use in the treatment of different categories of patients with CHF (women, the elderly , severe CHF forms, CHF with concomitant hypertension or diabetes are considered.

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

    Directory of Open Access Journals (Sweden)

    Scicchitano P

    2014-06-01

    Full Text Available Pietro Scicchitano,1 Francesca Cortese,1 Gabriella Ricci,1 Santa Carbonara,1 Michele Moncelli,1 Massimo Iacoviello,1 Annagrazia Cecere,1 Michele Gesualdo,1 Annapaola Zito,1 Pasquale Caldarola,2 Domenico Scrutinio,3 Rocco Lagioia,3 Graziano Riccioni,4 Marco Matteo Ciccone1 1Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy; 2Section of Cardiovascular Diseases, Policlinic, San Paolo Hospital, Bari, Italy; 3Section of Cardiovascular Diseases, Fondazione Maugeri, Cassano Murge, Italy; 4Intensive Cardiology Care Unit, San Camillo de Lellis Hospital, Manfredonia, Foggia, Italy Abstract: 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, β-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. Keywords: chronic heart failure, heart rate reduction, cardiac ischemic disease, heart-rate lowering drugs, funny current

  13. Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms.

    Science.gov (United States)

    Okuyama, Harumi; Langsjoen, Peter H; Hamazaki, Tomohito; Ogushi, Yoichi; Hama, Rokuro; Kobayashi, Tetsuyuki; Uchino, Hajime

    2015-03-01

    In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, we present a perspective that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 and 'heme A', and thereby ATP generation. Statins inhibit the synthesis of vitamin K2, the cofactor for matrix Gla-protein activation, which in turn protects arteries from calcification. Statins inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to suppress peroxidative stress. An impairment of selenoprotein biosynthesis may be a factor in congestive heart failure, reminiscent of the dilated cardiomyopathies seen with selenium deficiency. Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically reevaluated. PMID:25655639

  14. Stem Cell Therapy for Heart Failure

    OpenAIRE

    Michler, Robert E.

    2013-01-01

    The last decade has witnessed the publication of a large number of clinical trials primarily using bone marrow-derived stem cells as the injected cell. These “first-generation” clinical trials have advanced our understanding and shown us that (1) cell therapy is safe, (2) cell therapy has been modestly effective, and (3) in humans, bone marrow-derived stem cells do not transdifferentiate into cardiomyocytes or new blood vessels (or at least in sufficient numbers to have any effect).

  15. Nitric Oxide Synthases in Heart Failure

    OpenAIRE

    Carnicer, Ricardo; Crabtree, Mark J; Sivakumaran, Vidhya; Casadei, Barbara; Kass, David A

    2013-01-01

    Significance: The regulation of myocardial function by constitutive nitric oxide synthases (NOS) is important for the maintenance of myocardial Ca2+ homeostasis, relaxation and distensibility, and protection from arrhythmia and abnormal stress stimuli. However, sustained insults such as diabetes, hypertension, hemodynamic overload, and atrial fibrillation lead to dysfunctional NOS activity with superoxide produced instead of NO and worse pathophysiology. Recent Advances: Major strides in unde...

  16. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal;

    2016-01-01

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar...... management strategies. The probable mechanism of paroxysmal SVT can often be diagnosed from the clinical findings and a 12-lead ECG. This review describes the initial evaluation and treatment of patients with paroxysmal SVT, including distinctive features from the most important differential diagnoses....

  17. Accurate diagnoses, evidence based drugs, and new devices (3 Ds in heart failure

    Directory of Open Access Journals (Sweden)

    Bambang B. Siswanto

    2012-02-01

    Full Text Available Heart failure becomes main problem in cardiology because of increasing of heart failure patients, rehospitalization rate, morbidity, and mortality rate. The main causes of increasing heart failure problems are: (1 Successful treatment of acute myocardial infarction can be life saving, but its sequelae can cause heart failure. (2 Increasing life expectancy rate grows along with incidences of ageing related heart failure. (3 High prevalence of infection in Indonesia can cause rheumatic heart disease post Streptococcal beta hemolyticus infection, viral myocarditis, infective endocartitis, and tuberculoid pericarditis. (4 Many risk factors for coronary heart disease are often found in heart failure patients, for examples smoking, diabetes, hypercholesterolemia, hypertension, and obesity. Indonesia joined international multicentered registry in 2006. Acute Decompensated HEart failure REgistry is a web based international registry to record patient with acute decompensated heart failure treated in emergency room. It was found that heart failure patients in 5 big hospitals in Java and Bali island that joined this registry are younger, sicker and late to seek treatment. The median hospital length of stay was 7 days and in hospital mortality rate was 6.7%. The aim of this article is to give summary about essential things in diagnosing and treating heart failure patients. 3D (accurate diagnoses, evidence based drugs, and new devices are the most important but what to do and what not to do in dealing with heart failure is also useful for your daily practice. (Med J Indones 2012;21:52-8Keywords: Devices, diagnostic, drugs, heart failure

  18. Dyspnoea and worsening heart failure in patients with acute heart failure : results from the Pre-RELAX-AHF study

    NARCIS (Netherlands)

    Metra, Marco; Teerlink, John R.; Felker, G. Michael; Greenberg, Barry H.; Filippatos, Gerasimos; Ponikowski, Piotr; Teichman, Sam L.; Unemori, Elaine; Voors, Adriaan A.; Weatherley, Beth Davison; Cotter, Gad

    2010-01-01

    Although dyspnoea is the most common cause of admission for acute heart failure (AHF), more needs to be known about its clinical course and prognostic significance. The Pre-RELAX-AHF study randomized 232 subjects with AHF to placebo or four doses of relaxin and evaluated early (6-24 h Likert scale)

  19. Immunological Aspects of the Statins' Function in Patients with Heart Failure: A Report from the Annual Conference of ESC-Heart Failure 2005

    Institute of Scientific and Technical Information of China (English)

    Maciej Banach; Jaroslaw Dro(z)d(z); Piotr Okonski; Jacek Rysz

    2005-01-01

    The annual meeting of the Heart Failure Association of ESC in Lisbon, in June 2005, was exceptionally successful.There were many very interesting presentations and workshops with the unique title: Statins in heart failureCholesterol-lowering is not the only goal Heart failure (HF) is a progressive disease with coronary artery disease (CAD) as the most often underlying etiology. Treatment to prevent progression of heart failure has been targeted to reverse the consequences of HF and to a less extent the cause - the atherosclerotic plaque itself. On the average 50% of patients with heart failure are treated with lipid intervention. Lipid-lowering treatment with statins clearly reduces morbidity and mortality of patients with documented CAD. Since the prevalent etiology of heart failure is CAD, its prevention may reduce heart failure progression. However, recent studies suggest that pleiotropic effects of statins are more important than the influence related to their cholesterol lowering mechanism. Furthermore it is suggested that low levels of circulating lipoproteins and cholesterol may be independent predictors of impaired outcome in patients with heart failure. There are some possible explanations for this finding. High levels of cholesterol can be beneficial to heart failure patients; cholesterol-rich serum lipoproteins are able to modulate inflammatory immune function because they bind and detoxify bacterial lipopolysaccharide, a very strong stimulator of the release of proinflammatory cytokines that promote heart failure progression and death. So current recommendations strongly emphasize that the aim of treatment of HF is not to lower cholesterol.

  20. Atrial Fibrillation Associated with Heart Failure, Stroke and Mortality

    Directory of Open Access Journals (Sweden)

    Stefano Bordignon MD

    2012-06-01

    Full Text Available Atrial Fibrillation (AF is the most common arrhythmia in the western world. Because AF prevalence rises with age and western populations are increasingly aging, AF has been called a “growing epidemic”, especially among older persons, with social and economic consequences. AF may concur to disability and may cluster with other co-existing clinical conditions. AF is an independent risk factor for stroke by increasing the thromboembolic risk profile and is associated with heart failure severity. Among persons with AF, prevalence of stroke, coronary heart disease, peripheral artery disease, cognitive impairment and physical disability is significantly higher. AF is associated with higher risk of mortality through the association with stroke and heart failure: ischemic strokes are more severe if AF is present and AF may represent a marker of more severe heart failure. Independently of other known predictors of mortality, death rates are almost doubled by AF. AF, therefore, is a considerable source of morbidity and mortality, is associated with disability, and is a major determinant of quality of life.

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

    Science.gov (United States)

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

    2015-07-01

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

  2. ST2 and patient prognosis in chronic heart failure.

    Science.gov (United States)

    Bayes-Genis, Antoni; Zhang, Yuhui; Ky, Bonnie

    2015-04-01

    Biomarkers of cardiovascular diseases are indispensable tools for diagnosis and prognosis, and the use of several biomarkers is now considered the standard of care. New markers continue to be developed, but few prove to be substantially better than established markers. Suppression of tumorigenicity 2 (ST2) is a marker of cardiomyocyte stress and fibrosis that provides incremental value to natriuretic peptides for risk stratification of patients with a wide spectrum of cardiovascular diseases. On the basis of all available data, the 2013 American College of Cardiology and American Heart Association guidelines now recommend measurement of ST2 for additive risk stratification in patients with acute or chronic ambulatory heart failure (HF). This report provides an up-to-date overview of the clinical studies that led to the endorsement of ST2 as a cardiovascular prognostic marker in chronic HF. The presented data suggest that the addition of ST2 to a model that includes established mortality risk factors, including natriuretic peptides, substantially improves the risk stratification for death and HF hospitalization in patients with HF. ST2's prognostic value remains strong even in the subset of patients with renal insufficiency and is superior to other remodeling-fibrosis biomarkers currently being evaluated. In conclusion, these results have been repeatedly validated; thus, ST2 could be rapidly incorporated into clinical practice for risk prediction. Indeed, the body of evidence supporting the use of ST2 in chronic HF stratification continues to grow, with consistent data from cohorts around the world in single-center (Barcelona, Brussels, and San Diego cohorts) and multicenter (Penn Heart Failure Study [PHFS] and Muerte Subita en Insuficiencia Cardiac [MUSIC]) studies and in post hoc studies from clinical trials (Prospective Randomized Amlodipine Survival Evaluation 2 [PRAISE-2], Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF

  3. Skeletal muscle proton T 2 in chronic heart failure

    International Nuclear Information System (INIS)

    To evaluate the interest of proton T 2 measurement of skeletal muscle at rest and with exercise in patients with chronic heart failure, we performed associated measurements of proton T 2 using magnetic resonance imaging, of external work using ergometry, and of intra-cellular pH (pH) using magnetic resonance 31 P-spectroscopy, in skeletal muscle of the leg anterior compartment, in 37 patients with chronic heart failure. Sixteen patients were in New York Heart Association class II (NYHA II, moderate cardiac failure) and 21 in NYHA classes III-IV (severe cardiac failure). Rest T 2 was significantly increased in NYHA III-IV patients (30.9 ± 2.2 versus 32.8 ± 209 ms, p i variations were of -8 ± 4 versus -9 ± 5%, p =3D NS. The ratio of relative T 2 variations to W was significantly increased in NYPH III-IV patients (0.24 ± 0.12 versus 0.60 ± 0.41%/J, p i with exercise were coupled with external work, only in group NYHA II. T 2 variations negatively correlated with those of pHi in both groups (r=3D -0.78, pi variations with exercise which seems to depend on the exercise intensity level. (authors). 22 refs., 3 figs., 2 tabs

  4. Lack of prevention of heart failure by serial electrical cardioversion in patients with persistent atrial fibrillation

    NARCIS (Netherlands)

    Tuinenburg, AE; Van Gelder, IC; Van Den Berg, MP; Brugemann, J; De Kam, PJ; Crijns, HJGM

    1999-01-01

    Objective-To investigate the occurrence of heart failure complications, and to identify variables that predict heart failure in patients with (recurrent) persistent atrial fibrillation, treated aggressively with serial electrical cardioversion and antiarrhythmic drugs to maintain sinus rhythm. Desig

  5. Heart Failure With Normal Left Ventricular Ejection Fraction : What is the Evidence?

    NARCIS (Netherlands)

    Kindermann, Michael; Reil, Jan-Christian; Pieske, Burkert; van Veldhuisen, Dirk J.; Boehm, Michael

    2008-01-01

    Heart failure with a normal ejection fraction (HFNEF) is a common clinical problem with many unsolved questions regarding pathophysiology, diagnosis, and therapy. Although the term diastolic heart failure has been abandoned, diastolic left ventricular (LV) dysfunction together with combined systolic

  6. Effect of Cardiac Resynchronization Therapy on Inflammation in Congestive Heart Failure: A Review.

    Science.gov (United States)

    Lappegård, K T; Bjørnstad, H; Mollnes, T E; Hovland, A

    2015-09-01

    Congestive heart failure is associated with increased levels of several inflammatory mediators, and animal studies have shown that infusion of a number of cytokines can induce heart failure. However, several drugs with proven efficacy in heart failure have failed to affect inflammatory mediators, and anti-inflammatory therapy in heart failure patients has thus far been disappointing. Hence, to what extent heart failure is caused by or responsible for the increased inflammatory burden in the patient is still unclear. Over the past couple of decades, resynchronization therapy with a biventricular pacemaker has emerged as an effective treatment in a subset of heart failure patients, reducing both morbidity and mortality. Such treatment has also been shown to affect the inflammation associated with heart failure. In this study, we review recent data on the association between heart failure and inflammation, and in particular how resynchronization therapy can affect the inflammatory process. PMID:26099323

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

    Directory of Open Access Journals (Sweden)

    Adeseye A Akintunde

    2013-01-01

    Conclusion: Heart failure seems to be associated with snoring and a high risk for obstructive sleep apnea among Africans with heart failure. Assessment for sleep disordered breathing should be incorporated into their routine clinical workup.

  8. THE METHODS OF TOTAL BODY BIOIMPEDANCE SPECTROSCOPY IN ANALYSIS THE FUNCTIONAL CLASS OF CONGESTIVE HEART FAILURE

    OpenAIRE

    Ivanov, G.; Dvornicov, V.; Niculina, L.; Kotlarova, L.; Bernshtein, Ju; Pavlovich, A.

    2004-01-01

    The article presented result of studies, which determined signs an studies of total body bioimpedance spectros-copy analysis in evaluate of functional class of chronic heart failure. Key words: biompedance, congestive heart failure.

  9. Subclinical heart failure in juvenile idiopathic arthritis: a consequence of chronic inflammation and subclinical atherosclerosis

    Directory of Open Access Journals (Sweden)

    Hamada S Ahmad

    2016-01-01

    Conclusion Our findings indicate the presence of subclinical heart failure in these patients. JIA patients with subclinical atherosclerosis, with systemic disease, and with active disease are at greatest risk of developing subclinical heart failure.

  10. Cardiac resynchronization therapy in the elderly heart failure patient

    Institute of Scientific and Technical Information of China (English)

    George E. Taffet

    2005-01-01

    @@ Ms. BP is an 83 year old white female with a long history of congestive heart failure (HF). She is now symptomatic with minimal exertion, has a left ventricular ejection fraction (LVEF) of 20%. Her CHF is due to hypertension (HTN) plus coronary artery disease (CAD) and she is on angiotensin converting enzyme inhibitor (ACEI), furosemide, digoxin,spironolactone, low dose beta blocker and nitrates. Her beta-natriuretic peptide (BNP) in clinic is 3030 pg/ml, heart rate (HR) 100, blood pressure (BP) 89/43.

  11. The role of coronary artery disease in heart failure.

    Science.gov (United States)

    Lala, Anuradha; Desai, Akshay S

    2014-04-01

    Enhanced survival following acute myocardial infarction and the declining prevalence of hypertension and valvular heart disease as contributors to incident heart failure (HF) have fueled the emergence of coronary artery disease (CAD) as the primary risk factor for HF development. Despite the acknowledged role of CAD in the development of HF, the role of coronary revascularization in reducing HF-associated morbidity and mortality remains controversial. The authors review key features of the epidemiology and pathophysiology of CAD in patients with HF as well as the emerging data from recent clinical trials that inform the modern approach to management. PMID:24656111

  12. Discrimination power of long-term heart rate variability measures for Chronic Heart Failure detection

    OpenAIRE

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

    2011-01-01

    The aim of this study was to investigate the discrimination power of standard long-term Heart Rate Variability (HRV) measures for the diagnosis of Chronic Heart Failure (CHF). We performed a retrospective analysis on 4 public Holter databases, analyzing the data of 72 normal subjects and 44 patients suffering from CHF. To assess the discrimination power of HRV measures, we adopted an exhaustive search of all possible combinations of HRV measures and we developed classifiers based on Classi...

  13. Role of the Carotid Body in the Pathophysiology of Heart Failure

    OpenAIRE

    Schultz, Harold D.; Marcus, Noah J.; Rio, Rodrigo del

    2013-01-01

    Important recent advances implicate a role of the carotid body (CB) chemoreflex in sympathetic and breathing dysregulation in several cardio-respiratory diseases, drawing renewed interest in its potential implications for clinical treatment. Evidence from both chronic heart failure (CHF) patients and animal models indicates that the CB chemoreflex is enhanced in CHF, and contributes to the tonic elevation in sympathetic nerve activity (SNA) and periodic breathing associated with the disease. ...

  14. Impact of Telehealth on Healthcare Utilization by Congestive Heart Failure Patients

    OpenAIRE

    Craig A. Lehmann; Nancy Mintz; Jean Marie Giacini

    2006-01-01

    Background: Advances in telehealth are proving to be extremely conducive to effective management of congestive heart failure (CHF) and other disease states, particularly in ambulatory settings. In order to assess the impact of telehealth on healthcare utilization in CHF patients, telehealth technology was introduced into a demonstration project established by the Secretary of Health and Human Services. Demonstration projects examine health delivery factors that encourage the delivery of impro...

  15. β2 AR Agonists in Treatment of Chronic Heart Failure: Long Path to Translation

    OpenAIRE

    Talan, Mark I.; Ahmet, Ismayil; Xiao, Riu-Ping; Edward G Lakatta

    2010-01-01

    The main clinical manifestations of advanced chronic heart failure (CHF), e.g. in dilated cardiomyopathy (DCM), are reduced systolic and diastolic functions, increased arterial elastance and arterio-ventricular uncoupling, accompanied and exacerbated by an excessive sympathetic activation and extensive abnormalities in the βAR signaling. Loss of cardiomyocytes due to apoptosis is one mechanism that undoubtedly contributes to cardiac remodeling and functional deterioration associated with dila...

  16. Incidence and predictors of congestive heart failure after autologous hematopoietic cell transplantation

    OpenAIRE

    Armenian, Saro H; Sun, Can-Lan; Shannon, Tabitha; Mills, George; Francisco, Liton; Venkataraman, Kalyanasundaram; Wong, F. Lennie; Forman, Stephen J.; Bhatia, Smita

    2011-01-01

    Advances in autologous hematopoietic cell transplantation (HCT) strategies have resulted in a growing number of long-term survivors. However, these survivors are at increased risk of developing cardiovascular complications due to pre-HCT therapeutic exposures and conditioning and post-HCT comorbidities. We examined the incidence and predictors of congestive heart failure (CHF) in 1244 patients undergoing autologous HCT for a hematologic malignancy between 1988 and 2002. The cumulative inciden...

  17. “Nihilism” of chronic heart failure therapy in children and why effective therapy is withheld

    OpenAIRE

    Schranz, Dietmar; Voelkel, Norbert F.

    2016-01-01

    Major advances in chronic heart failure (cHF) therapy have been achieved and documented in adult patients, while research regarding the mechanisms and therapy of cHF in children has lagged behind. Based on receptor physiological studies and pharmacological knowledge, treatment with specific ß1-adrenergic receptor blocker (ARB), tissue angiotensin-converting enzyme inhibitor (ACE-I), and mineralocorticoid antagonists have to be recommended in children despite lack of sufficient data derived fr...

  18. [ANMCO/SIC/SIT Consensus document: The future of telemedicine in heart failure].

    Science.gov (United States)

    Di Lenarda, Andrea; Casolo, Giancarlo; Gulizia, Michele Massimo; Aspromonte, Nadia; Scalvini, Simonetta; Mortara, Andrea; Alunni, Gianfranco; Ricci, Renato Pietro; Mantovan, Roberto; Russo, Giancarmine; Gensini, Gian Franco; Romeo, Francesco

    2016-06-01

    Telemedicine applied to heart failure patients is a tool for recording, remote transmission, storage and interpretation of cardiocirculatory parameters and/or diagnostic images, useful, as emphasized by the latest guidelines, to allow for intensive home monitoring in patients with advanced heart failure or during the vulnerable post-acute phase to improve the prognosis and quality of life for patients.Recently, several meta-analyses have shown that the patterns of care supported by telemedicine are not only effective, but also economically advantageous. The benefit is unquestionable with a 30-35% reduction in mortality and a 15-20% reduction in hospitalizations. Patients implanted with cardiac devices can also benefit from an integrated remote clinical management as all modern devices can transmit technical and diagnostic data. However, telemedicine can bring benefits to the patient with heart failure only if it is part of a shared and integrated, multidisciplinary and multiprofessional "Chronic Care Model". Moreover, the future development of remote telemonitoring programs in our country goes through the primary use of products certified as medical device, field validation of organizational solutions proposed, a legislative and administrative adaptation to new care methods and the widespread growth of competence in clinical care to remotely manage the complexity of chronicity.With this consensus document the Italian Cardiology reaffirms its willingness to contribute to the government of the tumultuous and fragmented technological development, proposing a new phase of qualitative assessment, standardization of processes and testing the application of telemedicine to heart failure. PMID:27311090

  19. Heart failure in chemotherapy-related cardiomyopathy: Can exercise make a difference?

    Science.gov (United States)

    Nair, Nandini; Gongora, Enrique

    2016-12-01

    Medical therapies in oncology have resulted in better survival resulting in a large population who are at risk of early and late cardiac complications of chemotherapy. Cardiotoxicity related to chemotherapy can manifest decades after treatment with a threefold higher mortality rate as compared to idiopathic dilated cardiomyopathy. The leading cause of death in cancer survivors seems to be cardiac. Early detection and intervention could prevent progression of heart failure to end stage disease requiring advanced therapies such as implantation of ventricular assist devices or cardiac transplantation. This review focuses on the role of exercise in cardioprotection in this population. The current practice of depending on ejection fraction for diagnosis of heart failure is suboptimal to detect subclinical disease. It is also important to diagnose and treat early diastolic dysfunction as this tends to lead to heart failure with preserved ejection fraction. Hence we suggest an algorithm here that is based on using strain rate and tissue Doppler imaging modalities to detect subclinical systolic and diastolic dysfunction. Further research is warranted in terms of defining exercise prescriptions in this population. Human studies with multicenter participation in randomized controlled trials should be done to elucidate the intricacies of aerobic exercise intervention in cardiotoxicity dependent heart failure. It is also necessary to assess the utility of exercise interventions in the different chemotherapeutic regimens as they impact the outcomes. PMID:27413695

  20. REM-HF: REmote Monitoring an evaluation of implantable devices for management of Heart Failure Patients

    OpenAIRE

    Morgan, John M

    2016-01-01

    There is a pressing need to develop new ways of managing the rapidly increasing number of people living with heart failure in the UK. The epidemic of heart failure has arisen because of the rapidly ageing population and dramatic improvements in the survival from acute coronary disease and heart failure. Remote monitoring of heart failure using automated implanted devices and bespoke care pathways/protocols to give early warning of deterioration and facilitate pre-emptive action may be an impo...

  1. Therapeutic options in chronic heart failure. Findings on chest X-ray

    International Nuclear Information System (INIS)

    The contribution covers drugless therapeutic options for chronic heart failure: the implantable cardioverter/defibrillator (ICD), the cardiac resynchronization therapy (CRT), the interventional catheter treatment of functional mitral insufficiency, and mechanical heart supporting systems and heart transplantation.

  2. Intermittent claudication as a predictor of outcome in patients with ischaemic systolic heart failure : analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA)

    NARCIS (Netherlands)

    Inglis, Sally C.; McMurray, John J. V.; Boehm, Michael; Schaufelberger, Maria; van Veldhuisen, Dirk J.; Lindberg, Magnus; Dunselman, Peter; Hjalmarson, Ake; Kjekshus, John; Waagstein, Finn; Wedel, Hans; Wikstrand, John

    2010-01-01

    To examine the relationship between baseline intermittent claudication and outcomes in patients enrolled in the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA). Intermittent claudication is an independent predictor of worse outcome in coronary heart disease, but its progn

  3. Low-dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure

    NARCIS (Netherlands)

    C.A. den Uil; W.K. Lagrand; P.E. Spronk; M. van der Ent; L.S.D. Jewbali; J.J. Brugts; C. Ince; M.L. Simoons

    2009-01-01

    Impaired tissue perfusion is often observed in patients with acute heart failure. We tested whether low-dose nitroglycerin (NTG) improves microcirculatory perfusion in patients admitted for acute heart failure. In 20 acute heart failure patients, NTG was given as intravenous infusion at a fixed dose

  4. Pathways in heart failure disease management across socioeconomic spectra.

    Science.gov (United States)

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

    2011-12-01

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

  5. Quality of life in patients with chronic congestive heart failure

    Directory of Open Access Journals (Sweden)

    Anca D. Farcaş

    2011-12-01

    Full Text Available Objective: Quality of life (QOL is severely decreased in patients with chronic heart failure (CHF. Our study aims to identify the factors affecting the evaluation of QOL. Material and Methods: Clinical, demographic, social and economic data was collected from patients with CHF in NYHA class III and IV as part of a complex workup. The Minnesota Living with Heart Failure Questionnaire (MLHFQ was used to evaluate QOL. Results: QOL decreases as the NYHA class increases. Women evaluate their QOL as more severely affected than men. Age, social and economic factors modulate the perception of QOL. Conclusion: Combining demographic, social and economic data and evaluation of QOL can provide valuable and useful information for the medical management of patients with CHF.

  6. Assessment of congestive heart failure in chest radiographs

    International Nuclear Information System (INIS)

    The effect of observer variations and film-screen quality on the diagnosis of congestive heart failure based on chest radiographs was studied in 27 patients. For each patient, two films were exposed, one with the Kodak Lanex Medium system and one with the Agfa MR 400 system. The films were presented to three observers who assessed the presence of congestive heart failure on a three-graded scale. The results showed no significant difference between the two systems but large systematic differences between the observers. There were also differences between the two ratings by the same observer that could not be explained by the film-screen factor. It is concluded that the choice between these two systems is of little importance in view of the interobserver and intraobserver variability that can exist within the same department. (orig.)

  7. Demographics, Clinical Characteristics, Management, and Outcomes of Acute Heart Failure Patients: Observations from the Oman Acute Heart Failure Registry

    Directory of Open Access Journals (Sweden)

    Prashanth Panduranga

    2016-05-01

    Full Text Available Objectives: We sought to describe the demographics, clinical characteristics, management and outcomes of patients in Oman with acute heart failure (AHF as part of the Gulf aCute heArt failuRe rEgistry (CARE project. Methods: Data were analyzed from 988 consecutive patients admitted with AHF to 12 hospitals in Oman between 14 February and 14 November 2012. Results: The mean age of our patients was 63±12 years. Over half (57% were male and 95% were Omani citizens. Fifty-seven percent of patients presented with acute decompensated chronic heart failure (ADCHF while 43% had new-onset AHF. The primary comorbid conditions were hypertension (72%, coronary artery disease (55%, and diabetes mellitus (53%. Ischemic heart disease (IHD, hypertensive heart disease, and idiopathic cardiomyopathy were the most common etiologies of AHF in Oman. The median left ventricular ejection fraction of the cohort was 36% (27–45% with 56% of the patients having heart failure with reduced ejection fraction (< 40%. Atrial fibrillation was seen in 15% of patients. Acute coronary syndrome (ACS and non-compliance with medications were the most common precipitating factors. At discharge, angiotensin converting enzyme inhibitors and beta-blockers were prescribed adequately, but aldosterone antagonists were under prescribed. Within 12-months follow-up, one in two patients were rehospitalized for AHF. In-hospital mortality was 7.1%, which doubled to 15.7% at three months and reached 26.4% at one-year post discharge. Conclusions: Oman CARE was the first prospective multicenter registry of AHF in Oman and showed that heart failure (HF patients present at a younger age with recurrent ADCHF and HF with reduced ejection fraction. IHD was the most common etiology of HF with a low prevalence of AHF, but a high prevalence of acute coronary syndrome and non-compliance with medications precipitating HF. A quarter of patients died at one-year follow-up even though at discharge medical

  8. Multiscale Modeling and Simulation of Human Heart Failure

    OpenAIRE

    Gómez García, Juan Francisco

    2015-01-01

    [EN] Heart failure (HF) constitutes a major public health problem worldwide. Operationally it is defined as a clinical syndrome characterized by the marked and progressive inability of the ventricles to fill and generate adequate cardiac output to meet the demands of cellular metabolism that may have significant variability in its etiology and it is the final common pathway of various cardiac pathologies. Much attention has been paid to the understanding of the arrhythmogenic mechanisms induc...

  9. Nitrosative stress and pharmacological modulation of heart failure

    OpenAIRE

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

    2005-01-01

    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 pharmacol...

  10. Metabolomic Fingerprint of Heart Failure with Preserved Ejection Fraction

    OpenAIRE

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

    2015-01-01

    Background Heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly recognized as an important clinical entity. Preclinical studies have shown differences in the pathophysiology between HFpEF and HF with reduced ejection fraction (HFrEF). Therefore, we hypothesized that a systematic metabolomic analysis would reveal a novel metabolomic fingerprint of HFpEF that will help understand its pathophysiology and assist in establishing new biomarkers for its diagnosis. Methods and ...

  11. Remodeling of Calcium Handling in Human Heart Failure

    OpenAIRE

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

    2012-01-01

    Heart failure (HF) is an increasing public health problem accelerated by a rapidly aging global population. Despite considerable progress in managing the disease, the development of new therapies for effective treatment of HF remains a challenge. To identify targets for early diagnosis and therapeutic intervention, it is essential to understand the molecular and cellular basis of calcium handling and the signaling pathways governing the functional remodeling associated with HF in humans. Calc...

  12. Daily Physical Activity in Stable Heart Failure Patients

    OpenAIRE

    Dontje, Manon L.; van der Wal, Martje H.L; Stolk, Ronald P; Brügemann, Johan; Jaarsma, Tiny; Wijtvliet, Petra E P J; van der Schans, Cees P; Greef, Mathieu H.G.

    2014-01-01

    BACKGROUND:: Physical activity is the only nonpharmacological therapy that is proven to be effective in heart failure (HF) patients in reducing morbidity. To date, little is known about the levels of daily physical activity in HF patients and about related factors. OBJECTIVE:: The objectives of this study were to (a) describe performance-based daily physical activity in HF patients, (b) compare it with physical activity guidelines, and (c) identify related factors of daily physical activity. ...

  13. Atrial fibrillation and heart failure in seven nursing homes

    OpenAIRE

    Krüger, Kjell; Sandli, Marie; Geitung, Jonn Terje; Eide, Geir Egil; Grimsmo, Anders

    2012-01-01

    Objectives: Previous research suggests that blood-thinning treatment for patients with atrial fibrillation as well as treatment for patients with heart failure is not adequate among the elderly. We tested this among long-term patients in nursing homes. Methods: Information about the patients (n = 513) was collected during the period March-April 2008. Data collection consisted of electrocardiography, particulars of any stroke suffered and copying medication records. A standardized set of blood...

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

    OpenAIRE

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

    2013-01-01

    Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in sele...

  15. Experiences of air travel in patients with chronic heart failure

    OpenAIRE

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

    2012-01-01

    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 pati...

  16. Pulmonary Hypertension and Cardiopulmonary Exercise in Heart Failure

    OpenAIRE

    Kim, Chul-Ho; Jae, Sae Young; Johnson, Bruce D.

    2014-01-01

    In heart failure (HF), pulmonary hypertension (PH) is initially associated with a rise in the left ventricular filling pressure. PH is defined by pulmonary hemodynamic measurements including pulmonary capillary wedge pressure, mean pulmonary arterial pressure and pulmonary vascular resistance. Eventually, PH in HF may become more of a reactive process. Although the mechanism of the reactive PH development is not clearly understood, vascular dysfunction induced by remodeling, vasoactive substa...

  17. Psychological Responses and Adherence to Exercise in Heart Failure

    OpenAIRE

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

    2013-01-01

    The purpose of this study was to describe psychological effects and exercise adherence during a multicomponent exercise training intervention. A sample of 42 patients with heart failure (HF) were randomized into an exercise (INV) group, (n=22) and an attention control (AC) group (n=20). The exercise protocol included two 12-week phases, a structured phase and a self-managed phase. The psychological responses assessed were mood states and exercise self-efficacy. To meet the second purpose of t...

  18. Mammillary bodies and fornix fibers are injured in heart failure

    OpenAIRE

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

    2008-01-01

    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 cont...

  19. Cardiac Autonomic Nerve Stimulation in the Treatment of Heart Failure

    OpenAIRE

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

    2013-01-01

    Research on the therapeutic modulation of cardiac autonomic tone by electrical stimulation has yielded encouraging early clinical results. Vagus nerve stimulation has reduced the rates of morbidity and sudden death from heart failure, but therapeutic vagus nerve stimulation is limited by side effects of hypotension and bradycardia. Sympathetic nerve stimulation that has been implemented in the experiment may exacerbate the sympathetic-dominated autonomic imbalance. In contrast, concurrent sti...

  20. Hemodynamic aspects of biventricular pacing in heart failure

    OpenAIRE

    Ståhlberg, Marcus

    2010-01-01

    Background and aims Biventricular pacing or cardiac resynchronization therapy (CRT) is an established treatment option for selected heart failure (HF) patients. We aimed at evaluating acute and longer-term hemodynamic effects of different pacemaker programmings in CRT patients. For the latter purpose, 10 CRT patients also received an implantable hemodynamic monitor (IHM), allowing for long-term hemodynamic monitoring during ambulatory periods. Study I The hemodynamic ...

  1. The clinical value of cardiac sympathetic imaging in heart failure

    DEFF Research Database (Denmark)

    Christensen, Thomas Emil; Kjaer, Andreas; Hasbak, Philip

    2014-01-01

    The autonomic nervous system plays an important role in the pathology of heart failure. The single-photon emission computed tomography tracer iodine-123-metaiodobenzylguanidine ((123) I-MIBG) can be used to investigate the activity of the predominant neurotransmitter of the sympathetic nervous...... system, norepinephrine. Also, positron emission tomography tracers are being developed for the same purpose. With (123) I-MIBG as a starting point, this brief review introduces the modalities used for cardiac sympathetic imaging....

  2. Complement C3c as a Biomarker in Heart Failure

    OpenAIRE

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

    2013-01-01

    Introduction. Experimental data indicates an important role of the innate immune system in cardiac remodeling and heart failure (HF). Complement is a central effector pathway of the innate immune system. Animals lacking parts of the complement system are protected from adverse remodeling. Based on these data, we hypothesized that peripheral complement levels could be a good marker for adverse remodeling and prognosis in patients with HF. Methods and Results. Since complement activation conver...

  3. Impact of Depression on Prognosis in Heart Failure

    OpenAIRE

    Freedland, Kenneth E.; Carney, Robert M.; Rich, Michael W.

    2011-01-01

    Depression is a common comorbid condition in heart failure, and there is growing evidence that it increases the risks of mortality and other adverse outcomes, including rehospitalization and functional decline. The prognostic value of depression depends, in part, on how it is defined and measured. The few studies that have compared different subsets of depressed patients suggest that major (or severe) depression is a stronger predictor of mortality than is minor (or mild) depression. Whether ...

  4. Tumor necrosis factor alpha polymorphism in heart failure/cardiomyopathy.

    Science.gov (United States)

    Vadlamani, Lou; Iyengar, Srinivas

    2004-01-01

    Tumor necrosis factor a (TNF-alpha) is a proinflammatory cytokine that is produced by activated macrophages. It has been shown to stimulate the release of endothelial cytokines and NO, increase vascular permeability, decrease contractility, and induce a prothrombotic state. The most studied TNF-a gene mutation in heart disease is a gamma to alpha substitution, which occurs when 308 nucleotides move upstream from the transcription initiation site in the TNF promoter and has been associated with elevated levels of TNF-alpha. The TNF1 allele (wild type) contains gamma at this site, while the TNF2 allele has an alpha substitution at the site. The TNF2 allele is a more powerful transcriptional activator, therefore leading to higher TNF-alpha levels. Most of the studies to date have failed to conclusively show any link between the polymorphism and heart disease, both coronary artery disease and cardiomyopathy/heart failure. PMID:15591843

  5. Recognizing Pulmonary Hypertension and Right Ventricular Dysfunction in Heart Failure.

    Science.gov (United States)

    Lala, Anuradha; Pinney, Sean P

    2016-01-01

    Pulmonary hypertension (PH) in the setting of left heart disease (LHD) or heart failure (HF) is the most common form of PH, yet its prevalence is underappreciated. Varying terminology possibly leads to misconceptions in pathophysiology, diagnosis and management. The accurate diagnosis of PH due to LHD is contingent upon hemodynamic assessment via right heart catheterization, however due to limitations in access, comprehensive echocardiography and integrative scoring systems are frequently used. When present in the setting of PH due to LHD, right ventricular dysfunction (RVD) confers a poor clinical prognosis. The management of RVD is directed towards treating underlying HF and/or valvular disease. Implantable hemodynamic monitors may offer opportunity to obtain longitudinal information to increase diagnostic accuracy as well as monitor the effect of treatment of PH in the setting of HF with and without the presence of RVD. PMID:26780235

  6. HEART FAILURE, DIABETES, BETA-BLOCKERS AND RISK OF HYPOGLYCEMIA

    Directory of Open Access Journals (Sweden)

    A. A. Aleksandrov

    2008-01-01

    Full Text Available Aim. To evaluate an influence of carvedilol on risk of hypoglycemia in patients with diabetes type 2 (D2 and chronic heart failure (CHF treated with angiotensin converting enzyme (ACE inhibitors.Material and methods. 13 patients (10 men, 3 women; aged 59,8±6,7 y.o. with D2 and CHF caused by ischemic heart disease were included in the study. Before inclusion all patients were treated with ACE inhibitors and various beta-blockers (atenolol, metoprolol, bisoprolol. These beta-blockers were changed for carvedilol. Heart ultrasonography, blood pressure control, glycemia monitoring, HbA1c level determination were performed before, during and after carvedilol therapy.Results. Carvedilol reduces frequency and duration of hypoglycaemia episodes. There were not episodes of severe hypoglycaemia during carvedilol therapy.Conclusion. Carvedilol reduces risk of hypoglycemia when it is used in combination with ACE inhiditors in diabetic patients with CHF.

  7. Pattern of heart failure in a Nigerian teaching hospital

    Directory of Open Access Journals (Sweden)

    Arthur C Onwuchekwa

    2009-09-01

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

  8. Clinical Evaluation of Heart Failure: Agreement among Tests.

    Science.gov (United States)

    Pandey, Amit K; Penny, William F; Bhargava, Valmik; Lai, N Chin; Xu, Ronghui; Hammond, H Kirk

    2016-01-01

    Methods commonly used clinically to assess cardiac function in patients with heart failure include ejection fraction (EF), exercise treadmill testing (ETT), and symptom evaluation. Although these approaches are useful in evaluating patients with heart failure, there are at times substantial mismatches between individual assessments. For example, ETT results are often discordant with EF, and patients with minimal symptoms sometimes have surprisingly low EFs. To better define the relationship of these methods of assessment, we studied 56 patients with heart failure with reduced EF (HFrEF) who underwent measurement of ETT duration, EF by echocardiography, quantitative symptom evaluation, and LV peak dP/dt (rate of left ventricular pressure development and decline, measured invasively). Correlations were determined among these four tests in order to assess the relationship of EF, ETT, and symptoms against LV peak dP/dt. In addition, we sought to determine whether EF, ETT, and symptoms correlated with each other. Overall, correlations were poor. Only 15 of 63 total correlations (24%) were significant (p dP/dt. Linear regression analysis indicated that EF, ETT, and symptoms taken together predicted LV peak dP/dt better than any one measure alone. We conclude that clinical tests used to assess LV function in patients with HFrEF may not be as accurate or correlate as well as expected. All three clinical measures considered together may be the best representation of cardiac function in HFrEF patients currently available. PMID:27537778

  9. Heart Failure Monitoring System Based on Wearable and Information Technologies

    Directory of Open Access Journals (Sweden)

    E. Hoyo-Barbolla

    2007-03-01

    Full Text Available

    In Europe, Cardiovascular Diseases (CVD are the leading source of death, causing 45% of all deceases. Besides, Heart Failure, the paradigm of CVD, mainly affects people older than 65. In the current aging society, the European MyHeart Project was created, whose mission is to empower citizens to fight CVD by leading a preventive lifestyle and being able to be diagnosed at an early stage. This paper presents the development of a Heart Failure Management System, based on daily monitoring of Vital Body Signals, with wearable and mobile technologies, for the continuous assessment of this chronic disease. The System makes use of the latest technologies for monitoring heart condition, both with wearable garments (e.g. for measuring ECG and Respiration; and portable devices (such as Weight Scale and Blood Pressure Cuff both with Bluetooth capabilities.

  10. Nitrendipine binding in congestive heart failure due to myocardial infarction

    International Nuclear Information System (INIS)

    Depressed cardiac pump function is the hallmark of congestive heart failure, and it is suspected that decreased influx of Ca2+ into the cardiac cell is responsible for depressed contractile function. Since Ca2+ channels in the sarcolemmal membrane are considered to be an important route for the entry of Ca2+, we examined the status of Ca2+ receptors/channels in failing rat hearts after myocardial infarction of the left ventricular free wall. For this purpose, the left coronary artery was ligated and hearts were examined 4, 8, and 16 weeks later; sham-operated animals served as controls. Hemodynamic assessment revealed decreased total mechanical energy (left ventricular systolic pressure x heart rate), increased left ventricular diastolic pressure, and decreased positive and negative dP/dt in experimental animals at 4, 8, and 16 weeks. Although accumulation of ascites in the abdominal cavity was evident at 4 weeks, other clinical signs of congestive heart failure in experimental rats were evident from the presence of lung congestion and cardiac dilatation at 8 and 16 weeks after induction of myocardial infarction. The density of Ca2+ receptors/channels in crude membranes, as assessed by [3H]nitrendipine binding assay, was found to be decreased in the uninfarcted experimental left ventricle at 8 and 16 weeks; however, no change in the affinity of nitrendipine was evident. A similar depression in the specific binding of another dihydropyridine compound, [3H]PN200-110, was also evident in failing hearts. Brain and skeletal muscle crude membrane preparations, unlike those of the right ventricle and liver, revealed a decrease in Ca2+ receptors/channels density in experimental animals at 16 weeks

  11. Papel dos níveis de BNP no prognóstico da insuficiência cardíaca avançada descompensada Role of BNP levels on the prognosis of decompensated advanced heart failure

    Directory of Open Access Journals (Sweden)

    Antônio Carlos Pereira-Barretto

    2013-03-01

    Full Text Available FUNDAMENTO: A insuficiência cardíaca (IC é doença que cursa com má evolução, especialmente naqueles com IC avançada. A dosagem de peptídeo natriurético tipo B(BNP, ao lado da utilidade no diagnóstico da descompensação cardíaca, vem se mostrando útil na avaliação prognóstica. OBJETIVOS: Verificar se os níveis de BNP identificam quais pacientes evoluiriam pior e se o BNP seria fator independente de mortalidade considerando-se idade, sexo, funções cardíaca e renal e etiologia da cardiopatia. MÉTODOS: 189 pacientes com IC avançada em classe funcional III/IV foram estudados. Todos tinham disfunção sistólica e dosaram-se os níveis de BNP na hospitalização. Analisaram-se as variáveis relacionadas com a mortalidade através de análises univariada e multivariada. RESULTADOS: Os níveis de BNP foram mais elevados nos pacientes que morreram no primeiro ano de seguimento (1.861,9 versus 1.408,1 pg/dL; p = 0,044 e nos chagásicos (1.985 versus 1.452 pg/mL; p = 0,001, e esses pacientes chagásicos tiveram maior mortalidade no primeiro ano de seguimento (56% versus 35%; p = 0,010. Pela curva ROC, o valor de BNP de 1.400 pg/mL foi o melhor preditor de eventos, estando os valores elevados associados a FEVE mais baixa (0,23 versus 0,28; p = 0,002 e maior grau de disfunção renal (ureia média 92 versus 74,5 mg/dL; p = 0,002. CONCLUSÃO: Na IC avançada, os níveis elevados de BNP identificam pacientes com maior potencial de pior evolução. Os pacientes chagásicos apresentam níveis mais elevados de BNP do que as outras etiologias e têm pior evolução.BACKGROUND: Heart failure (HF is a condition with poor outcome, especially in advanced cases. Determination of B-type natriuretic peptide (BNP levels is useful in the diagnosis of cardiac decompensation and has also been proving useful in the prognostic evaluation. OBJECTIVES: To verify whether BNP levels are able to identify patients with a poorer outcome and whether it is an

  12. Mechanical Unloading Promotes Myocardial Energy Recovery in Human Heart Failure

    Science.gov (United States)

    Gupte, Anisha A.; Hamilton, Dale J.; Cordero-Reyes, Andrea M.; Youker, Keith A.; Yin, Zheng; Estep, Jerry D.; Stevens, Robert D.; Wenner, Brett; Ilkayeva, Olga; Loebe, Matthias; Peterson, Leif E.; Lyon, Christopher J.; Wong, Stephen T.C.; Newgard, Christopher B.; Torre-Amione, Guillermo; Taegtmeyer, Heinrich; Hsueh, Willa A.

    2015-01-01

    Background Impaired bioenergetics is a prominent feature of the failing heart, but the underlying metabolic perturbations are poorly understood. Methods and Results We compared metabolomic, gene transcript, and protein data from six paired failing human left ventricular (LV) tissue samples obtained during left ventricular assist device (LVAD) insertion (heart failure (HF) samples) and at heart transplant (post-LVAD samples). Non-failing left ventricular (NFLV) wall samples procured from explanted hearts of patients with right HF served as novel comparison samples. Metabolomic analyses uncovered a distinct pattern in HF tissue: 2.6 fold increased pyruvate concentrations coupled with reduced Krebs cycle intermediates and short-chain acylcarnitines, suggesting a global reduction in substrate oxidation. These findings were associated with decreased transcript levels for enzymes that catalyze fatty acid oxidation and pyruvate metabolism and for key transcriptional regulators of mitochondrial metabolism and biogenesis, peroxisome proliferator-activated receptor gamma co-activator1α (PGC1A, 1.3 fold) and estrogen-related receptor α (ERRA, 1.2 fold) and γ (ERRG, 2.2 fold). Thus, parallel decreases in key transcription factors and their target metabolic enzyme genes can explain the decreases in associated metabolic intermediates. Mechanical support with LVAD improved all of these metabolic and transcriptional defects. Conclusions These observations underscore an important pathophysiologic role for severely defective metabolism in HF, while the reversibility of these defects by LVAD suggests metabolic resilience of the human heart. PMID:24825877

  13. Heart research advances using database search engines, Human Protein Atlas and the Sydney Heart Bank.

    Science.gov (United States)

    Li, Amy; Estigoy, Colleen; Raftery, Mark; Cameron, Darryl; Odeberg, Jacob; Pontén, Fredrik; Lal, Sean; Dos Remedios, Cristobal G

    2013-10-01

    This Methodological Review is intended as a guide for research students who may have just discovered a human "novel" cardiac protein, but it may also help hard-pressed reviewers of journal submissions on a "novel" protein reported in an animal model of human heart failure. Whether you are an expert or not, you may know little or nothing about this particular protein of interest. In this review we provide a strategic guide on how to proceed. We ask: How do you discover what has been published (even in an abstract or research report) about this protein? Everyone knows how to undertake literature searches using PubMed and Medline but these are usually encyclopaedic, often producing long lists of papers, most of which are either irrelevant or only vaguely relevant to your query. Relatively few will be aware of more advanced search engines such as Google Scholar and even fewer will know about Quertle. Next, we provide a strategy for discovering if your "novel" protein is expressed in the normal, healthy human heart, and if it is, we show you how to investigate its subcellular location. This can usually be achieved by visiting the website "Human Protein Atlas" without doing a single experiment. Finally, we provide a pathway to discovering if your protein of interest changes its expression level with heart failure/disease or with ageing. PMID:23856366

  14. Right ventricular long noncoding RNA expression in human heart failure

    Science.gov (United States)

    Guo, Yan; Su, Yan Ru; Clark, Travis; Brittain, Evan; Absi, Tarek; Maltais, Simon; Hemnes, Anna

    2015-01-01

    Abstract The expression of long noncoding RNAs (lncRNAs) in human heart failure (HF) has not been widely studied. Using RNA sequencing (RNA-Seq), we compared lncRNA expression in 22 explanted human HF hearts with lncRNA expression in 5 unused donor human hearts. We used Cufflinks to identify isoforms and DESeq to identify differentially expressed genes. We identified the noncoding RNAs by cross-reference to Ensembl release 73 (Genome Reference Consortium human genome build 37) and explored possible functional roles using a variety of online tools. In HF hearts, RNA-Seq identified 84,793 total messenger RNA coding and noncoding different transcripts, including 13,019 protein-coding genes, 2,085 total lncRNA genes, and 1,064 pseudogenes. By Ensembl noncoding RNA categories, there were 48 lncRNAs, 27 pseudogenes, and 30 antisense RNAs for a total of 105 differentially expressed lncRNAs in HF hearts. Compared with donor hearts, HF hearts exhibited differential expression of 7.7% of protein-coding genes, 3.7% of lncRNAs (including pseudogenes), and 2.5% of pseudogenes. There were not consistent correlations between antisense lncRNAs and parent genes and between pseudogenes and parent genes, implying differential regulation of expression. Exploratory in silico functional analyses using online tools suggested a variety of possible lncRNA regulatory roles. By providing a comprehensive profile of right ventricular polyadenylated messenger RNA transcriptome in HF, RNA-Seq provides an inventory of differentially expressed lncRNAs, including antisense transcripts and pseudogenes, for future mechanistic study. PMID:25992278

  15. Palliative care among heart failure patients in primary care: a comparison to cancer patients using English family practice data.

    Directory of Open Access Journals (Sweden)

    Amy Gadoud

    Full Text Available INTRODUCTION: Patients with heart failure have a significant symptom burden and other palliative care needs often over a longer period than patients with cancer. It is acknowledged that this need may be unmet but by how much has not been quantified in primary care data at the population level. METHODS: This was the first use of Clinical Practice Research Datalink, the world's largest primary care database to explore recognition of the need for palliative care. Heart failure and cancer patients who had died in 2009 aged 18 or over and had at least one year of primary care records were identified. A palliative approach to care among patients with heart failure was compared to that among patients with cancer using entry onto a palliative care register as a marker for a palliative approach to care. RESULTS: Among patients with heart failure, 7% (234/3 122 were entered on the palliative care register compared to 48% (3 669/7 608 of cancer patients. Of heart failure patients on the palliative care register, 29% (69/234 were entered onto the register within a week of their death. CONCLUSIONS: This confirms that the stark inequity in recognition of palliative care needs for people with heart failure in a large primary care dataset. We recommend a move away from prognosis based criteria for palliative care towards a patient centred approach, with assessment of and attention to palliative needs including advance care planning throughout the disease trajectory.

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-02-10

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

  18. So many definitions of heart failure: are they all universally valid? A critical appraisal.

    Science.gov (United States)

    Tan, Lip-Bun; Williams, Simon G; Tan, David K H; Cohen-Solal, Alain

    2010-02-01

    Defining heart failure (HF) is a matter of finding the most appropriate words to formulate the definiens for HF that will be universally applicable in all specific circumstances pertaining to the nature of HF. Currently available definitions of HF contain ambiguities and notable deficiencies such that non-heart failure medical conditions can become mislabelled as heart failure. Principles of how best to formulate definitions have been employed to provide a guide on how to appraise published definitions of HF. A fundamental requirement of a good definition is that it should be universal, and by this criterion, we need to question the validity of a conventional dogma that a collection of clinical diagnostic features are equivalent to HF definitions. A long-standing deficiency in HF definitions is the inability to take into account the quantifiable extent of functional impairment of the heart. Other traditional misconceptions surrounding HF definitions have also been addressed. In line with Derek Gibson's proposal, we have rephrased William Harvey's description of the cardiac role in maintaining the circulation in terms of Newtonian physics and of the Law of Conservation of Energy to reach a more universal and less ambiguous definition of HF, with the objective of advancing the science of HF and the treatment of this distressing condition. PMID:20136608

  19. ACE inhibitors and calcium antagonists in the treatment of congestive heart failure

    DEFF Research Database (Denmark)

    Hansen, J F

    1995-01-01

    The increased mortality after myocardial infarction is related to the risk of reinfarction, sudden death, and the development and progression of heart failure; in congestive heart failure it is due to the progression of heart failure and sudden death. ACE inhibitors have been proven to prevent...... cardiovascular events, especially the progression of heart failure, in postinfarct patients with reduced ejection fraction and heart failure in the SAVE and AIRE trials. In patients with congestive heart failure, ACE inhibitor treatment has prevented cardiovascular death and reduced morbidity due to progressive...... by prevention of reinfarction and sudden death. Combination treatment with both verapamil, which has pronounced antiischemic properties and prevents sudden death and reinfarction, and an ACE inhibitor, which prevents the progression of heart failure, is a possibility for future cardiovascular therapy...

  20. Rationale and benefits of trimetazidine by acting on cardiac metabolism in heart failure.

    Science.gov (United States)

    Lopatin, Yuri M; Rosano, Giuseppe M C; Fragasso, Gabriele; Lopaschuk, Gary D; Seferovic, Petar M; Gowdak, Luis Henrique W; Vinereanu, Dragos; Hamid, Magdy Abdel; Jourdain, Patrick; Ponikowski, Piotr

    2016-01-15

    Heart failure is a systemic and multiorgan syndrome with metabolic failure as a fundamental mechanism. As a consequence of its impaired metabolism, other processes are activated in the failing heart, further exacerbating the progression of heart failure. Recent evidence suggests that modulating cardiac energy metabolism by reducing fatty acid oxidation and/or increasing glucose oxidation represents a promising approach to the treatment of patients with heart failure. Clinical trials have demonstrated that the adjunct of trimetazidine to the conventional medical therapy improves symptoms, cardiac function and prognosis in patients with heart failure without exerting negative hemodynamic effects. This review focuses on the rationale and clinical benefits of trimetazidine by acting on cardiac metabolism in heart failure, and aims to draw attention to the readiness of this agent to be included in all the major guidelines dealing with heart failure. PMID:26618252

  1. HeartDrive: A Broader Concept of Interoperability to Implement Care Processes for Heart Failure.

    Science.gov (United States)

    Lettere, M; Guerri, D; La Manna, S; Groccia, M C; Lofaro, D; Conforti, D

    2016-01-01

    This paper originates from the HeartDrive project, a platform of services for a more effective, efficient and integrated management of heart failure and comorbidities. HeartDrive establishes a cooperative approach based on the concepts of continuity of care and extreme, patient oriented, customization of diagnostic, therapeutic and follow-up procedures. Definition and development of evidence based processes, migration from parceled and episode based healthcare provisioning to a workflow oriented model and increased awareness and responsibility of citizens towards their own health and wellness are key objectives of HeartDrive. In two scenarios for rehabilitation and home monitoring we show how the results are achieved by providing a solution that highlights a broader concept of cooperation that goes beyond technical interoperability towards semantic interoperability explicitly sharing process definitions, decision support strategies and information semantics. PMID:27225572

  2. CYP2J2-Derived Epoxyeicosatrienoic Acids Suppress Endoplasmic Reticulum Stress in Heart Failure

    OpenAIRE

    Wang, Xingxu; Ni, Li; Yang, Lei; Duan, Quanlu; Chen, Chen; Edin, Matthew L.; Zeldin, Darryl C.; WANG, DAO WEN

    2014-01-01

    Prolonged endoplasmic reticulum (ER) stress causes apoptosis and is associated with heart failure. Whether CYP2J2 and its arachidonic acid metabolites [epoxyeicosatrienoic acids (EETs)] have a protective influence on ER stress and heart failure has not been studied. Assays of myocardial samples from patients with end-stage heart failure showed evidence of ER stress. Chronic infusion of isoproterenol (ISO) or angiotensin II (AngII) by osmotic mini-pump induced cardiac hypertrophy and heart fai...

  3. Electrophysiological and Structural Remodeling in Heart Failure Modulate Arrhythmogenesis. 2D Simulation Study

    OpenAIRE

    Gomez, Juan F.; Cardona, Karen; Martinez, Laura; Saiz, Javier; Trenor, Beatriz

    2014-01-01

    Background Heart failure is operationally defined as the inability of the heart to maintain blood flow to meet the needs of the body and it is the final common pathway of various cardiac pathologies. Electrophysiological remodeling, intercellular uncoupling and a pro-fibrotic response have been identified as major arrhythmogenic factors in heart failure. Objective In this study we investigate vulnerability to reentry under heart failure conditions by incorporating established electrophysiolog...

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

    OpenAIRE

    Akintunde, Adeseye A

    2013-01-01

    Background: Heart failure is an important cause of morbidity and mortality in developing nations like Nigeria. Sleep apnea and snoring has recently been recognized to be a cardiovascular risk factor. Sleep apnea is yet to be well studied among Africans with heart failure. We aimed to determine the prevalence of snoring and high risk for obstructive sleep apnea among Nigerians with stable heart failure. Materials and Methods: We studied 103 subjects that included 62 patients with heart fail...

  5. Electrophysiological and Structural Remodeling in Heart Failure Modulate Arrhythmogenesis. 2D Simulation Study

    OpenAIRE

    Gómez García, Juan Francisco; Saiz Rodríguez, Francisco Javier; Trenor Gomis, Beatriz Ana

    2014-01-01

    Background: Heart failure is operationally defined as the inability of the heart to maintain blood flow to meet the needs of the body and it is the final common pathway of various cardiac pathologies. Electrophysiological remodeling, intercellular uncoupling and a pro-fibrotic response have been identified as major arrhythmogenic factors in heart failure. Objective: In this study we investigate vulnerability to reentry under heart failure conditions by incorporating established ...

  6. Cardiac resynchronization therapy and B-type natriuretic peptide in heart failure

    Institute of Scientific and Technical Information of China (English)

    HUANG De-jia

    2009-01-01

    @@ Cardiac resynchronization therapy (CRT) improves left ventricular function, symptom status, quality of life and reduces hospitalization and mortality in patients with New York Heart Association (NYHA) Class Ⅲ or IV heart failure and intraventricular conduction delay despite optimal medical management.1 B-type natriuretic peptide (BNP) and its amino terminal cleavage equivalent (NT-pro BNP) levels correlate with the severity of heart failure and predict prognosis of heart failure patients.2

  7. Resynchronisation therapy in patients with heart failure: Our results

    Directory of Open Access Journals (Sweden)

    Milašinović Goran

    2005-01-01

    Full Text Available INTRODUCTION. Resynchronisation therapy with biventricular permanent pacing stimulation is one method of treating patients with systolic heart failure, with echocardiograph signs of ventricular asynchrony and a prolonged QRS of longer than 120 milliseconds. This method has been accepted in most medical centers around the world and was instigated in our Pacemaker Centre in December 2001, 3 months after FDA approval for human use. OBJECTIVE. The aim of the study was to present this new procedure and the results obtained from our own group of patients. METHOD. A multi-site, biventricular pacemaker, with a special electrode for left-half heart stimulation was implanted in the coronary sinus of 17 patients who had suffered systolic heart failure (12 male and 5 female, average age 59.9 years. For all of them, the duration of the QRS interval was longer than 120 ms, with left bundle branch morphology, and an ejection fraction below 30%. All the patients were NYHA class II or III. Prior to and after the implantation, a 12-channel ECG and ECHO were carried out, a b-minute hall walk test was performed, additionally, the total walked distance on a flat surface was measured, the general condition of the patient was evaluated, the number of medications being taken was noted, as was the number of days of hospitalization. RESULTS. The average time from diagnosis to implantation was 22 months, and the average post-operative follow-up was 14 months. Two of the patients died 10 and 7 months after the implantation, due to a new myocardial infarction and refractory heart failure. In addition, one patient did not show any improvement after the implantation of the multi-site pacemaker (there were three "non-responder" patients. All the other patients felt much better: decreased NYHA class for I - II class, increased left ventricle ejection fraction, reduced use of diuretics, increased b-minute hall walk distance and general walk distance on a flat surface, and

  8. Cardiac resynchronization therapy: prospect for long-lasting heart failure remission.

    Science.gov (United States)

    Sun, Shinning; Joglar, Jose A

    2011-08-01

    Heart failure (HF) remains an important heath care problem in the United States. With the aging of the US population, this trend is expected to continue. However, patients have also benefited from advances in pharmacologic and device-based therapies such as angiotensin-converting enzyme inhibitors, β-blockers, aldosterone blockers, and implantable cardioverter-defibrillators. More recently, cardiac resynchronization therapy (CRT) has become another important therapeutic option for treating heart failure due to systolic dysfunction. In this article, we review the physiologic basis for CRT, the clinical trials that support its efficacy, and the current indications for its use. We also examine key clinical questions regarding CRT still under research, including predictors of response. Finally, we look at the future of CRT and how its indications can be expanded to benefit more patients in the future. PMID:21441824

  9. The causes, consequences, and treatment of left or right heart failure

    Directory of Open Access Journals (Sweden)

    Pazos-Lopez P

    2011-04-01

    Full Text Available Pablo Pazos-López, Jesús Peteiro-Vázquez, Ana Carcía-Campos, Lourdes García-Bueno, Juan Pablo Abugattas de Torres, Alfonso Castro-BeirasDepartment of Cardiology, Complejo hospitalario Universitario A Coruña, A Coruña, SpainAbstract: Chronic heart failure (HF is a cardiovascular disease of cardinal importance because of several factors: a an increasing occurrence due to the aging of the population, primary and secondary prevention of cardiovascular events, and modern advances in therapy, b a bad prognosis: around 65% of patients are dead within 5 years of diagnosis, c a high economic cost: HF accounts for 1% to 2% of total health care expenditure. This review focuses on the main causes, consequences in terms of morbidity, mortality and costs and treatment of HF.Keywords: heart failure, cause, consequence, treatment

  10. Activation of endothelial β-catenin signaling induces heart failure.

    Science.gov (United States)

    Nakagawa, Akito; Naito, Atsuhiko T; Sumida, Tomokazu; Nomura, Seitaro; Shibamoto, Masato; Higo, Tomoaki; Okada, Katsuki; Sakai, Taku; Hashimoto, Akihito; Kuramoto, Yuki; Oka, Toru; Lee, Jong-Kook; Harada, Mutsuo; Ueda, Kazutaka; Shiojima, Ichiro; Limbourg, Florian P; Adams, Ralf H; Noda, Tetsuo; Sakata, Yasushi; Akazawa, Hiroshi; Komuro, Issei

    2016-01-01

    Activation of β-catenin-dependent canonical Wnt signaling in endothelial cells plays a key role in angiogenesis during development and ischemic diseases, however, other roles of Wnt/β-catenin signaling in endothelial cells remain poorly understood. Here, we report that sustained activation of β-catenin signaling in endothelial cells causes cardiac dysfunction through suppressing neuregulin-ErbB pathway in the heart. Conditional gain-of-function mutation of β-catenin, which activates Wnt/β-catenin signaling in Bmx-positive arterial endothelial cells (Bmx/CA mice) led to progressive cardiac dysfunction and 100% mortality at 40 weeks after tamoxifen treatment. Electron microscopic analysis revealed dilatation of T-tubules and degeneration of mitochondria in cardiomyocytes of Bmx/CA mice, which are similar to the changes observed in mice with decreased neuregulin-ErbB signaling. Endothelial expression of Nrg1 and cardiac ErbB signaling were suppressed in Bmx/CA mice. The cardiac dysfunction of Bmx/CA mice was ameliorated by administration of recombinant neuregulin protein. These results collectively suggest that sustained activation of Wnt/β-catenin signaling in endothelial cells might be a cause of heart failure through suppressing neuregulin-ErbB signaling, and that the Wnt/β-catenin/NRG axis in cardiac endothelial cells might become a therapeutic target for heart failure. PMID:27146149

  11. Telemonitoring in chronic heart failure: a systematic review.

    Science.gov (United States)

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

    2012-01-01

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

  12. Massive hepatic cyst presenting as right-sided heart failure.

    LENUS (Irish Health Repository)

    O'Connor, A

    2010-01-30

    A 70-year-old woman presented with clinical features of right heart failure. Cardiopulmonary investigations included an echocardiogram, which showed a hepatic cyst compromising venous return and affecting right atrial filling and a CT abdomen showed a 15.5 x 11.5 cm-cystic mass involving the right hepatic lobe and compressing the right atrium. Percutaneous drainage of the cyst was performed. This led to complete resolution of symptoms but these recurred as the fluid re-accumulated. Subsequent definitive treatment with excision of the cyst was undertaken with symptomatic cure. This case is the first report of a hepatic cyst presenting as right heart due to compression of the right atrium.

  13. Vascular Function and the Role of Oxidative Stress in Heart Failure, Heart Transplant, and Beyond

    OpenAIRE

    Witman, Melissa A.H.; Fjeldstad, Anette S.; McDaniel, John; Ives, Stephen J.; Zhao, Jia; Barrett-O’Keefe, Zachary; Nativi, Jose N.; Stehlik, Josef; Wray, D. Walter; Richardson, Russell S.

    2012-01-01

    Using flow-mediated vasodilation (FMD), reactive hyperemia (RH), and an acute oral antioxidant cocktail (AOC [Vitamin C, E and α-lipoic acid]), this study aimed to provide greater insight into altered vascular function and the role of oxidative stress in chronic heart failure patients with reduced ejection fraction (HFrEF) and at several time points beyond heart transplantation (HTx). A total of 61 age-matched subjects (12 healthy controls, 14 NYHA Class II and III HFrEF patients, and 35 HTx ...

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

    OpenAIRE

    Bonneux, Luc; Barendregt, Jan,; Meeter, K.J.; Bonsel, Gouke; Maas, Paul

    1994-01-01

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

  15. Conducting Family Nursing in Heart Failure outpatient clinics: Nurses experiences

    DEFF Research Database (Denmark)

    Voltelen, Barbara; Konradsen, Hanne; Østergaard, Birte

    Aim: This study aimed to explore what was documented during structured Family Nursing (FN) conversations with patients diagnosed with Heart Failure and their families, and to gain knowledge about the nurses’ experiences conducting FN. Background: Patients with HF face many challenges, and so do...... from throughout the FN intervention and a Focus group interview with 6 nurses who were conducting the conversations. Content analyses of all text material dealt with both manifest and latent content, and were analyzed through a deductive and inductive process. Results: Enabling bonding emerged as the...

  16. Myosin heavy chain gene expression in human heart failure.

    OpenAIRE

    Nakao, K; Minobe, W.; Roden, R; Bristow, M R; Leinwand, L A

    1997-01-01

    Two isoforms of myosin heavy chain (MyHC), alpha and beta, exist in the mammalian ventricular myocardium, and their relative expression is correlated with the contractile velocity of cardiac muscle. Several pathologic stimuli can cause a shift in the MyHC composition of the rodent ventricle from alpha- to beta-MyHC. Given the potential physiological consequences of cardiac MyHC isoform shifts, we determined MyHC gene expression in human heart failure where cardiac contractility is impaired si...

  17. Increased Circulating Cathepsin K in Patients with Chronic Heart Failure

    OpenAIRE

    Guangxian Zhao; Yuzi Li; Lan Cui; Xiang Li; Zhenyi Jin; Xiongyi Han; Ennan Fang; Yihua Gao; Dongmei Zhou; Haiying Jiang; Xueying Jin; Guanghao Piao; Xiangshan Li; Guang Yang; Jiyong Jin

    2015-01-01

    Cysteinyl cathepsin K (CatK) is one of the most potent mammalian collagenases involved in cardiovascular disease. Here, we investigated the clinical predictive value of serum CatK levels in patients with chronic heart failure (CHF). We examined 134 patients with CHF, measuring their serum CatK, troponin I, high-sensitive C-reactive protein, and pre-operative N-terminal pro-brain natriuretic peptide levels. The patients were divided into two groups: the 44 patients who showed a left ventricula...

  18. [Chronic heart failure and its consequences on the partner relationship].

    Science.gov (United States)

    Sztajzel, Juan

    2015-12-01

    There are presently few data on chronic heart failure (CHF) and its consequences on the partner relationship. The aim of our study was to assess how patients with severe CHF and their female partners were affected in their relationship. First, there was a need to address the issue of sexuality with the doctor because of fear of the occurrence of a cardiac event or an implantable cardioverter defibrillator shock. Second, there was often a significant decrease in libido and erectile dysfunction associated with general depressive symptoms. Finally, the female partners in several couples developed an overprotective behavior leading to resentment and frustration in patients towards them. PMID:26790235

  19. The importance of interactions between atrial fibrillation and heart failure.

    Science.gov (United States)

    Khan, Muhammad A; Satchithananda, Duwarakan K; Mamas, Mamas A

    2016-06-01

    Heart failure (HF) and atrial fibrillation (AF) are among the commonest cardiovascular conditions encountered in clinical practice and frequently coexist. Over the last decade, they have evolved into global cardiovascular epidemics. This, in turn, has huge clinical and economic implications. There is ample evidence that AF and HF have a mutually deleterious effect on each other. AF is not only a marker of HF severity but also affects HF prognosis independently. This article presents the close pathophysiological relationship between AF and HF and the adverse prognostic consequences of this bidirectional interaction. The scope of various therapeutic modalities and their potential impacts are discussed briefly. PMID:27251919

  20. Management of chronic heart failure in the older population

    OpenAIRE

    Azad, Nahid; Lemay, Genevieve

    2014-01-01

    Chronic heart failure (CHF) is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger pati...

  1. Heart failure in the general Danish population and among individuals with ischemic heart disease

    DEFF Research Database (Denmark)

    Kildemoes, Helle Wallach

    Background The incidence and fatality of acute myocardial infarction (MI) has decreased during the last decade - due to both improved medical treatment and a shift toward a healthier lifestyle. The consequence of the improved treatment is likely to be a falling incidens of heart failure following...... MI. Yet, the treatment of heart failure has also improved. It is unknown to what extent the incidence, prevalence and survival with heart failure in the general population and among patients with ischemic heart disease has changed over time. Aim The aim of this study is to estimate incidence and...... prevalence of heart failure (HF) in the Danish population and among individuals with ischemic heart disease (IHD) during 1996-2006, applying register data from the national patient register (NPR) and the national dispensing register (NDR). Data and methods All Danish inhabitants (aged >15) by January 1996...

  2. Creatine and Phosphate Pools are Maintained at Energetically Optimal Levels in the Heart During Hypertrophic Remodeling and Heart Failure

    OpenAIRE

    Beard, Daniel A.; Wu, Fan

    2009-01-01

    The ability of mitochondria to oxidatively synthesize ATP from ADP and inorganic phosphate is compromised in the failing heart. Specifically, the magnitude of the free energy at which ATP is synthesized in heart failure is diminished compared to control. However the causal mechanisms involved are not clearly understood. Here we used computer simulation to analyze the impact of reduction in three cytoplasmic metabolic pools that is observed with hypertrophic remodeling and heart failure. Our s...

  3. Post-Exercise Heart Rate Recovery Independently Predicts Clinical Outcome in Patients with Acute Decompensated Heart Failure

    OpenAIRE

    Youn, Jong-Chan; Lee, Hye Sun; Choi, Suk-Won; Han, Seong-Woo; Ryu, Kyu-Hyung; Shin, Eui-Cheol; Kang, Seok-Min

    2016-01-01

    Background Post-exercise heart rate recovery (HRR) is an index of parasympathetic function associated with clinical outcome in patients with chronic heart failure. However, its relationship with the pro-inflammatory response and prognostic value in consecutive patients with acute decompensated heart failure (ADHF) has not been investigated. Methods We measured HRR and pro-inflammatory markers in 107 prospectively and consecutively enrolled, recovered ADHF patients (71 male, 59 ± 15 years, mea...

  4. Ambulatory blood pressure monitoring of patients with heart failure: a new prognosis marker

    Directory of Open Access Journals (Sweden)

    Manoel F. Canesin

    2002-01-01

    Full Text Available OBJECTIVE: To evaluate the relationship between 24-hour ambulatory arterial blood pressure monitoring and the prognosis of patients with advanced congestive heart failure. METHODS: We studied 38 patients with NYHA functional class IV congestive heart failure, and analyzed left ventricular ejection fraction, diastolic diameter, and ambulatory blood pressure monitoring data. RESULTS: Twelve deaths occurred. Left ventricular ejection fraction (35.2±7.3% and diastolic diameter (72.2±7.8mm were not correlated with the survival. The mean 24-hour (SBP24, waking (SBPw, and sleeping (SBPs systolic pressures of the living patients were higher than those of the deceased patients and were significant for predicting survival. Patients with mean SBP24, SBPv, and SBPs > or = 105mmHg had longer survival (p=0.002, p=0.01 and p=0.0007, respectively. Patients with diastolic blood pressure sleep decrements (dip and patients with mean blood pressure dip or = 105 mmHg CONCLUSION: Ambulatory blood pressure monitoring appears to be a useful method for evaluating patients with congestive heart failure.

  5. Paediatric heart failure from the eyes of the cardiologist

    Directory of Open Access Journals (Sweden)

    Pier Paolo Bassareo

    2014-06-01

    Full Text Available The causes of heart failure (HF in children differ substantially from those found in the adult population. They comprise cardiac and noncardiac causes. Today, with the near-disappearance of rheumatic fever, the most common cause of pediatric HF are congenital heart diseases, whilst cardiomyopathies are the most common cause of HF in children with a structurally normal heart. Signs and symptoms of pediatric HF are often not specific, most of all in newborns (difficulties in breastfeeding, excessive sweating, growth retardation and poor weight gain. The aim of the therapy is to clinically control HF through general measures as well as drugs administration. In this respect, due to the lack of large interventional trials, the HF in newborns and children is often extrapolated from adult large trials. Cardiac transplantation is currently the treatment option with good outcome and long-term survival in pediatric patients with end-stage or refractory HF.  Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

  6. Treatment of heart failure in Dutch general practice

    Directory of Open Access Journals (Sweden)

    van den Bosch Wil JHM

    2006-07-01

    Full Text Available Abstract Background To study the relation between the prescription rates of selected cardiovascular drugs (ACE-inhibitors and Angiotensin receptor blockers, beta-blockers, diuretics, and combinations, sociodemographic factors (age, gender and socioeconomic class and concomitant diseases (hypertension, coronary heart disease, cerebrovascular accident, heart valve disease, atrial fibrillation, diabetes mellitus and asthma/COPD among patients with heart failure cared for in general practice. Methods Data from the second Dutch National Survey in General Practice, conducted mainly in 2001. In this study the data of 96 practices with a registered patient population of 374.000 were used. Data included diagnosis made during one year by general practitioners, derived from the electronic medical records, prescriptions for medication and sociodemographic characteristics collected via a postal questionnary (response 76% Results A diagnosis of HF was found with 2771 patients (7.1 in 1000. Their mean age was 77.7 years, 68% was 75 years or older, 55% of the patients were women. Overall prescription rates for RAAS-I, beta-blockers and diuretics were 50%, 32%, 86%, respectively, whereas a combination of these three drugs was prescribed in 18%. Variations in prescription rates were mainly related to age and concomitant diseases. Conclusion Prescription is not influenced by gender, to a small degree influenced by socioeconomic status and to a large degree by age and concomitant diseases.

  7. Molecular profiling of dilated cardiomyopathy that progresses to heart failure

    Science.gov (United States)

    Wakimoto, Hiroko; Gorham, Joshua M.; Conner, David A.; Christodoulou, Danos C.; Parfenov, Michael G.; DePalma, Steve R.; Eminaga, Seda; Konno, Tetsuo; Seidman, Jonathan G.; Seidman, Christine E.

    2016-01-01

    Dilated cardiomyopathy (DCM) is defined by progressive functional and structural changes. We performed RNA-seq at different stages of disease to define molecular signaling in the progression from pre-DCM hearts to DCM and overt heart failure (HF) using a genetic model of DCM (phospholamban missense mutation, PLNR9C/+). Pre-DCM hearts were phenotypically normal yet displayed proliferation of nonmyocytes (59% relative increase vs. WT, P = 8 × 10−4) and activation of proinflammatory signaling with notable cardiomyocyte-specific induction of a subset of profibrotic cytokines including TGFβ2 and TGFβ3. These changes progressed through DCM and HF, resulting in substantial fibrosis (17.6% of left ventricle [LV] vs. WT, P = 6 × 10−33). Cardiomyocytes displayed a marked shift in metabolic gene transcription: downregulation of aerobic respiration and subsequent upregulation of glucose utilization, changes coincident with attenuated expression of PPARα and PPARγ coactivators -1α (PGC1α) and -1β, and increased expression of the metabolic regulator T-box transcription factor 15 (Tbx15). Comparing DCM transcriptional profiles with those in hypertrophic cardiomyopathy (HCM) revealed similar and distinct molecular mechanisms. Our data suggest that cardiomyocyte-specific cytokine expression, early fibroblast activation, and the shift in metabolic gene expression are hallmarks of cardiomyopathy progression. Notably, key components of these profibrotic and metabolic networks were disease specific and distinguish DCM from HCM.

  8. Metabolomic Fingerprint of Heart Failure with Preserved Ejection Fraction

    Science.gov (United States)

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

    2015-01-01

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

  9. Management of chronic heart failure in the older population

    Institute of Scientific and Technical Information of China (English)

    Nahid Azad; Genevieve Lemay

    2014-01-01

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

  10. Association of Central Sleep Apnea with Impaired Heart Structure and Cardiovascular Hemodynamics in Patients with Chronic Heart Failure.

    Science.gov (United States)

    Kazimierczak, Anna; Krzesiński, Paweł; Gielerak, Grzegorz; Uziębło-Życzkowska, Beata; Smurzyński, Paweł; Ryczek, Robert; Cwetsch, Andrzej; Skrobowski, Andrzej

    2016-01-01

    BACKGROUND Advanced heart failure (HF) is commonly accompanied by central sleep apnea (CSA) with Cheyne-Stokes respiration (CSR). The aim of this study was to evaluate the relationship between CSA/CSR and other clinical features of HF, with particular emphasis on cardiovascular hemodynamics. MATERIAL AND METHODS In 161 stable HF patients with left ventricular ejection fraction (LVEF) ≤45% (NYHA class I-III; mean LVEF 32.8%) the clinical evaluation included: LVEF; left and right ventricular end-diastolic diameter (LVDd, RVDd); ratio of early transmitral flow velocity to early diastolic septal mitral annulus velocity (E/e') assessed by echocardiography; stroke index (SI); heart rate (HR); cardiac index (CI); and systemic vascular resistance index (SVRI) assessed by impedance cardiography (ICG). The comparison was performed between 2 subgroups: one with moderate/severe CSA/CSR - CSR_ [+] (n=51), and one with mild or no CSA/CSR - CSR_ [-] (n=110). RESULTS CSR_ [+] patients presented more advanced NYHA class (pCSR_ [+] were identified: NYHA class (OR=3.34 per class, pCSR in HF is associated with NYHA class, atrial fibrillation and more advanced impairment of cardiovascular structure and hemodynamics. Patient functional state remains the main determinant of CSR. PMID:27558771

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    Prospective studies on the role of psychosocial factors in heart failure development are virtually nonexistent. The authors aimed to address the effect of psychosocial factors on the risk of heart failure hospitalization in men and women free of cardiovascular disease. In 1991-1993, the 8...... population reported some degree of vital exhaustion. The vital exhaustion score was associated with a higher risk of heart failure in a dose-response manner (P <0.002), with high vital exhaustion being associated with a 2-fold higher risk of heart failure in both men (hazard ratio = 1.93, 95% confidence...... population, even a modestly higher risk of heart failure associated with vital exhaustion may be of importance in the planning of future preventive strategies for heart failure....

  12. Biomarkers for Heart Failure: An Update for Practitioners of Internal Medicine.

    Science.gov (United States)

    Wettersten, Nicholas; Maisel, Alan S

    2016-06-01

    Biomarkers have become an integral part of practicing medicine, especially in heart failure. The natriuretic peptides are commonly used in the evaluation of heart failure, but their role extends beyond diagnosis and includes risk stratification and management of heart failure patients. Newer biomarkers have arrived and are becoming part of routine care of heart failure patients. Both ST2 and high-sensitivity troponin have significant prognostic value for mortality, but also may assist in the titration of medical therapy. Procalcitonin can help guide appropriate antibiotic use in patients with heart failure. The ability to appropriately use and interpret these biomarkers is imperative to the care of heart failure patients, especially as these newer biomarkers become widely used. PMID:26844635

  13. Adherence to self-care in patients with heart failure in the HeartCycle study

    Directory of Open Access Journals (Sweden)

    Stut W

    2015-08-01

    Full Text Available Wim Stut,1 Carolyn Deighan,2 John G Cleland,3 Tiny Jaarsma4 1Philips Research Europe, Eindhoven, the Netherlands; 2The Heart Manual Department, NHS Lothian, Edinburgh, UK; 3National Heart and Lung Institute, Royal Brompton and Harefield Hospitals Imperial College, London, UK; 4Department of Social and Welfare studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden Purpose: The purpose of this study was to evaluate a novel online education and coaching program to promote self-care among patients with heart failure. In this program, education and coaching content is automatically tailored to the knowledge and behavior of the patient. Patients and methods: The evaluation of the program took place within the scope of the HeartCycle study. This multi-center, observational study examined the ability of a third generation telehealth system to enhance the management of patients recently (<60 days admitted to the hospital for worsening heart failure or outpatients with persistent New York Heart Association (NYHA Functional Classification III/IV symptoms. Self-reported self-care behavior was assessed at baseline and study-end by means of the 9-item European Heart Failure Self-care Behavior scale. Adherence to daily weighing, blood pressure monitoring, and reporting of symptoms was determined by analyzing the system’s database. Results: Of 123 patients enrolled, the mean age was 66±12 years, 66% were in NYHA III and 79% were men. Self-reported self-care behavior scores (n=101 improved during the study for daily weighing, low-salt diet, physical activity (P<0.001, and fluid restriction (P<0.05. Average adherence (n=120 to measuring weight was 90%±16%, to measuring blood pressure was 89%±17% and to symptom reporting was 66%±32%. Conclusion: Self-reported self-care behavior scores improved significantly during the period of observation, and the objective evidence of adherence to daily weight and blood pressure measurements was

  14. Defective support network: a major obstacle to coping for patients with heart failure: a qualitative study

    OpenAIRE

    Mangolian Shahrbabaki, Parvin; Nouhi, Esmat; Kazemi, Majid; Ahmadi, Fazlollah

    2016-01-01

    Background: Heart failure as a chronic disease poses many challenges for a patient in his or her everyday life. Support in various aspects of life positively affects coping strategies and influences the well-being and health outcomes of heart failure patients. Inadequate support may lead to a worsening of symptoms, increased hospital readmissions, psychological disorders, and a reduced quality of life.Objective: This study explored obstacles to coping related to support for heart failure pati...

  15. Defective support network: a major obstacle to coping for patients with heart failure: a qualitative study

    OpenAIRE

    Parvin Mangolian Shahrbabaki; Esmat Nouhi; Majid Kazemi; Fazlollah Ahmadi

    2016-01-01

    Background: Heart failure as a chronic disease poses many challenges for a patient in his or her everyday life. Support in various aspects of life positively affects coping strategies and influences the well-being and health outcomes of heart failure patients. Inadequate support may lead to a worsening of symptoms, increased hospital readmissions, psychological disorders, and a reduced quality of life. Objective: This study explored obstacles to coping related to support for heart failure pat...

  16. Elderly women's experiences of support when living with congestive heart failure

    OpenAIRE

    Sundin, Karin; Bruce, Elisabeth; Barremo, Ann-Sofi

    2010-01-01

    Heart failure is a chronic syndrome that has physiological, psychological and social effects. The aim of the study was to illuminate the meanings of support as experienced by elderly women with chronic heart failure. Narrative interviews were conducted with five elderly women with chronic heart failure. A phenomenological hermeneutic method of interpretation was used. The meanings of support were experienced by the women out of two perspectives, that is, when support is present and when there...

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

    Directory of Open Access Journals (Sweden)

    Andre Pascal Kengne

    2008-03-01

    Full Text Available Andre Pascal Kengne1, Anastase Dzudie2, Eugene Sobngwi31The George Institute for International Health, University of Sydney, Australia; 2Heart failure and transplantation Unit, Louis Pradel’s Cardiovascular Hospital, Lyon, France; 3National Obesity Centre, Yaounde Central Hospital, CameroonPurpose: 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.Keywords: diabetes mellitus, cardiovascular diseases, heart failure, sub-Saharan Africa

  18. [Role of echocardiography in the tailored follow-up of outpatients with chronic heart failure].

    Science.gov (United States)

    Temporelli, Pier Luigi; Cioffi, Giovanni; Dini, Frank L; Ghio, Stefano; Rossi, Andrea

    2010-05-01

    Although a huge number of papers have been published on echocardiography in heart failure, there is no expert consensus on how the ultrasound evaluation can really improve the management of heart failure patients. The only way to reach this goal is to have echocardiographers knowing which echo information are relevant for the clinicians who treat heart failure patients and to have clinicians becoming familiar with the interpretation of the echocardiographic examination. PMID:20873465

  19. Possibilities for the development of a decision support system for diagnosing heart failure

    OpenAIRE

    Olsson, Linda

    2007-01-01

    Heart failure is a common disease which is difficult to diagnose. To aid physicians in diagnosing heart failure, a decision support system has been proposed. Parameters useful to the system are suggested. Some of these, such as age and gender, should be provided by the physician, and some should be derived from electro- and phonocardiographic signals. Various methods of signal processing, such as wavelet theory and principal components analysis, are described. Heart failure should be diagnose...

  20. Informal Caregivers' Experiences and Needs When Caring for a Relative With Heart Failure: An Interview Study

    OpenAIRE

    Gusdal, A. K.; Josefsson, K.; Adolfsson, E. T.; Martin, L

    2016-01-01

    Background: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden. Objective: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home. Methods: The...

  1. Direct measurement of skeletal muscle fatigue in patients with chronic heart failure.

    OpenAIRE

    Buller, N. P.; Jones, D.; Poole-Wilson, P A

    1991-01-01

    Skeletal muscle function was measured as force production and fatigue in both the quadriceps (a large locomotive muscle) and adductor pollicis (a small intrinsic hand muscle) in five healthy volunteers, five patients with mild chronic heart failure, and five patients with severe chronic heart failure. The quadriceps of patients with chronic heart failure had a reduced muscle cross sectional area, a reduced maximum isometric force production, and an increased tendency to fatigue. Isometric for...

  2. Evaluating the Prediction of Heart Failure towards Health Monitoring using Particle Swarm Optimization

    OpenAIRE

    S. Radhimeenakshi; G. M. Nasira

    2014-01-01

    Heart failure is one of the real cardio-vascular ailments influencing the center matured and the matured. It happens because of diminished cardiovascular yield. It can be both right-sided and left-sided failure of heart. This research study proposes a bio-inspired computing paradigm called particle swarm optimization shortly termed as PSO towards the prediction of heart failure. The implementation is carried out using java. The metrics such as time complexity and prediction accuracy are taken...

  3. Exercise training and losartan improve endothelial function in heart failure rats by different mechanisms

    OpenAIRE

    Kemi, O.J.; Haram, P.M.; Høydal, M.A.; U. Wisløff; Ellingsen, Ø.

    2013-01-01

    Objectives. To investigate the mechanisms of losartan- and exercise training-induced improvements on endothelial dysfunction in heart failure. Design. Sprague-Dawley rats subjected to left coronary artery ligation inducing myocardial infarction and heart failure were randomized to losartan treatment, high-intensity exercise training, or both. Results. Losartan, but not exercise training, reduced the heart failure-associated elevation in left ventricular end-diastolic pressure (26 ± 2 mmHg vs....

  4. Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure

    OpenAIRE

    Zuccala, G; Cattel, C; Manes-Gravina, E.; Di, N; Cocchi, A; Bernabei, R.

    1997-01-01

    OBJECTIVES—Cognitive impairment has been reported in middle aged patients with end stage heart failure. This cross sectional study assessed the prevalence and determinants of cognitive dysfunction in older patients with mild to moderate heart failure.
METHODS—57 consecutive patients (mean age 76.7 years) with chronic heart failure underwent physical examination, blood chemistry, urinalysis, chest radiography ECG, Doppler echocardiography, and the mini mental state examination (...

  5. Effect of Cardiac Resynchronization Therapy on Pulmonary Function in Patients With Heart Failure

    OpenAIRE

    Cundrle, Ivan; Johnson, Bruce D.; Somers, Virend K.; Scott, Christopher G; REA, ROBERT F.; Olson, Lyle J.

    2013-01-01

    Pulmonary congestion due to heart failure causes abnormal lung function. Cardiac resynchronization therapy (CRT) is a proven effective treatment for heart failure. The aim of this study was to test the hypothesis that CRT promotes increased lung volumes, bronchial conductance, and gas diffusion. Forty-four consecutive patients with heart failure were prospectively investigated before and after CRT. Spirometry, gas diffusion (diffusing capacity for carbon monoxide), cardiopulmonary exercise te...

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

    Directory of Open Access Journals (Sweden)

    Andre Pascal Kengne

    2008-02-01

    Full Text Available Andre Pascal Kengne1, Anastase Dzudie2, Eugene Sobngwi31The George Institute for International Health, University of Sydney, Australia; 2Heart failure and transplantation Unit, Louis Pradel’s Cardiovascular Hospital, Lyon, France; 3National Obesity Centre, Yaounde Central Hospital, CameroonPurpose: 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.Keywords: diabetes mellitus, cardiovascular diseases, heart failure, sub-Saharan Africa

  7. Spotlight on valsartan–sacubitril fixed-dose combination for heart failure: the evidence to date

    OpenAIRE

    Vilela-Martin JF

    2016-01-01

    José Fernando Vilela-Martin Internal Medicine Department, São José do Rio Preto State Medical School (FAMERP), São José do Rio Preto, Brazil Abstract: Heart failure is a global problem with elevated prevalence, and it is associated with substantial cardiovascular morbidity and mortality. Treating heart-failure patients has been a very challenging task. This review highlights the main pharmacological developments in the field of heart failure with reduced e...

  8. Discovery of Genetic Variation on Chromosome 5q22 Associated with Mortality in Heart Failure

    OpenAIRE

    Smith, J. Gustav; Felix, Janine F.; Morrison, Alanna C.; Kalogeropoulos, Andreas; Trompet, Stella; Wilk, Jemma B.; Gidlöf, Olof; Wang, Xinchen; Morley, Michael; Mendelson, Michael; Joehanes, Roby; Ligthart, Symen; Shan, Xiaoyin; Bis, Joshua C.; Wang, Ying A.

    2016-01-01

    Failure of the human heart to maintain sufficient output of blood for the demands of the body, heart failure, is a common condition with high mortality even with modern therapeutic alternatives. To identify molecular determinants of mortality in patients with new-onset heart failure, we performed a meta-analysis of genome-wide association studies and follow-up genotyping in independent populations. We identified and replicated an association for a genetic variant on chromosome 5q22 with 36% i...

  9. Mitochondrial dynamics and cell death in heart failure.

    Science.gov (United States)

    Marín-García, José; Akhmedov, Alexander T

    2016-03-01

    The highly regulated processes of mitochondrial fusion (joining), fission (division) and trafficking, collectively called mitochondrial dynamics, determine cell-type specific morphology, intracellular distribution and activity of these critical organelles. Mitochondria are critical for cardiac function, while their structural and functional abnormalities contribute to several common cardiovascular diseases, including heart failure (HF). The tightly balanced mitochondrial fusion and fission determine number, morphology and activity of these multifunctional organelles. Although the intracellular architecture of mature cardiomyocytes greatly restricts mitochondrial dynamics, this process occurs in the adult human heart. Fusion and fission modulate multiple mitochondrial functions, ranging from energy and reactive oxygen species production to Ca(2+) homeostasis and cell death, allowing the heart to respond properly to body demands. Tightly controlled balance between fusion and fission is of utmost importance in the high energy-demanding cardiomyocytes. A shift toward fission leads to mitochondrial fragmentation, while a shift toward fusion results in the formation of enlarged mitochondria and in the fusion of damaged mitochondria with healthy organelles. Mfn1, Mfn2 and OPA1 constitute the core machinery promoting mitochondrial fusion, whereas Drp1, Fis1, Mff and MiD49/51 are the core components of fission machinery. Growing evidence suggests that fusion/fission factors in adult cardiomyocytes play essential noncanonical roles in cardiac development, Ca(2+) signaling, mitochondrial quality control and cell death. Impairment of this complex circuit causes cardiomyocyte dysfunction and death contributing to heart injury culminating in HF. Pharmacological targeting of components of this intricate network may be a novel therapeutic modality for HF treatment. PMID:26872674

  10. Influence of bilevel positive airway pressure on autonomic tone in hospitalized patients with decompensated heart failure

    OpenAIRE

    Lacerda, Diego; Costa, Dirceu; Reis, Michel; Gomes, Evelim Leal de F. Dantas; Costa, Ivan Peres; Borghi-Silva, Audrey; Marsico, Aline; Stirbulov, Roberto; Arena, Ross; Sampaio, Luciana Maria Malosá

    2016-01-01

    [Purpose] This study evaluated the effect of Bilevel Positive Airway (BiPAP) on the autonomic control of heart rate, assessed by heart rate variability (HRV), in patients hospitalized with decompensated heart failure. [Subjects and Methods] This prospective cross-sectional study included 20 subjects (age: 69±8 years, 12 male, left ventricular ejection fraction: 36 ±8%) diagnosed with heart failure who were admitted to a semi-intensive care unit with acute decompensation. Date was collected fo...

  11. Alpha-1-Adrenergic Receptors: Targets for Agonist Drugs to Treat Heart Failure

    OpenAIRE

    Jensen, Brian C.; O'Connell, Timothy D.; Simpson, Paul C.

    2010-01-01

    Evidence from cell, animal, and human studies demonstrates that α1-adrenergic receptors mediate adaptive and protective effects in the heart. These effects may be particularly important in chronic heart failure, when catecholamine levels are elevated and β-adrenergic receptors are down regulated and dysfunctional. This review summarizes these data and proposes that selectively activating α1-adrenergic receptors in the heart may represent a novel and effective way to treat heart failure.

  12. Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients

    OpenAIRE

    Pardaens, K; Van Cleemput, J.; Vanhaecke, J.; Fagard, R.

    1997-01-01

    Objective—To study the influence of atrial fibrillation on peak oxygen uptake (peak V̇O2) in chronic heart failure. An unfavourable effect of atrial fibrillation has been shown in several patient populations, but the results have not been consistent in chronic heart failure.
Methods—Data were analysed from male heart transplant candidates who were able to perform graded bicycle ergometry until exhaustion with respiratory gas analysis and measurement of heart rate. Patients in atrial fibrillat...

  13. Comparative RNA-sequencing analysis of myocardial and circulating small RNAs in human heart failure and their utility as biomarkers

    OpenAIRE

    Akat, Kemal Marc; Moore-McGriff, D’Vesharronne; Morozov, Pavel; Brown, Miguel; Gogakos, Tasos; Correa da Rosa, Joel; Mihailovic, Aleksandra; Sauer, Markus; Ji, Ruiping; Ramarathnam, Aarthi; Totary-Jain, Hana; Williams, Zev; Tuschl, Thomas; Schulze, P. Christian

    2014-01-01

    Heart failure (HF) has a high morbidity and mortality and its incidence is increasing worldwide. While protein biomarkers have been established for diagnostic and prognostic evaluation of patients with HF, there is currently no systematic assessment of RNA biomarkers. We determined the composition of myocardial tissue and circulating microRNAs (miRNAs) in a large cohort of patients with stable and advanced HF and compared it to the composition of normal adult and fetal samples. The advanced H...

  14. 31P-NMR analysis of congestive heart failure in the SHHF/Mcc-facp rat heart.

    Science.gov (United States)

    Michael O'Donnell, J; Narayan, P; Bailey, M Q; Abduljalil, A M; Altschuld, R A; McCune, S A; Robitaille, P M

    1998-02-01

    31P-NMR was used to monitor myocardial bioenergetics in compensated and failing SHHF/MCC-fa(cp) (SHF) rat hearts. The SHHF/Mcc-fa(cp) (spontaneous hypertension and heart failure) rat is a relatively new genetic model in which all individuals spontaneously develop congestive heart failure, most during the second year of life. Failing SHF rat hearts displayed a pronounced decrease in resting PCr:ATP ratios (Ppressure products (RRP, mmHg X beats/min) from 44.5+/-1.4 to 66.6+/-3. 4 K with dobutamine infusion, whereas hearts in end-stage failure were able to increase their RPP from baseline values of 27+/-4 K to only 37+/-7 K. The data indicate that a pronounced decline in PCr and total creatine signals the transition from compensatory hypertrophy to decompensation and failure in the SHF rat model of hypertensive cardiomyopathy. PMID:9515000

  15. [Are some antidiabetic drugs also drugs useful for heart failure treatment?].

    Science.gov (United States)

    Murín, Ján

    2016-04-01

    The prevalence of diabetes mellitus type 2 is rapidly growing. It is the cardiovascular mortality and morbidity why these patients suffer. Also heart failure becomes very frequent in diabetics, as it is a strong risk factor for development of heart failure and for its progression. Recently published data of EMPA-REG OUTCOME trial with empagliflozin hint to the possibility of heart failure treatment with this drug. The author presents data about the influence of antidiabetic drugs on cardiovascular risk factors, specifically on heart failure. This can be a way how to prevent heart failure in diabetic patients. Later he presents data about the influence of antidiabetics on symptoms and signs of heart failure. Some of these drugs are neutral, some are risky for patients and in the case of empagliflozin there is a beneficial influence. As heart failure is a great problem of clinical practice and diabetes is a strong risk factor of heart failure, we are looking also for prevention of heart failure and for its treatment also by using antidiabetic drug. PMID:27250612

  16. Proteomics of pediatric heart failure: from traditional biomarkers to new discovery strategies.

    Science.gov (United States)

    Xu, Mingguo; Ramirez-Correa, Genaro A; Murphy, Anne M

    2015-08-01

    Heart failure in children is a complex clinical syndrome with multiple aetiologies. The underlying disorders that lead to heart failure in children differ significantly from those in adults. Some clinical biomarkers for heart failure status and prognosis appear to be useful in both age groups. This review outlines the use and the present status of biomarkers for heart failure in paediatric cardiology. Furthermore, clinical scenarios in which development of new biomarkers might address management or prognosis are discussed. Finally, strategies for proteomic discovery of novel biomarkers and application to practice are described. PMID:26377710

  17. Cognitive impairment and self-care in heart failure

    Directory of Open Access Journals (Sweden)

    Hajduk AM

    2013-10-01

    Full Text Available Alexandra M Hajduk,1,2 Stephenie C Lemon,3 David D McManus,1,2,4 Darleen M Lessard,1 Jerry H Gurwitz,1,2,4 Frederick A Spencer,5 Robert J Goldberg,1,2 Jane S Saczynski1,2,4 1Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; 2Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA; 3Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; 4Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; 5Department of Medicine, McMaster University, Hamilton, ON, Canada 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

  18. Salt Intake Is Associated with Inflammation in Chronic Heart Failure

    Directory of Open Access Journals (Sweden)

    Alper Azak

    2015-09-01

    Full Text Available 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

  19. Sex Differences in Patients With Acute Decompensated Heart Failure: Insights From the Heart Function Assessment Registry Trial in Saudi Arabia.

    Science.gov (United States)

    AlFaleh, Hussam F; Thalib, Lukman; Kashour, Tarek; Hersi, Ahmad; Mimish, Layth; Elasfar, Abdelfatah A; Almasood, Ali; Al Ghamdi, Saleh; Ghabashi, Abdullah; Malik, Asif; Hussein, Gamal A; Al-Murayeh, Mushabab; Abuosa, Ahmed; Al Habeeb, Waleed; Al Habib, Khalid F

    2016-08-01

    We assessed sex-specific differences in clinical features and outcomes of patients with acute heart failure (AHF). The Heart function Assessment Registry Trial in Saudi Arabia (HEARTS), a prospective registry, enrolled 2609 patients with AHF (34.2% women) between 2009 and 2010. Women were older and more likely to have risk factors for atherosclerosis, history of heart failure (HF), and rheumatic heart and valve disease. Ischemic heart disease was the prime cause for HF in men and women but more so in men (P Women had higher rates of hypertensive heart disease and primary valve disease (P women and higher ventricular arrhythmias in men, no differences were observed in hospital outcomes. The overall survival did not differ between men and women (hazard ratio: 1.0, 95% confidence interval: 0.8-1.2, P = .981). Men and women with AHF differ significantly in baseline clinical characteristics and management but not in adverse outcomes. PMID:26438635

  20. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    Vaneet Jearath

    2016-01-01

    Full Text Available Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy.

  1. Sleep Apnea and Cognitive Function in Heart Failure

    Directory of Open Access Journals (Sweden)

    Krysten M. Knecht

    2012-01-01

    Full Text Available Background. Prior research indicates that heart failure (HF patients exhibit significant cognitive deficits on neuropsychological testing. Sleep apnea is associated with both HF and reduced cognitive function, but the combined impact of these conditions on cognitive function is unknown. Methods. In the current study, 172 older adults with a dual diagnosis of HF and sleep apnea or HF alone completed a battery of cognitive tests measuring attention, executive functioning, and memory. Results. Relative to patients with HF alone, persons with both HF and sleep apnea performed worse on measures of attention after adjusting for demographic and medical variables. Conclusions. The current findings suggest that HF patients with comorbid sleep apnea may be at greater risk for cognitive impairment relative to HF patient without such history. Further work is needed to clarify mechanisms for these findings and to determine whether the interactive effects on cognitive function lead to poorer patient outcomes.

  2. Fatal acute right heart failure in gastric cancer patients

    Directory of Open Access Journals (Sweden)

    Sang-Hoon Seol

    2013-01-01

    Full Text Available Pulmonary tumor thrombotic microangiopathy (PTTM is a rare condition causing pulmonary artery hypertension and acute right heart failure in patients with cancer. However, chest computer tomography shows negative finding of pulmonary thromboembolism. Serum D-dimer level may be elevated. Echocardiography reveals a dilated right ventricle and feature of pulmonary artery hypertension. Establishing this diagnosis can be very difficult, and most cases are diagnosed during autopsy, although a history of cancer may be a predictor. PTTM should be considered in all patients with apparent pulmonary artery hypertension and elevated D-dimer level, particularly when the patient is known to have an underlying malignancy, especially adenocarcinoma and most of all, the clinical manifestation is very rapidly progressive.

  3. Aliskiren, Enalapril, or Aliskiren and Enalapril in Heart Failure

    DEFF Research Database (Denmark)

    McMurray, John J V; Krum, Henry; Abraham, William T;

    2016-01-01

    (hazard ratio vs. enalapril, 0.99; 95% CI, 0.90 to 1.10); the prespecified test for noninferiority was not met. There was a higher risk of hypotensive symptoms in the combination-therapy group than in the enalapril group (13.8% vs. 11.0%, P=0.005), as well as higher risks of an elevated serum creatinine...... level (4.1% vs. 2.7%, P=0.009) and an elevated potassium level (17.1% vs. 12.5%, P<0.001). CONCLUSIONS: In patients with chronic heart failure, the addition of aliskiren to enalapril led to more adverse events without an increase in benefit. Noninferiority was not shown for aliskiren as compared with...

  4. Complexity in congestive heart failure: A time-frequency approach

    Science.gov (United States)

    Banerjee, Santo; Palit, Sanjay K.; Mukherjee, Sayan; Ariffin, MRK; Rondoni, Lamberto

    2016-03-01

    Reconstruction of phase space is an effective method to quantify the dynamics of a signal or a time series. Various phase space reconstruction techniques have been investigated. However, there are some issues on the optimal reconstructions and the best possible choice of the reconstruction parameters. This research introduces the idea of gradient cross recurrence (GCR) and mean gradient cross recurrence density which shows that reconstructions in time frequency domain preserve more information about the dynamics than the optimal reconstructions in time domain. This analysis is further extended to ECG signals of normal and congestive heart failure patients. By using another newly introduced measure—gradient cross recurrence period density entropy, two classes of aforesaid ECG signals can be classified with a proper threshold. This analysis can be applied to quantifying and distinguishing biomedical and other nonlinear signals.

  5. Dietary Nitrate and Skeletal Muscle Contractile Function in Heart Failure.

    Science.gov (United States)

    Coggan, Andrew R; Peterson, Linda R

    2016-08-01

    Heart failure (HF) patients suffer from exercise intolerance that diminishes their ability to perform normal activities of daily living and hence compromises their quality of life. This is due largely to detrimental changes in skeletal muscle mass, structure, metabolism, and function. This includes an impairment of muscle contractile performance, i.e., a decline in the maximal force, speed, and power of muscle shortening. Although numerous mechanisms underlie this reduction in contractility, one contributing factor may be a decrease in nitric oxide (NO) bioavailability. Consistent with this, recent data demonstrate that acute ingestion of NO3 (-)-rich beetroot juice, a source of NO via the NO synthase-independent enterosalivary pathway, markedly increases maximal muscle speed and power in HF patients. This review discusses the role of muscle contractile dysfunction in the exercise intolerance characteristic of HF, and the evidence that dietary NO3 (-) supplementation may represent a novel and simple therapy for this currently underappreciated problem. PMID:27271563

  6. The role of statins in chronic heart failure.

    Science.gov (United States)

    Szyguła-Jurkiewicz, Bożena; Szczurek, Wioletta; Król, Bogumiła; Zembala, Marian

    2014-09-01

    The efficacy of statins in reducing morbidity and mortality in patients with documented coronary artery disease is unquestionable. However, in chronic heart failure (CHF), evidence regarding the beneficial effects of statin therapy remains contradictory. Although numerous retrospective studies have demonstrated improved prognosis in CHF patients treated with statins, two randomized trials, GISSI-HF and CORONA, have not confirmed the benefit of rosuvastatin in this group of patients. The benefits of using statins in CHF probably result mostly from their pleiotropic action, including the improvement of endothelial function, the inhibition of neurohormonal activation, and the reduction of proinflammatory activation. On the other hand, it has been recognized that low cholesterol is associated with worse morbidity and mortality in patients with CHF. It appears that it is necessary to conduct further randomized clinical trials using different kinds of statins in different populations of patients with CHF. PMID:26336439

  7. PRIMARY CARE PROBLEMS IN PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    O. A. Shtegman

    2015-09-01

    Full Text Available Aim. To evaluate primary care efficacy in patients with chronic heart failure (CHF.Material and methods. Outpatients (n=139 with CHF and 35 primary care physicians were included into the study. The evaluation of drug therapy and patient awareness of the principles of non-drug CHF treatment were performed. An anonymous survey among doctors in terms of current CHF guidelines knowledge, patient information provided by physicians, and doctors’ burnout status was also carried out.Results. Only 39% and 10% of CHF outpatients received target doses of ACE inhibitors/sartans and beta-blockers, respectively. Majority of CHF outpatients and their doctors need in additional education/training. 56% of primary care physicians demonstrated an emotional burnout.Conclusion. Author considers it essential to distribute short pocket-guidelines on CHF management among primary care physicians, and to reduce the load on primary care physicians with simultaneous strengthening of their performance control.

  8. [Therapeutic education of heart failure patients in France].

    Science.gov (United States)

    Jourdain, Patrick; Juillière, Yves; Boireau, Amélie; Bellorini, Michel; Desnos, Michel; Dagorn, Joël; Funck, François

    2009-12-01

    Heart failure is a frequent and severe disease. The rate of avoidable hospitalizations due to lack of treatment adherence is estimated at 30% and, makes this disease a prime target for patient education. Implementation of such education initially began as a function of the local possibilities and willingness, which has led to great variety in the programs (only some of which meet the criteria set forth in the National Authority for Health guidelines) and the tools used. More recently, regional and even national programs, such as ICARE, sponsored by the two principal learned societies (The French Society and French Federation of Cardiology) have helped more than 200 private and public hospitals to set up field patient education programs based upon common concepts and tools. PMID:19926440

  9. Improving Health Outcomes for Low Health Literacy Heart Failure Patients.

    Science.gov (United States)

    Friel, Catherine J

    2016-09-01

    According to the National Assessment of Adult Literacy (2003), only 12% of U.S. adults have a proficient level of health literacy, with adults 65 years and older more likely to have a below basic or a basic health literacy level. An estimated 5.8 million individuals in the United States have heart failure (HF) and it is one of the most common reasons for those aged 65 and over to be hospitalized. Many patients with HF are at risk for poor health outcomes due to low health literacy. This article reviews the literature with regard to the effectiveness of methods used to address low health literacy among HF patients and describes a pilot study implemented by a home care agency in the northeast to address high HF readmission rates. PMID:27580282

  10. [Optimization of energy metabolism in patients with chronic heart failure].

    Science.gov (United States)

    Korzh, A N

    2010-01-01

    Nowadays particular interest of clinicians is attracted by metabolic therapy of patients with chronic heart failure (CHF). The objective of this study was to investigate the influence of complex therapy with addition of Vasonat on the dynamics of remodeling indexes of left ventricle and functional class of CHF on classification of NYHA. It has been shown that application of metabolic modulator Vasonat in addition to conventional therapy of CHF facilitated the clinical improvement and significant decline of functional class. Vasonat use resulted in the meaningful improvement of the contractive function of myocardium and increase of tolerance to the physical exercise. Moreover, high efficiency of Vasonat has been demonstrated in the control of the syndrome of oxidizing stress, by decrease in intensity of free-radical processes and activation of the antioxidant defense system. PMID:21265120

  11. Renal dysfunction prevalence and clinical impact in heart failure

    Directory of Open Access Journals (Sweden)

    Palazzuoli A

    2011-09-01

    Full Text Available Alberto Palazzuoli, Susanna Benincasa, Stefanie Grothgar, Pasquale Di Sipio, Giovanni Paganini, Marco Pellegrini, Ranuccio NutiDepartment of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, University of Siena, ItalyAbstract: Chronic kidney disease (CKD is associated with a significant increase in death and cardiovascular mortality. However the exact mechanism by which CKD impairs the cardiovascular outcome is not well established. Some reasons may lie in the association of CKD with several other cardiovascular and noncardiovascular disorders including accelerated systemic atherosclerosis, endothelial dysfunction, increased levels of inflammatory factors, anemic status, bone mineral dysfunction, electrolyte imbalance, and renin–angiotensin–aldosterone system (RAAS activation. Therefore several risk factors such as hypertension, diabetes, lipid disorders, and older age are common in both conditions. In patients affected with heart failure (HF a key role is represented by the neurohormonal activation. This condition causes fluid and sodium retention, peripheral vasoconstriction, as well as increased congestion and cardiac workload. Moreover, HF during the decompensated phases is often associated with a worsening renal function that leads to further RAAS activation, microvascular damage, and intrarenal flow redistribution. In order to clarify the interactions between these factors, several questions need to be answered: the universal definition of “worsening renal function,” the identification of the best laboratory parameters to investigate renal function in terms of sensitivity and specificity, and a better definition of the comorbidities’ role in the determination of the outcome, especially in patients with chronic HF. A clarification of these key points could lead to the individualization of new specific therapeutic targets and to a reduction in mortality and hospitalization in patients with HF and

  12. Assessing patient preferences in heart failure using conjoint methodology

    Directory of Open Access Journals (Sweden)

    Pisa G

    2015-08-01

    Full Text Available Giovanni Pisa,1 Florian Eichmann,1 Stephan Hupfer21Kantar Health GmbH, Munich, Germany; 2Novartis Pharma GmbH, Nuernberg, GermanyAim: The course of heart failure (HF is characterized by frequent hospitalizations, a high mortality rate, as well as a severely impaired health-related quality of life (HRQoL. To optimize disease management, understanding of patient preferences is crucial. We aimed to assess patient preferences using conjoint methodology and HRQoL in patients with HF.Methods: Two modules were applied: an initial qualitative module, consisting of in-depth interviews with 12 HF patients, and the main quantitative module in 300 HF patients from across Germany. Patients were stratified according to the time of their last HF hospitalization. Each patient was presented with ten different scenarios during the conjoint exercise. Additionally, patients completed the generic HRQoL instrument, EuroQol health questionnaire (EQ-5D™.Results: The attribute with the highest relative importance was dyspnea (44%, followed by physical capacity (18%. Of similar importance were exhaustion during mental activities (13%, fear due to HF (13%, and autonomy (12%. The most affected HRQoL dimensions according to the EQ-5D questionnaire were anxiety/depression (23% with severe problems, pain/discomfort (19%, and usual activities (15%. Overall average EQ-5D score was 0.39 with stable, chronic patients (never hospitalized having a significantly better health state vs the rest of the cohort.Conclusion: This paper analyzed patient preference in HF using a conjoint methodology. The preference weights resulting from the conjoint analysis could be used in future to design HRQoL questionnaires which could better assess patient preferences in HF care.Keywords: heart failure, quality of life, conjoint analysis, utility, patient preference

  13. Sildenafil Improves Erectile Function in Men with Chronic Heart Failure

    Directory of Open Access Journals (Sweden)

    Niloufar Samiei

    2015-06-01

    Full Text Available Background: Patients with Chronic Heart Failure (CHF have been shown to have enhanced risk of Erectile Dysfunction (ED due to low cardiac output, endothelial dysfunction, medications, co-morbid conditions, and psychogenic factors. Objectives: The present study aimed to evaluate the effects of sildenafil on erectile function of patients with stable CHF using the abridged 5-item version of the International Index of Erectile Function (IIEF-5. Patients and Methods: Using convenience sampling, 222 sexually-active adult males with NYHA class I-III stable CHF were included in this cross-sectional study. All the patients filled out the IIEF-5 questionnaire, in which they were required to score the five domains of male sexual function, including erectile function, orgasm function, sexual desire, intercourse satisfaction, and overall satisfaction. All the analyses were performed using the SPSS statistical software (v. 19 and P < 0.05 was considered as statistically significant. Results: In our sample, the patients’ mean age was 47.14 ± 11.86 years, their mean left ventricular ejection fraction was 20% (15% - 25%, and the prevalence of ED was 70.3%. In addition, severe, moderate, mild to moderate, and mild ED were seen in 57%, 17%, 7%, and 19% of the patients with ED, respectively. ED was significantly more prevalent in the patients with ischemic heart failure compared to those with idiopathic dilated cardiomyopathy (84.68% vs. 55.85%, P < 0.001. Moreover, the prevalence of ED was significantly lower in the patients taking sildenafil compared to the other group (42.85% vs. 82.89%, P < 0.001. Conclusions: Sildenafil appears to provide satisfactory results toward improving sexual function in patients with CHF.

  14. [Changes of heart function after different cell type stem cell transplantation in chronic heart failure].

    Science.gov (United States)

    Fan, Zhongcai; Chen, Mao; Deng, Juelin; Liu, Xiaojing; Zhang, Li; Rao, Li; Yang, Qing; Huang, Dejia

    2006-12-01

    To investigate the feasibility of introcoronary cell infusion into nonischemic heart failure (HF) heart and whether different types of stem cell transplantation would affect heart function to a similar degree. Japanese white ears rabbits were used as HF models by intravenous injection adriamycin. Autologous bone marrow mononuclear cells(BMCs), bone marrow stromal cells (MSCs), skeletal myoblasts (SMs) or culture medium were infused into coronary arteries respectively by occluding the root of ascending aorta. The mortality during and 4 weeks after the procedure the mortality was 7.1% and 16.7% respectively. After 4 weeks, the ejection fraction (EF) in BMCs group had significant improvement (P 0.05). In sham group,the left ventricular endostolic diameter (LVED) had significant enlargement (P 0.05). Immunofluorescence revealed de novo expression of cardiac troponin I in BMCs and MSCs groups, cardiac troponin I was not detected in SMs group. In conclusions, intracoronary cell transplantation could provide effective cell delivery into dilated cardiomyopathy hearts and could be a useful strategy for treating CHF, BMCs cell transplantation may be the first choice in all the above cell types. PMID:17228727

  15. It's Time for An Epigenomics Roadmap of Heart Failure.

    Science.gov (United States)

    Papait, Roberto; Corrado, Nadia; Rusconi, Francesca; Serio, Simone; V G Latronico, Michael

    2015-08-01

    The post-genomic era has completed its first decade. During this time, we have seen an attempt to understand life not just through the study of individual isolated processes, but through the appreciation of the amalgam of complex networks, within which each process can influence others. Greatly benefiting this view has been the study of the epigenome, the set of DNA and histone protein modifications that regulate gene expression and the function of regulatory non-coding RNAs without altering the DNA sequence itself. Indeed, the availability of reference genome assemblies of many species has led to the development of methodologies such as ChIP-Seq and RNA-Seq that have allowed us to define with high resolution the genomic distribution of several epigenetic elements and to better comprehend how they are interconnected for the regulation of gene expression. In the last few years, the use of these methodologies in the cardiovascular field has contributed to our understanding of the importance of epigenetics in heart diseases, giving new input to this area of research. Here, we review recently acquired knowledge on the role of the epigenome in heart failure, and discuss the need of an epigenomics roadmap for cardiovascular disease. PMID:27006627

  16. Epicardial adipose tissue in patients with heart failure

    Directory of Open Access Journals (Sweden)

    Michaely Henrik

    2010-07-01

    Full Text Available Abstract Purpose The aim of this study was to evaluate the extent of epicardial adipose tissue (EAT and its relationship with left ventricular (LV parameters assessed by cardiovascular magnetic resonance (CMR in patients with congestive heart failure (CHF and healthy controls. Background EAT is the true visceral fat deposited around the heart which generates various bioactive molecules. Previous studies found that EAT is related to left ventricular mass (LVM in healthy subjects. Further studies showed a constant EAT to myocardial mass ratio in normal, ischemic and hypertrophied hearts. Methods CMR was performed in 66 patients with CHF due to ischemic cardiomyopathy (ICM, or dilated cardiomyopathy (DCM and 32 healthy controls. Ventricular volumes, dimensions and LV function were assessed. The amount of EAT was determined volumetrically and expressed as mass indexed to body surface area. Additionally, the EAT/LVM and the EAT/left ventricular remodelling index (LVRI ratios were calculated. Results Patients with CHF had less indexed EAT mass than controls (22 ± 5 g/m2 versus 34 ± 4 g/m2, p 2 versus 23 ± 6 g/m2, p = 0.14. Linear regression analysis showed that with increasing LV end-diastolic diameter (LV-EDD (r = 0.42, p = 0.0004 and LV end-diastolic mass (LV-EDM (r = 0.59, p Conclusion Patients with CHF revealed significantly reduced amounts of EAT. An increase in LVM is significantly related to an increase in EAT in both patients with CHF and controls. However, different from previous reports the EAT/LVEDM-ratio in patients with CHF was significantly reduced compared to healthy controls. Furthermore, the LV function correlated best with the indexed EAT/LVRI ratio in CHF patients. Metabolic abnormalities and/or anatomic alterations due to disturbed cardiac function and geometry seem to play a key role and are a possible explanation for these findings.

  17. Efficacy of trimetazidine combining with metoprolol on plasma BNP in coronary heart disease patients with heart failure

    Institute of Scientific and Technical Information of China (English)

    Ping Li; You-Mei Li

    2016-01-01

    Objective:To explore the effect of combined application of trimetazidine and metoprolol on plasma BNP in coronary heart disease patients with heart failure and the clinical efficacy. Methods:A total of 140 cases of coronary heart disease patients with heart failure treated in Cardiology Department of our hospital from May 2012 to January 2015 were selected and divided into study group and control group by random number table method. The control group received digitalis, diuretics, ACEI (angiotensin-converting enzyme inhibitor) and other conventional drugs for treatment, the study group received combined use of trimetazidine and metoprolol on the basis of routine treatment of the control group, and treatment duration was 12 weeks. Then plasma BNP, systolic blood pressure, heart rate, left ventricular end diastolic diameter (LVEDD), left ventricular end systolic end (LVESD) and left ventricular ejection fraction (LVEF) of two groups before and after treatment were statistically analyzed, and the overall effect was evaluated.Results:Before treatment, there were no significant differences in plasma BNP, blood pressure, heart rate, LVEDD, LVESD and LVEF between the two groups; after treatment, plasma BNP, blood pressure, heart rate, LVEDD and LVESD of both groups decreased and LVEF increased, but the changes in study group were better than those in control group.Conclusion:Trimetazidine combined with metoprolol has better application effect in plasma BNP decrease and heart function improvement in coronary heart disease patients with heart failure.

  18. Clinical use of nuclear cardiology in the assessment of heart failure

    International Nuclear Information System (INIS)

    Nuclear cardiology is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays an important role in their assessment and management. Quantitative gated single positron emission computed tomography is used to assess quantitatively cardiac volume, left ventricular ejection fraction, stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging can not only identify nonischemic heart failure and ischemic heart failure, but also demonstrate myocardial viability. Diastolic heart failure also termed as heart failure with a preserved left ventricular ejection fraction is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate and time to peak filling rate. With newer techniques such as three-dimensional, quantitative gated single positron emission computed tomography can assess movement of the left ventricle, and wall thickening evaluation aids its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using 123I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using 123I-15-(p-iodophenyl) 3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to improve heart failure diagnosis. Nuclear cardiology techniques contribute significantly to identifying patients with heart failure and to guiding their management decisions. (authors)

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

    Science.gov (United States)

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

    1997-08-01

    In chronic heart failure (CHF), the ventilatory response is increased compared with normal. This response is, in part, caused by reduced perfusion to ventilated lung. Nitric oxide (NO) is a potent vasodilator and may have an important role in pulmonary vasodilatation during exercise. NO is present in exhaled air. The amount of NO in exhaled air, when breathing NO-free compressed air, is known to increase in normal subjects during exercise. In this study, we quantified NO output in exhaled air in patients with CHF during exercise. Six patients with CHF (New York Heart Association Class II and III; two with dilated cardiomyopathy, three with ischemic heart disease, and one with hypertensive heart disease) and six normal subjects were studied with a symptom-limited incremental exercise test on a cycle ergometer. Oxygen uptake (VO2), carbon dioxide output (VCO2), and minute ventilation (VE) were measured breath by breath with a mass spectrometer, flow meter, and computer. The NO concentration was continuously measured in mixed expired air by chemiluminescence. Peak exercise work rate was lower in patients with CHF than in normal subjects (71.3 +/- 41.6 W vs 257.0 +/- 49.7 W; p air at rest was lower in CHF patients than in normal subjects (4.0 +/- 2.2 ppb vs 10.5 +/- 6.2 ppb, respectively; p < 0.05). NO output from the respiratory tract (VNO) was significantly lower in patients with CHF compared with normal subjects at rest (45.3 +/- 24.3 nl/min, 117.5 +/- 60.1 nl/min, respectively, p < 0.05), and although it increased during exercise, it did not increase in patients with CHF as much as in normal subjects (75.3 +/- 43.4 nl/min vs 512.9 +/- 253.6 nl/min, respectively; p < 0.01). The increase above rest (exercise/rest) was smaller in patients with CHF than in normal subjects (2.10 +/- 1.92 vs 4.81 +/- 2.67, p < 0.05). These data support the concept that the smaller increase in NO production (VNO) during exercise may be responsible for a blunted vasodilation in patients

  20. Atrial fibrillation in heart failure is associated with an increased risk of death only in patients with ischaemic heart disease

    DEFF Research Database (Denmark)

    Raunsø, Jakob; Pedersen, Ole Dyg; Dominguez, Helena;

    2010-01-01

    The prognostic importance of atrial fibrillation (AF) in heart failure (HF) populations is controversial and may depend on patient selection. In the present study, we investigated the prognostic impact of AF in a large population with HF of various aetiologies.......The prognostic importance of atrial fibrillation (AF) in heart failure (HF) populations is controversial and may depend on patient selection. In the present study, we investigated the prognostic impact of AF in a large population with HF of various aetiologies....

  1. Loss of lag-response curvilinearity of indices of heart rate variability in congestive heart failure

    Directory of Open Access Journals (Sweden)

    Smith Michael L

    2006-06-01

    Full Text Available Abstract Background Heart rate variability (HRV is known to be impaired in patients with congestive heart failure (CHF. Time-domain analysis of ECG signals traditionally relies heavily on linear indices of an essentially non-linear phenomenon. Poincaré plots are commonly used to study non-linear behavior of physiologic signals. Lagged Poincaré plots incorporate autocovariance information and analysis of Poincaré plots for various lags can provide interesting insights into the autonomic control of the heart. Methods Using Poincaré plot analysis, we assessed whether the relation of the lag between heart beats and HRV is altered in CHF. We studied the influence of lag on estimates of Poincaré plot indices for various lengths of beat sequence in a public domain data set (PhysioNet of 29 subjects with CHF and 54 subjects with normal sinus rhythm. Results A curvilinear association was observed between lag and Poincaré plot indices (SD1, SD2, SDLD and SD1/SD2 ratio in normal subjects even for a small sequence of 50 beats (p value for quadratic term 3 × 10-5, 0.002, 3.5 × 10-5 and 0.0003, respectively. This curvilinearity was lost in patients with CHF even after exploring sequences up to 50,000 beats (p values for quadratic term > 0.5. Conclusion Since lagged Poincaré plots incorporate autocovariance information, these analyses provide insights into the autonomic control of heart rate that is influenced by the non-linearity of the signal. The differences in lag-response in CHF patients and normal subjects exist even in the face of the treatment received by the CHF patients.

  2. Plasma copeptin levels and prediction of outcome in heart failure outpatients

    DEFF Research Database (Denmark)

    Balling, Louise; Kistorp, Caroline; Schou, Morten;

    2012-01-01

    Copeptin, a stable fragment of the vasopressin prohormone, has been shown to be a significant biomarker for morbidity and mortality in heart failure. The aims of this study were to evaluate the influence of plasma sodium on the prognostic significance of copeptin concentrations in heart failure...... outpatients and to determine whether increased copeptin concentrations predict future development of hyponatremia....

  3. Isolated supra-cardiac partial anomalous pulmonary venous connection causing right heart failure

    Directory of Open Access Journals (Sweden)

    Robert Sogomonian

    2016-04-01

    Full Text Available Right heart failure (RHF has been overlooked as left heart failure has predominated. One of the many causes of RHF is partial anomalous pulmonary venous connection (PAPVC, an extremely rare entity in nature. Physicians should consider the unusual causes of RHF after ruling out the common causes.

  4. Risk prediction models for mortality in ambulatory patients with heart failure: a systematic review

    OpenAIRE

    Alba, Ana C; Agoritsas, Thomas; Jankowski, Milosz; Courvoisier, Delphine; Walter, Stephen D.; Guyatt, Gordon H; Ross, Heather J

    2013-01-01

    Optimal management of heart failure requires accurate assessment of prognosis. Many prognostic models are available. Our objective was to identify studies that evaluate the use of risk prediction models for mortality in ambulatory patients with heart failure and describe their performance and clinical applicability.

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

    Science.gov (United States)

    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...

  6. Electrophysiological and Structural Remodeling in Heart Failure Modulate Arrhythmogenesis. 1D Simulation Study

    OpenAIRE

    Gómez García, Juan Francisco; Romero Pérez, Lucia; Ferrero De Loma-Osorio, José María; Trenor Gomis, Beatriz Ana

    2014-01-01

    Background: Heart failure is a final common pathway or descriptor for various cardiac pathologies. It is associated with sudden cardiac death, which is frequently caused by ventricular arrhythmias. Electrophysiological remodeling, intercellular uncoupling, fibrosis and autonomic imbalance have been identified as major arrhythmogenic factors in heart failure etiology and progression. Objective: In this study we investigate in silico the role of electrophysiological and structur...

  7. Prognostic significance of cardiovascular biomarkers and renal dysfunction in outpatients with systolic heart failure

    DEFF Research Database (Denmark)

    Bosselmann, Helle; Egstrup, Michael; Rossing, Kasper;

    2013-01-01

    To assess whether the prognostic significance of cardiovascular (CV) biomarkers, is affected by renal dysfunction (RD) in systolic heart failure (HF).......To assess whether the prognostic significance of cardiovascular (CV) biomarkers, is affected by renal dysfunction (RD) in systolic heart failure (HF)....

  8. Transcatheter shunt embolotherapy in multiple myeloma with high output heart failure

    International Nuclear Information System (INIS)

    High-output heart failure may be fairly common in patients with multiple myeloma and is associated with severe bone involvement. In this report, we describe the case of a 67-year-old man with multiple myeloma who presented with high output heart failure subsequently treated by transcatheter arterial embolization

  9. Dose-dependent benefit of nitroglycerin on microcirculation of patients with severe heart failure

    NARCIS (Netherlands)

    C.A. den Uil; K. Caliskan; W.K. Lagrand; M. van der Ent; L.S.D. Jewbali; J.P. van Kuijk; P.E. Spronk; M.L. Simoons

    2009-01-01

    Microcirculatory abnormalities are frequently observed in patients with severe heart failure and correlate to worse outcomes. We tested the hypothesis that nitroglycerin dose-dependently improves perfusion in severe heart failure and that this could be monitored by measuring central-peripheral tempe

  10. Paroxysmal atrial fibrillation is uncommon in outpatients with chronic heart failure

    DEFF Research Database (Denmark)

    Corell, Pernille; Gustafsson, Finn; Mehlsen, Jesper;

    2008-01-01

    The objective was to evaluate the prevalence of paroxysmal atrial fibrillation (PAF) in patients with heart failure (HF) due to systolic dysfunction.......The objective was to evaluate the prevalence of paroxysmal atrial fibrillation (PAF) in patients with heart failure (HF) due to systolic dysfunction....

  11. Evaluation of the european heart failure self-care behaviour scale in a united kingdom population

    NARCIS (Netherlands)

    Shuldham, Caroline; Theaker, Chris; Jaarsma, Tiny; Cowie, Martin R.

    2007-01-01

    Title. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population Aim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in

  12. Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction : integrating evidence into clinical practice

    NARCIS (Netherlands)

    Zannad, Faiez; Stough, Wendy Gattis; Rossignol, Patrick; Bauersachs, Johann; McMurray, John J. V.; Swedberg, Karl; Struthers, Allan D.; Voors, Adriaan A.; Ruilope, Luis M.; Bakris, George L.; O'Connor, Christopher M.; Gheorghiade, Mihai; Mentz, Robert J.; Cohen-Solal, Alain; Maggioni, Aldo P.; Beygui, Farzin; Filippatos, Gerasimos S.; Massy, Ziad A.; Pathak, Atul; Pina, Ileana L.; Sabbah, Hani N.; Sica, Domenic A.; Tavazzi, Luigi; Pitt, Bertram

    2012-01-01

    Mineralocorticoid receptor antagonists (MRAs) improve survival and reduce morbidity in patients with heart failure, reduced ejection fraction (HFREF), and mild-to-severe symptoms, and in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction. These cl

  13. Do patients with suspected heart failure and preserved left ventricular systolic function suffer from “diastolic heart failure” or from misdiagnosis? A prospective descriptive study

    OpenAIRE

    Caruana, L; Petrie, M.C.; Davie, A.P.; McMurray, J.

    2000-01-01

    OBJECTIVES: To characterise the clinical features of patients with suspected heart failure but preserved left ventricular systolic function to determine if they have other potential causes for their symptoms rather than being diagnosed with 'diastolic heart failure.' DESIGN: Prospective descriptive study. SETTING: Outpatient based direct access echocardiography service. PARTICIPANTS: 159 consecutive patients with suspected heart failure referred by general practitioners. MAIN OUTCOME MEASURES...

  14. Diabetes, glycemic control, and new-onset heart failure in patients with stable coronary artery disease : data from the heart and soul study

    NARCIS (Netherlands)

    van Melle, J.P.; Bot, M.; de Jonge, P.; de Boer, R.A.; van Veldhuisen, D.J.; Whooley, M.A.

    2010-01-01

    OBJECTIVE Diabetes is a predictor of both coronary artery disease (CAD) and heart failure. It is unknown to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure. RESEARCH DESIGN AND METHODS We evaluated the association of diabetes and A

  15. Advanced heart block in acute rheumatic fever

    OpenAIRE

    Hubail, Zakariya; Ebrahim, Ishaq M.

    2015-01-01

    First degree heart block is considered a minor criterion for the diagnosis of this condition. The cases presented here demonstrate that higher degrees of heart block do occur in rheumatic fever. Children presenting with acquired heart block should be worked-up for rheumatic fever. Likewise, it is imperative to serially follow the electrocardiogram in patients already diagnosed with acute rheumatic fever, as the conduction abnormalities can change during the course of the disease.

  16. Overlap and distinctiveness of psychological risk factors in patients with ischemic heart disease and chronic heart failure

    DEFF Research Database (Denmark)

    Pelle, Aline J; Denollet, Johan; Zwisler, Ann-Dorthe; Pedersen, Susanne S.

    Growing evidence supports the importance of psychological factors in the etiology and progression of cardiovascular disease (CVD). However, this research has been criticized due to overlap between psychological constructs. We examined whether psychological questionnaires frequently used in...... cardiovascular research assess distinct constructs in a mixed group of ischemic heart disease (IHD) and chronic heart failure (CHF) patients....

  17. Classification tree for risk assessment in patients suffering from congestive heart failure via long-term heart rate variability

    OpenAIRE

    Melillo, Paolo; De Luca, Nicola; Bracale, Marcello; Pecchia, Leandro

    2013-01-01

    This study aims to develop an automatic classifier for risk assessment in patients suffering from congestive heart failure (CHF). The proposed classifier separates lower risk patients from higher risk ones, using standard long-term heart rate variability (HRV) measures. Patients are labeled as lower or higher risk according to the New York Heart Association classification (NYHA). A retrospective analysis on two public Holter databases was performed, analyzing the data of 12 patients suffering...

  18. Foundations of Pharmacotherapy for Heart Failure With Reduced Ejection Fraction: Evidence Meets Practice, Part I.

    Science.gov (United States)

    Paul, Sara; Page, Robert L

    2016-01-01

    Pharmacologic treatment for systolic heart failure, otherwise known as heart failure with reduced ejection fraction, has been established through clinical trials and is formulated into guidelines to standardize the diagnosis and treatment. The premise of pharmacologic therapy in heart failure with reduced ejection fraction is aimed primarily at interrupting the neurohormonal cascade that is responsible for altering left ventricular shape and function. This is the first in a series of articles to describe the pharmacologic agents in the guidelines that impact the morbidity and mortality associated with heart failure. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and vasodilators will be presented in the context of the mechanism of action in heart failure, investigational trials that showed beneficial effects, and the practical application for clinical use. PMID:26296245

  19. Dietary Habits Moderate the Association between Heart Failure and Cognitive Impairment

    Science.gov (United States)

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

    2016-01-01

    Cognitive impairment is common in heart failure patients. Poor dietary habits are associated with reduced neurocognitive function in other medical populations, including diabetes and Alzheimer’s disease. This study examined whether dietary habits help moderate the relationship between heart failure severity and cognitive function. A total of 152 persons with heart failure completed neuropsychological testing and a fitness assessment. Dietary habits were assessed using the Starting the Conversation-Diet questionnaire, a nutrition measure suggested for use in primary care settings. Moderation analyses showed that better dietary habits attenuated the adverse impact of heart failure severity on frontal functioning (b =1.28, p < .05). Follow-up analyses revealed consumption of foods high in sodium was associated with reduced cognitive function (p < .05). This study suggests dietary habits can moderate the association between heart failure and performance on tests of attention and executive function. Longitudinal studies are needed to confirm and clarify the mechanisms for our findings. PMID:23663211

  20. Takayasu Arteritis with Rheumatic Heart Disease with Congestive Cardiac Failure mimicking as having Infective Endocarditis

    OpenAIRE

    Upadhyay, Piyush

    2013-01-01

    Takayasu Arteritis (TA) is a chronic, idiopathic and granulomatous vasculitis of the large arteries. It involves primarily the aorta, especially aortic proximal branches, and occasionally the pulmonary arteries. We report a 10 year old boy with Takayasu arteritis with Rheumatic heart disease who developed congestive heart failure with valvular heart disease mimicking as having infective endocarditis. Complete aortogram revealed narrowing of abdominal aorta, superior ...