601
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Hrynchyshyn N, Jourdain P, Desnos M, Diebold B, Funck F. Galectin-3: a new biomarker for the diagnosis, analysis and prognosis of acute and chronic heart failure. Arch Cardiovasc Dis 2013; 106:541-6. [PMID: 24090952 DOI: 10.1016/j.acvd.2013.06.054] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 06/23/2013] [Accepted: 06/24/2013] [Indexed: 11/15/2022]
Abstract
Heart failure constitutes an important medical, social and economic problem. The prevalence of heart failure is estimated as 2-3% of the adult population and increases with age, despite the scientific progress of the past decade, especially the emergence of natriuretic peptides, which have been widely used as reliable markers for diagnostic and prognostic evaluation. Identification of new reliable markers for diagnosis, analysis, prognosis of mortality and prevention of hospitalization is still necessary. Galectin-3 is a soluble β-galactoside-binding protein secreted by activated macrophages. Its main action is to bind to and activate the fibroblasts that form collagen and scar tissue, leading to progressive cardiac fibrosis. Numerous experimental studies have shown the important role of galectin-3 in cardiac remodelling due to fibrosis, independent of the fibrosis aetiology. Galectin-3 is significantly increased in chronic heart failure (acute or non-acute onset), independent of aetiology. Some clinical studies have confirmed the predictive value of galectin-3 in all-cause mortality in patients with heart failure. In our review, we aim to analyse the role of galectin-3 in the development of heart failure, its value in screening and clinical decision making and its possible predictive application in follow-up as a "routine" test in an addition to established biomarkers, such as B-type natriuretic peptide and N-terminal prohormone of B-type natriuretic peptide.
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Affiliation(s)
- Nataliya Hrynchyshyn
- Heart Failure Unit, Cardiology Department, Rene-Dubos Hospital, 6, avenue de l'Île-de-France, 95303 Pontoise, France
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602
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Mohammadzadeh N, Safdari R, Rahimi A. Multi-agent system as a new approach to effective chronic heart failure management: key considerations. Healthc Inform Res 2013; 19:162-6. [PMID: 24195010 PMCID: PMC3810523 DOI: 10.4258/hir.2013.19.3.162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/22/2013] [Accepted: 09/24/2013] [Indexed: 11/23/2022] Open
Abstract
Objectives Given the importance of the follow-up of chronic heart failure (CHF) patients to reduce common causes of re-admission and deterioration of their status that lead to imposing spiritual and physical costs on patients and society, modern technology tools should be used to the best advantage. The aim of this article is to explain key points which should be considered in designing an appropriate multi-agent system to improve CHF management. Methods In this literature review articles were searched with keywords like multi-agent system, heart failure, chronic disease management in Science Direct, Google Scholar and PubMed databases without regard to the year of publications. Results Agents are an innovation in the field of artificial intelligence. Because agents are capable of solving complex and dynamic health problems, to take full advantage of e-Health, the healthcare system must take steps to make use of this technology. Key factors in CHF management through a multi-agent system approach must be considered such as organization, confidentiality in general aspects and design and architecture points in specific aspects. Conclusions Note that use of agent systems only with a technical view is associated with many problems. Hence, in delivering healthcare to CHF patients, considering social and human aspects is essential. It is obvious that identifying and resolving technical and non-technical challenges is vital in the successful implementation of this technology.
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Affiliation(s)
- Niloofar Mohammadzadeh
- Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
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603
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Affiliation(s)
- Maurice B Bizino
- Department of Radiology, Leiden University Medical Center, , Leiden, The Netherlands
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604
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Esmaeilzadeh M, Nikparvar M, Maleki M, Noohi F, Ojaghi Haghighi Z, Samiei N, Nakhostin-Davari P, Bakhshandeh H. Assessment of Inter and Intra-atrial Asynchrony in Patients with Systolic Heart Failure Using Velocity Vector Imaging. Res Cardiovasc Med 2013; 2:114-20. [PMID: 25478506 PMCID: PMC4253771 DOI: 10.5812/cardiovascmed.10332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 05/04/2013] [Accepted: 05/06/2013] [Indexed: 11/27/2022] Open
Abstract
Background: According to previous studies on the deformation properties of the left atrium, the systolic strain and strain rates represent the atrial reservoir function and the early and late diastolic strain rates show the conduit and booster functions, respectively. Objectives: We sought to evaluate the intra and interatrial asynchrony using strain/strain rate imaging in systolic heart failure patients. Patients and Methods: Twenty five patients with systolic heart failure (LVEF ≤ 40%) were enrolled into the study. Asynchrony quantifications were performed according to the standard deviation of time-to peak (TP-SD) of deformation of three segments manually located along the perimeter of the left atrium free wall, right atrium free wall and interatrial septum, as imaged in an apical four-chamber view. We also calculated classic echocardiography parameters such as LV end-diastolic dimension index, LA volume index, RA area, as well as deceleration time (DT) on transmitral pulsed wave Doppler and E/E’ ratio on mitral annular tissue Doppler imaging. Results: In heart failure patients either inter or intra-atrial asynchrony were far more common in comparison with normal subjects (P=0.008 and P=0.007 respectively). Conclusions: Left ventricular systolic heart failure, may result in inter and intra-atrial asynchrony even in clinically stable patients without significant pulmonary hypertension and diastolic dysfunction.
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Affiliation(s)
- Maryam Esmaeilzadeh
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Marzieh Nikparvar
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran
- Corresponding author: Marzieh Nikparvar, Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran. Tel: +98-9171630209, E-mail:
| | - Majid Maleki
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Feridoun Noohi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Zahra Ojaghi Haghighi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Niloufar Samiei
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Paridokht Nakhostin-Davari
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
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605
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Payvar S, Spertus JA, Miller AB, Casscells SW, Pang PS, Zannad F, Swedberg K, Maggioni AP, Reid KJ, Gheorghiade M. Association of low body temperature and poor outcomes in patients admitted with worsening heart failure: a substudy of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial. Eur J Heart Fail 2013; 15:1382-9. [PMID: 23858000 DOI: 10.1093/eurjhf/hft113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Risk stratification in patients admitted with worsening heart failure (HF) is essential for tailoring therapy and counselling. Risk models are available but rarely used, in part because many require laboratory and imaging results that are not routinely available. Body temperature is associated with prognosis in other illnesses, and we hypothesized that low body temperature would be associated with worse outcomes in patients admitted with worsening HF. METHODS AND RESULTS The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial was an event-driven, randomized, double-blind, placebo-controlled study of tolvaptan in 4133 patients hospitalized for worsening HF with an EF <40%. Co-primary endpoints were all-cause mortality and cardiovascular (CV) death or HF rehospitalization. Body temperature was measured orally at randomization and entered in analyses both as a continuous variable and categorized into three groups (<36 °C, 36-36.5 °C, and >36.5 °C) using Cox regression models. The composite of CV death or HF rehospitalization occurred in 1544 patients within 1 year. For every 1 °C decrease in body temperature, the risk of adverse outcomes increased by 16% [hazard raio (HR) 1.16, 95% confidence interval (CI) 1.04-1.28], after adjustment for age, gender, race, systolic blood pressure, EF, blood urea nitrogen, and serum sodium. In fully adjusted analysis, the risk of adverse outcomes in the lowest body temperature group (<36 °C) was 51% higher than that of the index group (>36.5 °C) (HR 1.35, 95% CI 1.15-1.58). CONCLUSIONS Low body temperature is an independent marker of poor cardiovascular outcomes in patients admitted with worsening HF and reduced EF.
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Affiliation(s)
- Saeed Payvar
- University of Florida College of Medicine, Jacksonville, FL, USA
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606
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Krishnamurthy A, Villongco CT, Chuang J, Frank LR, Nigam V, Belezzuoli E, Stark P, Krummen DE, Narayan S, Omens JH, McCulloch AD, Kerckhoffs RCP. Patient-Specific Models of Cardiac Biomechanics. J Comput Phys 2013; 244:4-21. [PMID: 23729839 PMCID: PMC3667962 DOI: 10.1016/j.jcp.2012.09.015] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Patient-specific models of cardiac function have the potential to improve diagnosis and management of heart disease by integrating medical images with heterogeneous clinical measurements subject to constraints imposed by physical first principles and prior experimental knowledge. We describe new methods for creating three-dimensional patient-specific models of ventricular biomechanics in the failing heart. Three-dimensional bi-ventricular geometry is segmented from cardiac CT images at end-diastole from patients with heart failure. Human myofiber and sheet architecture is modeled using eigenvectors computed from diffusion tensor MR images from an isolated, fixed human organ-donor heart and transformed to the patient-specific geometric model using large deformation diffeomorphic mapping. Semi-automated methods were developed for optimizing the passive material properties while simultaneously computing the unloaded reference geometry of the ventricles for stress analysis. Material properties of active cardiac muscle contraction were optimized to match ventricular pressures measured by cardiac catheterization, and parameters of a lumped-parameter closed-loop model of the circulation were estimated with a circulatory adaptation algorithm making use of information derived from echocardiography. These components were then integrated to create a multi-scale model of the patient-specific heart. These methods were tested in five heart failure patients from the San Diego Veteran's Affairs Medical Center who gave informed consent. The simulation results showed good agreement with measured echocardiographic and global functional parameters such as ejection fraction and peak cavity pressures.
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Affiliation(s)
| | | | - Joyce Chuang
- Department of Bioengineering, University of California, San Diego
| | - Lawrence R Frank
- Department of Radiology, University of California, San Diego
- Veteran’s Affairs Medical Center, San Diego
| | - Vishal Nigam
- Department of Pediatrics, University of California, San Diego
- Veteran’s Affairs Medical Center, San Diego
| | - Ernest Belezzuoli
- Department of Radiology, University of California, San Diego
- Veteran’s Affairs Medical Center, San Diego
| | - Paul Stark
- Department of Radiology, University of California, San Diego
- Veteran’s Affairs Medical Center, San Diego
| | - David E Krummen
- Department of Medicine (Cardiology), University of California, San Diego
- Veteran’s Affairs Medical Center, San Diego
| | - Sanjiv Narayan
- Department of Medicine (Cardiology), University of California, San Diego
- Veteran’s Affairs Medical Center, San Diego
| | - Jeffrey H. Omens
- Department of Bioengineering, University of California, San Diego
- Department of Medicine (Cardiology), University of California, San Diego
- Cardiac Biomedical Science and Engineering Center, University of California, San Diego
| | - Andrew D McCulloch
- Department of Bioengineering, University of California, San Diego
- Department of Medicine (Cardiology), University of California, San Diego
- Cardiac Biomedical Science and Engineering Center, University of California, San Diego
| | - Roy CP Kerckhoffs
- Department of Bioengineering, University of California, San Diego
- Cardiac Biomedical Science and Engineering Center, University of California, San Diego
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607
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Kim HS, No CW, Goo SH, Cha TJ. An Angiotensin receptor blocker prevents arrhythmogenic left atrial remodeling in a rat post myocardial infarction induced heart failure model. J Korean Med Sci 2013; 28:700-8. [PMID: 23678261 PMCID: PMC3653082 DOI: 10.3346/jkms.2013.28.5.700] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 04/01/2013] [Indexed: 12/19/2022] Open
Abstract
This study investigated the role of angiotensin II receptor blocker in atrial remodeling in rats with atrial fibrillation (AF) induced by a myocardial infarction (MI). MIs were induced by a ligation of the left anterior descending coronary artery. Two days after, the rats in the losartan group were given losartan (10 mg/kg/day for 10 weeks). Ten weeks later, echocardiography and AF induction studies were conducted. Ejection fraction was significantly lower in the MI rats. Fibrosis analysis revealed much increased left atrial fibrosis in the MI group than sham (2.22 ± 0.66% vs 0.25 ± 0.08%, P = 0.001) and suppression in the losartan group (0.90 ± 0.27%, P 0.001) compared with the MI group. AF inducibility was higher in the MI group than sham (39.4 ± 43.0% vs 2.0 ± 6.3%, P = 0.005) and significantly lower in losartan group (12.0 ± 31.6%, P = 0.029) compared with the MI. The left atrial endothelial nitric oxide synthase (NOS) and sarco/endoplasmic reticulum Ca(2+)-ATPase levels were lower in the MI group and higher in the losartan group significantly. The atrial inducible NOS and sodium-calcium exchanger levels were higher in the MI and lower in the losartan group significantly. Losartan disrupts collagen fiber formation and prevents the alteration of the tissue eNOS and iNOS levels, which prevent subsequent AF induction.
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Affiliation(s)
- Hyun-Su Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Chi-Wan No
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Sang-Ho Goo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Tae-Joon Cha
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
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608
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Nappi JM. A retrospective evaluation of the efficacy of intravenous bumetanide and comparison of potency with furosemide. Pharm Pract (Granada) 2013; 11:44-50. [PMID: 24155849 PMCID: PMC3780504 DOI: 10.4321/s1886-36552013000100008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 02/09/2013] [Indexed: 12/03/2022] Open
Abstract
Background The potency of intravenous bumetanide to furosemide using a ratio of 1:40 has been suggested; however, there are little data supporting this ratio. Recent drug shortages required the use of bumetanide in a large patient population, enabling further characterization of the efficacy of IV bumetanide. Objective The primary objective of this study was to estimate a dose-response effect of IV bumetanide on urine output (UOP) in all patients that received 48 hours of therapy as well as in a subgroup of patients with heart failure (HF). This subgroup was used to compare the potency of bumetanide with furosemide. A secondary safety objective described electrolyte replacement required during therapy. Methods This was a single-center retrospective study examining the dose-response effect of IV bumetanide in patients receiving at least 48 hours of intermittent (iIV) or continuous (cIV) dosing, measured by UOP per mg of drug received (mL/mg). The potency of IV bumetanide was compared with furosemide in a subset of patients with HF using pre-existing data. The safety of IV bumetanide was analyzed by quantifying electrolyte replacement received during the study period. Results The primary outcome was higher in the iIV group (n=93) at 1273 ± 844 mL/mg compared with the cIV group (n=16) at 749 ± 370 mL/mg (P=0.002). Among patients with HF who received furosemide (iIV n=30, cIV n=26) or bumetanide (iIV n=30, cIV n=3), a potency ratio of 41:1 was found for the iIV group and 34:1 for all patients with HF. There was no significant difference in electrolyte replacement between groups. Conclusions A greater response was seen with intermittent bumetanide compared with continuous infusion bumetanide. This study supports the 40:1 dose equivalence ratio (furosemide:bumetanide) in patients with HF receiving at least 48 hours of intravenous intermittent bumetanide.
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Affiliation(s)
- Jean M Nappi
- South Carolina College of Pharmacy, Medical University of South Carolina Campus. Charleston, SC (United States)
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609
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Demir S, Tufenk M, Karakaya Z, Akilli R, Kanadas M. The treatment of heart failure-related symptoms with ivabradine in a case with peripartum cardiomyopathy. Int Cardiovasc Res J 2013; 7:33-6. [PMID: 24757617 PMCID: PMC3987426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 01/03/2013] [Accepted: 02/02/2013] [Indexed: 11/30/2022] Open
Abstract
Peripartum cardiomyopathy is a form of dilated cardiomyopathy that is defined as deterioration in cardiac function presenting typically between the last month of pregnancy and up to five months postpartum. As with other forms of dilated cardiomyopathy, PPCM involves systolic dysfunction of the heart with a decrease of the left ventricular ejection fraction with associated congestive heart failure. In heart failure sinus tachycardia is a poor prognostic factor and the common symptom. In this paper, we presented a case treated with ivabradine which provided additional benefit in patient with acute heart failure.
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Affiliation(s)
- Serafettin Demir
- Department of Cardiology, Adana State Hospital, Adana, Turkey,Corresponding author: Serafettin Demir, Adana State Hospital, Department of Cardiology, Karata Street, 01270, Adana, Turkey. Tel/fax: +90-5336271991, E-mail:
| | - Mucahit Tufenk
- Department of Cardiology, Kiziltepe State Hospital, Mardin, Turkey
| | - Zeynep Karakaya
- Department of Emergency Medicine, Adana State Hospital, Adana, Turkey
| | - Rabia Akilli
- Department of Cardiology, School of Medicine, Cukurova University, Adana, Turkey
| | - Mehmet Kanadas
- Department of Cardiology, School of Medicine, Cukurova University, Adana, Turkey
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610
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Morani G, Gasparini M, Zanon F, Casali E, Spotti A, Reggiani A, Bertaglia E, Solimene F, Molon G, Accogli M, Tommasi C, Paoletti Perini A, Ciardiello C, Padeletti L. Cardiac resynchronization therapy-defibrillator improves long-term survival compared with cardiac resynchronization therapy-pacemaker in patients with a class IA indication for cardiac resynchronization therapy: data from the Contak Italian Registry. Europace 2013; 15:1273-9. [PMID: 23439866 DOI: 10.1093/europace/eut032] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS In candidates for cardiac resynchronization therapy (CRT), the choice between pacemaker (CRT-P) and defibrillator (CRT-D) implantation is still debated. We compared the long-term prognosis of patients who received CRT-D or CRT-P according to class IA recommendations of the European Society of Cardiology (ESC) and who were enrolled in a multicentre prospective registry. METHODS AND RESULTS A total of 620 heart failure patients underwent successful implantation of a CRT device and were enrolled in the Contak Italian Registry. This analysis included 266 patients who received a CRT-D and 108 who received a CRT-P according to class IA ESC indications. Their survival status was verified after a median follow-up of 55 months. During follow-up, 73 CRT-D and 44 CRT-P patients died (rate 6.6 vs. 10.4%/year; log-rank test, P = 0.020). Patients receiving CRT-P were predominantly older, female, had no history of life-threatening ventricular arrhythmias, and more frequently presented non-ischaemic aetiology of heart failure, longer QRS durations, and worse renal function. However, the only independent predictor of death from any cause was the use of CRT-P (hazard ratio, 1.97; 95% confidence interval, 1.21-3.16; P = 0.007). CONCLUSION The implantation of CRT-D, rather than CRT-P, may be preferable in patients presenting with current class IA ESC indications for CRT. Indeed, CRT-D resulted in greater long-term survival and was independently associated with a better prognosis.
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611
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Abstract
Hyperuricaemia is common in subjects with cardiovascular disease, but is not commonly considered a true risk factor. Recent studies suggest that uric acid is biologically active and can stimulate oxidative stress, endothelial dysfunction, inflammation and vasoconstriction. Epidemiological studies have found that uric acid can independently predict the development of hypertension, as well as stroke and heart failure. Experimentally raising uric acid in animals increases blood pressure, and pilot studies suggest that lowering uric acid in humans can reduce blood pressure in hypertensive individuals. Uric acid may also have emerging roles in the pathogenesis of kidney disease, metabolic syndrome and diabetes. More studies need to be performed on the pathophysiology and clinical consequences of hyperuricaemia in cardiovascular disease.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Medeniyet University School of Medicine, Kadikoy, Istanbul, Turkey.
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612
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Matthias AT, Ekanayaka R. Precipitant profile of acute heart failure: experience of a tertiary level cardiac centre in Sri Lanka. Heart Asia 2013; 5:86-91. [PMID: 27326091 DOI: 10.1136/heartasia-2013-010250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/16/2013] [Accepted: 05/05/2013] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a common cause of hospitalisation in most countries. Data on acute precipitants of HF and hospitalisation is not available in Sri Lanka. BACKGROUND AND METHODS A prospective study of 100 sequential admissions with HF to the cardiology unit (National Hospital of Sri Lanka) to describe the precipitants and clinical outcome of HF. RESULTS Fifty-eight male and 42 female admissions were studied. Mean age was 60.66 years. Mean hospital stay was 5.5(SD 4.6) days. Sixty had de novo HF and 40 had pre-existing HF. The most common identifiable precipitants were acute ischaemia 37 (37%), anaemia 41 (41%), respiratory tract infection 10 (10%), arrhythmia 11 (11%), worsening renal function 11 (11%) and alcohol 5 (5.7%). Non-adherence to medication 4 (4.6%), smoking 3 (3.9%), exposure to environmental stress 3 (3.4%) and uncontrolled hypertension 1 (1%) were also observed as precipitants. The most common arrhythmia was atrial fibrillation. Out of 34 patients in whom angiotensin-converting enzyme inhibitors or angiotensin-converting enzyme receptor blockers were indicated, 11% were not on the drug. Among 29 patients in whom spironolactone was indicated, seven patients were not on the drug. CONCLUSIONS Most precipitating factors of HF are preventable. Early identification and prevention of anaemia, preventing respiratory tract infection by vaccination, aggressive revascularisation for patients with ischaemia, monitoring of renal functions, and patient education regarding drug and diet compliance, would reduce the number of admissions.
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Affiliation(s)
| | - Ruvan Ekanayaka
- Cardiology Unit , National Hospital of Sri Lanka , Colombo , Sri Lanka
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613
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Dubey L, Sharma SK, Chaurasia AK. Clinical profile of patients hospitalized with heart failure in Bharatpur, Nepal. J Cardiovasc Thorac Res 2012; 4:103-5. [PMID: 24250996 DOI: 10.5681/jcvtr.2012.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 10/20/2012] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Heart failure (HF) is a common cardiovascular condition whose incidence and prevalence are increasing. Being a common reason for urgent hospital admission, it is a major cause of morbidity and mortality for the patients. In the developed countries coronary artery disease remains the leading cause of HF, whereas, in the underdeveloped countries, rheumatic heart disease leading to valvular lesion still remains the commonest causes of HF admission.The current study was designed to evaluate the clinical profile and medications prescribed reflecting the extent to which evidence based medicine is being practiced at our community. METHODS Clinical profile and prescribed medications of patients with diagnosis of HF who were admitted in the cardiology department of College of Medical Sciences & Teaching Hospital (CMS-TH), Bharatpur, Nepal, April 2010 to May 2012, were analyzed. A total of 255 patients presented with HF during the studied period were included. RESULTS Coronary artery disease, rheumatic heart disease, dilated cardiomyopathy, hypertensive heart failure, cor-pulmonale, and congenital heart disease leading to HF were found in 93 (36.5%), 65 (25.5%), 37 (14.5%), 22 (8.6%), 31 (12.2%),and 7 (2.7%) patients respectively. The commonest presenting symptom was shortness of breath (81%) and the commonest sign was bilateral basal crepitations (68%). From all patients, 89%, 64%, 51%, 16%, 48%, and 32% received loop diuretics, angiotensin-converting enzyme inhibitor, digoxin, angiotensin receptor blocker, spironolactone, and beta-blocking agents respectively. CONCLUSION Coronary artery disease leading to HF was the commonest cause of HF admission in our centre. Despite current guidelines suggesting the use of beta-blocking agent in patients with HF, only 32% of our patients received this class of medications. Thus, many patients were not being managed fully in accordance with the evidence-based guidelines.
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Affiliation(s)
- Laxman Dubey
- Department of Cardiology, College of Medical Sciences & Teaching Hospital, Bharatpur, Chitwan, Nepal
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614
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Shin JH, Kim SH, Park J, Lim YH, Park HC, Choi SI, Shin J, Kim KS, Kim SG, Hong MK, Lee JU. Unilateral pulmonary edema: a rare initial presentation of cardiogenic shock due to acute myocardial infarction. J Korean Med Sci 2012; 27:211-4. [PMID: 22323871 PMCID: PMC3271297 DOI: 10.3346/jkms.2012.27.2.211] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 11/01/2011] [Indexed: 12/15/2022] Open
Abstract
Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
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Affiliation(s)
- Jeong Hun Shin
- Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea
| | - Seok Hwan Kim
- Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea
| | - Jinkyu Park
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea
| | - Young-Hyo Lim
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea
| | - Hwan-Cheol Park
- Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea
| | - Sung Il Choi
- Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea
| | - Jinho Shin
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea
| | - Kyung-Soo Kim
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea
| | - Soon-Gil Kim
- Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea
| | - Mun K. Hong
- Division of Cardiology, St. Luke's Roosevelt Hospital, New York, NY, USA
| | - Jae Ung Lee
- Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea
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615
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Yuyun MF, Jutla SK, Quinn PA, Ng LL. Aldosterone predicts major adverse cardiovascular events in patients with acute myocardial infarction. Heart Asia 2012; 4:102-7. [PMID: 27326041 DOI: 10.1136/heartasia-2012-010129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Aldosterone is associated with increased mortality in chronic heart failure patients and correlates with adverse outcomes after an acute myocardial infarction (AMI) in smaller cohorts. We evaluated the prognostic significance of plasma aldosterone in a large cohort of post-AMI patients in relation to major adverse cardiovascular events (MACE). DESIGN A prospective cohort study. SETTING University Hospitals of Leicester, UK. PATIENTS Consecutive 955 patients admitted with AMI. Plasma aldosterone levels were measured in these patients. MAIN OUTCOME MEASURES During the 2 years follow-up, MACE which was a composite of all-cause mortality, myocardial reinfarction, and hospitalisation for heart failure as well as secondary endpoints (all-cause mortality and a combination of all-cause mortality and hospitalisation for heart failure), were ascertained. RESULTS MACE occured in N=261, 27.3%, all-cause mortality (N=114, 11.9%) and a combination of all-cause mortality and hospitalisation for heart failure (N=176, 18.4%). Patients with MACE had significantly higher median levels of aldosterone than those without (1150.1 vs 950.4 pmol/l, p=0.0118). The multivariate adjusted HR (95% CI) for log aldosterone on MACE was 1.26 (1.01 to 1.56), p=0.041; all-cause mortality 1.60 (1.13 to 2.27), p=0.008; and combination of all-cause mortality and heart failure 1.50 (1.14 to 1.97), p=0.003. CONCLUSIONS The prognostic significance of aldosterone for a variety of endpoints in this large cohort of post-AMI patients is not new and adds to the findings by others. The magnitude of the increase in aldosterone secretion post infarction is higher than previously believed.
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Affiliation(s)
- Matthew Fomonyuy Yuyun
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Sandeep K Jutla
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Paulene A Quinn
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
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616
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Zeighami Mohammadi S, Shahparian M, Fahidy F, Fallah E. Sexual dysfunction in males with systolic heart failure and associated factors. ARYA Atheroscler 2012; 8:63-9. [PMID: 23056105 PMCID: PMC3463996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 06/07/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is the inability to achieve or maintain the adequate erection for intercourse. Heart failure is a major risk factor for erectile dysfunction. The aim of this study was to investigate the prevalence and factors associated with erectile dysfunction in systolic heart failure. METHODS In a cross-sectional study 100 male patients with systolic heart failure were selected using convenience sampling method. IIEF-5 questionnaire (the International Index of Erectile Function, 5-item version), MLHFQ (Minnesota Living with Heart Failure Questionnaire) and CES-D (Centre for Epidemiologic Studies Depression Scale) were used to obtain data. RESULTS Mean score of erectile dysfunction was 14.02 ± 6.26 and 80% of heart failure patient had erectile dysfunction. Erectile dysfunction was significantly associated with age (P < 0.001), education (P = 0.019), occupation (P = 0.002), hemoglobin level (P = 0.003), left ventricular ejection fraction (P = 0.030), cholesterol level (P = 0.001), renal dysfunction (P = 0.009), use of digoxin (P = 0.014), angiotensin converting enzyme inhibitors (P < 0.001), beta blocker (P = 0.001), diuretics (P = 0.035), depression (P < 0.001) and quality of life (P < 0.001). CONCLUSION Erectile dysfunction (ED) was common in systolic heart failure and was associated with age, medical conditions, co morbidities, drugs for treatment and psychological disorders. In heart failure patients erectile dysfunction had negative impact on quality of life.
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Affiliation(s)
- Sharareh Zeighami Mohammadi
- Lecture, School of Nursing and Midwifery, Karaj Branch, Islamic Azad University, Karaj, Iran.,Sharareh Zeighami Mohammadi,
| | | | - Farzad Fahidy
- Nurse, Education Supervisor, Shahriar Hospital, Tehran, Iran
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617
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Ozturk TC, Unluer E, Denizbasi A, Guneysel O, Onur O. Can NT-proBNP be used as a criterion for heart failure hospitalization in emergency room? J Res Med Sci 2011; 16:1564-71. [PMID: 22973364 PMCID: PMC3434897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 11/26/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Heart failure is a common health problem with poor prognosis. The gold standard for diagnosis is echocardiography but it is not always reachable, especially in emergency conditions. NT-pro-brain natriuretic peptide (NT-proBNP) is a novel indicator for the diagnosis of heart failure and is being used in routine tests in emergency rooms. This study was conducted to compare NT-proBNP levels between hospitalized congestive heart failure (CHF) patients and outpatients. METHODS This study was designed as a single-centre, prospective, and controlled trial. Blood samples and data were collected from a total of 119 patients with shortness of breath admitted to Department of Emergency, School of Medicine, Marmara University. Patients were primarily diagnosed with decompensated heart failure according to the Framingham criteria and aged above 18 years. A total of 92 patients were included in the study after exclusions. NT-proBNP measurements were made by immune fluorescent method. Available data were compared between hospitalized patients and outpatients. RESULTS NT-proBNP levels were significantly higher in hospitalized patients compared to outpatients, and this finding was correlated with the clinical status of the patients. The mean NT-proBNP value of the patients was 9741.9 ± 8973 pg/ml (range: 245-35000) while the mean NT-proBNP value of patients diagnosed with non-decompensated congestive heart failure was 688.9 ± 284.5 pg/ml (range: 115-1450.65). CONCLUSIONS NT-proBNP can be used as an easy diagnostic method for congestive heart failure. A certain cut-off value may be determined in further multi-centre controlled trials with larger patient groups.
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Affiliation(s)
- Tuba Cimilli Ozturk
- Emergency Medicine Clinic, Umraniye Training and Research Hospital, Istanbul, Turkey.,
Corresponding author: Tuba Cimilli Ozturk E-mail:
| | - Erol Unluer
- Associate Professor, Emergency Medicine Clinic, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
| | - Arzu Denizbasi
- Professor, Department of Emergency Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ozlem Guneysel
- Associate Professor, Emergency Medicine Clinic, Kartal Lutfi K?rdar Training and Research Hospital, Istanbul, Turkey
| | - Ozge Onur
- Associate Professor, Department of Emergency Medicine, School of Medicine, Marmara University, Istanbul, Turkey
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618
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de Ruvo E, Sebastiani F, Sciarra L, Fagagnini A, Calo L. Usefulness Of Ivabradine To Treat "unexpected" Heart Failure Caused By "acute" Right Ventricular Pacing. Indian Pacing Electrophysiol J 2011; 11:149-52. [PMID: 21994473 PMCID: PMC3184451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
We present the case of a patient with a heart failure episode induced by acute right ventricular pacing. After reversal of beta-blockers because of chronic obstructive pulmonary disease (COPD) exacerbation, the following sinus tachycardia caused a 2:1 atrioventricular block and consequent continuous right ventricular pacing. He was treated with the selective I(f) inhibitor ivabradine, that reduced both ventricular pacing percentage and heart rate without affecting atrioventricular conduction. Ivabradine may be a valuable option in treatment of patients with atrioventricular conduction disturbances.
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619
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Abstract
LVAD = Left Ventricular Assist Device; LV = Left Ventricle; LA = Left Atrium; AO = Aorta.
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Affiliation(s)
- Sherif M Helmy
- Echocardiography Laboratory, Cardiology and Cardiothoracic Surgery Department, Hamad Medical Corporation, Doha, Qatar
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620
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Abstract
Positive inotropic effects of insulin were described early after the isolation of insulin from the pancreas but data on the effect of insulin on the heart are conflicting. Systemic insulin administration results in a reduction in circulating free fatty acids and an improvement in myocardial glucose uptake, which causes an efficiency improvement in the myocardial cell. There is strong evidence that insulin administration results in functional improvement in dysfunctional myocardium. (Neth Heart J 2010;18:197-201.).
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Affiliation(s)
- L J Klein
- Department of Cardiology, VU Medical Centre, Amsterdam, the Netherlands
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621
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Müller M, de Jong M, Jaarsma T, Koops A, Voors AA, Nieuwenhuis JA, Wijkstra PJ. Central sleep apnoea syndrome in chronic heart failure: an underestimated and treatable comorbidity. Neth Heart J 2011; 18:260-3. [PMID: 20505800 DOI: 10.1007/bf03091773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic heart failure is a clinical syndrome with a high mortality and morbidity. Despite optimal therapy, five-year survival is still only 50%. Central sleep apnoea syndrome is seen in approximately 40% of patients with congestive heart failure. Sleep apnoea syndrome can be divided into two forms in these patients: obstructive sleep apnoea syndrome (OSAS) and central sleep apnoea syndrome (CSAS, Cheyne-Stokes respiration), of which CSAS is the most common. CSAS is a form of sleep apnoea in congestive heart failure which is driven by changes in pCO(2). As a consequence of apnoea-hypopnoea an imbalance in myocardial oxygen delivery/consumption ratio will develop, sympathetic and other neurohormonal systems will be activated and right and left ventricular afterload will be increased. Sleep apnoea is associated with an increased mortality in patients with systolic heart failure. Treatment of sleep apnoea increases left ventricular ejection fraction and transplant-free survival. Because of its high prevalence, poor quality of life, poor outcome, and the beneficial effects of treatment, physicians treating patients with heart failure should be aware of central sleep apnoea. There are different treatment options, but the exact effects and indications of each option have not yet been fully determined. Further studies should be done to further investigate its prevalence, and to establish the most adequate therapy for the individual patient. (Neth Heart J 2010;18:260-3.).
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Affiliation(s)
- M Müller
- Department of Pulmonary Diseases, Isala Klinieken, Zwolle, the Netherlands
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622
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den Besten T, Sedney MI, Frederiks J, van Hemel NM. Left ventricular dysfunction due to right ventricular stimulation: is biventricular upgrade really necessary? Neth Heart J 2011; 18:604-5. [PMID: 21301623 DOI: 10.1007/s12471-010-0842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Left ventricular (LV) dysfunction can occur due to chronic right ventricular apical pacing. Upgrading of the pacemaker to biventricular pacing is an option to reverse LV dysfunction but reprogramming of the atrioventricular (AV) timing can also be favourable. In this case report we describe the effect of AV-time reprogramming in a patient with LV function deterioration that emerged two years after implantation of a dual chamber system for sick sinus syndrome. Echocardiographc studies demonstrated a tremendous improvement in LV function during two years follow-up whereas the percentage of right ventricular pacing diminished dramatically. Careful analysis of the cause of LV deterioration can avoid unnecessary upgrading to biventricular pacing. (Neth Heart J 2010;18:604-5.).
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Affiliation(s)
- T den Besten
- Department of Cardiology, Bronovo Hospital, The Hague, the Netherlands
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623
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Scheffer MG, van Dessel PF, van Gelder BM, Sutherland GR, van Hemel NM. Peak longitudinal strain delay is superior to TDI in the selection of patients for resynchronisation therapy. Neth Heart J 2010; 18:574-82. [PMID: 21301619 DOI: 10.1007/s12471-010-0838-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Mechanical dyssynchrony has proven to be superior to QRS duration in predicting response to cardiac resynchronisation therapy (CRT). Whether time to peak longitudinal strain delay between the mid-septum and mid-lateral left ventricular wall better predicts CRT response than tissue Doppler imaging (TDI) is unclear. This study compares the value of the two methods for the assessment of mechanical dyssynchrony and prediction of CRT responders. METHODS 66 clinical responders and 17 nonresponders to CRT with severe systolic heart failure (LVEF <35%), New York Heart Association classification III or IV and a wide QRS >130 ms with left bundle branch block were evaluated by peak longitudinal strain and TDI. Doppler echocardiograms and electromechanical time delay (EMD) intervals were acquired before and after pacemaker implantation. RESULTS In all responders EMD measured by peak longitudinal strain was >60 ms before implantation, compared with 76% of the patients measured by TDI. Nonresponders had EMD <60 ms measured by both techniques. Only peak longitudinal strain delay showed shortened values in every responder postimplantation and demonstrated the most significant reduction and could predict responders to CRT. However, EMD measured by TDI did not diminish in 30% of the positive clinical responders. Nonresponders showed worsening of the EMD with peak longitudinal strain, but not with TDI. CONCLUSIONS Responders to CRT can be excellently predicted if EMD before implantation determined by peak longitudinal strain delay is >60 ms. Peak longitudinal strain delay appears to be superior to TDI to predict the response to CRT. (Neth Heart J 2010;18:574-82.).
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624
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Son YJ, Kim HG, Kim EH, Choi S, Lee SK. Application of support vector machine for prediction of medication adherence in heart failure patients. Healthc Inform Res 2010; 16:253-9. [PMID: 21818444 PMCID: PMC3092139 DOI: 10.4258/hir.2010.16.4.253] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 09/14/2010] [Indexed: 12/16/2022] Open
Abstract
Objectives Heart failure (HF) is a progressive syndrome that marks the end-stage of heart diseases, and it has a high mortality rate and significant cost burden. In particular, non-adherence of medication in HF patients may result in serious consequences such as hospital readmission and death. This study aims to identify predictors of medication adherence in HF patients. In this work, we applied a Support Vector Machine (SVM), a machine-learning method useful for data classification. Methods Data about medication adherence were collected from patients at a university hospital through self-reported questionnaire. The data included 11 variables of 76 patients with HF. Mathematical simulations were conducted in order to develop a SVM model for the identification of variables that would best predict medication adherence. To evaluate the robustness of the estimates made with the SVM models, leave-one-out cross-validation (LOOCV) was conducted on the data set. Results The two models that best classified medication adherence in the HF patients were: one with five predictors (gender, daily frequency of medication, medication knowledge, New York Heart Association [NYHA] functional class, spouse) and the other with seven predictors (age, education, monthly income, ejection fraction, Mini-Mental Status Examination-Korean [MMSE-K], medication knowledge, NYHA functional class). The highest detection accuracy was 77.63%. Conclusions SVM modeling is a promising classification approach for predicting medication adherence in HF patients. This predictive model helps stratify the patients so that evidence-based decisions can be made and patients managed appropriately. Further, this approach should be further explored in other complex diseases using other common variables.
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Affiliation(s)
- Youn-Jung Son
- Department of Nursing, Soonchunhyang University, Cheonan, Korea
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625
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Al-Maskari S, Panduranga P, Al-Farqani A. Coronary Artery Fistula with Heart Failure in Early Infancy. Oman Med J 2010; 25:e004. [PMID: 28090270 PMCID: PMC5219904 DOI: 10.5001/omj.2010.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/27/2010] [Indexed: 08/30/2023] Open
Abstract
Heart failure in early infancy is commonly caused by lesions leading to pulmonary over circulation secondary to left-to-right shunt. This case report describes an unusual cause of significant left-to-right shunt in a 2 months old infant presenting with congestive heart failure, which was diagnosed with transthoracic echocardiography. In this infant, transthoracic echocardiography with Doppler color flow mapping allowed direct visualization of a large right coronary artery to right ventricular fistula that was surgically corrected successfully.
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626
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van der Horst I, de Boer R, Hillege H, Boomsma F, Voors A, van Veldhuisen D. Neurohormonal profile of patients with heart failure and diabetes. Neth Heart J 2010; 18:190-6. [PMID: 20428417 PMCID: PMC2856867 DOI: 10.1007/bf03091760] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background. Neurohormonal activation is generally recognised to play an important role in the pathophysiology, prognosis and treatment of chronic heart failure (HF). While the number of patients with diabetes increases, little if anything is known about neurohormonal activation in HF patients with diabetes. Methods. The study population consisted of 371 patients with advanced HF who were enrolled in a multicentre survival trial. Ten different plasma neurohormones were measured (noradrenaline, adrenaline, dopamine, aldosterone, renin, endothelin, atrial natriuretic peptide [ANP], N-terminal (pro)ANP, brain natriuretic peptide [BNP] and N-terminal (pro)BNP. Comparisons were made between patients with diabetes (n=81) and those without (n=290). Results. At baseline, the two groups were comparable regarding age (mean 68 years), left ventricular ejection fraction (23%), severity and aetiology of HF, while body weight was higher in those with diabetes (77.4 vs. 74.2 kg, p=0.04). Most plasma neurohormones were similar between groups, but patients with diabetes had higher values of BNP (94 vs. 47 pmol/l, p=0.03), while a similar trend was observed for N-terminal (pro)BNP (750 vs. 554 pmol/l, p=0.10). During almost five years of follow-up, 51/81 patients with diabetes died (63%), as compared with 144 of 290 non-diabetic patients (50%) who died (p=0.046). Natriuretic peptides and noradrenaline were the most powerful predictors of mortality in both diabetic and non-diabetic HF patients. Conclusion. HF patients with diabetes have higher (N-terminal (pro)) BNP levels than non-diabetic patients, while other neurohormones are generally similar. Natriuretic peptides are also good prognostic markers in diabetic HF patients. (Neth Heart J 2010;18:190-6.).
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Affiliation(s)
- I.C.C. van der Horst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - R.A. de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - H.L. Hillege
- Departments of Cardiology, and Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - F. Boomsma
- Department of Internal Medicine, Section of Vascular Pharmacology, Erasmus MC, Rotterdam, the Netherlands
| | - A.A. Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - D.J. van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
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627
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Rao HB, Krishnaswami R, Kalavakolanu S, Calambur N. Ventricular dyssynchrony patterns in left bundle branch block, with and without heart failure. Indian Pacing Electrophysiol J 2010; 10:115-21. [PMID: 20234808 PMCID: PMC2836215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Assessment of ventricular dyssynchrony in patients with heart failure is used for selecting candidates for cardiac resynchronization therapy (CRT). The patterns of regional distribution of dyssynchrony in a population with LBBB with and without heart failure have not been well delineated. This aspect forms the object of the study. METHODS Tissue Doppler Imaging (TDI) data of consecutive patients with heart failure and LBBB (Group A) was compared with those with LBBB and normal LV function (Group B). All patients had standard 2D-echocardigraphic examination and TDI. Tissue velocity curves obtained by placing sample volumes in opposing basal and mid segments of septal, lateral, inferior, anterior and posterior walls were analyzed. Inter ventricular dyssynchrony (IVD) was assessed by the difference between aortic and pulmonary pre ejection intervals. LV dyssynchrony (LVD) was assessed by the difference in times to peak velocity. A delay of >/= 40 msec was considered significant for presence of IVD and LVD. RESULTS There were 103 patients in Group A and 25 in Group B. The mean QRS duration and PR intervals respectively were 146 +/- 25 vs. 152+/-20 msec and 182+/- 47 vs. 165+/-36 msec. (p=NS) LVEF in the 2 groups were (32 +/- 6 % vs. 61+/- 11%; p< 0.01). Prevalence of dyssynchrony in the HF group compared to Group B was 72% vs. 16%, (P< 0.01). Lateral wall dyssynchrony in the 2 groups was 37% vs. 0% (p< 0.01) while septal dyssynchrony was 16% vs. 16% (p- NS). CONCLUSIONS 72% of heart failure patients with LBBB have documented dyssynchrony on TDI, which has a heterogeneous regional distribution. Dyssynchrony may be seen in LBBB and normal hearts but it is does not involve the lateral wall. Septal dyssynchrony in heart failure patients may not have the same significance as lateral wall delay.
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628
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Schimmer JJ, Billups SJ, Delate T. Beta-blocker therapy in patients with left ventricular systolic dysfunction and chronic obstructive lung disease in an ambulatory care setting. Pharm Pract (Granada) 2009; 7:205-12. [PMID: 25136395 PMCID: PMC4134838 DOI: 10.4321/s1886-36552009000400003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 11/09/2009] [Indexed: 01/13/2023] Open
Abstract
Objective: To evaluate beta blocker persistence six months after beta-blocker initiation or dose titration in heart failure (HF) patients with COPD compared to those without COPD. Secondary objectives included comparison of beta-blocker dose achieved, changes in left ventricular ejection fraction (LVEF) and incidence of hospitalizations or emergency department (ED) visits during follow-up. Methods: We conducted a matched, retrospective, cohort study including 86 patients with COPD plus concomitant HF (LVEF ≤40%) and 137 patients with HF alone. All patients were followed in an outpatient HF clinic. Eligible patients had a documented LVEF ≤40% and were initiated or titrated on a beta-blocker in the HF clinic. Patients were matched based on LVEF (categorized as ≤ 20% or 21-40%), gender, and age (> or ≤70 years). The primary outcome was beta blocker persistence at 6 months. Secondary outcomes were dose achieved, LVEF, and incidence of hospitalizations or ED visits. Results: There were no differences between the COPD and non-COPD groups in beta-blocker persistence at six-month follow-up (94.2% vs. 93.4% respectively, adjusted p=0.842). The proportion of patients who achieved a daily metoprolol dose equivalent of at least 100 mg was similar between the groups (adjusted p=0.188). The percent of patients with at least one ED visit or hospitalization in the six-month post-titration period was substantial but similar between the groups (53.5% and 48.2% for COPD and non-COPD patients, respectively, adjusted p=0.169). Conclusion: Our results support the use of beta-blockers in the population of heart failure patients with COPD and without reactive airway disease.
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Affiliation(s)
- Jennifer J Schimmer
- Clinical Pharmacy Specialist in Cardiology, Kaiser Permanente Colorado; Clinical Instructor, University of Colorado Denver School of Pharmacy. Denver, CO ( United States )
| | - Sarah J Billups
- Clinical Pharmacy Specialist in Research, Kaiser Permanente Colorado; Clinical Assistant Professor, University of Colorado Denver School of Pharmacy. Denver, CO ( United States )
| | - Thomas Delate
- Clinical Pharmacy Research Scientist, Kaiser Permanente Colorado; Clinical Instructor, University of Colorado Denver School of Pharmacy. Denver, CO ( United States )
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629
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Starr JA, Nappi JM. A retrospective characterization of worsening renal function in patients with acute decompensated heart failure receiving nesiritide. Pharm Pract (Granada) 2009; 7:175-80. [PMID: 25143796 PMCID: PMC4139050 DOI: 10.4321/s1886-36552009000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 08/31/2009] [Indexed: 11/11/2022] Open
Abstract
UNLABELLED Nesiritide is approved by Food and Drug Administration (FDA) for the treatment of patients with acute decompensated heart failure (ADHF) due its ability to rapidly reduce cardiac filling pressures and improve dyspnea. Numerous studies have shown that renal dysfunction is associated with unfavorable outcomes in patients with heart failure. In addition, there have been reports suggesting that nesiritide may adversely affect renal function and mortality. OBJECTIVE The purpose of this retrospective analysis was to assess the effect of dose and duration of nesiritide use and the dose and duration of diuretic therapy on worsening renal function and increased in-hospital mortality in this patient population. METHODS Seventy-five patients who were hospitalized for ADHF and who were treated with nesiritide for at least 12 hours were reviewed retrospectively. RESULTS The mean increase in SCr was 0.5 mg/dL (range 0 - 4.4 mg/dL). Thirty-six percent of patients (27/75) met the primary endpoint with an increase in SCr>0.5 mg/dL. Treatment dose and duration of nesiritide did not differ between those patients who had an increase in SCr>0.5 mg/dL and those who did not (p=0.44 and 0.61). Concomitant intravenous diuretics were used in 85% of patients with an increase in SCr >0.5 mg/dL compared to 90% of patients without an increase in SCr>0.5 mg/dL (p=0.57). The in-hospital mortality rate was also higher at 35% in those patients with an increase in creatinine >0.5 mg/dL compared to 11% in those without (p=0.01). CONCLUSION Nesiritide was associated with an increase in SCr > 0.5 mg/dL in approximately one-third of patients. The increase occurred independently of dose, duration of nesiritide therapy, blood pressure changes, and concomitant intravenous diuretic use. However, the increase in SCr was associated with an increase in hospital stay and in hospital mortality consistent with previous reports in the literature.
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Affiliation(s)
| | - Jean M Nappi
- South Carolina College of Pharmacy. Charleston, SC ( United States )
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Peraldo C, Azzolini P, Matera S, Nistri D, Bianchi S, Sgreccia F, Valsecchi S, Davinelli M, Puglisi A. Ventricular dyssynchrony: 12-month evaluation in ischemic versus nonischemic CRT patients. Indian Pacing Electrophysiol J 2009; 9:25-34. [PMID: 19165356 PMCID: PMC2615059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE Few data exist about the potential differences in the dyssynchrony status of cardiac resynchronization therapy (CRT) candidates stratified by etiology of heart failure, and about the evolution of dyssynchrony at long-term follow-up. We provided a description of intra-ventricular dyssynchrony at baseline, 6 months and 12 months in ischemic and nonischemic CRT patients. METHODS Tissue Doppler Imaging was performed in 35 CRT candidates (18 ischemic, 17 nonischemic) at baseline, and at 6-month and 12-month follow-up. A group of 11 healthy subjects was considered for comparison. RESULTS At baseline, the standard deviation and the maximum activation delay between any 2 segments were significantly greater in ischemic (38+/-33ms, 94+/-76ms) and nonischemic (38+/-24ms, 96+/-62ms) patients versus controls (9+/-7ms, 22+/-15ms) (all p<0.05). The average time to activation for posterior and lateral wall was significantly higher in nonischemic patients, while the anterior septum activated later in ischemic patients. At 6-month follow-up, standard deviation and maximum delay did not vary in nonischemic while decreased in ischemic group. All changes persisted at 12 months. CONCLUSIONS No baseline differences were observed between ischemic and nonischemic patients using studied indices. At 6- and 12-month follow-up, only ischemic patients presented a significant reduction in dyssynchrony values, although in both groups CRT did not lead to a complete normalization of LV synchronism.
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Affiliation(s)
- Carlo Peraldo
- Ospedale Fatebenefratelli - S. Giovanni Calibita, Rome, Italy
| | - Paolo Azzolini
- Ospedale Fatebenefratelli - S. Giovanni Calibita, Rome, Italy
| | - Sabrina Matera
- Ospedale Fatebenefratelli - S. Giovanni Calibita, Rome, Italy
| | | | - Stefano Bianchi
- Ospedale Fatebenefratelli - S. Giovanni Calibita, Rome, Italy
| | | | | | | | - Andrea Puglisi
- Ospedale Fatebenefratelli - S. Giovanni Calibita, Rome, Italy
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Stevenson WG, Tedrow UB, Seiler J. Atrial Fibrillation and Heart Failure. J Atr Fibrillation 2008; 1:101. [PMID: 28496583 DOI: 10.4022/jafib.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 07/11/2008] [Accepted: 07/14/2008] [Indexed: 02/02/2023]
Abstract
Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy. Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking. Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases. Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing. Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.
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Affiliation(s)
- William G Stevenson
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
| | - Usha B Tedrow
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
| | - Jens Seiler
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
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