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Sample records for chronic congestive heart

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

    Institute of Scientific and Technical Information of China (English)

    Marie-Louise Edvinsson; Erik Uddman; Sven E Andersson

    2011-01-01

    Background Chronic congestive heart failure is a complex condition that leads to dysfunction in the peripheral microcirculation. We have previously shown that vascular reactivity is reduced with increasing age.In this study,we examined a group of very old patients with severe chronic heart failure to test the hypothesis that vascular function is further compromised by a combination of heart failure and aging.Methods Cutaneous forearm blood flow was measured by laser Doppler flownretry and compared among three groups:Group 1 (n=20,men±SE:85.54 years),heart failure patients with New York Heart Association class Ⅳ(NYHA IV) and with a NT-proBNP level =10,mean±SE:67.6 ± 3.0 years),healthy controls with no clinical signs of heart failure.The vasodilator response to the iontophoretic administration of acetylcholine (ACh),acting via an endothelial mechanism,and sodium nitroprusside (SNP),acting via a smooth muscle cell mechanism,were studied. Results All patients with heart failure had significantly reduced vascular reactivity independent of the mode of stimulation (ACh,SNP or heat) when compared to healthy controls.However,the responses did not differ between the two groups of heart failure patients.Conclusions Cutaneous vascular reactivity is reduced in heart failure patients and does not correlate with the severity of the condition or age of patients.

  2. 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...... contribute to increased mortality. Hypothesis: That plasma concentration or activity of hemostatic biomarkers is altered in dogs with CHF and that these factors predict mortality. Animals: Thirty-four dogs with CHF caused by either dilated cardiomyopathy (DCM, n = 14) or degenerative valvular disease (CDVD......, n = 20) compared with 23 healthy age-matched control dogs were included in this study. Dogs with CHF were recruited from 2 referral cardiology clinics, and control dogs were owned by friends or colleagues of the investigators. Methods: Clinical examination and echocardiography were performed in all...

  3. 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.

  4. Importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Kjøller, Erik; Køber, Lars; Iversen, Kasper

    2004-01-01

    AIMS: To evaluate the importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction. METHOD AND RESULTS: Prospective registration of 6669 consecutive patients admitted with infarction and screened...... in patients with acute myocardial infarction without congestive heart failure, but is also a confounding factor for the diagnosis of congestive heart failure....

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

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    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. A perspective on sympathetic renal denervation in chronic congestive heart failure.

    Science.gov (United States)

    Madanieh, Raef; El-Hunjul, Mohammed; Alkhawam, Hassan; Kosmas, Constantine E; Madanieh, Abed; Vittorio, Timothy J

    2016-01-01

    Medical therapy has indisputably been the mainstay of management for chronic congestive heart failure. However, a significant percentage of patients continue to experience worsening heart failure (HF) symptoms despite treatment with multiple therapeutic agents. Recently, catheter-based interventional strategies that interrupt the renal sympathetic nervous system have shown promising results in providing better symptom control in patients with HF. In this article, we will review the pathophysiology of HF for better understanding of the interplay between the cardiovascular system and the kidney. Subsequently, we will briefly discuss pivotal renal denervation (RDN) therapy trials in patients with resistant hypertension and then present the available evidence on the role of RDN in HF therapy.

  7. Lung congestion in chronic heart failure: haemodynamic, clinical, and prognostic implications

    DEFF Research Database (Denmark)

    Melenovsky, Vojtech; Andersen, Mads Jønsson; Andress, Krystof

    2015-01-01

    AIMS:The goal of the study was to examine the prognostic impact, haemodynamic and clinical features associated with lung congestion in patients with chronic heart failure (HF). METHODS AND RESULTS:HF patients (n = 186) and HF-free controls (n = 21) underwent right heart catheterization...... and dysfunction and increased mortality in HF. These data reinforce the importance of aggressive decongestion in HF and suggest that novel agents aimed at reducing lung water may help to deter progression of pulmonary vascular disease and biventricular HF....

  8. The Administration and Effect of Sodium Nitroprusside in the Treatment of Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    Sun Ming; Wang Wenmeng; Wu Qiong

    2000-01-01

    To prove the effectiveness and safety of sodium nitroprusside (SNP) in the treatment of chronic congestive heart failure, 58 patients with heart failure and normal renal and hepatic function were selected and divided into 3 groups and treated differently. Group A was treated with routine vasodilators; Group B was treaeted intermittently with SNP (12.5 -75mg/24hrs);Group C was treated continuously with SNP (continuous infusion of 100-300mg/24hrs) Positively inotropie agents and diuretic agents were used in each group.The results showed that the highly effective rates of the three groups were 46.9% (15/32), 90.5% (19/21)and 100% (12/12) respectively. The effective rates were 81.3% (26/32), 100% (21/21), 100%(12/12) respectively. The highly effective rates of group B and C were much higher than that of group A (P<0.005, P< 0.005) . The reduction of blood pressure of group B and C was greater than that of group A ( P < 0. 025) . Among the patients we studied, no body had severe side effects. We concluded that the use of SNP in the treatment of chronic congestive heart failure is safe, with better effect than routine treatment,and continous infusion of SNP is the best choice.

  9. Serum Levels of Soluble Fas Ligand and Soluble Fas Receptor in Patients with Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    李刚; 令狐华; 魏良明

    2002-01-01

    @@ To understand the pathophysiologic significances of soluble Fas Ligand (sFasL) and soluble Fas receptor (sFas) in chronic congestive heart failure (CHF) and to determine the relationship of circulating levels of sFasL and sFas to the severity of CHF, the serum sFasL and sfas levels were evaluated in patients with CHF.

  10. Inverse relation between aldosterone and venous capacitance in chronically treated congestive heart failure.

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    Rietzschel, E; Duprez, D A; De Buyzere, M L; Clement, D L

    2000-04-15

    The purpose of this study was to examine if there is a relation between the aldosterone escape phenomenon and venous capacitance of the upper and lower limbs in patients with long-term congestive heart failure (CHF) receiving chronic treatment with angiotensin-converting enzyme (ACE) inhibitors. The study group consisted of 16 subjects with ischemic CHF in New York Heart Association functional class II (age 59 +/-2 years, ejection fraction 24+/-4%), stabilized under a constant drug regimen comprising furosemide, captopril 50 mg 3 times daily, and digoxin for at least 3 months. Thirteen apparently healthy volunteers, aged 50+/-4 years acted as controls. Forearm and calf venous capacitances were measured simultaneously by venous occlusion plethysmography using mercury-in-silastic strain gauges. The equilibration technique was used to derive venous capacitance from the recorded pressure-volume curves. Active renin, angiotensin II, and aldosterone levels were determined on venous blood samples obtained in the supine position. Angiotensin II (paldosterone (paldosterone escape phenomenon). In CHF, forearm venous capacitance was 2.19+/-0.18 ml/100 ml; calf venous capacitance was 2.83+/-0.27 ml/100 ml. Aldosterone significantly and inversely correlated with venous capacitance in both upper (r = -0.586; p = 0.017) and lower (r = -0.625; p = 0.01) limbs. No correlations were found between forearm or calf venous capacitance and renin or angiotensin II. In patients with heart failure chronically treated with diuretics and full ACE inhibition, venous capacitance is inversely correlated with aldosterone through the mechanism of aldosterone escape, creating the potential for further deterioration of the CHF process.

  11. Pharmacoeconomic analysis of valsartan for the treatment of chronic congestive heart failure in Italy

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    Sergio Iannazzo

    2008-09-01

    Full Text Available Objective: to evaluate pharmacoeconomic implications of the use of valsartan, an angiotensin II antagonist in addition to standard therapy for the treatment of chronic congestive heart failure (CHF. Methods: the study was conducted performing cost-utility and budget impact (B.I. analyses by means of a cohort simulation based on a probabilistic Markov model and projecting 23-months follow-up results in the Val-HeFT trial study over a 10-years time horizon. The model included four states (class NYHA I, II and III and death, and had a cycle of 1 year. Two probabilistic simulations (varying first patients parameters and after model parameters were performed using WinBUGS, a software for bayesian analysis. The distributions of patients parameters (sex, age, use of ACE inhibitors corresponding to Val-HeFT inclusion criteria in the simulated population were derived from the Italian CHF patients population. Individual mortality was derived from general mortality by adjusting with a NYHA state-specific HR, and the probability of changing NYHA class from Val-HeFT. Costs were calculated in the perspective of the Italian NHS and account for drugs and CHF hospitalizations. Quality of life weights were obtained by elaborating published HRQoL data of CHF patients. A 3.5% annual discount rate was applied; probabilistic sensitivity analysis was performed on each parameter using original-source 95% CI, or a ±10% range where it was unavailable. Results: in the 10 years horizon, patients were estimated to live an average of 4.4 years or 3.2 QALYs, with slight increases in the valsartan group. In this group, hospitalizations are predicted to be sensitively reduced and overall costs decreased by about 500 €/pz. In subgroup analysis, valsartan loses dominance in NYHAII and ACE-using patients, for which ICURs are 17,330 and 27,000 €/QALY, respectively. B.I. analysis predicts a saving of about 172 millions €. Conclusions: valsartan in addition to standard therapy

  12. Chronic congestive heart failure. Description and survival of 190 consecutive patients with a diagnosis of chronic congestive heart failure based on clinical signs and symptoms

    DEFF Research Database (Denmark)

    Madsen, B K; Hansen, J F; Stokholm, K H;

    1994-01-01

    -year mortality was 32%. Median left ventricular ejection fraction (LVEF) was 0.30, range 0.06 to 0.74. Eight per cent were in New York Heart Association (NYHA) class I, 46% in II, 44% in III and 2% in IV. Multivariate analysis, excluding exercise test variables, revealed seven variables...... with independent, significant prognostic information, (hazard ratios for death in brackets): ln (natural logarithm) (LVEF) (3.19), NYHA class III+IV (2.72), plasma urea > 7.6 mmol.l-1 (2.22), serum creatinine > 121 mumol.l-1 (2.05), serum sodium ... exercise time 7.6 mmol.l-1 (1.9). In conclusion, patients with CHF have a high risk of death despite intensive medical treatment. LVEF is a strong predictor of mortality. Both NYHA class and exercise...

  13. The effect of theophylline on sleep-disordered breathing in patients with stable chronic congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    胡克; 李清泉; 杨炯; 胡苏萍; 陈喜兰

    2003-01-01

    Objective To determine the prevalence of sleep-disordered breathing in patients with stable, optimally treated chronic congestive heart failure and the effect of short-term oral theophylline therapy on periodic breathing in these patients.Methods Patients with stable, optimally treated chronic congestive heart failure were monitored by polysomnography during nocturnal sleep. The effects of theophylline therapy on periodic breathing associated with stable heart failure were observed before and after treatment.Results Patients were divided into two groups. GroupⅠ(n=21) consisted of individuals with 15 episodes of apnea and hypopnea [as determined by the apnea-hypopnea index (AHI)] per hour or less; Group Ⅱ (n=15, 41.7%) individuals had an index of more than 15 episodes per hour. In group Ⅱ, the AHI varied from 16.8 to 78.8 (42.6±15.5) in which the obstructive AHI was 11.1±8.4 and the central AHI was 31.5±9.6. Group Ⅱ had significantly more arousals (36.8±21.3 compared with 19.4±11.2 in group Ⅰ) that were directly attributable to episodes of apnea and hypopnea, lower arterial oxyhemoglobin saturation (76.7%±4.6% compared with 86.5%±2.8%) and lower left ventricular ejection fraction (24.2%±8.8% compared with 31.5%±10.6%). Thirteen patients with compensated heart failure and periodic breathing received theophylline orally (at an average dose of 4.3 mg/kg) for five to seven days. After treatment, the mean plasma theophylline concentration was (11.3±2.5) μg/ml. Theophylline therapy resulted in significant decreases in the number of AHI (20.8±13.2 vs. 42.6±15.5; P<0.001) and the number of episodes of central apnea-hypopnea per hour (10.1±7.6 vs. 31.5±9.6; P<0.001). Furthermore, the percentage of total sleep time during which arterial oxyhemoglobin saturation (SaO2) was less than 90 percent (8.8%±8.6% vs. 23.4%±24.1%; P<0.05) and the arousals per hour (18.7±21.2 vs. 36.8±21.3; P<0.05) were also lower. There were no significant differences in the

  14. Apoptosis and congestive heart failure.

    Science.gov (United States)

    Feuerstein, G; Ruffolo, R R; Yue, T L

    1997-10-01

    Congestive heart failure (CHF) is the final clinical manifestation of a variety of cardiac (myopathies), coronary (atherosclerosis), and systemic diseases (diabetes, hypertension). Regardless of the origin of the cardiac insult, left ventricular dysfunction resulting in decreased cardiac output elicits a series of adaptational processes that attempt to compensate for some of the decrement in myocardial function. One of the key manifestations of these compensatory processes is cardiac hypertrophy, which is characterized by a marked increase in myocyte size and an increase in contractile proteins. The benefits resulting from these compensatory adaptational mechanisms, however, are only transient, and within a period of months to years, the changes induced in the myocardium fail to sustain cardiac output at a level that is sufficient to meet the demands of the body; subsequently, physical performance is impaired. Typically, progressive dilation and thinning of the left ventricle occur along with progression of CHF. The mechanisms responsible for the thinning of ventricular tissue and loss of left ventricular mass are poorly understood; traditionally, such loss has been attributed to tissue necrosis based on the morphologic observation of dead cardiac myocytes. Very recently, there have been data suggesting that apoptosis, a form of programmed cell death (PCD), occurs in the heart and may be responsible, at least in part, for the progression of CHF and the chronic loss of left ventricular function and mass. Evidence for a role of apoptosis/PCD in the progression of heart failure has been obtained from a variety of observations, including in vitro studies of cardiac myocytes in culture, experimental animal models of cardiac injury, and cardiac tissue obtained from patients with CHF. Thus, apoptosis/PCD may be a critical mechanism involved in the progressive loss of cardiac myocytes, which ultimately results in end-stage heart failure. In this brief review, the evidence

  15. Arteriosclerotic changes in the myocardium, lung, and kidney in dogs with chronic congestive heart failure and myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Falk, Bo Torkel; Jönsson, Lennart; Olsen, Lisbeth Høier;

    2006-01-01

    Background: The occurrence of small vessel arteriosclerosis in the myocardium, kidney, and lung in dogs with naturally occurring myxomatous mitral valve disease has not been previously investigated systematically. Methods: Twenty-one dogs with naturally occurring congestive heart failure and 21 age...... and pulmonary artery. Results: Dogs with congestive heart failure had significantly more arterial narrowing in the left ventricle (Pkidney (p...-matched, sex-matched, and weight-matched control dogs underwent extensive pathological and histopathological examination. Morphometry and scoring of tissue sections were used to measure arterial narrowing and fibrosis in the myocardium, kidney, and lung; and intimal thickness and plaque formation in the aorta...

  16. Relationship Between Serum Leptin Concentration and Lipids & Body Mass Index in Patients With Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    Li Gang; Yan Qingbo; Wei Liangming

    2006-01-01

    Objectives To investigate the relationship of serum leptin concentration with the lipids and body mass index (BMI) in patients with chronic congestive heart failure(CHF). Methods The serum concentration of leptin in 39 patients with CHF (14 in cardiac function class Ⅱ , 21 in class Ⅲ , 4 in class Ⅳ , NYHA) and in 46 patients with cardiac function class Ⅰ (NYHA) were assessed by radioimmunoassay. Results The serum concentration of leptin were 9.018±4.519μg/l in CHF group (cardiac function class Ⅱ 11.492±5.649 μg/l, class Ⅲ 7.763±3.321 μg/l, class Ⅳ 6.100±2.657 μg/l);11.674±6.911 μg/l in class Ⅰ group. The serum concentrations of leptin were significantly lower in CHF group, as compared with class Ⅰ group (P<0.05). Moreover, the decrease of serum leptin concentration was significantly correlated with the decreased serum concentrations of total cholesterol, triglyceride, body mass index and left ventricular ejection fraction in CHF group, respectively (P<0.05). Conclusions The significance of the decrease in serum leptin in CHF patients needs further study.

  17. Effects of thyroxine on cardiac function and lymphocyte β-adrenoceptors in patients with chronic congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    卢新政; 黄峻; 张晓文; 李新华; 王赤京; 张佩生; 陈永生

    2003-01-01

    Objective To explore the effects of thyroid hormone (TH) on cardiac function and peripheral lymphocyte β-adrenoceptors (β-Ars) of patients with chronic congestive heart failure (CHF). Methods Twenty-eight patients with class Ⅲ or Ⅳ advanced CHF due to dilated cardiomyopathy (DCM) or ischemic cardiomyopathy (ICM) were randomly divided into groups A and B. L-thyroxine (L-T50) was administered to group B. Exercise tolerance, chest X-rays, and echocardiographic parameters were obtained before and after one month of treatment, Ficoll-hypaque solution was used to separate peripheral lymphocytes, and 125I-pindolol radioligand binding was used to measure β-AR levels in peripheral lymphocytes. Results L-T50 therapy improved cardiac output [CO, (2.98±0.31)L/min vs (3.24±0.28) L/min, P<0.01], left ventricular ejection fraction (LVEF, 26.21%±3.21% vs 37.93%±9.01%, P<0.01), and decreased isovolumetric relaxation time (IVRT, 0.12±0.04 vs 0.10±0.02, P<0.01). Serum TH levels and the maximal number of β-AR binding sites (βmax ) in peripheral lymphocytes were lower in patients with CHF than in normal healthy people, but L-T50 administration induced a β-AR up-regulation on peripheral lymphocyte surfaces. L-T50 was well tolerated without episodes of ischemia or arrhythmia. There was no significant change in heart rate or metabolic rate.Conclusion TH administration improves cardiac function and β-AR expression in peripheral lymphocytes of patients with CHF.

  18. Focus on renal congestion in heart failure

    OpenAIRE

    Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet

    2015-01-01

    Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardia...

  19. Effects of ambient air pollution on functional status in patients with chronic congestive heart failure: a repeated-measures study

    Directory of Open Access Journals (Sweden)

    Phillips Russell S

    2007-09-01

    Full Text Available Abstract Background Studies using administrative data report a positive association between ambient air pollution and the risk of hospitalization for congestive heart failure (HF. Circulating levels of B-type natriuretic peptide (BNP are directly associated with cardiac hemodynamics and symptom severity in patients with HF and, therefore, serves as a marker of functional status. We tested the hypothesis that BNP levels would be positively associated with short-term changes in ambient pollution levels among 28 patients with chronic stable HF and impaired systolic function. Methods BNP was measured in whole blood at 0, 6, and 12 weeks. We used linear mixed models to evaluate the association between fine particulate matter (PM2.5, carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, and black carbon and log(BNP. Lags of 0 to 3 days were considered in separate models. We calculated the intraclass correlation coefficient and within-subject coefficient of variation as measures of reproducibility. Results We found no association between any pollutant and measures of BNP at any lag. For example, a 10 μg/m3 increase in PM2.5 was associated with a 0.8% (95% CI: -16.4, 21.5; p = 0.94 increase in BNP on the same day. The within-subject coefficient of variation was 45% on the natural scale and 9% on the log scale. Conclusion These results suggest that serial BNP measurements are unlikely to be useful in a longitudinal study of air pollution-related acute health effects. The magnitude of expected ambient air pollution health effects appears small in relation to the considerable within-person variability in BNP levels in this population.

  20. The Serum Levels of Soluble Fas Ligand and Soluble Fas Receptor in Patients with chronic congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    李刚; 令狐华; 魏良明; 陈运贞

    2002-01-01

    Objectives To investigate the association of soluble Fas ligand(sFasL) andsoluble Fas receptor(sFas)with human chronic congestive heart failure(CHF). Methods The serumlevel of sFasL and sFas in 33 patients with CHF (13in cardiac function class Ⅱ, 17 in class Ⅲ, 3 inclass IV, NYHA) was assessed with enzyme- linkedimmunosorbent assay, and was compared with that of18 age-, blood pressure- matched patients with cardiac function class I (NYHA). Results There wasno difference in the level of sFasL between the twogroups [CHF group: 231.50 + / - 84.50 (cardiacfunction class Ⅱ 216.50+/-96.00 , class Ⅲ226.80 + / - 85.70, class IV 244. 00 + / - 73.00 )vs. cardiac function class I group: 217.50+ /-89. 00 pg/mL, P>0. 05 ]. However, the level of sFaswas significantly higher in the patients with CHF thanthose of cardiac function class I group [CHF group:1353.30+/-507.71 (cardiac function class Ⅱ1154.85+/-371.20 , class Ⅲ 1412.88+/-493.62, class IV1875.67 + / - 806. 10) vs, cardiacfunction class I group: 983.11 + / -461.26 pg/mL,P<0. 05 ]. Conclusions sFasL was not associatedwith human CHF. However, the elevation of serumlevel of sFas was proportion to the severity of humanCHF. sFas may play an important role in the patho-genesis of human CHF.

  1. A re-appraisal of volume status and renal function impairment in chronic heart failure: combined effects of pre-renal failure and venous congestion on renal function.

    Science.gov (United States)

    Sinkeler, Steef J; Damman, Kevin; van Veldhuisen, Dirk J; Hillege, Hans; Navis, Gerjan

    2012-03-01

    The association between cardiac failure and renal function impairment has gained wide recognition over the last decade. Both structural damage in the form of systemic atherosclerosis and (patho) physiological hemodynamic changes may explain this association. As regards hemodynamic factors, renal impairment in chronic heart failure is traditionally assumed to be mainly due to a decrease in cardiac output and a subsequent decrease in renal perfusion. This will lead to a decrease in glomerular filtration rate and a compensatory increase in tubular sodium retention. The latter is a physiological renal response aimed at retaining fluids in order to increase cardiac filling pressure and thus renal perfusion. In heart failure, however, larger increases in cardiac filling pressure are needed to restore renal perfusion and thus more volume retention. In this concept, in chronic heart failure, an equilibrium exists where a certain degree of congestion is the price to be paid to maintain adequate renal perfusion and function. Recently, this hypothesis was challenged by new studies, wherein it was found that the association between right-sided cardiac filling pressures and renal function is bimodal, with worse renal function at the highest filling pressures, reflecting a severely congested state. Renal hemodynamic studies suggest that congestion negatively affects renal function in particular in patients in whom renal perfusion is also compromised. Thus, an interplay between cardiac forward failure and backward failure is involved in the renal function impairment in the congestive state, presumably along with other factors. Only few data are available on the impact of intervention in volume status on the cardio-renal interaction. Sparse data in cardiac patients as well as evidence from cohorts with primary renal disease suggest that specific targeting of volume overload may be beneficial for long-term outcome, in spite of a certain further decrease in renal function, at least

  2. Chronic administration of phosphodiesterase type 5 inhibitor suppresses renal production of endothelin-1 in dogs with congestive heart failure.

    Science.gov (United States)

    Yamamoto, Takashi; Wada, Atsuyuki; Ohnishi, Masato; Tsutamoto, Takayoshi; Fujii, Masanori; Matsumoto, Takehiro; Takayama, Tomoyuki; Wang, Xinwen; Kurokawa, Kiyoshi; Kinoshita, Masahiko

    2002-08-01

    Endothelin-1 (ET-1) and atrial natriuretic peptide (ANP) play important roles in the regulation of body fluid balance in congestive heart failure (CHF). Renal production of ET-1 increases in CHF and it is a significant independent predictor of sodium excretion. ANP inhibits the ET system through cGMP, a second messenger of ANP. However, in severe CHF, plasma cGMP levels reached a plateau despite the activation of ANP secretion. Thus, ANP does not seem to sufficiently oppose exaggerated ET-1 actions in severe CHF, partially due to the accelerated degradation of cGMP, through phosphodiesterase type 5 (PDE5). We examined the chronic effects of a PDE5 inhibitor, T-1032 (1 mg/kg per day, n=5), on renal function and renal production of ET-1 in dogs with CHF induced by rapid ventricular pacing (270 beats/min). Vehicle dogs were given a placebo (n=5) and normal dogs (n=5) served as normal controls without pacing. In this experimentally produced CHF, plasma levels of ET-1, ANP and cGMP were elevated and renal production of cGMP was increased compared with the normal group, associated with increases in renal expression of preproET-1 mRNA and the number of ET-1-positive cells in glomeruli. In the T-1032 group, systemic and renal production of cGMP were further increased compared with the vehicle group despite no significant difference in plasma ANP levels between the two groups. Subsequently, the agent significantly improved urine flow rate, sodium excretion rate and glomerular filtration rate (GFR) associated with reductions in renal expression of preproET-1 mRNA and the number of ET-1-positive cells compared with the vehicle group. Moreover, there was a significant negative correlation between the number of ET-1-positive cells and GFR (r=-0.802 and Prenal ANP and ET-1 through the cGMP pathway, subsequently preventing renal dysfunction during the progression of CHF.

  3. Focus on renal congestion in heart failure.

    Science.gov (United States)

    Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet

    2016-02-01

    Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardiac output (forward failure), tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure. Regardless of the cause, renal congestion is associated with increased morbidity and mortality in heart failure. The impact on outcomes of renal decongestion strategies that do not compromise renal function should be explored in heart failure. These studies require novel diagnostic markers that identify early renal damage and renal congestion and allow monitoring of treatment responses in order to avoid severe worsening of renal function. In addition, there is an unmet need regarding evidence-based therapeutic management of renal congestion and worsening renal function. In the present review, we summarize the mechanisms, diagnosis, outcomes, prognostic markers and treatment options of renal congestion in heart failure.

  4. 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.

  5. Aggressive therapy of congestive heart failure and associated chronic renal failure with medications and correction of anemia stops or slows the progression of both diseases.

    Science.gov (United States)

    Silverberg, D S; Wexler, D; Blum, M; Sheps, D; Schwartz, D; Yachnin, T; Baruch, R; Tchebiner, J; Zubkov, A; Shaked, M; Steinbruch, S; Keren, G; Iaina, A

    2001-01-01

    The prevalence of congestive heart failure (CHF) is increasing rapidly in the community. We and others have shown that the prevalence and severity of both anemia and chronic renal failure (CRF) increase steadily with increasing severity of CHF. We have also shown that CHF patients may be resistant to standard drug therapy for CHF as long as the associated anemia is not corrected, and that correction of the anemia with subcutaneous erythropoietin and intravenous iron sucrose (Venofer: Vifor International, St. Gallen, Switzerland) may improve both the CHF and CRF and markedly reduce hospitalizations without causing side effects. We report here our experience with correcting anemia in this manner in 126 cases of anemic-resistant CHF patients. As in our previous studies, correction of the anemia improved both CHF and CRF, and reduced hospitalizations. Our studies suggest that correction of even mild anemia in CHF may be an important addition to the treatment of patients with the combination of CHF and CRF.

  6. Prognostic value of echocardiography in 190 patients with chronic congestive heart failure. A comparison with New York Heart Association functional classes and radionuclide ventriculography

    DEFF Research Database (Denmark)

    Madsen, B K; Videbaek, R; Stokholm, H;

    1996-01-01

    Survival in 190 consecutive patients with congestive heart failure, discharged from a general hospital, was studied. Sixteen patients were in New York Heart Association (NYHA) class I, 87 in II, 83 in III and 4 in IV. Median left ventricular ejection fraction (LVEF) from radionuclide.......3. In classes III and IV survival was 68.9% for wall motion index > or = 1.3 and 39.9% when ... ventriculography was 0.30 (range 0.06-0.74). Two-year survival was 68%. Wall motion index was the only echocardiographic variable with significant, independent, prognostic information on survival. The 2-year survival in NYHA classes I and II was 90.7% for wall motion index > or = 1.3, and 78.6% when

  7. 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.

  8. Cardiac CT Angiography in Congestive Heart Failure.

    Science.gov (United States)

    Levine, Avi; Hecht, Harvey S

    2015-06-01

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

  9. Bisoprolol for congestive heart failure

    DEFF Research Database (Denmark)

    Rosenberg, J.; Gustafsson, F.

    2008-01-01

    . 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...

  10. Anemia, chronic renal disease and congestive heart failure--the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists.

    Science.gov (United States)

    Silverberg, Donald S; Wexler, Dov; Iaina, Adrian; Steinbruch, Shoshana; Wollman, Y; Schwartz, Doron

    2006-01-01

    Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, poor quality of life (QoL), progressive chronic kidney disease (CKD) which can lead to end stage kidney disease (ESKD), or die of cardiovascular complications within a short time. One factor that has generally been ignored in many of these people is the fact that they are often anemic. The anemia in CHF is due mainly to the frequently-associated CKD but also to the inhibitory effects of cytokines on erythropoietin production and on bone marrow activity, as well as to their interference with iron absorption from the gut and their inhibiting effect on the release of iron from iron stores. Anemia itself may further worsen cardiac and renal function and make the patients resistant to standard CHF therapy. Indeed anemia in CHF has been associated with increased severity of CHF, increased hospitalization, worse cardiac function and functional class, the need for higher doses of diuretics, progressive worsening of renal function and reduced QoL. In both controlled and uncontrolled studies of CHF, the correction of the anemia with erythropoietin (EPO) and oral or intravenous (IV) iron has been associated with improvement in many cardiac and renal parameters and an increased QoL. EPO itself may also play a direct role in improving the heart unrelated to the improvement of the anemia--by reducing apoptosis of cardiac and endothelial cells, increasing the number of endothelial progenitor cells, and improving endothelial cell function and neovascularization of the heart. Anemia may also play a role in the worsening of acute myocardial infarction and chronic coronary heart disease (CHD) and in the cardiovascular complications of renal transplantation. Anemia, CHF and CKD interact as a vicious circle so as to cause or worsen each other- the so-called cardio renal anemia syndrome. Only adequate treatment of all three conditions can

  11. Can complexity decrease in congestive heart failure?

    Science.gov (United States)

    Mukherjee, Sayan; Palit, Sanjay Kumar; Banerjee, Santo; Ariffin, M. R. K.; Rondoni, Lamberto; Bhattacharya, D. K.

    2015-12-01

    The complexity of a signal can be measured by the Recurrence period density entropy (RPDE) from the reconstructed phase space. We have chosen a window based RPDE method for the classification of signals, as RPDE is an average entropic measure of the whole phase space. We have observed the changes in the complexity in cardiac signals of normal healthy person (NHP) and congestive heart failure patients (CHFP). The results show that the cardiac dynamics of a healthy subject is more complex and random compare to the same for a heart failure patient, whose dynamics is more deterministic. We have constructed a general threshold to distinguish the border line between a healthy and a congestive heart failure dynamics. The results may be useful for wide range for physiological and biomedical analysis.

  12. SERUM CONCENTRATIONS OF HYALURONIC ACID, PROCOLLAGEN TYPE Ⅲ NH2-TERMINAL PEPTIDE, AND LAMININ IN PATIENTS WITH CHRONIC CONGESTIVE HEART FAILURE

    Institute of Scientific and Technical Information of China (English)

    Gang Li; Qing-bo Yan; Liang-ming Wei

    2006-01-01

    Objective To explore the role of serum fibrotic indices including hyaluronic acid (HA), procollagen type ⅢNH2-terminal peptide (PCⅢP), and laminin (LN) in assessing the severity of myocardial fibrosis in chronic congestive heart failure (CHF).Methods Serum levels of HA, PCⅢP, and LN in 39 patients with CHF [ 14 with New York Heart Association (NYHA) functional class Ⅱ, 21 with class Ⅲ, 4 with class Ⅳ] and in 46 patients with NYHA functional class Ⅰ were assessed by radioimmunoassay.Results The serum concentrations of HA, PCⅢP, and LN were 359.75 ± 84. 59 μg/L, 77.88±24. 67μg/L,86.73±23.90 μg/L in CHF group, and 211.60±54. 80μg/L, 64.82±23.99 μg/L, 82.26±23.98μg/L in NYHA functional class Ⅰ group, respectively. The HA level was significantly higher in CHF patients as compared with NYHA functional class Ⅰ group (P<0.05 ). However, no difference was found in the levels of PCⅢP and LN between CHF group and NYHA functional class Ⅰ group. The serum HA concentration was negatively correlated with left ventricular ejection fraction (r=-0.71, P<0.05 ).Conclusion Serum HA level may act as an indicator for myocardial fibrosis.

  13. 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....

  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. Relationship Between Prohormone Brain Natriuretic Peptide (NT-proBNP Level and Severity of Pulmonary Dysfunction in Patients With Chronic Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Nazemiyeh Masoud

    2015-03-01

    Full Text Available Introduction: Congestive heart failure (CHF is a common disease and its prevalence is increasingin industrialized countries. NT-proBNP measurement is an established diagnostic test fordiagnosis of CHF in patients who present to emergency room with acute dyspnea. The primaryobject of this study was to determine the relationship between levels of brain natriuretic peptideprecursor and severity of lung function impairment in patients with chronic CHF.Methods: This cross-sectional and analytical study that performed in Tuberculosis andLung Disease Research Center of Tabriz University of Medical Sciences on 95 patients withchronic heart failure, and relation between NT-proBNP levels and pulmonary functionparameters were examined.Results: Sixty-four patients were male and 31 were female. The average age of male and femaleswas 62.90 ± 11.54 and 61.61 ± 11.98 years, respectively. A significant inverse linear correlationwas found between NT-proBNP and FEV1 (P<0.001, r = -0.367, FVC (P<0.001, r = -0.444,TLC (P=0.022, r = -0.238, maximal midexpiratory flow (MMEF (P=0.047, r = -0.207 andleft ventricular ejection fraction (LVEF (P<0.001, r = -0.461. A significant positive linearcorrelation was found between NT-proBNP and FEV1/FVC (P =0.013, r = 0.257, RV/TLC (P =0.003, r=0.303 and 5 Hz Raw (r = 0.231, P = 0.024.Conclusion: This study showed that, both restrictive and obstructive ventilator impairments canoccur in chronic CHF and as NT-proBNP increases appropriate to hemodynamic deterioration,pulmonary dysfunction increases.

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

    Science.gov (United States)

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

    2015-01-01

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

  17. New auxiliary indicators for the differential diagnosis of functional cardiorespiratory limitation in patients with chronic obstructive pulmonary disease and congestive heart failure

    Directory of Open Access Journals (Sweden)

    Cesar Marcelo de Castro

    2003-01-01

    Full Text Available OBJECTIVE: To differentiate the nature of functional cardiorespiratory limitations during exercise in individuals with chronic obstructive pulmonary disease (COPD or congestive heart failure (CHF and to determine indicators that may help their classifications. METHODS: The study comprised 40 patients: 23 with COPD and 17 with CHF. All individuals underwent maximal cardiopulmonary exercise testing on a treadmill. RESULTS: The values of peak gas exchange ratio (R peak, peak carbon dioxide production (VCO2 peak, and peak oxygen ventilatory equivalent (V E O2 peak were higher in the patients with CHF than in those with COPD, and, therefore, those were the variables that characterized the differences between the groups. For group classification, the differentiating functions with the R peak, VCO2 peak (L/min, and V E O2 peak variables were used as follows: group COPD: - 44.886 + 78.832 x R peak + 5.442 x VCO2 peak + 0.336 x V E O2 peak; group CHF: - 69.251 + 89.740 x R peak + 8.461 x VCO2 peak + 0.574 x V E O2 peak. The differentiating function, whose result is greater, correctly classifies the patient's group as 90%. CONCLUSION: The R peak, VCO2 peak, and V E O2 peak values may be used to identify the cause of the functional cardiorespiratory limitations in patients with COPD and CHF.

  18. Stem Cell Therapy for Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Gunduz E

    2011-01-01

    experience from this patient. ConclusionStudies in the era of cardiac stem cell therapy are heterogenous. It is not yet possible to comment on the most appropriate stem cell type and route of administration. When we assess the results from literature and the improvement in our own patient we think stem cell therapy can be an option for bridging to heart transplantation or an adjuvant therapy for CHF.References1.Ohnishi S, Ohgushi H, Kitamura S, Nagaya N. Mesenchymal stem cells for the treatment of heart failure. Int J Hematol 2007; 86: 17-21.2.Bukharovich IF, Kukin M. Optimal medical therapy for heart failure. Prog Cardiovasc Dis 2006; 48: 372-385.3.Tongers J, Losordo DW, Landmesser U. Stem and progenitor cell-based therapy in ischaemic heart disease: promise, uncertainties and challenges. Eur Heart J 2011. Epub ahead of print.4.Krause DS, Theise ND, Collector MI, Henegariu O, Hwang S, Gardner R, Neutzel S, Sharkis SJ. Multi-organ, multi-lineage engraftment by a single bone marrow-derived stem cell. Cell 2001; 105:369-377.5.Strauer BE, Yousef M, Schannwell CM. the acute and long term effects of intracoronary stem cell transplantation in 191 patients with chronic heart failure: the STAR-heart study. Eur J Heart Fail 2010; 12:721-729.6.Hamano K, Nishida M, Mirata K, Mikarno A, Li TS, Harada M, Miura T, Matsuzaki M, Esato K. Local implantation of autologous bone marrow cells for therapeutic angiogenesis in patients with ishemic heart disease: clinical trial and preliminary results Jpn Circ J. 2001; 65:845-847.7.Brehm M, Zeus T, Strauer BE. Stem cells-clinical application and perspectives. Herz 2002; 27:611-620.8.Ozbaran M, Omay SB, Nalbantgil S, Kultursay H, Kumanlioglu K, Nart D, Pektok E. Autologous peripheral stem cell transplantation in patients with congestive heart failure due to ischemic heart disease. Eur J Cardiothorac Surg. 2004; 25:342-350.9.Abdel-Latif A, Bolli R, Tleyjeh IM, Montori VM, Perin EC, Hornung CA, Zuba-Surma EK, Al-Mallah M, Dawn B. Adult bone marrow

  19. Advanced Congestive Heart Failure Associated With Disseminated Intravascular Coagulopathy.

    Science.gov (United States)

    Sarcon, Annahita; Liu, Xiaoli; Ton, David; Haywood, James; Hitchcock, Todd

    2015-01-01

    Background. Disseminated intravascular coagulopathy (DIC) is a complication of an underlying disease and not a primary illness. It is most commonly associated with sepsis, trauma, obstetrical complications, and malignancies. There are very few cases in the literature illustrating the association between DIC and congestive heart failure. Findings. In this report, we present a case of severe congestive heart failure, leading to biventricular thrombi and subsequently DIC. Conclusion. We suggest that the association between congestive heart failure and DIC is an underrecognized one. Congestive heart failure continues to remain a major cause of morbidity and mortality despite advances in medical therapies. Thus far, the precise role of coagulation factors in congestive heart failure is unknown. Further investigations are needed to elucidate the pathophysiology of congestive heart failure and coagulation factors.

  20. Effect of dyspnea and clinical variables on the quality of life and functional capacity in patients with chronic obstructive pulmonary disease and congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Hale Karapolat; Sibel Eyigor; Alev Atasever; Mehdi Zoghi; Sanem Nalbantgil; Berrin Durmaz

    2008-01-01

    Background Chronic obstructive pulmonary disease(COPD)and congestive heart failure(CHF)are two chronic diseases that affect negatively the functional condition and quality of life of patients.We assessed the effect of symptoms and clinical variables on the functional capacity and quality of life in COPD and CHF patients.Methods The study included 42 COPD and 39 CHF patients.In both patient groups,dyspnea was assessed using Borg scale;functional capacity by shuttle-walk and cardiopulmonary exercise test and quailty of life by short fOrm-36 (SF36).Results No statistically significant difference was found in neither of the two disease groups regarding the dyspnea score,shuttle-walk test and the maiority of subgroup scores of SF36 (P>0.05).A statistically significant difference was obsewed in peak VO2 in favor of COPD group(P<0.05).No significant relationship was established between dyspnea score and forced expiratory volume in one second(FEV1)in COPD patients,and left ventricular ejection fraction(L.VEF)in CHF patients (P>0.05).A significant negative correlation was obsewed between dyspnea score and functional capacity tests in both disease groups(P<0.05).On the other hand,no relationship was found between L-VEF and FEV1 and quailty of life and functional capacity (P>0.05),Conclusions It was revealed that symptoms have an impact on functional capacity and quality of life in both disease groups,however,objective indicators of disease severity do not show a similar relationship.Therefore,in addition to the objective data related to the disease,we recommend that symptoms should also be taken into consideration to assess cardiopulmonary rehabilitation program and during following-up.

  1. 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.

  2. 葶丹生脉汤治疗慢性充血性心力衰竭52例%The Draba Dan Shengmai for 52 cases with Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    景晓玲; 李录花

    2012-01-01

    目的:观察葶丹生脉汤治疗慢性充血性心力衰竭的临床疗效.方法:选取慢性充血性心力衰竭患者102例,随机分为治疗组52例,对照组50例,对照组口服单硝酸异山梨酯缓释片、阿司匹林肠溶片等基础治疗,治疗组加服葶丹生脉汤,疗程均为2周.结果:治疗组总有效率明显高于对照组.结论:葶丹生脉汤治疗充血性心力衰竭疗效可靠.%Objective: To observe the clinical efficacy of Draba Dan Shengmai soup for chronic congestive heart failure. Methods; 102 cases patients with chronic congestive heart failure, were randomly divided into 52 cases treatment group with the Draba Dan Shengmai stirred and 50 cases control group with basic treatments such as mononitrate isosorbide mononitrate sustained release tablets, aspirin, enteric-coated tablets for lasted two weeks. Results; the treatment group was significantly higher efficiency. Conclusion; Draba Dan Shengmai soup for congestive heart failure is effective and reliable.

  3. Congestive heart failure in acromegaly: A review of 6 cases

    OpenAIRE

    Dutta, P.; Das, S; Bhansali, A; S K Bhadada; B V Rajesh; Reddy, K. S.; Vaiphei, K; K. K. Mukherjee; Pathak, A.; Shah, V N

    2012-01-01

    Background: Though cardiac involvement is common in acromegaly, overt congestive heart failure is uncommon. Materials and Methods: This is retrospective analysis of hospital record between 1996 and 2007. We analyzed records of 150 consecutive patients with acromegaly. We included the patients with acromegaly those who had overt congestive heart failure either at presentation or during the course of illness for the present analysis. The diagnosis of acromegaly and congestive cardiac failure we...

  4. Impact of β-blocker selectivity on long-term outcomes in congestive heart failure patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Kubota Y

    2015-03-01

    Full Text Available Yoshiaki Kubota, Kuniya Asai, Erito Furuse, Shunichi Nakamura, Koji Murai, Yayoi Tetsuou Tsukada, Wataru Shimizu Department of Medicine (Division of Cardiology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan Background: Chronic obstructive pulmonary disease (COPD is present in approximately one-third of all congestive heart failure (CHF patients, and is a key cause of underprescription and underdosing of β-blockers, largely owing to concerns about precipitating respiratory deterioration. For these reasons, the aim of this study was to evaluate the impact of β-blockers on the long-term outcomes in CHF patients with COPD. In addition, we compared the effects of two different β-blockers, carvedilol and bisoprolol. Methods: The study was a retrospective, non-randomized, single center trial. Acute decompensated HF patients with COPD were classified according to the oral drug used at discharge into β-blocker (n=86; carvedilol [n=52] or bisoprolol [n=34] and non-β-blocker groups (n=46. The primary endpoint was all-cause mortality between the β-blocker and non-β-blocker groups during a mean clinical follow-up of 33.9 months. The secondary endpoints were the differences in all-cause mortality and the hospitalization rates for CHF and/or COPD exacerbation between patients receiving carvedilol and bisoprolol. Results: The mortality rate was higher in patients without β-blockers compared with those taking β-blockers (log-rank P=0.039, and univariate analyses revealed that the use of β-blockers was the only factor significantly correlated with the mortality rate (hazard ratio: 0.41; 95% confidence interval: 0.17–0.99; P=0.047. Moreover, the rate of CHF and/or COPD exacerbation was higher in patients treated with carvedilol compared with bisoprolol (log-rank P=0.033. In the multivariate analysis, only a past history of COPD exacerbation significantly increased the risk of re-hospitalization due to CHF and/or COPD exacerbation (adjusted hazard

  5. Clinical analysis of thyroid hormone changes in patients with chronic congestive heart failure%慢性充血性心力衰竭患者甲状腺激素变化临床分析

    Institute of Scientific and Technical Information of China (English)

    袁云华; 郑文武; 汪代杰

    2009-01-01

    目的 观察慢性充血性心力衰竭(CHF)患者血清甲状腺激素的变化情况.方法 用化学发光免疫分析技术微粒子酶免分析法测定72例CHF患者和48例健康者血清甲状腺激素水平.结果 CHF患者与健康者相比血清三碘甲状腺原氨酸、游离三碘甲状腺原氨酸明显降低,差异具有统计学意义(P<0.05);而总甲状腺素浓度、游离甲状腺素、促甲状腺激素2组间相似,差异无统计学意义(P0.05).结论 慢性充血性心力衰竭患者常合并正常甲状腺功能病态综合征.%Objective To observe the thyroid hormones changes in patients with chronic congestive heart failure. Methods Serum thyroid hormones levels were analyzed in 72 patients with chronic congestive heart failure and forty-eight healthy people by the chemiluminescence immune analytical technique. Results T4、FT4、TSH showed no difference between the two groups. Conclusion Patients with chronic congestive heart failure usually develop euthroid sick syndrome(ESS).

  6. 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.

  7. 酒石酸美托洛尔注射液治疗慢性充血性心力衰竭的临床分析%Clinical Analysis of Metoprolol in Treatment of Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    朱丽翠; 马凯

    2015-01-01

    目的:分析酒石酸美托洛尔注射液治疗慢性充血性心力衰竭的效果。方法88例患者分为治疗组(常规治疗+酒石酸美托洛尔注射液)和对照组(常规治疗)各44例。结果两组治疗效果与治疗后心功能变化对比,P<0.05。结论酒石酸美托洛尔注射液治疗慢性充血性心力衰竭效果较好。%Objective To analyze the effect of metoprolol on chronic congestive heart failure. Methods 88 patients were divided into treatment group (conventional treatment+tartaric acid and metoprolol injection) and control group (routine treatment) , 44 cases in each group. Results Two groups of treatment effect and the middle of the back function changes in contrast, P<0.05. Conclusion The effect of metoprolol in treatment of chronic congestive heart failure is good.

  8. Management of congestion and diuretic resistance in heart failure

    Directory of Open Access Journals (Sweden)

    Giuseppe Regolisti

    2016-11-01

    Full Text Available We present the case of a patient with heart failure and severe congestion who was responding poorly to diuretic therapy. We discuss the key problems concerning the pathophysiology and bedside therapeutic approach to congestion and fluid overload in this clinical setting, and we give practical suggestions to overcome congestion, especially in the setting of diuretic resistance and worsening renal function. We conclude that the application of key pharmacokinetic and pharmacodynamic principles of diuretic therapy, along with in-depth knowledge of the pathophysiology of heart failure, still represent the cornerstones for a correct approach to decongestive therapy in these patients.

  9. Volume control in treatment-resistant congestive heart failure : role for peritoneal dialysis

    NARCIS (Netherlands)

    Broekman, K. E.; Sinkeler, S. J.; Waanders, F.; Bartels, G. L.; Navis, G.; Janssen, W. M. T.

    2014-01-01

    Chronic congestive heart failure (HF) has a rising prevalence and increasing impact on health care systems. Current treatment consists of diuretics, renin-angiotensin-aldosterone system blockers, and restriction of salt and fluids. This strategy is often hampered by a drop in effective circulating v

  10. Gene transfer for congestive heart failure: update 2013.

    Science.gov (United States)

    Tang, Tong; Hammond, H Kirk

    2013-04-01

    Congestive heart failure is a major cause of morbidity and mortality with increasing social and economic costs. There have been no new high impact therapeutic agents for this devastating disease for more than a decade. However, many pivotal regulators of cardiac function have been identified using cardiac-directed transgene expression and gene deletion in preclinical studies. Some of these increase function of the failing heart. Altering the expression of these pivotal regulators using gene transfer is now either being tested in clinical gene transfer trials, or soon will be. In this review, we summarize recent progress in cardiac gene transfer for clinical congestive heart failure.

  11. CONGESTIVE HEART FAILURE IN DOGS IS ASSOCIATED WITH INCREASED PLATELET LEUKOCYTE AGGREGATION MEASURED BY FLOW CYTOMETRY

    DEFF Research Database (Denmark)

    Tarnow, Inge; Andreasen, Susanne SH; Olsen, Lisbeth Høier

    2010-01-01

    CONGESTIVE HEART FAILURE IN DOGS IS ASSOCIATED WITH ENHANCED PLATELET-LEUKOCYTE AGGREGATES - A MARKER FOR PLATELET ACTIVATION. I Tarnow1, LH Olsen2, SHS Andreasen2, SG Moesgaard2, CE Rasmussen2, AT Kristensen1, T Falk2. 1Departments of Small Animal Clinical Sciences and 2Animal and Veterinary Basic...... Sciences, Faculty of Life Science, University of Copenhagen, Denmark. Chronic congestive heart failure (CHF) in humans is associated with abnormal hemostasis, and changes in hemostatic biomarkers carry a poor prognosis. CHF in dogs has been associated with plasma markers of hypercoagulability, however...

  12. 温阳活血利水方治疗慢性充血性心力衰竭临床观察%Effect of Warming Yang Promoting Blood Deleting Urine Prescription on Patients with Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    郭美珠; 肖燕倩

    2011-01-01

    Objective: To evaluate the effect of warming Yang promoting blood deleting urine prescription on the patients with chronic congestive heart failure. Method; In the study, 61 patients with chronic congestive heart failure have been randomly divided into treatment group and control group. The 30 patients in the treatment group have been given warming Yang promoting blood deleting urine prescription and western medicine, and 31 patients in the control group were treated with western medicine. Four weeks were taken as a whole course. The symptoms and related items were measured and recorded before and after treatment Results; Warming Yang promoting blood deleting urine prescription can improve the disease more significantly than that in the control group , such as cardiac function, clinical symptoms and life quality of patients. Conclusion: Wanning Yang promoting blood deleting urine prescription is safe and effective in treating chronic congestive heart failure.%目的:观察温阳活血利水方治疗慢性充血性心力衰竭的临床疗效。方法:将61例慢性充血性心力衰竭患者随机分为2组,治疗组30例,给予基础治疗加温阳活血利水方口服,对照组31例给予基础治疗,4周为一个疗程,观察2组患者治疗前后的心功能、中医证候积分、生活质量积分。结果:温阳活血利水方有明显提高心功能、改善临床症状、改善生活质量积分的作用。结论:温阳活血利水方疗效确切,服用安全,无不良反应。

  13. Metoprolol for chronic congestive heart failure: a clinical analysis of 46 cases%46例无创正压治疗COPD急性加重期伴呼吸衰竭临床分析

    Institute of Scientific and Technical Information of China (English)

    许进雄

    2010-01-01

    目的 探讨无创正压治疗COPD急性加重期伴呼衰的临床疗效.方法 选择2007年1月-2009年12月收治于我院的COPD急性加重期伴呼衰患者92例,随机分为观察组(46例)和对照组(46例),对照组采用常规疗法治疗;治疗组在常规治疗的基础上加用无创正压通气治疗.比较两组治疗效果.结果 观察组在治疗后PaCO2(42.24±6.22)mmHg、呼吸频率(21.2±1.3)次/分、PaO2(89.26±9.27)mmHg,治疗效果显著优于对照组(P<0.05).结论 无创正压通气治疗COPD急性加重期伴呼衰患者,能有效的降低PaCO2、呼吸频率和提高PaO2等,具有较好的临床疗效.%Objective To explore the efficay of metoprolol for chronic congestive heart failure. Methods 92 patients with chronic congestive heart failure admitted during the period of January 2008 to December 2009 were randomly assigned to receive combination therapy with cardiac glycosides, diuretics, and ACE inhibitors (control group) or the combination therapy plus metoprolol (study group). The efficacy was compared between the two groups. Results 6 months after treatment, the study group was superior to the control group in efficacy (91.3% vs. 76.1% for total effective rate, P<0.05). Conclusions Metoprolol for chronic congestive heart failure can improve LVEF, LVDd, and LVPWT, resulting in a better clinical efficacy.

  14. Pathophysiological targets for beta-blocker therapy in congestive heart failure.

    Science.gov (United States)

    Just, H

    1996-04-01

    The treatment of congestive heart failure has seen considerable changes: while treatment with diuretics, digitalis glycosides and vasodilators has remained the mainstay of therapy, recently neurohumeral inhibition has been developed as an important principle: ACE-inhibitors have been shown to significantly improve quality of life and exercise performance and to substantially reduce mortality. Beta-blockers have been employed with increasing success mainly in congestive heart failure due to dilated idiopathic cardiomyopathy, in which a significant improvement in symptoms and life expectancy has been demonstrated. However, the precise mechanisms by which beta-blockade improves congestive heart failure remain to be elucidated. In addition to direct sympathoadrenal inhibition, reduction of heart rate may also play a major role in the therapeutic efficacy of beta-blockade in congestive heart failure. In the normal human heart increase in heart rate is accompanied by an increase in myocardial contractile performance (Bowditch-Treppe phenomenon). In chronic heart failure the myocardium undergoes a phenotype change which includes alterations of the activity of enzymes regulating calcium homoeostasis. The sarcoplasmic reticulum calcium ATPase (SERCA) is depressed both in function, as well as in expression. At the same time the sarcolemmal sodium-calcium exchanger is increased both in function and in expression. The result is a characteristic change in calcium homoeostasis with decreased diastolic uptake of calcium into the sarcoplasmic reticulum with subsequently reduced calcium release during the next systole, resulting in reduced contractile performance. At the same time increased capacity of the sodium-calcium exchanger extrudes intracellular calcium ions to the extra-cellular space, thereby rendering these ions unavailable for the contractile cycle. A result of these, seemingly specific, phenotype changes is an alteration of the force/frequency relationship. Instead of

  15. Understanding chronic heart failure

    OpenAIRE

    Fenton, Matthew; Burch, Michael

    2007-01-01

    The key principles of chronic heart failure and the development of clinical management strategies are described. The physiological changes in chronic heart failure and the clinical management of children with heart failure are considered, but the treatment of heart failure related to congenital heart disease or the intensive care management of heart failure are not mentioned as both topics require consideration in their own right. A greater understanding of the maladaptive responses to chroni...

  16. Self-perceived symptoms and care needs of patients with severe to very severe chronic obstructive pulmonary disease, congestive heart failure or chronic renal failure and its consequences for their closest relatives: the research protocol

    Directory of Open Access Journals (Sweden)

    Schols Jos MGA

    2008-05-01

    Full Text Available Abstract Background Recent research shows that the prevalence of patients with very severe chronic obstructive pulmonary disease (COPD, congestive heart failure (CHF and chronic renal failure (CRF continues to rise over the next years. Scientific studies concerning self-perceived symptoms and care needs in patients with severe to very severe COPD, CHF and CRF are scarce. Consequently, it will be difficult to develop an optimal patient-centred palliative care program for patients with end-stage COPD, CHF or CRF. The present study has been designed to assess the symptoms, care needs, end-of-life care treatment preferences and communication needs of patients with severe to very severe COPD, CHF or CRF. Additionally, family distress and care giving burden of relatives of these patients will be assessed. Methods/design A cross-sectional comparative and prospective longitudinal study in patients with end-stage COPD, CHF or CRF has been designed. Patients will be recruited by their treating physician specialist. Patients and their closest relatives will be visited at baseline and every 4 months after baseline for a period of 12 months. The following outcomes will be assessed during home visits: self-perceived symptoms and care needs; daily physical functioning; general health status; end-of-life care treatment preferences; end-of-life care communication and care-giver burden of family caregivers. Additionally, end-of-life care communication and prognosis of survival will be assessed with the physician primarily responsible for the management of the chronic organ failure. Finally, if patients decease during the study period, the baseline preferences with regard to life-sustaining treatments will be compared with the real end-of-life care. Discussion To date, the symptoms, care needs, caregiver burden, end-of-life care treatment preferences and communication needs of patients with very severe COPD, CHF or CRF remain unknown. The present study will

  17. Increased walking variability in elderly persons with congestive heart failure

    Science.gov (United States)

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

    1994-01-01

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

  18. Teaching Congestive Heart Failure to Doctor of Pharmacy Students.

    Science.gov (United States)

    Parker, Robert B.

    1992-01-01

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

  19. Effects of Traditional Chinese Medicine on Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    任海玲; 李海芸; 江时森

    2002-01-01

    Congestive heart failure (CHF) belongs to the category of "palpitation", "chest pain", "retention of phlegm and fluid" etc. in traditional Chinese medicine (TCM). The medical books of past generations recorded a lot of important prescriptions to treat above-mentioned symptoms. This article briefly summarized certain TCM prescriptions on pharmacological actions and therapeutic effects of CHF.

  20. Prognostic impact of carboxylesterase 1 gene variants in patients with congestive heart failure treated with angiotensin-converting enzyme inhibitors

    DEFF Research Database (Denmark)

    Nelveg-Kristensen, Karl E; B. Madsen, Majbritt; Torp-Pedersen, Christian;

    2016-01-01

    with congestive heart failure (CHF). METHODS: Danish patients with chronic CHF enrolled in the previously reported Echocardiography and Heart Outcome Study were categorized according to their CES1 variants and followed up for up to 10 years. Risk for cardiovascular death and all-cause death was modeled by Cox...

  1. Respiratory sleep disorders in patients with congestive heart failure.

    Science.gov (United States)

    Naughton, Matthew T

    2015-08-01

    Respiratory sleep disorders (RSD) occur in about 40-50% of patients with symptomatic congestive heart failure (CHF). Obstructive sleep apnea (OSA) is considered a cause of CHF, whereas central sleep apnea (CSA) is considered a response to heart failure, perhaps even compensatory. In the setting of heart failure, continuous positive airway pressure (CPAP) has a definite role in treating OSA with improvements in cardiac parameters expected. However in CSA, CPAP is an adjunctive therapy to other standard therapies directed towards the heart failure (pharmacological, device and surgical options). Whether adaptive servo controlled ventilatory support, a variant of CPAP, is beneficial is yet to be proven. Supplemental oxygen therapy should be used with caution in heart failure, in particular, by avoiding hyperoxia as indicated by SpO2 values >95%.

  2. Congestive Heart Failure: A Case of Protein Misfolding

    Science.gov (United States)

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

    2014-01-01

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

  3. Renal Replacement Therapy in Congestive Heart Failure Requiring Left Ventricular Assist Device Augmentation

    OpenAIRE

    Thomas, Bernadette A.; Logar, Christine M.; Anderson, Arthur E.

    2012-01-01

    “Cardiorenal syndrome” is a term used to describe a dys-regulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner (1,2). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy (2). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a u...

  4. 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

  5. Congestive heart failure in acromegaly: A review of 6 cases

    Directory of Open Access Journals (Sweden)

    P Dutta

    2012-01-01

    Full Text Available Background: Though cardiac involvement is common in acromegaly, overt congestive heart failure is uncommon. Materials and Methods: This is retrospective analysis of hospital record between 1996 and 2007. We analyzed records of 150 consecutive patients with acromegaly. We included the patients with acromegaly those who had overt congestive heart failure either at presentation or during the course of illness for the present analysis. The diagnosis of acromegaly and congestive cardiac failure were based on standard criteria. Results:Out of 150 patients with acromegaly, 6 patients had overt CHF (4.0%, of which 4 presented with the features of CHF and 2 developed during the course of illness. Three patients had hypertension and 1 had diabetes. Baseline echocardiography showed severe biventricular dysfunction and global hypokinesia in all. Angiography showed dilated hypokinetic left ventricle with normal coronaries in 3, it was confirmed at autopsy in 1. Three underwent trans-sphenoidal surgery, 1 received somatostatin analogue as primary treatment modality. Normalization of growth hormone and IGF-1 led to improvement in cardiac function in 1, 1 patient lost to follow up, and 4 died during the course of illness. In 1 patient, autopsy was performed and cardiac specimen revealed normal coronaries, concentric ventricular hypertrophy, and dilatation with myofibrolysis and interfascicular fibrosis. Conclusion:Prevalence of overt CHF is 4% in present series. Overt CHF carries poor prognosis and hence, this complication should be recognized at earliest, and medical management to normalized cardiac function should be given utmost priority.

  6. Cardiac sympathetic nerve terminal function in congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Chang-seng LIANG

    2007-01-01

    Increased cardiac release of norepinephrine (NE) and depleted cardiac stores of NE are two salient features of the human failing heart. Researches from my labo-ratory have shown that these changes are accompanied by a functional defect of NE uptake in the cardiac sympathetic nerve terminals. Our studies have shown that the decrease of NE uptake is caused by reduction of NE transporter density in the sympathetic nerve endings, and this change is responsible, at least in part, for the increased myocardial interstitial NE, decreased myocardial adrenoceptor density, and increased myocyte apoptosis in experimental cardiomyopathies. We have also provided evidence in both intact animals and cultured PC12 cells that the decrease of NE transporter is induced by the actions of oxidative metabolites of exogenous NE, involving endoplasmic reticulum stress and impaired N-glycosylation of the NE transporter. This change in the cardiac sympathetic NE uptake function, as demonstrated by [123I] metaiodobenzylguanidine in human studies, may not only serve as an important prognostic variable in patients with congestive heart failure, but also be used as a surrogate for the efficacies of various therapeutic interventions for heart failure. Finally, increasing evidence suggests and further studies are needed to show that the cardiac sympathetic nerve terminal function may be a direct target for pharmacologic treatment of congestive heart failure.

  7. Restoration of normal hemoglogbin level in patients with sever chronic congestive heart failure accompanied by anemia%贫血治疗对改善慢性心力衰竭预后的价值

    Institute of Scientific and Technical Information of China (English)

    王骏; 张雁; 周赞; 黄少华; 陶文其; 徐志强; 曹宾; 唐琦; 方唯一

    2012-01-01

    目的:探讨低剂量重组人促红细胞生成素(rhEPO)加铁剂治疗重症慢性充血性心力衰竭合并贫血的临床安全性以及对临床预后的影响. 方法:入选慢性心力衰竭纽约心功能分级Ⅲ级以上、左心室射血分数(LVEF)<0.4且血红蛋白<100 g/L的患者共128例,随机分为贫血治疗组(n=66)和对照组(n=62).随访12个月,记录2组无事件生存时间、主要终点事件(心衰恶化住院、心衰死亡)、次要终点事件(非心衰死亡、猝死、心肌梗死、不稳定性心绞痛、卒中、动脉栓塞、药物不良反应导致停药).比较两组存活患者治疗前后的LVEF、左心室室壁应力(MWS)、左心室质量指数(LVMI)以及肿瘤坏死因子α(TNF-α)、高敏C反应蛋白(hsCRP)和B型利钠肽(BNP)水平. 结果:与对照组比较,治疗组无事件生存时间延长,但心衰死亡和心衰恶化住院率无显著性差异;非心衰心血管事件治疗组未增加.治疗组MWS和LVMI在治疗后显著降低,与对照组差异显著,而LVEF、BNP、TNF-α以及hsCRP水平两组无差异. 结论:低剂量rhEPO加用铁剂治疗可安全用于重症充血性心力衰竭合并贫血患者,能延长生存时间和改善左心室功能,但不降低心衰病死率和心衰恶化入院率.%Objective: To evaluate the clinical safety and efficacy of treating severe chronic congestive heart failure accompanied by anemia using low-dose recombinant human erythropoietin (rhEPO) plus iron. Methods: A total of 128 patients with chronic heart failure (NYHA functional class m and above), left ventricular ejection fraction less than 0. 4, and hemoglobin level below l00g/L were selected and randomly divided into the anemia treatment group (n = 66) and the control group (n = 62). A 12-month follow-up observational study was conducted to record event-free survival, primary endpoint events (hospitalization due to worsening heart failures, deaths from heart failures), and secondary endpoint

  8. Team management of congestive heart failure across the continuum.

    Science.gov (United States)

    Venner, G H; Seelbinder, J S

    1996-01-01

    Despite an increased incidence of congestive heart failure and frequency of hospital admissions for the Medicare population, there is little information available on improving outcomes for these patients. As changes in health care lead toward capitation, efficient care with limited use of expensive inpatient hospital resources is a necessity. The coordination of three critical components--inpatient, outpatient, and home care--can lead to positive outcomes in terms of functional capacity changes, length of stay, readmission rates, patient self-care knowledge, and patient satisfaction.

  9. Low-salt diet and hyponatremia in chronic congestive heart failure%慢性充血性心力衰竭低盐饮食与低钠血症

    Institute of Scientific and Technical Information of China (English)

    姚亚丽; 李俨; 秦建茹; 张博

    2009-01-01

    目的 探讨慢性充血性心力衰竭(CHF)患者合并低钠血症的病因、后果及治疗措施.方法 120例慢性CHF患者,心功能NYHA分级Ⅲ~Ⅳ级,按就诊先后随机分为观察组60例和对照组60例.观察组给予常规抗心力衰竭治疗和低盐饮食,对照组给予常规抗心力衰竭治疗和正常饮食,观察期3个月.结果 观察组中有32例发生轻度低钠血症,8例出现严重低钠血症,2例因严重低钠血症合并碱中毒和严重低钠血症致心功能恶化死亡;对照组中有2例发生轻度低钠血症,没有发生严重低钠血症及死亡.结论 对于心功能Ⅲ~Ⅳ级慢性CHF患者需长期或间断服用利尿剂,适当补充钠盐或者放宽钠盐的摄入,可有效防止低钠血症及并发症的发生,对已发生低钠血症患者口服钠盐安全有效.%Objective To investigate the causes,prognosis and treatments of chronic congestive heart failure (CHF) with hyponatremia. Methods 120 patients with chronic CHF at Ⅲ~Ⅳ heart function levels were randomly divided into study group and control group with 60 cases in each. The study group received standard heart failure therapy along with low-salt diet while the control group received standard heart failure therapy along with normal diet. All cases were observed for 3 months. Results In the study group,32 cases had mild hyponatremia,8 cases had severe hyponatremia,and 2 cases died of severe hyponatremia with alkalosis and deterioration of heart function. In the control group,2 cases suffered from mild hyponatremia but no cases had sever hyponatremia and died. Conclusion For CHF at Ⅲ~Ⅳ heart function levels,long-term or intermittent diuretic administration accompanied by proper sodium salt supply or loosening the restriction of sodium salt intake may effectively prevent hyponatremia and its complications. For the patients with hyponatremia,oral administration of sodium salt is safe and effective.

  10. Role of Diuretics and Ultrafiltration in Congestive Heart Failure

    Science.gov (United States)

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

    2013-01-01

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

  11. Role of Diuretics and Ultrafiltration in Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Jo Ann Lindenfeld

    2013-07-01

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

  12. A novel distributed model of the heart under normal and congestive heart failure conditions.

    Science.gov (United States)

    Ravanshadi, Samin; Jahed, Mehran

    2013-04-01

    Conventional models of cardiovascular system frequently lack required detail and focus primarily on the overall relationship between pressure, flow and volume. This study proposes a localized and regional model of the cardiovascular system. It utilizes noninvasive blood flow and pressure seed data and temporal cardiac muscle regional activity to predict the operation of the heart under normal and congestive heart failure conditions. The analysis considers specific regions of the heart, namely, base, mid and apex of left ventricle. The proposed method of parameter estimation for hydraulic electric analogy model is recursive least squares algorithm. Based on simulation results and comparison to clinical data, effect of congestive heart failure in the heart is quantified. Accumulated results for simulated ejection fraction percentage of the apex, mid and base regions of the left ventricle in congestive heart failure condition were 39 ± 6, 36 ± 9 and 38 ± 8, respectively. These results are shown to satisfactorily match those found through clinical measurements. The proposed analytical method can in effect be utilized as a preclinical and predictive tool for high-risk heart patients and candidates for heart transplant, assistive device and total artificial heart.

  13. 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.

  14. Congestive heart failure from suspected ductal closure in utero.

    Science.gov (United States)

    Arcilla, R A; Thilenius, O G; Ranniger, K

    1969-07-01

    This is the 1st case report of a ductal closure occurring during fetal growth. The case was a spontaneous delivery in cephalic presentation from a 31-year-old gravida 3, para 3 Black woman who had been treated with isoniazid and spreptomycin up to 2 months before her delivery. Gestational age was 37 weeks when the fetus was delivered weighing 3.15 kgm. The cord had been wrapped around the fetus's neck, and breathing was delayed 2 minutes. In the nursery, the baby's general condition was poor, and congestive heart failure was diagnosed. The newborn had trieuspid insufficiency, severe heart failure, and acidosis at birth. These disappeared the next day. Hemodynamic studies when the baby was 4 hours old showed a large cone-shaped ductus arteriousus extending from the pulmonary artery but ending blindly at the aortic end.

  15. Decrease of cardiac chaos in congestive heart failure

    Science.gov (United States)

    Poon, Chi-Sang; Merrill, Christopher K.

    1997-10-01

    The electrical properties of the mammalian heart undergo many complex transitions in normal and diseased states. It has been proposed that the normal heartbeat may display complex nonlinear dynamics, including deterministic chaos,, and that such cardiac chaos may be a useful physiological marker for the diagnosis and management, of certain heart trouble. However, it is not clear whether the heartbeat series of healthy and diseased hearts are chaotic or stochastic, or whether cardiac chaos represents normal or abnormal behaviour. Here we have used a highly sensitive technique, which is robust to random noise, to detect chaos. We analysed the electrocardiograms from a group of healthy subjects and those with severe congestive heart failure (CHF), a clinical condition associated with a high risk of sudden death. The short-term variations of beat-to-beat interval exhibited strongly and consistently chaotic behaviour in all healthy subjects, but were frequently interrupted by periods of seemingly non-chaotic fluctuations in patients with CHF. Chaotic dynamics in the CHF data, even when discernible, exhibited a high degree of random variability over time, suggesting a weaker form of chaos. These findings suggest that cardiac chaos is prevalent in healthy heart, and a decrease in such chaos may be indicative of CHF.

  16. Sex-linked differences in the course of chronic kidney disease and congestive heart failure: a study in 5/6 nephrectomized Ren-2 transgenic hypertensive rats with volume overload induced using aorto-caval fistula.

    Science.gov (United States)

    Červenka, Luděk; Škaroupková, Petra; Kompanowska-Jezierska, Elzbieta; Sadowski, Janusz

    2016-10-01

    The role of hypertension and the renin-angiotensin system (RAS) in sex-related differences in the course of chronic kidney disease (CKD) and congestive heart failure (CHF) remain unclear, especially when the two diseases are combined. In male and female Ren-2 transgenic rats (TGR), a model of hypertension with activation of endogenous RAS, CKD was induced by 5/6 renal mass reduction (5/6 NX) and CHF was elicited by volume overload achieved by creation of an aorto-caval fistula (ACF). The primary aim of the study was to examine long-term CKD- and CHF-related mortality, especially in animals with CKD and CHF combined, with particular interest in the potential sex-related differences. The follow-up period was 23 weeks after the first intervention (5/6 NX). We found, first, that TGR did not exhibit sexual dimorphism in the course of 5/6 NX-induced CKD. Second, in contrast, TGR exhibited important sex-related differences in the course of ACF-induced CHF-related mortality: intact female TGR showed higher survival rate than male TGR. This situation is reversed in the course of combined 5/6 NX-induced CKD and ACF-induced CHF-related mortality: intact female TGR exhibited poorer survival than male TGR. Third, the survival rate in animals with combined 5/6 NX-induced CKD and ACF-induced CHF was significantly worsened as compared with rat groups that were exposed to 'single organ disease'. Collectively, our present results clearly show that CKD aggravates long-term mortality of animals with CHF. In addition, TGR exhibit remarkable sexual dimorphism with respect to CKD- and CHF-related mortality, especially in animals with combined CKD and CHF.

  17. Medical advances in the treatment of congestive heart failure.

    Science.gov (United States)

    Armstrong, P W; Moe, G W

    1993-12-01

    The increased incidence and prevalence of congestive heart failure place a high priority on novel treatment strategies. Left ventricular ejection fraction remains the single most valuable measurement providing both diagnostic and prognostic insights. The most systematic approach to heart failure involves an objective assessment of functional disability, to include exercise tests such as a 6-minute walk under standardized conditions. Left ventricular dysfunction incites a host of neurohumoral compensations that are of fundamental importance in the heart failure syndrome expression. Both vasoconstrictor and vasodilator neurohormones are stimulated and provide new therapeutic opportunities. The therapeutic approach to heart failure begins with a strong emphasis on prevention, patient education, and self-participation in therapy with respect to both its monitoring and adjustment. Diuretics remain a mainstay of therapy but, in the face of severe heart failure, may become ineffectual, requiring constant infusion of loop-active diuretics, combination diuretics, or diuretics in association with concomitant low-dose dopamine infusion. Vasodilator therapy has been an important advance: combination hydralazine and nitrate therapy was initially shown to be efficacious in improving survival, and more recently, angiotensin-converting enzyme (ACE) inhibitors, in the form of enalapril, have shown incremental benefit on survival over this combination. Interestingly, there is now evidence from both SOLVD and SAVE to demonstrate an unexpected and, as yet, unexplained reduction in the frequency of both unstable angina and myocardial infarction. Although, on balance, the weight of evidence concerning the long-term efficacy of inotropic agents has been disappointing, especially as it relates to their unfavorable effects on survival, recent information on vesnarinone, an agent with a complex and diversified mechanism of action, suggests that with appropriate doses, improved symptoms and

  18. Liver congestion in heart failure contributes to inappropriately increased serum hepcidin despite anemia.

    Science.gov (United States)

    Ohno, Yukako; Hanawa, Haruo; Jiao, Shuang; Hayashi, Yuka; Yoshida, Kaori; Suzuki, Tomoyasu; Kashimura, Takeshi; Obata, Hiroaki; Tanaka, Komei; Watanabe, Tohru; Minamino, Tohru

    2015-01-01

    Hepcidin is a key regulator of mammalian iron metabolism and mainly produced by the liver. Hepcidin excess causes iron deficiency and anemia by inhibiting iron absorption from the intestine and iron release from macrophage stores. Anemia is frequently complicated with heart failure. In heart failure patients, the most frequent histologic appearance of liver is congestion. However, it remains unclear whether liver congestion associated with heart failure influences hepcidin production, thereby contributing to anemia and functional iron deficiency. In this study, we investigated this relationship in clinical and basic studies. In clinical studies of consecutive heart failure patients (n = 320), anemia was a common comorbidity (41%). In heart failure patients without active infection and ongoing cancer (n = 30), log-serum hepcidin concentration of patients with liver congestion was higher than those without liver congestion (p = 0.0316). Moreover, in heart failure patients with liver congestion (n = 19), the anemia was associated with the higher serum hepcidin concentrations, which is a type of anemia characterized by induction of hepcidin. Subsequently, we produced a rat model of heart failure with liver congestion by injecting monocrotaline that causes pulmonary hypertension. The monocrotaline-treated rats displayed liver congestion with increase of hepcidin expression at 4 weeks after monocrotaline injection, followed by anemia and functional iron deficiency observed at 5 weeks. We conclude that liver congestion induces hepcidin production, which may result in anemia and functional iron deficiency in some patients with heart failure.

  19. Problems of rapid digitalization in severe congestive heart failure.

    Science.gov (United States)

    Haustein, K O; Assmann, I; Fiehring, H

    1980-02-01

    The pharmacodynamic effects (changes of systolic time intervals, STI, reaction of pulmonary arterial pressure) of digitoxin were studied in 7 patients with severe congestive heart failure in comparison with the corresponding plasma level. STI indicated glycoside-dependent changes, i.e. shortening of LVETc and QS2c and normalization of prolonged PEPc, while ICT shortening was less observed. In 2 patients with cor pulmonale a pulmonary oedema occurred accompanied with prolonged LVETc. During the early period of glycoside-dependent recompensation no significant correlation between STI shortening and glycoside plasma level was observed. Because of the retarded normalization of the haemodynamics of the pulmonary circulation and because of possible side-effects, rapid digitalization has to be reconsidered.

  20. 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.

  1. Congestive heart failure and cognitive functioning amongst older adults

    Directory of Open Access Journals (Sweden)

    Almeida Osvaldo P.

    2001-01-01

    Full Text Available BACKGROUND: Congestive heart failure is associated with decline in quality of life and, possibly, cognitive functions such as memory and attention. AIMS: The present study was designed to investigate the presence of cognitive impairment amongst patients with congestive heart failure (CHF. We hypothesised that CHF patients would have lower scores than elderly controls on general measures of cognitive functioning. METHODS AND RESULTS: We examined a sample of 50 consecutive patients admitted to hospital with CHF functional class III/IV and a convenience sample of 30 older adults assessed at the outpatient service of geriatric medicine of a teaching hospital in São Paulo, Brazil. All subjects were interviewed with the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX, as well as the neuropsychological battery of the CAMDEX (CAMCOG, Mini-Mental State Examination (MMSE, Trail Making A and B, Digit Span, Digit Symbol, and Letter Cancellation Test. All CHF patients had left ventricular ejection fraction (EF below 45% and all controls above 65%. The cognitive performance of CHF patients was significantly worse than controls for all cognitive assessments. Twenty-seven of 50 CHF patients had a MMSE total score lower than 24, compared with only 10/30 controls (p=0.073. Similarly, 36/49 and 9/30 CHF subjects and controls respectively had CAMCOG scores below 80 (p<0.001. Cognitive scores were significantly associated with EF, which was the most robust predictor of cognitive impairment according to the CAMCOG in a logistic regression model. CONCLUSION: Our results indicate that CHF is associated with significant levels of cognitive impairment and show that mental performance is, at least partly, a consequence of EF. Physicians should be prepared to assess the mental state of patients, as poor cognitive functioning may interfere with treatment compliance and management plan.

  2. Fluid Volume Overload and Congestion in Heart Failure: Time to Reconsider Pathophysiology and How Volume Is Assessed.

    Science.gov (United States)

    Miller, Wayne L

    2016-08-01

    Volume regulation, assessment, and management remain basic issues in patients with heart failure. The discussion presented here is directed at opening a reassessment of the pathophysiology of congestion in congestive heart failure and the methods by which we determine volume overload status. Peer-reviewed historical and contemporary literatures are reviewed. Volume overload and fluid congestion remain primary issues for patients with chronic heart failure. The pathophysiology is complex, and the simple concept of intravascular fluid accumulation is not adequate. The dynamics of interstitial and intravascular fluid compartment interactions and fluid redistribution from venous splanchnic beds to central pulmonary circulation need to be taken into account in strategies of volume management. Clinical bedside evaluations and right heart hemodynamic assessments can alert clinicians of changes in volume status, but only the quantitative measurement of total blood volume can help identify the heterogeneity in plasma volume and red blood cell mass that are features of volume overload in patients with chronic heart failure and help guide individualized, appropriate therapy-not all volume overload is the same.

  3. 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...... heart failure in the SOLVD trials. In post-myocardial infarction patients, the calcium antagonist nifedipine did not affect mortality or morbidity; diltiazem improved prognosis in patients without congestive heart failure and in patients with non-Q-wave infarction; and verapamil improved prognosis...

  4. 甲状腺功能与老年慢性充血性心力衰竭患者心功能、左心室重构的关系研究%Relationship Between Thyroid Function and Cardiac Function/Left Ventricular Remodeling of Elderly Patients With Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    张萍; 赵东升

    2016-01-01

    with chronic congestive heart failure. Methods A total of 90 elderly patients with chronic congestive heart failure(equal or over 60 years old)admitted to the Second People′s Hospital of Hengshui from January 2013 to January 2015 were selected as A group,77 elderly patients without chronic congestive heart failure were selected as B group at the same time. Index of thyroid function,cardiac function and left ventricular remodeling were compared between the two groups, index of thyroid function was compared in elderly chronic congestive heart failure patients with different NYHA cardiac function grades,the correlation between index of thyroid function and cardiac function was analyzed. Results The NYHA cardiac function grades of B group were all Ⅰ - grade;of A group,37 cases′ NYHA cardiac function grades were Ⅱ - grade,36 cases′were Ⅲ - grade,17 cases′ were Ⅳ - grade. TSH,TT3 ,TT4 ,FT3 ,FT4 and LVEF of A group were statistically significantly lower than those of B group,while LVESD,LVEDD and LVMI of A group were statistically significantly lower than those of B group(P < 0. 05). TSH,TT3 and FT3 of chronic congestive heart failure patients with Ⅲ - grade NYHA cardiac function grades were statistically significantly lower than those of chronic congestive heart failure patients with Ⅱ - grade NYHA cardiac function grades(P < 0. 05);TSH,TT3 ,TT4 ,FT3 and FT4 of chronic congestive heart failure patients with Ⅳ - grade NYHA cardiac function grades were statistically significantly lower than those of chronic congestive heart failure patients with Ⅱ - grade NYHA cardiac function grades,TT3 ,FT3 and FT4 of chronic congestive heart failure patients with Ⅳ - grade NYHA cardiac function grades were statistically significantly lower than those of chronic congestive heart failure patients with Ⅲ - grade NYHA cardiac function grades. Of patients with chronic congestive heart failure,TSH was negatively correlated with LVEDD( r = - 0. 598) and LVMI(r = - 0

  5. Angiotensin-converting enzyme inhibitors in congestive heart failure.

    Science.gov (United States)

    Deedwania, P C

    1990-09-01

    Angiotensin-converting enzyme inhibitors have had a significant impact on the treatment of congestive heart failure (CHF). Hemodynamic and clinical improvements in patients with severe CHF fostered the use of angiotensin-converting enzyme inhibitors in mild to moderate CHF. Angiotensin-converting enzyme inhibitors produce acute and sustained improvements in ventricular hemodynamics and quality of life. Captopril plus diuretic therapy is an effective alternative to digoxin in patients with mild to moderate CHF. Enalapril maleate and lisinopril have been shown to be effective in moderate to severe CHF when combined with digoxin and diuretics. Captopril and enalapril also improve survival in selected patients; captopril attenuates left ventricular dilatation after myocardial infarction. Although all angiotensin-converting enzyme inhibitors are similar in mechanism of action, pharmacokinetic differences impact their clinical use. Prolonged symptomatic hypotension compromising systemic perfusion and organ function has been reported with longer-acting agents; hypotension is usually short-lived and rarely compromises organ function with shorter-acting agents.

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

    Directory of Open Access Journals (Sweden)

    R.S. Silva

    2008-03-01

    Full Text Available We investigated the relationship between sleep-disordered breathing (SDB and Cheyne-Stokes respiration (CSR while awake as well as mortality. Eighty-nine consecutive outpatients (29 females with congestive heart failure (CHF; left ventricular ejection fraction, LVEF 5 and >15, respectively. CHF etiologies were similar according to the prevalence of SDB and sleep pattern. Males and females were similar in age, body mass index, and LVEF. Males presented more SDB (P = 0.01, higher apnea-hypopnea index (P = 0.04, more light sleep (stages 1 and 2; P < 0.05, and less deep sleep (P < 0.001 than females. During follow-up (25 ± 10 months, 27% of the population died. Non-survivors had lower LVEF (P = 0.01, worse New York Heart Association (NYHA functional classification (P = 0.03, and higher CSR while awake (P < 0.001 than survivors. As determined by Cox proportional model, NYHA class IV (RR = 3.95, 95%CI = 1.37-11.38, P = 0.011 and CSR while awake with a marginal significance (RR = 2.96, 95%CI = 0.94-9.33, P = 0.064 were associated with mortality. In conclusion, the prevalence of SDB and sleep pattern of patients with Chagas' disease were similar to that of patients with CHF due to other etiologies. Males presented more frequent and more severe SDB and worse sleep quality than females. The presence of CSR while awake, but not during sleep, may be associated with a poor prognosis in patients with CHF.

  7. Effects of tolvaptan on congestive heart failure complicated with chylothorax in a neonate.

    Science.gov (United States)

    Sato, Nikiko; Sugiura, Tokio; Nagasaki, Rika; Suzuki, Kazutaka; Ito, Koichi; Kato, Takenori; Inukai, Sachiko; Saitoh, Shinji

    2015-10-01

    Tolvaptan is an oral vasopressin type 2 receptor antagonist that can be used for heart failure patients with hyponatremia or symptomatic congestion. Although the effects of tolvaptan in adults have been well documented, only limited information is available in children. The case of a neonate with congestive heart failure complicated with chylothorax after palliative surgery for transposition of the great arteries treated with tolvaptan is reported. Slow up-titration to 0.1 mg/kg successfully increased urine output and improved refractory congestive heart failure without hypernatremia. Subsequently, bodyweight and chylothorax decreased gradually. Moreover, the use of tolvaptan reduced the dosage of furosemide. Tolvaptan could be an alternative drug for neonates with congestive heart failure. Further large studies are needed to confirm the efficacy and identify the appropriate dose of tolvaptan in neonates.

  8. Altered neuropeptide Y Y1 responses in mesenteric arteries in rats with congestive heart failure

    DEFF Research Database (Denmark)

    Bergdahl, A; Nilsson, T; Sun, X Y;

    1998-01-01

    The aim of the present study was to elucidate if the potentiating effect of neuropeptide Y on various vasoactive agents in vitro is (1) altered in mesenteric arteries from rats with congestive heart failure and (2) mediated by the neuropeptide Y Y1 receptor. The direct vascular effects...... of the neuropeptide Y Y1 antagonist, BIBP3226 (BIBP3226¿(R)-N2-(diphenylacetyl)-N-[(4-hydroxyphenyl)methyl ]-D-arginine-amide¿). Neuropeptide Y, per se, had no vasoactive effect in the arteries. The potency of endothelin-1 was significantly decreased in congestive heart failure rats. Neuropeptide Y and neuropeptide Y......-(13-36) potentiated the endothelin-1-induced contraction in congestive heart failure mesenteric arteries. In 20% of the congestive heart failure rats, sarafotoxin 6c induced a contraction of 31+/-4%. Neuropeptide Y also potentiated U46619- and noradrenaline-induced contractions but not 5-HT...

  9. Congestive heart failure induces downregulation of P2X1-receptors in resistance arteries

    DEFF Research Database (Denmark)

    Malmsjö, M; Bergdahl, A; Möller, S;

    1999-01-01

    OBJECTIVE: Congestive heart failure (CHF) is accompanied by enhanced peripheral sympathetic nerve activity, increased vascular resistance and impaired peripheral blood flow. Besides noradrenaline and neuropeptide Y, the sympathetic nervous system also releases ATP, which has contractile effects...

  10. Clinical Significance of Serum Cardiac Troponin T and Serum uric acid levels in Aged Patients with Chronic Congestive Heart Failure%老年慢性心力衰竭患者血清肌钙蛋白T及尿酸检测的临床意义

    Institute of Scientific and Technical Information of China (English)

    李莉

    2011-01-01

    目的 探讨老年慢性心力衰竭(CHF)患者血清肌钙蛋白T(cTnT)及尿酸(UA)水平检测的意义.方法 回顾性分析200例老年慢性心力衰竭患者临床资料,心功能Ⅰ级为对照组,Ⅱ、Ⅲ、Ⅳ级患者为观察组,每组50例.分析血UA、cTnT与慢性心力衰竭的发生是否存在相关性.按cTnT浓度分为正常组和增高组,比较其住院期间及随访2年发生的心脏事件(心力衰竭反复或加重、死亡)的发生情况.结果 观察组cTnT与UA含量明显高于对照组.cTnT增高组患者心脏事件的发生率明显高于正常组(P<0.05).结论 心衰越重,cTnT与UA增高越明显,血尿酸、肌钙蛋白T与充血性心力衰竭密切相关,是充血性心力衰竭发病的危险因素,二者联合可作为评价老年心力衰竭严重程度的指标.cTnT对判断老年慢性心力衰竭患者的预后有较好的预测价值.%Objective To evaluate the correlations of serum cardiac troponin T and serum uric acid levels in in aged patients with chronic congestive heart failure(CHF) and the effect of cardiac troponin T(cTnT) on the prognosis of the CHF. Methods 200 cases of congestive heart failure patients(Cardiac function NYHA class Ⅰ-Ⅳ) were enrolled for retrospective analysis and divided into four groups ,50 cases per group;randomly picked 50 cases of pantients with cardiac function NYHA class Ⅰ as a control group; and analyzed the relationship of serum uric (UA) and cTnT level and the occurrence of CHF. All the patients were arranged into normal group and higher group according to cTnT concentration. Cardiac events, including repeated or aggravated heart failure or cardiac death,in patients with increased cTnT during hospitalization were compared to those without it. Results In congestive heart failure group (Cardiac function NYHA class Ⅱ-Ⅳ) ,the cTnT and UA contents increased significantly than that in control group.Incidence of cardiac events was higher in patients with increased c

  11. Digoxin:A systematic review in atrial fibrillation,congestive heart failure and post myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Sebastiano; Virgadamo; Richard; Charnigo; Yousef; Darrat; Gustavo; Morales; Claude; S; Elayi

    2015-01-01

    AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction. METHODS: A comprehensive Pub Med search was performed using the key words "digoxin and congestive heart failure", "digoxin and atrial fibrillation", "digoxin, atrial fibrillation and systolic congestive heart failure", and "digoxin and myocardial infarction". Only articles written in English were included in this study. We retained studies originating from randomized controlled trials, registries and included at least 500 patients. The studies included patients with atrial fibrillation or heart failure or myocardial infarction and had a significant proportion of patients(at least 5%) on digoxin. A table reviewing the different hazard ratios was developed based on the articles selected. Our primary endpoint was the overall mortality in the patients on digoxin vs those without digoxin, among patients with atrial fibrillation and also among patients with atrial fibrillation and systolic heart failure. We reviewed the most recent international guidelines to discuss current recommendations.RESULTS: A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm(n = 5), atrial fibrillation with and without systolic congestive heart failure(n = 9), and myocardial infarction(n = 4). Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is employed. However, most of the observational studies evaluating digoxin use in atrial fibrillation without systolic congestive heart failure showed an increase in overall mortality when taking digoxin. In the studies evaluated in this systematic review, the data among patients with atrial fibrillation and systolic congestive heart failure, as well as post myocardial infarction were

  12. Congestive heart failure in subjects with thyrotoxicosis in a black community

    Directory of Open Access Journals (Sweden)

    R C Anakwue, B J C Onwubere

    2010-07-01

    Full Text Available R C Anakwue, B J C Onwubere, B C Anisiuba, V O Ikeh, A Mbah, S O IkeDepartment of Medicine, College of Medicine, University of Nigeria Enugu CampusIntroduction: Thyroid hormone has profound effects on a number of metabolic processes in virtually all tissues but the cardiovascular manifestations are prominent usually creating a hyperdynamic circulatory state. Thyrotoxicosis is not a common cause of congestive heart failure among black communities.Objectives: To determine the hospital prevalence, clinical characteristics and echocardiographic findings in patients with thyrotoxicosis who present with congestive heart failure (CCF in the eastern part of Nigeria.Subjects and methods: A total of 50 subjects aged 15 years and above who were diagnosed as thyrotoxic following clinical and thyroid function tests were consecutively recruited. Fifty age- and sex-matched controls with no clinical or biochemical evidence of thyrotoxicosis and no comorbidities were used as controls. Two-dimensional echocardiography was carried out on all the subjects. CCF was determined clinically and echocardiographically.Results: Eight patients (5 females and 3 males out of a total of 50 thyrotoxic patients presented with congestive heart failure.Conclusion: The study revealed that congestive heart failure can occur in thyrotoxicosis in spite of the associated hyperdynamic condition. The underlying mechanism may include direct damage by autoimmune myocarditis, congestive circulation secondary to excess sodium, and fluid retention.Keywords: thyrotoxicosis, congestive heart failure, echocardiography, black community

  13. Importance of congestive heart failure and interaction of congestive heart failure and left ventricular systolic function on prognosis in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Pedersen, O D;

    1996-01-01

    Left ventricular (LV) systolic function and congestive heart failure (CHF) are important predictors of long-term mortality after acute myocardial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis has not been studied in detail previously...

  14. 螺内酯联合贝那普利治疗慢性充血性心力衰竭47例疗效观察%Clinical Effect Observation of Spironolactone Combined with Benazepri in Treatment of 47 Cases with Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    王林华

    2013-01-01

    Objective To explore the clinical effect of spironolactone combined with benazepri in treatment of chronic congestive heart failure. Methods 94 patients with chronic congestive heart failure in our hospital were randomly divided into spironolactone combined with benazepri treatment group (observation group) and benazepri treatment group (control group), 47 cases in each group, compared the clinical effect of patients in two groups. Results The total effective rate of patients in observation group was 91.5%, significantly higher than that in control group (74.5%), there was significant difference between two groups (P<0.05). There were no obvious adverse reactions during treatment. Conclusion Taking spironolactone combined with benazepri in the treatment of chronic congestive heart failure has effective clinical effect, worthy of further clinical application.%目的:探讨螺内酯联合贝那普利治疗慢性充血性心力衰竭的疗效。方法将我院收治的94例慢性充血性心力衰竭患者随机分为螺内酯联合贝那普利治疗组(观察组)和贝那普利治疗组(对照组),每组各47例,比较两组患者的临床疗效。结果观察组患者治疗总有效率为91.5%,显著高于对照组患者的74.5%,组间差异有统计学意义(P<0.05)。两组患者治疗期间均未出现明显不良反应。结论螺内酯联合贝那普利治疗慢性充血性心力衰竭临床疗效确切,值得临床进一步推广使用。

  15. Long-term outcome of patients with acromegaly and congestive heart failure.

    Science.gov (United States)

    Bihan, Hélène; Espinosa, Consuelo; Valdes-Socin, Hernan; Salenave, Sylvie; Young, Jacques; Levasseur, Suzanne; Assayag, Patrick; Beckers, Albert; Chanson, Philippe

    2004-11-01

    Cardiovascular complications are a major cause of morbidity and mortality in patients with acromegaly. Normalization of GH secretion is associated with an improvement in structural and functional cardiac abnormalities. However, the long-term cardiac effects of treatment for acromegaly have not been studied in patients who have already developed chronic congestive heart failure (CHF). We reviewed the charts of 330 consecutive patients with acromegaly treated in two French and Belgian centers since 1985. Ten patients with both acromegaly and CHF (eight men, two women, mean age 49.7 yr) were studied retrospectively. One of them was excluded because CHF was due to severe aortic stenosis.CHF (New York Heart Association stages III-IV and echocardiography showing dilated hypokinetic cardiomyopathy with left ventricular systolic dysfunction and a left ventricular ejection fraction less than 45%) was diagnosed before, concomitantly, or after acromegaly in, respectively, two, five, and two patients. Three patients were referred with terminal heart failure requiring transplantation.One patient had transient CHF associated with a hypertensive crisis. The other eight patients had symptomatic chronic CHF. Control of GH hypersecretion failed, totally or partially, in three patients: one had a long-term survival, and the two others died at 1 and 5 yr. Good GH control was achieved in five patients: four of these are still alive 2-16 yr after diagnosis of CHF, their clinical status is stable or improved, and their quality of life is good. Overall, the 1- and 5-yr mortality (or transplantation) rates for patients with chronic symptomatic CHF were 25% (2 of 8 patients) and 37.5% (3 of 8 patients), respectively. In conclusion, less than 3% of acromegalic patients developed CHF in this study. Although effective treatment of acromegaly improved short-term cardiovascular status, its impact on long-term survival is questionable.

  16. New approach for new target: adaptive servo-ventilation on Cheyne-Stokes respiration in congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) occurs when periods of hyperventilation with waxing/waning tidal volume alternated with periods of central hypopnea/apnea. It is present in approximately 40 percent of patients with severe congestive heart failure (CHF). CSR-CSA may contribute to the progression of heart failure by causing repetitive arterial oxygen desaturation, sleep fragmentation, increased left ventricular afterload, activation of sympathetic nervous system, and oscillations in heart rate and blood pressure. There are evidences indicating that CSR-CSA is associated with a remarkable increase in mortality and is also an independent risk factor for cardiac transplantation; furthermore, treatment of CSR-CSA in combination with optimal medical therapy may influence the course of chronic heart failure, improve quality of life and the survival of patients.1 The paper by Zhang et al2 highlights the importance of recognizing this pathological breathing pattern as a potential therapeutic target.

  17. Recompensation of Heart and Kidney Function after Treatment with Peritoneal Dialysis in a Case of Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Lars P. Kihm

    2011-01-01

    Full Text Available We report the case of a 57-year-old woman suffering from congestive heart failure. Due to refractory congestions despite optimised medical treatment, the patient was listed for heart transplantation and peritoneal dialysis was initiated. Peritoneal dialysis led to a significant weight loss, reduction of hyperhydration and extracellular water obtained by bioimpedance measurement, and a significant improvement in clinical and echocardiographic examination. Furthermore, residual kidney function increased during the long-term followup, and subsequently peritoneal dialysis was ceased. Pulmonary artery pressure and left ventricular ejection fraction remained stable and the patient did well. This case demonstrates the possibility of treating hyperhydration due to congestive heart failure with peritoneal dialysis resulting in recompensation of both heart and kidney functions.

  18. Inflammatory Biomarkers in Refractory Congestive Heart Failure Patients Treated with Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Margarita Kunin

    2015-01-01

    Full Text Available Proinflammatory cytokines play a pathogenic role in congestive heart failure. In this study, the effect of peritoneal dialysis treatment on inflammatory cytokines levels in refractory congestive heart failure patients was investigated. During the treatment, the patients reached a well-tolerated edema-free state and demonstrated significant improvement in NYHA functional class. Brain natriuretic peptide decreased significantly after 3 months of treatment and remained stable at 6 months. C-reactive protein, a plasma marker of inflammation, decreased significantly following the treatment. Circulating inflammatory cytokines TNF-α and IL-6 decreased significantly after 3 months of peritoneal dialysis treatment and remained low at 6 months. The reduction in circulating inflammatory cytokines levels may be partly responsible for the efficacy of peritoneal dialysis for refractory congestive heart failure.

  19. Insomnia Self-Management in Heart Failure

    Science.gov (United States)

    2016-12-07

    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. Effects of spironolactone on electrical and structural remodeling of atrium in congestive heart failure dogs

    Institute of Scientific and Technical Information of China (English)

    YANG Shu-sen; XIU Chun-hong; LI Wei-min; HAN Wei; ZHOU Hong-yan; DONG Guo; WANG Bai-chun; HUO Hong; WEI Na; CAO Yong; ZHOU Guo

    2008-01-01

    Background Renin-angiotensin-aldosterone System has been demonstrated to be associated with both congestive heart failure (CHF) and atrial fibrillation (AF). This study investigated the effects of spironolactone, a kind of aldosterone antagonist, on atrial electrical remodeling and fibrosis in CHF dogs induced by chronic rapid ventricular pacing. Methods Twenty one dogs were randomly divided into sham-operated group, control group, and spironolactone group. In control group and spironolactone group, dogs were ventricular paced at 220 beats per minute for 6 weeks. Additionally, spironolactone at 15 mg·kg-1·d-1 was given to dogs 1 week before rapid ventricular pacing until pacing stopped. Transthoracic and transoesophageal echocardiographic examinations were performed to detect structural and functional changes of the atrium. Swan2 Ganz floating catheters were used to measure hemadynamics variances. Atrial effective refractory period (AERP), AERP dispersion (AERPd), intra- and inter-atrium conduction time (CT) and intra-atrium conduction velocity (CV) were determined. The inducibility and duration of AF were also measured in all groups. Finally, atrial fibrosis was quantified with Massen staining.Results AERP did not change significantly after dogs were ventricular paced for 6 weeks. However, AERPd, intra- and inter-atrium CT increased significantly, and CV decreased apparently, which was negatively correlated to the atrial fibrosis (r=-0.74, P<0.05). Simultaneously, left atriums were enlarged and cardiac hemadynamics worsened in pacing dogs. Although spironolactone could not affect cardiac hemadynamics effectively, it can obviously improve left atrial ejection fraction (P<0.05). Spironolactone treatment did not alter AERP duration, but this medicine dramatically decreased AERPd (P<0.05), shortened intra- and inter-atrium conduction time (P<0.05), and increased atrium CV. Moreover, spironolactone decreased the inducibility and duration of AF (P<0.05),as

  1. Supplying sodium and chlorine is effective on patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Yu Li; Changcong Cui

    2005-01-01

    Objective: To analyze the relationship of severity of heart failure and the concentration of serum sodium(Na + ) and chlorine(Cl- ) and to explore the effect of supplying sodium and chlorine on patients with Congestive heart failure. Methods: 80 patients with congestive heart failure were divided into two groups, namely supplying and control group. Serum sodium and chlorine were measured in all these patients. All treatments but supplying sodium and chlorine were same between the supplying and control groups. Results:According to NYHA, patients who were in class Ⅳ had lower level of serum sodium and chlorine than those in class Ⅱ ( P < 0.05). The heart function was improved after the level of serum sodium and chlorine were raised. Conclusions: The concentration of serum sodium and chlorine relates to the severity of heart failure. The therapy of supplying sodium and chlorine is an effective way to decrease death rate.

  2. 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.

  3. The potential role of calcium antagonists in the management of congestive heart failure : Initial experience with lacidipine

    NARCIS (Netherlands)

    deVries, RJM; Dunselman, PHJM

    1995-01-01

    First-generation calcium antagonists have been used in patients with congestive heart failure with rather disappointing results. Therefore, second-generation dihydropyridine calcium-channel blockers, such as felodipine and lacidipine, have been developed that may be beneficial in congestive heart fa

  4. 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.

  5. Baroreflex Activation Therapy in Congestive Heart Failure: Novel Findings and Future Insights.

    Science.gov (United States)

    Grassi, Guido; Brambilla, GianMaria; Pizzalla, Daniela Prata; Seravalle, Gino

    2016-08-01

    Congestive heart failure is characterized by hemodynamic and non-hemodynamic abnormalities, the latter including an activation of the sympathetic influences to the heart and peripheral circulation coupled with an impairment of baroreceptor control of autonomic function. Evidence has been provided that both these alterations are hallmark features of the disease with a specific relevance for the disease progression as well as for the development of life-threatening cardiac arrhythmias. In addition, a number of studies have documented in heart failure the adverse prognostic role of the sympathetic and baroreflex alterations, which both are regarded as major independent determinants of cardiovascular morbidity and mortality. This represents the pathophysiological and clinical background for the use of carotid baroreceptor activation therapy in the treatment of congestive heart failure. Promising data collected in experimental animal models of heart failure have supported the recent performance of pilot small-scale clinical studies, aimed at providing initial information in this area. The results of these studies demonstrated the clinical safety and efficacy of the intervention which has been tested in large-scale clinical studies. The present paper will critically review the background and main results of the published studies designed at defining the clinical impact of baroreflex activation therapy in congestive heart failure patients. Emphasis will be given to the strengths and limitations of such studies, which represent the background for the ongoing clinical trials testing the long-term effects of the device in heart failure patients.

  6. AFFECTION OF COMBINED TREATMENT WITH FLUVASTATIN AND VALSARTAN ON BNP LEVEL AND HEART FUNCTION OF CHRONIC CONGESTIVE HEART FAILURE PATIENTS%氟伐他汀联合缬沙坦对慢性心力衰竭患者血清BNP水平和心功能的影响

    Institute of Scientific and Technical Information of China (English)

    刘聪

    2011-01-01

    [ Objective] To observe the affection of combined treatment with fluvastatin and valsartan on heart function (HF) and BNP level of chronic congestive heart failure (CCHF) patients. [Methods] 100 cases were divided into therapy grup and control group. The control group was treated with valsartan and therapy group was treated with fluvastatin based on control group for 1 year as a course BNP level, HF and echocardiography indictora were detected. [ Resutts ] HF, LVEF and LVEDd in therapy group were improved than those in control group (P < 0.05). The level of BNP in therapy group was lower than control group ( P < 0.05). [ Conclusion] The combination therapy with fluvastatin and valsartan might decrease level of BNP and improve HF better than single use of valsartan.%[目的]观察氟伐他汀联合缬沙坦对慢性充血性心力衰竭患者血清BNP水平和心功能的影响.[方法]100例慢性充血性心力衰竭患者随机分为治疗组和对照组.对照组给予缬沙坦及常规治疗,治疗组在此基础上加用氟伐他汀,疗程均为1年.比较两组治疗前后血清BNP水平的变化和心功能疗效及心脏彩超指标.[结果]治疗组1年后血清BNP水平较对照组显著下降(P<0.05);心功能改善总有效率显著优于对照组(P<0.05);左心室射血分数(LVEF)、左室舒张末内径(LVEDd)均较对照组有明显改善(P<0.05).[结论]氟伐他汀联合缬沙坦治疗慢性充血性心力衰竭能显著降低患者血清BNP水平,明显改善心功能,疗效优于单加缬沙坦.

  7. 慢性充血性心力衰竭外周甲状腺素水平变化%Alteration of peripheral thyroid hormone in patients with chronic congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    姜腾勇; 吴学思

    2001-01-01

    Objective:This study is to ev aluate the prevelence and the pathophysiological significance of sick euthyroid syndro me in patients with chronic cardiovascular diseases,especially in chronic conges tive heart fa ilure(CHF).Method:The study population included 54 patients with ch ronic heart f ailure and 20 patients with chronic cardiovascular diseases.Blood sample were as sessed after a fast-night.SES was defined as the serum total triiodothyronine(T 3) l evel was less than the lowest normal limit (<0.8ng/ml)with the normal serum thy roid stimulating hormone and quiiodothyronine(T4).Result:SES was founded in 33/74(4 4%)patients,as high as 51%(28/54)in CHF patients.The prevalence of SES increase d as th e degree of chronic heart failure increased.The function status(NYHA),end diasto l ic diameter and ejecton fraction of left ventricle and T4 concentration in ser um exited a significantly difference.between the CHF patients with and without S ES,and the functional index of liver and kindey.physical characteristics did not exist significantly difference.Conclusion:The sick euthyroid syndro me presents i n chronic cardiovascular diseases,and the higher of its prevalvence,the more sev erve of cardiac function insufficiency.The functional status of liver and kidney was not the major determinant of SES in CHF patients.To recognize the phenomeno n of SES in patients with CHF may offer a valuable train of thought in management of CHF.%目的: 观察评价慢性心血管病,尤其是慢性心衰患者甲状腺功能正常病态综合症(SES)发生情况 并探讨其病理生理意义。方法:病史大于2年的慢 性心衰(CHF)病人54例和同期住院非CHF的慢性心血管病人20例,病情平稳后抽取空腹血临床 生化检验和甲状腺素测定。SES定义为血清总3-碘甲腺原氨酸(T3)低于正常值的低限(<0 .8 ng/ml),4-碘甲腺原氨酸(T4)和促甲状腺素正常。结果:74 例受试者中有33例发生SES,CH F

  8. Optimized cardiac resynchronization therapy in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    NIU Hong-xia; HUA Wei; ZHANG Shu; SUN Xin; CHEN Ke-ping; WANG Fang-zheng; CHEN Xin

    2007-01-01

    @@ Heart failure was a major and increasing public health problem, with an almost "epidemic increase in the number of patients.1 Despite recent advances in pharmacotherapy, the prognosis remains poor. Cardiac resynchronization therapy (CRT), by pacing right and left ventricles, has been proved to improve symptoms and reduce mortality for heart failure patients with cardiac dyssynchrony.

  9. Parvovirus B19-Induced Constellation of Acute Renal Failure, Elevated Aminotransferases and Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Iain W McAuley

    1997-01-01

    Full Text Available This report details a case of acute renal failure and elevated aminotransferases with subsequent development of congestive heart failure in a patient with history of exposure to parvovirus B19 and serological evidence of acute infection with this agent. This constellation of organ involvement has not been previously reported in the literature.

  10. The Impact of Family Functioning on Caregiver Burden among Caregivers of Veterans with Congestive Heart Failure

    Science.gov (United States)

    Moore, Crystal Dea

    2010-01-01

    A cross-sectional study of 76 family caregivers of older veterans with congestive heart failure utilized the McMaster model of family functioning to examine the impact of family functioning variables (problem solving, communication, roles, affective responsiveness, and affective involvement) on caregiver burden dimensions (relationship burden,…

  11. A history of arterial hypertension does not affect mortality in patients hospitalised with congestive heart failure

    DEFF Research Database (Denmark)

    Gustafsson, F; Torp-Pedersen, C; Seibaek, M;

    2006-01-01

    OBJECTIVES: To evaluate the importance of a history of hypertension on long-term mortality in a large cohort of patients hospitalised with congestive heart failure (CHF). DESIGN: Retrospective analysis of 5491 consecutive patients, of whom 24% had a history of hypertension. 60% of the patients had...

  12. Bootstrapping Results of Exercise Therapy and Education for Patients with Congestive Heart Failure

    Science.gov (United States)

    Witta, E. Lea; Brubaker, Craig

    2003-01-01

    When studies are conducted over a period of time, the sample size typically decreases. In a study of the effects of exercise therapy and education with recovering congestive heart failure (CHF) patients (Brubaker, Witta, & Angelopoulus, 2003), the sample size decreased from over 40 to 9 participants after an 18-month time span. Although the…

  13. Enhanced endothelin-1-induced contractions in mesenteric arteries from rats with congestive heart failure

    DEFF Research Database (Denmark)

    Bergdahl, A; Valdemarsson, S; Adner, M;

    2001-01-01

    Studies of congestive heart failure (CHF) in man and in experimental CHF have demonstrated elevated circulating levels of endothelin (ET). In order to examine whether there are concomitant ET receptor alterations, the vasomotor effects of endothelin-1 (ET-1) and sarafotoxin 6c (S6c) were examined...

  14. Post-Acute Home Care and Hospital Readmission of Elderly Patients with Congestive Heart Failure

    Science.gov (United States)

    Li, Hong; Morrow-Howell, Nancy; Proctor, Enola K.

    2004-01-01

    After inpatient hospitalization, many elderly patients with congestive heart failure (CHF) are discharged home and receive post-acute home care from informal (family) caregivers and formal service providers. Hospital readmission rates are high among elderly patients with CHF, and it is thought that use of informal and formal services may reduce…

  15. Phlegmonous enteritis in a patient with congestive heart failure and colon cancer

    Energy Technology Data Exchange (ETDEWEB)

    Namkung, Sook; Yoo, Yoon Sik; Hwang, Im Kyung; Kim, Bong Soo; Bae, Sang Hoon; Choi, Young Hee [Hallym University, Chuncheon (Korea, Republic of)

    2001-12-01

    Phlegmonous enteritis is a rare infective inflammatory disease of the intestine, predominantly involving the submucosal layer. It is difficult to diagnose and often fatal. Its association with alcoholism and various liver diseases, although rarely reported, is well documented. We report a case of phlegmonous enteritis in a male patient with congestive heart failure and colon cancer, and describe the ultrasonographic and CT findings.

  16. Treatment of congestive heart failure a neuroendocrine disorder.

    Science.gov (United States)

    Martin, M W S

    2003-04-01

    The understanding of heart failure is no longer based on a supply and demand model of pump failure. Rather, heart failure is seen as a complex pathophysiological process with activation of various neuroendocrine systems. The goals of treatment have changed towards modifying these counterproductive neuroendocrine systems and slowing myocardial maladaptation. Angiotensin converting enzyme inhibitors are the only licensed drugs in veterinary practice that have a direct effect on neurohormones in heart failure. The range of drug options in human medicine is greater and some of these drugs are also increasingly being used in veterinary cardiology practice. This review describes the neuroendocrine systems involved in heart failure and discusses the range of drugs available in human and veterinary medicine. In doing so, it concentrates on the evidence available from good quality randomised trials in both the veterinary field and, where relevant, the human medical field.

  17. Enhanced Ca2+-induced contractions and attenuated alpha-adrenoceptor responses in resistance arteries from rats with congestive heart failure

    DEFF Research Database (Denmark)

    Bergdahl, A; Valdemarsson, S; Sun, X Y;

    2001-01-01

    AIM: The aim of the present study was to examine the role of Ca2+-mediated contractile responses in isolated mesenteric resistance arteries from rats with congestive heart failure (CHF). METHODS: Heart failure was induced by ligation of the left coronary artery. Rats exposed to the same surgical......-adrenoceptors and a difference of Ca2+-mediated vascular contractility in resistance arteries of congestive heart failure rats....

  18. Treatment of feline asthma with ciclosporin in a cat with diabetes mellitus and congestive heart failure.

    Science.gov (United States)

    Nafe, Laura A; Leach, Stacey B

    2015-12-01

    A 5-year-old domestic shorthair cat that had been previously diagnosed with diabetes mellitus was presented for episodes of coughing and respiratory distress. Diagnostic testing revealed congestive heart failure secondary to hypertrophic cardiomyopathy and concurrent asthma. All clinical signs and eosinophilic airway inflammation resolved with oral ciclosporin while the cat was concurrently receiving medications for treatment of heart failure (furosemide and enalapril). Ciclosporin should be considered for treatment of feline asthma in patients with concurrent diseases (eg, diabetes mellitus, severe heart disease) that may contraindicate use of oral glucocorticoid therapy.

  19. Serial pulmonary function tests to diagnose COPD in chronic heart failure

    NARCIS (Netherlands)

    Minasian, A.G.; Elshout, F.J.J. van den; Dekhuijzen, P.N.R.; Vos, P.J.E.; Willems, F.F.; Bergh, P.J.P.C. van den; Heijdra, Y.F.

    2014-01-01

    BACKGROUND: It is unknown whether serial pulmonary function tests are necessary for the correct diagnosis of chronic obstructive pulmonary disease (COPD) in patients with stable non-congested chronic heart failure (CHF). The aim of this study was to determine the prevalence of COPD in outpatients wi

  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. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction

    Science.gov (United States)

    Jearath, Vaneet; Vashisht, Rajan; Rustagi, Vipul; Raina, Sujeet; Sharma, Rajesh

    2016-01-01

    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. PMID:27127397

  2. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction.

    Science.gov (United States)

    Jearath, Vaneet; Vashisht, Rajan; Rustagi, Vipul; Raina, Sujeet; Sharma, Rajesh

    2016-01-01

    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.

  3. Implementing home telemanagement of congestive heart failure using Xbox gaming platform.

    Science.gov (United States)

    Finkelstein, Joseph; Wood, Jeffrey

    2011-01-01

    Gaming platforms have been recognized for user-friendly interface which does not require previous computer-related experience. Easy to use and wide availability of these platforms at patient households make them an attractive means to facilitate consumer health. The potential of such widely used platforms as Xbox for self-management of chronic health conditions has not yet been fully uncovered. We developed a Home Automated Telemanagement (HAT) system which utilizes Xbox to access personal health record, receive self-care support and exchange information with health care providers. The system questions patients with congestive heart failure (CHF) to monitor symptoms, weight changes, medication adherence and quality of life while educating the patient on their disease. The patients receive an instant feedback on their condition in the form of a 3-zone CHF action plan. The patient self-management information can be reviewed by a provider on a designated web site. The system is programmed to run on the Microsoft Xbox videogame console using an active internet connection and a connection to a computer running Windows Media Center. The system is designed to be as simple as possible making it usable by patients with no prior computer or videogame experience. The feasibility of this approach was tested in ten adults with no previous Xbox experience who completed attitudinal surveys and semi-structured qualitative interviews after using the system. All participants claimed that they did not have any problems in using the system and that they would use the system in the future if necessary. An Xbox-based telemanagement system has potential to optimize the care of patients with CHF and other chronic conditions.

  4. B-type Natriuretic Peptide Assay in Differentiating Congestive Heart Failure from Lung Disease in Patients Presenting with Dyspnea.

    Science.gov (United States)

    Islam, M A; Bari, M S; Islam, M N; Bari, M A; Siddique, S R; Islam, M Z; Begum, M S; Ahammed, S U; Rahman, M A

    2016-07-01

    This cross-sectional analytical study was conducted in Cardiology & Medicine Department of Mymensingh Medical College Hospital. After fulfilling the exclusion & inclusion criteria, B-type natriuretic peptide concentrations were measured in a convenience sample of 100 predominantly male (94%) dyspnic patients who got admitted in Cardiology & Medicine Department of Mymensingh Medical College & Hospital from November 2013 to October 2014. The diagnosis of Congestive Heart Failure (CHF) was based on generally accepted Framingham criteria with corroborative information including hospital course (response to diuretics, vasodilators, inotropes or hemodynamic monitoring) and results of further cardiac testing, including echocardiography. Patients with right heart failure from cor pulmonale were classified as having CHF. Pulmonary disease was confirmed by using the following diagnostic tools: i) A chest X-ray without signs of heart enlargement or pulmonary venous hypertension or a chest X-ray with signs of chronic obstructive lung disease, ii) Normal heart function as seen by echocardiography, iii) Abnormal pulmonary function tests or follow-up results and iv) A positive response to treatment with steroids, nebulizers or antibiotics in hospital. Patients with CHF (n=50) had mean BNP level 1146.72pg/ml (range 103 to 5000pg/ml), which is significantly higher than the group of patients with a final diagnosis of pulmonary disease (n=50) whose BNP was 34pg/ml (range 10 to 90pg/ml) (pcongestive heart failure from lung disease in patients presenting with dyspnea.

  5. Plasma immunoreactive neuropeptide Y in congestive heart failure at rest and during exercise

    DEFF Research Database (Denmark)

    Madsen, B K; Husum, D; Videbaek, R

    1993-01-01

    The purpose of the study described here was to study plasma immunoreactive Neuropeptide Y (NPY) at rest and during exercise in patients with congestive heart failure (CHF) and in healthy subjects. Thirty-five patients, mean age 64 years, with CHF in optimal treatment and with a mean ejection...... fraction of 32%, were studied at rest and during exercise. Twelve age and sex matched healthy subjects were compared for resting values. Another nine healthy subjects were studied at rest and during exercise at a constant low load of 75W and at a high load defined as 80% of their individual maximal...... capacity. In patients with congestive heart failure mean plasma immunoreactive NPY at rest was 10.3 pmol l-1 and was not significantly different from the control group. No differences between patients with slight and severe CHF were found and there was no correlation between plasma immunoreactive NPY...

  6. Decreasing Congestive Heart Failure Readmission Rates Within 30 Days at the Tampa VA.

    Science.gov (United States)

    Messina, William

    2016-01-01

    High hospital readmission rates contribute to the problem of escalating costs and fragmented quality in the US health care system. This article describes the implementation of a home telehealth (HT) performance improvement project with subsequent cost-avoidance savings. The HT project was designed to potentiate communication between and among patients, clinicians, and administrative staff, in addition to reducing readmissions for patients with congestive heart failure at the James A. Haley Veterans Hospital in Tampa, Florida. Pre- and post-HT implementation comparisons were made of readmission rates, costs, and veteran satisfaction from the same 4-month periods in 2012 and 2013. The application of telehealth and phone care initiatives reduced the congestive heart failure hospital readmission rate by 5%, decreased costs, and improved veteran satisfaction with overall care experience.

  7. Cardiomyopathy and right-sided congestive heart failure in a red-tailed hawk (Buteo jamaicensis).

    Science.gov (United States)

    Knafo, S Emmanuelle; Rapoport, Gregg; Williams, Jamie; Brainard, Benjamin; Driskell, Elizabeth; Uhl, Elizabeth; Crochik, Sonia; Divers, Stephen J

    2011-03-01

    A 15-year-old female red-tailed hawk (Buteo jamaicensis) was evaluated because of dyspnea, anorexia, and coelomic distension. Diagnostic imaging results confirmed severe coelomic effusion and revealed a markedly dilated right ventricle. The diagnosis was right-sided congestive heart failure. Results of measurements of vitamin E, selenium, lead, zinc, and cardiac troponin levels were normal or nondiagnostic. The hawk was treated with furosemide, antifungal and antimicrobial agents, and supplemental fluids and oxygen, but euthanasia was elected because of the poor prognosis and the practical difficulties associated with intensive case management. To our knowledge, this is the first described case of cardiomyopathy and congestive heart failure in a captive red-tailed hawk.

  8. Diagnosis and treatment of congestive heart failure secondary to hypertrophic cardiomyopathy in a kinkajou (Potos flavus).

    Science.gov (United States)

    Eshar, David; Peddle, Gordon D; Briscoe, Jeleen A

    2010-06-01

    An adult castrated male pet kinkajou (Potos flavus) presented with dyspnea due to congestive heart failure and was diagnosed with hypertrophic cardiomyopathy (HCM) and suspected pulmonary arterial hypertension. Diagnosis was based on history, clinical signs, clinical pathology, radiographs, abdominal ultrasonography, abdominal fluid analysis, electrocardiography, and echocardiogram. An undetermined hepatopathy also was found at presentation and resolved after metronidazole antimicrobial treatment. Cardiopulmonary medical treatment, including a loop diuretic, an angiotensin-converting enzyme inhibitor, a beta-adrenergic receptor blocker, and a bronchodilator provided improvement of the clinical signs. To the best of our knowledge, this is the first reported case of antemortem diagnosis and treatment of congestive heart failure and cardiomyopathy in a member of the family Procyonidae, suggesting that HCM should be considered as a differential diagnosis in kinkajous displaying clinical signs of dyspnea and exercise intolerance.

  9. Congestive heart failure patient monitoring using wearable Bio-impedance sensor technology.

    Science.gov (United States)

    Seulki Lee; Squillace, Gabriel; Smeets, Christophe; Vandecasteele, Marianne; Grieten, Lars; de Francisco, Ruben; Van Hoof, Chris

    2015-08-01

    A new technique to monitor the fluid status of congestive heart failure (CHF) patients in the hospital is proposed and verified in a clinical trial with 8 patients. A wearable Bio-impedance (BioZ) sensor allows a continuous localized measurement which can be complement clinical tools in the hospital. Thanks to the multi-parametric approach and correlation analysis with clinical reference, BioZ is successfully shown as a promising parameter for continuous and wearable CHF patient monitoring application.

  10. RESTRICTIVE CARDIOMYOPATHY AND SECONDARY CONGESTIVE HEART FAILURE IN A MCDOWELL'S CARPET PYTHON (MORELIA SPILOTA MCDOWELLI).

    Science.gov (United States)

    Schilliger, Lionel; Chetboul, Valérie; Damoiseaux, Cécile; Nicolier, Alexandra

    2016-12-01

    Echocardiography is an established and noninvasive diagnostic tool used in herpetologic cardiology. Various cardiac lesions have been previously described in reptiles with the exception of restrictive cardiomyopathy. In this case report, restrictive cardiomyopathy and congestive heart failure associated with left atrial and sinus venosus dilation were diagnosed in a 2-yr-old captive lethargic McDowell's carpet python ( Morelia spilota mcdowelli), based on echocardiographic, Doppler, and histopathologic examinations. This cardiomyopathy was also associated with thrombosis within the sinus venosus.

  11. Exercise training in congestive heart failure: risks and benefits.

    Science.gov (United States)

    Keteyian, Steven J

    2011-01-01

    After decades of concern about the safety and effectiveness of exercise training in patients with heart failure (HF) due to reduced ejection fraction, initial research demonstrated the feasibility and physiologic benefits associated with such an intervention. Subsequent controlled studies confirmed these results and suggested improved clinical outcomes as well. This review summarizes the findings from single-site and multisite trials and meta-analyses that addressed the effects of exercise training on exercise capacity and clinical outcomes. Conclusions from these studies indicate that exercise is safe, improves health status and exercise capacity, attenuates much of the abnormal physiology that develops with HF, and yields a modest reduction in clinical events. Future research needs to identify which patient subgroups might benefit the most, the optimal exercise dose needed to lessen disease-related symptoms and maximize clinical benefit, and the effects of exercise training in patients with HF and preserved ejection fraction.

  12. Enhanced acetylcholine and P2Y-receptor stimulated vascular EDHF-dilatation in congestive heart failure

    DEFF Research Database (Denmark)

    Malmsjö, M; Bergdahl, A; Zhao, Xin;

    1999-01-01

    OBJECTIVE: Congestive heart failure (CHF) is accompanied by impaired peripheral blood flow and endothelial dysfunction with decreased release of nitric oxide (NO). Strong evidence supports the existence of another vasodilatory substance, endothelium derived hyperpolarising factor (EDHF), which has...

  13. Complications of cardiac resynchronization therapy in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Previous clinical studies have suggested that patients with congestive heart failure and intraventricular conduction delay could benefit from cardiac resynchronization therapy (CRT). Implantation of left ventricular lead is a complex procedure with some potential for complications. This study was conducted to analyse the complications of CRT in patients with congestive heart failure.Methods Totally 117 patients, 86 males and 31 females, mean age of 53 years, with congestive heart failure and intraventricular conduction delaywere enrolled in this study. Venography was performed on all patients. Different types of coronary sinus leads were used to pace the left ventricle. Results Left ventricular lead was attempted to implant through coronary sinus for all the 117 patients and was successfully implanted in 111 patients. The success rate was 94.9%. Main complications rate was 6.8%, including coronary sinus dissection in 4 patients, phrenic nerve stimulation required lead repositioning in 2 patients and lead dislodgement in 2 patients. Conclusions It is feasible and safe to pace left ventricle through coronary sinus. However, there are some procedural complications.

  14. [Intraoperative fluid therapy in infants with congestive heart failure due to intracranial pial arteriovenous fistula].

    Science.gov (United States)

    Arroyo-Fernández, F J; Calderón-Seoane, E; Rodríguez-Peña, F; Torres-Morera, L M

    2016-05-01

    Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding.

  15. Population pharmacokinetics of levosimendan in patients with congestive heart failure

    Science.gov (United States)

    Jonsson, E Niclas; Antila, Saila; McFadyen, Lynn; Lehtonen, Lasse; Karlsson, Mats O

    2003-01-01

    Aims The aim of this study was to characterize the population pharmacokinetics of levosimendan in patients with heart failure (NYHA grades III and IV) and its relationship to demographic factors, disease severity and concomitant use of digoxin and β-blocking agents. Methods Data from two efficacy studies with levosimendan administered by intravenous infusion were combined (190 patients in total). The data were analysed using a nonlinear mixed-effects modelling approach as implemented in the NONMEM program. The model development was done in three sequential steps. First the best structural model was determined (e.g. a one-, two- or three-compartment pharmacokinetic model). This was followed by the identification and incorporation of important covariates into the model. Lastly the stochastic part of the model was refined. Results A two-compartment model best described levosimendan pharmacokinetics. Clearance and the central volume of distribution were found to increase linearly with bodyweight. No other covariates, including concomitant use of digoxin and β-blocking agents, influenced the pharmacokinetics. In the final model, a 76-kg patient was estimated to have a clearance ± s.e. of 13.3 ± 0.4 l h−1 and a central volume of distribution of 16.8 ± 0.79 l. The interindividual variability was estimated to be 39% and 60% for clearance and central volume of distribution, respectively. Weight changed clearance by 1.5% [95% confidence interval (CI) 0.9%, 2.1%] and the central volume of distribution by 0.9% (95% CI 0.5%, 1.3%) per kg. Conclusions The population pharmacokinetics parameters of levosimendan in this patient group were comparable to those obtained by traditional methods in healthy volunteers and patients with mild heart failure. Bodyweight influenced the clearance and the central volume of distribution, which in practice is accounted for by weight adjusting doses. None of the other covariates, including digoxin and β-blocking agents, significantly

  16. Thoracic endovascular aortic repair for patent ductus arteriosus in an elderly patient with congestive heart failure.

    Science.gov (United States)

    Kato, Gentaro; Nakai, Mikizo; Tokunaga, Noriyuki; Shimizu, Shuji; Okada, Masahiro

    2016-05-01

    In elderly patients, open surgery for patent ductus arteriosus (PDA) is more difficult than that in children and often requires a cardiopulmonary bypass. We report the case of a 67-year-old patient with a PDA that was successfully treated with thoracic endovascular aortic repair (TEVAR). The patient was diagnosed with congestive heart failure (ejection fraction, 36 %) and PDA (9.7 mm in diameter). TEVAR was successfully performed to exclude the PDA. After TEVAR, the patient's heart failure was well controlled by diuretics. TEVAR may be a good alternative to open surgery.

  17. Heterobilharzia americana infection and congestive heart failure in a llama (Lama glama).

    Science.gov (United States)

    Corapi, W V; Eden, K B; Edwards, J F; Snowden, K F

    2015-05-01

    The schistosome Heterobilharzia americana infects several mammalian species in the southeastern United States, including horses, but infections have not been reported in camelids. This is a report of H. americana infection in a 6-year-old llama with extensive cardiac pathology and congestive heart failure. Parasite-induced granulomas were widely disseminated and included overwhelming involvement of the lungs and liver. Microscopic lesions in the heart included myofiber degeneration and necrosis, with extensive replacement fibrosis. Polymerase chain reaction amplification and sequencing confirmed the presence of H. americana in the lungs.

  18. Pharmacogenetic risk stratification in angiotensin-converting enzyme inhibitor-treated patients with congestive heart failure

    DEFF Research Database (Denmark)

    Nelveg-Kristensen, Karl Emil; Busk Madsen, Majbritt; Torp-Pedersen, Christian;

    2015-01-01

    BACKGROUND: Evidence for pharmacogenetic risk stratification of angiotensin-converting enzyme inhibitor (ACEI) treatment is limited. Therefore, in a cohort of ACEI-treated patients with congestive heart failure (CHF), we investigated the predictive value of two pharmacogenetic scores...... SNPs of the angiotensin-converting enzyme gene (rs4343) and ABO blood group genes (rs495828 and rs8176746). METHODS: Danish patients with CHF enrolled in the previously reported Echocardiography and Heart Outcome Study were included. Subjects were genotyped and categorized according to pharmacogenetic...

  19. Congestive heart failure and converting enzyme inhibition: failure of current prognostic criteria for predicting subsequent renal insufficiency.

    OpenAIRE

    1991-01-01

    Angiotensin-1-converting enzyme inhibitors have an effective and established role in the treatment of patients with congestive heart failure. However, a small number of such patients will subsequently develop renal insufficiency. These patients may be identified prior to, or shortly after, commencement of therapy by recognized criteria. This report describes 4 patients with congestive heart failure who developed severe renal insufficiency secondary to either enalapril or captopril therapy in ...

  20. Female sex is associated with a better long-term survival in patients hospitalized with congestive heart failure

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Torp-Pedersen, Christian; Burchardt, Hans;

    2004-01-01

    AIMS: Results of previous studies on the influence of gender on prognosis in heart failure have been conflicting and most studies have been conducted in selected populations. The aim of this study was determine whether mortality risk in women and men hospitalized with congestive heart failure...... is different. METHODS AND RESULTS: Survival analysis of 5491 consecutive patients admitted with congestive heart failure to 34 Danish hospitals between 1993-1996. Follow-up time was 5-8 years. Forty percent of the patients were female. Females were older, had less evidence of ischaemic heart disease...... with an increased risk of death (RR 1.25 (1.17-1.34)) and the increased risk was confirmed in a multivariate model containing several covariates. CONCLUSIONS: In patients hospitalized with congestive heart failure male gender is an independent predictor of mortality. Female heart failure patients may be under...

  1. Multifractal properties of ECG patterns of patients suffering from congestive heart failure

    Science.gov (United States)

    Dutta, Srimonti

    2010-12-01

    The multifractal properties of two-channel ECG patterns of patients suffering from severe congestive heart failure (New York Heart Association (NYHA) classes III-IV) are studied and are compared with those for normal healthy people using the multifractal detrended fluctuation analysis methodology. Ivanov et al (1999 Nature 399 461) have studied the multifractality of human heart rate dynamics using the wavelet transformation modulus maxima (WTMM) methodology. But it has been observed by several scientists that multifractal detrended fluctuation analysis (MFDFA) works better than the WTMM method in the detection of monofractal and multifractal characteristics of the data. Galaska et al (2008 Ann. Noninvasive Electrocardiol. 13 155) have observed that MFDFA is more sensitive compared to the WTMM method in the differentiation between multifractal properties of the heart rate in healthy subjects and patients with left ventricular systolic dysfunction. In the present work the variation of two parameters of the multifractal spectrum—its width W (related to the degree of multifractality) and the value of the Hölder exponent α0—for the healthy and congestive heart failure patients is studied. α0 is a measure of the degree of correlation. The degree of multifractality varies appreciably (85-90% C.L.) for the normal and the CHF sets for channel I. For channel II no significant change in the values is observed. The degree of correlation is found to be comparatively high for the normal healthy people compared to those suffering from CHF.

  2. Pneumoconiosis increases the risk of congestive heart failure: A nationwide population-based cohort study.

    Science.gov (United States)

    Yen, Chia-Ming; Lin, Cheng-Li; Lin, Ming-Chia; Chen, Huei-Yong; Lu, Nan-Han; Kao, Chia-Hung

    2016-06-01

    The purpose of the study was to determine the relationship between pneumoconiosis and congestive heart failure (CHF).We collected data from the National Health Insurance Research Database in Taiwan. The study sample comprised 8923 patients with pneumoconiosis and 35,692 nonpneumoconiosis controls enrolled from 2000 to 2011. Patients were followed up until the end of 2011 to evaluate the incidence of CHF. The risk of CHF was analyzed using Cox proportional hazard regression models, and the analysis accounted for factors such as sex, age, comorbidities, and air pollutants (μg/m).The overall incidence of CHF was higher in the pneumoconiosis cohort (15.7 per 1000 person-y) than in the nonpneumoconiosis cohort (11.2 per 1000 person-y), with a crude hazard ratio (HR) of 1.40 (P < 0.001). The HR for CHF was 1.38-fold greater in the pneumoconiosis cohort than in the nonpneumoconiosis cohort (P < 0.001) after the model was adjusted for age, sex, various comorbidities, and air pollutants (μg/m). The relative risk for CHF in the sex-specific pneumoconiosis cohort compared with the nonpneumoconiosis cohort was significant for men (adjusted HR = 1.40, 95% confidence interval = 1.21-1.62, P < 0.001). The incidence density rates of CHF increased with age; pneumoconiosis patients had a higher relative risk of CHF for all age group.Patients with pneumoconiosis were at higher risk for developing CHF than patients in the nonpneumoconiosis cohort, particularly in cases with coexisting coronary artery disease, hypertension, and chronic obstructive pulmonary disease.

  3. Responsiveness of the Chinese Quality of Life Instrument in Patients with Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective:The Chinese Quality of Life Instrument (ChQOL) was developed as a valid generic health status instrument based on the well-established theory of health in Chinese medicine.Psychometric properties of the ChQOL were good.In the present study,the responsiveness of the ChQOL in patients with congestive heart failure (CHF) were investigated and compared with two generic questionnaires,the Medical Outcomes Study Short Form 36-item Health Survey (SF-36) and World Health Organization Quality of Life Assessment (WHOQOL-BREF),as well as one disease-specific questionnaire,the Minnesota Living with Heart Failure Questionnaire (MLHF).Methods:Thirty-nine in-patients with CHF who had undergone treatment with integrative medicine were recruited.The health status measurements were performed at enrolment and after a 4-week treatment.The following responsiveness indices were used:the effect size (ES) and standardized response mean (SRM).All patients were classified into those groups with stable measures and those groups with changes after a 4-week treatment,based upon both the doctor's global rating of changes in heart function tests,and the patient's global rating of changes in overall quality of life.Results:All domains of the ChQOL showed significant improvement.In the comparison of the responsiveness indices,the ChQOL was regarded as more responsive than the WHOQOL-BREF or SF-36 utility,but it was less responsive than the MLHF.Conclusions:The ChQOL was better in sensitivity and responsiveness for assessing congestive heart failure as a generic measure than the SF-36 and WHOQOL-BREF.The ChQOL is considered suitable as an outcome measure for clinical trials in patients with congestive heart failure.

  4. Honolulu Heart Program

    Science.gov (United States)

    2016-04-13

    Cardiovascular Diseases; Coronary Disease; Cerebrovascular Accident; Heart Diseases; Heart Failure, Congestive; Myocardial Infarction; Asthma; Emphysema; Lung Diseases, Obstructive; Aortic Aneurysm, Abdominal; Bronchitis; Dementia; Hypertension; Chronic Obstructive Pulmonary Disease; Heart Failure

  5. Iodine-123 metaiodobenzylguanidine imaging of the heart in idiopathic congestive cardiomyopathy and cardiac transplants

    Energy Technology Data Exchange (ETDEWEB)

    Glowniak, J.V.; Turner, F.E.; Gray, L.L.; Palac, R.T.; Lagunas-Solar, M.C.; Woodward, W.R.

    1989-07-01

    Iodine-123 metaiodobenzylguanidine ((/sup 123/I)MIBG) is a norepinephrine analog which can be used to image the sympathetic innervation of the heart. In this study, cardiac imaging with (/sup 123/I)MIBG was performed in patients with idiopathic congestive cardiomyopathy and compared to normal controls. Initial uptake, half-time of tracer within the heart, and heart to lung ratios were all significantly reduced in patients compared to normals. Uptake in lungs, liver, salivary glands, and spleen was similar in controls and patients with cardiomyopathy indicating that decreased MIBG uptake was not a generalized abnormality in these patients. Iodine-123 MIBG imaging was also performed in cardiac transplant patients to determine cardiac nonneuronal uptake. Uptake in transplants was less than 10% of normals in the first 2 hr and nearly undetectable after 16 hr. The decreased uptake of MIBG suggests cardiac sympathetic nerve dysfunction while the rapid washout of MIBG from the heart suggests increased cardiac sympathetic nerve activity in idiopathic congestive cardiomyopathy.

  6. Effect of Metformin on Diabetic Cardiomyopathy Chronic Congestive Heart Failure and Myocardial Perfusion%二甲双胍对糖尿病心肌病慢性充血性心力衰竭及心肌灌注的影响

    Institute of Scientific and Technical Information of China (English)

    游琼; 吴铿

    2011-01-01

    目的 探讨二甲双胍对糖尿病心肌病慢性充血性心力衰竭及心肌灌注的影响.方法 将66例糖尿病心肌病患者随机分为二甲双胍组(36例)和安慰剂组(30例),利用门控单电子发射计算机体层扫描(SPECT)进行心功能定量分析及心肌灌注图像可视化分析,随访12个月.结果 两组患者治疗后运动试验持续时间、总做功负荷、毛花甙丙每月用量、心力衰竭每月发作次数、总运动负荷评分(SSS评分)、总静息评分(SRS评分)、收缩期室壁厚度(SWT)、室壁运动评分指数(WMI)和左室射血分数(LVEF)比较,差异均有统计学意义(P<0.05);两组患者治疗后心率和收缩压比较,差异均无统计学意义(P>0.05).结论 二甲双胍不仅能改善心肌灌注,而且能在不影响心率和血压的基础上改善糖尿病心肌病患者心功能.%Objective To study the effect of metfonnin on diabetic cardiomyopathy ( DC ) chronic congestive heart failure ( CCHF ) and myocardial perfusion. Methods Sixty - six DC patients were randomized into groups A ( treated with metform-in, n=36), B( treated with placebo, n = 30 ). Single - photon Emission Computed Tomography ( SPECT ) was used to perform heart function quantitative analysis and cardiac perfusion imaging visual analysis. Follow - up lasted 12 months. Results There was significant difference between 2 groups in exercise test duration, total power load, monthly lanatoside C dosage, monthly a-cute exacerbation frequency of CCHF summed stress score ( SSS ), summed resting score ( SRS ), systolic wall thickness ( SWT ), wall motion index ( WMI ), left ventricular ejection fraction ( LVEF ) ( P < 0. 05 ); no significant difference was noted in post - treatment heart rate and systolic blood pressure between 2 groups ( P >0. 05 ). Conclusion Metformin can improve not only myocardial perfusion but also cardiac function in DC patients, not influencing heart rate or blood pressure.

  7. Relationship between lipidslevelsand right ventricular volume overload in congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Ying CHEN; Yu TIAN; Gang LIU; Zhen-Guo JI; Kun-Shen LIU; Chao LIU; Xiao-Mei HE; Hong MENG; Qing-Zhen ZHAO; Yu-Zhi ZHEN; Li TIAN; Le WANG; Li-Shuang JI; Guo-Ping MA

    2014-01-01

    BackgroundThe relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechan-isms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels.MethodsWe collected data of clinical characteristics, echocardio-graph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels[including total cho-lesterol(TCL), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), and triglycerides(TG)]and right ventricle end diastolic diameter (RVEDD), left ventricle end diastolic diameter (LVEDD), right atrium diameter (RA), left atrium diameter (LA), or left ventricle ejection fraction (LVEF) were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area.ResultsThere was a significantly inverse correlation between TCL le-vels and RVEDD (r=-0.34,P<0.001) and RA (r=-0.36,P<0.001). Other lipids such as LDL-C, HDL-C, and TG had asimilar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use.ConclusionsLipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as wellas identify a causal relationship, if any.

  8. [Effects of hot water bath or sauna on patients with congestive heart failure: acute hemodynamic improvement by thermal vasodilation].

    Science.gov (United States)

    Tei, C; Horikiri, Y; Park, J C; Jeong, J W; Chang, K S; Tanaka, N; Toyama, Y

    1994-01-01

    The acute hemodynamic effects of thermal vasodilation caused by exposure to hot water bath or sauna in chronic congestive heart failure were investigated in 32 patients (mean age 57 +/- 15 years old) with dilated cardiomyopathy (25 idiopathic and 7 ischemic). The clinical symptoms were New York Heart Association Class II in 2 patients, III in 17 and IV in 13, and the mean ejection fraction was 25 +/- 9% (9-44%). Exposure to hot water bath was for 10 minutes at 41 degrees C in a semi-sitting position, and to sauna for 15 minutes at 60 degrees C in a supine position using a special far infrared ray sauna chamber. Blood pressure, electrocardiogram, two-dimensional and Doppler echocardiograms, expiration gas, and intracardiac pressure tracings were recorded before (control), during, and 30 minutes after hot water bath or sauna. 1. The increase in oxygen consumption was only 0.3 Mets during hot water bath or sauna, and returned to the control level 30 minutes later. 2. The deep temperature in the main pulmonary artery increased by 1.0-1.2 degrees C on average at the end of hot water bath or sauna. 3. Heart rate increased significantly (p sauna, while, diastolic blood pressure decreased significantly during (p sauna (p < 0.01), and after hot water bath (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Improved Cardiac Contractility of Human Recombinant Growth Hormone on the Congestive Heart Failure of Pig

    Institute of Scientific and Technical Information of China (English)

    Yang Ping; He Yu-quan; Zeng Hong; Ni Jin-song; Yun Qing-jun; Huang Xiao-ping; Li Shu-mei

    2005-01-01

    The enhanced cardiac contractility effect of human recombinant growth hormone (hr-GH) on the congestive heart failure (CHF) was studied on the pig. To build a pig model of congestive heart failure, a temporary artificial cardiac pacemaker was implanted in the pig's body and paced at 220 beats to 240 beats per minute for 1 week. After the model of congestive heart failure was successfully set up, the frequency of the pacemaker was changed to 150 beats to 180 beats per minute to maintain the CHF model stable. Pigs were divided into three groups: The hr-GH group in which 0.5 mg/kg per day of hr-GH was administrated intramuscularly for 15 days, the injection control group in which an equal amount of physiological saline was injected intramuscularly, and a normal control group. The left ventricular diastolic end pressure was (10.60±2.41 ) mmHg in the hr-GH group, but (19.00±3.81) mmHg in the saline control group (P<0.01); Cardiac output was (1.86±0.13) L/min in the hr-GH group, but (1.56 ±0.18) L/min in the saline control group (P<0.05); Peripheral min) -1 in the saline control group (P<0.05); ± dp/dtmax was (2900 ±316.23) and (2280 ±286.36) in the hr-HG group and the saline control group respectively (P<0.05). The results show that hr-GH enhances myocardial contractility of CHF, and the CHF model built by a temporary artificial cardiac pacemaker at a high rate of stimulation is reasonable and applicable.

  10. Use of sympathomimetic drugs leads to increased risk of hospitalization for arrhythmias in patients with congestive heart failure

    DEFF Research Database (Denmark)

    Bouvy, M L; Heerdink, E R; De Bruin, M L;

    2000-01-01

    BACKGROUND: Sympathomimetic agents have a direct positive chronotropic effect on heart rate and may cause hypokalemia, even when administered by inhalation. In selected patients (e.g., patients with congestive heart failure [CHF]) this can lead to arrhythmias. Despite the potential adverse effects...

  11. Renal and cardiac function during alpha1-beta-blockade in congestive heart failure

    DEFF Research Database (Denmark)

    Heitmann, M; Davidsen, U; Stokholm, K H

    2002-01-01

    The kidney and the neurohormonal systems are essential in the pathogenesis of congestive heart failure (CHF) and the physiologic response. Routine treatment of moderate to severe CHF consists of diuretics, angiotensin-converting enzyme (ACE) inhibition and beta-blockade. The need for control...... of renal function during initiation of ACE-inhibition in patients with CHF is well known. The aim of this study was to investigate whether supplementation by a combined alpha1-beta-blockade to diuretics and ACE-inhibition might improve cardiac function without reducing renal function....

  12. Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Møller, Jacob Eifer; Brendorp, Bente; Ottesen, Michael

    2003-01-01

    AIMS: To characterise the prevalence, in-hospital complications, management, and long-term outcome of patients with congestive heart failure but preserved left ventricular systolic function after acute myocardial infarction. METHODS: 3166 consecutive patients screened for entry in the Bucindolol...... Evaluation in Acute Myocardial Infarction Trial with definite acute myocardial infarction and echocardiographic assessment of left ventricular systolic function were included between 1998 and 1999 in this prospective observational study. Main outcome measures were occurrences of in-hospital complications...... ventricular systolic function, and is associated with increased risk of in-hospital complications and death following acute myocardial infarction....

  13. Development of congestive heart failure after treatment with metoprolol in acute myocardial infarction.

    OpenAIRE

    Herlitz, J; Hjalmarson, A.; Holmberg, S.; Swedberg, K; Vedin, A; Waagstein, F; Waldenström, A; Wedel, H.; Wilhelmsen, L; Wilhelmsson, C

    1984-01-01

    In a double blind study of metoprolol in the treatment of suspected acute myocardial infarction 698 patients (study group) received metoprolol and 697 a placebo (control group). Metoprolol was given in an intravenous dose of 15 mg as soon as possible after admission to hospital followed by 50 g by mouth four times a day for two days and thereafter 100 mg twice a day for three months. A placebo was similarly given. Congestive heart failure occurred in a similar percentage of patients in both t...

  14. Renal and cardiac neuropeptide Y and NPY receptors in a rat model of congestive heart failure.

    Science.gov (United States)

    Callanan, Ean Y; Lee, Edward W; Tilan, Jason U; Winaver, Joseph; Haramati, Aviad; Mulroney, Susan E; Zukowska, Zofia

    2007-12-01

    Neuropeptide Y (NPY) is coreleased with norepinephrine and stimulates vasoconstriction, vascular and cardiomyocyte hypertrophy via Y1 receptors (R) and angiogenesis via Y2R. Although circulating NPY is elevated in heart failure, NPY's role remains unclear. Activation of the NPY system was determined in Wistar rats with the aortocaval (A-V) fistula model of high-output heart failure. Plasma NPY levels were elevated in A-V fistula animals (115.7 +/- 15.3 vs. 63.1 +/- 17.4 pM in sham, P renal failure (urinary Na(+) excretion renal blood flow (RBF), and death within 5-7 days (DECOMP). Cardiac and renal tissue NPY decreased with heart failure, proportionate to the severity of renal complications. Cardiac and renal Y1R mRNA expression also decreased (1.5-fold, P failure. In contrast, Y2R expression increased up to 72-fold in the heart and 5.7-fold in the kidney (P failure and cardiac hypertrophy. Changes in receptor expression were confirmed since the Y1R agonist, [Leu31, Pro34]-NPY, had no effect on RBF, whereas the Y2R agonist (13-36)-NPY increased RBF to compensate for disease. Thus, in this model of heart failure, cardiac and renal NPY Y1 receptors decrease and Y2 receptors increase, suggesting an increased effect of NPY on the receptors involved in cardiac remodeling and angiogenesis, and highlighting an important regulatory role of NPY in congestive heart failure.

  15. Behavioral intervention on quality of life in chronic heart congestive failure patients with urinary incontinence: a pilot randomized controlled trial%行为干预改善慢性心力衰竭尿失禁患者生命质量的随机对照试验

    Institute of Scientific and Technical Information of China (English)

    于艳丽; 张洪莹; 田春燕

    2015-01-01

    Objective To explore the effect of behavioral intervention on the quality of life of chronic heart congestive failure patients with urinary incontinence, to further provide basis for more effective clinical nursing measures. Methods 62 patients with chronic heart congestive failure combining urinary incontinence were divided into two groups by random digital table method, the control group and the intervention group, with 31 cases in each group. Patients in the control group received routine nursing care, while patients in the intervention group received behavioral intervention on the basis of routine care. The behavioral intervention included pelvic floor muscle training, pectineus exercise and reconstruction of micturition habits. The effect of the intervention on incontinence, quality of life and depression were observed in two groups. Results 61 patients completed the study, including 30 cases in the intervention group and 31 cases in the control group. There were no significant differences in the scores of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICI-Q-SF), the MOS item Short Form Health Survey (SF-36) and Zung Self-rating Depression Scale ( SDS) between two groups before the intervention (P>0.05). After 6 weeks of continuous intervention, the scores of ICI-Q-SF and SDS in the intervention group were(8.69±1.94)points and (55.91±4.57) points, which were significantly lower than (11.07±2.14) points and (61.44±5.98) points of the control group (t=5.04, 3.18, P0.05;连续干预6周后,干预组ICI-Q-SF评分为(8.69±1.94)分, SDS评分为(55.91±4.57)分,均明显低于对照组的(11.07±2.14)分和(61.44±5.98)分,t=5.04和3.18,P<0.01,差异均有统计学意义;干预组SF-36评分中生理功能、社会功能两方面评分分别为(76.77±10.34)分和(77.69±6.17)分,明显高于对照组的(60.39±10.07)分和(59.38±8.25)分,t=43.31和120.36,P<0.01,差异均有统计学意义.结论 行为干预能

  16. Measurement of lung density in congestive heart failure by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Nomura, Masanori; Miyagi, Yutaka; Tachi, Keiji; Sakabe, Yoshiyuki; Sakai, Yasuhiko; Hishida, Hitoshi; Mizuno, Yasushi; Sasaki, Fumio; Koga, Sukehiko (Fujita-Gakuen Health Univ., Toyoake, Aichi (Japan))

    1984-11-01

    The computed tomography (CT) number within the region of interest (ROI) was used as a parameter to assess lung density in patients with congestive heart failure. Thirty-eight patients with valvular heart disease (VHD) and 34 patients with ischemic heart disease (IHD) were studied. Based on the New York Heart Association (NYHA) classification, 24 VHD patients were in class I or II (VHD I-II) and the other 14 were in NYHA class III or IV (VHD III-IV). Eighteen patients with IHD were in NYHA class I or II (IHD I-II) and 16 were in class III or IV (IHD III-IV). The CT number was measured bilaterally at the upper, middle and lower levels of the chest and compared with the corresponding value in 21 normal subjects (Group N). In a preliminary study on Group N, the CT numbers were insensitive to the size of the ROI, but were closely related to its location. In clinical applications, the mean values of the CT numbers in all six lung fields increased in the order of IHD I-II, to VHD I-II, IHD III-IV and VHD III-IV. Except for patients in IHD I-II, they were significantly larger than in Group N. The relationship between the CT number and the systolic and mean pulmonary arterial pressures and the pulmonary capillary wedge pressure were evaluated in 36 patients. Significant correlations were obtained in all six lung fields (r=0.65-0.78, p < 0.001). The results suggest that measurement of lung density by CT is useful for the quantitative evaluation of the severity of disease in patients with congestive heart failure.

  17. Sociopsychological factors in women with chronic pelvic pain with and without pelvic venous congestion.

    Science.gov (United States)

    Fry, R P; Beard, R W; Crisp, A H; McGuigan, S

    1997-01-01

    Social and psychological factors have long been proposed as being of importance in a sizeable subgroup of women complaining of unexplained chronic pelvic pain (CPP). The aim of this study was to examine this in two subgroups of CPP patients, thereby eliminating pain alone as the determining variable. Consecutive attenders at a clinic for CPP were assessed on a range of somatic, historical, social, and psychological variables using detailed interviews and questionnaires. They were subsequently allocated to one of two groups, based on the presence or absence of pelvic venous congestion (PVC). Significant associations emerged between some social arrangements, paternal parenting, and patterns of hostility in the group with pelvic venous congestion. The groups also differed in patterns of family illness, and the congested group tended to report more childhood sexual abuse (CSA). Clear case definition in CPP is important. In the subgroup with pelvic venous congestion early social experience may play an important role. Father-daughter relationships may be particularly relevant. Hostility patterns may influence the development of the condition. CSA does not appear to play a specific role in all unexplained CPP cases, but may have relevance for the subgroup with pelvic venous congestion.

  18. Administration of tolvaptan with reduction of loop diuretics ameliorates congestion with improving renal dysfunction in patients with congestive heart failure and renal dysfunction.

    Science.gov (United States)

    Hanatani, Akihisa; Shibata, Atsushi; Kitada, Ryouko; Iwata, Shinichi; Matsumura, Yoshiki; Doi, Atsushi; Sugioka, Kenichi; Takagi, Masahiko; Yoshiyama, Minoru

    2017-03-01

    In patients with congestive heart failure and renal dysfunction, high dose of diuretics are necessary to improve congestion, which may progress to renal dysfunction. We examined the efficacy of tolvaptan with reduction of loop diuretics to improve renal function in patients with congestive heart failure and renal dysfunction. We conducted a multicenter, prospective, randomized study in 44 patients with congestive heart failure and renal dysfunction (serum creatinine concentration ≥1.1 mg/dl) treated with conventional diuretics. Patients were randomly divided into two groups: tolvaptan (15 mg) with a fixed dose of diuretics or with reducing to a half-dose of diuretics for 7-14 consecutive days. We examined the change of urine volume, body weight, serum creatinine and electrolyte concentrations in each group. Both groups demonstrated significant urine volume increase (724 ± 176 ml/day in the fixed-dose group and 736 ± 114 ml/day in the half-dose group) and body weight reduction (1.6 ± 1.5 kg and 1.6 ± 1.9 kg, respectively) from baseline, with no differences between the two groups. Serum creatinine concentration was significantly increased in the fixed-dose group (from 1.60 ± 0.47 to 1.74 ± 0.66 mg/dl, p = 0.03) and decreased in the half-dose group (from 1.98 ± 0.91 to 1.91 ± 0.97 mg/dl, p = 0.10). So the mean changes in serum creatinine concentration from baseline significantly differed between the two groups (0.14 ± 0.08 mg/dl in the fixed-dose group and -0.07 ± 0.19 mg/dl in the half-dose group, p = 0.006). The administration of tolvaptan with reduction of loop diuretics was clinically effective to ameliorate congestion with improving renal function in patients with congestive heart failure and renal dysfunction.

  19. Congestive heart failure in 6 African grey parrots (Psittacus e erithacus).

    Science.gov (United States)

    Juan-Sallés, C; Soto, S; Garner, M M; Montesinos, A; Ardiaca, M

    2011-05-01

    Six African grey parrots (Psittacus e erithacus) were diagnosed with cardiomyopathy and congestive heart failure based on gross and microscopic findings. Ages ranged from 15 days to 8 years, and 5 of 6 parrots were either neonates or juveniles at the time of diagnosis. Two neonates and 2 juveniles came from the same breeding aviary; the 2 juveniles were born to the same breeding pair. The 2 other parrots were kept as pets. Clinical signs included distention of the coelomic cavity (4 of 6), rales (3 of 6), weakness (4 of 6), bradyarrhythmia (1 of 6), growth retardation (1 of 6), crop stasis (1 of 6), and regurgitation (1 of 6). Three parrots were euthanized and 3 died. Gross findings included cardiomegaly due to biventricular, right-, or left-sided cardiomyopathy (6 of 6); coelomic effusion (6 of 6); whitish or yellow foci in the liver (6 of 6); atrophy of the liver (particularly, the left lobe; 5 of 6); reddened or grey lungs (5 of 6); subcutaneous edema (2 of 6); hydropericardium (1 of 6); and bilateral thyroid gland enlargement (1 of 6). Relevant microscopic findings included passive hepatic congestion (6 of 6) and pulmonary congestion (2 of 6), lymphocytic thyroiditis (2 of 6), and diffuse thyroid follicular hyperplasia (2 of 6). Microscopically, the heart was unremarkable (2 of 6) or had mild lymphocytic myocarditis (2 of 6), mild multifocal cytoplasmic vacuolation of cardiomyocytes (2 of 6), mild lymphocytic myocardial (Purkinje cell) ganglioneuritis (1 of 6), and mild multifocal interstitial fibrosis and nuclear hypertrophy of cardiomyocytes (1 of 6). One parrot had concurrent proventricular dilatation disease (systemic ganglioneuritis). The cause of cardiomyopathy in these parrots was not determined.

  20. Relationship of left heart size and left ventricular mass with exercise capacity in chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    SHEN Yu-qin; WANG Le-min; CHE Lin; SONG Hao-ming; ZHANG Qi-ping

    2011-01-01

    Background Impaired exercise capacity is one of the most common clinical manifestations in patients with chronic heart failure (CHF). The severity of reduced exercise capacity is an indicator of disease prognosis. The aim of the current study was to investigate the association between left heart size and mass with exercise capacity.Methods A total of 74 patients were enrolled in the study, with 37 having congestive heart failure (left ventricular ejection fraction (LVEF) <0.45) and the other 37 with coronary heart disease (by coronary angiography) serving as the control group (LVEF >0.55). Echocardiography and cardiopulmonary exercise test were performed. The multiply linear regression model was used to evaluate the association between echocardiogrphic indices and exercise capacities.Results The study showed that left ventricular end diastolic / systolic diameter (LVEDD/LVESD), left atrial diameter (LAD) and left ventricular mass index (LVMI) were significantly enlarged in patients with chronic heart failure compared with controls (P <0.01). The VO2AT, Peak VO2, Load AT, and Load Peak in chronic heart failure patients were also significantly reduced compared with controls (P <0.05), VE/VCO2 slope was increased in patients with chronic heart failure (P <0.01). Multivariate linear regression analysis indicated that the patients' exercise capacity was significantly associated with the left heart size and mass, however, the direction and/or strength of the associations sometimes varied in chronic heart failure patients and controls. Load AT correlated negatively with LVEDD in chronic heart failure patients (P=0.012), while Load AT correlated positively with LVEDD in control patients (P=0.006). VE/VCO2 slope correlated positively with LAD (B=0.477, P <0.0001) in chronic heart failure patients, while the VE/VCO2 slope correlated negatively with LAD in control patients (P=0.009).Conclusion The study indicates that the size of LVEDD and LAD are important

  1. [Renal dysfunction in heart failure and hypervolumenia : Importance of congestion and backward failure].

    Science.gov (United States)

    Druml, W

    2014-05-01

    Traditionally, renal dysfunction in congestive heart failure (cardiorenal syndrome type 1) has been attributed to reduced cardiac output and low mean arterial perfusion pressure, which elicit a series of neurohumoral activations resulting in increased renal vascular resistance and decreased renal function.During the last decade, several studies have shown that the extent of renal dysfunction is not so closely associated with indices of forward failure-such as the cardiac index or mean arterial pressure-but rather with indicators of congestion, such as left ventricular enddiasystolic pressure or central venous pressure (CVP), which are indicators of backward failure. The impact of backward failure on renal function is not confined to an elevation of CVP, the renal drainage pressure, but includes a broad spectrum of mechanisms. Involved are the organ systems right heart, lung, the liver, the proinflammatory signals originating from the intestines, but also renal interstitial edema (renal compartment syndrome) and the intraabdominal pressure.The therapeutic measures must focus on the modulation of the preload adapted to the specific situation of an individual patient. This includes diuretics aiming at different segments of the tubulus system including antagonists of aldosteron and ADH, extracorporeal fluid elimination by ultrafiltration or peritoneal dialysis.

  2. Patient medication adherence and physician prescribing among congestive heart failure patients of Yemen

    Directory of Open Access Journals (Sweden)

    K M Alakhali

    2013-01-01

    Full Text Available Congestive heart failure has been associated with high morbidity and mortality requiring hospitalisation and is further complicated by noncompliance and under prescriptions. We aim to determine medication adherence and percentage deviation among Asians population in general and Yemenis in particular. A cross-sectional, prospective observational study with purposive sampling was conducted at two cardiac outpatient centers in 70 congestive heart failure patients for a period of 3 months. An Arabic translated Morisky 4 item scale assessed the adherence of patients. Deviation in prescribing was determined by chart review. All 70 patients had mean age of 56.6΁16 years. Morisky 4 item scale predicted low adherence (n=33; 47.1% and overall nonadherencerate (n=38; 54.2% was slightly higher than adherence. Percentage nonadherence versus adherence was high with diuretics (53 vs. 46% and, digoxin (40 vs. 29%. The adherence percentage of angiotensin receptor blockers (9% and beta blockers (8% was low. Diuretics were the most prescribed drugs (n=69; 99%, followed by angiotensin converting enzyme inhibitors (n=51; 73%, cardiac glycoside (n=48; 69%, few patients were on angiotensin receptor blockers (n=8; 11% and (n=9; 13% beta blockers. The maximum prescribing rate deviation was seen with angiotensin receptor blockers (−89% and beta blockers (−87% followed by nitrates (−77%. Digoxin (−31% and angiotensin converting enzymes (−27% deviated comparatively less. Prescribing as well as utilisation rates generally were low resulting in nonachievement of therapeutic goals which could be resolved using multimodel approach.

  3. Patient Medication Adherence and Physician Prescribing among Congestive Heart Failure Patients of Yemen

    Science.gov (United States)

    Alakhali, K. M.; Daniel, P. S; Noohu, A. M.; Sirajudeen, S. A.

    2013-01-01

    Congestive heart failure has been associated with high morbidity and mortality requiring hospitalisation and is further complicated by noncompliance and under prescriptions. We aim to determine medication adherence and percentage deviation among Asians population in general and Yemenis in particular. A cross-sectional, prospective observational study with purposive sampling was conducted at two cardiac outpatient centers in 70 congestive heart failure patients for a period of 3 months. An Arabic translated Morisky 4 item scale assessed the adherence of patients. Deviation in prescribing was determined by chart review. All 70 patients had mean age of 56.6±16 years. Morisky 4 item scale predicted low adherence (n=33; 47.1%) and overall nonadherencerate (n=38; 54.2%) was slightly higher than adherence. Percentage nonadherence versus adherence was high with diuretics (53 vs. 46%) and, digoxin (40 vs. 29%). The adherence percentage of angiotensin receptor blockers (9%) and beta blockers (8%) was low. Diuretics were the most prescribed drugs (n=69; 99%), followed by angiotensin converting enzyme inhibitors (n=51; 73%), cardiac glycoside (n=48; 69%), few patients were on angiotensin receptor blockers (n=8; 11%) and (n=9; 13%) beta blockers. The maximum prescribing rate deviation was seen with angiotensin receptor blockers (−89%) and beta blockers (−87%) followed by nitrates (−77%). Digoxin (−31%) and angiotensin converting enzymes (−27%) deviated comparatively less. Prescribing as well as utilisation rates generally were low resulting in nonachievement of therapeutic goals which could be resolved using multimodel approach. PMID:24403656

  4. Secular trends in the etiology and comorbidity of hospitalized patients with congestive heart failure: A single-center retrospective study

    Institute of Scientific and Technical Information of China (English)

    Zhi-Yong Pei; Yu-Sheng Zhao; Jia-Yue Li; Qiao Xue; Lei Gao; Shi-Wen Wang

    2012-01-01

    Objective To assess the secular trends in the etiology and comorbidity of patients hospitalized with congestive heart failure (CHF). Methods Data of 7,319 patients (mean age 59.6 years, 62.1% male) with a primary discharge diagnosis of CHF, hospitalized from January 1, 1993 to December 31, 2007 at the Chinese People's Liberation Army (PLA) General Hospital were extracted and analyzed. These patients were divided into three groups according to hospitalization period: 1993-1997 (n = 1623), 1998-2002 (n = 2444), and 2003-2007 (n = 3252). The etiological characteristics and comorbidities were assessed. Results Over the study period, the proportion of patients with ischemic heart disease (IHD) increased from 37.2% during the period 1993-1997 to 46.8% during the period 2003-2007, while that with valvular heart disease (VHD) decreased from 35.2% during the period 1993-1997 to 16.6% during the period 2003-2007 (both P < 0.05). Atrial fibrillation (AF) was the most common comorbidity of heart failure (23.2%, 23.0% and 20.6%, respectively, in the three periods). Compared to that of the period of 1993-1997 with that of, the proportion of patients with myocardial infarction, pneumonia, renal function impairment and hepatic cirrhosis of the period of 2003-2007 increased significantly (P < 0.05) and the proportion of patients with chronic obstructive pulmonary disease and atrial fibrillation decreased significantly (P < 0.05). Conclusions This study implies that IHD has became a more common etiology of CHF, while VHD has deceased as an etiology of CHF in Chinese patients during the last two decades.

  5. Mechanical analysis of congestive heart failure caused by bundle branch block based on an electromechanical canine heart model

    Science.gov (United States)

    Dou, Jianhong; Xia, Ling; Zhang, Yu; Shou, Guofa; Wei, Qing; Liu, Feng; Crozier, Stuart

    2009-01-01

    understanding of the mechanical implications of congestive heart failure (CHF) caused by BBB.

  6. Mechanical analysis of congestive heart failure caused by bundle branch block based on an electromechanical canine heart model

    Energy Technology Data Exchange (ETDEWEB)

    Dou Jianhong; Xia Ling; Zhang Yu; Shou Guofa [Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027 (China); Wei Qing; Liu Feng; Crozier, Stuart [School of Information Technology and Electrical Engineering, University of Queensland, St Lucia, Brisbane, Queensland 4072 (Australia)], E-mail: xialing@zju.edu.cn

    2009-01-21

    understanding of the mechanical implications of congestive heart failure (CHF) caused by BBB.

  7. CD28/B7 Deficiency Attenuates Systolic Overload-Induced Congestive Heart Failure, Myocardial and Pulmonary Inflammation, and Activated T Cell Accumulation in the Heart and Lungs.

    Science.gov (United States)

    Wang, Huan; Kwak, Dongmin; Fassett, John; Hou, Lei; Xu, Xin; Burbach, Brandon J; Thenappan, Thenappan; Xu, Yawei; Ge, Jun-Bo; Shimizu, Yoji; Bache, Robert J; Chen, Yingjie

    2016-09-01

    The inflammatory response regulates congestive heart failure (CHF) development. T cell activation plays an important role in tissue inflammation. We postulate that CD28 or B7 deficiency inhibits T cell activation and attenuates CHF development by reducing systemic, cardiac, and pulmonary inflammation. We demonstrated that chronic pressure overload-induced end-stage CHF in mice is characterized by profound accumulation of activated effector T cells (CD3(+)CD44(high) cells) in the lungs and a mild but significant increase of these cells in the heart. In knockout mice lacking either CD28 or B7, there was a dramatic reduction in the accumulation of activated effector T cells in both hearts and lungs of mice under control conditions and after transverse aortic constriction. CD28 or B7 knockout significantly attenuated transverse aortic constriction-induced CHF development, as indicated by less increase of heart and lung weight and less reduction of left ventricle contractility. CD28 or B7 knockout also significantly reduced transverse aortic constriction-induced CD45(+) leukocyte, T cell, and macrophage infiltration in hearts and lungs, lowered proinflammatory cytokine expression (such as tumor necrosis factor-α and interleukin-1β) in lungs. Furthermore, CD28/B7 blockade by CTLA4-Ig treatment (250 μg/mouse every 3 days) attenuated transverse aortic constriction-induced T cell activation, left ventricle hypertrophy, and left ventricle dysfunction. Our data indicate that CD28/B7 deficiency inhibits activated effector T cell accumulation, reduces myocardial and pulmonary inflammation, and attenuates the development of CHF. Our findings suggest that strategies targeting T cell activation may be useful in treating CHF.

  8. The kidney in congestive heart failure: 'are natriuresis, sodium, and diuretics really the good, the bad and the ugly?'.

    Science.gov (United States)

    Verbrugge, Frederik H; Dupont, Matthias; Steels, Paul; Grieten, Lars; Swennen, Quirine; Tang, W H Wilson; Mullens, Wilfried

    2014-02-01

    This review discusses renal sodium handling in heart failure. Increased sodium avidity and tendency to extracellular volume overload, i.e. congestion, are hallmark features of the heart failure syndrome. Particularly in the case of concomitant renal dysfunction, the kidneys often fail to elicit potent natriuresis. Yet, assessment of renal function is generally performed by measuring serum creatinine, which has inherent limitations as a biomarker for the glomerular filtration rate (GFR). Moreover, glomerular filtration only represents part of the nephron's function. Alterations in the fractional reabsorptive rate of sodium are at least equally important in emerging therapy-refractory congestion. Indeed, renal blood flow decreases before the GFR is affected in congestive heart failure. The resulting increased filtration fraction changes Starling forces in peritubular capillaries, which drive sodium reabsorption in the proximal tubules. Congestion further stimulates this process by augmenting renal lymph flow. Consequently, fractional sodium reabsorption in the proximal tubules is significantly increased, limiting sodium delivery to the distal nephron. Orthosympathetic activation probably plays a pivotal role in those deranged intrarenal haemodynamics, which ultimately enhance diuretic resistance, stimulate neurohumoral activation with aldosterone breakthrough, and compromise the counter-regulatory function of natriuretic peptides. Recent evidence even suggests that intrinsic renal derangements might impair natriuresis early on, before clinical congestion or neurohumoral activation are evident. This represents a paradigm shift in heart failure pathophysiology, as it suggests that renal dysfunction-although not by conventional GFR measurements-is driving disease progression. In this respect, a better understanding of renal sodium handling in congestive heart failure is crucial to achieve more tailored decongestive therapy, while preserving renal function.

  9. Abnormalities of skeletal muscle in patients with chronic heart failure.

    Science.gov (United States)

    Lipkin, D P; Jones, D A; Round, J M; Poole-Wilson, P A

    1988-02-01

    We have examined muscle strength, mitochondrial enzyme activity, histochemistry and fibre size in the quadriceps muscle of 9 patients with severe chronic heart failure. A needle biopsy of the quadriceps muscle was taken with patients at rest. Maximum oxygen uptake was measured during treadmill exercise. Mean maximal oxygen consumption was 11.7 ml.kg-1.min-1. Isometric maximum voluntary contraction was reduced to 55% of the predicted value for weight. Eight biopsies were abnormal. Findings included increased acid phosphatase, increased interstitial cellularity, excess intracellular lipid accumulation, atrophy of both type I and II fibres and variation in size with hypertrophy and atrophy of fibers. Muscle fibre capillary density and the activity of mitochondrial enzymes were normal. Changes in skeletal muscle strength may play a role in the limitation of exercise capacity seen in patients with congestive heart failure.

  10. Prolonged signal-averaged P wave duration as a prognostic marker for morbidity and mortality in patients with congestive heart failure

    DEFF Research Database (Denmark)

    Dixen, Ulrik; Wallevik, Laura; Hansen, Maja;

    2003-01-01

    To evaluate the prognostic roles of prolonged signal-averaged P wave duration (SAPWD), raised levels of natriuretic peptides, and clinical characteristics in patients with stable congestive heart failure (CHF).......To evaluate the prognostic roles of prolonged signal-averaged P wave duration (SAPWD), raised levels of natriuretic peptides, and clinical characteristics in patients with stable congestive heart failure (CHF)....

  11. Infantile Hepatic Hemangioendothelioma Associated With Congestive Heart Failure: Two Case Reports With Different Outcomes.

    Science.gov (United States)

    Wang, Tao; Wang, Yibin; Liang, Yun; Lu, Guoyan

    2015-12-01

    Infantile hepatic hemangioendothelioma (IHH) is rare which can regress spontaneously. Arteriovenous shunts within hemangiomas, however, may result in pulmonary artery hypertension (PAH) and congestive heart failure (CHF).The authors report 2 young infants suffering from multifocal IHH associated with CHF were both treated with glucocorticoid and transcatheter arterial embolization (TAE), but had different outcomes. The PAH decreased immediately and the symptoms of CHF were alleviated after TAE for both of them. For the Tibetan infant, the development was normal with tumor regression by follow-up. For the Han ethnic neonate, PAH increased again in the seventh day with progressive cardiovascular insufficiency. Ultrasound showed a persisting perfusion caused by collateralization around occluded main feeders. Furthermore, a pulmonary infection occurred and ventilation was performed. As a result, the infant died from multiorgan failure caused by CHF and infection.TAE is a treatment of reducing shunting for hemangiomas. Fistula recanalization in multifocal IHH, however, might be an important risk factor affecting the outcome of TAE. TAE should be further evaluated with special attention to anatomy of feeding and draining vessels, and cardiopulmonary conditions. In addition, the patients were susceptible to secondary pulmonary infection because of lung congestion. As well, the infant from the high altitude area showed better adaptability to hypoxia.

  12. Pharmacodynamics and pharmacokinetics of oral levosimendan and its metabolites in patients with severe congestive heart failure: a dosing interval study.

    Science.gov (United States)

    Põder, Pentti; Eha, Jaan; Sundberg, Stig; Antila, Saila; Heinpalu, Marika; Loogna, Imbrit; Planken, Ulle; Rantanen, Satu; Lehtonen, Lasse

    2004-10-01

    The objective of this study was to explore the pharmacodynamics and pharmacokinetics of oral levosimendan in patients with severe congestive heart failure. This was a randomized, parallel-group, double-blind, placebo-controlled trial. Oral levosimendan 2 to 8 mg daily or placebo was administered to 25 patients with New York Heart Association class III-IV congestive heart failure for 4 weeks. Pharmacodynamic variables consisted of heart rate-corrected electromechanical systole, heart rate, and systolic and diastolic blood pressure. The pharmacokinetics of levosimendan and its metabolites, OR-1855 and OR-1896, was assessed. The 4- to 8-mg daily doses of oral levosimendan showed moderate inotropic effects. Blood pressure remained unchanged with all doses. A moderate increase in heart rate was observed except with the 2-mg dose. Pharmacokinetic parameters of the metabolites increased linearly with the dose (P < or = .002 for Cmax and AUC0-8h for both treatment groups). It was concluded that oral levosimendan has inotropic and chronotropic effects in patients with severe congestive heart failure. Plasma concentrations of its metabolites increase dose dependently.

  13. Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities; Pollution atmospherique ambiante et hospitalisations pour insuffisance cardiaque congestive chez les personnes agees dans sept grandes villes des Etats-Unis

    Energy Technology Data Exchange (ETDEWEB)

    Morris, R.D.; Naumova, E.N.; Munasinghe, R.L.M.

    2001-01-01

    The aim of this study is the temporal associations between the urban atmospheric pollution, in particular the carbon monoxide, and the hospitalization for congestive heart failure in elderly people, in seven large US cities. (A.L.B.)

  14. Core Measures for Congestive Heart Failure in a Tertiary Care Setting in Pakistan

    Science.gov (United States)

    Zafar, Rizwan; Haris, Muhammad; Shabbir, Muhammad Usman; Ghazanfar, Haider; Malik, Sarah A; Khalid, Tehreem; Abbas, Ali H; Saleem, Asad A

    2016-01-01

    significant association between gender and mean duration of hospitalization (p = 0.411). No significant association was found between EF ≤ 40% and mean duration of hospitalization (p = 0.426). Conclusion: We found that symptom assessment of congestive heart failure (CHF) patients, according to NYHA guidelines, are strikingly low. Also, a significant percentage of patients who need ACEi and BB are not prescribed the required medications despite echocardiography showing low left ventricular function. PMID:27630801

  15. [Gliptins, cardiovascular safety and congestive heart failure: state of the art after TECOS].

    Science.gov (United States)

    Scheen, A J

    2015-08-26

    The cardiovascular safety of dipeptidyl peptidase-4 inhibitors (gliptins) has been well studied. Favourable effects of these oral antidiabetic agents have been reported in meta-analyses of phase II-III randomised controlled trials. Three large prospective trials, which were specifically designed to investigate cardiovascular safety, showed non-inferiority of saxagliptin (SAVOR-TIMI 53), alogliptin (EXA-MINE) and sitagliptin (TECOS) versus placebo as far as major cardiovascular events are concerned, including mortality. The suspected increase in the rate of hospitalisation due to congestive heart failure reported in SAVOR-TIMI 53 was neither found in EXAMINE nor recently confirmed in TECOS. Direct comparative trials, evaluating not only safety but also efficacy, with other oral antidiabetic medications would be of major interest.

  16. Differential pathways of positive and negative health behavior change in congestive heart failure patients.

    Science.gov (United States)

    Chaves, Covadonga; Park, Crystal L

    2016-08-01

    This longitudinal study applied a stress and coping model to examine the differential pathways of perceived positive and negative health behavior changes. Participants with congestive heart failure completed self-report measures of psychological resources, coping strategies, and perceived behavior changes and were assessed again 6 months later. Patients with higher positive affect and spiritual well-being reported more positive health behavior changes over time, effects mediated by approach coping. Alternatively, patients with lower psychological resources reported more negative behavior changes over time, effects mediated by avoidance coping. The results suggest that different psychological resources are related to different types of coping which, in turn, are associated with perceived positive or negative changes in health behavior over time.

  17. Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure.

    Science.gov (United States)

    Qin, Chuan; Zhang, Li; Zhang, Zi-Ming; Wang, Bin; Ye, Zhou; Wang, Yong; Nanda, Navin C; Xie, Ming-Xing

    2016-06-01

    The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure (CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization (CRT) and presented with low ejection fraction (EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio (FT/RR), left ventricular pre-ejection delay (PED), interventricular mechanical delay (IVMD), longitudinal opposing wall delay (LOWD) and radial septal to posterior wall delay (RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group (Pcardiac dyssynchrony in patients with CHF.

  18. INSUFICIENCIA CARDÍACA CONGESTIVA O COR PULMONALE Congestive heart failure or Cor Pulmonale

    Directory of Open Access Journals (Sweden)

    Oscar Ernesto Amarís Peña

    2006-06-01

    Full Text Available La insuficiencia cardíaca es una de las principales causas de muerte cardiovascular y se presenta como consecuencia, en más del 70 por ciento de los casos, de las dos enfermedades cardiovasculares de mayor prevalencia: la hipertensión arterial y la enfermedad coronaria. La disnea y el edema en los miembros inferiores son los dos criterios más usados para el diagnóstico de insuficiencia cardíaca congestiva y estos son, justamente, las principales manifestaciones de los pacientes con Cor Pulmonale. Este documento propone algunos criterios para el diagnóstico diferencial de las dos entidades.Heart failure is one of the most important causes of cardiovascular death, as consequence of arterial hypertension or coronary heart disease. Dyspnea and legs edema are the commonest symptoms of congestive heart failure, but there are important symptoms in Cor Pulmonale, too. This paper propose some distinctive clues to differential diagnosis.

  19. Reduced Data Dualscale Entropy Analysis of HRV Signals for Improved Congestive Heart Failure Detection

    Science.gov (United States)

    Kuntamalla, Srinivas; Lekkala, Ram Gopal Reddy

    2014-10-01

    Heart rate variability (HRV) is an important dynamic variable of the cardiovascular system, which operates on multiple time scales. In this study, Multiscale entropy (MSE) analysis is applied to HRV signals taken from Physiobank to discriminate Congestive Heart Failure (CHF) patients from healthy young and elderly subjects. The discrimination power of the MSE method is decreased as the amount of the data reduces and the lowest amount of the data at which there is a clear discrimination between CHF and normal subjects is found to be 4000 samples. Further, this method failed to discriminate CHF from healthy elderly subjects. In view of this, the Reduced Data Dualscale Entropy Analysis method is proposed to reduce the data size required (as low as 500 samples) for clearly discriminating the CHF patients from young and elderly subjects with only two scales. Further, an easy to interpret index is derived using this new approach for the diagnosis of CHF. This index shows 100 % accuracy and correlates well with the pathophysiology of heart failure.

  20. Macro- and micronutrients in patients with congestive heart failure, particularly African-Americans

    Directory of Open Access Journals (Sweden)

    Kevin P Newman

    2007-11-01

    Full Text Available Kevin P Newman1, Syamal K Bhattacharya1,2, Ahmad Munir1, Richard C Davis1, Judith E Soberman1, Kodangudi B Ramanathan11Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA 2Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USAAbstract: Not all patients with heart failure, defined as a reduced ejection fraction, will have an activation of the RAAS, salt and water retention, or the congestive heart failure (CHF syndrome. Beyond this cardiorenal perspective, CHF is accompanied by a systemic illness that includes oxidative stress, a proinflammatory phenotype, and a wasting of soft tissues and bone. A dyshomeostasis of calcium, magnesium, zinc, selenium, and vitamin D contribute to the appearance of oxidative stress and to compromised endogenous defenses that combat it. A propensity for hypovitaminosis D, given that melanin is a natural sunscreen, and for secondary hyperparathyroidism in African-Americans make them more susceptible to these systemic manifestations of CHF—a situation which is further threatened by the calcium and magnesium wasting that accompanies the secondary aldosteronism of CHF and the use of loop diuretics.Keywords: African-Americans, heart failure, calcium, magnesium, zinc, selenium

  1. Dilatory responses to acetylcholine, calcitonin gene-related peptide and substance P in the congestive heart failure rat

    DEFF Research Database (Denmark)

    Bergdahl, A; Valdemarsson, S; Nilsson, T;

    1999-01-01

    It was examined to what extent congestive heart failure (CHF) in rats, induced by ligation of the left coronary artery, affects the vascular responses to the vasodilatory substances acetylcholine (ACh), calcitonin gene-related peptide (CGRP), and substance P (SP). After induction of CHF status...

  2. Sudden cardiovascular death following myocardial infarction: the importance of left ventricular systolic dysfunction and congestive heart failure

    DEFF Research Database (Denmark)

    Abildstrøm, Steen Zabell; Ottesen, Michael M; Rask-Madsen, Christian;

    2005-01-01

    BACKGROUND: To study the prognostic information of congestive heart failure (CHF) and left ventricular systolic dysfunction regarding sudden and non-sudden cardiovascular death (SCD and non-SCD) in patients with acute myocardial infarction (MI), as this may indicate the potential benefit...

  3. 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

    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...

  4. Radiographic and echocardiographic assessment of left atrial size in 100 cats with acute left-sided congestive heart failure.

    Science.gov (United States)

    Schober, Karsten E; Wetli, Ellen; Drost, Wm Tod

    2014-01-01

    The aims of this study were to evaluate left atrial size in cats with acute left-sided congestive heart failure. We hypothesized that left atrial size as determined by thoracic radiography can be normal in cats with acute left-sided congestive heart failure. One hundred cats with acute left-sided congestive heart failure in which thoracic radiography and echocardiography were performed within 12 h were identified. Left atrial size was evaluated using right lateral and ventrodorsal radiographs. Measurements were compared to two-dimensional echocardiographic variables of left atrial size and left ventricular size. On echocardiography, left atrial enlargement was observed in 96% cats (subjective assessment) whereas maximum left atrial dimension was increased (>15.7 mm) in 93% cats. On radiographs left atrial enlargement (subjective assessment) was found in 48% (lateral view), 53% (ventrodorsal view), and 64% (any view) of cats whereas left atrial enlargement was absent in 36% of cats in both views. Agreement between both methods of left atrial size estimation was poor (Cohen's kappa 0.17). Receiver operating characteristic curve analysis identified a maximum echocardiographic left atrial dimension of approximately 20 mm as the best compromise (Youden index) between sensitivity and specificity in the prediction of radiographic left atrial enlargement. Left atrial enlargement as assessed by thoracic radiography may be absent in a clinically relevant number of cats with congestive heart failure. Therefore, normal left atrial size on thoracic radiographs does not rule out presence of left-sided congestive heart failure in cats with clinical signs of respiratory distress.

  5. Combined effects of ramipril and angiotensin Ⅱ receptor blocker TCV116 on rat congestive heart failure after myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    TAO Ze-wei; HUANG Yuan-wei; XIA Qiang; XU Qi-wen

    2005-01-01

    Background Congestive heart failure (CHF) is a major cause of morbidity and mortality worldwide and angiotensin converting-enzyme inhibitor (ACEI) is the cornerstone in its treatment. However, CHF continues to progress despite this therapy, perhaps because of production of angiotensin Ⅱ (Ang Ⅱ) by alternative pathways. The present study was conducted to examine the combined effects of a chronic ACEI, ramipril, and a chronic Ang Ⅱ type 1 receptor blocker, TCV116, on rat CHF after myocardial infarction (MI). Methods Congestive heart failure was caused by MI in rats, which was induced by ligating the left anterior descending coronary artery. The experiment protocol included sham-operated rats (Sham), MI-control rats (MI-control), MI rats treated with ramipril 3 mg/kg (MI-ramipril) or TCV116 2 mg/kg (MI-TCV116) per day, half dosage (MI-1/2R&T) or full dosage (MI-R&T) combination of the two. At 22 weeks, cardiac hemodynamic parameters such as mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), maximal rate of left ventricule pressure development and decline (LV dP/dtmax) and left ventricular end diastolic pressure (LVEDP), and cardiac morphometric parameters such as heart weight (HW), left ventricular weight (LVW) and left ventricular cavity area (LVCA) were measured, mRNA expressions of cardiac molecule genes such as β myosin heavy chain (βMHC), B-type natriuretic peptide (BNP), transforming growth factor-β1 (TGF-β1), collagen I and Ⅲ were quantified with reverse transcription polymerase chain reaction (RT-PCR) in the surviving septum myocardium, and survival rates were calculated. Results There were no significant differences in MI sizes (%) among each MI related experimental groups (33±13, 34±14, 33±13, 35±13 and 33±14 for MI-control, MI-ramipril, MI-TCV116, MI-1/2R&T and MI-R&T, respectively, no statistical significance for all). Compared with sham-operated rats, MI rats without therapy showed significant increases in

  6. Relation of systemic and local muscle exercise capacity to skeletal muscle characteristics in men with congestive heart failure

    Science.gov (United States)

    Massie, B. M.; Simonini, A.; Sahgal, P.; Wells, L.; Dudley, G. A.

    1996-01-01

    OBJECTIVES. The present study was undertaken to further characterize changes in skeletal muscle morphology and histochemistry in congestive heart failure and to determine the relation of these changes to abnormalities of systemic and local muscle exercise capacity. BACKGROUND. Abnormalities of skeletal muscle appear to play a role in the limitation of exercise capacity in congestive heart failure, but information on the changes in muscle morphology and biochemistry and their relation to alterations in muscle function is limited. METHODS. Eighteen men with predominantly mild to moderate congestive heart failure (mean +/- SEM New York Heart Association functional class 2.6 +/- 0.2, ejection fraction 24 +/- 2%) and eight age- and gender-matched sedentary control subjects underwent measurements of peak systemic oxygen consumption (VO2) during cycle ergometry, resistance to fatigue of the quadriceps femoris muscle group and biopsy of the vastus lateralis muscle. RESULTS. Peak VO2 and resistance to fatigue were lower in the patients with heart failure than in control subjects (15.7 +/- 1.2 vs. 25.1 +/- 1.5 ml/min-kg and 63 +/- 2% vs. 85 +/- 3%, respectively, both p congestive heart failure is associated with changes in the characteristics of skeletal muscle and local as well as systemic exercise performance. There are fewer slow twitch fibers, smaller fast twitch fibers and lower succinate dehydrogenase activity. The latter finding suggests that mitochondrial content of muscle is reduced in heart failure and that impaired aerobic-oxidative capacity may play a role in the limitation of systemic exercise capacity.

  7. Chronic heart failure and micronutrients.

    Science.gov (United States)

    Witte, K K; Clark, A L; Cleland, J G

    2001-06-01

    Heart failure (HF) is associated with weight loss, and cachexia is a well-recognized complication. Patients have an increased risk of osteoporosis and lose muscle bulk early in the course of the disease. Basal metabolic rate is increased in HF, but general malnutrition may play a part in the development of cachexia, particularly in an elderly population. There is evidence for a possible role for micronutrient deficiency in HF. Selective deficiency of selenium, calcium and thiamine can directly lead to the HF syndrome. Other nutrients, particularly vitamins C and E and beta-carotene, are antioxidants and may have a protective effect on the vasculature. Vitamins B6, B12 and folate all tend to reduce levels of homocysteine, which is associated with increased oxidative stress. Carnitine, co-enzyme Q10 and creatine supplementation have resulted in improved exercise capacity in patients with HF in some studies. In this article, we review the relation between micronutrients and HF. Chronic HF is characterized by high mortality and morbidity, and research effort has centered on pharmacological management, with the successful introduction of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists into routine practice. There is sufficient evidence to support a large-scale trial of dietary micronutrient supplementation in HF.

  8. 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.

  9. The hemodynamic effects of ibopamine, a dopamine congener, in patients with congestive heart failure.

    Science.gov (United States)

    Leier, C V; Ren, J H; Huss, P; Unverferth, D V

    1986-01-01

    Ten patients with congestive heart failure underwent noninvasive and invasive hemodynamic testing before and sequentially after the administration of ibopamine to determine the cardiovascular effects of this oral dopamine congener. Single doses of 200, 400 and 600 mg were administered to all patients and 5 repeated doses of 200 or 400 mg were studied in 8. Hemodynamic effects occurred as early as 30 minutes and lasted up to 4 hours after dosing. In general, ibopamine elicited statistically significant dose-related increases in cardiac output and reductions in the derived resistance of the systemic and pulmonary circulations. A biphasic response in central and peripheral pressures was observed; up to 1 hour after administration, ibopamine elevated mean right and left atrial pressures and pulmonary and systemic arterial pressures with a significant reduction of these measurements beyond 1 hour. It did not alter heart rate. Repeated doses qualitatively affected hemodynamics similar to the initial dose and did not appear to be accompanied by short-term tolerance. While oral ibopamine elicits some favorable hemodynamic effects in humans with cardiac failure, the biphasic hemodynamic response is generally undesirable in the majority of these patients.

  10. Nutritional Status Assessment of the Elderly Patients with Congestive Heart Failure by Mini Nutritional Assessment Test

    Directory of Open Access Journals (Sweden)

    Hosseini

    2016-08-01

    Full Text Available Background Malnutrition is a common problem among elderly patients, especially those with heart failure, and is known to increase mortality rates. Objectives The current study evaluated nutritional status to identify changes in the elderly patients with congestive heart failure (CHF during hospital stay. Patients and Methods This cross-sectional study recruited 225 CHF hospitalized elderly patients, comprised of 154 males (68.4% and 71 females (31.6% at a mean age of 71.1 ± 7.35 years. The mini nutritional assessment (MNA was performed to estimate functional, cognitive and nutritional status. The MNA, an18-item tool to evaluate subjective and objective findings, including anthropometric measurements for nutritional risk, is found to be sensitive, specific and accurate in identifying elderly people at nutritional risk. Results According to the MNA questionnaire, 9.8% of the elderly were malnourished, 80.9% at risk of malnutrition and 9.3% well nourished. Weight loss, bedsore, and level of knowledge and income had a significant relationship with nutritional status based on the MNA (P value < 0.05. Conclusions Considering the high percentage of elderly patients with malnutrition or at risk of malnutrition, the need for nutritional intervention is obvious. The MNA seems to be a reliable tool to identify individuals at risk of malnutrition. To decrease hospital stay duration and cost, application of the MNA is suggested.

  11. Prognosis of emergency room stabilization of decompensated congestive heart failure with high dose lasix

    Directory of Open Access Journals (Sweden)

    Mahboob Pouraghaei

    2015-06-01

    Full Text Available Objective: Congestive heart failure (CHF has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency department (ED without admission with patients who were admitted to hospital for standard treatment. Methods: This was a randomized prospective clinical trial study. The patients who came to the ED from March 20, 2008 up to August 20, 2008 were divided into two groups randomly. The length of ED stay in the experimental group was documented. Also, readmission and mortality in 6 months and satisfaction in both groups were taken into consideration. All data were analyzed using SPSS 15.0. Results: In experimental group, the rate of recurrent admission, expiration, discharge, clinic visit, and clinic admission was 8%, 4%, 29%, 18%, and 0% respectively. On the other hand, in control group it was 16%, 40%, 18%, 22%, and 2% respectively. Additionally, there was a significant difference between these groups (P = 0.00. Conclusion: This study is the first regional prospective trial to comprehensively examine the therapeutic management in patients with CHF. This study, comparing the high dose diuretic efficacy in the decreasing of hospital stay and readmission; and decreasing mortality rate with routine therapy, showed that there was a significant difference between these two strategies in the mortality rate, readmission, and length of hospital stay (P = 0.00.

  12. Thyrotropin-secreting pituitary tumor presenting with congestive heart failure and good response to dopaminergic agonist cabergoline.

    Science.gov (United States)

    Kao, Yu-Hsi; Chang, Tien-Jyun; Huang, Tien-Shang

    2013-11-01

    Hyperthyroidism is an important inducing factor in patients with atrial fibrillation, and may trigger heart failure. Thyrotropin (thyroid stimulating hormone, TSH)-secreting pituitary tumors are rare causes of hyperthyroidism. Here, we report a 66-year-old man with a pituitary TSH-secreting tumor who presented with hyperthyroidism and congestive heart failure. Endonasal trans-sphenoidal pituitary adenomectomy was performed. After the operation, the symptoms of hyperthyroidism and congestive heart failure were relieved, associated with normalization of thyroid function tests. Unfortunately, hand tremor and progressively elevated free T4 and TSH concentrations recurred 5 months after surgery. A dopaminergic agonist, cabergoline was administered and euthyroidism was restored for at least 11 months.

  13. Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications

    DEFF Research Database (Denmark)

    Møller, Jacob Eifer; Brendorp, Bente; Ottesen, Michael;

    2003-01-01

    AIMS: To characterise the prevalence, in-hospital complications, management, and long-term outcome of patients with congestive heart failure but preserved left ventricular systolic function after acute myocardial infarction. METHODS: 3166 consecutive patients screened for entry in the Bucindolol...... and all cause mortality. RESULTS: Congestive heart failure was seen during hospitalisation in 1464 patients (46%), 717 patients had preserved left ventricular systolic function (wall motion index > or =1.3 corresponding to ejection fraction > or =0.40), and 732 patients had systolic dysfunction (wall.......3 (95% CI 2.8-4.0), and after adjustment for baseline characteristics and left ventricular systolic function in multivariate Cox proportional hazards analysis the risk was 2.1 (95% CI 1.7-2.6), PCongestive heart failure is frequently present in patients with preserved left...

  14. Loss of the eIF2α kinase GCN2 protects mice from pressure overload induced congestive heart failure without affecting ventricular hypertrophy

    Science.gov (United States)

    Lu, Zhongbing; Xu, Xin; Fassett, John; Kwak, Dongmin; Liu, Xiaoyu; Hu, Xinli; Wang, Huan; Guo, Haipeng; Xu, Dachun; Yan, Shuo; McFalls, Edward O.; Lu, Fei; Bache, Robert J.; Chen, Yingjie

    2016-01-01

    In response to a number of stresses, including nutrient deprivation, General Control Nonderepressible 2 kinase (GCN2) attenuates mRNA translation by phosphorylating eukaryotic initiation factor 2 alpha (eIF2αSer51). Energy starvation is known to exacerbate congestive heart failure (CHF) and eIF2αSer51 phosphorylation is increased in the failing heart. However, the impact of GCN2 during the evolution of CHF has not been tested. In this study we examined the influence of GCN2 expression in response to a cardiac stress by inducing chronic pressure overload with Transverse Aortic Constriction (TAC) in Wild Type (WT) and GCN2 knockout (GCN2−/−) mice. Under basal conditions, GCN2−/− had normal LV structure or function but following TAC, demonstrated less contractile dysfunction, less increase of lung weight, less increase of lung inflammation and vascular remodeling, and less myocardial apoptosis and fibrosis compared with WT mice, despite an equivalent degree of LV hypertrophy. As expected, GCN2−/− attenuated TAC induced cardiac eif2αSer51 phosphorylation and preserved Sarcoplasmic reticulum Ca2+ ATPase (Serca2a) expression compared with WT mice. Interestingly, expression of the anti-apoptotic protein Bcl-2 was significantly elevated in GCN2−/− hearts, while in isolated neonatal cardiomyocytes, selective knockdown of GCN2 increased Bcl-2 protein expression and enhanced myocyte resistance to an apoptotic stress. Collectively, our data support the notion that GCN2 impairs the ventricular adaptation to chronic pressure overload by reducing Bcl-2 expression and increasing cardiomyocyte susceptibility to apoptotic stimuli. Our findings suggest that strategies to reduce GCN2 activity in cardiac tissue may be a novel approach to attenuate congestive heart failure development. PMID:24166753

  15. Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations

    Energy Technology Data Exchange (ETDEWEB)

    Chabbert, Valerie; Canevet, Guillaume; Otal, Philippe; Joffre, Francis [Department of Radiology, University of Toulouse, Avenue Jean-Poulhes, 31403, Toulouse (France); Baixas, Cecile; Galinier, Michel [Department of Cardiology, University of Toulouse, Avenue Jean-Poulhes, 31403, Toulouse (France); Deken, Valerie; Duhamel, Alain [Department of Medical Statistics, University of Lille, Place de Verdun, 59037, Lille Cedex (France); Remy, Jacques; Remy-Jardin, Martine [Department of Radiology, Hospital Calmette, University Center of Lille, Boulevard Jules Leclerc, 59037, Lille Cedex (France)

    2004-05-01

    The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III-IV dyspnea at T1, n=24, 78% vs grade I-II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean{+-}SD value: 34{+-}12.9 vs 43{+-}13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean{+-}SD value: 17{+-}2.75 vs 14{+-}3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening (n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%). (orig.)

  16. Impact of congestive heart failure and left ventricular systolic function on the prognostic significance of atrial fibrillation and atrial flutter following acute myocardial infarction

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Bagger, Henning; Køber, Lars

    2005-01-01

    BACKGROUND: Reports on the prognostic importance of atrial fibrillation following myocardial infarction have provided considerable variation in results. Thus, this study examined the impact of left ventricular systolic function and congestive heart failure on the prognostic importance of atrial...... and congestive heart failure were prospectively collected. Mortality was followed for 5 years. RESULTS: In patients with left ventricular ejection fraction... mortality. In patients with 0.250.35. In patients with congestive heart failure, atrial fibrillation/atrial flutter was associated with an increased in-hospital mortality (OR=1.5 (1.2-1.9); p

  17. PULMONARY ARTERIAL DISEASE ASSOCIATED WITH RIGHT-SIDED CARDIAC HYPERTROPHY AND CONGESTIVE HEART FAILURE IN ZOO MAMMALS HOUSED AT 2,100 M ABOVE SEA LEVEL.

    Science.gov (United States)

    Juan-Sallés, Carles; Martínez, Liliana Sofía; Rosas-Rosas, Arely G; Parás, Alberto; Martínez, Osvaldo; Hernández, Alejandra; Garner, Michael M

    2015-12-01

    Subacute and chronic mountain sickness of humans and the related brisket disease of cattle are characterized by right-sided congestive heart failure in individuals living at high altitudes as a result of sustained hypoxic pulmonary hypertension. Adaptations to high altitude and disease resistance vary among species, breeds, and individuals. The authors conducted a retrospective survey of right-sided cardiac hypertrophy associated with pulmonary arterial hypertrophy or arteriosclerosis in zoo mammals housed at Africam Safari (Puebla, México), which is located at 2,100 m above sea level. Seventeen animals with detailed pathology records matched the study criterion. Included were 10 maras (Dolichotis patagonum), 2 cotton-top tamarins (Saguinus oedipus oedipus), 2 capybaras (Hydrochaeris hydrochaeris), and 1 case each of Bennet's wallaby (Macropus rufogriseus), nilgai antelope (Boselaphus tragocamelus), and scimitar-horned oryx (Oryx dammah). All had right-sided cardiac hypertrophy and a variety of arterial lesions restricted to the pulmonary circulation and causing arterial thickening with narrowing of the arterial lumen. Arterial lesions most often consisted of medial hypertrophy or hyperplasia of small and medium-sized pulmonary arteries. All maras also had single or multiple elevated plaques in the pulmonary arterial trunk consisting of fibrosis, accompanied by chondroid metaplasia in some cases. Both antelopes were juvenile and died with right-sided congestive heart failure associated with severe pulmonary arterial lesions. To the authors' knowledge, this is the first description of cardiac and pulmonary arterial disease in zoo mammals housed at high altitudes.

  18. Acromegaly with Normal Insulin-Like Growth Factor-1 Levels and Congestive Heart Failure as the First Clinical Manifestation.

    Science.gov (United States)

    Lee, Hyae Min; Lee, Sun Hee; Yang, In Ho; Hwang, In Kyoung; Hwang, You Cheol; Ahn, Kyu Jeung; Chung, Ho Yeon; Hwang, Hui Jeong; Jeong, In Kyung

    2015-09-01

    The leading cause of morbidity and mortality in patients with acromegaly is cardiovascular complications. Myocardial exposure to excessive growth hormone can cause ventricular hypertrophy, hypertension, arrhythmia, and diastolic dysfunction. However, congestive heart failure as a result of systolic dysfunction is observed only rarely in patients with acromegaly. Most cases of acromegaly exhibit high levels of serum insulin-like growth factor-1 (IGF-1). Acromegaly with normal IGF-1 levels is rare and difficult to diagnose. Here, we report a rare case of an acromegalic patient whose first clinical manifestation was severe congestive heart failure, despite normal IGF-1 levels. We diagnosed acromegaly using a glucose-loading growth hormone suppression test. Cardiac function and myocardial hypertrophy improved 6 months after transsphenoidal resection of a pituitary adenoma.

  19. Acromegaly with Normal Insulin-Like Growth Factor-1 Levels and Congestive Heart Failure as the First Clinical Manifestation

    Directory of Open Access Journals (Sweden)

    Hyae Min Lee

    2015-09-01

    Full Text Available The leading cause of morbidity and mortality in patients with acromegaly is cardiovascular complications. Myocardial exposure to excessive growth hormone can cause ventricular hypertrophy, hypertension, arrhythmia, and diastolic dysfunction. However, congestive heart failure as a result of systolic dysfunction is observed only rarely in patients with acromegaly. Most cases of acromegaly exhibit high levels of serum insulin-like growth factor-1 (IGF-1. Acromegaly with normal IGF-1 levels is rare and difficult to diagnose. Here, we report a rare case of an acromegalic patient whose first clinical manifestation was severe congestive heart failure, despite normal IGF-1 levels. We diagnosed acromegaly using a glucose-loading growth hormone suppression test. Cardiac function and myocardial hypertrophy improved 6 months after transsphenoidal resection of a pituitary adenoma.

  20. Clinical significance of serum cardiac troponin T in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    薛春才; 于宏伟; 李瑞杰; 沃金善; 崔家玉; 程海宾; 王洪云; 管庆华; 索晓霞; 贾荣波

    2003-01-01

    Objective To determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF). Methods This study consisted of 265 patients with CHF and 75 healthy people. Serum cTnT was measured by electrochemiluminescence immunoassay using an Elecsys 1010 automatic analyzer. Results cTnT concentration was 0.181±0.536 ng/mL in CHF patients and 0.003±0.001 ng/mL in controls (P35%, cTnT was 0.07±0.0 5ng/mL (P0.05, class Ⅱ vs class Ⅲ P<0.01, class Ⅲ vs class Ⅳ P<0.01). A negative correlation was observed between serum cTnT concentration and LVEF in 265 patients with CHF (r=-0.493, P<0.001).Conclusions This study shows that the level of serum cTnT is increased in patients with CHF and that the increased level indicates the severity of CHF.

  1. Integrative Medical Care Plus Mindfulness Training for Patients With Congestive Heart Failure: Proof of Concept.

    Science.gov (United States)

    Kemper, Kathi J; Carmin, Cheryl; Mehta, Bella; Binkley, Phillip

    2016-10-01

    Congestive heart failure (CHF) has a high rate of morbidity and mortality. It is often accompanied by other medical and psychosocial comorbidities that complicate treatment and adherence. We conducted a proof of concept pilot project to determine the feasibility of providing integrative group medical visits plus mindfulness training for patients recently discharged with CHF. Patients were eligible if they had been discharged from an inpatient stay for CHF within the 12 months prior to the new program. The Compassionate Approach to Lifestyle and Mind-Body (CALM) Skills for Patients with CHF consisted of 8 weekly visits focusing on patient education about medications, diet, exercise, sleep, and stress management; group support; and training in mind-body skills such as mindfulness, self-compassion, and loving-kindness. Over two 8-week sessions, 8/11 (73%) patients completed at least 4 visits. The patients had an average age of 57 years. The most common comorbidities were weight gain, sleep problems, and fatigue. After the sessions, 100% of patients planned to make changes to their diet, exercise, and stress management practices. Over half of the patients who met with a pharmacist had a medication-related problem. Improvements were observed in depression, fatigue, and satisfaction with life. Integrative group visits focusing on healthy lifestyle, support, and skill-building are feasible even among CHF patients and should be evaluated in controlled trials as a patient-centered approach to improving outcomes related to improving medication management, depression, fatigue, and quality of life.

  2. Efficacy of pimobendan on survival and reoccurrence of pulmonary edema in canine congestive heart failure.

    Science.gov (United States)

    Mizuno, Masashi; Yamano, Shigeki; Chimura, Shuichi; Hirakawa, Atsushi; Takusagawa, Yoshimi; Sawada, Tamotsu; Maetani, Shigeki; Takahashi, Arane; Mizuno, Takeshi; Harada, Kayoko; Shinoda, Asako; Uchida, Shuhei; Takeuchi, Junichiro; Mizukoshi, Takahiro; Endo, Masaaki; Uechi, Masami

    2017-01-20

    The aim of this study was to evaluate the efficacy of pimobendan with conventional therapies on survival and reocurrence of pulmonary edema in dogs with congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD). Records of 197 client-owned dogs from 14 veterinary hospitals were included in this study. Dogs were administered conventional treatments with or without pimobendan. Sixty-four dogs received a standard dose of pimobendan (0.20-0.48 mg/kg every 12 hr (q12hr)), 49 dogs received a low dose of pimobendan (0.05-0.19 mg/kg q12hr), and 84 dogs received conventional therapy alone. Dogs in the standard-dose and low-dose pimobendan groups had significantly longer median survival times than dogs in the conventional group (334, 277 and 136 days, respectively; P<0.001). The reoccurrence rate of pulmonary edema in the standard-dose group was significantly lower than in the low-dose and conventional groups (43%, 59% and 62%, respectively; P<0.05). Combination of pimobendan with a conventional treatment regimen significantly prolonged survival time after an initial episode of pulmonary edema in dogs with CHF caused by MMVD. There was no difference in survival between dogs administered standard and low doses of pimobendan, but pimobendan did prevent the reoccurrence of pulmonary edema in a dose-dependent manner.

  3. Effects of 6-minute walk test on the QT dispersion in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    惠海鹏; 许顶立; 李琦

    2003-01-01

    Objective: To investigate the clinical value of QT dispersion (QTd) and the effects of 6-minute walk test (6-MWT) mimicking the patients' daily activities on QTd in patients with congestive heart failure (CHF).Methods: Twenty-eight CHF patients and 22 normal subjects participated these study, who all completed 6-MWT without developing severe arrhythmias.Before and after 6-MWT, standardized 12-lead surface ECGs were obtained to measure QTd and corrected QTd (QTcd).Results: Both before and after 6-MWT, the QTd and QTcd in CHF patients were longer than those in the controls (P<0.001), and QTd and QTcd after 6-MWT were significantly shorter than those before 6-MWT in CHF patients (P=0.007, and 0.018).There was no significant difference in the measurement in the control group.Conclusion: QTd and QTcd are longer in CHF patients than in normal subjects.Moderate exercise may improve the inhomogeneity of ventricular repolarization dispersion in CHF patients.

  4. Cortical Brain Connectivity and B-Type Natriuretic Peptide in Patients With Congestive Heart Failure.

    Science.gov (United States)

    Vecchio, Fabrizio; Miraglia, Francesca; Valeriani, Lavinia; Scarpellini, Maria Gabriella; Bramanti, Placido; Mecarelli, Oriano; Rossini, Paolo M

    2015-07-01

    The brain has a high level of complexity and needs continuous oxygen supply. So it is clear that any pathological condition, or physiological (aging) change, in the cardiovascular system affects functioning of the central nervous system. We evaluated linear aspects of the relationship between the slowness of cortical rhythms, as revealed by the modulation of a graph connectivity parameter, and congestive heart failure (CHF), as a reflection of neurodegenerative processes. Eyes-closed resting electroencephalographic (EEG) data of 10 patients with CHF were recorded by 19 electrodes positioned according the international 10-20 system. Graph theory function (normalized characteristic path length λ) was applied to the undirected and weighted networks obtained by lagged linear coherence evaluated by eLORETA software, therefore getting rid of volumetric propagation influences. The EEG frequency bands of interest were: delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), beta 2 (20-30 Hz), and gamma (30-40 Hz). The analysis between B-type natriuretic peptide (BNP) values and λ showed positive correlation in delta, associated with a negative correlation in alpha 2 band. Namely, the higher the severity of the disease (as revealed by the BNP vales), the higher the λ in delta, and lower in alpha 2 band. Results suggest that delta and alpha λ indices are good markers of the severity of CHF.

  5. Exogenous midkine administration prevents cardiac remodeling in pacing-induced congestive heart failure of rabbits.

    Science.gov (United States)

    Harada, Masahide; Hojo, Mayumi; Kamiya, Kaichiro; Kadomatsu, Kenji; Murohara, Toyoaki; Kodama, Itsuo; Horiba, Mitsuru

    2016-01-01

    Midkine (MK), a heparin-binding growth factor, has been shown to prevent cardiac remodeling after ischemic injury through its anti-apoptotic effect. Cell apoptosis is central to the pathophysiology of cardiac remodeling in congestive heart failure (CHF) of ischemic as well as non-ischemic origin. We hypothesized that MK exerts the anti-apoptotic cardioprotective effect in CHF of non-ischemic etiology. MK protein or vehicle (normal saline) was subcutaneously administered in tachycardia-induced CHF rabbits (right ventricular pacing, 350 beats/min, 4 weeks). The vehicle-treated rabbits (n = 19, control) demonstrated severe CHF and high mortality rate, whereas MK (n = 16) demonstrated a well-compensated state and a lower mortality rate. In echocardiography, left ventricular (LV) end-diastolic dimension decreased in MK versus control, whereas LV systolic function increased. In histological analysis (picrosirius red staining), MK decreased collagen deposition area compared with control. TUNEL staining showed that MK prevented cell apoptosis and minimized myocyte loss in the CHF rabbit ventricle, associated with activation of PI3-K/Akt signaling, producing a parallel decrease of Bax/Bcl-2 ratio. MK prevented progression of cardiac remodeling in the CHF rabbit, likely by activation of anti-apoptotic signaling. Exogenous MK application might be a novel therapeutic strategy for CHF due to non-ischemic origin.

  6. Management of congestive heart failure: a gender gap may still exist. Observations from a contemporary cohort

    Directory of Open Access Journals (Sweden)

    Weller Iris

    2003-02-01

    Full Text Available Abstract Background Unlike other cardiovascular diseases the incidence and prevalence of congestive heart failure (CHF continues to increase. While gender differences in coronary artery disease have been well described, to date, there has been a relative paucity of similar data in patients with CHF. We conducted a pilot study to evaluate the profile and management of patients with CHF at a tertiary care centre to determine if a gender difference exists. Methods A chart review was performed at a tertiary care centre on consecutive patients admitted with a primary diagnosis of CHF between June 1997 and 1998. Co-morbidity, diagnostic investigations, and management of CHF were recorded. Comparisons between male and female patients were conducted. Results One hundred and forty five patients were reviewed. There were 80 male (M and 65 female (F patients of similar age [71.6 vs. 71.3 (M vs. F, p = NS]. Male patients were more likely to have had a previous myocardial infarction (66% vs. 35%, p Conclusions This pilot study demonstrated that there seem to be important gender differences in the profile and management of patients with CHF. Importantly women were less likely to have an evaluation of LV function. As assessment of LV function has significant implications on patient management, this data justifies the need for larger studies to assess gender differences in CHF profile and treatment.

  7. A case of ACTH-independent bilateral macronodular adrenal hyperplasia and severe congestive heart failure.

    Science.gov (United States)

    Suri, D; Alonso, M; Weiss, R E

    2006-11-01

    Cortisol secretion in ACTH independent bilateral macronodular adrenal hyperplasia (AIMAH) can be regulated by aberrant adrenal receptors. We describe a patient with Cushing's syndrome (CS) due to AIMAH and concomitant Class IV congestive heart failure (CHF). Clinical testing for the presence of aberrant receptors revealed a pronounced serum cortisol (257%) and aldosterone response (212%) to the administration of ACTH and a partial serum cortisol (35%) and aldosterone (106%) response to upright posture. This suggested the possible presence of aberrant hormone receptors for ACTH [melanocortin 2 receptor (MC2-R)], vasopressin, catecholamines or angiotensin II (AT-II) on the patient's adrenal glands. Adrenal tissue from the patient demonstrated an eight-fold increased expression of MC2-R compared to normal adrenal tissue. This increased expression was consistent with the increase in cortisol and aldosterone seen in response to exogenous ACTH. We propose that the severe CHF resulted in activation of the renin-angiotensin system, with an increased production of AT-II. The elevated circulating levels of AT-II may have led to increased expression of MC2-R on the patient's adrenal glands and increased responsiveness to ACTH. This unusual case of CS may elucidate a heretofore unknown mechanism for the development of AIMAH.

  8. Hemostatic Markers in Congestive Heart Failure Dogs with Mitral Valve Disease

    Directory of Open Access Journals (Sweden)

    Kreangsak Prihirunkit

    2014-01-01

    Full Text Available Prothrombin time (PT, activated partial thromboplastin time (APTT, fibrinogen, D-dimer, antithrombin III (AT III, protein C (PC, factor VII (F.VII, and factor VIII (F.VIII, as well as hematocrit (HCT, platelets number (PLT, total plasma protein (TP, and albumin (ALB, were studied on fifty-eight congestive heart failure (CHF dogs with mitral valve disease (MVD and fifty control dogs. All of variables of MVD group, except APTT, were significantly different (P<0.5 from control group. The variables were also compared among functional classes of CHF dogs and control dogs. It was determined that the higher the functional class of CHF dogs was, the greater the levels of fibrinogen and D-dimer were, whereas the lesser the activities of AT III and PC were presented. Additionally, TP had linear correlation with fibrinogen, D-dimer, HCT, and PLT (r=0.31, 0.30, 0.43, and 0.38, resp., P<0.5. These findings suggested that fibrinogen and D-dimer were the factors predisposing hypercoagulability through an increase in blood viscosity. The hemorheological abnormalities would shift an overall hemostatic balance toward a more thrombotic state in CHF dogs with MVD.

  9. A Comparison of Selenium Concentrations Between Congestive Heart Failure Patients and Healthy Volunteers

    Directory of Open Access Journals (Sweden)

    Ali Ghaemian

    2012-06-01

    Full Text Available Background: Selenium (Se is an essential trace element mainly obtained from seafood, meat, and cereals. Se deficiency has been identified as a major contributing factor in the pathogenesis of certain congestive heart failure (CHF syndromes. Since there is controversy over the prevalence of Se deficiency among patient with CHF, the aim of this study was to assess the serum Se concentrations in patients with CHF and compared them with the Se status of healthy controls.Methods: The study included 77 patients (age, 68.4 ± 10.4 years old; 40.3% female and 73 healthy volunteers (64.9 ± 4.7 years old; 35.6% female. A complete medical/drug history and physical examination were performed for all patients and healthy volunteers. All patients had symptoms and signs of CHF and had a left ventricular ejection fraction (EF of < 40% obtained by echocardiography. The Se concentration was assessed by atomic absorption spectrometer with the Graphite Tube Atomizer. The limit of measurement was 5 μg/L. Results: The Se concentrations in CHF patients did not show a significant difference from those of healthy controls (185.9 ± 781.2 μg/L vs. 123.3 ± 115.5 μg/L, respectively; p value = 0.499. There was no correlation between serum Se concentrations and EF in both the normal group and the patients with heart failure (p value = 0.96 and 0.99; r = 0.006 and 0.002 for patients and healthy volunteers, respectively.Conclusion: In this study, serum Se levels in CHF patients were similar to those of controls and the Se concentrations did not correlate with the degree of left ventricular dysfunction.

  10. Pharmacodynamic models for the cardiovascular effects of moxonidine in patients with congestive heart failure

    Science.gov (United States)

    Brynne, Lena; McNay, John L; Schaefer, Hans G; Swedberg, Karl; Wiltse, Curtis G; Karlsson, Mats O

    2001-01-01

    Aims To assess the pharmacodynamics of moxonidine in patients with functional NYHA Class II-III congestive heart failure (CHF). Methods A parallel population pharmacokinetic/pharmacodynamic (PK/PD) analysis was performed to assess the effect of moxonidine (0.1, 0.2, 0.3 mg twice daily) and placebo treatment on plasma noradrenaline (NA) levels, standing systolic blood pressure (SBP), and heart rate (HR) over 12 weeks in 97 patients with CHF using a parallel group design with dose escalation. A sequential analysis was also developed, where the relative changes in NA concentration were related to both SBP and HR. Results In the parallel PD analysis, an effect delay was shown for all three end points (NA, SBP, and HR). An inhibitory Emax model was used to characterize the concentration-effect relationships. For SBP and HR, the EC50 value increased over time. For NA, there was a positive baseline drift over the 12 weeks; this was interpreted as disease progression. Moxonidine delayed this increase by 9.8 weeks. For SBP, there was a circadian pattern at baseline. In the sequential PD analysis, the relationship between the drug response (NA) and SBP or HR was best described by an inhibitory Emax model. No effect delays between the response and effects were found. Conclusions Effects of moxonidine on NA, SBP, and HR could be quantified by an effect compartment model in the presence of disease progression and circadian variations. Disease progression, as judged by increasing NA levels with time, was delayed by moxonidine. A direct relationship was found between NA and SBP/HR. PMID:11167663

  11. Effect of dofetilide on QT dispersion and the prognostic implications of changes in QT dispersion for patients with congestive heart failure

    DEFF Research Database (Denmark)

    Brendorp, Bente; Elming, Hanne; Jun, Li;

    2002-01-01

    AIMS: Drug-induced changes in QT dispersion may be a way of detecting harmful repolarisation abnormalities for patients receiving antiarrhythmic drugs affecting ventricular repolarisation. METHODS AND RESULTS: In 463 congestive heart failure (CHF) patients enrolled in the Danish Investigations...

  12. Acquired post-traumatic aortic coarctation presenting as new-onset congestive heart failure: treatment with endovascular repair.

    Science.gov (United States)

    Thompson, Norris B; Hamidian Jahromi, Alireza; Ballard, David H; Rao, Vyas R; Samra, Navdeep S

    2015-01-01

    Acquired coarctation of the thoracic aorta is a rare phenomenon in adults. The etiology is often idiopathic, but severe stenosis can develop from prior surgery, blunt thoracic aortic injuries, or severe atherosclerotic/atheroembolic disease. Common symptomatic presentations include refractory upper extremity hypertension and new-onset congestive heart failure. We present the case of a 52-year-old man who developed acquired thoracic aortic coarctation 30 years after a blunt trauma and deceleration injuries to the aorta requiring open surgical aortic repair. He presented with poorly controlled hypertension and new-onset heart failure and was treated surgically with endovascular repair.

  13. Effect of age on short and long-term mortality in patients admitted to hospital with congestive heart failure

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Torp-Pedersen, Christian; Seibaek, Marie

    2004-01-01

    function the RR was 1.57 (1.43-1.72, multivariate analyses). CONCLUSION: The clinical characteristics of CHF patients vary considerably with age. Elderly patients hospitalised with CHF face a very grave prognosis, particularly if their heart failure symptoms are caused by LV systolic dysfunction.......AIMS: To describe the association between age and risk factors in patients hospitalised with congestive heart failure (CHF) and to determine the effect of age on mortality. METHODS AND RESULTS: Consecutive patients admitted to 34 hospitals with CHF during a period of 2 years were registered. Mean...

  14. Effect of diosmin on chronic nonbacterial prostatitis caused by pelvic congestion in rats

    Directory of Open Access Journals (Sweden)

    Gong-ting CUI

    2014-08-01

    Full Text Available Objective To explore the effect of diosmin on chronic nonbacterial prostatitis (CNP in rats and its possible mechanisms. Methods Thirty-two healthy adult male SD rats were randomly divided into 4 groups: Sham-operated group (SO group, chronic prostatitis model group (CPM group, chronic prostatitis model + prostat treatment group (CPM-P group, and chronic prostatitis model + diosmin treatment group (CPM-D group. Rats in SO group underwent laparotomy only to expose the prostate, and those in other groups received prostatic vein ligation to reproduce pelvic congestion. HE staining was used for the examination of the prostate 35 days after the operation. 80mg/(kg.d of diosmin was given to the rats in CPM-D group, and 60mg/(kg.d of diosmin to the rats in CPM-P group twice a day by gavage for 7 days. Same volume of 5% acacia gum was given to rats in SO and CPM groups. All of the rats were sacrificed 1h after the last administration, and the serum levels of interleukin-10 (IL-10, IL-8, IL-1β, malondialdehyde (MDA, nitric oxide (NO were determined by ELISA, and the pathological changes in the prostate tissue were observed after HE staining and compared between the groups. Results The serum levels of IL-1β, IL-8 and NO were significantly lower in CPM-D group and CPM-P group than in CPM group (P<0.05, the serum level of IL-10 was significantly higher in CPM-D group and CPM-P group than in CPM group (P<0.05, and the serum MDA level was similar between the 3 groups. HE staining showed that chronic inflammatory changes in rats' prostate were reduced more significantly in CPM-P group and CPM-D group than in CPM group. Conclusion The therapeutic effect of diosmin on pelvic-congestion-induced chronic prostatitis is similar to that of prostat tablets, and its mechanism may be related to the alleviation of local inflammatory response by reducing the IL-1β, IL-8 and NO levels and increasing the IL-10 content in serum. DOI: 10.11855/j.issn.0577-7402.2014.06.04

  15. A case of juvenile acromegaly that was initially diagnosed as severe congestive heart failure from acromegaly-induced dilated cardiomyopathy.

    Science.gov (United States)

    Sue, Mariko; Yoshihara, Aya; Okubo, Yoichiro; Ishikawa, Mayumi; Ando, Yasuyo; Hiroi, Naoki; Shibuya, Kazutoshi; Yoshino, Gen

    2010-01-01

    Acromegaly is characterized by chronic hypersecretion of growth hormone (GH) and is associated with increased mortality rate because of the potential complications such as cardiovascular disease, respiratory disease, or malignancy, which are probably caused by the long-term exposure of tissues to excess GH, for at least 10 years, before diagnosis and treatment. A 22-year-old man with a 2-month history of fatigue was admitted to our hospital because of chest discomfort, dyspnea, and pitting edema of the lower limbs experienced over a 1-month period. On admission, his height and body weight were 186 cm and 138.5 kg, respectively, with a BMI of 39.8 kg/m(2). He showed acromegalic features and elevated serum GH and IGF-1 levels, which were 11.5 ng/mL and 960 ng/mL, respectively. There was no GH suppression in the 75-g oral glucose tolerance test. Pituitary magnetic resonance imaging (MRI) revealed microadenoma. Chest X-ray revealed cardiomegaly, and echocardiogram showed dilated left ventricular (LV) cavity and diffuse hypokinesis with extremely decreased ejection fraction (EF). He was diagnosed as having acromegaly with congestive heart failure from diastolic cardiomyopathy. After the successful transsphenoidal resection of the pituitary adenoma, the level of GH was normalized. However, the cardiac dysfunction did not show any improvement even after the administration of β-blockers, angiotensin-converting enzyme inhibitor (ACE-I), or diuretics. The patient was re-hospitalized, and he died of cardiac failure at the age of 25 years. Patients with acromegaly have been reported to have about 30% higher mortality rate, and cardiovascular disease accounts for 60% of the deaths. We report a case of a patient with juvenile acromegaly who was diagnosed with severe cardiac failure at the time of diagnosis and failed to recover cardiac function even after the successful resection of the pituitary adenoma. Immediate diagnosis and treatment are required for better control of

  16. Relation of systemic and local muscle exercise capacity to skeletal muscle characteristics in men with congestive heart failure

    Science.gov (United States)

    Massie, B. M.; Simonini, A.; Sahgal, P.; Wells, L.; Dudley, G. A.

    1996-01-01

    OBJECTIVES. The present study was undertaken to further characterize changes in skeletal muscle morphology and histochemistry in congestive heart failure and to determine the relation of these changes to abnormalities of systemic and local muscle exercise capacity. BACKGROUND. Abnormalities of skeletal muscle appear to play a role in the limitation of exercise capacity in congestive heart failure, but information on the changes in muscle morphology and biochemistry and their relation to alterations in muscle function is limited. METHODS. Eighteen men with predominantly mild to moderate congestive heart failure (mean +/- SEM New York Heart Association functional class 2.6 +/- 0.2, ejection fraction 24 +/- 2%) and eight age- and gender-matched sedentary control subjects underwent measurements of peak systemic oxygen consumption (VO2) during cycle ergometry, resistance to fatigue of the quadriceps femoris muscle group and biopsy of the vastus lateralis muscle. RESULTS. Peak VO2 and resistance to fatigue were lower in the patients with heart failure than in control subjects (15.7 +/- 1.2 vs. 25.1 +/- 1.5 ml/min-kg and 63 +/- 2% vs. 85 +/- 3%, respectively, both p twitch, type I fibers than did control subjects (36 +/- 3% vs. 46 +/- 5%, p = 0.048) and a higher proportion of fast twitch, type IIab fibers (18 +/- 3% vs. 7 +/- 2%, p = 0.004). Fiber cross-sectional area was smaller, and single-fiber succinate dehydrogenase activity, a mitochondrial oxidative marker, was lower in patients (both p twitch to slow twitch fiber cross-sectional area was lower in patients (0.780 +/- 0.06 vs. 1.05 +/- 0.08, p = 0.019). Peak VO2 was strongly related to integrated succinate dehydrogenase activity in patients (r = 0.896, p = 0.001). Peak VO2, resistance to fatigue and strength also correlated significantly with several measures of fiber size, especially of fast twitch fibers, in patients. None of the skeletal muscle characteristics examined correlated with exercise capacity in control

  17. Low-dose carvedilol reduces transmural heterogeneity of ventricular repolarization in congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Jiang-hua ZHONG; Xiao-pan CHEN; Mei-ling YUN; Wei-jing LI; Yan-fang CHEN; Zhen YAO

    2007-01-01

    Aim: To study the effects of carvedilol on the transmural heterogeneity of ven-tricular repolarization in rabbits with congestive heart failure (CHF). Methods:Rabbits were randomly divided into 3 groups: control, CHF and carvedilol treated CHF group. Monophasic action potential duration (MAPD) in the 3 myocardial layers was simultaneously recorded. Results: All the rabbits in the CHF group had signs of severe CHF. Compared with the control group, the mean blood pressure and cardiac output were significantly decreased, while peripheral resis-tance was significantly increased in the CHF group. This proved that the CHF model was successful created with adriamycin in this study. Compared to the control group, the ventricular fibrillation threshold (VFT) was remarkably decreased and all MAPD of the 3 myocardial layers were extended in rabbits with CHF. However, the extension of MAPD in the midmyocardium was more obvious. The transmural dispersion of repolarization (TDR) was significantly increased in CHF.Low-dose carvedilol (0.25 mg/kg, twice daily) had no effects on ventricular remodeling. Treatment with low-dose carvedilol significantly increased VFT. Al-though the MAPD of the 3 myocardial layers were further prolonged in the carvedilol treated CHF group, the prolongation of MAPD in the midmyocardium was shorter than those in the epicardium and endocardium. Treatment with low-dose carvedilol significantly decreased TDR in CHF. Conclusion: In the present study, the trans-mural heterogeneity of ventricular repolarization increased in the rabbits with CHF. Low-dose carvedilol decreased the transmural heterogeneity of ventricular repolarization in CHF, which may be related to its direct electrophysiological pro-perty rather than its effect on ventricular remodeling.

  18. Efficacy of adaptive servoventilation in patients with congestive heart failure and Cheyne-Stokes respiration

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Congestive heart failure (CHF) is associated with Cheyne-Stokes respiration (CSR), which may hasten CHF. Adaptive servoventilation (ASV) is a novel method of ventilatory support designed for removal of CSF in CHF patients. This study compares the efficacy of ASV in patients with CHF and CSR with the efficacy of oxygen therapy. Methods Fourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were each performed for two weeks. Comparison before and after each treatment was made for the following items: a) parameters of sleep respiration, sleep structure and quality; b) left ventricle ejection fraction (LVEF) and 6-minute walk distance. Results Compared with the baseline levels of apnoea hypopnoea index of 34.5±6.1 before treatment, the apnoea hypopnoea index significantly decreased following oxygen therapy to 27.8±8.2, P 0.05). LVEF was significantly higher on day 14 of ASV treatment (37.2±4.1)% than on day 14 of oxygen therapy (33.2±5.1)% and before treatment (30.2±4.6)% (all P<0.05). Six-minute walk distance was the shortest before treatment (226±28) m, longer on day 14 of oxygen therapy (289±26) m, and the longest on day 14 of ASV treatment (341±27) m (all P < 0.01). Conclusion ASV treatment is of better efficacy and greater clinical significance in improvement of CHF by eliminating CSR than oxygen therapy.

  19. Computerized lung sound analysis following clinical improvement of pulmonary edema due to congestive heart failure exacerbations

    Institute of Scientific and Technical Information of China (English)

    WANG Zhen; XIONG Ying-xia

    2010-01-01

    Background Although acute congestive heart failure (CHF) patients typically present with abnormal auscultatory findings on lung examination, lung sounds are not normally subjected to rigorous analysis. The goals of this study were to use a computerized analytic acoustic tool to evaluate lung sound patterns in CHF patients during acute exacerbation and after clinical improvement and to compare CHF profiles with those of normal individuals.Methods Lung sounds throughout the respiratory cycle was captured using a computerized acoustic-based imaging technique. Thirty-two consecutive CHF patients were imaged at the time of presentation to the emergency department and after clinical improvement. Digital images were created, geographical area of the images and lung sound patterns were quantitatively analyzed.Results The geographical areas of the vibration energy image of acute CHF patients without and with radiographically evident pulmonary edema were (67.9±4.7) and (60.3±3.5) kilo-pixels, respectively (P <0.05). In CHF patients without and with radiographically evident pulmonary edema (REPE), after clinical improvement the geographical area of vibration energy image of lung sound increased to (74.5±4.4) and (73.9±3.9) kilo-pixels (P <0.05), respectively. Vibration energy decreased in CHF patients with REPE following clinical improvement by an average of (85±19)% (P <0.01). Conclusions With clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image. Lung sound analysis may be useful to track in acute CHF exacerbations.

  20. Compromised Global and Regional Cerebral Blood Flow in Congestive Heart Failure

    Energy Technology Data Exchange (ETDEWEB)

    Kim, J. S.; Kim, J. J.; Im, K. C.; Moon, D. H. [College of Medicine, Univ. of Ulsan, Seoul (Korea, Republic of)

    2003-07-01

    It has been known that cerebral perfusion is maintained in patients with congestive heart failure (CHF) by a complex series of compensatory mechanisms. However cognitive impairment is a common problem experienced by patients with CHF and may result from deranged cerebral perfusion. We prospectively investigated the global and regional CBF of patients with CHF and compared the results with that of normal controls. Thirty two patients (M/F: 22/10, 4211 yr) with CHF (LVEF=218.1%) and 10 healthy controls (M/F: 6/4, 398 yr) were prospectively studied. No patients had cerebrovascular disease or other disease affecting cognitive function. All patients and normal controls underwent radionuclide angiography including cerebral hemispheres and aortic arch, and brain perfusion SPECT using Tc-99m ECD. Global CBF was measured non-invasively by the application of Patlak plot graphical analysis. Quantitative rCBF images were obtained from SPECT image using global CBF values, regional/global count ratios, and Lassen's linearization correction algorithm. Difference of regional CBF between CHF and normal control were assessed using a SPM99 without global count normalization (uncorrected p<0.0001, extent threshold>100 voxels). Global CBF (41.54.7 ml/min/100g) of the patients with CHF were significantly lower than those (49.15.7 ml/min/100g) of controls (p<0.001). Regional CBF was significantly decreased in frontal, temporal and parietal neocortex of both cerebral hemispheres compared to normal controls. Regional rCBF of basal ganglia, thalamus, and brain stem were preserved, even though global CBF was variably compromised. Our study show that global CBF is significantly decreased in CHF and regional CBF of frontal, parietal and temporal neocortex is compromised preferentially. Further studies would be needed to investigate the relationship of rCBF change and cognitive impairment in patients with CHF.

  1. 慢性充血性心力衰竭患者血清syndecan-4水平及临床意义%Changes and clinical significance of serum level of syndecan-4 protein in patients with chronic congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    马晓玲; 欧阳平; 张志能; 赖文岩; 许顶立

    2013-01-01

    Objective To detect serum level of syndecan-4 protein in patients with chronic congestive heart failure (CHF) and investigate its correlation with New York Heart Association (NYHA) class and echocardiographic parameters.Methods The concentration of serum syndecan-4 protein was measured by enzyme-linked immunosorbent assay (ELISA) in 40 patients with CHF and 40 healthy controls (NCD),respectively.The parameters such as left ventricle ejection fraction (LVEF),fraction shortening (FS),left ventricle end-diastolic diameter (LVDd),left ventricle end-systolic diameter (LVDs),left ventricle end-diastolic volume (LVEDV) and left ventricle end-systolic volume (LVESV) were detected by echocardiography in 40 patients of CHF.Meanwhile,the patients' cardiac function was graded according to NYHA class.Results The levels of serum syndecan-4 protein significantly increased in CHF group as compared with control group (P<0.01).In CHF group,as the increased grading of NYHA cardiac function,the levels of serum syndecan-4 protein significantly increased (P <0.05).The more upgraded the NYHA grading,the higher level of serum syndecan-4 protein.In bivariate correlations analysis showed that the level of serum syndecan-4 protein was significantly negatively correlated with LVEF and FS (P <0.05) and was significantly positively correlated with LVDd,LVDs,LVEDV and LVESV,respectively (P < 0.05).Conclusion Serum syndecan-4 concentration significantly increased in CHF patients,and it was closely correlated with NYHA class and left ventricle function parameters,so the level of serum syndecan-4 protein may have an important value in detection and surveillance of CHF.%目的 探讨慢性充血性心力衰竭(CHF)患者血清中syndecan-4浓度变化与CHF NYHA心功能分级及超声心动图指标变化的关系.方法 选择40名CHF患者和40位健康人;用ELISA检测外周血中的syndecan-4浓度,超声心动图测定左室射血分数(LVEF)、左室短轴缩短率(FS)、左室舒

  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......Atrial fibrillation is a growing health problem and the most common cardiac arrhythmia, affecting 5% of persons above the age of 65 years. The number of hospital discharges for atrial fibrillation has more than doubled in the past decade. It occurs very often in patients with congestive heart...

  3. Effect of repeated intracoronary injection of bone marrow cells in patients with ischaemic heart failure the Danish stem cell study - congestive heart failure trial (DanCell-CHF)

    DEFF Research Database (Denmark)

    Diederichsen, A.C.; Møller, Jacob Eifer; Thayssen, P.;

    2008-01-01

    BACKGROUND: It has been suggested that myocardial regeneration may be achieved by a single intracoronary bone marrow derived stem cell infusion in selected patients with ischaemic heart disease. The effect is uncertain in patients with chronic ischaemic heart failure and it is not known whether...... repeated infusions would have additional positive effects. AIMS: To assess whether two treatments of intracoronary infusion of bone marrow stem cells, administered 4 months apart, could improve left ventricular (LV) systolic function in patients with chronic ischaemic heart failure. METHODS: The study......, NYHA class improved (pstem cell treatment in patients with chronic ischaemic heart failure Udgivelsesdato: 2008/7...

  4. Occurrence, aetiology and challenges in the management of congestive heart failure in sub-saharan Africa: experience of the Cardiac Centre in Shisong, Cameroon

    Directory of Open Access Journals (Sweden)

    Tantchou Tchoumi Jacques Cabral

    2011-02-01

    Full Text Available INTRODUCTION: The aim of the study was to investigate the occurrence, the aetiology and the management of congestive heart failure in the cardiac centre of the St. Elizabeth catholic general hospital Shisong in Cameroon. METHODS: Between November 2002 and November 2008, a population of 8121 patients was consulted in the referral cardiac centre of St. Elizabeth Catholic General Hospital. Of these patients, 462 were diagnosed with congestive heart failure according to the modified Framingham criteria for the diagnosis of heart failure. Complementary investigations used to confirm and establish the aetiology of the disease were the chest X-ray, electrocardiography, bi-dimensional Doppler echocardiography. RESULTS: The results showed that the occurrence of congestive heart failure in our centre was 5,7%. Congestive heart failure was diagnosed in 198 females and 264 males, aged between 8 and 86 years old (42.5, plus or minus 18 years old. Post rheumatic valvulopathies (14.6% and congenital heart diseases (1.9% were the first aetiologic factor of congestive heart failure in the young, meanwhile cardiomyopathies (8,3% in elderly followed by hypertensive cardiomyopathy (4.4%. Congestive heart failure was also seen in adults with congenital heart diseases in 0.01%. In this zone of Cameroon, we discovered that HIV cardiomyopathy (1.6% and Cor pulmonale (8% were represented, aetiological factors not mentioned in previous studies conducted in urban areas of Cameroon. The mean duration of hospital stay for the compensation treatment was thirteen days, ranging between 7 and 21 days, the mortality being 9.2%. All the medications recommended for the treatment of congestive heart failure are available in our centre but many patients are not compliant to the therapy or cannot afford them. Financial limitation is causing the exacerbation of the disease and premature death. CONCLUSION: Our data show a high incidence of congestive heart failure mainly due to post

  5. The prognostic analysis of dose adjustment for beta blockers in the acute exacerbation of chronic congestive heart failure in the elderly%老年慢性充血性心力衰竭急性加重期患者美托洛尔剂量调整的临床研究

    Institute of Scientific and Technical Information of China (English)

    陈春泉; 王敏; 李庆丰; 翁小雁; 陈积党

    2015-01-01

    Objective To evaluate the effects and the prognosis of beta receptor blocker (metoprolol)dose adjustment of senile patients with chronic congestive heart failure (CHF)of acute exacerbation,and to provide reference for clinical treatment.Methods 76 cases with chronic CHF in acute exacerbation who treated with beta blockers and other reasonable treatment were randomly divided into half dose group (40 cases)and full stop group (36 cases).After adjusted for 3 months,the clinical symptoms were observed,noninvasive hemodynamic machine was used to detect cardiac index (CI),left cardiac work (LCW),cardiac output (CO)and changes of other indicators. Immunoradiometric analysis was used to detect plasma type B natriuretic peptide (BNP).Results 72h after treatment,in the half dose group,the progression of the disease in 13 cases,improved in 27 cases,in the full stop group,progression in 20 cases,improvement in 16 cases,the difference was statistically significant (χ2 =4.09,P <0.05).Before the adjustment of metoprolol,the index of the two groups had statistically significant difference(χ2 =4.52,P <0.05 ).Compared with pretreatment,the changes of NYHA classification,Co,CI,LCW of the half dose group were not obvious,and he change of NYHA of the full stop group was obvious,,III /IV the progression of the disease the number of cases increased in 5 cases and 3 cases,Co,Ci,LCW were reduced by about 25%,35% and 30%.After the adjustment of metoprolol,BNP of the half dose group was (321.8 ±97.6 )mg/L,which was significantly lower than (422.3 ±139.4)mg/L of the full stop group,the difference was statistically significant (t =3.94,P <0.05 ).Conclusion In the patients with beta blockers combined with other reasonable treatment, CHF patients with acute exacerbation of the beta blockers than the discontinuation of the prognosis,and the safety is high.%目的:评价美托洛尔剂量调整对老年人慢性充血性心力衰竭急性加重期的临床疗效和对预后的影响,为

  6. 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

  7. New pharmacological strategies in chronic heart failure

    NARCIS (Netherlands)

    van de Wal, RMA; Voors, AA; Plokker, HWM; van Gilst, WH; van Veldhuisen, DJ

    2004-01-01

    Diuretics, ACE inhibitors and betablockers form the cornerstone of pharmacological treatment of chronic heart failure (CHF), while angiotensin receptor blockers are gaining ground. However, despite optimal treatment CHF remains a syndrome with poor prognosis. For this reason, a large number of new a

  8. Gas exchange during exercise in different evolutional stages of chronic Chagas' heart disease

    Directory of Open Access Journals (Sweden)

    Fátima Palha de Oliveira

    2000-12-01

    Full Text Available OBJECTIVE: To compare gas exchange at rest and during exercise in patients with chronic Chagas' heart disease grouped according to the Los Andes clinical/hemodynamic classification. METHODS: We studied 15 healthy volunteers and 52 patients grouped according to the Los Andes clinical/hemodynamic classification as follows: 17 patients in group IA (normal electrocardiogram/echocardiogram, 9 patients in group IB (normal electrocardiogram and abnormal echocardiogram, 14 patients in group II (abnormal electrocardiogram/echocardiogram, without congestive heart failure, and 12 patients in group III (abnormal electrocardiogram/echocardiogram with congestive heart failure. The following variables were analyzed: oxygen consumption (V O2, carbon dioxide production (V CO2, gas exchange rate (R, inspiratory current volume (V IC, expiratory current volume (V EC, respiratory frequency, minute volume (V E, heart rate (HR, maximum load, O2 pulse, and ventilatory anaerobic threshold (AT. RESULTS: When compared with the healthy group, patients in groups II and III showed significant changes in the following variables: V O2peak, V CO2peak, V ICpeak, V ECpeak, E, HR, and maximum load. Group IA showed significantly better results for these same variables as compared with group III. CONCLUSION: The functional capacity of patients in the initial phase of chronic Chagas' heart disease is higher than that of patients in an advanced phase and shows a decrease that follows the loss in cardiac-hemodynamic performance.

  9. Increase in cardiac P2X1-and P2Y2-receptor mRNA levels in congestive heart failure

    DEFF Research Database (Denmark)

    Hou, M; Malmsjö, M; Möller, S;

    1999-01-01

    We wanted to study the expression of P2-receptors at the mRNA-level in the heart and if it is affected by congestive heart failure (CHF). To quantify the P2 receptor mRNA-expression we used a competitive RT-PCR protocol which is based on an internal RNA standard. The P2 receptor m...

  10. 阿托伐他汀对慢性充血性心力衰竭患者外周血Toll样受体表达的影响%Effect of atorvastatin on toll-like receptor 4 expression in peripheral blood of patients with chronic congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    吴炎; 蒲红

    2012-01-01

    Objective To study the changes of toll-like receptor 4 (TLR4) expression In peripheral blood mononuclear cells (PBMCs) in the patients with chronic congestive heart failure (CCHF) after application of atorvastatin. Methods Eighty in-hospital CCHF patients were randomly divided into routine treatment group and atorvastatin group (n = 40). All the patients received routine treatment of CCHF. Moreover, the patients in atorvastatin group took atorvastatin (20 mg/d) orally. Forty healthy subjects were regarded as normal control. TLR4 expression in PBMCs was measured by flow cytometry and serum tumor necrosis factor (TNF)-α was detected by ELISA before treatment and one month after treatment. The correlation between TLR4 expression and TNF-α level was analyzed. Results Before treatment, TLR4 expression in routine treatment group and atorvastatin group was significantly higher than that in normal control (both P<0.05) and positively correlated with TNF-α level (r = 0.076, P<0.05). TLR4 expression and TNF-α level were significantly decreased one month after treatment (all P<0. 05). Conclusion CCHF may be associated with enhanced expression of TLR4. Atorvastatin can significantly decrease TLR4 expression in PBMCs, which indicates that the anti-inflammatory effect caused by atorvastatin may be partially due to down-regulation of TLR4-mediated immune reaction.%目的 探讨慢性充血性心力衰竭(CCHF)患者外周血单个核细胞Toll样受体4(TLR4)表达改变情况及阿托伐他汀对其的干预效应.方法 选取80例CCHF住院患者,其中40例按照标准治疗方案进行治疗(标准治疗组);另外40例在标准治疗的基础上口服阿托伐他汀20 mg/d(阿托伐他汀组).40名健康者为对照组.在治疗前和治疗后1个月,应用流式细胞仪检测外周血单个核细胞表面TLR4的表达,采用酶联免疫吸附试验检测血清肿瘤坏死因子(TNF)-α水平;并对TLR4的表达与血清TNF-α水平进行相关性分析.结果 标

  11. Common variants in IL-17A/IL-17RA axis contribute to predisposition to and progression of congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    CHAUGAI Sandip; TAN Lun; HUANG Jin; LI Qing; NI Li; Katherine CIANFLONE; WANG Dao-wen

    2016-01-01

    AIM:Heart failure is characterized by immune activation leading to production and release of proinflammatory cytokines .Inter-leukin 17A (IL-17A) is a proinflammatory cytokine and multiple lines of evidence from animal and human studies suggest crucial roles of IL-17A in heart failure.Therefore, we investigated whether common polymorphisms of genes IL17A and IL17RA (coding interleukin 17 receptor A) gene contribute to genetic predisposition to heart failure and adverse clinical outcomes associated with it .METHODS AND RESULTS:A total of 1713 adults patients with congestive heart failure and 1713 age-and sex-matched controls were genotyped for promoter SNPs, rs2275913 and rs8193037 in IL17A and rs4819554 in IL17RA, to assess the relationship between individual SNPs and the risk of congestive heart failure .Results showed that rs8193037 in IL17A was associated with the risk of congestive heart failure (P<0.01) after adjustment for multiple cardiovascular risk factors including age , sex, smoking status, diabetes, hypertension and dyslipidemia.This association was evident in both ischemic and non-ischemic heart failure (P<0.05).Furthermore, prospective fol-low-up of 12.7 months for the occurrence of adverse clinical outcomes showed that rs 4819554 in IL17RA was significantly associated with cardiovascular mortality (P<0.05) after adjustments for multiple cardiovascular risk factors and New York Heart Association functional class.CONCLUSION:This study demonstrated associations of rs8193037 in the promoter of IL17A with the risk of conges-tive heart failure, and of rs4819554 in the promoter of IL17RA with the risk of cardiovascular mortality in patients with congestive heart failure.These data lend further support to the notion that immune activation and genetic polymorphisms contribute to heart failure path -ogenesis and progression .

  12. Evaluation of the efficacy of a nurse practitioner-led home-based congestive heart failure clinical pathway.

    Science.gov (United States)

    Moore, Jo-Ann Mary

    2016-01-01

    Frequent exacerbations of symptoms and financial penalties for 30-day hospital readmissions of patients with congestive heart failure (CHF) have led to new disease management approaches. A nurse practitioner (NP)-led interdisciplinary program for CHF management that included home telemonitoring and early NP assessments and interventions was piloted by a home health agency. A 4-month evaluation of the efficacy of a clinical pathway for CHF patients resulted in the enrollment of 22 CHF patients in the program. Two clients were readmitted within 30 days. The new program was effective in reducing 30-day readmission rates to 9% compared to the national average of 23%.

  13. Skills review: the CHF patient. A review of BLS ssessment and care of the congestive heart failure patient.

    Science.gov (United States)

    Brophy, John R

    2009-08-01

    As an EMT-B, there will be times when your assessment and treatment skills will be put to the test as you find yourself on scene with a critical patient and no ALS backup. Your ability to recognize patients with critical symptoms and do the most good for them within the EMT-B scope of practice could have a tremendous impact on patient survival. The importance of rapid but accurate assessment of both the clinical presentation and the patient's history cannot be overemphasized. This article will review BLS assessment and care of the congestive heart failure (CHF) patient.

  14. Cardiac MRI and Transthoracic Echocardiography of Left Ventricular Myocardial Noncompaction in A Patient with Congestive Heart Failure: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eui Min; Byun, Joo Nam [Chosun University Hospital College of Medicine, Gwangju (Korea, Republic of); Kim, Dong Hun [Soonchunhyang University Hospital Bucheon College of Medicine, Bucheon (Korea, Republic of)

    2010-11-15

    We report a case of a 38-year-old male presenting with new-onset dyspnea, that was diagnosed as left ventricular noncompaction by transthoracic echocardiographic and cardiac MR. The tests revealed left ventricular systolic dysfunction with prominent trabeculations associated with deep intertrabecular recesses and an enddiastolic noncompacted to compacted ratio of 2.5 in the whole apical wall and mid-ventricular anterolateral and inferolateral walls. Delayed gadolinium contrast-enhanced MRI revealed subepicardial mid-wall hyperenhancement of the midventricular anteroseptal and inferoseptal walls, which suggested myocardial fibrosis. We review the pathophysiology, clinical characteristics, and diagnostic approach of the left ventricular noncompaction associated with congestive heart failure

  15. Chronic heart failure part 2: treatment and management.

    Science.gov (United States)

    Brake, Rebecca; Jones, Ian David

    2017-01-11

    Chronic heart failure is a common and complex clinical syndrome that results from impaired cardiac relaxation or contraction. There have been considerable advances in the management of chronic heart failure; however, the mortality rate remains high. Patients with chronic heart failure may experience multiple debilitating symptoms, such as fatigue, pain, and peripheral oedema. However, breathlessness may be considered the most debilitating symptom. The management of chronic heart failure aims to improve the patient's quality of life by reducing symptoms and supporting the patient to manage their condition. Treatment of patients with chronic heart failure may involve a combination of pharmacological therapy, device implantation and cardiac rehabilitation. This is the second of two articles on chronic heart failure. Part 1 discussed the pathophysiology of chronic heart failure, its causes, assessment, signs and symptoms. Part 2 outlines the treatment and management of patients with the condition, including pharmacological strategies, device implantation, lifestyle modification, cardiac rehabilitation and palliative care.

  16. Isometric exercise and chronic heart failure

    Directory of Open Access Journals (Sweden)

    Efthimia Zerva

    2013-07-01

    Full Text Available The resistance exercise is an important part of all rehabilitation programs in patients with chronic heart failure. Among several kinds of resistance exercises, the one mainly applied is isotonic exercise, whereas, in the contrary, isometric is not heavily used although it affects the daily lives of patients who, trying to look after themselves (moving, walking, lifting objects, twitch in an isometric way their peripheral muscles due to reduced cardiovascular endurance. Purpose: The purpose of the present review was to present the data available so far for isometric exercise in cardiovascular patients and to examine the importance of applying this kind of exercise in rehabilitation programs in the context of, firstly, evaluation, and secondly therapeutic intervention. Material - Methods: The methodology followed included searching inquiries and reviews from international databases (Pubmed, Medline, Scopus on the effects of isometric exercise in patients with chronic heart failure. The progress and development of the studies are of particular importance to this work and, to this end, the literature refers to the entire range of time in the last three decades, from 1985 to 2012 according the key words noted. Results: In rehabilitation programs for patients with chronic heart failure, resistance exercise if applied in an isotonic way helps improve hemodynamic and functional parameters. In contrast, resistance exercise applied in an isometric way requires further investigation because most findings are related to hemodynamic disturbances. The data which is encouraging for isometric exercise programs are few and, therefore, it cannot be directly recommended as a proper way to exercise. Conclusions: Isometric exercise has an important place in the evaluation of patients with chronic heart failure, and limits should be "placed" in its application as a therapeutic tool to prevent complications.

  17. [The efficacy of ivabradine in chronic heart failure (review)].

    Science.gov (United States)

    Isakadze, A; Makharadze, T; Gvishiani, M

    2015-04-01

    This review article is devoted to the treatment of chronic heart failure (HF) with a new generation drug - ivabradine. It is well known that HF is one of the most frequent reason of high mortality worldwide. HF is characterised by cardiac remodeling, which is central in the pathophysiology of HF including hemodynamic, neurohumoral and neurohormonal mechanisms during its development and established prognostic factor in patients suffered with this disease. Despite the introduction in medical practice of many drugs for the treatment of chronic HF the lethal outcome associated with HF remains high nowadays, which can be explained by complexity of remodeling mechanisms characteristic for development of HF. Ivabradine that has been introduced in medical practice in last decade is a pure heart rate-slowing agent. A large number of studies in patients with cardiovascular disease have demonstrated that heart rate (HR) is a very important and major independent risk factor for prognosis, because lowering of HR reduces cardiac work and diminished myocardial oxygen requirement. It was shown that ivabradine a selective inhibitor of the hyperpolarisation activated sodium chanel (If) is involved in pacemaker generation and responsiveness of the sino-atrial node resulting in HR reduction without negative inotropic action. Ivabradine in chronic HF improves diastolic function and attenuates cardiac tissue hypoxia. Long-term reduction of HR induced by ivabradine reduced remodeling and preserved nitric oxide (NO) bioavailability, resulting from processes triggered early after reduction of HR. The complex therapy including ivabradine promotes HR fall, leading in reduction of attacks of a stable angina and improved quality of life. Ivabradine may target the endothelial NO production via inhibition of protein tyrosine phosphatase 1B leading to endothelial protection. HR reduction by ivabradine reduces oxidative stress, improves endothelial function and prevents development of

  18. Diálise peritoneal (DP como tratamento da insuficiência cardíaca congestiva (ICC em pacientes com doença renal crônica estágio IV Peritoneal dialysis for treating congestive heart failure in patients with stage IV chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Prompt

    2009-09-01

    Full Text Available A Insuficiência Cardíaca Congestiva (ICC é uma patologia com incidência crescente e que representa uma condição de grande impacto na saúde pública, com alta morbidade e mortalidade. O excesso de volume é uma complicação prevalente, presente em 80% dos pacientes atendidos com o diagnóstico de ICC. Estratégias farmacológicas e não farmacológicas no manejo terapêutico da ICC visam ao melhor manejo do volume e à redução no uso de diuréticos. A ultrafiltração extracorpórea tem evidenciado melhor controle de peso, redução nos dias de hospitalização e re-hospitalização dos pacientes com ICC. Neste artigo, relatamos dois casos atendidos no Hospital de Clínicas de Porto Alegre, relativos a pacientes com diagnóstico de ICC tratados com diálise peritoneal.Congestive heart failure (CHF has a growing incidence, a great impact on public health, and high morbidity and mortality. Excessive blood volume is a prevalent complication present in 80% of the patients diagnosed with CHF. Pharmacological and non-pharmacological strategies in the treatment of CHF aim to better manage blood volume and reduce the use of diuretics. Extracorporeal ultrafiltration has evidenced better weight control, and a reduction in the length of hospitalization and re-hospitalization of patients with CHF. We report the cases of 2 patients diagnosed with CHF and treated with peritoneal dialysis at Hospital de Clínicas de Porto Alegre.

  19. Sleeping and resting respiratory rates in dogs and cats with medically-controlled left-sided congestive heart failure.

    Science.gov (United States)

    Porciello, F; Rishniw, M; Ljungvall, I; Ferasin, L; Haggstrom, J; Ohad, D G

    2016-01-01

    Sleeping and resting respiratory rates (SRR and RRR, respectively) are commonly used to monitor dogs and cats with left-sided cardiac disease and to identify animals with left-sided congestive heart failure (L-CHF). Dogs and cats with subclinical heart disease have SRRmean values 40 breaths/min. Median feline RRRmean was 24 breaths/min (15-45 breaths/min); five cats had RRRmean ≥25 breaths/min; one had ≥30 breaths/min, and two had ≥40 breaths/min. These data suggest that most dogs and cats with CHF that is medically well-controlled and stable have SRRmean and RRRmean <30 breaths/min at home. Clinicians can use these data to help determine how best to control CHF in dogs and cats.

  20. Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group

    DEFF Research Database (Denmark)

    Torp-Pedersen, C; Møller, M; Bloch-Thomsen, P E;

    1999-01-01

    patients with symptomatic congestive heart failure and severe left ventricular dysfunction at 34 Danish hospitals. We randomly assigned 762 patients to receive dofetilide, a novel class III antiarrhythmic agent, and 756 to receive placebo in a double-blind study. Treatment was initiated in the hospital......BACKGROUND: Atrial fibrillation occurs frequently in patients with congestive heart failure and commonly results in clinical deterioration and hospitalization. Sinus rhythm may be maintained with antiarrhythmic drugs, but some of these drugs increase the risk of death. METHODS: We studied 1518...... (hazard ratio for the recurrence of atrial fibrillation, 0.35; 95 percent confidence interval, 0.22 to 0.57; Pcases of torsade de pointes in the dofetilide group (3.3 percent) as compared with none in the placebo group. CONCLUSIONS: In patients with congestive heart failure...

  1. Usefulness of the Sum of Pulmonary Capillary Wedge Pressure and Right Atrial Pressure as a Congestion Index that Prognosticates Heart Failure Survival (from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness Trial).

    Science.gov (United States)

    Ma, Tony S; Paniagua, David; Denktas, Ali E; Jneid, Hani; Kar, Biswajit; Chan, Wenyaw; Bozkurt, Biykem

    2016-09-15

    In the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial, use of a pulmonary artery catheter did not significantly affect advanced heart failure outcomes. However, the success of achieving the targeted hemodynamic goals of pulmonary capillary wedge pressure (PCWP) of 15 mm Hg and right atrial pressure (RAP) of 8 mm Hg and the association of these goals with clinical outcomes were not addressed. Furthermore, goals with 2 independent variables, PCWP and RAP, left room for uncertainties. We assessed the ability of a single hemodynamic target to achieve a threshold sum of PCWP and RAP as a predictor of all-cause mortality, death-or-transplantation (DT), or death-or-rehospitalization (DR) at 6 months in the pulmonary artery catheter-guided treatment arm of ESCAPE (n = 206). Patients with a posttreatment PCWP + RAP of <30 mm Hg had characteristics similar to those of the population who achieved the ESCAPE hemodynamic goals. This group had 8.7% mortality, 13.0% DT, and 58.7% DR at 6 months. The contrasting cohort with PCWP + RAP of ≥30 mm Hg had 45.3% mortality, 54.7% DT, and 84.9% DR at 6 months, with greater relative risk (RR) of death (RR 5.76), DT (RR 4.92), and DR (RR 1.80) and higher prevalence of jugular venous pulsation, edema, hepatomegaly, and ascites at admission and discharge. In conclusion, PCWP + RAP of 30 mm Hg posttreatment, obtained early in the index hospitalization, may represent as a simple congestion index that has prognostic value for heart failure survival and readmission rates at 6 months and as a warning signal for more aggressive intervention, thus warranting further validation.

  2. 血浆脑钠肽及脂肪酸结合蛋白水平与慢性收缩性心力衰竭关系的探讨%Investigation of the relationships among plasma B type natriuretic peptide,fatty acid binding protein and chronic congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    曹磊

    2011-01-01

    目的 测定慢性收缩性心力衰竭(CHF)患者的血浆脑钠肽(BNP)及血清脂肪酸结合蛋白(FABP)水平,探讨血浆BNP及血清FABP对CHF诊断及心功能评估的价值.方法 选择住院CHF患者60例,其中NYHA I级12例,II级18例,III级20例,IV级10例;原发疾病:冠心病30例,瓣膜性心脏病9例,扩张型心肌病10例,高血压性心脏病11例.另纳入20例健康体检者为健康对照组,分别测定BNP及FABP浓度,评价心功能.结果 CHF组血浆BNP及血清FABP水平显著高于健康对照组(PNYHA III级>NYHA II级,P均40%患者(P0.05).BNP与FABP呈正相关(r=0.801,P<0.01),两者与LVEF呈负相关(r=-0.718,r=-0.881,P<0.01).结论 血浆BNP及血清FABP测定对CHF的诊断和心功能的分级及预后判断都有重要的临床价值.%Objective To determine the plasma B type natriuretic peptide ( BNP ) and fatty acid binding protein ( FABP ) levels in patients with chronic heart failure ( CHF ), and to investigate the value of plasma BNP and FABP in diagnose of patients with chronic heart failure and in assessment of cardiac function. Methods There were 60 cases of CHF, according to NYHA classification, 12 cases were in degree of Ⅰ, 18 cases were Ⅱ, 20 were Ⅲ, 10 cases in IV. Primary disease:30 cases with CHD,9 cases with valvular heart disease,10 cases with dilated cardiomyopathy, 11 cases with hypertensive heart disease. The plasma BNP and FABP concentration in these 60 patients with chronic heart failure and 20 controls were determined, cardiac function assessment was conducted. Results Level of plasma BNP and FABP in CHF group were significantly higher than that of the control group( P < 0.01 ); and with the increase of degree of heart failure, plasma BNP and FABP levels gradually increased( NYHA Ⅳ > NYHA Ⅲ > NYHA Ⅱ, P < 0.01 ), meanwhile patients with LVEF ≤40% significantly higher than patients with LVEF > 40% ( P < 0.01 ). BNP was positively correlated with FABP( r = 0. 801, P < 0

  3. 充血性心力衰竭的中医药治疗进展%Congestive heart failure of traditional chinese medicine to progress

    Institute of Scientific and Technical Information of China (English)

    唐燕萍; 卢青; 陈新宇

    2011-01-01

    阐述了充血性心力衰竭的病因病机,从辨证论治和专方治疗两方面综述了中医药治疗充血性心力衰竭的研究进展,并对药物作用的机理研究做了概述.%Expounds congestive heart failure of the etiology and pathogenesis, syndrome differentiation and treatment from the treatment designed and reviewed the two traditional Chinese medicine for congestive heart failure is reviewed, and the mechanism of the effect of drug research is given.

  4. COMPARISON OF TREATMENT WITH LISINOPRIL VERSUS ENALAPRIL FOR CONGESTIVE-HEART-FAILURE

    NARCIS (Netherlands)

    ZANNAD, F; VANDENBROEK, SAJ; BORY, M

    1992-01-01

    The effect of lisinopril 5-20 mg once daily or enalapril 5-20 mg once daily on exercise capacity, ventricular ectopic activity, and signs and symptoms of heart failure have been studied in 278 patients with mild-to-moderate (New York Heart Association [NYHA] classes II and III) heart failure in a ra

  5. Evaluation of passive cardiomyoplasty using left- and right-ventricular volume measurements by EBCT and MRI in patients with chronic congestive heart failure; Evaluierung der passiven Kardiomyoplastie mittels links- und rechtsventrikulaerer EBCT- und MRT-Volumetrie bei Patienten mit chronischer Herzinsuffizienz

    Energy Technology Data Exchange (ETDEWEB)

    Lembcke, A.; Enzweiler, C.N.H.; Wiese, T.H.; Kivelitz, D.E.; Rogalla, P.; Hamm, B. [Inst. fuer Radiologie, Universitaetsklinikum Charite, Campus Charite Mitte, Humboldt Univ. zu Berlin (Germany); Hotz, H.; Dushe, S.; Konertz, W. [Klinik fuer Kardiovaskulaere Chirurgie, Universitaetsklinikum Charite, Campus Charite Mitte, Humboldt Univ. zu Berlin (Germany)

    2003-08-01

    Purpose: To evaluate the efficacy of passive cardiomyoplasty with the determination of biventricular volumes, global systolic function as well as left-ventricular muscle mass. Materials and Methods: In 19 patients with congestive heart failure of idiopathic or ischemic origin, a polyester mesh-graft was implanted around both ventricles for stabilization and functional support. Before and three months after surgery, 15 patients underwent EBCT and 4 patients with impaired renal function underwent MRI, for the evaluation of the volume and ejection fraction of both ventricles. Results: EBCT demonstrated a decrease from 385 to 310 ml in LV-EDV, from 312 to 242 ml in LV-ESV, from 209 to 160 ml in RV-EDV and from 149 to 87 ml in RV-ESV, and an increase from 20 to 26% in LV-EF and from 37 to 50% in RV-EF as well as a reduction of LV-MM from 300 to 274 g (p < 0.05 each). Similar results were obtained by MRI. Conclusion: Following passive cardiomyoplasty, EBCT and MRI revealed an improvement of the global systolic function as well as a reduction of biventricular volumes and left-ventricular muscle mass. (orig.) [German] Ziel: Evaluierung des Therapieerfolges der passiven Kardiomyoplastie durch Bestimmung der biventrikulaeren Volumina und global systolischen Funktion sowie der linksventrikulaeren Muskelmasse. Methoden: Bei 19 Patienten mit idiopathisch und ischaemisch bedingter Herzinsuffizienz erfolgte die Implantation eines Polyesternetzes um die Ventrikel zu deren Stabilisierung und funktioneller Unterstuetzung. Praeoperativ sowie drei Monate postoperativ wurden bei 15 Patienten durch EBCT und bei 4 Patienten mit eingeschraenkter Nierenfunktion durch MRT die Volumina und Ejektionsfraktion beider Ventrikel sowie die linksventrikulaere Muskelmasse bestimmt. Ergebnisse: Die EBCT zeigte eine Abnahme des LV-EDV von 385 auf 310 ml, des LV-ESV von 312 auf 242 ml, des RV-EDV von 209 auf 160 ml und des RV-ESV von 149 auf 87 ml, eine Zunahme der LV-EF von 20 auf 26% und der RV

  6. Change in nasal congestion index after treatment in patients with chronic rhinosinusitis with nasal polyposis

    Science.gov (United States)

    Sahin-Onder, Serap; Oysu, Cagatay; Deveci, Ildem; Sahin, Samil; Aktas, Betul

    2016-01-01

    Background: The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) involves both surgical and medical approaches, and remains a controversial subject. Objective: The objective of this prospective, randomized, controlled trial was to compare the medical and surgical treatments of CRSwNP in terms of their effect on the nasal congestion index (NCI). Methods: Forty-eight patients with CRSwNP were randomized either to medical or surgical therapy. Pretreatment and 3- and 6-month posttreatment assessments of the visual analog scale score, the 20-Item Sino-Nasal Outcome Test, saccharine clearance time, nasal endoscopy, and NCI measurement with acoustic rhinometry were performed. Forty-one subjects were included in the analysis. Results: Both the medical and surgical interventions for CRSwNP resulted in significant improvement in the visual analog scale score, 20-Item Sino-Nasal Outcome Test, saccharine clearance time, and nasal endoscopic examination scores. There was no difference between the two groups in terms of the percentage change from baseline for any of the parameters at the 6-month posttreatment assessment. NCI showed no significant difference from baseline. Similarly, no significant difference was found between the medical and surgical groups in terms of their effect on the NCI (p > 0.05). Conclusion: Because NCI does not correlate with standard subjective measures in outcomes for this group of patients, it cannot be used as an outcome measurement of treatment of subjects with CRSwNP. Results of this prospective randomized study did not find any additional benefit of surgical therapy over medical therapy in subjects with CRSwNP.

  7. Automated quality measurement in Department of the Veterans Affairs discharge instructions for patients with congestive heart failure.

    Science.gov (United States)

    Garvin, Jennifer H; Elkin, Peter L; Shen, Shuying; Brown, Steven; Trusko, Brett; Wang, Enlai; Hoke, Linda; Quiaoit, Ylenia; Lajoie, Joan; Weiner, Mark G; Graham, Pauline; Speroff, Theodore

    2013-01-01

    Quality measurement is an important issue for the United States Department of Veterans Affairs (VA). In this study, we piloted the use of an informatics tool, the Multithreaded Clinical Vocabulary Server (MCVS), which extracted automatically whether the VA Office of Quality and Performance measures of quality of care were met for the completion of discharge instructions for inpatients with congestive heart failure. We used a single document, the discharge instructions, from one section of the medical records for 152 patients and developed a reference standard using two independent reviewers to assess performance. When evaluated against the reference standard, MCVS achieved a sensitivity of 0.87, a specificity of 0.86, and a positive predictive value of 0.90. The automated process using the discharge instruction document worked effectively. The use of the MCVS tool for concept-based indexing resulted in mostly accurate data capture regarding quality measurement, but improvements are needed to further increase the accuracy of data extraction.

  8. Increased serum C-reactive protein concentrations in dogs with congestive heart failure due to myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Reimann, M. J.; Ljungvall, I.; Hillstrom, A.;

    2016-01-01

    Cardiovascular disease in humans and dogs is associated with mildly increased circulating concentrations of C-reactive protein (CRP). Few studies have evaluated associations between circulating CRP and canine myxomatous mitral valve disease (MMVD) and the results reported have been divergent....... The aim of this study was to investigate whether serum concentrations of CRP, determined using a novel automated canine-specific high -sensitivity CRP assay (Gentian hsCRP), were associated with severity of MMVD and selected clinical variables in dogs. The study included 188 client-owned dogs...... with different severities of MMVD. Dogs were classified based on ACVIM consensus statement guidelines (group A, n = 58; group BI, n = 56; group B2, n = 38; group C, n = 36). Data were analysed using descriptive statistics and multiple regression analysis. Dogs with congestive heart failure (CHF; group C) had...

  9. Safety and predictors of adherence of a new rehabilitation program for older women with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Nahid A. Azad; Kathy Bouchard; Alain Mayhew; Maureen Carter; Frank J. Molnar

    2012-01-01

    Objectives To assess the safety of a cardiac rehabilitation program for older women with Congestive Heart Failure (CHF) anddetermine if certain factors influence adherence. Methods Women over the age of 65 with CHF attended an exercise program supervisedby a physiotherapist. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and severity ofdisease by the New York Heart Association (NYHA) Class. Subjects were classified into those who attended 90% or more of the sessionsand those who attended less than 90% of the sessions. Results Fifty-one subjects were studied. Eight subjects did not attend any sessions.Of the 43 attendees, the average percentage of sessions attended was 87%. There were no significant differences between the two groups inage, MLHFQ or NYHA Class. There was only one adverse event out of 280 participant attendances. Conclusions The program had a highlevel of adherence in this population. Age, MLHFQ or NYHA Class did not impact on session attendance. Our data suggests this program issafe for this population. Further research is needed to determine other predictors of attendance and the examination of safety issues andlong-term adherence to exercise in this population.

  10. COMPARISON OF EFFECTS ON PEAK OXYGEN-CONSUMPTION, QUALITY-OF-LIFE, AND NEUROHORMONES OF FELODIPINE AND ENALAPRIL IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

    NARCIS (Netherlands)

    DEVRIES, RJM; QUERE, M; LOK, DJA; SIJBRING, P; BUCX, JJJ; VANVELDHUISEN, DJ; DUNSELMAN, PHJM

    1995-01-01

    Angiotensin-converting enzyme (ACE) inhibition is currently the cornerstone of congestive heart failure (CHF) therapy, but these drugs are not tolerated in up to 20% of patients, For these patients, therapeutic alternatives with comparable efficacy are needed. Felodipine, a vasoselective dihydropyri

  11. Qtc interval as a guide to select those patients with congestive heart failure and reduced left ventricular systolic function who will benefit from antiarrhythmic treatment with dofetilide

    DEFF Research Database (Denmark)

    Brendorp, B; Elming, H; Jun, L

    2001-01-01

    AND RESULTS: This prospectively defined substudy included 703 patients enrolled in the Danish Investigations of Arrhythmia and Mortality on Dofetilide-Congestive Heart Failure (DIAMOND-CHF) study. Patients included had moderate to severe CHF and reduced left ventricular systolic function. Baseline QTc...

  12. Survival after withdrawal of dofetilide in patients with congestive heart failure and a short baseline QTc interval; a follow-up on the Diamond-CHF QT substudy

    DEFF Research Database (Denmark)

    Brendorp, B; Torp-Pedersen, C; Elming, H;

    2003-01-01

    withdrawal of dofetilide. METHODS: Patients with congestive heart failure (CHF) and reduced left ventricular function enrolled in the Diamond-CHF (Danish Investigations of Arrhythmia and Mortality on Dofetilide-CHF) study were eligible for our QT substudy provided they were in sinus rhythm and had...

  13. 充血性心力衰竭的临床分析%To Explore the Clinical of Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    吴凤军

    2015-01-01

    目的:探讨充血性心力衰竭的临床治疗措施。方法回顾性分析从2012年6月~2013年12月我院收治的43例充血性心力衰竭患者的临床资料。结果对充血性心力衰竭患者进行针对性的临床治疗,显效20例,有效22例,无效1例,总有效率97.7%。结论充血性心力衰竭患者临床表现单一,诱因复杂,应采取综合方案进行治疗。%Objective To investigate the clinical treatment of congestive heart failure.Methods Selected 43 cases of congestive heart failure from 2012 June to 2013 December in our hospital analysis of clinical data. ResultsPatients with congestive heart failure targeted clinical treatment, 20 cases markedly effective, 1 case effective, the total efifciency of 97.7%. ConclusionThe clinical manifestations of congestive heart failure in patients with a single, complex incentives, should take a comprehensive treatment program.

  14. Novel Use of Tolvaptan in a Pediatric Patient With Congestive Heart Failure Due to Duchenne Muscular Dystrophy and Congenital Adrenal Hyperplasia

    OpenAIRE

    Sami, Sarah A.; Moffett, Brady S.; Karlsten, Melissa L.; Cabrera, Antonio G.; Price, Jack F.; Dreyer, William J; Denfield, Susan W.; Jeewa, Aamir

    2015-01-01

    Successful management of hyponatremia in heart failure patients requires a multifaceted approach in order to preserve end-organ function. We describe the novel use of a selective vasopressin receptor antagonist, tolvaptan, for management of hyponatremia in a 17-year-old Caucasian male with severe Duchenne muscular dystrophy, congestive heart failure (CHF), and congenital adrenal hyperplasia. The medical history was significant for recurrent admissions for hyponatremia secondary to adrenal cri...

  15. Hemodynamic and neurochemical determinates of renal function in chronic heart failure.

    Science.gov (United States)

    Gilbert, Cameron; Cherney, David Z I; Parker, Andrea B; Mak, Susanna; Floras, John S; Al-Hesayen, Abdul; Parker, John D

    2016-01-15

    Abnormal renal function is common in acute and chronic congestive heart failure (CHF) and is related to the severity of congestion. However, treatment of congestion often leads to worsening renal function. Our objective was to explore basal determinants of renal function and their response to hemodynamic interventions. Thirty-seven patients without CHF and 59 patients with chronic CHF (ejection fraction; 23 ± 8%) underwent right heart catheterization, measurements of glomerular filtration rate (GFR; inulin) and renal plasma flow (RPF; para-aminohippurate), and radiotracer estimates of renal sympathetic activity. A subset (26 without, 36 with CHF) underwent acute pharmacological intervention with dobutamine or nitroprusside. We explored the relationship between baseline and drug-induced hemodynamic changes and changes in renal function. In CHF, there was an inverse relationship among right atrial mean pressure (RAM) pressure, RPF, and GFR. By contrast, mean arterial pressure (MAP), cardiac index (CI), and measures of renal sympathetic activity were not significant predictors. In those with CHF there was also an inverse relationship among the drug-induced changes in RAM as well as pulmonary artery mean pressure and the change in GFR. Changes in MAP and CI did not predict the change in GFR in those with CHF. Baseline values and changes in RAM pressure did not correlate with GFR in those without CHF. In the CHF group there was a positive correlation between RAM pressure and renal sympathetic activity. There was also an inverse relationship among RAM pressure, GFR, and RPF in patients with chronic CHF. The observation that acute reductions in RAM pressure is associated with an increase in GFR in patients with CHF has important clinical implications.

  16. Common variants in IL-17A/IL-17RA axis contribute to predisposition to and progression of congestive heart failure.

    Science.gov (United States)

    Sandip, Chaugai; Tan, Lun; Huang, Jin; Li, Qing; Ni, Li; Cianflone, Katherine; Wang, Dao Wen

    2016-07-01

    Heart failure is characterized by immune activation leading to production and release of proinflammatory cytokines. Interleukin 17A (IL-17A) is a proinflammatory cytokine and multiple lines of evidence from animal and human studies suggest crucial roles of IL-17A in heart failure. Therefore, we investigated whether common polymorphisms of genes IL17A and IL17RA (coding interleukin 17 receptor A) contribute to genetic predisposition to heart failure and adverse clinical outcomes associated with it.A total of 1713 adult patients with congestive heart failure and 1713 age- and sex-matched controls were genotyped for promoter single nucleotide polymorphisms (SNPs), rs2275913 and rs8193037 in IL17A and rs4819554 in IL17RA, to assess the relationship between individual SNPs and the risk of congestive heart failure. Results showed that rs8193037 in IL17A was associated with the risk of congestive heart failure (odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.63-0.90, adjusted P = 0.002) after adjustment for multiple cardiovascular risk factors including age, sex, smoking status, diabetes, hypertension, and dyslipidemia. This association was evident in both ischemic and nonischemic heart failure (P = 0.005 and P = 0.05, respectively). Furthermore, prospective follow-up of 12.7 months for the occurrence of adverse clinical outcomes showed that rs4819554 in IL17RA was significantly associated with cardiovascular mortality (hazard ratio [HR] = 1.28; 95% CI = 1.02-1.59, adjusted P = 0.03) after adjustments for multiple cardiovascular risk factors and New York Heart Association functional class.This study demonstrated associations of rs8193037 in the promoter of IL17A with the risk of congestive heart failure, and of rs4819554 in the promoter of IL17RA with the risk of cardiovascular mortality in patients with congestive heart failure. These data lend further support to the notion that immune activation and genetic polymorphisms contribute to heart failure pathogenesis

  17. Systemic arterial and venous determinants of renal hemodynamics in congestive heart failure.

    Science.gov (United States)

    Braam, Branko; Cupples, William A; Joles, Jaap A; Gaillard, Carlo

    2012-03-01

    Heart and kidney interactions are fascinating, in the sense that failure of the one organ strongly affects the function of the other. In this review paper, we analyze how principal driving forces for glomerular filtration and renal blood flow are changed in heart failure. Moreover, renal autoregulation and modulation of neurohumoral factors, which can both have repercussions on renal function, are analyzed. Two paradigms seem to apply. One is that the renin-angiotensin system (RAS), the sympathetic nervous system (SNS), and extracellular volume control are the three main determinants of renal function in heart failure. The other is that the classical paradigm to analyze renal dysfunction that is widely applied in nephrology also applies to the pathophysiology of heart failure: pre-renal, intra-renal, and post-renal alterations together determine glomerular filtration. At variance with the classical paradigm is that the most important post-renal factor in heart failure seems renal venous hypertension that, by increasing renal tubular pressure, decreases GFR. When different pharmacological strategies to inhibit the RAS and SNS and to assist renal volume control are considered, there is a painful lack in knowledge about how widely applied drugs affect primary driving forces for ultrafiltration, renal autoregulation, and neurohumoral control. We call for more clinical physiological studies.

  18. Particulate Air Pollution and the Rate of Hospitalization for Congestive Heart Failure among Medicare Beneficiaries in Pittsburgh, Pennsylvania.

    Science.gov (United States)

    Wellenius, Gregory A.; Bateson, Thomas F.; Mittleman, Murray A.; Schwartz., Joel

    2006-01-01

    We used a case-crossover approach to evaluate the association between ambient air pollution and the rate of hospitalization for congestive heart failure (CHF) among Medicare recipients (age ≥ 65) residing in Allegheny County (Pittsburgh area), PA, during 1987–1999. We also explored effect modification by age, gender, and specific secondary diagnoses. During follow-up, there were 55,019 admissions with a primary diagnosis of CHF. We found that particulate matter with aerodynamic diameter ≤ 10 μm (PM10), carbon monoxide (CO), nitrogen dioxide (NO2), and sulfur dioxide – but not ozone – were positively and significantly associated with the rate of admission on the same day in single-pollutant models. The strongest associations were observed with CO, NO2 and PM10. The associations with CO and NO2 were the most robust in two-pollutant models, remaining statistically significant even after adjusting for other pollutants. Patients with a recent myocardial infarction were at greater risk of particulate-related admission, but there was otherwise no significant effect modification by age, gender, or other secondary diagnoses. These results suggest that short-term elevations in air pollution from traffic-related sources may trigger acute cardiac decompensation of heart failure patients and that those with certain comorbid conditions may be more susceptible to these effects. PMID:15901623

  19. Aortocaval Fistula in Rat: A Unique Model of Volume-Overload Congestive Heart Failure and Cardiac Hypertrophy

    Directory of Open Access Journals (Sweden)

    Zaid Abassi

    2011-01-01

    Full Text Available Despite continuous progress in our understanding of the pathogenesis of congestive heart failure (CHF and its management, mortality remains high. Therefore, development of reliable experimental models of CHF and cardiac hypertrophy is essential to better understand disease progression and allow new therapy developement. The aortocaval fistula (ACF model, first described in dogs almost a century ago, has been adopted in rodents by several groups including ours. Although considered to be a model of high-output heart failure, its long-term renal and cardiac manifestations are similar to those seen in patients with low-output CHF. These include Na+-retention, cardiac hypertrophy and increased activity of both vasoconstrictor/antinatriureticneurohormonal systems and compensatory vasodilating/natriuretic systems. Previous data from our group and others suggest that progression of cardiorenal pathophysiology in this model is largely determined by balance between opposing hormonal forces, as reflected in states of CHF decompensation that are characterized by overactivation of vasoconstrictive/Na+-retaining systems. Thus, ACF serves as a simple, cheap, and reproducible platform to investigate the pathogenesis of CHF and to examine efficacy of new therapeutic approaches. Hereby, we will focus on the neurohormonal, renal, and cardiac manifestations of the ACF model in rats, with special emphasis on our own experience.

  20. A new approach to detect congestive heart failure using Teager energy nonlinear scatter plot of R-R interval series.

    Science.gov (United States)

    Kamath, Chandrakar

    2012-09-01

    A novel approach to distinguish congestive heart failure (CHF) subjects from healthy subjects is proposed. Heart rate variability (HRV) is impaired in CHF subjects. In this work hypothesizing that capturing moment to moment nonlinear dynamics of HRV will reveal cardiac patterning, we construct the nonlinear scatter plot for Teager energy of R-R interval series. The key feature of Teager energy is that it models the energy of the source that generated the signal rather than the energy of the signal itself. Hence, any deviations in the genesis of HRV, by complex interactions of hemodynamic, electrophysiological, and humoral variables, as well as by the autonomic and central nervous regulations, get manifested in the Teager energy function. Comparison of the Teager energy scatter plot with the second-order difference plot (SODP) for normal and CHF subjects reveals significant differences qualitatively and quantitatively. We introduce the concept of curvilinearity for central tendency measures of the plots and define a radial distance index that reveals the efficacy of the Teager energy scatter plot over SODP in separating CHF subjects from healthy subjects. The k-nearest neighbor classifier with RDI as feature showed almost 100% classification rate.

  1. Progress in the study of the pulmonary embolism in congestive heart failure%心力衰竭并发肺动脉栓塞研究进展

    Institute of Scientific and Technical Information of China (English)

    陈远刚

    2014-01-01

    Many clinical manifestations of congestive heart failure are similar to that of pulmonary embolism. Pulmonary embolism is a common complication of heart failure. The prognosis will be worse when a heart failure patient was complicated with pulmonary embolism. Here we briefly review the progress in the study of the pulmonary embolism in congestive heart failure from the aspects of etiopathogenisis,risk factor,clinical manifestation,diagnosis and prognosis,precaution and treatment. We hope that it may provide some informa-tion and study strategies for the diagnosis and precaution of the pulmonary embolism in congestive heart failure.%充血性心力衰竭(CHF)在许多临床表现上与肺动脉栓塞相似,而前者易并发后者,两者一旦合并存在,即提示患者预后更为恶劣。该文从发病原因、危险因素、临床表现、诊断与预后、预防及治疗等方面复习近年心力衰竭并发肺动脉栓塞研究进展,以期能在诊断及预防CHF并发肺动脉栓塞等方面提供相关的信息和思路。

  2. 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

  3. Metabolic remodeling in chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    Jing WANG; Tao GUO

    2013-01-01

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

  4. Continuous infusion or bolus injection of loop diuretics for congestive heart failure?

    Science.gov (United States)

    Zepeda, Patricio; Rain, Carmen; Sepúlveda, Paola

    2016-04-22

    Loop diuretics are widely used in acute heart failure. However, there is controversy about the superiority of continuous infusion over bolus administration. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified four systematic reviews including 11 pertinent randomized controlled trials overall. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded continuous administration of loop diuretics probably reduces mortality and length of stay compared to intermittent administration in patients with acute heart failure.

  5. Thoracic radiography in the cat: Identification of cardiomegaly and congestive heart failure.

    Science.gov (United States)

    Guglielmini, Carlo; Diana, Alessia

    2015-12-01

    Thoracic radiography is one of the most commonly employed diagnostic tools for the clinical evaluation of cats with suspected heart disease and is the standard diagnostic method in the confirmation of cardiogenic pulmonary edema. In the past, interpretation of feline radiographs focused on a description of the qualitative radiographic features of feline heart disease or the measurement of the cardiac silhouette in healthy cats and cats with different cardiovascular disorders. More recently, studies have begun to critically address the issue of the diagnostic accuracy of thoracic radiography in the diagnostic work-up of cats with heart disease. In these studies, qualitative and quantitative radiographic parameters were compared to echocardiographic findings to evaluate the usefulness of thoracic radiography for the identification of cardiac enlargement and pulmonary edema in the cat. Thoracic radiography is reasonably specific but has a low sensitivity when identifying cardiomegaly in cats with mild structural heart disease. Feline cardiogenic pulmonary edema has a variable radiographic presentation and several specific radiographic findings (i.e., enlargement of the left atrium and the pulmonary veins) can be absent or non-recognizable in affected cats.

  6. Angiotensin II vaccine promising for patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    CHEN Yang-xin; YAO You-jie; NIE Ru-qiong; ZHOU Shu-xian; WANG Jing-feng

    2009-01-01

    @@ Chronic heart failure (CHF), as the end-stage presentation of all kinds of heart diseases, is a major public health problem as well as a pressing public policy issue. There are more than 5 million patients diagnosed with CHF in USA alone and approximately 550 000 new cases appear per year. About 0.4%-2% of the European population is affected by symptomatic heart failure. Hence heart failure is the leading cause of hospitalization especially in older people around the world.

  7. Study on Apoptosis and Expression of P53, Bcl-2, Bax in Cardiac Myocytys of Congestive Heart Failure Induced by Ventricular Pacing

    Institute of Scientific and Technical Information of China (English)

    QI; Benling; CAO; Linsheng; WANG; Lin; ZHOU; Jingqun

    2001-01-01

    The apoptosis and the expression of p53, bcl-2 and Bax in myocytes of chronic rapid ventricular pacing-induced congestive heart failure (CHF) in rabbits were investigated. The CHF rabbit model (P, n= 7) was established by chronic rapid ventricular pacing for 3 weeks. By using TUNEL technique the apoptosis in the myocytes in the rabbit model was studied and the expression of p53,bcl-2 and Bax in myocytes was detected by using immunohistochemical method. Sham-operated (C,n = 9) group served as control group. The results showed that there were about 4033± 884.56 apoptotic cells/106 myocytes in P group, but no apoptotic cells were found in C group. Myocytes positive for p53 immunoreactivity (18. 86±8. 48 vs 5. 06±0. 87, P<0.01) and positive for Bax immunoreactivity (7. 15±1.91 vs 0. 43±0. 09, P<0.01) were increased in P group as compared with those in C group, while the myocytes positive for bcl-2 immunoreactivity (7. 08±1.05 vs 14. 97±4.47,P<0. 01) and the ratio of bcl-2/Bax were decreased in P group as compared with those in C group.Apoptosis was involved in the development of CHF induced by continuously rapid ventricular pacing in rabbit. The expression of p53 and Bax was increased, while the expression of bcl-2 was inhibited.These might play an important role in the acceleration of the apoptosis.

  8. Prognostic value of myocardial {sup 123}I-BMIPP imaging in patients with congestive heart failure without coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Sindoh, Takashi; Sawada, Yoshihiro; Honda, Minoru [Sumitomo Hospital, Osaka (Japan)

    1998-04-01

    We performed {sup 123}I-BMIPP (BMIPP) imaging in order to clarify the characteristics of fatty acid metabolism and its effect on prognosis in patients with congestive heart failure (CHF) without coronary artery disease. We studied 15 normal subjects and 42 patients with CHF (idiopathic dilated cardiomyopathy; 24, hypertensive heart disease; 12, valvular heart disease; 6). We obtained cardiac imaging with BMIPP and {sup 201}Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (%Uptake). We calculated the cardiac uptake ratio of BMIPP (%Uptake of BMIPP divided by %Uptake of {sup 201}Tl), percent washout of BMIPP from the heart over 3 hours and unhomogeneity of myocardial distribution of BMIPP (coefficient of variation of BMIPP, CV) as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of CHF which requiring readmission. Uptake ratio (CHF; 0.91{+-}0.17, normal; 1.10{+-}0.09, p=0.0000) and CV (CHF; 20{+-}5, normal; 16{+-}5, p=0.0385) were different significantly between CHF and normal subjects. During the follow-up period of 27.2{+-}14.4 months (4.5-53.5 months) cardiac events developed in 15 patients (cardiac death; 8, deterioration of CHF; 7). In univariate analysis, % uptake of {sup 201}Tl, uptake ratio, % FS, serum norepinephrine level and serum renin activity were different significantly between event and event-free groups. Cox proportional hazard analysis showed that the uptake ratio (p=0.0000) and age (p=0.018) were independent predictors of cardiac events. In patients with uptake ratio less than 0.88, relative risks of cardiac events was 23.7 times greater than in patients with uptake ratio more than 0.89. These data suggested that in patients with CHF fatty acid metabolism was deteriorated and cardiac uptake of BMIPP was a strong and independent predictor of long-term prognosis in patients with heart failure. (author)

  9. Treatment of Congestive Heart Failure in Children%小儿充血性心力衰竭治疗分析

    Institute of Scientific and Technical Information of China (English)

    许伟力

    2015-01-01

    目的:探讨小儿充血性心力衰竭的临床治疗。方法对30例小儿充血性心力衰竭患者临床治疗方法资料进行分析。结果经治疗显效21例,有效7例,无效2例,总有效率93.33%。结论通过对小儿充血性心力衰竭的临床治疗,消除其病因及诱因,改善血液动力学,维护衰竭的心脏。%Objective To investigate the clinical treatment of children with congestive heart failure.Methods30 cases of pediatric patients with congestive heart failure clinical treatment were analyzed.Results21 cases were cured after treatment, effective in 7 cases, 2 cases, the total efifciency of 93.33 %.Conclusion The clinical treatment of children with congestive heart failure, eliminate the cause and incentives, improve hemodynamics, maintain heart failure.

  10. Carbon monoxide and hospital admissions for congestive heart failure: evidence of an increased effect at low temperatures; Pollution par le monoxyde de carbone et hospitalisations pour insuffisance cardiaque congestive: mise en evidence d'une augmentation d'effet a basse temperature

    Energy Technology Data Exchange (ETDEWEB)

    Morris, R.D.; Naumova, E.N.

    2001-01-01

    This study presents the combined effect of the low temperatures and the air pollution exposure, especially the carbon monoxide, on the hospital admissions for congestive heart failure in Chicago during 1986-1989. (A.L.B.)

  11. Effect of mibefradil on heart rate variability in patients with chronic heart failure

    NARCIS (Netherlands)

    Brouwer, J; de Kam, PJ; Haaksma, J; Crijns, HJGM; van Veldhuisen, DJ

    2000-01-01

    Background: Mibefradil was recently withdrawn from the market because of an unfavorable clinical profile in patients with chronic heart failure. Although drug interactions appear to play a role, other mechanisms such as proarrhythmia and autonomic deterioration could also be relevant. Chronic heart

  12. Efficacy of regional renal nerve blockade in patients with chronic refractory heart failure

    Institute of Scientific and Technical Information of China (English)

    DAI Qi-ming; FEN Yi; LU Jing; MA Gen-shan

    2013-01-01

    Background Increased renal sympathetic nerve activity can result in diuretic resistance in patients with chronic congestive heart failure.We investigated the effect of regional renal nerve blockade on the patients with chronic refractory heart failure and diuretic resistance.Methods Eighteen patients with chronic refractory heart failure were enrolled (mean age (64±11) years).The patients were randomly divided into two groups (renal nerve blockade group and standard therapy group,n=9 each).Renal nerve blockade was performed by percutaneous injection of local anaesthetic under computed tomographic guidance.Heart rate,mean arterial blood pressure,plasma and urine electrolytes,neurohormones,factional excretion of sodium (FENa),24-hour urine volume were monitored at baseline and the first 24 hours after therapy.Dyspnea and oedema were also evaluated.The major adverse cardiovascular events (MACE),plasma brain natriuretic peptide (BNP) level and left ventricular ejection fraction (LVEF) were compared between the two groups during the 3-12 months follow-up period.Results No complication was observed during the acute phase of renal nerve blockade.After renal nerve blockade,the 24-hour urine volume and FENa were significantly increased,while the level of plasma rennin,angiotensin Ⅱ,aldosterone,BNP and atrial natriuretic peptide as well as dyspnea and oedema were significantly reduced in renal nerve blockade group compared with baseline and standard therapy group.During three to 12 months of follow-up,the rate of MACE and plasma BNP level were significantly lower,while LVEF was significantly higher in renal nerve blockade group than those in standard therapy group.Conclusion Regional renal nerve blockade may be a safe and effective treatment for patients with chronic refractory heart failure.

  13. Increased interleukin-13 levels in patients with chronic heart failure.

    Science.gov (United States)

    Nishimura, Yuki; Inoue, Teruo; Nitto, Takeaki; Morooka, Toshifumi; Node, Koichi

    2009-01-24

    A great number of basic and clinical studies have demonstrated that inflammatory cytokines play an important role in development and progress of heart failure. However, there is limited information about allergic cytokine interleukin-13 (IL-13). The inflammatory responses mediated by allergic cytokines can cause significant morbidity and mortality when they become chronic. Therefore, we elucidated the role of IL-13 in the pathophysiology of chronic heart failure. We measured plasma IL-13 levels by enzyme-linked immunosorbent assay in 110 patients with chronic heart failure and 20 control subjects. Plasma IL-13 levels were increased in heart failure patients, compared with the controls, in association with NYHA functional class. In addition, IL-13 levels were correlated positively with plasma levels of brain natriuretic peptide and C-reactive protein, and negatively with left ventricular ejection fraction. Plasma IL-13 levels may be useful for evaluating disease severity in chronic heart failure.

  14. [Effects of xinshuaikang granule on cardiac function and atrial natriuretic polypeptide levels in rabbits with experimental congestive heart failure].

    Science.gov (United States)

    Jin, X C; Sun, J Z; Wang, X

    1996-07-01

    Xinshuaikang (XSK) granule mainly consisted of Radix Ginseng, Aconifum carmichaeli, Ligustici wallichii, Semen Lepidii seu Descurainiae, etc. Thirty-five white rabbits of Japanese strain with big ears were used and five groups were divided randomly. The models of chronic heart failure (CHF) was made by injection of adriamycin through the marginal vein of rabbit's ear. Only one group without adriamycin injection was taken as blank group. After the making of models, Xinbao (XB) was used to treat one group which was regarded as control group, XSK was used to treat two model groups, one used higher dose, the other one used lower dose. Fifteen days was taken as a course of treatment. The results were: the body weight of all model groups was heavier than that without adriamycin. After a course of treatment, the body weight of the groups treated by XSK or XB decreased rapidly, the general conditions of the three groups were improved; the two drugs could reduce heart rate and enhance heart function, at the same time they reduced the level of atrial natriuretic polypeptide (ANP) in plasma. The best results was obtained in XSK group with higher dose, the effect of XSK group with lower dose was equivalent to that of XB group. Hence, XSK granule could enhance the CHF rabbits' heart function, improve their heart endocrine activity, this drug had a reliable effect on CHF.

  15. 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.

  16. Methamphetamine-Associated Congestive Heart Failure: Increasing Prevalence and Relationship of Clinical Outcomes to Continued Use or Abstinence.

    Science.gov (United States)

    Sliman, Sean; Waalen, Jill; Shaw, David

    2016-10-01

    The purpose of this study was to determine the prevalence of methamphetamine-associated congestive heart failure (MAC) and to evaluate the relationship between methamphetamine abuse and EF and functional status over time. A retrospective review of records from 2009 to 2014 was carried out. Prevalence of methamphetamine abuse among all patients admitted with CHF was calculated for each of the 6 years of the study (n = 141) and was compared with prevalence of cocaine abuse and alcohol abuse. For patients with two or more admissions during the entire time period, the trajectories of NYHA functional class and EF over time were determined (n = 58). MAC has significantly increased from 1.8 to 5.6 % of total CHF patients admitted (n = 3705). Among patients who stopped using methamphetamine, NYHA functional class significantly improved, while among patients who continued methamphetamine use, NYHA was significantly worsened (p < 0.001). Significantly more patients with improved EF stopped using methamphetamine than continued (p = 0.05). There was a significant increase in the prevalence of MAC during the study period for all CHF patients admitted in our hospital system. Continued methamphetamine use is associated with worsening functional status, while cessation of methamphetamine is associated with improvement in functional status.

  17. Vibrational and thermal characterisation of a new chiral drug under investigation for the therapy of congestive heart failure

    Science.gov (United States)

    Taddei, Paola; Torreggiani, Armida; Fini, Giancarlo

    2002-12-01

    Racemic (5,6-bis 2-methyl propanoic acid-1,2,3,4-tetrahydro-naphtalen-2-yl)-methylammonium chloride, CHF-1035, under clinical investigation for the treatment of congestive heart failure, was here characterised by Raman and IR spectroscopies coupled with thermal analysis (thermogravimetry and differential scanning calorimetry). These techniques proved suitable for investigating the presence of different polymorphic forms, their relative stability and interconversion tendency in relation to industrial manufacturing processes undergone by the drug (i.e. grinding, compression, heating). Crystallisation experiments were carried out and two different CHF-1035 polymorphic forms were identified. Both grinding and heating revealed to cause a polymorphic transformation of the drug crystal form. It was hypothesised that a change in molecular packing occurs in the drug by effect of both treatments. The possible sources of polymorphism were identified in the -OCOCH(CH 3) groups and in the saturated ring. The non-ground sample showed two endothermic transitions; since they are reversible and not due to desolvation processes the system is probably enantiotropic.

  18. Influence of renal dysfunction on clinical outcomes in patients with congestive heart failure complicating acute myocardial infarction.

    Science.gov (United States)

    Kim, Chang Seong; Kim, Min Jee; Kang, Yong Un; Choi, Joon Seok; Bae, Eun Hui; Ma, Seong Kwon; Ahn, Young-Keun; Jeong, Myung Ho; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jin; Kim, Soo Wan

    2013-01-01

    The clinical course and medical treatment of patients with congestive heart failure (CHF) complicating acute myocardial infarction (AMI) are not well established, especially in patients with concomitant renal dysfunction. We performed a retrospective analysis of the prospective Korean Acute Myocardial Infarction Registry to assess the medical treatments and clinical outcomes of patients with CHF (Killip classes II or III) complicated by AMI, in the presence or absence of renal dysfunction. Of 13,498 patients with AMI, 2769 (20.5%) had CHF on admission. Compared to CHF patients with preserved renal function, in-hospital mortality and major adverse cardiac events were increased both at 1 month and at 1 year after discharge in patients with renal dysfunction (1154; 41.7%). Postdischarge use of aspirin, betablockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers and statins significantly reduced the 1-year mortality rate for CHF patients with renal dysfunction; such reduction was not observed for those without renal dysfunction, except in the case of aspirin. Patients with CHF complicating AMI, which is accompanied by renal dysfunction, are at higher risk for adverse cardiovascular outcomes than patients without renal dysfunction. However, they receive fewer medications proven to reduce mortality rates.

  19. Impact of collaborative care on survival time for dogs with congestive heart failure and revenue for attending primary care veterinarians.

    Science.gov (United States)

    Lefbom, Bonnie K; Peckens, Neal K

    2016-07-01

    OBJECTIVE To assess the effects of in-person collaborative care by primary care veterinarians (pcDVMs) and board-certified veterinary cardiologists (BCVCs) on survival time of dogs after onset of congestive heart failure (CHF) and on associated revenue for the attending pcDVMs. DESIGN Retrospective cohort study. ANIMALS 26 small-breed dogs treated for naturally occurring CHF secondary to myxomatous mitral valve disease at a multilocation primary care veterinary hospital between 2008 and 2013. PROCEDURES Electronic medical records were reviewed to identify dogs with confirmed CHF secondary to myxomatous mitral valve disease and collect information on patient care, survival time, and pcDVM revenue. Data were compared between dogs that received collaborative care from the pcDVM and a BCVC and dogs that received care from the pcDVM alone. RESULTS Dogs that received collaborative care had a longer median survival time (254 days) than did dogs that received care from the pcDVM alone (146 days). A significant positive correlation was identified between pcDVM revenue and survival time for dogs that received collaborative care (ie, the longer the dog survived, the greater the pcDVM revenue generated from caring for that patient). CONCLUSIONS AND CLINICAL RELEVANCE Findings suggested that collaborative care provided to small-breed dogs with CHF by a BCVC and pcDVM could result in survival benefits for affected dogs and increased revenue for pcDVMs, compared with care provided by a pcDVM alone.

  20. Intervention Effect of Jianxin Decoction(健心汤) on Serum Cytokine Level of Congestive Heart Failure Patients

    Institute of Scientific and Technical Information of China (English)

    赵海滨; 沈承玲

    2004-01-01

    Objective: To investigate the intervention effect of Jianxin Decoction (健心汤, JXD) on the cytokine level in serum of patients with congestive heart failure (CHF). Methods: Sixty-six patients with CHF were randomly divided into the control group (n=33) and the trial group (n=33). The control group received conventional treatment, and the trial group was treated with conventional therapy plus JXD for 4weeks. Before and after treatment, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and nitrogen monoxide (NO) in serum and cardiac function were determined. Results: After treatment, the levels of TNF-α,IL-6 and NO were significantly lower than those before treatment (P<0.05, or P<0. 01) in the two groups,and the lowering degree of the indices in the trial group was more significantly reduced than that in the control group (P<0. 05). And cardiac functions in both groups were improved significantly (P < 0.05, or P <0.01). Conclusion: JXD could prevent and reverse ventricular remodeling so as to ameliorate cardiac function through regulating the levels of cytokines.

  1. Intervention Effect of Jianxin Decoction (健心汤) on Serum Cytokine Level of Congestive Heart Failure Patients

    Institute of Scientific and Technical Information of China (English)

    赵海滨; 沈承玲

    2004-01-01

    Objective: To investigate the intervention effect of Jianxin Decoction (健心汤, JXD) on the cytokine level in serum of patients with congestive heart failure (CHF). Methods: Sixty-six patients with CHF were randomly divided into the control group (n = 33) and the trial group (n = 33). The control group received conventional treatment, and the trial group was treated with conventional therapy plus JXD for 4 weeks. Before and after treatment, tumor necrosis factor-α( (TNF-α), interleukin-6 (IL-6) and nitrogen monoxide (NO) in serum and cardiac function were determined. Results: After treatment, the levels of TNF-α,IL-6 and NO were significantly lower than those before treatment (P<0. 05, or P<0. 01) in the two groups, and the lowering degree of the indices in the trial group was more significantly reduced than that in the control group (P<0.05). And cardiac functions in both groups were improved significantly (P<0.05, or P<0.01). Conclusion: JXD could prevent and reverse ventricular remodeling so as to ameliorate cardiac function throuah reaulatina the levels of cytokines.

  2. CARDIAC RISK STRATIFICATION IN PATIENTS WITH CONGESTIVE HEART FAILURE: A CATECHOLAMINES-β- ADRENOCEPTOR-cAMP PATHWAY

    Institute of Scientific and Technical Information of China (English)

    Ying-xin Peng; Jiang Shan; Su-jun Zhang; Chun-li Rong; Jun-ping Li; Na Wang; Hao Xue; Shi-ling Zheng; Min Wu

    2005-01-01

    Objective To investigate the stratification risk of catecholamines-β-adrenoceptor (β-AR)-cAMP pathway for cardiogenic death events in patients with congestive heart failure (CHF).Methods A total of 83 identified CHF patients with a baseline and follow-up plasma levels of norepinephrine (NE)and epinephrine (E), lymphocytes β-AR density (Bmax), and intralymphocyte cAMP content in peripheral blood were followed up. Major cardiogenic death events were registered.Results The period between the initial entry and the last follow-up measurement were 51± 16 months, the total duration of clinical follow-up after the last measurement were 14±8 months. During follow-up, 39 patients died of cardiogenic (sudden death 17 patients, worsening heart failure 22 patients). Persistence of high NE, E, and cAMP from baseline to follow-up were confirmed as risk predicting factors of cardiovascular events. Persistence NE above 4.0 nmol/L, E above adverse prognostic predictors. The major cardiogenic death events rates per 100 patients-years were 1.33 and 4.82 in patients with NE below and above 4.0 nmol/L (HR: 2.91; 95% CI: 1.08-7.33; P = 0.015); were 1.42 and 4.36 in the patients with E levels below and above 3.5 nmol/L (HR: 2.64; 95% CI: 1.02-6.41; P = 0.019); were 1.81 and 4.67 in the 0.017), but difference was not significant between the β-AR density below and above median.Conclusions Persistent increase in circulating catecholamines and intralymphocyte cAMP content may increase the long-term mortality in CHF patients.

  3. Managing anemia in patients with chronic heart failure: what do we know?

    Directory of Open Access Journals (Sweden)

    Ankur Sandhu

    2010-04-01

    Full Text Available Ankur Sandhu1, Sandeep Soman1, Michael Hudson2, Anatole Besarab11Divisions of Nephrology, 2Cardiology, Henry Ford Health System, Detroit, Michigan, USAAbstract: Anemia is common in patients with chronic heart failure (HF with an incidence ranging from 4% to 55% depending on the studied population. Several studies have highlighted that the prevalence of anemia increases with worsening heart failure as reflected by New York Heart Association classification. Additionally, several epidemiological studies have highlighted its role as a prognostic marker, linking it to worse outcomes including; malnutrition, increased hospitalizations, refractory heart failure and death. The pathophysiology of anemia is multifactorial and related to various factors including; hemodilution, iron losses from anti-platelet drugs, activation of the inflammatory cascade, urinary losses of erythropoietin and associated renal insufficiency. There are a host of epidemiological studies examining HF outcomes and anemia, but only a few randomized trials addressing this issue. The purpose of this article is to review the literature that examines the interrelationship of anemia and congestive HF, analyzing its etiology, impact on outcomes and also the role of associated kidney disease as well as cardiorenal syndrome both as a marker of morbidity and mortality.Keywords: anemia, cardio-renal syndrome, heart failure

  4. Diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture

    DEFF Research Database (Denmark)

    Ring-Larsen, H; Henriksen, Jens Henrik Sahl; Wilken, C;

    1986-01-01

    in the supine position or normal daily activity in the upright position for the next six hours. Two days later the procedure was repeated, the patients being assigned to the other posture. The diuretic response was similar in patients with heart failure and cirrhosis, and was significantly greater in the supine...... than in the upright position: mean 1133 v 626 ml/6 h (p less than 0.01). The natriuresis was similarly larger during recumbency: mean sodium 96 v 45 mmol(mEq)/6h (p less than 0.01), and the excreted potassium in six hours was similar in both postures. The glomerular filtration rate was 100 and 66 ml...

  5. Prognostic importance of a short deceleration time in symptomatic congestive heart failure

    DEFF Research Database (Denmark)

    Akkan, Dilek; Kjaergaard, Jesper; Møller, Jacob Eifer;

    2008-01-01

    AIMS: A restrictive transmitral filling (RF) pattern predicts increased mortality in heart failure (HF) with reduced left ventricular (LV) systolic function. We performed a combined evaluation of LV function and RF for prognosis in patients with HF with and without systolic dysfunction. METHODS...... AND RESULTS: Doppler echocardiography was performed in 972 patients with symptomatic HF. RF was considered present when deceleration time (DT) was 140 ms. A DT >240 ms was defined as delayed relaxation. During a median of 51 months the unadjusted all-cause mortality rates were significantly increased among...... patients with RF vs. the non-RF group (1- and 4-year mortality was 25% and 54% vs. 17% and 43%). In a multivariable model, RF was a significant predictor of all-cause mortality (hazard ratio (HR)=2.0, 95% confidence interval (CI):1.5-2.6) whereas delayed relaxation was without prognostic importance (HR=0...

  6. RESIDENT PROGENITOR CARDIAC CELLS IN PATIENTS WITH DILATED CARDIOMYOPATHY AND CONGESTIVE HEART FAILURE

    Directory of Open Access Journals (Sweden)

    T. G. Kulikova

    2014-01-01

    Full Text Available Aim. To study content of resident progenitor cardiomyocytes in endomyocardial biopsy samples of patients with dilated cardiomyopathy (DCM and heart failure (HF at different disease stages and relate it to patient clinical characteristics.Material and methods. Resident progenitor cardiomyocytes were studied in endomyocardial biopsy samples from 14 patients (age from 26 to 52 years old with DCM and HF by immunofluorescence method. Results were analyzed individually for each patient.Results. Resident progenitor cardiomyocytes expressing simultaneously stem cell markers c-kit, MDR-1 and early cardiomyocyte differentiation markers GATA-4 and Nkx2.5 were found in endomyocardial biopsy samples from patients with DCM and HF. Resident progenitor cardiomyocytes detected by these cell markers were found in all patients at all disease stages.Conclusion. Results show that the myocardial regenerative processes exist at all stages of the disease progression.

  7. RESIDENT PROGENITOR CARDIAC CELLS IN PATIENTS WITH DILATED CARDIOMYOPATHY AND CONGESTIVE HEART FAILURE

    Directory of Open Access Journals (Sweden)

    T. G. Kulikova

    2015-09-01

    Full Text Available Aim. To study content of resident progenitor cardiomyocytes in endomyocardial biopsy samples of patients with dilated cardiomyopathy (DCM and heart failure (HF at different disease stages and relate it to patient clinical characteristics.Material and methods. Resident progenitor cardiomyocytes were studied in endomyocardial biopsy samples from 14 patients (age from 26 to 52 years old with DCM and HF by immunofluorescence method. Results were analyzed individually for each patient.Results. Resident progenitor cardiomyocytes expressing simultaneously stem cell markers c-kit, MDR-1 and early cardiomyocyte differentiation markers GATA-4 and Nkx2.5 were found in endomyocardial biopsy samples from patients with DCM and HF. Resident progenitor cardiomyocytes detected by these cell markers were found in all patients at all disease stages.Conclusion. Results show that the myocardial regenerative processes exist at all stages of the disease progression.

  8. Influence of age on the prognostic importance of left ventricular dysfunction and congestive heart failure on long-term survival after acute myocardial infarction. TRACE Study Group

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Ottesen, M;

    1996-01-01

    The aim of this study was to assess the importance of congestive heart failure and left ventricular (LV) systolic dysfunction after an acute myocardial infarction (AIM) on long-term mortality in different age groups. A total of 7,001 consecutive enzyme-confirmed AMIs (6,676 patients) were screened...... for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Medical history, echocardiographic estimation of LV systolic function determined as wall motion index, infarct complications, and survival were documented for all patients. To study the importance of congestive heart failure and wall motion......%, and 55%, respectively. The risk ratios (and 95% confidence limits) associated with congestive heart failure in the same 4 age strata were 1.9 (1.3 to 2.9), 2.8 (2.1 to 3.7), 1.8 (1.5 to 2.2) and 1.8 (1.5 to 2.2), respectively. The risk ratios associated with decreasing wall motion index were 6.5 (3...

  9. Treatment with verapamil and trandolapril in patients with congestive heart failure and angina pectoris or myocardial infarction. The DAVIT Study Group. Danish Verapamil Infarction Trial

    DEFF Research Database (Denmark)

    Hansen, J F; Hagerup, L; Sigurd, B

    1997-01-01

    In a double-blind, randomized trial in a consecutive group of postinfarct patients in treatment with diuretic agents for congestive heart failure, the 3 month rate of cardiac events (i.e., death, repeat infarction, unstable angina pectoris, or repeat admission because of heart failure) was 14......% in patients treated with verapamil and trandolapril and 35% in patients treated with trandolapril (p = 0.01). In another study of patients with angina pectoris and left ventricular ejection fraction less than 40%, trandolapril plus verapamil improved exercise duration and left ventricular ejection fraction...

  10. Effects of perindopril on cardiac sympathetic nerve activity in patients with congestive heart failure: comparison with enalapril

    Energy Technology Data Exchange (ETDEWEB)

    Kasama, Shu; Toyama, Takuji; Suzuki, Tadashi; Kurabayashi, Masahiko [Gunma University School of Medicine, Department of Cardiovascular Medicine, Maebashi, Gunma (Japan); Kumakura, Hisao; Takayama, Yoshiaki; Ichikawa, Shuichi [Cardiovascular Hospital of Central Japan, Department of Internal Medicine, Gunma (Japan)

    2005-08-01

    The production of aldosterone in the heart is suppressed by the angiotensin-converting enzyme (ACE) inhibitor perindopril in patients with congestive heart failure (CHF). Moreover, perindopril has been reported to have more cardioprotective effects than enalapril. Forty patients with CHF [left ventricular ejection fraction (LVEF) <45%; mean 33{+-}7%] were randomly assigned to perindopril (2 mg/day; n=20) or enalapril (5 mg/day; n=20). All patients were also treated with diuretics. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate (WR) were determined from {sup 123}I-meta-iodobenzylguanidine (MIBG) images, and plasma brain natriuretic peptide (BNP) concentrations were measured before and 6 months after treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and LVEF were also determined by echocardiography. After treatment, in patients receiving perindopril, TDS decreased from 39{+-}10 to 34{+-}9 (P<0.01), H/M ratios increased from 1.62{+-}0.27 to 1.76{+-}0.29 (P<0.01), WR decreased from 50{+-}14% to 42{+-}14% (P<0.05) and plasma BNP concentrations decreased from 226{+-}155 to 141{+-}90 pg/ml (P<0.0005). In addition, the LVEDV decreased from 180{+-}30 to 161{+-}30 ml (P<0.05) and the LVESV decreased from 122{+-}35 to 105{+-}36 ml (P<0.05). Although the LVEF tended to increase, the change was not statistically significant (from 33{+-}8% to 36{+-}12%; P=NS). On the other hand, there were no significant changes in these parameters in patients receiving enalapril. Plasma BNP concentrations, {sup 123}I-MIBG scintigraphic and echocardiographic parameters improved after 6 months of perindopril treatment. These findings indicate that perindopril treatment can ameliorate the cardiac sympathetic nerve activity and the left ventricular performance in patients with CHF. (orig.)

  11. 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

  12. Central Mechanisms of Abnormal Sympathoexcitation in Chronic Heart Failure

    Directory of Open Access Journals (Sweden)

    Takuya Kishi

    2012-01-01

    Full Text Available It has been recognized that the sympathetic nervous system is abnormally activated in chronic heart failure, and leads to further worsening chronic heart failure. In the treatment of chronic heart failure many clinical studies have already suggested that the inhibition of the abnormal sympathetic hyperactivity by beta blockers is beneficial. It has been classically considered that abnormal sympathetic hyperactivity in chronic heart failure is caused by the enhancement of excitatory inputs including changes in peripheral baroreceptor and chemoreceptor reflexes and chemical mediators that control sympathetic outflow. Recently, the abnormalities in the central regulation of sympathetic nerve activity mediated by brain renin angiotensin system-oxidative stress axis and/or proinflammatory cytokines have been focused. Central renin angiotensin system, proinflammatory cytokines, and the interaction between them have been determined as the target of the sympathoinhibitory treatment in experimental animal models with chronic heart failure. In conclusion, we must recognize that chronic heart failure is a syndrome with an abnormal sympathoexcitation, which is caused by the abnormalities in the central regulation of sympathetic nerve activity.

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

    Science.gov (United States)

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

    2014-03-01

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

  14. Predictors of sudden death and death from pump failure in congestive heart failure are different. Analysis of 24 h Holter monitoring, clinical variables, blood chemistry, exercise test and radionuclide angiography

    DEFF Research Database (Denmark)

    Madsen, B K; Rasmussen, Verner; Hansen, J F

    1997-01-01

    One hundred and ninety consecutive patients discharged with congestive heart failure were examined with clinical evaluation, blood chemistry, 24 h Holter monitoring, exercise test and radionuclide angiography. Median left ventricular ejection fraction was 0.30, 46% were in New York Heart Associat......One hundred and ninety consecutive patients discharged with congestive heart failure were examined with clinical evaluation, blood chemistry, 24 h Holter monitoring, exercise test and radionuclide angiography. Median left ventricular ejection fraction was 0.30, 46% were in New York Heart...

  15. 充血性心力衰竭患者心率变异性分析%Analysis of Heart Rate Variability of Patients With Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    骆小梅; 徐洁; 王贵鹏

    2016-01-01

    目的:探讨充血性心力衰竭患者心率变异性的变化规律。方法收集我院2014年6月~2015年12月门诊及住院部收治的充血性心力衰竭患者97例,根据NYHA心功能分级标准分为心功能Ⅰ~Ⅳ级,选择同期于我院体检健康志愿者100例为对照组。采用Holter系统记录分析仪对受检者进行24 h连续动态心电图监测,应用时域分析法分析心率变异性各指标。结果观察组SDNN、SDANN、SDNNI、RMSSD及PNN50指标均低于对照组,差异有统计学意义(P<0.05);随心功能的降低,SDNN、SDANN呈现下降趋势,但各分级之间差异无统计学意义(P>0.05),心功能Ⅲ级、Ⅳ级患者SDNNI、RMSSD及PNN50低于心功能Ⅰ级患者,心功能Ⅲ级患者RMSSD及PNN50低于心功能Ⅰ级患者,差异均有统计学意义(P<0.05)。结论充血性心力衰竭患者心率变异性下降,并与心功能的改变有关。%Objective To explore the change rule of heart rate variability of patients with congestive heart failure. Methods From June 2014 to December 2015, 97 cases of patients in our hospital were selected and divided into Ⅰ~ Ⅳ stages by NYHA classification criterion of cardiac function. 100 cases of healthy volunteers in the same period were selected as control group. All subjects were examined for 24 hours dynamic electrocardiogram by Holter recording and analyzing instrument. By means of time-domain analysis method, the HRV parameters were analyzed. Results The index of SDNN, SDANN, SDNNI, RMSSD and PNN50 in observation group were lower than control group, differences between two groups were statistically significant (P0.05). The index of SDNNI, RMSSD and PNN50 in Ⅲ and Ⅳ cardiac function patients were low that inⅠcardiac function;the index of RMSSD and PNN50 inⅢcardiac function patients were low that in Ⅰ cardiac function, differences between two groups were statistically significant (P<0.05). Conclusion The heart

  16. Comparison of Ventricular Electrophysiological Effects of Amiodarone in Canine Models With Congestive Heart Failure and Normal Dogs

    Institute of Scientific and Technical Information of China (English)

    Shuxian Zhou; Yuling Zhang; Juan Lei; Wei Wu; Xuming Zhang

    2008-01-01

    Objectives This study compared the effects of amiodarone on ventricular electrophysiological properties in normal dogs and CHF dogs.Methods Dogs(n=44) were randomized into four groups:Group 1(n=10)was the control.Group 2(n=10) was given amiodarone orally 300 mg·d-1 for4 to 5 weeks.Group 3(n=12)was the congestive heart failure(CHF)models induced by right ventricular rapid pacing(240 pulses·rain-1 for 4 to 5 weeks).Group 4 (n=12) was the CHF models given amiodarone orally 300 mg·d-1 for 4 to 5 weeks.The ventricular electrophysiological variables were evaluated by standard electric stimulation and monophasic action potential(MAP)recording.Results Amiodarone prolonged sinus cycle length(SCL),intra-ventricular conduction time(IVCT),MAP duration(MAPD90),ventricular effective period(VERP),ventricular activation time(VAT)and ventficular recovery time(VRT)without significant effects on the ratio of VERP to MAPD90 (VERP/MAPD90),ventricular fibrillation threshold(VFT),the dispersion of VRT(VRTD),and ventricular late repolarization duration(VLRD)in normal dogs.However,amiodarone did not further prolong the prolonged SCL,MAPD90,VERP,VAT and VRT,but further prolonged IVCT in CHF dogs.Amiodarone normalized the abnormal ventficular electrophysiological properties in CHF dogs as manifested by increasing the decreased VERP/MAPD90 and VFT,shortening the prolonged VLRD,and decreasing the increased VRTD.Amiodarone did not worsen the hemodynamic parameters in normal and CHF dogs.Conclusions Amiodarone had different effects on ventricular electrophysiological properties in normal and CHF dogs.The favorable effects of amiodarone in normalizing some abnormal cardiac electrophysiological properties in CHF models may have potential value on the prevention and treatment of ventricular arrhythmias and sudden cardiac death in CHF.

  17. Relationship of the plasma urotensin Ⅱ with proadrenomedullin N-terminal 20 peptide in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    钟萍; 李志樑; 吴宏超; 唐朝枢; 陆青

    2003-01-01

    Objective: To understand the role of urotensin Ⅱ(UⅡ) and proadrenomedullin N-terminal 20 peptide (PAMP), a fragment of proadrenomedullin (proADM) possessing biological activity, in the pathophysiological process of congestive heart failure (CHF) by observing the variation of their plasma levels and exploring their interrelations. Methods: Plasma UⅡ and PAMP levels were measured by radioimmunoassay in 52 patients with CHF and 14 healthy subjects. Left ventricular ejection fraction (LVEF) and the ratio of E/A were determined by echocardiography. Results: The plasma UⅡ level was significantly lower in patients with CHF than the healthy subjects (1.5±1.0 pg/ml vs 4.3±1.2 pg/ml, P<0.05), while plasma PAMP level was significantly higher in the former group (30.6±5.8 pg/ml vs 21.0±6.6 pg/ml P<0.05). The levels of UⅡ and PAMP were parallel with the severity of CHF, and significant correlation of plasma levels of UⅡ with LVEF (r=0.530, P=0.000) and the ratio of E/A (r=0.618, P=0.000) was noted. LVEF and ratio of E/A were found to be inversely correlated with plasma PAMP levels in the patients (r=-0.568, P=0.000; r=-0.350, P=0.004). Also found was the significant correlation between plasma UⅡ and PAMP levels (r=-0.528, P=0.000). The treatment of the patients resulted in increased plasma UⅡ levels and lowered PAMP levels. Conclusion: The variations of plasma levels of UⅡ and PAMP are parallel with the severity of CHF, suggesting their cooperative actions in the pathophysiology of CHF.

  18. New Results in Magnitude and Sign Correlations in Heartbeat Fluctuations for Healthy Persons and Congestive Heart Failure (CHF) Patients

    Science.gov (United States)

    Diosdado, A. Muñoz; Cruz, H. Reyes; Hernández, D. Bueno; Coyt, G. Gálvez; González, J. Arellanes

    2008-08-01

    Heartbeat fluctuations exhibit temporal structure with fractal and nonlinear features that reflect changes in the neuroautonomic control. In this work we have used the detrended fluctuation analysis (DFA) to analyze heartbeat (RR) intervals of 54 healthy subjects and 40 patients with congestive heart failure during 24 hours; we separate time series for sleep and wake phases. We observe long-range correlations in time series of healthy persons and CHF patients. However, the correlations for CHF patients are weaker than the correlations for healthy persons; this fact has been reported by Ashkenazy et al. [1] but with a smaller group of subjects. In time series of CHF patients there is a crossover, it means that the correlations for high and low frequencies are different, but in time series of healthy persons there are not crossovers even if they are sleeping. These crossovers are more pronounced for CHF patients in the sleep phase. We decompose the heartbeat interval time series into magnitude and sign series, we know that these kinds of signals can exhibit different time organization for the magnitude and sign and the magnitude series relates to nonlinear properties of the original time series, while the sign series relates to the linear properties. Magnitude series are long-range correlated, while the sign series are anticorrelated. Newly, the correlations for healthy persons are different that the correlations for CHF patients both for magnitude and sign time series. In the paper of Ashkenazy et al. they proposed the empirical relation: αsign≈1/2(αoriginal+αmagnitude) for the short-range regime (high frequencies), however, we have found a different relation that in our calculations is valid for short and long-range regime: αsign≈1/4(αoriginal+αmagnitude).

  19. Aldosterone and aldosterone receptor antagonists in patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Nappi J

    2011-06-01

    Full Text Available Jean M Nappi, Adam SiegClinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, SC, USAAbstract: Aldosterone is a mineralocorticoid hormone synthesized by the adrenal glands that has several regulatory functions to help the body maintain normal volume status and electrolyte balance. Studies have shown significantly higher levels of aldosterone secretion in patients with congestive heart failure compared with normal patients. Elevated levels of aldosterone have been shown to elevate blood pressure, cause left ventricular hypertrophy, and promote cardiac fibrosis. An appreciation of the true role of aldosterone in patients with chronic heart failure did not become apparent until the publication of the Randomized Aldactone Evaluation Study. Until recently, the use of aldosterone receptor antagonists has been limited to patients with severe heart failure and patients with heart failure following myocardial infarction. The Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF study added additional evidence to support the expanded use of aldosterone receptor antagonists in heart failure patients. The results of the EMPHASIS-HF trial showed that patients with mild-to-moderate (New York Heart Association Class II heart failure had reductions in mortality and hospitalizations from the addition of eplerenone to optimal medical therapy. Evidence remains elusive about the exact mechanism by which aldosterone receptor antagonists improve heart failure morbidity and mortality. The benefits of aldosterone receptor antagonist use in heart failure must be weighed against the potential risk of complications, ie, hyperkalemia and, in the case of spironolactone, possible endocrine abnormalities, in particular gynecomastia. With appropriate monitoring, these risks can be minimized. We now have evidence that patients with mild-to-severe symptoms

  20. Novel application of multi dynamic trend analysis as a sensitive tool for detecting the effects of aging and congestive heart failure on heart rate variability

    Science.gov (United States)

    Lin, Yu-Cheng; Lin, Yu-Hsuan; Lo, Men-Tzung; Peng, Chung-Kang; Huang, Norden E.; Yang, Cheryl C. H.; Kuo, Terry B. J.

    2016-02-01

    The complex fluctuations in heart rate variability (HRV) reflect cardiac autonomic modulation and are an indicator of congestive heart failure (CHF). This paper proposes a novel nonlinear approach to HRV investigation, the multi dynamic trend analysis (MDTA) method, based on the empirical mode decomposition algorithm of the Hilbert-Huang transform combined with a variable-sized sliding-window method. Electrocardiographic signal data obtained from the PhysioNet database were used. These data were from subjects with CHF (mean age = 59.4 ± 8.4), an age-matched elderly healthy control group (59.3 ± 10.6), and a healthy young group (30.3 ± 4.8); the HRVs of these subjects were processed using the MDTA method, time domain analysis, and frequency domain analysis. Among all HRV parameters, the MDTA absolute value slope (MDTS) and MDTA deviation (MDTD) exhibited the greatest area under the curve (AUC) of the receiver operating characteristics in distinguishing between the CHF group and the healthy controls (AUC = 1.000) and between the healthy elderly subject group and the young subject group (AUC = 0.834 ± 0.067 for MDTS; 0.837 ± 0.066 for MDTD). The CHF subjects presented with lower MDTA indices than those of the healthy elderly subject group. Furthermore, the healthy elderly subjects exhibited lower MDTA indices than those of the young controls. The MDTA method can adaptively and automatically identify the intrinsic fluctuation on variable temporal and spatial scales when investigating complex fluctuations in the cardiac autonomic regulation effects of aging and CHF.

  1. 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

  2. Iron deficiency in chronic heart failure : An international pooled analysis

    NARCIS (Netherlands)

    Klip, IJsbrand T.; Comin-Colet, Josep; Voors, Adriaan A.; Ponikowski, Piotr; Enjuanes, Cristina; Banasiak, Waldemar; Lok, Dirk J.; Rosentryt, Piotr; Torrens, Ainhoa; Polonski, Lech; van Veldhuisen, Dirk J.; van der Meer, Peter; Jankowska, Ewa A.

    2013-01-01

    Background Iron deficiency (ID) is an emerging problem in patients with chronic heart failure (HF) and can be a potential therapeutic target. However, not much is known about the prevalence, predictors, and prognosis of ID in patients with chronic HF. Methods In an international pooled cohort compri

  3. Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels.

    Directory of Open Access Journals (Sweden)

    Sayoko Negi

    Full Text Available BACKGROUND: Congestive physical findings such as pulmonary rales and third heart sound (S3 are hallmarks of acute heart failure (AHF. However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients. METHODS: We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD, S3, and edema. The primary endpoint was defined as rehospitalization for HF. RESULTS: Majority (63.9% of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9% of the patients, JVD in 54.1%, and pulmonary rales in 43.6%. The mean follow-up period was 726 ± 31 days. Patients with pulmonary rales (p < 0.001 and S3 (p  =  0.011 had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT levels at the time of discharge (odds ratio [OR] 2.8; p  =  0.02 and OR 2.6; p  =  0.05, respectively. CONCLUSION: Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.

  4. HEART RATE-LOWERING THERAPY IN THE TREATMENT OF CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    S. V. Shalaev

    2015-01-01

    Full Text Available Aspects of heart rate-lowering therapy in patients with chronic heart failure using If-channel blocker ivabradine are discussed. The evidence-based data on ivabradine use reveal its advantages, disadvantages and place in the treatment of cardiac patients.

  5. HEART RATE-LOWERING THERAPY IN THE TREATMENT OF CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    S. V. Shalaev

    2015-09-01

    Full Text Available Aspects of heart rate-lowering therapy in patients with chronic heart failure using If-channel blocker ivabradine are discussed. The evidence-based data on ivabradine use reveal its advantages, disadvantages and place in the treatment of cardiac patients.

  6. Anemia associated with chronic heart failure: current concepts

    Directory of Open Access Journals (Sweden)

    Shah R

    2013-02-01

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

  7. {sup 123}I-meta-iodo-benzyl-guanidine myocardial scintigraphy and congestive heart failure: current data and perspective; Scintigraphie myocardique a la {sup 123}I-meta-iodobenzylguanidine et insuffisance cardiaque congestibe: donnees actuelles et perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Agostini, D.; Darlas, Y.; Quennelle, F.; Bouvard, G.; Scanu, P.; Grollier, G.; Potier, J.C.; Babatasi, G. [Centre Hospitalier Universitaire, 14 - Caen (France); Belin, A. [Hopital de Trouville, Trouville (France)

    1997-12-31

    Congestive heart failure is often associated with an impairment of the sympathetic nervous system, i.e., global hyperactivity and regional impairment of the adrenergic system. Cardiac {sup 123}I-MIBG scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Myocardial MIBG fixation is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic nerve endings. The impairment of presynaptic function occurs early in the disease and is actually involved in the pathogenesis of cardiac failure. Cardiac MIBG scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. It could be proposed in patients with severe ventricular dysfunction in order to assist physicians in setting-up the timing of heart transplantation. (authors). 52 refs.

  8. Ca(2+) sensitisation of force production by noradrenaline in femoral conductance and resistance arteries from rats with postinfarction congestive heart failure

    DEFF Research Database (Denmark)

    Trautner, Simon; Amtorp, Ole; Boesgaard, Soren

    2006-01-01

    In this study we tested the hypothesis that arterial myofilament Ca(2+) sensitivity and/or the Ca(2+) sensitising effect of noradrenaline (NA) is enhanced in post-infarction congestive heart failure (CHF), which could contribute to the high peripheral vascular resistance in this condition. Femoral....... We conclude that an abnormality in the sensitivity of the contractile apparatus to Ca(2+), or in NA-induced Ca(2+) sensitisation in arterial vascular smooth muscle cells is unlikely to contribute to the ubiquitously elevated vascular resistance associated with CHF. However, our data demonstrate...

  9. The change of cerebral blood flow after heart transplantation in congestive heart failure: a voxel-based and automatic VOl analysis of Tc-99m ECD SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Hong, I. K.; Kim, J. J.; Lee, C. H.; Lim, K. C.; Moon, D. H.; Rhu, J. S.; Kim, J. S. [Asan Medical Center, Seoul (Korea, Republic of)

    2007-07-01

    To investigate the change of global and regional cerebral blood flow after heart transplantation (HT) in congestive heart failure (CHF) patients. Twenty-one patients with CHF who underwent HT (45{+-}12 yrs, M/F=19/2) and 10 healthy volunteers (39{+-}13 yrs, M/F = 7/3) were prospectively included. All patients underwent echocardiography and radionuclide angiography including brain and aorta with brain SPECT which was performed after iv bolus injection of Tc-99m ECD (740MBq) before (175{+-}253 days) and after (129{+-}82 days) HT. Patients were divided into two groups according to the interval between HT and postoperative SPECT [early follow-up (f/u): <6 mo, n=14; late f/u: >6 mo, n=7]. Global CBF (gCBF) of bilateral hemispheres were calculated by Patlak graphical analysis. Absolute rCBF map was obtained from brain SPECT by Lassen's correction algorithm. Age-corrected voxel-based analysis using SPM2 and automatic VOl analysis were performed to assess the rCBF change. Cardiac ejection fraction of all patients improved after HT (20.8%{yields}64.0%). gCBF was reduced compared to normal before HT (35.7{+-}3.9 vs. 49.1{+-}3.0 ml/100g/min; p<0.001) and improved postoperatively (46.6{+-}5.4, p<0.001). The preoperative gCBFs of early and late f/u group were not different (34.6{+-}3.2 vs. 38.0{+-}4.4, p=0.149) but postoperative gCBF (43.9{+-}3.7) of late f/u group was higher than those (52.0{+-}4.0) of early f/u group (p<0.001). On voxel-based analysis, preoperative rCBF was reduced in entire brain but most severely in bilateral superior and inferior frontal cortex, supplementary motor area, precuneus and anterior cingulum, compared to normals (uncorrected p<0.001). After HT, rCBF of these areas improved more significantly in late f/u group than in early f/u group but still lower than normals. Global CBF was significantly reduced in CHF patients and improved after HT. rCBFs of the frontal cortex, precuneus and cingulum were most severely reduced and slowly improved after

  10. Extra-aortic implantable counterpulsation pump in chronic heart failure.

    Science.gov (United States)

    Mitnovetski, Sergei; Almeida, Aubrey A; Barr, Althea; Peters, William S; Milsom, F Paget; Ho, Betty; Smith, Julian A

    2008-06-01

    Extra-aortic counterpulsation for the management of chronic heart failure is a novel approach. We report the use of an extra-aortic implantable counterpulsation pump in the management of a 73-year-old patient with severe heart failure refractory to medical therapy. The implantable counterpulsation pump prolonged his life and greatly improved its quality. The patient lived almost 7 months after the implantation of the device and died of septic complications secondary to gas line infection.

  11. Impaired mitochondrial function in chronically ischemic human heart

    DEFF Research Database (Denmark)

    Stride, Nis Ottesen; Larsen, Steen; Hey-Mogensen, Martin;

    2013-01-01

    , and finally to assess myocardial antioxidant levels. Mitochondrial respiration in biopsies from ischemic and nonischemic regions from the left ventricle of the same heart was compared in nine human subjects. Maximal oxidative phosphorylation capacity in fresh muscle fibers was lower in ischemic compared.......05), and the levels of antioxidant protein expression was lower. Diminished mitochondrial respiration capacity and excessive ROS production demonstrate an impaired mitochondrial function in ischemic human heart muscle. No chronic ischemic preconditioning effect was found....

  12. Tolvaptan Improves the Long-Term Prognosis in Patients With Congestive Heart Failure With Preserved Ejection Fraction as Well as in Those With Reduced Ejection Fraction.

    Science.gov (United States)

    Imamura, Teruhiko; Kinugawa, Koichiro

    2016-09-28

    Tolvaptan (TLV), an arginine vasopressin type 2 antagonist, has been shown to play a role in ameliorating symptomatic congestion and normalizing diluted hyponatremia in patients with congestive heart failure (HF). However, most evidence was derived from patients with HF with reduced ejection fraction (HFrEF), and the clinical efficacy of TLV in patients with HF with preserved ejection fraction (HFpEF) remains uncertain. In this study, we retrospectively enrolled 60 in-hospital patients with stage D HF, who had received TLV to treat symptomatic congestion at our institute between 2011 and 2013. As a control group, we also enrolled 60 background-matched HF patients who did not receive TLV therapy. Patients with HFpEF (n = 29), whose left ventricular ejection fraction was > 45%, had higher age and a lower urine aquaporin-2 level relative to the plasma arginine vasopressin concentration compared with those with HFrEF (n = 91). TLV therapy significantly reduced the 2-year readmission rates in both the HFrEF and HFpEF populations (P < 0.05 for both), indicating that TLV therapy may improve the long-term prognosis not only in patients with HFrEF but also in those with HFpEF.

  13. Anemic syndrome in patients with ischemic heart disease and chronic heart failure (review

    Directory of Open Access Journals (Sweden)

    Shvarts Y.G.

    2011-12-01

    Full Text Available Anemic syndrome of different severity often accompanies ischemic heart disease (IHD and chronic heart failure (CHF. Anemia has association with unfavorable prognosis in patients with all forms of CVD — acute and chronic. In this article the authors summarize a literature review of English articles dedicated to the problem of anemia and ischemic heart disease (IHD and the results of original research on the relationship between anemic syndrome and prognosis in the hospitalized patients with IHD and chronic heart failure (CHF. Anemia is frequently observed in patients with CHF, and evidence suggests that anemia might be associated with an increased mortality in both systolic and diastolic chronic heart failure (CHF, morbidity and rate of hospitalization in CHF patients. Moreover, CHF itself could be involved in the pathogenesis of anemia. Early studies suggested a pathogenic role of inflammation mediators. The normalization of hemoglobin concentration by EPO and iron supply in patients with CHF and chronic renal insufficiency results in improved exercise capacity by increasing oxygen delivery and improving cardiac function. However, there is limited information concerning the association of hemoglobin concentration and new onset of clinically recognized coronary artery disease, and lack of information about the effect of anemia treatment on prognosis of acute forms of IHD

  14. Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Kragelund, Charlotte B; Torp-Pedersen, Christian

    2004-01-01

    AIMS: Previous studies have suggested that a high body mass index (BMI) is associated with an improved outcome in congestive heart failure (CHF). However, the studies addressing this problem have not included enough patients with non-systolic heart failure to evaluate how left ventricular systolic...... function interacts with obesity on prognosis in CHF. The aim of this study was to evaluate how BMI influences mortality in patients hospitalized with CHF, and to address in particular whether the effect of BMI is influenced by left ventricular (LV) systolic function. METHODS AND RESULTS: Retrospective...... with increasing BMI from the underweight to the obese. Compared with normal weight, and adjusted for sex and age, risk ratios (RR) and 95% confidence limits were: underweight 1.56 (1.33-1.84), overweight 0.90 (0.83-0.97), obese 0.77 (0.70-0.86). Being underweight conferred a greater risk in CHF patients...

  15. Novel Use of Tolvaptan in a Pediatric Patient With Congestive Heart Failure Due to Duchenne Muscular Dystrophy and Congenital Adrenal Hyperplasia.

    Science.gov (United States)

    Sami, Sarah A; Moffett, Brady S; Karlsten, Melissa L; Cabrera, Antonio G; Price, Jack F; Dreyer, William J; Denfield, Susan W; Jeewa, Aamir

    2015-01-01

    Successful management of hyponatremia in heart failure patients requires a multifaceted approach in order to preserve end-organ function. We describe the novel use of a selective vasopressin receptor antagonist, tolvaptan, for management of hyponatremia in a 17-year-old Caucasian male with severe Duchenne muscular dystrophy, congestive heart failure (CHF), and congenital adrenal hyperplasia. The medical history was significant for recurrent admissions for hyponatremia secondary to adrenal crises, which was also exacerbated by his CHF. After initiation of tolvaptan and its extended administration, he had no further hyponatremia-related admissions and no adverse reactions. The complexity of this combination of conditions is presented, and the efficacy of the drug and the rationale behind the treatment approach is discussed.

  16. Junctional Bradycardia as Early Sign of Digoxin Toxicity in a Premature Infant with Congestive Heart Failure due to a Left to Right Shunt.

    Science.gov (United States)

    Dasgupta, Soham; Aly, Ashraf M; Jain, Sunil K

    2016-03-01

    Introduction Congestive heart failure due to left to right cardiac shunt is usually managed medically with diuretics, angiotensin converting enzyme inhibitors, and, in some cases, with the addition of digoxin. Case We report a 31-week gestation premature male infant who did not respond to such treatment and developed hyperaldosteronism and severe hypokalemia secondary to activation of the renin angiotensin aldosterone system. The hypokalemia was not responsive to intravenous KCL supplementation and induced digoxin toxicity despite a relatively normal digoxin level. The earliest signs of digoxin toxicity in the patient were junctional rhythm and bradycardia. The discontinuation of digoxin and the administration of digoxin specific immunoglobulin fragments (Fab) reversed those changes. The addition of spironolactone (an aldosterone antagonist) had a dramatic effect, resulting in clinical improvement of the patient coupled with normalization of Q4 serum and urine electrolytes. Conclusion Serum Digoxin level alone may fail as an independent guide in the diagnosis of digoxin toxicity when hypokalemia is present. In premature infants with congestive heart failure and hypokalemia, addition of an aldosterone antagonist should be considered.

  17. The Effectiveness of Healthy Lifestyle Promotion Intervention on Quality of Life in Patients with Congestive Heart Failure via Cognitive-Behavioral Procedure

    Directory of Open Access Journals (Sweden)

    M Zeraatkar

    2016-02-01

    Full Text Available Introduction: Reduced quality of life in cardiac patients and their frequent hospitalizations in the coronary care units is regarded as a main challenge for such patients. Therefore, this study aimed to explore the effectiveness of healthy lifestyle promotion intervention on quality of life in patients with congestive heart failure via cognitive-behavioral procedure. Methods: In this randomized controlled trial, assessment in pretest, posttest, and follow-up along with the control group were applied. Twenty-six patients with congestive heart failure were selected via convenience sampling among patients attended to Shahid Rajaee Heart hospital in Tehran. Then, they were randomly assigned to the experimental group (n=11; under administration of healthy lifestyle promotion intervention via cognitive-behavioral procedure during eight group sessions once a week and control group (n=15. Quality of life was measured for all the participants in three phases of pre-test, post-test and follow-up by Questionnaire of Quality of Life in Patients with Heart Failure (IHF-QoL and Depression Anxiety Stress Scales (DASS. Results: According to the results of variance analysis with repeated measures, this intervention was proved to have short-time effects on quality of life and its psychological components (P<0.001. Following the therapy termination, patients were returned to baseline, though the effect of intervention on depression was continued within 2 month follow-up (P<0.001. Conclusion: In regard with the effectiveness of healthy lifestyle promotion intervention via cognitive-behavioral procedure in improving quality of life and its psychological aspects, as well as high costs of hospital and prolonged treatment for these patients, applying this intervention in a permanent manner seem to be beneficial.

  18. SERUM YKL-40 LEVELS IN CHRONIC HEART FAILURE.

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    Maria Kazakova

    2014-06-01

    Full Text Available Inflammatory processes are involved in the pathogenesis and development of chronic heart disease. The promising novel inflammatory biomarker YKL-40 is related to the degree of inflammation and pathological tissue remodeling. The aim of this study was to determine serum YKL-40 levels in patients with chronic heart failure and to evaluate the potential relationship with ultrasonography findings. Forty-three individuals were enrolled in the study – 24 patients (10 females and 14 males with chronic heart failure, aged 70±11 (mean ± standard deviation and 16 healthy people as age-matched controls (above 50 years. The serum YKL-40 levels were assessed by ELISA. Sonographic measurements such as two-dimensional, Power wave, Continuous Wave, Colour mode and M-Mode were performed using a diagnostic ultrasound system (PHILIPS Ultrasound, Washington, US with a L11-3 probe of 3-11 MHz. The six minute walk test was used to assess functional capability of patients. Our study revealed significantly higher serum YKL-40 levels in patients compared to the control group (P=0.010. No relation was found between the glycoprotein and the results from the ultrasonographic and functional examination. We suppose that increased serum YKL-40 levels in patients with chronic heart failure might reflect the inflammatory route in the development of the disease.

  19. Bone marrow dysfunction in chronic heart failure patients

    NARCIS (Netherlands)

    Westenbrink, B. Daan; Voors, Adriaan A.; de Boer, Rudolf A.; Schuringa, Jan J.; Klinkenberg, Theo; van der Harst, Pim; Vellenga, Edo; van Veldhuisen, Dirk J.; van Gilst, Wiek H.

    2010-01-01

    To investigate whether chronic heart failure (CHF) is associated with a general dysfunction of the haematopoietic compartment. Bone marrow was obtained during coronary artery bypass graft surgery from 20 patients with CHF (age 67 +/- 6 years, 75% NYHA class >= III, LVEF 32 +/- 6%), and 20 age- and g

  20. 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.

  1. High prevalence of microalbuminuria in chronic heart failure patients

    NARCIS (Netherlands)

    Van De Wal, RMA; Asselbergs, FW; Plokker, HWT; Smilde, TDJ; Lok, D; Van Veldhuisen, DJ; Van Gilst, WH; Voors, AA

    2005-01-01

    Background: Microalbuminuria is associated with increased risk for cardiovascular morbidity and mortality. However, the relation between microalbuminuria and chronic heart failure has not been well described yet. In this cross-sectional study, we aim to evaluate the prevalence of microalbuminuria an

  2. Nebivolol in chronic heart failure : current evidence and future perspectives

    NARCIS (Netherlands)

    Lipsic, Erik; van Veldhuisen, Dirk J.

    2010-01-01

    Areas covered in the review: We describe the role of the sympathetic nervous system, beta-blockers and specifically nebivolol in chronic heart failure. What the reader will gain: Nebivolol is a third-generation beta-blocker, with high beta(1)/beta(2) selectivity. Moreover, it has important vasodilat

  3. Hope in elderly adults with chronic heart failure. Concept analysis.

    Science.gov (United States)

    Caboral, Meriam F; Evangelista, Lorraine S; Whetsell, Martha V

    2012-01-01

    This topic review employed Walker and Avant's method of concept analysis to explore the construct of hope in elderly adults with chronic heart failure. The articles analyzed revealed that hope, as the belief of the occurrence of a positive result without any guarantee that it will be produced, is necessary for the survival and wellbeing of the elderly adults enduring this disease.

  4. Heart rate variability in patients with chronic cerebral ischemia

    Directory of Open Access Journals (Sweden)

    Smyshlaeva О.М.

    2010-12-01

    Full Text Available The purpose of the work is to estimate the status of autonomic nervous system in patients with chronic cerebral ischemia by means of the analysis of heart rate variability at various stages of disease. 120 patients with chronic cerebral ischemia aged from 45 to 65 took part in the research. The comparison group included 30 patients with an arterial hypertension and without chronic cerebral ischemia. Heart rate variability analisis included time-domain and frequency-domain methods of five-minute sequence of the electrocardiographic intervals registered in at rest and in or-thostatic probe. The results of research have shown, that autonomic disorders with prevalence of sympathetic nervous system accompany initial implications of chronic cerebral ischemia. The second stage of disease is characterized by depression of activity of both autonomic, and central regulation. The expressed depression of autonomic maintenance of regulation of heart rhythm of both from sympathetic, and from parasympathetic nervous system was observed at the third stage of chronic cerebral ischemia

  5. Rate of change in physical fitness and quality of life and depression following exercise training in patients with congestive heart failure.

    Science.gov (United States)

    Smart, Neil A; Murison, Robert

    2013-01-01

    Exercise training appears to improve peak oxygen consumption (VO(2) ) and quality of life (QOL) in heart failure patients, although disease etiology, patient demographics and medication may alter the rate of adaptation. The authors sought to identify rate of change from baseline in fitness, QOL, and depression following exercise training in a cohort of patients with congestive heart failure. Thirty male systolic heart failure patients (aged 63.8±8.3 years, baseline peak VO(2) 12.2±4.8 mL/kg/min, left ventricular ejection fraction 28.2±9.4%, New York Heart Association class II/II 22/8) undertook 52 weeks of exercise training, 16 weeks as an outpatient and a further 36 weeks of home exercise. Peak VO(2) and QOL was measured using the Minnesota Living With Heart Failure (MLWHF) questionnaire and depression using the Hare-Davis scale. The authors analyzed the rate of change in peak VO(2) and MLWHF after grouping patients according to clinical, demographic, and pharmacologic characteristics. Peak VO(2) measurements varied over time, with no effect of disease pathology or β-blocker on peak VO(2) . The rate of change in physical MLWHF score was significantly greater (improved) during 0 to 16 weeks in patients with dilated pathology, but was not significantly affected by β-blocker use or age. The exercise training venue and supervision, or lack thereof, is the major determinant of adaptation to the intervention in heart failure patients, although age, β-adrenergic medication, and heart failure etiology also explain some of the variation in adaptive responses observed.

  6. Heart Failure Update: Chronic Disease Management Programs.

    Science.gov (United States)

    Fountain, Lorna B

    2016-03-01

    With high mortality and readmission rates among patients with heart failure (HF), multiple disease management models have been and continue to be tested, with mixed results. Early postdischarge care improves outcomes for patients. Telemonitoring also can assist in reducing mortality and HF-related hospitalizations. Office-based team care improves patient outcomes, with important components including rapid access to physicians, partnerships with clinical pharmacists, education, monitoring, and support. Pay-for-performance measures developed for HF, primarily use of angiotensin-converting enzyme inhibitors and beta blockers, also improve patient outcomes, but the influence of adherence to other measures has been minimal. Evaluating comorbid conditions, including diabetes and hypertension, and making drug adjustments for patients with HF to include blood pressure control and use of metformin, when possible, can reduce mortality and morbidity.

  7. Bed rest and increased diuretic treatment in chronic congestive heart failure

    DEFF Research Database (Denmark)

    Abildgaard, U; Aldershvile, J; Ring-Larsen, H

    1985-01-01

    increased diuresis (P less than 0.05) during the first day of the study and a tendency towards increased natriuresis. The cumulated diuresis for the two groups (24-hour bed rest versus night bed rest) during the three days of study were 7773 +/- 700 ml and 5861 +/- 909 ml (0.05 less than P less than 0...

  8. Association between ambient carbon monoxide levels and hospitalizations for congestive heart failure in the elderly in 10 canadian cities; Association entre les niveaux atmospheriques de monoxyde de carbone et les hospitalisations pour insuffisance cardiaque congestive des personnes agees dans 10 villes canadiennes

    Energy Technology Data Exchange (ETDEWEB)

    Burnett, R.T.; Dales, R.E.; Brook, J.R.; Raizenne, M.E.; Krewski, D.

    2001-01-01

    In 1995, two studies, realized in the USA, showed the relation between the carbon monoxide content in the urban air and the hospitalization of elderly people for congestive heart failure. This study, realized this time in the Canada, take again the protocol of one of them increasing the period (4 to 11 years) and the number of concerned towns. (A.L.B.)

  9. Changes in derived measures from six-minute walk distance following home-based exercise training in congestive heart failure: A preliminary report.

    Science.gov (United States)

    Babu, Abraham Samuel; Desai, Charmie V; Maiya, Arun G; Guddattu, Vasudeva; Padmakumar, Ramachandran

    2016-01-01

    The response of derived parameters from six-minute walk distance (6MWD), like 6MW work (6MWW), to exercise training and its correlation with quality of life (QoL) in congestive heart failure (CHF) is not known. A secondary analysis from a randomized controlled trial on 30 patients (23 males; mean age 57.7±10.4 years; mean ejection fraction 31±10%) with CHF in NYHA class I-IV who completed an eight-week home-based exercise training program found a significant improvement in 6MWW (p<0.05), with similar correlations between 6MWD and 6MWW with QoL. 6MWW does not appear to provide additional benefit to 6MWD in cardiac rehabilitation for CHF.

  10. Patent ductus arteriosus in an adult cat with pulmonary hypertension and right-sided congestive heart failure: hemodynamic evaluation and clinical outcome following ductal closure.

    Science.gov (United States)

    Novo-Matos, José; Hurter, Karin; Bektas, Rima; Grest, Paula; Glaus, Tony

    2014-09-01

    Right-sided congestive heart failure (CHF) developed secondary to severe pulmonary hypertension (PH) in an 8-year-old cat with a left-to-right shunting patent ductus arteriosus (PDA). Vascular reactivity was tested prior to shunt ligation by treatment with oxygen and sildenafil. This treatment was associated with a significant decrease in pulmonary artery pressure as assessed by echocardiography. Subsequently surgical shunt ligation was planned. During thoracotomy, digital occlusion of the PDA was performed for 10 min with simultaneous catheter measurement of right ventricular pressure, which did not increase. Permanent shunt ligation resulted in a complete and sustained clinical recovery. A lung biopsy sample obtained during thoracotomy demonstrated histopathological arterial changes typical of PH. Cats can develop clinically severe PH and right-sided CHF secondary to a left-to-right PDA even at an advanced age. Assuming there is evidence of pulmonary reactivity, PDA occlusion might be tolerated and can potentially produce long-term clinical benefits.

  11. Is there a place for combining angiotensin-converting enzyme inhibitors and angiotensin-receptor antagonists in the treatment of hypertension, renal disease or congestive heart failure?

    Science.gov (United States)

    Taylor, A A

    2001-09-01

    Angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists have proven to be effective and well tolerated antihypertensive agents. They also exhibit unique cardioprotective and renoprotective properties in patients with comorbid conditions such as congestive heart failure and proteinuria or renal insufficiency. This benefit is observed most dramatically in diabetic persons. Although inconclusive, the results of a limited number of clinical trials support the notion that additive antihypertensive, cardioprotective, and renoprotective effects may be obtained with combined used of angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists in some patients. More studies are needed to confirm the findings of these preliminary studies, and to define more clearly those subsets of patients who might derive the greatest benefit from angiotensin-converting enzyme inhibitor-angiotensin II receptor subtype 1 antagonist combination therapy.

  12. ST2 and patient prognosis in chronic heart failure.

    Science.gov (United States)

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

    2015-04-02

    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

  13. Significance of QRS duration and left bundle branch block in development and course of congestive heart failure

    Directory of Open Access Journals (Sweden)

    Bockeria L. A.

    2012-03-01

    Full Text Available Patients with severe chronic heart failure (CHF often have such intraventricular conduction disturbances as left bundle branch block which show morphological and QRS-duration changes on ECG and result in evident intra- and interventricular dyssinchrony. Delayed left ventricular activation via interventricular septum results in evident asynchrony at the beginning of left and right ventricular contration. Diagnostic significance of ECG data increases in presence of CHF clinical signs, especially echocardiographic signs of myocardial dysfunction. EVEREST study analyzed the influence of QRS duration on number of hospital admissions and mortality in patients with CHF. The study included 2962 patients, 1614 of them had normal QRS duration – less than 120 ms, 1321 patients had increased QRS duration – more than 120 ms. 678 deaths occurred during followup period, 307 (18.7% of them were from group with normal QRS duration and 371 (28.1% – from group with increased QRS interval. Mortality rate due to cardiovascular causes was more significant in patients with increased QRS. In 3 months of follow-up the mortality rate was 21.1% in patients with increased QRS and 14.6% in patients with normal QRS. In 9.9 months of follow-up the rates were 41.6% and 32.4%, respectively. Different international studies showed that isolated right ventricular pacing resulted in prolongation of QRS complex and contributed to CHF progression. 2010 patients were randomized in MOST-study which aimed to compare dual chamber pacing and right ventricular pacing. Reduction of CHF symptoms was noted in the course of study in patients who underwent dual chamber pacing, while M.O. Sweeney et al. analyzed the results of treatment of 1339 patients with initially normal QRS duration. However the authors revealed a higher rate in group of right ventricular pacing which proved the higher rates of hospital admission for CHF and more frequent rates for atrial fibrillation occurrence

  14. Heart failure - tests

    Science.gov (United States)

    CHF - tests; Congestive heart failure - tests; Cardiomyopathy - tests; HF - tests ... the best test to: Identify which type of heart failure (systolic versus diastolic, valvular) Monitor your heart failure ...

  15. Role of continuous positive airway pressure in patients with combined sleep apnea syndrome without congestive heart failure

    Directory of Open Access Journals (Sweden)

    Shereen Farghaly

    2016-07-01

    Conclusion: CPAP can be effective in combined obstructive and central apnea patients without heart failure with consideration of individual variability. A trial of CPAP titration should be done in those patients.

  16. Prognostic importance of a restrictive transmitral filling pattern in patients with symptomatic congestive heart failure and atrial fibrillation

    DEFF Research Database (Denmark)

    Raunsø, Jakob; Møller, Jacob Eifer; Kjaergaard, Jesper

    2009-01-01

    BACKGROUND: Restrictive diastolic filling pattern is associated with increased mortality in patients with myocardial infarction and heart failure. Most studies have excluded patients with atrial fibrillation. The aim of the present study was to assess the prognostic value of a restrictive filling...... pattern in patients with atrial fibrillation. METHODS: Doppler echocardiography including pulsed wave Doppler assessment of transmitral flow was performed in 880 patients with a clinical diagnosis of heart failure on hospital admission. Filling was considered restrictive when the mitral deceleration time...

  17. Delivering Chronic Heart Failure Telemanagement via Multiple Interactive Platforms

    Directory of Open Access Journals (Sweden)

    Joseph Finkelstein

    2013-06-01

    Full Text Available Existing telemonitoring systems provide limited support in implementing personalized treatment plans. We developed a Home Automated Telemanagement (HAT system for patients with congestive heart failure (CHF to provide support in following individualized treatment plans as well as to monitor symptoms, weight changes, and quality of life, while educating the patient on their disease. The system was developed for both a laptop computer and a Nintendo Wii. The system is designed to be placed in the patient's home and to communicate all patient data to a central server implementing real-time clinical decision support. The system questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3-zone CHF action plan. Their medication regimen and suggested actions are determined by their care management team and integrated into the system, keeping a personalized approach to disease management while taking advantage of the technology available. The systems are designed to be as simple as possible, making it usable by patients with no prior computer or videogame experience. A feasibility assessment in African American patients with CHF and without prior computer or videogame experience demonstrated high level of acceptance of the CHF HAT laptop and Wii systems. Keywords: telem

  18. Sympathetic reflex control of skeletal muscle blood flow in patients with congestive heart failure: evidence for beta-adrenergic circulatory control

    Energy Technology Data Exchange (ETDEWEB)

    Kassis, E.; Jacobsen, T.N.; Mogensen, F.; Amtorp, O.

    1986-11-01

    Mechanisms controlling forearm muscle vascular resistance (FMVR) during postural changes were investigated in seven patients with severe congestive heart failure (CHF) and in seven control subjects with unimpaired left ventricular function. Relative brachioradial muscle blood flow was determined by the local /sup 133/Xe-washout technique. Unloading of baroreceptors with use of 45 degree upright tilt was comparably obtained in the patients with CHF and control subjects. Control subjects had substantially increased FMVR and heart rate to maintain arterial pressure whereas patients with CHF had decreased FMVR by 51 +/- 11% and had no increase in heart rate despite a fall in arterial pressure during upright tilt. The autoregulatory and local vasoconstrictor reflex responsiveness during postural changes in forearm vascular pressures were intact in both groups. In the patients with CHF, the left axillary nerve plexus was blocked by local anesthesia. No alterations in forearm vascular pressures were observed. This blockade preserved the local regulation of FMVR but reversed the vasodilator response to upright tilt as FMVR increased by 30 +/- 7% (p less than .02). Blockade of central neural impulses to this limb combined with brachial arterial infusions of phentolamine completely abolished the humoral vasoconstriction in the tilted position. Infusions of propranolol to the contralateral brachial artery that did not affect baseline values of heart rate, arterial pressure, or the local reflex regulation of FMVR reversed the abnormal vasodilator response to upright tilt as FMVR increased by 42 +/- 12% (p less than .02). Despite augmented baseline values, forearm venous but not arterial plasma levels of epinephrine increased in the tilted position, as did arteri rather than venous plasma concentrations of norepinephrine in these patients.

  19. Prognostic value of repeated {sup 123}I-metaiodobenzylguanidine imaging in patients with dilated cardiomyopathy with congestive heart failure before and after optimized treatments. Comparison with neurohumoral factors

    Energy Technology Data Exchange (ETDEWEB)

    Matsui, Toshiki; Tsutamoto, Takayoshi; Maeda, Keiko; Kusukawa, Junya; Kinoshita, Masahiko [Shiga Univ. of Medical Science, Otsu (Japan)

    2002-06-01

    The present study was undertaken to assess whether repeated measurement of cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) imaging parameters before and after optimized treatments is useful for predicting the prognosis of patients with congestive heart failure (CHF) resulting from dilated cardiomyopathy (DCM). The subjects were 85 consecutive patients with DCM who had a left ventricular ejection fraction (LVEF) of less than 45%. The MIBG and the concentrations of neurohumoral factors were measured at baseline and after 6 months of optimized treatments. Cox proportional hazards analysis was performed to assess the various parameters before and after treatment. Twenty-three patients had a cardiac event (12 died; 11 hospitalized) during a mean follow-up period of 2 years. Although there was no difference between the baseline heart to mediastinum (H/M) ratio measured by MIBG between survivors and nonsurvivors, the H/M ratio was significantly decreased in nonsurvivors after 6 months. Multivariate analysis revealed that a high plasma concentration of brain natriuretic peptide level after 6 months (p=0.0049) and absolute changes in the H/M ratio (p=0.0046) were independent predictors of mortality. Comparison of the H/M ratio on MIBG imaging before and after optimized additional treatment provided useful information for predicting mortality and was independent of clinical and neurohumoral factors previously shown to be associated with poor prognosis in patients with DCM. (author)

  20. Differential number of CD34+, CD133+ and CD34+/CD133+ cells in peripheral blood of patients with congestive heart failure

    Directory of Open Access Journals (Sweden)

    Fritzenwanger M

    2009-03-01

    Full Text Available Abstract Background Endothelial progenitor cells (EPC which are characterised by the simulateous expression of CD34, CD133 and vascular endothelial growth receptor 2 (VEGF 2 are involved in the pathophysiology of congestive heart failure (CHF and their number and function is reduced in CHF. But so far our knowledge about the number of circulating hematopoietic stem/progenitor cells (CPC expressing the early hematopoietic marker CD133 and CD34 in CHF is spares and therefore we determined their number and correlated them with New York Heart Association (NYHA functional class. Methods CD34 and CD133 surface expression was quantified by flow cytometry in the peripheral venous blood of 41 healthy adults and 101 patients with various degrees of CHF. Results CD34+, CD133+ and CD34+/CD133+ cells correlated inversely with age. Both the number of CD34+ and of CD34+/CD133+ cells inversely correlated with NYHA functional class. The number of CD133+ cells was not affected by NYHA class. Furthermore the number of CD133+ cells did not differ between control and CHF patients. Conclusion In CHF the release of CD34+, CD133+ and CD34+/CD133+ cells from the bone marrow seems to be regulated differently. Modulating the releasing process in CHF may be a tool in CHF treatment.

  1. Dofetilide in patients with congestive heart failure and left ventricular dysfunction: safety aspects and effect on atrial fibrillation. The Danish Investigators of Arrhythmia and Mortality on Dofetilide (DIAMOND) Study Group

    DEFF Research Database (Denmark)

    Møller, M; Torp-Pedersen, C T; Køber, L

    2002-01-01

    and reduced left ventricular systolic function were randomized to receive either placebo or a new class III antiarrhythmic drug, dofetilide. The dose of dofetilide was adjusted according to the presence of atrial fibrillation, the length of the QT interval, and renal function. Patients were continuously......INTRODUCTION. Atrial fibrillation is a frequent cause of worsening of symptoms in patients with congestive heart failure. The drugs currently available for maintenance of sinus rhythm all have major side effects. METHODS. In 34 Danish coronary care units, 1518 patients with congestive heart failure......, 0.81-1.11). Treatment with dofetilide reduced worsening of heart failure significantly (hazard ratio, 0.75; 0.63-0.89). After 1 year, 61% of patients with atrial fibrillation at the start of the study had converted to sinus rhythm on dofetilide, vs. 33% in the placebo group. After conversion...

  2. 卡维地洛对扩张型心肌病心力衰竭患者心功能及运动耐量的改善作用%Improving effect of carvedilol on cardiac function and exercise tolerance in patients with congestive heart failure of dilated cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    吴大庆; 杨永健

    2002-01-01

    Objective To observe the improving effect of carvedilol on cardiac function in patients with congestive heart failure(CHF) of dilated cardiomyopathy(DCM).Methods Total 60 patients with chronic heart failure secondary to DCM were divided into two groups randomly, namely carvedilol group additionally treated with carvedilol (the test group), conventional group receiving placebo (the controls). The left ventricular fraction shortening (FS), ejection fraction (EF), stroke volume (SV), left ventricular diastolic dimension (LVDD) were measured with echocardiography, were measured before and after 4 month treatment. Results After treated for 4 months , the cardiac function improved greatly in both groups.In the test group, LVDD, EF and 6 minute walking distance improved more signicantly compared to the controls. Conclusion Carvedilol can improve cardiac function and exercise tolerance in the patients with CHF of DCM obviously.

  3. 城市道路拥堵状态下驾驶人心率特性研究%Characteristics Research for Driver's Heart Rate in Congestion State of Urban Road

    Institute of Scientific and Technical Information of China (English)

    漆巍巍; 裴玉龙

    2014-01-01

    Transportation infrastructure scale is constrained by many factors ,due to the limited space of the cities . Traffic congestion will affect people's daily life in a long time with the rapid increase of vehicle population .The mean heart rate is selected as an indicator to quantify the impact of traffic congestion on the driver's physiological and psychological status .Moreover ,the impact of traffic congestion level on the driver's heart rate characteristics is studied based on a large number of measured data .In addition ,the relational model between mean heart rate and pressure coefficient is estab-lished .Research shows that the effect of traffic congestion on heart rate characteristics is significant ,and that the deter-mination coefficient of the goodness-of-fit of the three regression models can be above 0 .6 with the best regression result of the quadratic polynomial .The results can provide a theoretical support for the efficiency and safety evaluation of traffic congestion .%为了量化交通拥堵对驾驶人生理和心理特性的影响,选取驾驶人的心率均值为指标,在大量实测数据基础上研究交通拥堵程度对驾驶人心率特性的影响,并构建心率均值和压力系数间的关系模型。研究表明,交通拥堵对驾驶人的心率特性影响显著,3种回归模型拟合优度的确定系数都达到了0.6以上,且二次多项式的回归效果最好。

  4. 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 possible relationship between right and left ventricular function and pulmonary function. DESIGN: Prospective substudy. SETTING: Systematic screening at 11 centres. SUBJECTS: Consecutive patients (n = 532) admitted with HF requiring medical treatment with diuretics and an episode with symptoms...... corresponding to New York Heart Association class III-IV within a month prior to admission. INTERVENTIONS: Forced expiratory volume in 1 s (FEV(1)) and forced vital capacity (FVC) were measured by spirometry and ventricular function by echocardiography. The diagnosis of COPD and HF were made according...

  5. Traffic Congestion and Congestion Pricing

    OpenAIRE

    Verhoef, E.T.; Lindsey, C.R.

    2000-01-01

    For several decades growth of traffic volumes has outstrippedinvestments inroad infrastructure. The result has been a relentless increase intrafficcongestion. This paper reviews the economic principles behindcongestionpricing in static and dynamic settings, which derive from thebenefits ofcharging travellers for the externalities they create. Specialattention ispaid to various complications that make simple textbook congestionpricingmodels of limited relevance, and dictate that congestion pri...

  6. Influence of diabetes and diabetes-gender interaction on the risk of death in patients hospitalized with congestive heart failure

    DEFF Research Database (Denmark)

    Gustafsson, Ida; Brendorp, Bente; Seibaek, Marie;

    2004-01-01

    OBJECTIVES: The purpose of this study was to investigate the influence of diabetes on long-term mortality in a large cohort of patients hospitalized with heart failure (HF). BACKGROUND: Diabetes is common in HF patients, but information on the prognostic effect of diabetes is sparse. METHODS: The...

  7. Heart rate and heart rate variability modification in chronic insomnia patients.

    Science.gov (United States)

    Farina, Benedetto; Dittoni, Serena; Colicchio, Salvatore; Testani, Elisa; Losurdo, Anna; Gnoni, Valentina; Di Blasi, Chiara; Brunetti, Riccardo; Contardi, Anna; Mazza, Salvatore; Della Marca, Giacomo

    2014-01-01

    Chronic insomnia is highly prevalent in the general population, provoking personal distress and increased risk for psychiatric and medical disorders. Autonomic hyper-arousal could be a pathogenic mechanism of chronic primary insomnia. The aim of this study was to investigate autonomic activity in patients with chronic primary insomnia by means of heart rate variability (HRV) analysis. Eighty-five consecutive patients affected by chronic primary insomnia were enrolled (38 men and 47 women; mean age: 53.2 ± 13.6). Patients were compared with a control group composed of 55 healthy participants matched for age and gender (23 men and 32 women; mean age: 54.2 ± 13.9). Patients underwent an insomnia study protocol that included subjective sleep evaluation, psychometric measures, and home-based polysomnography with evaluation of HRV in wake before sleep, in all sleep stages, and in wake after final awakening. Patients showed modifications of heart rate and HRV parameters, consistent with increased sympathetic activity, while awake before sleep and during Stage-2 non-REM sleep. No significant differences between insomniacs and controls could be detected during slow-wave sleep, REM sleep, and post-sleep wake. These results are consistent with the hypothesis that autonomic hyper-arousal is a major pathogenic mechanism in primary insomnia, and confirm that this condition is associated with an increased cardiovascular risk.

  8. Incidence of cancer in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Banke, Ann; Schou, Morten; Videbaek, Lars;

    2016-01-01

    AIMS: With improvement in survival of chronic heart failure (HF), the clinical importance of co-morbidity is increasing. The aim of this study was to assess the incidence and risk of cancer and all-cause mortality in a large Danish HF cohort. METHODS AND RESULTS: A total of 9307 outpatients......-specific risk of cancer was analysed in an adjusted Poisson and Cox regression analysis. The 975 diagnoses of cancer in the HF cohort and 330 843 in the background population corresponded to incidence rates per 10 000 patient-years of 188.9 [95% confidence interval (CI) 177.2-200.6] and 63.0 (95% CI 63...

  9. Effects of hope promoting interventions based on religious beliefs on quality of life of patients with congestive heart failure and their families

    Science.gov (United States)

    Binaei, Niloufar; Moeini, Mahin; Sadeghi, Masoumeh; Najafi, Mostafa; Mohagheghian, Zahra

    2016-01-01

    Background: Heart failure is one of the most important and prevalent diseases that may have negative effects on the quality of life (QOL). Today, the promotion of QOL in patients with heart failure is important in nursing care programs. This research aimed to determine the efficacy of hope-promoting interventions based on religious beliefs on the QOL of patients with congestive heart failure (CHF). Materials and Methods: In this randomized clinical trial (IRCT2014100619413N1) conducted in Isfahan, Iran, 46 adult patients with CHF were selected and randomly assigned to study and control groups. Ferrans and Powers Quality of Life Index (QLI) was completed by both groups before, immediately after, and 1 month after the intervention. For the study group participants and their families, 60-min sessions of hope-promoting interventions based on religious beliefs were held twice a week for 3 weeks. Independent t, repeated measures analysis of variance (ANOVA), Chi-square, Mann–Whitney, and Fisher's exact tests were adopted for data analysis. Results: The mean (standard deviation) overall QOL score in the area of satisfaction significantly increased in the study group, compared to the controls, immediately [70.7 (8.5) vs. 59.2 (12.5)] and 1 month after the intervention [75.2 (7.4) vs. 59.4 (12.9)] (P < 0.05). There was also a similar difference between the two groups in the area of importance immediately [73.6 (5.8) vs. 65.7 (7.5)] and 1 month after the intervention [76.3 (8.1) vs. 66.8 (8.5)] (P < 0.05). Conclusions: Hope-promoting intervention based on religious beliefs is a useful method for improving QOL in patients with CHF. PMID:26985226

  10. Congestive Hepatomegaly

    Science.gov (United States)

    ... Prompt Healthier Eating Scientists Working on Solar-Powered Prosthetic Limbs Health Highlights: March 23, 2017 Fruit Juice for Kids: A Serving a Day OK ALL NEWS > Resources First Aid ... heart failure causes blood to back up from the heart into the inferior vena cava (the large vein that carries blood from the lower parts of the body to the heart). Such ...

  11. Effect of the Diagnosis of Inflammatory Bowel Disease on Risk-Adjusted Mortality in Hospitalized Patients with Acute Myocardial Infarction, Congestive Heart Failure and Pneumonia

    Science.gov (United States)

    Ehrenpreis, Eli D.; Zhou, Ying; Alexoff, Aimee; Melitas, Constantine

    2016-01-01

    Introduction Measurement of mortality in patients with acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia (PN) is a high priority since these are common reasons for hospitalization. However, mortality in patients with inflammatory bowel disease (IBD) that are hospitalized for these common medical conditions is unknown. Methods A retrospective review of the 2005–2011 National Inpatient Sample (NIS), (approximately a 20% sample of discharges from community hospitals) was performed. A dataset for all patients with ICD-9-CM codes for primary diagnosis of acute myocardial infarction, pneumonia or congestive heart failure with a co-diagnosis of IBD, Crohn’s disease (CD) or ulcerative colitis (UC). 1:3 propensity score matching between patients with co-diagnosed disease vs. controls was performed. Continuous variables were compared between IBD and controls. Categorical variables were reported as frequency (percentage) and analyzed by Chi-square tests or Fisher’s exact test for co-diagnosed disease vs. control comparisons. Propensity scores were computed through multivariable logistic regression accounting for demographic and hospital factors. In-hospital mortality between the groups was compared. Results Patients with IBD, CD and UC had improved survival after AMI compared to controls. 94/2280 (4.1%) of patients with IBD and AMI died, compared to 251/5460 (5.5%) of controls, p = 0.01. This represents a 25% improved survival in IBD patients that were hospitalized with AMI. There was a 34% improved survival in patients with CD and AMI. There was a trend toward worsening survival in patients with IBD and CHF. Patients with CD and PN had improved survival compared to controls. 87/3362 (2.59%) patients with CD and PN died, compared to 428/10076 (4.25%) of controls, p < .0001. This represents a 39% improved survival in patients with CD that are hospitalized for PN. Conclusion IBD confers a survival benefit for patients hospitalized with AMI. A

  12. Effects of Long-term Ramipril on Ventricular Remodeling, Cardiac Function and Survival in Rat Congestive Heart Failure after Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    陶则伟; 黄元伟

    2004-01-01

    Objectives The purpose of this study was to investigate the effects of long-term ramipril on ventricular remodeling, cardiac function and survival in rat congestive heart failure after myocardial infarction. Methods Myocardial infarction (MI) was caused by ligation of the left anterior descending coronary artery in rats. 7 days after the surgery, the surviving rats were randomly assigned to the following treatment protocols: 1) MI rats with no therapy, 2) MI rats treated with ramipril 3 mg/kg per day, 3) Sham-operated control rats, and 4) Sham-operated rats treated with ramipril 3 mg/kg per day. At 22 weeks, cardiac hemodynamic parameters such as MAP, LVSP, ±dP/dtmax and LVEDP were measured,and cardiac morphometric parameters such as HW,LVW and LVCA were measured, mRNA of cardiacmolecule genes, such as βMHC, BNP, collagen Ⅰ and Ⅲ, and TGF-β1, were quantified, and survival rates were calculated. Results Compared with sham-operated rats, MI rats without therapy showed significant increases in cardiac morphological parameters as well as in mRAN expressions of cardiac molecule genes (P<0.01); while their hemodynamic parameters were significantly impaired (P<0.01), and survival rate shortened (P<0.05). Compared with MI rats with no therapy, MI rats treated with ramipril showed significant attenuation of mRAN expressions of cardiac molecule genes (P<0.01); while their hemodynamic parameters were significantly impaired (P<0.01), and survival rate shortened (P<0.05). Compared with MI rats with no therapy, MI rats treated with ramipril showed significant attenuation of mRAN expressions of cardiac molecule genes (P<0.01); while their hemodynamic parameters were significantly improved (P<0.05 or P<0.01), and survival rates prolonged (P<0.05). Conclusions Treatment with long-term ramipril may improve LV remodeling, cardiac function and survival in rat congestive heart failure after MI.

  13. [Chronic heart failure and cachexia: role of endocrine system].

    Science.gov (United States)

    Dei Cas, A; Muoio, A; Zavaroni, I

    2011-12-01

    Chronic heart failure (CHF) is a major health problem that carries a devastating prognosis. The prognosis worsens considerably once cardiac cachexia has been diagnosed. Neurohormonal, metabolic, hemodynamic and immunological alterations are involved in the initiation and progression of cardiac cachexia. Cachexia is characterized by a hypothalamic inappropriate response to the mechanisms controlling energy homeostasis. Levels of the anorexigenic hormone leptin are decreased whereas the orexigenic gherlin hormone levels are normal or elevated. Nevertheless, energy intake is not increased as expected due to a persistent activation of the proopiomelanocortin (POMC) system (anorexigenic) paralleled by a decreased activity of the neuropeptide Y (NPY, orexigenic) neurons. Cachexia is also characterized by an imbalance in anabolic (impairment in the growth hormone/insulin-like growth factor-I axis, insulin resistance) and catabolic (increased levels of catecholamines, increased cortisol/dehydroepiandrosterone ratio and activation of proinflammatory cytokines such as tumor necrosis factor-alpha, interleuchin-6, interleuchin-1') at the basis of the wasting process. This review discusses the complex role of the endocrine system in modulating energy balance, appetite and metabolism in patients with chronic heart failure. A joint multidisciplinary effort of the cardiologists, immunologists and endocrinologists might be useful to identify the precise mechanisms involved in the neuroendocrine alteration and to develop therapeutic strategies able to improve the prognosis of CHF patients.

  14. Pulmonary Hypertension and Right Heart Dysfunction in Chronic Lung Disease

    Directory of Open Access Journals (Sweden)

    Amirmasoud Zangiabadi

    2014-01-01

    Full Text Available Group 3 pulmonary hypertension (PH is a common complication of chronic lung disease (CLD, including chronic obstructive pulmonary disease (COPD, interstitial lung disease, and sleep-disordered breathing. Development of PH is associated with poor prognosis and may progress to right heart failure, however, in the majority of the patients with CLD, PH is mild to moderate and only a small number of patients develop severe PH. The pathophysiology of PH in CLD is multifactorial and includes hypoxic pulmonary vasoconstriction, pulmonary vascular remodeling, small vessel destruction, and fibrosis. The effects of PH on the right ventricle (RV range between early RV remodeling, hypertrophy, dilatation, and eventual failure with associated increased mortality. The golden standard for diagnosis of PH is right heart catheterization, however, evidence of PH can be appreciated on clinical examination, serology, radiological imaging, and Doppler echocardiography. Treatment of PH in CLD focuses on management of the underlying lung disorder and hypoxia. There is, however, limited evidence to suggest that PH-specific vasodilators such as phosphodiesterase-type 5 inhibitors, endothelin receptor antagonists, and prostanoids may have a role in the treatment of patients with CLD and moderate-to-severe PH.

  15. Chronic oral pathology and ischemic heart disease and its complications

    Directory of Open Access Journals (Sweden)

    Ivaschenko Y.Y.

    2013-09-01

    Full Text Available Objective: to establish the relationship of chronic generalized periodontitis, multiple cavities and dentofacial anomalies with various forms of coronary heart disease and its complications. Material and methods. The study included 294 patients with coronary heart disease and its complications. The patients were divided into two groups. Group I included 89 patients with acute Q-myocardial infarction, which was placed in the presence of at least 2 of the following criteria identified on the basis of a comprehensive clinical and instrumental examination: clinical, laboratory confirmation (CK-MB, electrocardiographic signs of damage or myocardial necrosis. The following statistical methods were used: multi-variate and univariate analysis of variance, non-parametric tests, crosstabulation, chi-square test, Fisher»s exact test. As a measure of variability of the normal distribution standard deviation was used. Results. It is noted that in patients with myocardial infarction more likely than in patients without coronary heart attack in history severe generalized periodontitis, dentofacial anomalies and multiple dental caries have appeared. In patients with acute myocardial infarction, severe periodontal disease has been associated with increased fibrinogen levels in the blood and an increase in the dispersion of the interval QT, which are known to be indicators of poor prognosis in acute coronary disease.

  16. Chronic kidney disease and worsening renal function in acute heart failure: different phenotypes with similar prognostic impact?

    Science.gov (United States)

    Palazzuoli, Alberto; Lombardi, Carlo; Ruocco, Gaetano; Padeletti, Margherita; Nuti, Ranuccio; Metra, Marco; Ronco, Claudio

    2016-12-01

    Nearly a third of patients with acute heart failure experience concomitant renal dysfunction. This condition is often associated with increased costs of care, length of hospitalisation and high mortality. Although the clinical impact of chronic kidney disease (CKD) has been well established, the exact clinical significance of worsening renal function (WRF) during the acute and post-hospitalisation phases is not completely understood. Therefore, it is still unclear which of the common laboratory markers are able to identify WRF at an early stage. Recent studies comparing CKD with WRF showed contradictory results; this could depend on a different WRF definition, clinical characteristics, haemodynamic disorders and the presence of prior renal dysfunction in the population enrolled. The current definition of acute cardiorenal syndrome focuses on both the heart and kidney but it lacks precise laboratory marker cut-offs and a specific diagnostic approach. WRF and CKD could represent different pathophysiological mechanisms in the setting of acute heart failure; the traditional view includes reduced cardiac output with systemic and renal vasoconstriction. Nevertheless, it has become a mixed model that encompasses both forward and backward haemodynamic dysfunction. Increased central venous pressure, renal congestion with tubular obliteration, tubulo-glomerular feedback and increased abdominal pressure are all potential additional contributors. The impact of WRF on patients who experience preserved renal function and individuals affected with CKD is currently unknown. Therefore it is extremely important to understand the origins, the clinical significance and the prognostic impact of WRF on CKD.

  17. 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.

  18. Comparison of the Frequency-dependent Effects of Amiodarone on Ventricular Electrophysiology in Congestive Heart Failure Canine Models and Normal Dogs

    Institute of Scientific and Technical Information of China (English)

    Zhou Shuxian; Zhang Yuling; Lei Juan; Wu Wei; Zhang Xuming

    2007-01-01

    Objectives To compare the frequency-dependent effects of amiodarone (Ami) on ventricular electrophysiology in right ventricular rapid pacing-induced congestive heart failure (CHF) canine models.Methods Thirty-two dogs were randomized into four groups: the control group, the Ami group in which the normal dogs were given Ami orally 300 mg a day for 4~5 weeks, the CHF group induced by right ventricular rapid pacing ( 240 pulses. min -1 for 4 ~ 5 weeks), and the group of CHF dogs fed with Ami orally 300 mg a day for 4 ~ 5 weeks. The techniques of electrical stimulation and monophasic action potential (MAP) recording were used in the electrophysiology studies. Results The effects of Ami on ventricular MAP duration(MAPD90) and effective refractory period (VERP)were not frequency-dependent in CHF dogs. There was also no frequency-dependent effect on the increase in the ratio of VERP to MAPD90 (VERP/MAPD90). The prolongation of ventricular conduction time was frequencydependent. Conclusions The frequency-dependent effects of Ami on ventricular electrophysiology in CHF dogs were similar to that in normal dogs.

  19. Automated diagnosis of congestive heart failure using dual tree complex wavelet transform and statistical features extracted from 2s of ECG signals.

    Science.gov (United States)

    Sudarshan, Vidya K; Acharya, U Rajendra; Oh, Shu Lih; Adam, Muhammad; Tan, Jen Hong; Chua, Chua Kuang; Chua, Kok Poo; Tan, Ru San

    2017-02-07

    Identification of alarming features in the electrocardiogram (ECG) signal is extremely significant for the prediction of congestive heart failure (CHF). ECG signal analysis carried out using computer-aided techniques can speed up the diagnosis process and aid in the proper management of CHF patients. Therefore, in this work, dual tree complex wavelets transform (DTCWT)-based methodology is proposed for an automated identification of ECG signals exhibiting CHF from normal. In the experiment, we have performed a DTCWT on ECG segments of 2s duration up to six levels to obtain the coefficients. From these DTCWT coefficients, statistical features are extracted and ranked using Bhattacharyya, entropy, minimum redundancy maximum relevance (mRMR), receiver-operating characteristics (ROC), Wilcoxon, t-test and reliefF methods. Ranked features are subjected to k-nearest neighbor (KNN) and decision tree (DT) classifiers for automated differentiation of CHF and normal ECG signals. We have achieved 99.86% accuracy, 99.78% sensitivity and 99.94% specificity in the identification of CHF affected ECG signals using 45 features. The proposed method is able to detect CHF patients accurately using only 2s of ECG signal length and hence providing sufficient time for the clinicians to further investigate on the severity of CHF and treatments.

  20. Inverse association of N-terminal pro-B-type natriuretic peptide with metabolic syndrome in patients with congestive heart failure.

    Directory of Open Access Journals (Sweden)

    Huai-Ren Chang

    Full Text Available BACKGROUND: Metabolic syndrome has been shown to be associated with lower levels of plasma N-terminal pro-B-type natriuretic peptide (Nt-proBNP in the general population. We sought to elucidate the relationship between Nt-proBNP and components of metabolic syndrome in patients with congestive heart failure (CHF. METHODS: Fasting blood samples were obtained from 93 patients in our institution. Plasma levels of Nt-proBNP and other biochemical data were measured. The New York Heart Association (NYHA classification system (I-IV was used to define the functional capacity of CHF. Metabolic syndrome and its components were defined using diagnostic criteria from the International Diabetes Federation. RESULTS: Forty-nine patients (52.7% had CHF. There was a positive correlation between plasma Nt-proBNP levels and NYHA functional capacity in CHF patients. Plasma Nt-proBNP levels increased significantly with each increasing NYHA class of the disease. The prevalence of metabolic syndrome in CHF patients was higher than that in patients without CHF. Most importantly, we found that plasma Nt-proBNP levels were lower in CHF patients with metabolic syndrome attributable to inverse relationships between plasma Nt-proBNP and body mass index (β = -0.297, plasma triglyceride (β = -0.286 and homeostasis model assessment of insulin resistance (HOMA-IR; β = -0.346. Fasting glucose to insulin ratio (FGIR, an insulin sensitivity index was positively associated with plasma Nt-proBNP levels (β = 0.491, and was the independent predictor of plasma Nt-proBNP levels in CHF patients. CONCLUSIONS: Plasma Nt-proBNP levels are inversely associated with metabolic syndrome in CHF patients. Reduced plasma Nt-proBNP levels in CHF patients may lead to impaired lipolysis and metabolic function, and may contribute to the development of metabolic syndrome in CHF patients.

  1. 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

    2009-01-01

    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....

  2. Effect of repeated intracoronary injection of bone marrow cells in patients with ischaemic heart failure the Danish stem cell study--congestive heart failure trial (DanCell-CHF)

    DEFF Research Database (Denmark)

    Diederichsen, Axel Cosmus Pyndt; Møller, Jacob E; Thayssen, Per;

    2008-01-01

    BACKGROUND: It has been suggested that myocardial regeneration may be achieved by a single intracoronary bone marrow derived stem cell infusion in selected patients with ischaemic heart disease. The effect is uncertain in patients with chronic ischaemic heart failure and it is not known whether...... repeated infusions would have additional positive effects. AIMS: To assess whether two treatments of intracoronary infusion of bone marrow stem cells, administered 4 months apart, could improve left ventricular (LV) systolic function in patients with chronic ischaemic heart failure. METHODS: The study...... was prospective and non-randomised, comprising an observational baseline period of 4 months followed by an interventional period of 12 months. Intracoronary bone marrow cell infusion was performed at the end of the baseline period and repeated 4 months later. RESULTS: 32 patients were included. LV ejection...

  3. Cognitive dysfunction in congestive heart failure: transcranial Doppler evidence of microembolic etiology Disfunção cognitiva na insuficiência cardíaca congestiva: evidência de etiologia microembólica ao Doppler transcraniano

    OpenAIRE

    Pedro A.P. Jesus; Rodrigo M. Vieira-de-Melo; Francisco J.F.B. Reis; Leila C. Viana; Amanda Lacerda; Dias,Jesangeli S.; Jamary Oliveira-Filho

    2006-01-01

    Cognitive symptoms are common in patients with congestive heart failure (CHF) and are usually attributed to low cerebral blood flow. In the present study, we aimed to evaluate global cognitive function (Mini Mental State Exam MMSE) in relation to both cardiac function (evaluated by echocardiogram) and cerebrovascular hemodynamics (evaluated by transcranial Doppler TCD) in CHF patients. In 83 patients studied, no correlation was found between echocardiographic parameters and MMSE scores. In co...

  4. Percentage of peak-to-peak pulsatility of portal blood flow can predict right-sided congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Jui-Ting Hu; Sien-Sing Yang; Yun-Chih Lai; Cheng-Yen Shih; Cheng-Wen Chang

    2003-01-01

    AIM: To study the change of portal blood flow for the prediction of the status of right-sided heart failure by using non-invasive way.METHODS: We studied 20 patients with rheumatic and atherosclerotic heart diseases. All the patients had constant systemic blood pressure and body weight 1 week prior to the study. Cardiac index (CI), left ventricular end-diastolic pressure (LVEDP), mean aortic pressure (AOP), pulmonary wedge pressure (PWP), mean pulmonary arterial pressure (PAP), mean right atrial pressure (RAP), right ventricular end-diastolic pressure (RVEDP) were recorded during cardiac catheterization. Ten patients with RAP<10 mmHg were classified as Group 1. The remaining 10 patients with RAP ≥ 10 mmHg were classified as Group 2. Portal blood velocity profiles were studied using an ultrasonic Doppler within 12h after cardiac catheterization.RESULTS: CI, AOP, and LVEDP had no difference between two groups. Patients in Group 1 had normal PWP (14.6±7.3mmHg), PAP (25.0±8.2 mmHg), RAP (4.7±2.4 mmHg), and RVEDP (6.4±2.7 mmHg). Patients in Group 2 had increased PWP (29.9±9.3 mmHg), PAP (46.3±13.2 mmHg), RAP (17.5±5.7 mmHg), and RVEDP (18.3±5.6 mmHg) (P<0.001).Mean values of maximum portal blood velocity (Vmax), mean portal blood velocity (Vmean), cross-sectional area (Area)and portal blood flow volume (PBF) had no difference between 2 groups. All the patients in Group 1 had a continuous antegrade portal flow with a mean percentage of peak-topeak pulsatility (PP) 27.0±8.9 % (range: 17-40 %). All the patients in Group 2 had pulsatile portal flow with a mean PP 86.6±45.6 (range: 43-194 %). One patient had a transient stagnant and three patients had a transient hepatofugal portal flow, which occurred mainly during the ventricular systole. Vmax, Vmean and PBF had a positive correlation with CO (P<0.001) but not with AOP, LVEDP, PWP, PAP,RAP, and RVEDP.PP showed a good correlation (P<0.001)with PWP, PAP, RAP, and RVEDP but not with CI, AOP, and LVEDP. All

  5. Vasopressin Receptor Antagonists for the Correction of Hyponatremia in Chronic Heart Failure: An Underutilized Therapeutic Option in Current Clinical Practice?

    Directory of Open Access Journals (Sweden)

    Renato De Vecchis

    2016-10-01

    Full Text Available In the congestive heart failure (CHF setting, chronic hyponatremia is very common. The present review aims at addressing topics relevant to the pathophysiology of hyponatremia in the course of CHF as well as its optimal treatment, including the main advantages and the limitations resulting from the use of the available dietary and pharmacological measures approved for the treatment of this electrolytic trouble. A narrative review is carried out in order to represent the main modalities of therapy for chronic hyponatremia that frequently complicates CHF. The limits of usual therapies implemented for CHF-related chronic hyponatremia are outlined, while an original analysis of the main advancements achieved with the use of vasopressin receptor antagonists (VRAs is also executed. The European regulatory restrictions that currently limit the use of VRAs in the management of CHF are substantially caused by financial concerns, i.e., the high costs of VRA therapy. A thoughtful reworking of current restrictions would be warranted in order to enable VRAs to be usefully associated to loop diuretics for decongestive treatment of CHF patients with hyponatremia.

  6. Effect of renal function on prognosis in chronic heart failure.

    Science.gov (United States)

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

    2015-01-01

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

  7. Clinical significance of pain in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    GAN Qian; ZHANG Feng-ru; ZHOU Qing-fen; DAI Li-ying; LIU Ye-hong; CHAI Xi-chen; WU Fang; SHEN Wei-feng

    2012-01-01

    Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure (CHF) patients.This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain.Methods Sociodemographics,serum levels of creatinine,NT-proBNP,high-sensitivity C-reactive protein (hs-CRP),tumor necrosis factor (TNF)-α,interleukin (IL)-6 and IL-10,and two-dimensional echocardiographic left ventricular ejection fraction (LVEF) were determined in 305 patients with CHF.A questionnaire packet including the Brief Pain Inventory (BPI) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to assess the degree of pain rated on a 0-10 scale and the quality of life (QOL).A six-minute walking test was performed during routine clinic visits.Major adverse cardiac events (MACE) were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction,worsening heart failure or stroke at follow-up.Results Pain occurred in 25.6% of CHF patients,and was more common when the New York Heart Association (NYHA) functional class was worse.More patients with pain were female in gender,and had more co-morbidities,lower LVEF,and shorter distance during the 6-minute walking test.Despite similar serum levels of creatinine,N-terminal prohormone of brain natriuretic peptide (NT-proBNP),IL-6 and IL-10,the TNF-α levels were higher and MLHFQ scores were greater in CHF patients with pain.At follow-up,CHF patients with moderate to severe pain (≥4 scale) had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction,worsening heart failure or stroke.Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.Conclusions Pain occurs in all stages of the CHF trajectory,and its incidence increases as clinical

  8. CHRONIC HEART FAILURE AND IRON-DEFICIENT ANEMIA

    Directory of Open Access Journals (Sweden)

    M. V. Melnik

    2015-12-01

    Full Text Available 62 chronic heart failure (CHF patients with iron-deficient anemia (IDA were studied. Standard CHF therapy (angiotensin converting enzyme inhibitors, β-blockers, diuretics, cardiac glycosides was accompanied with the correction of iron deficiency by intravenous injection of Venofer and subsequent Ferro-Folgamma prescription (average daily dose of iron 137,75±5mg. After treatment serum iron level increased by 95,5% and hemoglobin level – by 9,8%. Left ventricular ejection fraction increased by 32,2% and physical activity tolerance – by 47,6%. Before treatment 32 CHF patients with IDA (51,6% had III functional class (FC of CHF according to NYHA and 16 patients (25,8% – IV FC. After treatment I FC was observed in 18 CHF patients (29%, II FC – in 26 patients and only 18 patients demonstrated III FC of CHF.

  9. 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.

  10. PRIMARY CARE PROBLEMS IN PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    O. A. Shtegman

    2013-01-01

    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.

  11. CHRONIC HEART FAILURE AND IRON-DEFICIENT ANEMIA

    Directory of Open Access Journals (Sweden)

    M. V. Melnik

    2007-01-01

    Full Text Available 62 chronic heart failure (CHF patients with iron-deficient anemia (IDA were studied. Standard CHF therapy (angiotensin converting enzyme inhibitors, β-blockers, diuretics, cardiac glycosides was accompanied with the correction of iron deficiency by intravenous injection of Venofer and subsequent Ferro-Folgamma prescription (average daily dose of iron 137,75±5mg. After treatment serum iron level increased by 95,5% and hemoglobin level – by 9,8%. Left ventricular ejection fraction increased by 32,2% and physical activity tolerance – by 47,6%. Before treatment 32 CHF patients with IDA (51,6% had III functional class (FC of CHF according to NYHA and 16 patients (25,8% – IV FC. After treatment I FC was observed in 18 CHF patients (29%, II FC – in 26 patients and only 18 patients demonstrated III FC of CHF.

  12. 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.

  13. Association of chronic mucus hypersecretion with FEV1 decline and chronic obstructive pulmonary disease morbidity. Copenhagen City Heart Study Group

    DEFF Research Database (Denmark)

    Vestbo, J; Prescott, E; Lange, P

    1996-01-01

    The aim of this study was to examine the association between chronic mucus hypersecretion, and FEV1 decline, and subsequent hospitalization from chronic obstructive pulmonary disease (COPD). We used data from The Copenhagen City Heart Study on 5,354 women and 4,081 men 30 to 79 yr of age with ass......The aim of this study was to examine the association between chronic mucus hypersecretion, and FEV1 decline, and subsequent hospitalization from chronic obstructive pulmonary disease (COPD). We used data from The Copenhagen City Heart Study on 5,354 women and 4,081 men 30 to 79 yr of age...

  14. Impact of Ivabradine on Inflammatory Markers in Chronic Heart Failure

    Directory of Open Access Journals (Sweden)

    Ilonka Rohm

    2016-01-01

    Full Text Available Background. Inflammation plays a crucial role in the progression of chronic heart failure (CHF. Ivabradine is known to reduce the morbidity and mortality of patients with CHF under certain conditions. Beyond the reduction of heart rate, only limited knowledge exists about potential anti-inflammatory effects of ivabradine that might contribute to its benefit in CHF. Thus, the present study aimed to investigate the effect of ivabradine on systemic inflammation. Methods. In the present study, 33 patients with CHF due to dilated, ischemic, and hypertensive cardiomyopathy were treated with ivabradine according to the guidelines of the European Society of Cardiology (ESC. A number of circulating dendritic cells as well as inflammatory mediators were investigated using FACS analysis and ELISA, respectively, before and during ivabradine therapy. Results. Treatment with ivabradine resulted in a significant improvement of CHF symptoms as well as an increase in left ventricular ejection fraction. Moreover, ivabradine treatment led to a significant reduction of TNF-alpha (TNF-α serum levels and a reconstitution of circulating dendritic cells which are known to be reduced in patients with CHF. Conclusion. We show that treatment with ivabradine in patients with CHF resulted in an improvement of HF symptoms and ejection fraction as well as a normalization of inflammatory mediators.

  15. Impact of Ivabradine on Inflammatory Markers in Chronic Heart Failure.

    Science.gov (United States)

    Rohm, Ilonka; Kretzschmar, Daniel; Pistulli, Rudin; Franz, Marcus; Schulze, P Christian; Stumpf, Christian; Yilmaz, Atilla

    2016-01-01

    Background. Inflammation plays a crucial role in the progression of chronic heart failure (CHF). Ivabradine is known to reduce the morbidity and mortality of patients with CHF under certain conditions. Beyond the reduction of heart rate, only limited knowledge exists about potential anti-inflammatory effects of ivabradine that might contribute to its benefit in CHF. Thus, the present study aimed to investigate the effect of ivabradine on systemic inflammation. Methods. In the present study, 33 patients with CHF due to dilated, ischemic, and hypertensive cardiomyopathy were treated with ivabradine according to the guidelines of the European Society of Cardiology (ESC). A number of circulating dendritic cells as well as inflammatory mediators were investigated using FACS analysis and ELISA, respectively, before and during ivabradine therapy. Results. Treatment with ivabradine resulted in a significant improvement of CHF symptoms as well as an increase in left ventricular ejection fraction. Moreover, ivabradine treatment led to a significant reduction of TNF-alpha (TNF-α) serum levels and a reconstitution of circulating dendritic cells which are known to be reduced in patients with CHF. Conclusion. We show that treatment with ivabradine in patients with CHF resulted in an improvement of HF symptoms and ejection fraction as well as a normalization of inflammatory mediators.

  16. The clinical significance of detection to heart rate deceleration capacity and heart rate variability in patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Jiang-rong Zhou

    2015-01-01

    Full Text Available Objective: To study the change of heart rate deceleration capacity ( DC and heart rate variability in patients with chronic heart failure (CHF and its relationship with left ventricular ejection fraction (LVEF. Methods: DC, LVEF, time and frequency domain parameters of HRV were measured in 66 patients with CHF and 34 healthy adults (control group by using 24h Holter recordings and Echocardiography. The standard deviation of normal R-R intervals( SDNN, squares of differences between adjacent NN intervals ( RMSSD,low frequency power( LFn and high frequency power( HFn and the changes of LVEF were compared between  the two groups,the relationship between DC,LVEF and HRV were studied in patients with CHF. Results: The median value of DC in the patients with CHF was significantly lower than that in control group( 3.1 ± 2.4 ms vs 7.2 ± 1.3 ms,P <0.01.Incidence of abnormal DC in the CHF group was 57.5%,which was significantly higher than that in the control group (P <0.01.The HRV index, including SDNN、RMSSD、LFn、HFn, in the CHF group was significantly lower than that in normal control group (P < 0.01. Significant positive correlation between HRV index and LVEF were confirmed (P < 0.01. Conclusions: DC and HRV index are lower in patients with CHF and have a good correlation with the left ventricular ejection fraction.

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

    Science.gov (United States)

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

    2013-01-01

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

  18. [Chronic systolic heart failure - dosing recommendations at beginning and end of treatment].

    Science.gov (United States)

    Zugck, Christian; Remppis, Andrew; Katus, Hugo A; Frankenstein, Lutz

    2008-10-01

    As a multi-system disease, chronic heart failure requires a complex, multimodal therapy. Achieving maximum guideline adherence in (advanced) chronic heart failure can therefore become a challenge. The important decrease in morbidity and mortality seen lately largely depends on consequent and sometime tedious implementation of guideline targets. The present paper provides a comprehensive overview on medical therapeutic strategies with a particular focus of onset and discontinuation of drugs in patients with chronic systolic dysfunction.

  19. The change of plasma leptin level and its correlation study with insulin resistance or TNF-αin patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    张金国; 杨娜; 高东升; 王学忠; 宋光耀; 王智华

    2004-01-01

    Objectives To determine the change of plasma leptin levels and the correlation between hyperleptinaemia and insulin resistance or TNF-o in patients with congestive heart failure (CHF). Methods The levels of plasma leptin, fasting plasma insulin (FINS) and TNF-α in 64 male patients with CHF and 30 healthy male people were measured by ELISA. Body mass index (BMI), waist/hip ratio (WHR) and insulin resistance index (Homa-IR) were calculated respectively. Results The plasma leptin levels in CHF group were higher compared with control group (P<0.001). There was a increased trend of plasma leptin levels in CHF group with the increase of NYHA class (rs=0.884, P<0.001); according to different etiology ,there was no significant difference of plasma leptin levels in CHF group (P>0.05); FINS,Homa-IR and TNF-o levels in CHF group were higher than in control group (all P<0.001); in CHF group plasma leptin levels correlated with FINS (r=0.652,P<0.001),Homa-IR (r=0.561,P<0.001) and TNF-α (r=0.629,P<0.001); in multiple stepwise regression analysis BMI, FINS and TNF-α were isolated factors affecting plasma leptin levels in CHF group, Y=-3.466+0.456 (BMI)+ 0.162 (FINS)+4.487(TNF-α), F=38.405,P<0.001. Conclusions plasma leptin levels were raised and correlated with disease severity in patients with CHF; FINS and TNF-α were isolated factor affecting plasma leptin level in CHF patients; hyperleptinaemia may play a role in the pathophysiology of CHF such as catabolic process and activation of neurohormonal.

  20. Cautious application of pleural N-terminal pro-B-type natriuretic peptide in diagnosis of congestive heart failure pleural effusions among critically ill patients.

    Directory of Open Access Journals (Sweden)

    Jiann-Horng Yeh

    Full Text Available Several studies on diagnostic accuracy of pleural N-terminal pro-B-type natriuretic peptide (NT-pro-BNP for effusions from congestive heart failure (CHF conclude that pleural NT-pro-BNP is a useful biomarker with high diagnostic accuracy for distinguishing CHF effusions. However, its applicability in critical care settings remains uncertain and requires further investigations.NT-proBNP was measured in pleural fluid samples of a prospective cohort of intensive care unit patients with pleural effusions. Receiver operating characteristic curve analysis was performed to determine diagnostic accuracy of pleural NT-proBNP for prediction of CHF effusions.One hundred forty-seven critically ill patients were evaluated, 38 (26% with CHF effusions and 109 (74% with non-CHF effusions of various causes. Pleural NT-proBNP levels were significantly elevated in patients with CHF effusions. Pleural NT-pro-BNP demonstrated the area under the curve of 0.87 for diagnosing effusions due to CHF. With a cutoff of 2200 pg/mL, pleural NT-proBNP displayed high sensitivity (89% but moderate specificity (73%. Notably, 29 (27% of 109 patients with non-CHF effusions had pleural NT-proBNP levels >2200 pg/mL and these patients were more likely to experience septic shock (18/29 vs. 10/80, P<0.001 or acute kidney injury (19/29 vs. 9/80, P<0.001.Among critically ill patients, pleural NT-proBNP measurements remain a useful diagnostic aid in evaluation of pleural effusions. However, patients with non-CHF effusions may exhibit high pleural NT-proBNP concentrations if they suffer from septic shock or acute kidney injury. Accordingly, it is suggested that clinical context should be taken into account when interpreting pleural NT-proBNP values in critical care settings.

  1. [CHARACTERISTIC OF ALTERATIONS OF ARTERIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CHRONIC HEPATITIS C].

    Science.gov (United States)

    Guliaev, N I; Kuznetsov, V V; Poltareĭko, D S; Qleksiuk, I B; Gordienko, A V; Barsukov, A V

    2015-01-01

    The article presents an assessment of degree and type of atherosclerosis of coronary and non-coronary vessels in old patients with ischemic heart disease associated with chronic viral hepatitis C (VHC), the incidence of myocardial infarction and the possibility of participation chronic VHC in atherogenesis. Patients with ischemic heart disease have correlation of atherosclerosis of arteries with age, hypercholesterinemia. Patients without chronic VHC more often give a higher risk of myocardial infarction, especially in early period (1-1,5 years) of onset of ischemic heart disease clinical implications. Patients with ischemic heart disease associated with chronic viral hepatitis C more often have generalized alterations in vessels, multifocal type of alteration. So, participation of VHC in atherogenesis is most probably connected with maintenance of chronic immune inflammation in vascular endothelium.

  2. 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.

  3. [Heart rhythm disturbances in patients with chronic obstructive pulmonary disease in aggregate with coronary heart disease].

    Science.gov (United States)

    Shoĭkhet, Ia N; Klester, E B; Golovin, V A

    2008-01-01

    The purpose of the research was to study kinds, frequencies and features of heart rhythm disturbances (HRD) in patients with chronic obstructive pulmonary disease (COPD) subject to degree of severity, including presence of coronary heart disease (CHD). 1189 of patients with registered HRD were examined. 315 of them had COPD (group 1), 531--combination of COPD and CHD (group 2), 343 were CHD patients (group 3). The extent of examinations included electrocardiogram (ECG), Halter monitoring (HM), bicycle ergometry (BEM), external respiration function estimation. Supraventricular HRD were registered statistically more frequently in group 1: according to ECG data in rest - in 37.2% patients, by BEM results--in 18.8%, by HM--in 50%. Combined (supraventricular and ventricular) HRD were registered most frequently in group 2: 41.2 24.4, and 45.5% respectively. Ventricular HRD dominated in group 3: 47.6, 29.3 and 48.6% respectively. The results of the study indicate that supraventricular HRDprevaile in patients with COPD, combined HRD - in patients with COPD and CHD. Ventricular HRD, which most informatively reflect changes in intracardiac geometry and left ventricle hemodynamics, dominate in CHD patients. The optimization of therapy correction consists in early diagnostics of HRD subject to features of cardiorespiratory system functional state.

  4. EFFECT OF MITRAL REGURGITATION ON CHRONIC HEART FAILURE COURSE AND STRUCTURE-FUNCTIONAL HEART STATE

    Directory of Open Access Journals (Sweden)

    V. N. Larina

    2009-01-01

    Full Text Available Aim. To evaluate chronic heart failure (CHF course, functional and structural heart changes in patients with functional mitral regurgitation (MR of various degrees.Material and methods. A total of 104 outpatients (60-85 y. o. with CHF of functional class II-IV by NYHA and functional MR of I-II degrees and MR of III-IV degrees were included into the study groups.Results: Patients in both groups were comparable in sex, age, CHF duration, body mass index, systolic and diastolic blood pressure, clinical state by the clinical state scale, quality of life, anxious and depressive status. The majority of patients with MR III had significant left ventricle (LV systolic dysfunction (p=0,029, severe CHF course (p=0,034, received furosemide (p=0.004 and digoxin (p=0,004. They had significant increase in end-diastolic dimension (p<0,001, end-systolic dimension (p<0,001, left atrium (p=0,004, end-diastolic volume (p<0,001, end-systolic volume (p<0,001, pulmonary artery pressure (p<0,001, decrease in LV relative wall thickness (p=0,021 and LV ejection fraction (p<0,001. Patients of this group were hospitalized because of CHF decompensation and ischemic heart disease exacerbation more often (p=0,045.Conclusion. MR can be considered as one of sensitive predictors of LV geometry and function alteration in CHF patients and play an important role in symptoms development.

  5. EFFECT OF MITRAL REGURGITATION ON CHRONIC HEART FAILURE COURSE AND STRUCTURE-FUNCTIONAL HEART STATE

    Directory of Open Access Journals (Sweden)

    V. N. Larina

    2016-01-01

    Full Text Available Aim. To evaluate chronic heart failure (CHF course, functional and structural heart changes in patients with functional mitral regurgitation (MR of various degrees.Material and methods. A total of 104 outpatients (60-85 y. o. with CHF of functional class II-IV by NYHA and functional MR of I-II degrees and MR of III-IV degrees were included into the study groups.Results: Patients in both groups were comparable in sex, age, CHF duration, body mass index, systolic and diastolic blood pressure, clinical state by the clinical state scale, quality of life, anxious and depressive status. The majority of patients with MR III had significant left ventricle (LV systolic dysfunction (p=0,029, severe CHF course (p=0,034, received furosemide (p=0.004 and digoxin (p=0,004. They had significant increase in end-diastolic dimension (p<0,001, end-systolic dimension (p<0,001, left atrium (p=0,004, end-diastolic volume (p<0,001, end-systolic volume (p<0,001, pulmonary artery pressure (p<0,001, decrease in LV relative wall thickness (p=0,021 and LV ejection fraction (p<0,001. Patients of this group were hospitalized because of CHF decompensation and ischemic heart disease exacerbation more often (p=0,045.Conclusion. MR can be considered as one of sensitive predictors of LV geometry and function alteration in CHF patients and play an important role in symptoms development.

  6. The relationship of H-type hypertension and renal insufficiency in coronary heart disease patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    郑卫峰

    2014-01-01

    Objective To discuss the relationship between Htype hypertension and renal insufficiency in patients with coronary atherosclerotic heart disease(CHD)and chronic heart failure(CHF).Methods 100 CHD patients with both hypertension and CHF were chosen in our hospital from January 2011 to July 2013.Left ventricular ejection fraction(LVEF)was measured with echocardiography and estimated glomerular filtration rate(e GFR)was calculated with the simplified modification of diet in renal

  7. 胺碘酮治疗心衰伴心律失常的临床分析%Therapeutic effects of amiodarone on chronic heart failure complicated by arrhythmia

    Institute of Scientific and Technical Information of China (English)

    周兰珠

    2010-01-01

    目的 评价胺碘酮治疗心力衰竭(HF)伴心律失常的疗效.方法 选择心力衰竭合并心律失常患者96例,在抗心衰治疗同时给予口服胺碘酮6周.结果 治疗6周后观察总有效率91.9%.结论 胺碘酮治疗HF伴心律失常安全、有效.%Objective To evaluate the the therapeutic effects of amiodarone on chronic heart failure complicated by arrhythmia. Methods From 2006 to 2008,96 chronic congestive heart failure patients with arrhythmia were enrolled. All patients were given standard medical treatment according to the current practice guidelines with a β-blocker, an angiotensin-converting enzyme(ACE) inhibitor, and diuretics. At the same time,they were also given oral amiodarone for six weeks. Results After 6 weeks' treatment with amiodarone,the total effective therapeutic effects was 91.9 percent. Conclusion For patients with chronic congestive heart failure complicated by with arrhythmia, amiodarone treatment for six weeks is safe and effective.

  8. The Analysis of Anemia in Chronic Heart Failure

    Institute of Scientific and Technical Information of China (English)

    Yuan Guiyi; Wu Wei; Luo Yilong; Li Yiqing; Zhou Shuxian; Fang Chang

    2006-01-01

    objectives To demonstrate the phenomena and explore the causes of anemia in patients with chronic heart failure (CHF). Methods To observe the phenomena of anemia in patients with CHF, a total of 276 patients with CHF were included in this retrospective study. The clinical characteristics of the patients are: mean age 69.2±11.0 years; male 151,female 125; NYHA Ⅲ and Ⅳ 115 (41.7%). Results ①Among the 276 patients with CHF, 81 (29.4%)had anemia (Mean hemoglobulin concentration 101.5±13.0g/L). ② Patients with Anemia were more likely to be female and to have greater NYHA (Ⅲ or Ⅳ) (P<0.05), higher serum creatinine, as well as lower serum albumin and low-density lipoprotein levels (P<0.01).③ A weak negative correlation was also noted between the level of NYHA and hemoglobulin. ④ There was no significant difference in age, the primary cardiac etiology of the CHF, the history of diabetes, left ventricular end diastolic diameter, and left ventricular ejection fraction between CHF patient with and without anemia. Conclusions The prevalence of anemia is high among patients with CHF. The anemia patients with CHF tend to be female, have greater cardiac and renal functional impairment, but with lower serum albumin and LDL that suggests some degree of malnutrition.

  9. 参麦注射液对充血性心力衰竭患者微循环的影响研究%Study on the influence of Shenmai injection for the microcirculation of patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    尤莉

    2014-01-01

    目的:研究观察参麦注射液对充血性心力衰竭患者微循环的影响。方法将本院于2011年12月~2013年12月收治的70例充血性心力衰竭患者随机分为对照组(常规充血性心力衰竭治疗组)35例和观察组(常规充血性心力衰竭治疗加参麦注射液组)35例,然后将两组患者治疗前和治疗后1周与2周时的甲襞微循环积分值及其他指标进行统计与比较。结果观察组治疗后1周与2周时的甲襞微循环积分值均低于对照组,而其他指标也均好于对照组(P<0.05),两组患者治疗后1周与2周时统计结果之间差异均有统计学意义。结论参麦注射液对充血性心力衰竭患者微循环的影响较大,在充血性心力衰竭患者中的应用价值较高。%Objective To study and observe the influence of Shenmai injection for the microcirculation of patients with congestive heart failure. Methods 70 patients with congestive heart failure in our hospital from December 2011 to December 2013 were randomly divided into control group(conventional congestive heart failure treatment group) 35 cases and observation group(conventional congestive heart failure treatment and Shenmai injection group) 35 cases,then the nail fold microcirculation integral value and other indexes of two groups before the treatment and at first and second week after the treatment were analyzed and compared. Results The nail fold microcirculation integral value of observation group at first and second week after the treatment were all lower than those of control group,other indexes were all better than those of control group too(P<0.05),the analysis results of two groups at first and second week after the treatment all had significant differences. Conclusion The influence of Shenmai injection for the microcirculation of patients with congestive heart failure is great,and its application value in the patients with congestive heart failure is high.

  10. Inhalation of diluted diesel engine emission impacts heart rate variability and arrhythmia occurrence in a rat model of chronic ischemic heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Anselme, Frederic [Rouen University Hospital, Service de Cardiologie, Rouen (France); Loriot, Stephane; Henry, Jean-Paul; Thuillez, Christian; Morin, Jean-Paul [University of Rouen France, INSERM U644, School of Medicine-Pharmacy, Rouen, Cedex (France); Dionnet, Frederic [Centre d' Etudes et de Recherches Technologiques en Aerothermique et Moteurs, Saint Etienne du Rouvray (France); Napoleoni, Jean-Gerard [EMKA Technologies, Paris (France)

    2007-04-15

    Both increase in cardiac arrhythmia incidence and decrease in heart rate variability (HRV) have been described following human and experimental animal exposures to air pollutants. However, the potential causal relationship between these two factors remains unclear. Incidence of ventricular arrhythmia and HRV were evaluated during and after a 3 h period of Diesel engine exhaust exposure in ten healthy and ten chronic ischemic heart failure (CHF, 3 months after coronary ligation) Wistar rats using implantable ECG telemetry. Air pollutants were delivered to specifically designed whole body individual exposure chambers at particulate matter concentrations similar to those measured inside cabins of cars inserted in congested urban traffic. Recordings were obtained from unrestraint and unsedated vigil rats. Immediate decrease in RMSSD was observed in both healthy (6.64 {+-} 2.62 vs. 4.89 {+-} 1.67 ms, P < 0.05) and CHF rats (8.01 {+-} 0.89 vs. 6.6 {+-} 1.37 ms, P < 0.05) following exposure. An immediate 200-500% increase in ventricular premature beats was observed in CHF rats only. Whereas HRV progressively returned to baseline values within 2.5 h after exposure start, the proarrhythmic effect persisted as late as 5 h after exposure termination in CHF rats. Persistence of ventricular proarrhythmic effects after HRV normalization suggests that HRV reduction is not the mechanism of cardiac arrhythmias in this model. Our methodological approach, closely reflecting the real clinical situations, appeared to be a unique tool to provide further insight into the pathophysiological mechanisms of traffic related airborne pollution health impact. (orig.)

  11. [Parenteral iron therapy in chronic kidney disease or chronic heart failure].

    Science.gov (United States)

    Eisenga, Michele F; Diepenbroek, Adry; Swinkels, Dorine W; Bakker, Stephan J L; van der Meer, Peter; Gaillard, Carlo A J M

    2015-01-01

    Iron deficiency and anaemia occur frequently in patients with chronic kidney disease (CKD) or chronic heart failure (CHF) and are associated with lower quality of life and higher mortality. Treating anaemia with erythropoietic growth factors produces no improvement. In recent years, the focus has therefore shifted to correction of iron deficiency. Chronic inflammation in CKD increases the production of hepcidin, which blocks iron absorption from the intestine and leads to less efficient re-use of iron from the macrophages. In absolute iron deficiency the body's iron stores are depleted, whereas in functional iron deficiency the supply of iron is not sufficient to meet demand from the bone marrow. Normal or high ferritin levels do not exclude iron deficiency at tissue level. The iron saturation fraction is a more useful indicator. Parenteral iron therapy ameliorates in CHF the symptoms of iron deficiency, irrespective of the effect on haemoglobin levels. The long-term effects of intravenous iron on mortality and morbidity are still unknown.

  12. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Paul L., E-mail: pnguyen@LROC.harvard.edu [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, CT (United States); Beckman, Joshua A. [Department of Cardiology, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Beard, Clair J.; Martin, Neil E. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Choueiri, Toni K. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Hu, Jim C. [Division of Urologic Surgery, Brigham and Women' s/Faulkner Hospital, Harvard Medical School, Boston, MA (United States); Hoffman, Karen E. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Dosoretz, Daniel E. [21st Century Oncology, Fort Myers, FL (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, IL (United States); Salenius, Sharon A. [21st Century Oncology, Fort Myers, FL (United States); Braccioforte, Michelle H. [Chicago Prostate Center, Westmont, IL (United States); Kantoff, Philip W. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); D' Amico, Anthony V. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Ennis, Ronald D. [Department of Radiation Oncology, St. Luke' s-Roosevelt and Beth Israel Hospitals, Continuum Cancer Centers of New York, Albert Einstein College of Medicine, New York, NY (Israel)

    2012-03-15

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  13. Expression of platelet-bound stromal-cell derived factor-1 (SDF-1) and number of CD34(+) progenitor cells in patients with congestive heart failure.

    Science.gov (United States)

    Jorbenadze, Rezo; Schleicher, Erwin; Bigalke, Boris; Stellos, Konstantinos; Gawaz, Meinrad

    2014-01-01

    Platelet-bound stromal cell-derived factor-1 (SDF-1) plays a crucial role in attachment of circulating CD34(+) progenitor cells to the vascular wall, facilitating tissue healing after injury. However there is no evidence about expression of platelet-bound SDF-1 in patients with congestive heart failure (CHF). The aim of our study was to evaluate expression of platelet-bound SDF-1 and number of CD34(+) progenitor cells in patients with CHF. Forty-eight patients with idiopathic dilated cardiomyopathy (DCM) and 61 patients with ischaemic cardiomyopathy (ICM) were consecutively enrolled into the study. Blood taken from 109 consecutive patients was studied for surface expression of platelet-bound SDF-1 and number of CD34(+) progenitor cells by flow cytometry. The highest expression of platelet-bound SDF-1 was observed in patients with severe impairment of left ventricular systolic function compared with patients with mild or moderate impairment of left ventricular systolic function (mild vs. moderate vs. severe impairment of left ventricular systolic function: MFI ± SD: 35.6 ± 34 vs. 101.45 ± 73 vs. 124.86 ± 86.7, Kruskal-Wallis p SDF-1 number of CD34(+) progenitor cells was the highest in severe impairment of left ventricular systolic function (mild vs. moderate vs. severe impairment of left ventricular systolic function: mean ± SD: 260.4 ± 177.5 vs. 580.7 ± 340.5 vs. 640.82 ± 370.6, Kruskal-Wallis p SDF-1 expression was associated with number of circulating CD34(+) progenitor cells (r = 0.454, p SDF-1 and number of CD34(+) cells were higher in patients with DCM compared with patients with ICM (p SDF-1 and CD34(+) progenitor cells are especially increased in patients with severe impairment of left ventricular systolic function in CHF.

  14. Atrial natriuretic peptide in patients with heart failure and chronic atrial fibrillation : Role of duration of at atrial fibrillation

    NARCIS (Netherlands)

    Van Den Berg, MP; Crijns, HJGM; Van Veldhuisen, DJ; Van Gelder, IC; De Kam, PJ; Lie, KI

    1998-01-01

    The purpose of this study was to analyze the determinants of atrial natriuretic peptide level in patients with congestive heart failure and atrial fibrillation. In particular, the duration of atrial fibrillation was analyzed because atrial fibrillation per se might have a specific effect on atrial n

  15. Cardiac resynchronization therapy for chronic heart failure in China: guideline and practice

    Institute of Scientific and Technical Information of China (English)

    HUA Wei

    2010-01-01

    @@ The value of cardiac resynchronization therapy (CRT)in chronic heart failure has been well recognized around the world. Multi-center clinical trials have confirmed that CRT not only can improve cardiac function and quality of life, but also reduce mortality and improve the prognosis in patients with advanced heart failure and ventricular dyssynchrony.

  16. Gene expression changes associated with myocarditis and fibrosis in hearts of mice with chronic chagasic cardiomyopathy

    DEFF Research Database (Denmark)

    Soares, Milena Botelho Pereira; de Lima, Ricardo Santana; Rocha, Leonardo Lima;

    2010-01-01

    Chronic chagasic cardiomyopathy is a leading cause of heart failure in Latin American countries. About 30% of Trypanosoma cruzi-infected individuals develop this severe symptomatic form of the disease, characterized by intense inflammatory response accompanied by fibrosis in the heart. We perform...

  17. Pelvic congestion syndrome and chronic pelvic pain%盆腔淤血综合征与慢性盆腔痛

    Institute of Scientific and Technical Information of China (English)

    肖喜荣; 李斌

    2013-01-01

    Pelvic congestion syndrome (PCS), caused by mechanical and/or hormonal factors, plays an important role in the disease of chronic pelvic pain. Patients commonly present with pelvic pain without positive physical examination finding. The imaging examination such as doppler ultrasound, contrast-enhanced magnetic resonance venography and pelvic venogra-phy is vital in the assessment of PCS and is often used to confirm the clinical suspicion of this condition. Besides traditional therapy, transcatheter embo-lotherapy gradually turns to be the optimal treatment option.%盆腔淤血综合征是慢性盆腔痛的重要原因,其发生与盆腔静脉解剖、体循环、内分泌等因素有关.盆腔淤血综合征患者的临床症状与体征不符,超声、增强磁共振静脉造影及盆腔静脉造影有助于诊断.在沿袭传统治疗的同时,经导管栓塞技术已逐步成为治疗盆腔淤血综合征的首选方案.

  18. CHRONIC HEART FAILURE: CLINICAL GUIDELINES AND REAL CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    E. K. Shavarova

    2016-01-01

    Full Text Available Aim. Expert assessment of real clinical practice compliance with national guidelines on management of patients with chronic heart failure (HF before the opening of the Expert Center of HF treatment.Material and methods. All patients admitted to 2 city clinical hospitals of Moscow with HF were included into the register. Clinical, demographic, laboratory and instrumental characteristics and medical treatment before and during hospitalization were evaluated, as well as recommendations contained in the discharge summary.Results. 300 patients with HF were included into the register. The mean age was 75 years (39, 95; the proportion of men – 44%. 95% of patients had HF IIIV (NYHA, among them 24% HF II, 61% HF III, 15% HF IV (NYHA. HF with reduced ejection fraction (HFrEF was found in 45% of patients. 22% of the patients did not receive medical treatment before admission. 34% of patients with HFrEF received ACE inhibitors/angiotensin receptor blockers (ARBs, of which only 23% in effective dose. β-blockers were prescribed in 41% of HFeEF patients, of which 22% in the target dose. A third of patients needed in mineralocorticoid receptor antagonists (MRA received spironolactone. During hospitalization 81% of HFrEF patients received ACEI therapy, 12% – ARBs, 91% – β-blockers, 90% – MRA, 81% – loop diuretics and 13% – thiazide diuretics. According to the discharge summary 5% of patients did not receive post-discharge blocker of the renin-angiotensin-aldosterone system without explanation in the medical documentation. β-blocker with proven efficacy was prescribed to 70% of HFrEF patients. Spironolactone was recommended after discharge in 89% of HFrEF patients.Conclusion. Implementation of register of hospitalized patients with HF gives an opportunity to identify shortcomings in the provision of medical care both in outpatient and inpatient stages. 

  19. Clinical utility of biomarkers in chronic kidney disease and chronic heart failure.

    Science.gov (United States)

    Zachariah, Donah; Olechowski, Bartosz; Kalra, Paul R

    2013-09-01

    Biomarkers have an increasingly important clinical role in managing patients with heart failure as well as those with kidney disease, both common conditions with generally poor prognostic outcomes and huge impacts on healthcare economics. For patients with chronic heart failure, biomarkers have become centre place in streamlining diagnostic pathways as well as identifying those with worse prognosis. There is much interest in the role for biomarkers in identifying patients at risk of acute kidney injury, although a number of these currently remain as research tools or are in the early stages of evaluation in clinical practice. Patients with cardiorenal syndrome represent a particular challenge to the clinician, and recent studies have suggested a valuable clinical role for certain biomarkers in this setting, either on their own or in combination. This paper will focus on biomarkers with a current clinical role in patients with cardiorenal disease (natriuretic peptides and neutrophil gelatinase-associated lipocalin), although brief reference will be made to other biomarkers with potential future application.

  20. Evaluation of proinflammatory cytokines and brain natriuretic peptide in patients with rheumatic heart diseases and coronary heart disease complicated by chronic heart insufficiency

    OpenAIRE

    2005-01-01

    Objective. To study proinflammatory cytokines and brain natriuretic peptide (BNP) in patients with rheumatic heart diseases (RHD) and coronary heart disease (CHD) complicated by chronic heart insufficiency (CHI). Material and methods. 54 pts with CHI (among them 16 with RHD and 38 with CHD with signs of CHI ofll-IV functional class according to NYHA that correspond to 11A-III stage according to N.D. Strazesko-V.H. \\frsilenko classification) and 30 healthy persons of control group were examine...

  1. Anemia associated with chronic heart failure: current concepts

    OpenAIRE

    Shah R; Agarwal AK

    2013-01-01

    Ravish Shah, Anil K AgarwalDivision of Nephrology, The Ohio State University, Columbus, Ohio, USAAbstract: Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not...

  2. 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

  3. Shifts in the age distribution and from acute to chronic coronary heart disease hospitalizations

    NARCIS (Netherlands)

    Koopman, Carla; Bots, Michiel L.; Van Dis, Ineke; Vaartjes, Ilonca

    2016-01-01

    Background Shifts in the burden of coronary heart disease (CHD) from an acute to chronic illness have important public health consequences. Objective To assess age-sex-specific time trends in rates and characteristics of acute and chronic forms of CHD hospital admissions in the Netherlands. Methods

  4. Type D personality and cardiac mortality in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Smith, Otto R F; Pedersen, Susanne S.

    2010-01-01

    Clinical predictors of cardiac mortality in chronic heart failure (CHF) are established, but less is known about chronic psychological predictors. Therefore, we examined the prognostic value of Type D personality (tendency to experience negative feelings and inhibit self-expression) in CHF patients....

  5. Current Evidence on Treatment of Patients With Chronic Systolic Heart Failure and Renal Insufficiency

    NARCIS (Netherlands)

    Damman, Kevin; Tang, W. H. Wilson; Felker, G. Michael; Lassus, Johan; Zannad, Faiez; Krum, Henry; McMurray, John J. V.

    2014-01-01

    Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients

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

    OpenAIRE

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

    1995-01-01

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

  7. [Left ventricular assist devices in cardiogenic shock and chronic refractory heart failure].

    Science.gov (United States)

    Genton, Audrey; Hullin, Roger; Tozzi, Piergiorgio; Cook, Stéphane; Liaudet, Lucas

    2012-12-12

    Decompensated heart failure, either acute (cardiogenic shock) or chronic (terminal heart failure) may become refractory to conventional therapy, then requiring mechanical assistance of the failing heart to improve hemodynamics. In the acute setting, aortic balloon counterpulsation is used as first line therapy. In case of failure, other techniques include the extracorporal membrane oxygenator or a percutaneous left ventricular assist device, such as the TandemHeart or the Impella. In chronic heart failure, long-term left ventricular assist devices can be surgically implanted. The continuous flow devices give here the best results. The aim of the present review article is to present with some details the various methods of mechanical left ventricle assistance to which the intensivist may be confronted in his daily practice.

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

    Science.gov (United States)

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

    2012-06-01

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

  9. Renal Denervation for Chronic Heart Failure: Background and Pathophysiological Rationale.

    Science.gov (United States)

    Böhm, Michael; Ewen, Sebastian; Mahfoud, Felix

    2017-01-01

    The activation of the sympathetic nervous system is associated with cardiovascular hospitalizations and death in heart failure. Renal denervation has been shown to effectively reduce sympathetic overdrive in certain patients with uncontrolled hypertension. Pilot trials investigating renal denervation as a potential treatment approach for heart failure were initiated. Heart failure comorbidities like obstructive sleep apnea, metabolic syndrome and arrhythmias could also be targets for renal denervation, because these occurrences are also mediated by the activation of the sympathetic nervous system. Therefore, renal denervation in heart failure is worthy of further investigation, although its effectiveness still has to be proven. Herein, we describe the pathophysiological rationale and the effect of renal denervation on surrogates of the heart failure syndrome.

  10. Anemia associated with chronic heart failure: current concepts.

    Science.gov (United States)

    Shah, Ravish; Agarwal, Anil K

    2013-01-01

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

  11. Interactions of the heart and the liver

    DEFF Research Database (Denmark)

    Møller, Søren; Bernardi, Mauro

    2013-01-01

    There is a mutual interaction between the function of the heart and the liver and a broad spectrum of acute and chronic entities that affect both the heart and the liver. These can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting...... the heart and the liver at the same time. In chronic and acute cardiac hepatopathy, owing to cardiac failure, a combination of reduced arterial perfusion and passive congestion leads to cardiac cirrhosis and cardiogenic hypoxic hepatitis. These conditions may impair the liver function and treatment should...... cardiomyopathy. Electrophysiological abnormalities include prolonged QT interval, chronotropic incompetance, and electromechanical uncoupling. No specific therapy can be recommended, but it should be supportive and directed against the heart failure. Numerous conditions affect both the heart and the liver...

  12. Chronic heart failure: Ca(2+), catabolism, and catastrophic cell death.

    Science.gov (United States)

    Cho, Geoffrey W; Altamirano, Francisco; Hill, Joseph A

    2016-04-01

    Robust successes have been achieved in recent years in conquering the acutely lethal manifestations of heart disease. Many patients who previously would have died now survive to enjoy happy and productive lives. Nevertheless, the devastating impact of heart disease continues unabated, as the spectrum of disease has evolved with new manifestations. In light of this ever-evolving challenge, insights that culminate in novel therapeutic targets are urgently needed. Here, we review fundamental mechanisms of heart failure, both with reduced (HFrEF) and preserved (HFpEF) ejection fraction. We discuss pathways that regulate cardiomyocyte remodeling and turnover, focusing on Ca(2+) signaling, autophagy, and apoptosis. In particular, we highlight recent insights pointing to novel connections among these events. We also explore mechanisms whereby potential therapeutic approaches targeting these processes may improve morbidity and mortality in the devastating syndrome of heart failure.

  13. Chemical sympathectomy restores baroreceptor-heart rate reflex and heart rate variability in rats with chronic nitric oxide deficiency.

    Science.gov (United States)

    Chaswal, M; Das, S; Prasad, J; Katyal, A; Fahim, M

    2015-01-01

    Nitric oxide (NO) plays a crucial role not only in regulation of blood pressure but also in maintenance of cardiac autonomic tone and its deficiency induced hypertension is accompanied by cardiac autonomic dysfunction. However, underlying mechanisms are not clearly defined. We hypothesized that sympathetic activation mediates hemodynamic and cardiac autonomic changes consequent to deficient NO synthesis. We used chemical sympathectomy by 6-hydroxydopamine to examine the influence of sympathetic innervation on baroreflex sensitivity (BRS) and heart rate variability (HRV) of chronic N(G)-nitro-L-arginine methyl ester (L-NAME) treated adult Wistar rats. BRS was determined from heart rate responses to changes in systolic arterial pressure achieved by intravenous administration of phenylephrine and sodium nitroprusside. Time and frequency domain measures of HRV were calculated from 5-min electrocardiogram recordings. Chronic L-NAME administration (50 mg/kg per day for 7 days orally through gavage) in control rats produced significant elevation of blood pressure, tachycardia, attenuation of BRS for bradycardia and tachycardia reflex and fall in time as well as frequency domain parameters of HRV. Sympathectomy completely abolished the pressor as well as tachycardic effect of chronic L-NAME. In addition, BRS and HRV improved after removal of sympathetic influence in chronic L-NAME treated rats. These results support the concept that an exaggerated sympathetic activity is the principal mechanism of chronic L-NAME hypertension and associated autonomic dysfunction.

  14. Transcapillary escape rate of albumin and right atrial pressure in chronic congestive heart failure before and after treatment

    DEFF Research Database (Denmark)

    Hesse, B; Parving, H H; Lund-Jacobsen, H;

    1976-01-01

    The transcapillary escape rate of albumin (TERalb), i.e., the fraction of intravascular mass of albumin that passes to the extravascular space per unit of time, was determined from the disappearance of intravenously injected 125I-labeled human serum albumin during the first 60 minutes after injec...

  15. Associations between cardiac pathology and clinical, echocardiographic and electrocardiographic findings in dogs with chronic congestive heart failure

    DEFF Research Database (Denmark)

    Falk, Bo Torkel; Jönsson, Lennart; Olsen, Lisbeth Høier

    2010-01-01

    of fibrosis was associated with shorter survival time (P=0.002), and the papillary muscle fibrosis score tended to correlate with proximal isovelocity surface area radius (P=0.03). Data from this study lend support to the hypothesis that naturally occurring canine CHF is affected by several factors...... such as MMVD, myocardial atrophy and fibrosis, and by arteriosclerosis. Further, more extensive research will be required to establish cause-effect relationships between these cardiac lesions and the pathophysiology of CHF in dogs....

  16. 重组人脑钠肽治疗失代偿性充血性心力衰竭的研究进展%Research progress on the treatment of compensatory Congestive Heart Failure with recombinant human brain natriuretic peptide

    Institute of Scientific and Technical Information of China (English)

    张麦叶; 姬秋和

    2009-01-01

    重组人脑钠肽(rhBNP)为一种合成肽,作用与内源性脑钠肽相似,具有扩张血管、利尿、利钠、抗交感神经系统、降低醛固酮和内皮素等作用,具有降压不加快心率,不激活肾素.血管紧张素.醛固酮系统等特点.现已有许多临床实验证实其在治疗充血性心力衰竭(CHF)方面,具有有效改善心功能、减轻心脏负荷及心室重构等优势,目前rhBNP已经上市,并且已经在临床上应用于充血性心力衰竭的治疗.本文就rhBNP的药理作用,与CHF的关系,以及其治疗失代偿性CHF的进展作一综述.%Recombinant human brain natriuretic peptide(rhBNP) is a synthetic peptide, its role is similar to endogenous brain natriuretic peptide, with effects on expanding blood vessel, diuretic, natriuretic, anti-sympathetic nervous system, decreasing plasma aldoste-rone and endothelin, also with characteristic of depress urization while neither speeding up the heart rate, nor activating the renin-angiotensin-aldosterone system. A number of studies had confirmed that recombinant human brain natriuretic peptide was effective in the treatment of Congestive Heart Failure (CHF), it could effectively improve the cardiac function, reduce the cardiac load and reverse left ventricular remodeling. It is now put on to market and applied in clinical treatment of Congestive Heart Failure. The article introduces rh-BNP pharmacologic action, the relationship with CHF, and the research progress on the treatment of CHF.

  17. 探讨超声在评价充血性心力衰竭患者心脏非同步化运动中的应用效果%Application Effect of Ultrasound in the Asynchronous Movement of the Heart in Congestive Heart Failure Patients

    Institute of Scientific and Technical Information of China (English)

    沈梦茜; 陈耀琴

    2015-01-01

    ObjectiveTo analyze the effect of ultrasound applied in patients with congestive heart failure heart asynchronous movement in the evaluation work. Methods35 patients with congestive heart failure in our hospital, according to the different of QRS duration can be divided into three groups A, B, C, and analysis the clinical data of the three groups retrospectively, there were some differences analysising the ultrasound examination index level.ResultsThe patients with left ventricular diastolic filling time, left/right ventricular ejection time difference value before cardiac synchronization movement related indexes such as compared with statistical signiifcance (P<0.05).Conclusion For patients with congestive heart failure, the use of ultrasound evaluate heart asynchronous movement has the good effect.%目的分析超声技术应用于充血性心力衰竭患者心脏非同步化运动评价工作中的效果。方法选择本院35例充血性心力衰竭患者,根据QRS时限的不同将其划分为A、B、C三组,对三组患者的临床资料开展回顾性分析,分析其超声检查指标水平存在的差异。结果患者左室舒张充盈时间、左/右室射血前时间差值等心脏同步化运动相关指标比较具有统计学意义(P<0.05)。结论针对充血性心力衰竭患者,采用超声技术进行心脏非同步化运动评价具有良好效果。

  18. Extracellular matrix remodeling in patients with ischemic chronic heart failure with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2015-04-01

    Full Text Available Aim. To identify features, relationships between parameters of the extracellular matrix and renal function in 110 patients with ischemic chronic heart failure the activity of collagen metabolism markers (MMP-9, TIMP-1, PICP, cystatin C, structural and functional parameters of the heart were studied using ELISA, echocardiography. Results. It was established that imbalance in the system MMP/TIMP in ischemic heart failure with preserved left ventricular ejection fraction leads to disruption of the extracellular matrix structural functional sufficiency, increases functional failure and is associated with impaired renal function. Conclusion. Correlation analysis showed significant relationships between MMP/TIMP and GFR, cystatin C, indicating that the significant role of extracellular matrix imbalance in the development of renal dysfunction in patients with ischemic chronic heart failure.

  19. Sudden cardiac death in patients with diabetes mellitus and chronic heart failure.

    Science.gov (United States)

    Walker, Andrew Mn; Cubbon, Richard M

    2015-07-01

    In patients with diabetes mellitus, around 50% of deaths due to cardiovascular causes are sudden cardiac deaths. The prevalence of diabetes in cohorts with chronic heart failure is increasing, and while sudden cardiac death is an increasingly rare mode of death in chronic heart failure patients as a whole, the risk of this outcome remains high in those with diabetes. This review summarises the current knowledge on the incidence of sudden cardiac death in patients with diabetes and chronic heart failure, before discussing the causes of the excess risk seen in those with these coexistent conditions. We then describe current strategies for risk stratification and prevention of sudden cardiac death in these patients before discussing the priorities for further study in this area.

  20. [A failed improvement in pulmonary function and exercise capacity with carvedilol in congestive heart failure despite an excellent effect on left ventricular function].

    Science.gov (United States)

    Guazzi, M; Pontone, G; Trevisi, N; Lomanto, M; Matturri, M; Agostoni, P

    1998-02-01

    This study was aimed at investigating in chronic heart failure (CHF) the effects that beta-blockade with carvedilol may have on lung function, and their relationship with left ventricular (LV) performance and peak exercise oxygen uptake (VO2p). CHF causes disturbances in ventilation and pulmonary gas transfer (stress failure of alveolar-capillary membrane) that participate in limiting VO2p. Carvedilol improves LV function and not VO2p. Twenty-one NYHA functional class II-III patients were randomized (2 to 1) to carvedilol (25 mg bid., 14 patients) or placebo (7 patients) for 6 months. Rest forced expiratory volume (FEV1), vital capacity (VC), total lung capacity (TLC), carbon monoxide diffusing capacity (DLCO), its alveolar-capillary membrane component (DM), pulmonary venous and transmitral flows (for monitoring changes in LV end-diastolic pressure, EDP), LV diastolic (EDD) and systolic (ESD) dimensions, stroke volume (SV), ejection fraction (EF), fiber shortening velocity (VCF) were measured at baseline and at 3 and 6 months. VO2p, peak ratio of dead space to tidal volume (VD/VTp), ventilatory equivalent for CO2 production (VE/VCO2), VO2 at anaerobic threshold (VO2at) were also determined. FEV1, VC, TLC, DLCO, DM were impaired in CHF compared to 14 volunteers, and did not vary with treatment. Carvedilol reduced EDP, EDD, ESD, and increased EF, SV, VCF, without affecting VO2p, VO2at, VD/VTp, VE/VCO2, at 3 and 6 months. Placebo was ineffective. In CHF, carvedilol exerts neutral effects on ventilation and pulmonary gas transfer and ameliorates LV function at rest. This proves that antifailure treatment may not be similarly effective on cardiac and pulmonary function; and does not contradict the possibility that persistence of lung impairment may contribute to lack of improvement in exercise performance with carvedilol.

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

    OpenAIRE

    Bruno-Pierre Dubé; Piergiuseppe Agostoni; Pierantonio Laveneziana

    2016-01-01

    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 o...

  2. Early predictors of renal dysfunction in patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Umida Kamilova

    2013-04-01

    Full Text Available Study was aimed at an early detection of subclinical disorders in renal function in patients with chronic heart failure (CHF. Fifty-two patients with ischemic heart disease (IHD with post-infarction cardiosclerosis were examined. All the patients were underwent complex clinical examination, a level of serum creatinine, residual nitrogen and urine enzymes. Determination of urine enzymes level in CHF patients may be considered as diagnostic approach for an early diagnosis of renal dysfunction.

  3. Clinical Curative Effect Observation of Milrinone in the Treatment of Senile Congestive Heart Failure%米力农治疗老年性充血性心力衰竭的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘跃忠

    2015-01-01

    目的:探究米力农在治疗老年性充血性心力衰竭中的临床治疗效果。方法选取我院就诊的49例老年性充血性心力衰竭患者为研究对象,将其随机分为对照组和治疗组,对照组24例患者,治疗组25例患者。对照组采用常规性治疗方法,治疗组采用米力农进行治疗。对两组治疗效果进行比较分析。结果对照组总有效率为62.5%,治疗组总有效率为84%。治疗组的治疗效果优于对照组,两组比较结果的差异具有统计学意义(P<0.05)。结论对老年充血性心力衰竭患者采用米力农进行治疗,能有效的减少临床不良症状,起到稳定病情。%Objective To explore the clinical therapeutic effect of milrinone in the treatment of senile congestive heart failure. Methods 49 elderly patients with congestive heart failure in our hospital were randomly selected into control group(24 patients)and treatment group(25 patients). The control group patients were treated with conventional therapy,the treatment group patients were treated with milrinone. The treatment effects of two groups were compared. Results The total effective rate of treatment group(84%)was better than control group(62.5%)significantly(P< 0.05). Conclusion Milrinone in the treatment of senile congestive heart failure,can effectively reduce the clinical symptoms,stabilize patient’s condition,it is worthy to be promoted in clinical.

  4. Haptoglobin Phenotype Predicts a Low Heart Rate Variability in Patients with Chronic Kidney Disease

    DEFF Research Database (Denmark)

    Svensson, My; Strandhave, Charlotte; Krarup, H.B.;

    F-PO1096 Haptoglobin Phenotype Predicts a Low Heart Rate Variability in Patients with Chronic Kidney Disease My Svensson,1 Charlotte Strandhave,1 Henrik My Svensson,1 Charlotte Strandhave,1 HenrikKrarup,2 Jeppe H. Christensen.1 1Department of Nephrology, Aalborg Hospital, Aalborg, Denmark; 2...... to a phenotype-dependent antioxidant capacity where Hp 2-2 exhibits a low antioxidant ability, increasing the risk of cardiovascular disease. An attenuated heart rate variability (HRV) may be an important predictor of mortality in patients with chronic kidney disease (CKD). In the present study, we examined...

  5. Angiotensin Ⅱ receptor antagonists for treatment of congestive heart failure%血管紧张素Ⅱ受体拮抗剂治疗充血性心力衰竭的进展

    Institute of Scientific and Technical Information of China (English)

    谢瑞奎

    2002-01-01

    @@ 充血性心力衰竭(Congestive heart failure,CHF)的主要矛盾是心脏收缩无力,心脏泵血功能不足,造成动脉系统供血不足,组织缺血缺氧,静脉系统回流障碍,出现肺循环和体循环瘀血征象;同时由于心输出量减少,通过窦弓压力感受器的反射性调节,使交感神经活性增强;肾素-血管紧张素-醛固酮系统(RAAS)被激活等,从而使心率加快,血管收缩,外周阻力升高,心衰征象加重.

  6. 细胞凋亡与充血性心力衰竭关系及中医药研究%Discussing the relationship between cell apoptosis and congestive heart-failure and study progress of TCM

    Institute of Scientific and Technical Information of China (English)

    李爱民; 张明辉

    2006-01-01

    细胞凋亡是充血性心力衰竭(congestive heart failure,CHF)发生发展的重要机制.心肌细胞丧失可能是心力衰竭进行性恶化的重要基础.神经内分泌改变、TNF-a、氧化应激是此过程中的重要因素.大量研究表明,单味中药及复方可明显抑制心肌细胞凋亡,从而改善心肌供血及心功能.中医药对CHF中细胞凋亡影响的研究是中医现代化的方向之一.

  7. Progress in the Predictive Value of Brain Natriuretic Peptide for Congestive Heart Failure%脑钠肽对充血性心力衰竭近期预后影响研究进展

    Institute of Scientific and Technical Information of China (English)

    洪斌; 葛均波

    2007-01-01

    脑钠肽(brain natriuretic peptide,BNP)是由心室分泌的一种调节心血管系统功能的多肽类激素,半衰期为23min,随充血性心力衰竭(congestive heart failure,CHF)的加重而分泌增加。BNP来源于心室,心肌缺血、损伤、坏死,心室壁张力和压力过重、苯福林、肾上腺素、异丙肾上腺素等均刺激BNP的合成与分泌。BNP通过受体起作用。

  8. 胰岛素抵抗与充血性心力衰竭关系的研究%The research of relationship between insulin resistance and congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    罗宗; 秦永文

    2009-01-01

    充血性心力衰竭(congestive heart failure,CHF)患者存在胰岛素抵抗(IR)已引起人们的高度重视,研究表明随着心功能的恶化IR也进一步加重。IR特点表现为具有与正常对照者相似的空腹血糖水平和明显高于对照者的胰岛素水平,但胰岛素在促进靶器官的葡萄糖摄取和利用方面的作用低于正常的预计水平而导致代谢异常。这种异常的高胰岛素血症不可避免地引起一系列非生理性代谢效应,

  9. Changes in absolute and relative importance in the prognostic value of left ventricular systolic function and congestive heart failure after acute myocardial infarction. TRACE Study Group. Trandolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Jørgensen, S;

    1998-01-01

    ) by echocardiography, was assessed in 6,676 consecutive patients with an enzyme-confirmed AMI. So that changes in the prognostic value of WMI or CHF could be studied, separate analyses were performed at selected time periods. Average monthly mortality (deaths per 100 patients per month) was determined from life......Changes in the importance of left ventricular (LV) systolic dysfunction and congestive heart failure (CHF) with time after an acute myocardial infarction (AMI) after the introduction of thrombolytic therapy have not been studied. LV systolic function, measured as wall motion index (WMI...... dysfunction or CHF, monthly mortality was high during the first month (18.3 +/- 1.6% and 20.2 +/- 1.6%, respectively), decreased during the first year, and was stable thereafter (0.8 +/- 0.1% and 1.0 +/- 0.1%, respectively, average monthly mortality after year 3). The relative risk of LV dysfunction decreased...

  10. The use of metoprolol CR/XL in the treatment of patients with diabetes and chronic heart failure

    Directory of Open Access Journals (Sweden)

    Ovidio De Freitas

    2006-06-01

    Full Text Available Ovidio De Freitas, Oliver Lenz, Alessia Fornoni, Barry J MatersonDivision of Nephrology and Hypertension, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USAAbstract: About 5 million Americans suffer from heart failure. Given the correlation of heart failure with age and the rising life expectancy, the prevalence of heart failure continues to increase in the general population. Sympathetic stimulation intensifies with progressive heart failure. The rationale to use β-blockers in individuals with impaired myocardial function is based on experimental evidence supporting the notion that prolonged α- and β-adrenergic stimulation leads to worsening heart failure. Until recently, safety concerns have precluded the use of β-blockers in patients with diabetes and heart failure. However, several large, randomized, placebo-controlled clinical trials such as Metoprolol Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF have shown that β-blockers can be safely used in patients with diabetes and heart failure. Moreover, β-blockers significantly improved morbidity and mortality in this population. Based on this evidence, it is now recommended to add β-blockers such as metoprolol CR/XL with an escalating dosage regimen to the treatment of patients with symptomatic heart failure who already are receiving a stable medical regimen including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, diuretics, vasodilators, or digitalis.Keywords: metoprolol, heart failure, diabetes mellitus, β-adrenergic blocking agents, MERITHF

  11. Exercise training in chronic heart failure: mechanisms and therapies

    OpenAIRE

    Piepoli, M. F.

    2012-01-01

    Decreased exercise capacity negatively affects the individuals’ ability to adequately perform activities required for normal daily life and, therefore, the independence and quality of life. Regular exercise training is associated with improved quality of life and survival in healthy individuals and in cardiovascular disease patients. Also in patients with stable heart failure, exercise training can relieve symptoms, improve exercise capacity and reduce disability, hospitalisation and probably...

  12. Renal Hemodynamic Effects of Serelaxin in Patients With Chronic Heart Failure A Randomized, Placebo-Controlled Study

    NARCIS (Netherlands)

    Voors, Adriaan A.; Dahlke, Marion; Meyer, Sven; Stepinska, Janina; Gottlieb, Stephen S.; Jones, Andrew; Zhang, Yiming; Laurent, Didier; Slart, Riemer H. J. A.; Navis, Gerjan J.

    2014-01-01

    Background-Serelaxin is a promising therapy for acute heart failure. The renal hemodynamic effects of serelaxin in patients with chronic heart failure are unknown. Methods and Results-In this double-blind, randomized, placebo-controlled, multicenter study, patients with New York Heart Association Cl

  13. [Quality of life and iron metabolism in patients with anemic syndrome developed on the background of chronic heart failure].

    Science.gov (United States)

    Ryndina, N; Kravchun, P; Tytova, G

    2013-03-01

    The presence of concomitant anemia in many aspects defines an unfavorable course of chronic heart failure, affects patient's quality of life. Among anemic patients with chronic heart failure prevailed persons with a relative deficiency of iron. Aim of the study - to evaluate the quality of life for patients with anemia on the background of chronic heart failure, using a questionnaire FACT-An, and to analyze the existence and nature of the relations between quality of life and indicators of the iron metabolism, based on the study of transferrin saturation and ferritin. Ferritin concentration was determined by ELISA. Transferrin saturation were determined by the formula. Questionnaire FACT-An was used for assess the quality of life in anemic patients with chronic heart failure. The presence of functional iron deficiency in patients with chronic heart failure and anemic syndrome is accompanied by deterioration of parameters of quality of life mainly due to the scale of physical activity and social functioning.

  14. Changes of the pulmonary function in the chronic heart failure after treatment%慢性心功能不全住院患者治疗前后肺功能的改变

    Institute of Scientific and Technical Information of China (English)

    文红; 欧雪珍; 卫展扬; 罗海波; 张平; 邓念强

    2011-01-01

    目的:探索慢性心功能不全患者治疗前后肺功能的变化.方法:选取临床诊断的慢性心功能不全患者49例,于治疗前后分别进行肺通气功能、肺弥散功能及超声心动图检查,分析治疗前后各项肺功能及心功能参数的变化.结果:81.63%的慢性心功能不全患者存在限制性或混合性通气功能障碍,治疗后多项肺功能指标如1 s用力呼气容积( FEV1)、FEV1占预计值%、用力肺活量(FVC)、FVC占预计值%、最大呼气中期流量(MMEF)、一氧化碳弥散量( DLCO)均显著改善(P<0.05),治疗后FEV1、FVC、MMEF及DLCO较治疗前分别提高6.5%、9.9%、22%和11.5%.超声心动图测出左室射血分数(LVEF)显著改善(P<0.05).结论:慢性心功能不全患者治疗后肺通气及肺弥散功能显著改善.%Aim: This study investigates the effects of congestive heart failure on pulmonary function and assesses the Changes in pulmonary function as the Chronic Heart Failure after was treated. Methods: 49 patients with chronic systolic heart failure were included. Patients had spirometry, diffusing capacity measurements and echocardiography before and after treatment for the chronic heart failure. Results-. A restrictive ventilatory defect was present in 81. 63 percent of the patients with systolic heart failure presence. The lung function parameters such as FEV1 ,FVC,FEVl%pre,FVC%pre,MMEF and DLCO were significant increased in the patients with systolic heart failure after treatment (P<0. 05). The mean FEV1, FVC, MMEF and DLCO improved 6. 5% ,9. 9% ,22% and 11. 5% respectively. Conclusion: Patients with systolic heart failure significant improve in lung function after treatment. Spirometry and diffusing capacity measurements can be used to assess in therapeutic effect of the congestive heart failure.

  15. The fascial system and exercise intolerance in patients with chronic heart failure: hypothesis of osteopathic treatment

    Directory of Open Access Journals (Sweden)

    Bordoni B

    2015-10-01

    Full Text Available Bruno Bordoni,1–3 F Marelli2,3 1Don Carlo Gnocchi Foundation, Department of Cardiology, IRCCS Santa Maria Nascente, Milan, Italy; 2School CRESO, Osteopathic Centre for Research and Studies, Falconara Marittima, AN, Italy; 3School CRESO, Osteopathic Centre for Research and Studies, Castellanza, VA, Italy Abstract: Chronic heart failure is a progressive, debilitating disease, resulting in a decline in the quality of life of the patient and incurring very high social economic costs. Chronic heart failure is defined as the inability of the heart to meet the demands of oxygen from the peripheral area. It is a multi-aspect complex disease which impacts negatively on all of the body systems. Presently, there are no texts in the modern literature that associate the symptoms of exercise intolerance of the patient with a dysfunction of the fascial system. In the first part of this article, we will discuss the significance of the disease, its causes, and epidemiology. The second part will explain the pathological adaptations of the myofascial system. The last section will outline a possible osteopathic treatment for patients with heart failure in order to encourage research and improve the general curative approach for the patient. Keywords: manual therapy, fatigue, chronic heart failure, osteopathic

  16. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008037 Factors associated with efficacy of cardiac resynchronization therapy for patients with congestive heart failure. SHI Haoying(史浩颖), et al. Dept Cardiol, Zhongshan Hosp Fudan Univ, Shanghai 200032. Chin J Cardiol 2007;35(12):1099-1163. Objective The efficacy of cardiac resynchronization therapy (CRT) in patients with congestive heart failure and the potential factors associated with responder or nonresponder were investigated. Methods Fifty

  17. Erythropoiesis-stimulating agents for anaemia in chronic heart failure patients

    NARCIS (Netherlands)

    Ngo, Katherine; Kotecha, Dipak; Walters, Julia A. E.; Manzano, Luis; Palazzuoli, Alberto; van Veldhuisen, Dirk J.; Flather, Marcus

    2010-01-01

    Background Chronic heart failure (CHF) is a leading cause of morbidity and mortality worldwide. Anaemia is a common (12-55%) co-morbid condition and is associated with worsening symptoms and increased mortality. Anaemia is treatable and can be targeted in the treatment of patients with CHF. Erythrop

  18. What Works In Chronic Care Management : The Case Of Heart Failure

    NARCIS (Netherlands)

    Sochalski, Julie; Jaarsma, Tiny; Krumholz, Harlan M.; Laramee, Ann; McMurray, John J. V.; Naylor, Mary D.; Rich, Michael W.; Riegel, Barbara; Stewart, Simon

    2009-01-01

    The evidence base of what works in chronic care management programs is underdeveloped. To fill the gap, we pooled and reanalyzed data from ten randomized clinical trials of heart failure care management programs to discern how program delivery methods contribute to patient outcomes. We found that pa

  19. Plasma calprotectin levels reflect disease severity in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Jensen, Louise Jn; Kistorp, Caroline Michaela Nervil; Bjerre, Mette

    2011-01-01

    Background: Low-grade inflammation has been associated with cardiovascular disease (CVD) and chronic heart failure (CHF). The aim of the present study was to investigate the potential usefulness of the inflammatory protein calprotectin as a biomarker in CHF. Methods: Plasma calprotectin...

  20. Nebivolol: Its role in the treatment of hypertension and chronic heart failure

    NARCIS (Netherlands)

    Voors, Adriaan; Van Veldhuisen, D.J.

    2006-01-01

    (beta)-blockers are standard therapy in patients with cardiovascular disease, and have become a cornerstone in the treatment of both hypertension and chronic heart failure. However, two meta-analyses have recently raised doubts about the use of (beta)-blockers in patients with essential hypertension

  1. Distinct trajectories of fatigue in chronic heart failure and their association with prognosis

    NARCIS (Netherlands)

    Smith, Otto R. F.; Kupper, Nina; de Jonge, Peter; Denollet, Johan

    2010-01-01

    Aims To identify distinct trajectories of fatigue over a 12-month period and to examine their impact on mortality in chronic heart failure (CHF). Methods and results Consecutive CHF patients (n = 310) were assessed at baseline and at 2- and 12-month follow-up for symptoms of exertion and general fat

  2. Determinants of increased angiotensin II levels in severe chronic heart failure patients despite ACE inhibition

    NARCIS (Netherlands)

    van de Wal, RMA; Plokker, HWM; Lok, DJA; Boomsma, F; van Veldhuisen, DJ; van Gilst, WH; Voors, AA; Van Der Horst, F.A.L.

    2006-01-01

    Introduction: The beneficial effects of ACE inhibitors are generally ascribed to blockade of neurohormonal activation. However, especially in chronic heart failure (CHF) patients plasina angiotensin II and aldosterone levels can be elevated despite ACE inhibition, the so-called ACE escape. In the pr

  3. Exercise-based cardiac rehabilitation in patients with chronic heart failure : a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, A.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.A. (Tinus); Hendriks, E.J.M.

    2015-01-01

    Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. Guideline development A systematic literature search was performed to formulate c

  4. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, R.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.; Hendriks, E.J.

    2015-01-01

    RATIONALE: To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. GUIDELINE DEVELOPMENT: A systematic literature search was performed to formulate

  5. Statins in the treatment of chronic heart failure: A systematic review

    NARCIS (Netherlands)

    van der Harst, P.; Voors, Adriaan; van Gilst, W.H.; Bohm, M.; Van Veldhuisen, D.J.

    2006-01-01

    Background The efficacy of statin therapy in patients with established chronic heart failure (CHF) is a subject of much debate. Methods and Findings We conducted three systematic literature searches to assess the evidence supporting the prescription of statins in CHF. First, we investigated the part

  6. Statins in the treatment of chronic heart failure : A systematic review

    NARCIS (Netherlands)

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

    2006-01-01

    Background The efficacy of statin therapy in patients with established chronic heart failure (CHF) is a subject of much debate. Methods and Findings We conducted three systematic literature searches to assess the evidence supporting the prescription of statins in CHF. First, we investigated the part

  7. Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure

    NARCIS (Netherlands)

    Conraads, Viviane M.; Spruit, Martijn A.; Braunschweig, Frieder; Cowie, Martin R.; Tavazzi, Luigi; Borggrefe, Martin; Hill, Michael R. S.; Jacobs, Sandra; Gerritse, Bart; van Veldhuisen, Dirk J.

    2014-01-01

    Background- Physical activity (PA) predicts cardiovascular mortality in the population at large. Less is known about its prognostic value in patients with chronic heart failure (HF). Methods and Results- Data from 836 patients with implantable cardioverter defibrillator without or with cardiac resyn

  8. Survival in Mediterranean Ambulatory Patients With Chronic Heart Failure. A Population-based Study

    NARCIS (Netherlands)

    Frigola Capell, E.; Comin-Colet, J.; Davins-Miralles, J.; Gich-Saladich, I.J.; Wensing, M.; Verdu-Rotellar, J.M.

    2013-01-01

    INTRODUCTION AND OBJECTIVES: Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors. METHODS: We carried out a population-based retrospective

  9. Anaemia is associated with shorter leucocyte telomere length in patients with chronic heart failure

    NARCIS (Netherlands)

    Wong, Liza S. M.; Huzen, Jardi; van der Harst, Pim; de Boer, Rudolf A.; Codd, Veryan; Westenbrink, B. Daan; Benus, Germaine F. J. D.; Voors, Adriaan A.; van Gilst, Wiek H.; Samani, Nilesh J.; Jaarsma, Tiny; van Veldhuisen, Dirk J.

    2010-01-01

    Aims Anaemia is highly prevalent and associated with poor prognosis in patients with chronic heart failure (CHF). Reduced erythroid proliferation capacity of haematopoietic progenitor cells is associated with reduced telomere length, a marker of cellular ageing. We hypothesize that short telomere le

  10. [Body composition and heart rate variability in patients with chronic obstructive pulmonary disease pulmonary rehabilitation candidates].

    Science.gov (United States)

    Curilem Gatica, Cristian; Almagià Flores, Atilio; Yuing Farías, Tuillang; Rodríguez Rodríguez, Fernando

    2014-07-01

    Body composition is a non-invasive method, which gives us information about the distribution of tissues in the body structure, it is also an indicator of the risk of mortality in patients with chronic obstructive pulmonary disease. The heart rate variability is a technique that gives us information of autonomic physiological condition, being recognized as an indicator which is decreased in a number of diseases. The purpose of this study was to assess body composition and heart rate variability. The methodology used is that of Debora Kerr (1988) endorsed by the International Society for advances in Cineantropometría for body composition and heart rate variability of the guidelines described by the American Heart Association (1996). Roscraff equipment, caliper Slimguide and watch Polar RS 800CX was used. , BMI 26.7 ± 3.9 kg / m²; Muscle Mass 26.1 ± 6.3 kg ; Bone Mass 1.3 kg ± 8.1 76 ± 9.9 years Age : 14 candidates for pulmonary rehabilitation patients were evaluated , Adipose mass 16.4 ± 3.6 kg ; FEV1 54 ± 14%. Increased waist circumference and waist hip ratio was associated with a lower overall heart rate variability. The bone component was positively related to the variability of heart rate and patients with higher forced expiratory volume in one second had lower high frequency component in heart rate variability. In these patients, the heart rate variability is reduced globally and is associated with cardiovascular risk parameters.

  11. Adjustment and Characterization of an Original Model of Chronic Ischemic Heart Failure in Pig

    Directory of Open Access Journals (Sweden)

    Laurent Barandon

    2010-01-01

    Full Text Available We present and characterize an original experimental model to create a chronic ischemic heart failure in pig. Two ameroid constrictors were placed around the LAD and the circumflex artery. Two months after surgery, pigs presented a poor LV function associated with a severe mitral valve insufficiency. Echocardiography analysis showed substantial anomalies in radial and circumferential deformations, both on the anterior and lateral surface of the heart. These anomalies in function were coupled with anomalies of perfusion observed in echocardiography after injection of contrast medium. No demonstration of myocardial infarction was observed with histological analysis. Our findings suggest that we were able to create and to stabilize a chronic ischemic heart failure model in the pig. This model represents a useful tool for the development of new medical or surgical treatment in this field.

  12. [Pharmacotherapy of patients with chronic heart failure. Analysis of multicenter international studies].

    Science.gov (United States)

    Chekman, I S

    2008-01-01

    Leterature data and own investigations are summarized in the article. New experimental facts about mechanism of action of cardiac glycosides (especially digoxin) were obtained last year. It was shown that in human organism there are endogenous cardiosteroids (digitalis-like substances, endogenous oubain and other). They are in different organs (adrenal glands, hypothalamus, pituitary gland) and have influence on different organs and systems. Indications, contraindications, side effects, interactions with other drugs have been studied by cardiologists. Results of international multicentere studies demonstrate high efficacy of digoxin in treatment of chronic heart failure caused by compromised contractile activity of myocardium, atrium fibrillation and is used for controlling number of heart contractions and supraventricular paroxysmal tachycardia. More than 200 years history of scientific researches and clinical use of cardiac glycosides show that this group of medicine may be applied in a combine pharmacotherapy of chronic heart failure together with antihypertensive drugs.

  13. Effectiveness of education programs in the treatment of patients with heart failure

    OpenAIRE

    Natalya Zagorulya; Gulnar Zhussupova

    2010-01-01

    The paper describes efficiency of education program targeted to patientsin “School for patients with congestive heart failure”. During 6 months20 patients proceeding standard therapy were being simultaneouslyeducated on topics related to heart failure. These topics covered causesof chronic heart failure (CHF) formation, basic clinical CHF displays,the role of medicamentous and non-medicamentous CHF treatment,significance of self-control with CHF. The screening group was similarto baseline (wh...

  14. Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

    Directory of Open Access Journals (Sweden)

    Stefan Köberich

    2015-07-01

    Full Text Available Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.

  15. Congestion in the bathtub

    DEFF Research Database (Denmark)

    Fosgerau, Mogens

    2015-01-01

    This paper presents a model of urban traffic congestion that allows for hypercongestion. Hypercongestion has fundamental importance for the costs of congestion and the effect of policies such as road pricing, transit provision and traffic management, treated in the paper. In the simplest version...

  16. Congestion in the bathtub

    DEFF Research Database (Denmark)

    Fosgerau, Mogens

    2015-01-01

    This paper presents a model of urban traffic congestion that allows for hypercongestion. Hypercongestion has fundamental importance for the costs of congestion and the effect of policies such as road pricing, transit provision and traffic management, treated in the paper. In the simplest version ...

  17. Therapeutic options in chronic heart failure. Findings on chest X-ray; Nicht medikamentoese Therapieoptionen der chronischen Herzinsuffizienz. Befunde in der Projektionsradiografie des Thorax

    Energy Technology Data Exchange (ETDEWEB)

    Granitz, M.R.; Meissnitzer, T.; Meissnitzer, M.W.; Hergan, K.; Altenberger, J.; Granitz, C. [Uniklinikum Salzburg - Landeskrankenhaus (Austria)

    2016-05-15

    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.

  18. Randomised trial of low-dose amiodarone in severe congestive heart failure. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA)

    Science.gov (United States)

    Doval, H C; Nul, D R; Grancelli, H O; Perrone, S V; Bortman, G R; Curiel, R

    1994-08-20

    In severe heart failure many deaths are sudden and are presumed to be due to ventricular arrhythmias. The GESICA trial evaluated the effect of low-dose amiodarone on two-year mortality in patients with severe heart failure. Our prospective multicentre trial included 516 patients on optimal standard treatment for heart failure. Patients were randomised to 300 mg/day amiodarone (260) or to standard treatment (256). Intention-to-treat analysis showed 87 deaths in the amiodarone group (33.5%) compared with 106 in the control group (41.4%) (risk reduction 28%; 95% CI 4%-45%; log rank test p = 0.024). There were reductions in both sudden death (risk reduction 27%; p = 0.16) and death due to progressive heart failure (risk reduction 23%; p = 0.16). Fewer patients in the amiodarone group died or were admitted to hospital due to worsening heart failure (119 versus 149 in the control group; risk reduction 31%; 95% CI 13-46%; p = 0.0024). The decrease in mortality and hospital admission was present in all subgroups examined and independent of the presence of non-sustained ventricular tachycardia. Side-effects were reported in 17 patients (6.1%); amiodarone was withdrawn in 12. Low-dose amiodarone proved to be an effective and reliable treatment, reducing mortality and hospital admission in patients with severe heart failure independently of the presence of complex ventricular arrhythmias.

  19. Cardiorenal consideration as a risk factor for heart failure.

    Science.gov (United States)

    Obialo, Chamberlain I

    2007-03-26

    Cardiovascular disease-related factors are responsible for about 50% of the mortality in patients with both chronic kidney disease and end-stage renal disease. Therefore, it is not surprising that 30%-50% of patients with congestive heart failure also have an impaired glomerular filtration rate. This signifies a co-dependence between the kidneys and the heart. The role of anemia, microalbuminuria, calcium, and phosphorus imbalance in this cardiorenal interdependence is discussed in this article.

  20. [Biomarkers of iron metabolism and inflammation in patients with chronic heart failure and various types of left ventricular dysfunction].

    Science.gov (United States)

    Kazymyrko, V K; Kutovyĭ, V V; Ivanyts'ka, L M; Dubkova, A G; Silant'ieva, T S

    2013-09-01

    Study the level of some of the indicators of iron metabolism and inflammatory markers in patients with chronic heart failure due to hypertension and coronary heart disease. The results of the study in systolic and diastolic dysfunction of the left ventricle, the varying degrees of severity of heart failure. The level of the studied parameters determined by the severity of heart failure and does not depend on the nature of left ventricular dysfunction.

  1. Readmission patterns in patients with chronic obstructive pulmonary disease, chronic heart failure and diabetes mellitus: an administrative dataset analysis.

    Science.gov (United States)

    Brand, C; Sundararajan, V; Jones, C; Hutchinson, A; Campbell, D

    2005-05-01

    Comprehensive disease management programmes for chronic disease aim to improve patient outcomes and reduce health-care utilization. Readmission rates are often used as an outcome measure of effectiveness. This study aimed to document readmission rates, and risk for early and late readmission, for patients discharged from the Royal Melbourne Hospital with a disease diagnosis of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes mellitus compared to those with other general medical conditions. Eighty five (8.6%) of patients were readmitted within 28 days and 183 (20.8%) were readmitted between 29 and 180 days. No risk factors for early readmission were identified. Patients with a primary disease diagnosis of CHF and COPD are at increased risk of late readmissions (29-180 days).

  2. Decongestion in acute heart failure

    NARCIS (Netherlands)

    Mentz, Robert J.; Kjeldsen, Keld; Rossi, Gian Paolo; Voors, Adriaan A.; Cleland, John G. F.; Anker, Stefan D.; Gheorghiade, Mihai; Fiuzat, Mona; Rossignol, Patrick; Zannad, Faiez; Pitt, Bertram; O'Connor, Christopher; Felker, G. Michael

    2014-01-01

    Congestion is a major reason for hospitalization in acute heart failure (HF). Therapeutic strategies to manage congestion include diuretics, vasodilators, ultrafiltration, vasopressin antagonists, mineralocorticoid receptor antagonists, and potentially also novel therapies such as gut sequesterants

  3. Reduction of atrial fibrillation by Tanshinone IIA in chronic heart failure.

    Science.gov (United States)

    He, Zhifeng; Sun, Changzheng; Xu, Yi; Cheng, Dezhi

    2016-12-01

    The aim of the present study was to confirm the effect of Tanshinone IIA (TAN) on the prevention of AF in chronic heart failure (CHF), and to elucidate the underlying electrophysiological mechanisms for the antiarrhythmic effects of TAN at the level of the atrium in an experimental model of CHF. In 10 female rabbits, CHF was induced by rapid ventricular pacing, leading to a significant decrease in ejection fraction in the presence of a dilated left ventricle and atrial enlargement. Twelve rabbits were sham-operated and served as controls. Isolated hearts were perfused using the Langendorff method. Burst pacing was used to induce AF. Monophasic action potential recordings showed an increase of atrial action potential duration (aAPD) and effective refractory period (aERP) in CHF hearts compared with sham hearts. Infusion of acetylcholine (1μm) and isoproterenol (1μm) led to AF in all failing hearts and in 11 sham hearts. Simultaneous infusion of TAN (10μm) remarkably reduced inducibility of AF in 50% of sham and 50% of failing hearts. TAN had no effect on aAPD but significantly increased aERP, leading to a marked increase in atrial post-repolarization refractoriness. Moreover, TAN application moderately increased interatrial conduction time. TAN has been shown to be effective in reducing the inducibility of AF in an experimental model of AF. The antiarrhythmic effect is mainly due to prolongations of atrial post-repolarization refractoriness and a moderate increase in interatrial conduction time.

  4. 生物标志物-血清脑钠素在充血性心力衰竭诊断中的价值%Measurement of Serum Brain Natriuretic Peptide Level as a Biomarker for Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    王频佳; 王娴

    2007-01-01

    Objective To explore the value of Brain Natriuretic pepfide (BNP) in estimating the degree of seriousness of congestive heart failure (HF) and study BNP level of CHF caused by various cardiovascular diseases.Methods 100 patients with CHF were divided into three classes (classⅠ,Ⅱ and Ⅳ)by New York Heart Association (NYHA) functional classification Standard. 100 healthy individuals were selected into control group.Serum BNP concentration Were measured by electrochemical luminescence assay (Elecsys 2010,Roche Diagnostics).Results Mean serum BNP concentration of patients with CHF was 4 745.49±3 698.70 ng/ml,which was higher significantly than that of normal control (66.18±44.30ng/ml).Moreover,the growth in BNP level was increased with NYHA functional classification:class Ⅳ (1 0251±9 326.8 ng/ml) >class Ⅲ(1 239±1 063.8 ng/ml) > class Ⅱ (167.4±143.4 ng/ml),which was statistically significant (P0.05),但NYHAⅡ级各病因组间BNP水平差异有显著性(P<0.05).结论 CHF患者血清BNP水平显著增高,且随着NYHA分级增加而增加,可作为评价CHF严重程度的客观指标.

  5. Surgery of congestive heart failure - the role of computed tomography in the pre- and postsurgical diagnostic evaluation; Chirurgie der Herzinsuffizienz - Stellenwert der Computertomographie in der prae- und postoperativen Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Lembcke, A.; Kivelitz, D.E.; Rogalla, P.; Dewey, M.; Klessen, C.; Hamm, B.; Enzweiler, C.N.H. [Inst. fuer Radiologie, Charite - Universitaetsmedizin Berlin, Charite Campus Mitte, Berlin (Germany); Dohmen, P.M.; Konertz, W.F. [Klinik fuer Kardiovaskulaere Chirurgie, Charite - Universitaetsmedizin Berlin, Charite Campus Mitte, Berlin (Germany); Wiese, T.H. [Inst. fuer Radiologie, Augusta-Kranken-Anstalt, Bochum (Germany)

    2005-07-01

    The treatment of advanced, drug resistant congestive heart failure gains in importance in the field of cardiac surgery. Cardiac imaging for preoperative assessment and follow-up focuses on the determination of ventricular volumes and function as well as on the detection of postoperative complications. Computed tomography (CT) is highly accurate irrespective of the individual patient's anatomic situation, has a low examiner dependence and short examination time, does not require an arterial vascular access and can be performed in patients with metal implants. CT is the modality of choice in the follow-up of heart transplants to detect extracardiac and cardiac complications including coronary calcifications as an early sign of transplant vasculopathy. In addition, CT visualizes the elements of mechanical assist devices and can identify their possible local cardiac and mediastinal complications CT can detect fibrolipomatous involution of the mobilized muscle flap in dynamic cardiomyoplasty and can depict fibrous reactions along the epicardial mesh implant in passive cardiac containment. Further indications include assessment of typical local postoperative complications, such as intrathoracic infection and mediastinal bleeding, intracardiac thrombus formation or pericardial effusion. CT is routinely used for evaluating bypass patency but is limited in assessing associated valve defects since it does not visualize flow. (orig.)

  6. 基于HRV信号分析的人工神经网络用于CHF的诊断研究%An application of ANN for classification patients with congestive heart failure based on HRV analysis

    Institute of Scientific and Technical Information of China (English)

    杨林; 党艳军; 林家瑞

    2007-01-01

    建立了基于心率变异性(heart rate variability,HRV)信号分析的人工神经网络(artificial neural network,ANN)模型,以寻求用于充血性心衰(congestive heart failure,CHF)诊断的最佳向量-网络组合.结果表明,将经过改进的BP算法和小波分析所抽取的特征向量相结合所获得的神经网络在诊断敏感性和特异性上有着均衡且优良的表现,并且经由AR模型谱估计获取的向量价值也不亚于小波分析所提取的特征向量.因此,基于HRV信号分析的人工神经网络用于诊断CHF可作为临床诊断的一种重要参考方法.

  7. Prognostic value of Doppler transmitral filling patterns in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    ZHENG Zhe-lan郑哲岚; A.Meissner; B.Hausmann; H.Alexander; R.Simon

    2004-01-01

    Background Chronic heart failure is a significant cause of cardiovascular morbidity and mortality.This study tested the hypothesis that restrictive filling pattern may provide useful prognostic data for identifying patients with chronic heart failure at high risk of all-cause cardiac death.Methods Ninety patients with chronic heart failure [70 men and 20 women, mean age (58.1±11.6) years] were investigated and followed for (18. 8±7. 9) months. During this period, 14 patients died of progressive pump failure, 12 patients underwent heart transplantation, 5 patients died suddenly, and 2 patients died of acute myocardial infarction. A new criterion, the restrictive filling index (RFI), was designed to subgroup patients into a restrictive and a nonrestrictive group.Results Patients with restrictive filling pattern had a more severe left ventricular dysfunction and a higher cardiac mortality. Analysis by the Kaplan-Meier method revealed that patients in the RFI≥1 and RFI<1 groups had a cardiac events-free survival rate of 52% versus 94% at 1 year, and 27. 5% versus 92% at 2 years, respectively. The multivariate Cox proportional hazard model selected RFI as the most powerful prognostic factor (χ2 =8. 8017, P =0. 0030) for all-cause cardiac death.

  8. Lysophospholipids in coronary artery and chronic ischemic heart disease

    Science.gov (United States)

    Abdel-Latif, Ahmed; Heron, Paula M.; Morris, Andrew J.; Smyth, Susan S.

    2015-01-01

    Purpose of review The bioactive lysophospholipids, lysophosphatidic acid (LPA) and sphingosine 1 phosphate (S1P) have potent effects on blood and vascular cells. This review focuses their potential contributions to the development of atherosclerosis, acute complications, such as acute myocardial infarction, and chronic ischemic cardiac damage. Recent findings Exciting recent developments have provided insight into the molecular underpinnings of LPA and S1P receptor signaling. New lines of evidence suggest roles for these pathways in the development of atherosclerosis. In experimental animal models, the production, signaling and metabolism of LPA may be influenced by environmental factors in the diet that synergize to promote the progression of atherosclerotic vascular disease. This is supported by observations of human polymorphisms in the lysophospholipid metabolizing enzyme, PPAP2B, that are associated with risk of coronary artery disease and myocardial infarction. S1P signaling protects from myocardial damage that follows acute and chronic ischemia both by direct effects on cardiomyocytes and through stem cell recruitment to ischemic tissue. Summary This review will suggest novel strategies to prevent the complications of coronary artery disease by targeting LPA production and signaling. Additionally, ways in which S1P signaling pathways may be harnessed to attenuate ischemia-induced cardiac dysfunction will be explored. PMID:26270808

  9. Pathophysiology of nasal congestion

    Directory of Open Access Journals (Sweden)

    Robert M Naclerio

    2010-02-01

    Full Text Available Robert M Naclerio1, Claus Bachert2, James N Baraniuk31University of Chicago, Department of Surgery, Section of Otolaryngology – Head and Neck Surgery, Chicago, Illinois, USA; 2University of Ghent, Ghent, Belgium; 3Georgetown University, Washington, DC, USAAbstract: Nasal congestion is a common symptom in rhinitis (both allergic and nonallergic, rhinosinusitis and nasal polyposis. Congestion can also be caused by physical obstruction of nasal passages and/or modulation of sensory perception. Mucosal inflammation underlies many of the specific and interrelated factors that contribute to nasal congestion, as well as other symptoms of both allergic rhinitis and rhinosinusitis. A wide range of biologically active agents (eg, histamine, tumor necrosis factor-α, interleukins, cell adhesion molecules and cell types contribute to inflammation, which can manifest as venous engorgement, increased nasal secretions and tissue swelling/edema, ultimately leading to impaired airflow and the sensation of nasal congestion. Inflammation-induced changes in the properties of sensory afferents (eg, expression of peptides and receptors that innervate the nose can also contribute to altered sensory perception, which may result in a subjective feeling of congestion. Increased understanding of the mechanisms underlying inflammation can facilitate improved treatment selection and the development of new therapies for congestion.Keywords: allergic rhinitis, congestion, obstruction, pathophysiology, rhinosinusitis

  10. Prevalence, correlative and statistical relationships of renal dysfunction in patients with chronic ischemic heart failure

    Directory of Open Access Journals (Sweden)

    D. A. Lashkul

    2014-02-01

    Full Text Available Chronic heart failure (CHF is one of the most common complications of cardiovascular disease. According multicenter studies conducted during recent years, coronary heart disease was the leading cause of heart failure and has been on average 64% of patients with chronic heart failure. The tight functional relationship of cardiovascular and urinary system causes a lot of interest to the functional state of kidneys in various cardiovascular diseases. Most risk factors for cardiovascular disease are common risk factors of renal failure. Causes significant differences in the prevalence of chronic kidney disease (CKD in patients with chronic heart failure, defined as coronary artery disease and hypertension remain unclear. Need clarification prevalence of CKD among patients with CHF in general and in specific groups of patients. The aim of the study was to examine the prevalence, correlation and statistical relationships of renal dysfunction with functional class, age and gender of patients with coronary heart disease and heart failure, were hospitalized. Materials and methods. Analyzed the medical cards 344 patients (286 men and 58 women with ischemic chronic heart failure, mean age 59.2±9.4 years. The etiology of heart failure in 298 (86.6% patients had a combination of coronary artery disease and essential hypertension in 46 (13.4% - CHD. Chronic heart failure 1 functional class (FC was diagnosed in 10 (2.9% patients, 2 FC - in 106 (31%, 3 FC - 207 (60.5% and 4 FC - 19 (5, 6% patients. Diabetes was 62 (18% patients. Myocardial infarction had a history of 245 (71.2% patients. Glomerular filtration rate was calculated using the formula MDRD (Modification of Diet in Renal Disease. Descriptive statistics are presented as mean±standard deviation for continuous variables and as percentages for categorical variables. Depending on the distribution of the analyzed parameters used unpaired Student's t-test or U-Mann-Whitney test. Comparisons among all

  11. Treatment of congestion in upper respiratory diseases

    Directory of Open Access Journals (Sweden)

    Eli O Meltzer

    2010-02-01

    Full Text Available Eli O Meltzer1, Fernan Caballero2, Leonard M Fromer3, John H Krouse4, Glenis Scadding51Allergy and Asthma Medical Group and Research Center, San Diego, CA and Department of Pediatrics, University of California, San Diego, USA; 2Allergy and Clinical Immunology Service, Centro Medico-Docente La Trinidad, Caracas, Venezuela; 3David Geffen School of Medicine, University of California, Los Angeles, USA; 4Wayne State University School of Medicine, Detroit, Michigan, USA; 5Department of Allergy and Rhinology, Royal National TNE Hospital, London, UKAbstract: Congestion, as a symptom of upper respiratory tract diseases including seasonal and perennial allergic rhinitis, acute and chronic rhinosinusitis, and nasal polyposis, is principally caused by mucosal inflammation. Though effective pharmacotherapy options exist, no agent is universally efficacious; therapeutic decisions must account for individual patient preferences. Oral H1-antihistamines, though effective for the common symptoms of allergic rhinitis, have modest decongestant action, as do leukotriene receptor antagonists. Intranasal antihistamines appear to improve congestion better than oral forms. Topical decongestants reduce congestion associated with allergic rhinitis, but local adverse effects make them unsuitable for long-term use. Oral decongestants show some efficacy against congestion in allergic rhinitis and the common cold, and can be combined with oral antihistamines. Intranasal corticosteroids have broad anti-inflammatory activities, are the most potent long-term pharmacologic treatment of congestion associated with allergic rhinitis, and show some congestion relief in rhinosinusitis and nasal polyposis. Immunotherapy and surgery may be used in some cases refractory to pharmacotherapy. Steps in congestion management include (1 diagnosis of the cause(s, (2 patient education and monitoring, (3 avoidance of environmental triggers where possible, (4 pharmacotherapy, and (5 immunotherapy

  12. Standardized evaluation of lung congestion during COPD exacerbation better identifies patients at risk of dying

    Directory of Open Access Journals (Sweden)

    Høiseth AD

    2013-12-01

    Full Text Available Arne Didrik Høiseth,1 Torbjørn Omland,1 Bo Daniel Karlsson,2 Pål H Brekke,1 Vidar Søyseth11Cardiothoracic Research Group, Division of Medicine, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 2Deptartment of Radiology, Akershus University Hospital, Lørenskog, NorwayBackground: Congestive heart failure is underdiagnosed in patients with chronic obstructive pulmonary disease (COPD. Pulmonary congestion on chest radiograph at admission for acute exacerbation of COPD (AECOPD is associated with an increased risk of mortality. A standardized evaluation of chest radiographs may enhance prognostic accuracy.Purpose: We aimed to evaluate whether a standardized, liberal assessment of pulmonary congestion is superior to the routine assessment in identifying patients at increased risk of long-term mortality, and to investigate the association of heart failure with N-terminal prohormone of brain natriuretic peptide (NT-proBNP concentrations.Material and methods: This was a prospective cohort study of 99 patients admitted for AECOPD. Chest radiographs obtained on admission were routinely evaluated and then later evaluated by blinded investigators using a standardized protocol looking for Kerley B lines, enlarged vessels in the lung apex, perihilar cuffing, peribronchial haze, and interstitial or alveolar edema, defining the presence of pulmonary congestion. Adjusted associations with long-term mortality and NT-proBNP concentration were calculated.Results: The standardized assessment was positive for pulmonary congestion in 32 of the 195 radiographs (16% ruled negative in the routine assessment. The standardized assessment was superior in predicting death during a median follow up of 1.9 years (P=0.022, and in multivariable analysis, only the standardized assessment showed a significant association with mortality (hazard ratio 2.4, 95% confidence interval [CI] 1.2–4.7 (P=0.016 and NT-proBNP (relative

  13. Comparison of clinical results of pharmaceutical and surgical therapy in patients with severe chronic heart failure

    Directory of Open Access Journals (Sweden)

    Kotsoeva О.Т.

    2016-06-01

    Full Text Available The aim of the presented paper is a meta-analysis of clinical studies on the comparative effectiveness of pharmaceutical therapy and surgical treatment such as cardiac resynchronization therapy (CRT, cardiac resynchronization therapy with cardioversion-defibrillation (CRT-D, circulatory support system and heart transplantation in patients with severe chronic heart failure (CHF. Material and Methods. Results of 41 clinical studies (29799 patients with severe CHF were included in a meta-analysis. Data search was conducted in the following databases: Medline, Medscape, Pubmed, and websites dedicated to clinical research (National Institutes of Health, Clinical Center, ClinicalStudyResults.org, ClinicalTrials.gov. Results. As compared with pharmaceutical therapy, surgical treatment of severe CHF is better to reduce fatal risk, incidence of decompensation of CHF, frequency of cardiac arrhythmias, the need to perform or re-perform heart transplantation. It is also shown that CRT better reduced the mortality from progression of heart failure than heart transplantation. Both pharmaceutical therapy and surgical treatment improved functional class of CHF and quality of patients' life, but does not affect the left ventricular ejection fraction. Conclusion. It was found out that there was a number of significant advantages of surgical treatment of severe CHF, compared with pharmaceutical therapy. However, it is still a number of unresolved issues (particularly in relation to heart transplantation on the effectiveness comparing pharmaceutical and surgical therapies of severe CHF

  14. Diagnostic Utility of ANG in Coronary Heart Disease Complicating Chronic Heart Failure: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Peng Yu

    2016-01-01

    Full Text Available Angiogenin (ANG has been shown to be elevated in several cardiovascular diseases. To detect its levels and diagnostic capacity in coronary heart disease (CHD patients complicating chronic heart failure (CHF, we performed this cross-sectional study and enrolled 616 CHD patients and 53 healthy controls. According to complicating CHF or not, the patients were divided into CHF group (n=203 and CHD disease controls (n=413, in which the CHF group was subdivided as heart failure with reduced ejection fraction (HFrEF group or heart failure with preserved ejection fraction (HFpEF group on the basis of left ventricular ejection fraction (LVEF, or as different NYHA class group. Their plasma ANG levels were detected using enzyme-linked immunosorbent assay (ELISA. Plasma ANG was 342.8 (IQR [273.9,432.9], 304.5 (IQR [254.0,370.5], and 279.7 (IQR [214.4,344.0] ng/mL in the CHF group, CHD disease controls, and healthy controls, respectively, significantly higher in the CHF group compared with the others. Furthermore, among CHF group, ANG is dramatically higher in the HFrEF patients compared with the HFpEF patients. As for the diagnostic capacity of ANG, the area under the receiver operating characteristic curve was 0.71 (95% CI 0.63–0.78. We concluded that plasma ANG is elevated in CHD complicating CHF patients and may be a moderate discriminator of CHF from CHD or the healthy.

  15. Diagnostic Utility of ANG in Coronary Heart Disease Complicating Chronic Heart Failure: A Cross-Sectional Study

    Science.gov (United States)

    Liu, Ming; Yang, Xue; Yu, Ying; Zhao, Ji; Zhang, Lei; Tong, Rui; Zou, Yunzeng; Ge, Junbo

    2016-01-01

    Angiogenin (ANG) has been shown to be elevated in several cardiovascular diseases. To detect its levels and diagnostic capacity in coronary heart disease (CHD) patients complicating chronic heart failure (CHF), we performed this cross-sectional study and enrolled 616 CHD patients and 53 healthy controls. According to complicating CHF or not, the patients were divided into CHF group (n = 203) and CHD disease controls (n = 413), in which the CHF group was subdivided as heart failure with reduced ejection fraction (HFrEF) group or heart failure with preserved ejection fraction (HFpEF) group on the basis of left ventricular ejection fraction (LVEF), or as different NYHA class group. Their plasma ANG levels were detected using enzyme-linked immunosorbent assay (ELISA). Plasma ANG was 342.8 (IQR [273.9,432.9]), 304.5 (IQR [254.0,370.5]), and 279.7 (IQR [214.4,344.0]) ng/mL in the CHF group, CHD disease controls, and healthy controls, respectively, significantly higher in the CHF group compared with the others. Furthermore, among CHF group, ANG is dramatically higher in the HFrEF patients compared with the HFpEF patients. As for the diagnostic capacity of ANG, the area under the receiver operating characteristic curve was 0.71 (95% CI 0.63–0.78). We concluded that plasma ANG is elevated in CHD complicating CHF patients and may be a moderate discriminator of CHF from CHD or the healthy. PMID:27872509

  16. Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences A respiração de Cheyne-Stokes em pacientes com insuficiência cardíaca congestiva: causas e conseqüências

    Directory of Open Access Journals (Sweden)

    Geraldo Lorenzi-Filho

    2005-08-01

    Full Text Available Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO2 (PaCO2 that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.A respiração de Cheyne-Stokes é uma forma de respiração periódica na qual apnéias e hipopnéias se alternam com períodos de hiperpnéias que apresentam um padrão crescendo e decrescendo de volume corrente. Esta revisão enfoca as causa e conseqüências da respiração de Cheyne- Stokes em pacientes com insuficiência cardíaca congestiva na qual a prevalência é extremamente alta e varia entre 30 a 50%. Vários fatores foram implicados na gênese da respiração de Cheyne-Stokes, incluindo baixo debito cardíaco e hipoxia recorrente. Hiperventilacão e baixos níveis de CO2 arterial (PaCO2, que quando abaixo do limiar de apnéia desencadeiam apnéia central são os mecanismos fisiopatológicos chave na g

  17. Clinical and morphologic features of acute, subacute and chronic cor pulmonale (pulmonary heart disease).

    Science.gov (United States)

    Roberts, William Clifford; Shafii, Alexis E; Grayburn, Paul A; Ko, Jong Mi; Weissenborn, Matthew R; Rosenblatt, Randall L; Guileyardo, Joseph M

    2015-03-01

    Described are certain clinical and morphologic features of one patient with acute, another with subacute, and one with chronic cor pulmonale. All 3 had evidence of severe pulmonary hypertension. The patient with acute cor pulmonale 4 days after coronary bypass for unstable angina pectoris suddenly developed severe breathlessness with cyanosis and had fatal cardiac arrest and necropsy disclosed massive pulmonary embolism. The patient with subacute cor pulmonale had severe right-sided heart failure for 5 weeks and necropsy disclosed microscopic-sized neoplastic pulmonary emboli from a gastric carcinoma without parenchymal pulmonary metastases. The patient with chronic cor pulmonale had evidence of right-sided heart failure for years, the result of primary or idiopathic pulmonary hypertension almost certainly present from birth because the pattern of elastic fibers in the pulmonary trunk was that seen in newborns where the pressure in the pulmonary trunk and ascending aorta are similar. The patient with chronic cor pulmonale had plexiform pulmonary lesions indicative of irreversible pulmonary hypertension. Neither the acute nor the subacute patient had chronic pulmonary vascular changes. All 3 patients had dilated right ventricular cavities and non-dilated left ventricular cavities and only the patient with chronic cor pulmonale had right ventricular hypertrophy.

  18. Reproducibility of cardiac power output and other cardiopulmonary exercise indices in patients with chronic heart failure.

    Science.gov (United States)

    Jakovljevic, Djordje G; Seferovic, Petar M; Nunan, David; Donovan, Gay; Trenell, Michael I; Grocott-Mason, Richard; Brodie, David A

    2012-02-01

    Cardiac power output is a direct measure of overall cardiac function that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the reproducibility of cardiac power output and other more commonly reported cardiopulmonary exercise variables in patients with chronic heart failure. Metabolic, ventilatory and non-invasive (inert gas re-breathing) central haemodynamic measurements were undertaken at rest and near-maximal exercise of the modified Bruce protocol in 19 patients with stable chronic heart failure. The same procedure was repeated 7 days later to assess reproducibility. Cardiac power output was calculated as the product of cardiac output and mean arterial pressure. Resting central haemodynamic variables demonstrate low CV (coefficient of variation) (ranging from 3.4% for cardiac output and 5.6% for heart rate). The CV for resting metabolic and ventilatory measurements ranged from 8.2% for respiratory exchange ratio and 14.2% for absolute values of oxygen consumption. The CV of anaerobic threshold, peak oxygen consumption, carbon dioxide production and respiratory exchange ratio ranged from 3.8% (for anaerobic threshold) to 6.4% (for relative peak oxygen consumption), with minute ventilation having a CV of 11.1%. Near-maximal exercise cardiac power output and cardiac output had CVs of 4.1 and 2.2%, respectively. Cardiac power output demonstrates good reproducibility suggesting that there is no need for performing more than one cardiopulmonary exercise test. As a direct measure of cardiac function (dysfunction) and an excellent prognostic marker, it is strongly advised in the assessment of patients with chronic heart failure undergoing cardiopulmonary exercise testing.

  19. ANGIOTENSIN CONVERTING ENZYME INHIBITORS IN MANAGEMENT OF PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    S. N. Tereshchenko

    2009-01-01

    Full Text Available The role of ACE inhibitors in modern pharmacotherapy of patients with chronic heart failure (CHF is discussed. The actual usage of these highly effective drugs is underlined taking into account high prevalence and social significance of CHF. Necessity of ACE inhibitors usage is confirmed by pharmacodynamic features of these drugs in CHF. The special attention is given to enalapril, that has the biggest evidence base in treatment of CHF patients.

  20. Prevalence and characteristics of diabetic patients in a chronic heart failure population

    DEFF Research Database (Denmark)

    Kistorp, Caroline; Galatius, Søren; Gustafsson, Finn;

    2005-01-01

    Previously, estimates of the prevalence of diabetes mellitus (DM) in patients with chronic heart failure (CHF) have solely been based on history in retrospective studies. The aim of this study was to investigate the prevalence of DM and glucose abnormalities in patients with CHF in accordance...... with the modern diagnostic criteria of DM. A second aim was to characterize patients with DM with respect to severity of CHF....

  1. Alterations of cardiac and lymphocyte β-adrenoceptors in rat with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    张萍; 韩启德; 张幼怡; 许开明; 田斌; 吕志珍; 郭静萱; 陈明哲

    1997-01-01

    The alterations of cardiac and lymphocyte β-adrenoceptors were observed in the rats with chronic heart failure produced by constriction of both abdominal aorta and renal artery. The results showed that β1-adrenocep-tor density and mRNA levels were increased, whereas these levels remained unchanged for β2 The concentration-contractile response curve for isoproterenol was shifted to the right in cardiac atrium, whereas the concentration-cAMP accumulation response curve for isoproterenol in myocardium was not changed. The number of β-adrenoceptors in blood lymphocyte was markedly reduced. Thus in the heart-failure rats the density of cardiac β-adrenoceptor was increased accompanying reduced β-adrenoceptor-mediated positive inotropic response, suggesting a post adenylate cyclase dys-function or impaired contractile components. In contrast, the alteration of β-adrenoceptor in lymphocyte is consistent with the reduced β-adrenoceptor-mediated inotropic response in heart.

  2. Complexity in caring for an ageing heart failure population: concomitant chronic conditions and age related impairments.

    Science.gov (United States)

    De Geest, Sabina; Steeman, Els; Leventhal, Marcia E; Mahrer-Imhof, Romy; Hengartner-Kopp, Beatrice; Conca, Antoinette; Bernasconi, Arlette T; Petry, Heidi; Brunner-La Rocca, Hanspeter

    2004-12-01

    The complexity of caring for the ageing heart failure (HF) population is further complicated by concomitant chronic conditions (i.e., polypharmacy, depression), age related impairments (i.e., hearing, visual and cognitive impairments, impairments in activities of daily living (ADL/IADL), and other issues (e.g., health illiteracy, lack of social support). This paper provides an overview of these risk factors, outlines how they individually and in interplay endanger favourable outcome by putting patients at risk for poor self-management. Moreover, suggestions are made on how these issues could be addressed and integrated in heart failure management by applying gerontological care principles in caring for the ageing heart failure population.

  3. 心肌梗死致心力衰竭大鼠模型构建方法的改进%Improvement and Assessment of Rat Model of Myocardial Infarction Induced Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    罗经宏; 李玲; 高修仁

    2012-01-01

    [Objective] This study was designed to explore a better method for establishing model of congestive heart failure in rats after myocardial infarction and whether two weeks after coronary artery ligation could establish congestive heart failure. [Methods] Forty male SD rats were randomly divided into two groups:Control group (without coronary artery ligation, re = 10) and heart failure group (n = 30). Rats were anesthetized by intraperitoneal administration of pentobarbital sodium, oral tracheal intubation under direct vision, following left thoracotomy, a large transmural myocardial infarction was induced by suspended the ventricle and then ligated left anterior descending coronary artery at 1 mm from the origin. Echocardiography, hemodynamic measurements, plasma inflammatory cytokines levels, Masson's trichrome staining and collagen volume fraction were detected two weeks post-surgery. [ Results ] Compared with the control group, EF/%(78.05 ± 7.36 vs. 45.69 ± 7.54) was significantly reduced, but LVEDP/mmHg(-3 ± 3 vs. 9 ± 5) was significantly higher in heart failure group (P < 0.05). In addition, the levels of plasma inflammatory cytokines (IL-1β, IL-6, and TNF-α) and CVF were significantly increased (P < 0.05). [Conclusion] Two weeks after myocardial infarction can be successfully constructed the model of heart failure and through the suspended and then ligated methods could improve model success rate obviously.%[目的]探索提高心肌梗死致心力衰竭大鼠模型构建成功率的方法,及心肌梗死后2周能否有效形成心力衰竭的问题.[方法]将40只雄性SD大鼠随机分为对照组(不结扎冠脉,n=10)和心衰模型组(n=30).分别对大鼠实施戊巴比妥钠腹腔注射麻醉、经口腔气管插管、开胸后通过悬吊结扎法准确地结扎冠状动脉左前降支根部.2周后行超声心动图、血流动力学、血浆炎症因子水平和心肌Masson染色及胶原容积分数的测定.[结果]与对照

  4. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2011-01-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  5. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2014-07-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  6. Improving medication adherence of patients with chronic heart failure: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Shah D

    2015-07-01

    Full Text Available Deval Shah,1 Kim Simms,2 Debra J Barksdale,3 Jia-Rong Wu3 1Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, 2Duke University Hospital, Durham, 3School of Nursing, University of North Carolina, Chapel Hill, NC, USA Abstract: Heart failure is a chronic debilitating illness that affects 5.7 million Americans. The financial burden of heart failure in the US toppled $31 billion in 2012, which is one of the highest among all chronic medical conditions. Medication adherence is a major component of heart failure self-care behaviors. Therefore, medication non-adherence is associated with more emergency department visits, frequent rehospitalizations, and higher medical cost. Medication adherence rates have varied from 10% to 98% depending on the definition and measurement used to assess and analyze adherence. Many factors contribute to medication non-adherence such as lack of support, finances, absent of symptoms, cognitive decline, adverse reactions, depression, poor attention span, poor knowledge about medication, multiple medications, difficulty swallowing large pills, and inconveniences of urinary frequency with diuretics. Researchers have explored various strategies such as the use of pharmacists, nurses, telemedicine, and interdisciplinary teams to provide interventions to improve medication adherence in heart failure. Health care providers should continue to provide education, constantly reinforce the importance of taking medication as prescribed, and when feasible, utilize one of the successful evidence-based strategies to increase adherence. Keywords: pharmacy, tele-health, interdisciplinary, registered nurse, interventions

  7. [New markers of progression of chronic heart failure in patients with myocardial infarction, type 2 diabetes and obesity].

    Science.gov (United States)

    Kravchun, P P; Kadykova, O I; Gabisonia, T N

    2015-01-01

    Currently identified a large number of biomarkers that are closely linked with the development of chronic heart failure, some of which are clusterin and fractalkine. Accordingly, the purpose of our study was - to evaluate the role of clusterin and fractalkine in progression of chronic heart failure in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity. We investigated 71 patients with postinfarction cardiosclerosis, type 2 diabetes and obesity. All patients with postinfarction cardiosclerosis, diabetes and obesity were divided into groups according to the functional class of chronic heart failure (CHF). It was found that an increase the level of fractalkine and reduced clusterin leads due to the development of systolic dysfunction and heart failure progression in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity. Fractalkine and clusterin play an important role in progression of the heart failure in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity, and this gives them the right to be considered indicators of the severity of CHF.

  8. Differential effects of chronic cyanide intoxication on heart, lung and pancreatic tissues.

    Science.gov (United States)

    Okolie, N P; Osagie, A U

    2000-06-01

    The histotoxic effects of chronic cyanide insult on heart, lung and pancreatic tissues, and some corroborative enzyme and metabolite changes were studied in New Zealand White rabbits using colorimetric, enzymatic and histochemical methods. Two groups of rabbits were fed for 10 months on either pure growers mash or grower mash +702 ppm inorganic cyanide. There were no significant differences in time-course profiles of serum amylase and fasting blood glucose between the cyanide-fed group and control. Pancreatic islet and heart histologies showed no pathological changes, and there were no significant differences in both serum and heart aspartate transaminase activities between the two groups. However, there were significant decreases (Pactivity in the lungs of the cyanide-fed group, with corresponding significant (Pactivity of the enzyme. Histological examination of lung tissue of the cyanide-treated rabbits revealed focal areas of pulmonary oedema and necrosis. These results suggest the existence of variabilities in tissue susceptibilities to the toxic effect of chronic cyanide exposure. It would appear that chronic cyanide exposure may not predispose to diabetes in the presence of adequate protein intake.

  9. Strength improvement of knee extensor muscles in patients with chronic heart failure by neuromuscular electrical stimulation.

    Science.gov (United States)

    Quittan, M; Sochor, A; Wiesinger, G F; Kollmitzer, J; Sturm, B; Pacher, R; Mayr, W

    1999-05-01

    Patients with severe chronic heart failure (CHF) suffer from marked weakness of skeletal muscles. Neuromuscular electrical stimulation (NMES) proved to be an alternative to active strength training. The objective of this study was to test the feasibility and effectiveness of NMES in patients with chronic heart failure. Seven patients (56.0 +/- 5.0 years, CHF for 20 +/- 4 months, left ventricular ejection fraction 20.1 +/- 10.0%) finished an 8 week course of NMES of the knee extensor muscles. The stimulator delivered biphasic, symmetric, constant voltage impulses of 0.7 ms pulse width with a frequency of 50 Hz, 2 s on and 6 s off. No adverse effects occurred. After the stimulation period, the isokinetic peak torque of the knee extensor muscles increased by 13% from 101.0 +/- 8.7 Nm to 113.5 +/- 7.2 Nm (p = 0.004). The maximal isometric strength increased by 20% from 294.3 +/- 19.6 N to 354.14 +/- 15.7 N (p = 0.04). This increased muscle strength could be maintained in a 20 min fatigue test indicating decreased muscle fatigue. These results demonstrate that NMES of skeletal muscles in patients with severe chronic heart failure is a promising method for strength training in this group of patients.

  10. Characterization of exercise limitations by evaluating individual cardiac output patterns : A prospective cohort study in patients with chronic heart failure

    NARCIS (Netherlands)

    Spee, Ruud F.; Niemeijer, Victor M.; Wessels, Bart; Jansen, Jasper P.; Wijn, Pieter F F; Doevendans, Pieter A F M; Kemps, Hareld M C

    2015-01-01

    Background: Patients with chronic heart failure (CHF) suffer from exercise intolerance due to impaired central hemodynamics and subsequent alterations in peripheral skeletal muscle function and structure. The relative contribution of central versus peripheral factors in the reduced exercise capacity

  11. Results of a non-specific immunomodulation therapy on chronic heart failure (ACCLAIM trial): a placebo-controlled randomised trial

    DEFF Research Database (Denmark)

    Torre-Amione, G.; Anker, S.D.; Bourge, R.C.;

    2008-01-01

    Background Evidence suggests that inflammatory mediators contribute to development and progression of chronic heart failure. We therefore tested the hypothesis that immunomodulation might counteract this pathophysiological mechanism in patients. Methods We did a double-blind, placebo-controlled s...

  12. Effects of perindopril on expression of kidney aquaporin-2 and urine aquaporin-2 excretion in chronic heart failure rats

    Institute of Scientific and Technical Information of China (English)

    欧阳邵

    2013-01-01

    Objective To determine the expression of kidneyaquaporin-2(AQP2) and urine AQP2 excretion in chronic heart failure(CHF) rats and investigate effects of perindopril on the expression and excretion of AQP2.Methods

  13. Efficacy and safety of ivabradine as an add-on to atenolol in patients with chronic stable ischemic heart disease

    Directory of Open Access Journals (Sweden)

    Elavarasi Pichai

    2016-12-01

    Conclusions: Ivabradine is safe and effective in preventing and treating further anginal attacks in patients with chronic stable ischemic heart disease already on atenolol therapy. [Int J Basic Clin Pharmacol 2016; 5(6.000: 2546-2551

  14. Concurrent neutral endopeptidase and ACE inhibition in experimental heart failure: renal and hormonal effects

    DEFF Research Database (Denmark)

    Helin, K

    1993-01-01

    Neutral endopeptidase (NEP) inhibitors have been shown to strengthen the effects of endogenous atrial natriuretic peptide (ANP). It has been well documented that angiotensin I-converting enzyme (ACE) inhibitors act beneficially in chronic congestive heart failure (CHF). In the present study, renal...

  15. Assessment of cardiac sympathetic nerve activity in children with chronic heart failure using quantitative iodine-123 metaiodobenzylguanidine imaging

    Energy Technology Data Exchange (ETDEWEB)

    Karasawa, Kensuke; Ayusawa, Mamoru; Noto, Nobutaka; Sumitomo, Naokata; Okada, Tomoo; Harada, Kensuke [Nihon Univ., Tokyo (Japan). School of Medicine

    2000-12-01

    Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5{+-}6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease. Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR). The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33{+-}0.22 in chronic heart failure class I, 2.50{+-}0.34 in class II, 1.95{+-}0.61 in class III, and 1.39{+-}0.29 in class IV (p<0.05). %WR was 24.8{+-}12.8% in chronic heart failure class I, 23.3{+-}10.2% in class II, 49.2{+-}24.5% in class III, and 66.3{+-}26.5% in class IV (p<0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure. Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure. (author)

  16. Physiological parameters during the initial stages of cardiopulmonary exercise testing in patients with chronic heart failure - Their value in the assessment of clinical severity and prognosis

    NARCIS (Netherlands)

    de Vries, RJM; van Veldhuisen, DJ; Dunselman, PHJM; van der Veer, N; Crijns, HJGM

    1997-01-01

    Aims To analyse the relationship between initial exercise parameters and peak oxygen consumption and prognosis in 96 patients with congestive heart failure. Methods and Results Comparison of responses during the initial 6 min of cardiopulmonary exercise testing (Naughton modified protocol) in patien

  17. Effects of a 14-month low-cost maintenance training program in patients with chronic systolic heart failure

    DEFF Research Database (Denmark)

    Prescott, Eva; Hjardem-Hansen, Rasmus; Ørkild, Bodil;

    2009-01-01

    Exercise training is known to be beneficial in chronic heart failure (CHF) patients but there is a lack of studies following patient groups for longer duration with maintenance training programs to defer deconditioning.......Exercise training is known to be beneficial in chronic heart failure (CHF) patients but there is a lack of studies following patient groups for longer duration with maintenance training programs to defer deconditioning....

  18. 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.

  19. Resting heart rate is a risk factor for mortality in chronic obstructive pulmonary disease, but not for exacerbations or pneumonia

    NARCIS (Netherlands)

    Warnier, Miriam J.; Rutten, Frans H.; De Boer, Anthonius; Hoes, Arno W.; De Bruin, Marie L.

    2014-01-01

    Background: Although it is known that patients with chronic obstructive pulmonary disease (COPD) generally do have an increased heart rate, the effects on both mortality and non-fatal pulmonary complications are unclear. We assessed whether heart rate is associated with all-cause mortality, and non-

  20. The effect of chronic heart failure and type 2 diabetes on insulin-stimulated endothelial function is similar and additive

    DEFF Research Database (Denmark)

    Falskov, Britt; Hermann, Thomas Steffen; Rask-Madsen, Christian;

    2011-01-01

    AIM: Chronic heart failure is associated with endothelial dysfunction and insulin resistance. The aim of this investigation was to study insulin-stimulated endothelial function and glucose uptake in skeletal muscles in patients with heart failure in comparison to patients with type 2 diabetes. ME...