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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The goal of the treatment of chronic heart failure is improvement of patient's prognosis and QOL. To achieve this goal, new pharmacological and nonpharmacological approaches have been developed. ACE inhibitor - and beta-blocker-treatment added to the standard therapy has been established to improve the prognosis, and ICD, cardiac resynchronization treatment (CRT) with biventricular pacing and LV assist device also contribute to the advances in the therapeutic progress. However, recent clinical trials for the new drugs which antagonize the endothelin receptors and TNF receptors failed to demonstrate the benefit of these new drugs. Establishment of the therapeutic strategies for treatment of diastolic heart failure is also another problem to be solved.
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PMID:[Recent advances in treatment and the future problems to be solved]. 1668 59

We report the case of a 35-year-old man who was suffering from severe heart failure due to cardiomyopathy. He underwent heart transplantation years ago and developed complex ventricular arrhythmias in the following months in combination with recurrent episodes of syncope due to hypertrophic non-obstructive cardiomyopathy in the transplanted heart, so a dual chamber ICD was implanted. Months later repetitive episodes of intermittent T-wave oversensing with consecutive activation of the ICD could be observed. Surgical revision of the electrode was performed and the patient was closely followed up. One year later, further episodes of T-wave oversensing led to multiple inappropriate IDC-shocks. A very short AV-conduction time was programmed to allow ventricular capture whenever possible, because T-wave oversense after ventricular capture would be annotated as single ventricular ectopy not resulting in antitachycardia pacing. As a consequence, the patient was free from inappropriate ICD-shocks, but showed several shorter episodes of T-wave oversensing. They were all initiated by atrial activity that was seen in the refractory period, thus leading to a loss of AV synchrony. Programming a very short post ventricular atrial refractory period (PVARP) in addition to a short AV-delay led to the complete disappearance of T-wave oversensing in this patient. During a 9-month follow-up, no further tachycardia episodes were detected by the device.
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PMID:[Avoidance of intermittent T-wave oversensing with device programming]. 1678 69

Cardiac resynchronization in heart failure already has a history of 12 years. However, the major advances have been the result of large multi center trials dating from 2001. In all these trials patients with a LVEF < or = 35% were included, and a QRS above 120 msec. Follow up was from 3-36 months. The majority of these trials showed a positive effect in reduction of composite and points of death or hospitalization for major cardiovascular events. Many of these trials also showed a diminution of left ventricular and systolic diameter or volume. Even in NYHA class II patients an improvement was seen. Some unanswered questions still remain as regards the agreement on electrical or electromechanical dyssynchrony criteria. There is a number of patients with "wide" QRS who do not improve and conversely a number of patients with a narrow QRS who witness improvement. The benefit in patients with atrial fibrillation also remains unanswered. Finally the value of this modality in patients with mild heart failure or asymptomatic left ventricular systolic dysfunction, NYHA class I-II remains to be determined in large on going trials. Another question is whether biventricular or left ventricular patient is preferable. Finally whether biventricular patient should be complemented by a defibrillator insertion is being currently studied. Cardiac resynchronization therapy along or in combination with an ICD improves symptoms, reduces major morbidity and mortality in patients with a left ventricular EF<35%, ventricular dilatation and a QRS > or = 120 msec in NYHA class III-IV. Further indications are currently being examined.
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PMID:Cardiac resynchronisation therapy in heart failure: current status. 1693 34

The problem of sudden cardiac death (SCD) is complex and many questions concerning the pathophysiologic mechanism are still unanswered. At present the only reliable way of recognizing high risk patients is by means of left ventricular dysfunction, measured as LV-EF<or=35%. The positive predictive accuracy for other non-invasive risk markers is too low. So far, antiarrhythmic drugs have failed to successfully prevent SCD. More than 25 years of clinical experience with the implantable defibrillator (ICD) with its continuous technical improvement has made the ICD the most effective weapon against SCD. Its effectiveness has been demonstrated in many prospective trials and the use of the ICD is fully enclosed within the current guidelines for the prevention of SCD. Guidelines do not, however, replace the physician's judgement and experience to correctly evaluate the patient's status. ICD therapy in the primary and secondary prevention of heart failure, which is often accompanied by a high risk of SCD is, however, not justified without guideline-adjusted therapy.
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PMID:[Prevention of sudden cardiac death]. 1698 3

With the rapid advancements in heart failure device therapy, many physicians now use these devices in everyday clinical practice. However, questions remain regarding the clinical benefit of these therapies in different patient subgroups. Since the majority of patients enrolled in device trials are white men, extrapolating the data to specific patient subpopulations becomes important. Specifically, the question of clinical outcomes in women with implantable device therapy for prevention of sudden cardiac death and management of heart failure is an important clinical issue. In this article, we review the data on survival and clinical outcomes with heart failure device therapy (implantable cardioverter defibrillators [ICDs] and cardiac resynchronization therapy [CRT]) and analyze the results from clinical trials for any differences in outcomes based on gender. Even though women are a significantly under-represented population with regard to clinical investigation and utilization of heart failure devices, they still derive the same morbidity and mortality benefits compared to men. Specifically, ICD devices confer the same rates of sudden cardiac death prevention, and CRT devices improve CHF morbidity and mortality at rates comparable to those found in men. These results support equal use of ICDs and CRT in men and women.
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PMID:Sex-based differences in cardiac resynchronization therapy and implantable cardioverter defibrillator therapies: effectiveness and use. 1705 76

Heart failure is one of the main clinical entities in modern society, with a prevalence of 0.4 to 2% in Europe. It has an adverse prognosis, with 5 to 20% annual mortality, even when properly medicated. Mortality in heart failure is frequently due to sudden death, which means preventive strategies should be adopted. Risk stratification is essential in order to identify which patients will benefit most. The main risk factor for sudden death is low ejection fraction. However, ECG data, Holter monitoring and electrophysiological studies are also useful. In primary prevention, all reversible conditions and precipitating factors should be identified and heart failure treatment optimized. The best preventive strategy, after appropriate patient selection, is ICD implantation. Recently, devices with both cardioversion-defibrillation and cardiac resynchronization have proved beneficial in terms of morbidity, quality of life and survival.
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PMID:Sudden death prevention in heart failure. 1706 38

Primary and secondary prevention of sudden cardiac death is not sufficiently assured by medication. The (automatic) implantable cardioverter/defibrillator ((A)ICD) is able to terminate life-threatening arrhythmias (ventricular fibrillation/flutter, ventricular tachycardia) reliably. The identification and care of risk patients is of crucial importance. Initially, only survived resuscitation for ventricular fibrillation or ventricular tachycardia was regarded as a confirmed indication. Several studies (CABG patch, MADIT, MADIT II, MUSTT, DINAMIT, CAT AMIOVIRT, DEFINITE, COMPANION, SCD-HeFT) have examined the prophylactic indication for ICD therapy in risk groups. Patients with chronic state after myocardial infarction with markedly impaired left ventricular function and/or spontaneous, non-sustained ventricular tachycardia have been documented to benefit. Patients with moderately severe or severe heart failure also profit from ICD implantation, where appropriate in combination with cardiac resynchronization therapy in conduction disorders. There is divergent data on dilated cardiomyopathy. ICD is not indicated in patients with acute infarctions or undergoing elective bypass surgery.
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PMID:AICD treatment in 2004--state of the art. 1710 77

In view of the high incidence of heart failure and sudden cardiac death, efforts in the development of compounds which target-specific mechanisms such as a reduced expression of SERCA2, the Ca2+ pump of sarcoplasmic reticulum, of hypertrophied cardiomyocytes of pressure-overloaded or infarcted hearts should be strengthened. Lead compounds for correcting a dysregulated gene expression are the carnitine palmitoyltransferase-1 (CPT-1) inhibitors etomoxir and oxfenicine. Since bypassing the CPT-1 inhibition by a medium-chain fatty acid diet had a lesser effect on myosin V1 proportion than on lipid droplet number, one has to infer also other mechanisms such as PPARalpha activation (FOXIB/PPARalpha). In view of the intricate interrelationship between depressed pump function and malignant arrhythmias, stimulation of endogenous antiarrhythmogenic mechanisms linked to an enhanced production of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) could potentially provide alternatives to the administration of 1 g EPA and DHA ethyl esters (minimum 84% EPA + DHA) for secondary prevention of myocardial infarction. The apparently greater efficacy of omega-3 fatty acids in post-myocardial infarction patients (GISSI-Prevention study) compared with ICD patients (SOFA study) can be attributed to the greater ischemia-induced release of membrane-bound EPA and DHA and a better compliance (one vs. four capsules daily).
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PMID:Acute heart failure--basic pathomechanism and new drug targets. 1714 74

This article provides information and a commentary on trials presented at the American Heart Association meeting held in November 2006, relevant to the pathophysiology, prevention and treatment of heart failure. All reports should be considered as preliminary data, as analyses may change in the final publication. The OAT study failed to show a benefit of PCI over optimal medical therapy in patients with persistent total occlusion of the infarct related artery following a myocardial infarction. In SALT 1 and 2, tolvaptan was found to correct hyponatraemia of various aetiologies; however, whether this has an impact on heart failure prognosis requires further evaluation. A placebo controlled study of myocardial implantation of skeletal myoblasts in patients with moderate to severe LVSD (MAGIC) showed equivocal/uncertain effects, long term follow-up data are awaited. The ABCD study which compared the ability of an invasive and a non-invasive test to identify patients at risk of arrhythmic events prior to ICD implantation, suggested that the two strategies were comparable, although the practical value of either test remains uncertain and the study had many major flaws. The PABA-CHF study hinted that pulmonary vein antrum isolation might be more effective than AV node ablation with bi-ventricular pacing for the treatment of patients with heart failure in atrial fibrillation. In IMPROVE-CHF, an NT-pro BNP guided treatment strategy was found to reduce the cost of managing patients with acute breathlessness.
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PMID:Clinical trials update from the American Heart Association 2006: OAT, SALT 1 and 2, MAGIC, ABCD, PABA-CHF, IMPROVE-CHF, and percutaneous mitral annuloplasty. 1718 69

The need to refine the identification of patients who might benefit from implantation of an implantable cardioverter defibrillator has been risen by the results of many clinical trials on ICD therapy. Traditional parameters such as left ventricular ejection fraction and the presence of non-sustained ventricular tachycardia were not strong enough to achieve this goal with reasonable cost-effectiveness. Heart rate variability (HRV) is one of the most popular parameters used to assess the autonomic tone. HRV has been reported as a strong predictor of cardiovascular mortality. Currently, three different categories of methods in HRV analysis are being used; the time domain, frequency domain, and non-linear dynamic analysis. Both time domain and frequency domain analyses of HRV have been investigated extensively regarding their use as a prognostic marker for cardiovascular mortality. The non-linear dynamic analysis is the latest tool that has shown to have an even higher predictive value than any of the traditional parameters. However, standardized and supporting evidence on this new technique is still lacking. In this article, the current role of HRV in the prediction of cardiovascular mortality in myocardial infarction and heart failure patients has been reviewed.
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PMID:Heart rate variability in myocardial infarction and heart failure. 1734 99


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