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Jurgens CY, Lee CS, Aycock DM, Masterson Creber R, Denfeld QE, DeVon HA, Evers LR, Jung M, Pucciarelli G, Streur MM, Konstam MA. State of the Science: The Relevance of Symptoms in Cardiovascular Disease and Research: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e173-e184. [PMID: 35979825 DOI: 10.1161/cir.0000000000001089] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Symptoms of cardiovascular disease drive health care use and are a major contributor to quality of life. Symptoms are of fundamental significance not only to the diagnosis of cardiovascular disease and appraisal of response to medical therapy but also directly to patients' daily lives. The primary purpose of this scientific statement is to present the state of the science and relevance of symptoms associated with cardiovascular disease. Symptoms as patient-reported outcomes are reviewed in terms of the genesis, manifestation, and similarities or differences between diagnoses. Specifically, symptoms associated with acute coronary syndrome, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease are reviewed. Secondary aims include (1) describing symptom measurement methods in research and application in clinical practice and (2) describing the importance of cardiovascular disease symptoms in terms of clinical events and other patient-reported outcomes as applicable.
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Bestetti RB, Cardinalli-Neto A, Couto LB. The history of the evolution of the knowledge about the diagnosis and the pathogenetic aspects of heart failure: From the Egyptians to James Mackenzie. Int J Cardiol 2020; 304:109-115. [DOI: 10.1016/j.ijcard.2019.12.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/13/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
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Pediatric Heart Failure: A Practical Guide to Diagnosis and Management. Pediatr Neonatol 2017; 58:303-312. [PMID: 28279666 DOI: 10.1016/j.pedneo.2017.01.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 12/27/2022] Open
Abstract
Pediatric heart failure represents an important cause of morbidity and mortality in childhood. Currently, there are well-established guidelines for the management of heart failure in the adult population, but an equivalent consensus in children is lacking. In the clinical setting, ensuring an accurate diagnosis and defining etiology is essential to optimal treatment. Diuretics and angiotensin-converting enzyme inhibition are the first-line therapies, whereas beta-blockers and devices for electric therapy are less used in children than in adults. In the end-stage disease, heart transplantation is the best choice of treatment, while a left ventricular assist device can be used as a bridge to transplantation (due to the difficulties in finding organ donors), recovery (in the case of myocarditis), or destination therapy (for patients with systemic disease).
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Bera A, Sen D. Promise of adeno-associated virus as a gene therapy vector for cardiovascular diseases. Heart Fail Rev 2017; 22:795-823. [DOI: 10.1007/s10741-017-9622-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Conceptualizing the body and the logics of performing. JOURNAL OF MANAGEMENT HISTORY 2015. [DOI: 10.1108/jmh-04-2014-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to examine how residues of ancient images have influenced one’s perspectives on management. Increased attention has been given to the absence of bodies within discussions of organisations; however, far less attention has been given to the interplay between organisations and images of one’s body.
Design/methodology/approach
By comparing the perceived benefits of studying sport (e.g. passion, embodiment and action) with the tensions that existed between athletic performances and an ancient image of the body, this paper draws attention to residuals that exist within discussions of organisations.
Findings
In a context where an image of the body encouraged moderation, the appropriate levels of heat, and the development of an immaterial and eternal soul, athletic performances, which were physical, extreme, focused on the body and generated excessive heat, were often problematic. These problems are then examined within the literature discussing current issues in management.
Research limitations/implications
Sport has the potential to facilitate one’s understanding of issues that management, consistent with ancient images of the body, has traditionally neglected (i.e. extremes, passion) and the possibilities of using embodied cognition to enhance our understandings of performance, teams and leading are discussed.
Social implications
As scientists become increasingly concerned about the long-term consequences of the reduced opportunities for cultural programs (sport, art, music, etc.), revisiting one’s assumptions is increasingly important, especially as athletics and philosophy once shared the same physical space.
Originality/value
By describing how residues from historical images of the body have influenced the thinking about organizing, this paper highlights the connection between the social and the biological and demonstrates how vestiges from the past influence contemporary discussions.
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Khodadoust K, Ardalan M, Ghabili K, Golzari SE, Eknoyan G. Discourse on pulse in medieval Persia—the Hidayat of Al-Akhawayni (?–983AD). Int J Cardiol 2013; 166:289-93. [DOI: 10.1016/j.ijcard.2012.04.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
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Stec D. The personification of an object and the emergence of coaching. JOURNAL OF MANAGEMENT HISTORY 2012. [DOI: 10.1108/17511341211236273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Boontje NM, Merkus D, Zaremba R, Versteilen A, de Waard MC, Mearini G, de Beer VJ, Carrier L, Walker LA, Niessen HWM, Dobrev D, Stienen GJM, Duncker DJ, van der Velden J. Enhanced myofilament responsiveness upon β-adrenergic stimulation in post-infarct remodeled myocardium. J Mol Cell Cardiol 2010; 50:487-99. [PMID: 21156182 DOI: 10.1016/j.yjmcc.2010.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 11/19/2010] [Accepted: 12/03/2010] [Indexed: 12/12/2022]
Abstract
Previously we showed that left ventricular (LV) responsiveness to exercise-induced increases in noradrenaline was blunted in pigs with a recent myocardial infarction (MI) [van der Velden et al. Circ Res. 2004], consistent with perturbed β-adrenergic receptor (β-AR) signaling. Here we tested the hypothesis that abnormalities at the myofilament level underlie impaired LV responsiveness to catecholamines in MI. Myofilament function and protein composition were studied in remote LV biopsies taken at baseline and during dobutamine stimulation 3 weeks after MI or sham. Single permeabilized cardiomyocytes demonstrated reduced maximal force (F(max)) and higher Ca(2+)-sensitivity in MI compared to sham. F(max) did not change during dobutamine infusion in sham, but markedly increased in MI. Moreover, the dobutamine-induced decrease in Ca(2+)-sensitivity was significantly larger in MI than sham. Baseline phosphorylation assessed by phosphostaining of β-AR target proteins myosin binding protein C (cMyBP-C) and troponin I (cTnI) in MI and sham was the same. However, the dobutamine-induced increase in overall cTnI phosphorylation and cTnI phosphorylation at protein kinase A (PKA)-sites (Ser23/24) was less in MI compared to sham. In contrast, the dobutamine-induced phosphorylation of cMyBP-C at Ser282 was preserved in MI, and coincided with increased autophosphorylation (at Thr282) of the cytosolic Ca(2+)-dependent calmodulin kinase II (CaMKII-δC). In conclusion, in post-infarct remodeled myocardium myofilament responsiveness to dobutamine is significantly enhanced despite the lower increase in PKA-mediated phosphorylation of cTnI. The increased myofilament responsiveness in MI may depend on the preserved cMyBP-C phosphorylation possibly resulting from increased CaMKII-δC activity and may help to maintain proper diastolic performance during exercise.
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Affiliation(s)
- Nicky M Boontje
- Laboratory for Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
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Synthesis, crystal structure, DNA binding properties and antioxidant activities of transition metal complexes with 3-carbaldehyde-chromone semicarbazone. INORG CHEM COMMUN 2010. [DOI: 10.1016/j.inoche.2010.07.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Affiliation(s)
- Daphne T Hsu
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, NY, USA
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Saba MM, Ventura HO, Saleh M, Mehra MR. Ancient Egyptian medicine and the concept of heart failure. J Card Fail 2006; 12:416-21. [PMID: 16911907 DOI: 10.1016/j.cardfail.2006.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 02/28/2006] [Accepted: 03/02/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The cardiac glosses of the Ebers papyrus comprise the concepts and notions of the Egyptian physicians about the heart and its diseases. We sought to analyze some of the cardiac glosses of the Ebers papyrus, focusing on those which may describe early concepts of the syndrome of heart failure. METHODS AND RESULTS Review of Joachim's German translation and both Bryan's and Ghalioungui's English translations of the Ebers papyrus. One clinical scenario describes patients with "weakness of the heart" or "cardiac dysfunction:" "His heart is bored," "The heart weakens," "This means that the heart does not speak or that the vessels of the heart are dumb. Its information under your hands normally appears because of the air with which they are filled is missing...." Debility that has arisen in the heart." The other clinical scenario supplies information about patients with heart failure and "fluid retention" or "congestion": "His heart is flooded. This is the liquid of the mouth. His body parts are all together weak"..."His heart is over flooded...." CONCLUSION Whether or not Egyptian medicine and the contents of the papyri paved the way for future knowledge, the clinical scenarios included in the Ebers papyrus may represent one of the earliest documented observations of the syndrome of heart failure.
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Affiliation(s)
- Magdi M Saba
- Cardiomyopathy and Heart Transplantation Center, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA
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Abstract
Over the past 10 years, there has been an increasing demand for heart failure patients to have access to palliative care services. The concerns of this group have been highlighted and there is growing recognition in national palliative care and cardiology bodies that these concerns should be addressed. In spite of this, there is little improvement. There are concerns about the acceptability of hospice services to heart failure patients, worries about service overload, lack of appropriate knowledge and skills and difficulty in knowing when to refer a heart failure patient for palliative care. In Scarborough, a joint approach by a cardiologist and palliative care physician was set up in September 2000. This paper describes the service so far in an attempt to address some of the above reservations and to provide a catalyst and encouragement to others beginning a similar venture.
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Affiliation(s)
- M J Johnson
- Hull York Medical School and St. Catherine's Hospice, Scarborough.
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13
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Abstract
In pathological conditions associated with persistent increases in hemodynamic workload (old myocardial infarction, high blood pressure, valvular heart disease), a number of signalling pathways are activated in the heart, all of which promote hypertrophic growth of the heart, characterised at the cellular level by increases in individual cardiac myocyte size. Some of these pathways are required for a successful adaptation to cardiac injury. Other pathways are maladaptive, however, as they lead to progressive contractile dysfunction and heart failure. The free radical gas nitric oxide and natriuretic peptides, both of which are produced in the heart, have emerged as endogenous inhibitors of maladaptive hypertrophy signalling. Overall, it appears that cardiac hypertrophy is controlled by an interplay of pro- and antihypertrophic signalling networks. This delicate balance can tip towards adaptation or heart failure. In the future, patients living with cardiac disease may benefit from therapeutic strategies targeting maladaptive hypertrophy signalling pathways.
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Affiliation(s)
- Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Abstract
Recent advances in our understanding of the pathophysiology of heart failure have greatly increased the number of potential targets for therapy. The most important of these advances was the recognition that a major goal of therapy should be to modify long-term proliferative responses, as well as to achieve short-term functional improvement. This conclusion emerged from several clinical trials which showed that correction of functional abnormalities in these patients, although often of immediate clinical value, can worsen long-term prognosis. Although vasodilators alleviate the disability that is caused by excessive afterload, most increase long-term mortality: similarly, although inotropic drugs provide immediate relief of symptoms and are useful as temporary support in patients with damaged hearts, most inotropes also shorten long-term survival. Treatment of chronic heart failure should not be targeted simply at the signs and symptoms noted by Withering. Instead, a major goal of therapy should be to slow progression by modifying maladaptive growth responses in the failing heart, which were unknown when Withering discovered that digitalis can alleviate the signs and symptoms of heart failure. New targets for treatment, therefore, include the maladaptive proliferative signaling cascades that cause progressive ventricular dilatation (remodeling) and hastens cardiac cell death. The ability to inhibit maladaptive proliferative signaling in patients with heart failure was greatly enhanced by the rapid pace of discovery in molecular biology. New understanding of the ability of neurohumoral mediators, such as norepinephrine and angiotensin II, to stimulate remodeling, apoptosis, and other deleterious features of the hypertrophic response has opened important areas for research into the causes and therapy of heart failure. Similarly, potential roles for cell adhesion molecules, cytokines, and peptide growth factors in activating maladaptive proliferative responses suggests additional targets for therapy. This and other new information regarding signal transduction pathways, notably the many crossovers between functional and proliferative signaling, provide promising opportunities in this rapidly advancing area of study.
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Affiliation(s)
- Arnold M Katz
- University of Connecticut Health Center, Farmington, CT, USA.
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Abstract
Heart failure has traditionally been viewed as a hemodynamic syndrome characterized by fluid retention, high venous pressure, and low cardiac output. Over the past decade, however, it has become clear that because of deterioration and progressive dilatation (remodeling) of the diseased heart, this is also a rapidly fatal syndrome. The importance of prognosis came to be appreciated when clinical trials showed that therapy which initially improves such functional abnormalities, as high venous pressure and low cardiac output, often fail to improve survival, and that some drugs which improve hemodynamics worsen long-term prognosis. The latter is true for most vasodilators which, in spite of alleviating the adverse short-term consequences of high afterload, shorten survival. Notable exceptions are ACE inhibitors, whose vasodilator effects do not explain their ability to prolong survival; instead, these drugs slow both deterioration and remodeling of the failing heart. Inotropic agents, while providing immediate relief of symptoms, generally shorten long-term survival, whereas beta-blockers slow deterioration and remodeling, and reduce mortality. Aldosterone antagonists exert beneficial effects on prognosis that are not easily explained by their diuretic effects, but instead can be explained by their ability to inhibit signaling pathways that stimulate maladaptive hypertrophy, remodeling, apoptosis and other deleterious responses that cause deterioration of the failing heart. These and other findings demonstrate that heart failure is more than a hemodynamic disorder; these patients suffer from maladaptive proliferative responses that cause cardiac cell death and progressive dilatation that play a key role in determining the poor prognosis in this syndrome.
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Affiliation(s)
- A M Katz
- Cardiology Division, Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA.
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Roenicke V, Leclair S, Hoffmann A, Becker M, Szado T, Kirsch T, Stoss O, Navé BT, Henkel T. Emerging therapeutic targets in chronic heart failure: part I. Expert Opin Ther Targets 2002; 6:649-58. [PMID: 12472378 DOI: 10.1517/14728222.6.6.649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic heart failure (CHF) is a life threatening disease with an enormous medical requirement. Approximately 15 million people worldwide suffer from CHF. The prevalence will inevitably increase due to the ageing population. Nevertheless, current treatment options based on angiotensin-converting enzyme inhibitors and beta-adrenergic receptor antagonists merely slow progression of the disease. Novel treatment concepts based on new therapeutic targets must have the capability to reverse the severity of this disease. This review, focusing on the emerging targets in the most promising therapeutic areas for the treatment of CHF, will be divided into two parts. In Part I, disease concepts such as altered calcium handling and ion channel activity, pathophysiological hypertrophy and inefficient cardiac metabolism are discussed. Validation status and potential therapeutic value for new targets in each research field is given by summarising the results of in vitro and in vivo studies.
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Katz AM. A Modern View of Heart Failure: Practical Applications of Cardiovascular Physiology. Compr Physiol 2002. [DOI: 10.1002/cphy.cp020121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Cachexia has been known to physicians since ancient Greek times as a 'signum mali ominis' in various diseases indicating end stage disease and poor quality of life. Cardiac cachexia is recently receiving growing attention as modern treatment options prevent early death from cardiac events and more patients live with chronic compensated heart failure. Nevertheless, observation and clinical documentation of this condition go back as long as medical science itself. Pioneering studies on the reasons and mechanisms of cachexia were performed several decades ago. These studies provide fundamental insights and guidance towards a better understanding of cachexia. This review presents an overview of early thoughts and milestone studies on metabolic abnormalities and cachexia in chronic heart failure.
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Affiliation(s)
- Wolfram Doehner
- Department of Clinical Cardiology, NHLI, Imperial College School of Medicine, London, UK.
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19
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Abstract
Therapy for heart failure has traditionally been directed to such short-term functional abnormalities as low cardiac output, high filling pressures, and fluid retention. More recently, it has become clear that therapy must also inhibit the proliferative responses that contribute to the progressive deterioration of the failing heart. That heart failure is more than a hemodynamic disorder became apparent when clinical trials showed that drugs that improve such functional abnormalities as high venous pressure and low cardiac output failed to improve long-term prognosis. Most vasodilators, in spite of alleviating short-term problems caused by excessive afterload, increase long-term mortality; the notable exceptions are ACE inhibitors, the ability of which to prolong survival and inhibit remodeling can be attributed to inhibition of proliferative signaling. Other clinical trials showed that inotropic drugs, while providing immediate relief of symptoms, generally shorten long-term survival, whereas beta-adrenergic receptor blockers, which inhibit proliferative signaling by norepinephrine, improve prognosis. These findings can be explained by crossovers between functional and proliferative signaling, among the most important of which is the ability of neurohumoral mediators, such as norepinephrine and angiotensin II, to stimulate maladaptive hypertrophy, remodeling, apoptosis and other deleterious proliferative responses in the failing heart. The emerging understanding of the role of cytoskeletal and cell adhesion molecules in activating maladaptive proliferative responses suggests additional targets for therapy, and the rapid pace of discovery in molecular biology promises additional opportunities to inhibit this abnormal signaling, which causes progressive ventricular dilatation (remodeling) and cardiac cell death, now recognized to be major problems in this syndrome.
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Affiliation(s)
- Arnold M Katz
- Department of Medicine, University of Connecticut Health Center, Farmington, USA.
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20
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Abstract
There are two major reasons why hypertension is an important risk factor for heart failure. The first is that an elevated blood pressure increases the wall stress in the left ventricle. The second is that hypertension, in a complex manner, contributes to the development of atheromatous vascular disease. Among the more common causes of heart failure are the sequelae of coronary heart disease. The treatment of hypertension modifies the progression to heart failure and the occurrence of coronary events. In patients who have heart failure, hypotension rather than hypertension is a predictor of a poor outcome, likely because low blood pressure is a consequence of damage to the myocardium. The clinical message is that hypertension should be treated aggressively. Where heart failure is a likely outcome, or where hypertension occurs in the presence of heart failure, there is a strong case for using drugs that have been shown to be beneficial in the treatment of both hypertension and heart failure.
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Affiliation(s)
- P A Poole-Wilson
- Department of Cardiac Medicine, National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 7AG, England.
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Katz AM. Crossovers between functional and proliferative signaling: key to understanding the pathophysiology and management of heart failure. J Cell Mol Med 2001; 5:125-31. [PMID: 12067495 PMCID: PMC6517809 DOI: 10.1111/j.1582-4934.2001.tb00145.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- A M Katz
- Cardiology Division, Department of Medicine, University of Connecticut Health Center, Farmington CT 06030, USA.
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Stevenson LW, Kormos RL, Bourge RC, Gelijns A, Griffith BP, Hershberger RE, Hunt S, Kirklin J, Miller LW, Pae WE, Pantalos G, Pennington DG, Rose EA, Watson JT, Willerson JT, Young JB, Barr ML, Costanzo MR, Desvigne-Nickens P, Feldman AM, Frazier OH, Friedman L, Hill JD, Konstam MA, McCarthy PM, Michler RE, Oz MC, Rosengard BR, Sapirstein W, Shanker R, Smith CR, Starling RC, Taylor DO, Wichman A. Mechanical cardiac support 2000: current applications and future trial design. June 15-16, 2000 Bethesda, Maryland. J Am Coll Cardiol 2001; 37:340-70. [PMID: 11153769 DOI: 10.1016/s0735-1097(00)01099-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Grady KL, Dracup K, Kennedy G, Moser DK, Piano M, Stevenson LW, Young JB. Team management of patients with heart failure: A statement for healthcare professionals from The Cardiovascular Nursing Council of the American Heart Association. Circulation 2000; 102:2443-56. [PMID: 11067802 DOI: 10.1161/01.cir.102.19.2443] [Citation(s) in RCA: 320] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Our understanding of the syndrome of heart failure has undergone several revisions, most importantly in the second half of the 20th century. New insights into the mechanisms of diseases offer new, challenging, controversial and sometimes counterintuitive forms of therapy. The development and progression of heart failure results from a complex interplay of hemodynamic and neurohormonal, cellular and genetic factors, rather than simply changes in cardiac function. It is because of this reason that our therapeutic focus can no longer be solely based on supply and demand models. Since the description of the pulsatile nature of the heart function and the flow of blood around a circuit by W. Harvey, numerous new paradigms have been put forward to explain the nature of heart failure. However, no single new model thus far proposed has been able to displace previous ones and successfully dictate therapy. It is the purpose of this manuscript to review the overall current understanding of the heart failure syndrome and how these new ideas may affect our therapeutic approach.
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Affiliation(s)
- M Auslender
- Pediatric Cardiology Program, New York University Medical Center, 10016, New York, NY, USA
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Sussman MA, Welch S, Gude N, Khoury PR, Daniels SR, Kirkpatrick D, Walsh RA, Price RL, Lim HW, Molkentin JD. Pathogenesis of dilated cardiomyopathy: molecular, structural, and population analyses in tropomodulin-overexpressing transgenic mice. THE AMERICAN JOURNAL OF PATHOLOGY 1999; 155:2101-13. [PMID: 10595939 PMCID: PMC1866919 DOI: 10.1016/s0002-9440(10)65528-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dilated cardiomyopathy is characterized by decreased contractile function and loss of myofibril organization. Previously unexplored structural and molecular events that precede and initiate dilation can now be studied in tropomodulin-overexpressing transgenic (TOT) mice exhibiting progressive dilated cardiomyopathy. Onset of dilation did not correspond to a change in transgene expression levels, which were more than threefold above normal at birth and remained elevated throughout postnatal life. Similarly, mitogen-activated protein kinase activation (p38, ERK1/ERK2, JNK1/JNK2) was not associated with dilation. In contrast, calcineurin was activated before dilation, presumably due to doubling of intracellular diastolic calcium levels in TOT cardiomyocytes. Amplitude of systolic calcium transients was greatly increased as well, demonstrating the novel and unique calcium handling profile of TOT cardiomyocytes. Loss of myofibril organization was not apparent by confocal microscopy until over 1 week after birth, although neonatal sarcomeric abnormalities were revealed by ultrastructural analysis. Rapid postnatal increases in heart:body weight ratio at 1.5 weeks were followed by two waves of mortality between 2 and 3 weeks after birth coincident with maturational stress. Ultimately, TOT pathogenesis is a compensatory response to altered sarcomeric structure driven by calcineurin activation within days after birth, making TOTs an excellent paradigm for studying the role of calcium overload in dilated cardiomyopathy.
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Affiliation(s)
- M A Sussman
- Division of Molecular Cardiovascular Biology, Children's Hospital and Research Foundation, Cincinnati, Ohio 45229, USA.
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