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

Heart transplantation has recently become an accepted method of treating heart failure patients, also in Poland. Criteria of patient selection to heart transplantation and follow-up was based (and in some centers still is) on the assessment of the patients' clinical status according to NYHA classification and on the data on the extend of myocardial damage obtained from echocardiography or ventriculography at rest. However, examinations performed in the resting state do not provide complete information on the patient's clinical status, especially during increased oxygen demand. Recently cardiopulmonary exercise testing (CPX-to measure maximal oxygen consumption) has been increasing used to establish the prognosis in patients with severe heart failure and to define indications to heart transplantation. CPX combines exercise testing with monitoring the air flow and gas exchange. The measurement of oxygen uptake and anaerobic threshold during exercise is an objective, reproducible, safe and non-invasive method to assess cardiac reserve. There is evidence implying that in heart failure patients VO2max is a good short-term indicator of mortality and that its deterioration frequently precedes clinical decompensation. Thus, the parameter may be useful not only in defining the indications, but also in the monitoring the patient's clinical state and timing of heart transplantation.
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PMID:[Clinical usefulness of cardiopulmonary exercise testing in patients with cardiac failure waiting heart transplantation]. 950 96

Over the next 10 years, heart failure is likely to become a medical and sociological problem as a result of improved treatment of ischaemic heart disease and hypertension. At present, in Poland, there are only 50% of the cardiological or cardiac surgery procedures (coronarography, PTCA, CABG, surgery of congenital or acquired heart disease) performed compared to Western Europe. After being registered on the waiting list, it can take anything between 3 and 12 months before the procedure is done. Patients with heart failure have diagnostic tests such as ECG, chest X-ray, and biochemical evaluation performed regardless of the level of care. When echocardiography, exercise testing or Holter monitoring is required, it is done at specialist or reference specialist facilities with a waiting time of approximately 1-3 months. Pharmaceutical treatment of CHF is also inadequate. ACE inhibitors are prescribed in approximately 68% of patients. The average prescribed dosage is far from that recommended in guidelines. Only 18-29% of patients with HF are on beta blockers. The improvement of cardiological care standards depends mainly on the financial resources of State Health System Agencies.
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PMID:Management of heart failure patients in Poland. 1195 52

The authors present the diagnostic and therapeutic management in bleeding episodes associated with cardiosurgical operations, which constitutes the policy that is employed at Department of Cardiac Surgery and Transplantology, Silesian Academy of Medicine, Zabrze, Poland. The paper also presents a compendium of information on the pathophysiology of coagulation processes, most significant from the standpoint of cardiosurgical practice. Separate issues associated with providing optimal hemostasis in patients operated on using cardiopulmonary bypass are discussed, along with the effect of cardiac procedures on coagulation processes. Further, the authors present their clinical observations and experience in the utilization of the recombinant activated factor VII (NovoSeven, NovoNordisk) in two patients with severe perioperative bleeding. In the first case bleeding was associated heart transplantation procedure in a 37-year old woman, who had previously been twice subjected to operations for valvular heart disease. A dysfunction of two artificial valves implanted 15 years previously resulted in considerable heart muscle damage and an extremenally severe form of cardiac insufficiency. Two months after the heart transplant the patient unfortunately died due to infectious complications. In the second patient the recombinant activated factor VII was employed in an attempt at controlling severe bleeding encountered in a 15-year old boy in the course of reoperation in surgical treatment of a complex congenital heart defect. In this case the treatment was successful. In both described patients who were characterized by a high risk of surgical bleeding, the employment of the recombinant activated factor VII led to significant improvement in coagulation system indices and the hemostatic outcome was regarded positive. The authors state that the introduction of the recombinant activated factor VII to clinical practice in a selected group of patients presenting with most serious coagulation abnormalities and difficult to control perioperational bleeding allows for improving therapeutic results and decreasing mortality in cardiac surgery patients. In view of the significant economic barrier associated with a high cost of the preparation, the authors propose a consistent approach of employing at all times the classic, well-balanced hemostatic management, based primarily on extended knowledge of the pathophysiology of the clotting system and on very thorough surgical hemostasis, with the recombinant activated factor VII being reserved for exceptional situations only.
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PMID:[New possibilities in the postoperative measures to prevent bleeding in cardiac surgery. Will the recombinant activated factor VII improve surgical results?]. 1271 27

Numerous animal experimental studies as well as the initial human experience have shown that autologous skeletal myoblast transplantation into area of post-infarction left ventricular injury results in an increase in segmental contractile performance related to contraction of cells differentiated from transplanted myoblasts. We have previously introduced skeletal myoblast transplantation performed at the time of coronary artery bypass grafting. Currently, we report the first two cases in Poland of percutaneous autologous myoblast transplantation in the treatment of post-infarction heart failure. The procedures were performed using a catheter system enabling intra-myocardial injections from the lumen of cardiac veins under intravascular ultrasound guidance. Lack of major procedural complications and expected benefits from myocardial regeneration in patients with post-infarction heart failure justify initiation of phase one clinical trial to evaluate this method.
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PMID:Percutaneous autologous myoblast transplantation in the treatment of post-infarction myocardial contractility impairment--report on two cases. 1472 96

This article continues a series of reports on recent research developments in the field of heart failure. Key presentations made at the European Society of Cardiology Heart Failure Update meeting, held in Wroclaw, Poland, in June 2004 are reported. The SHAPE study identified a need to educate general practitioners (GPs) in order to optimise treatment of heart failure in primary care. BRING-UP 2 VAS showed that cognitive impairment is very common in elderly heart failure patients and that these patients require specialist care. Carvedilol was shown to be well tolerated and effective in elderly heart failure patients in the observational COLA II study. In the FOSIDIAL study of patients with end-stage renal disease, fosinopril showed no benefit over placebo in reducing the incidence of cardiovascular events in these high-risk patients. The BETACAR study showed that carvedilol and metoprolol produced a similar effect on left ventricular ejection fraction (+13.1% and +12.0%, respectively). Revised mortality data for the CASINO study and a meta-analysis of the effects of cardiac resynchronisation therapy on mortality in the light of the recently published COMPANION study are reported.
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PMID:Clinical trials update from the European Society of Cardiology Heart Failure meeting: SHAPE, BRING-UP 2 VAS, COLA II, FOSIDIAL, BETACAR, CASINO and meta-analysis of cardiac resynchronisation therapy. 1530 18

Standards for secondary prevention in patients after acute coronary syndromes have been recently published by the European Society of Cardiology. They do not differ between patients without or with renal failure, but it may be suggested that the later group deserves special attention and more aggressive treatment. Both after myocardial infarction and unstable angina, practically all patients are supposed to receive antiplatelet therapy, statins, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors. They also are submitted to intensive coronary risk factor modifications. In recently undertaken Polish registry study of secondary prevention in acute myocardial infarction/unstable angina survivors and post-revascularization patients (STOK--Standard Terapii i Opieki Kardiologicznej trial) over 31,000 records of individual patients discharged from internal disease or cardiologic wards in Poland in 2002 were gathered. When records of 2,780 patients with concomitant elevated serum creatinine were compared with data of 28,585 patients with normal renal function, some interesting conclusions were drawn. Firstly, the group of patients with suspected renal dysfunction was characterized with more often recognized: diabetes, heart failure and peripheral vessel disease. Secondly paradoxically--they were less often prescribed with antiplatelet drugs, statins, beta-blockers and ACE inhibitors. Thus theory do not translate into practice.
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PMID:[Renal failure in patients after acute coronary syndrome--does it change the standards? From theory to practice]. 1662 16

The authors present a case of a 77-year-old man with heart failure in the course of dilated cardiomyopathy (DCM) and atrial fibrillation (AF), after implantation of an automatic cardioverter-defibrillator (ICD) due to recurrent symptomatic ventricular tachycardia (VT). Addition of cardiac resynchronization therapy (CRT) was decided due to the heart-failure dependent intensification of the arrhythmia and poststimulation enlargement of QRS. CRT was led to withdraw patient's arrhythmia and to improvement of the general condition of the patient for approximately one year. After the arrhythmia reoccurred due to dislocation of the electrode in the coronary sinus with loss of left ventricle stimulation. Multiple attempts at restoration of resynchronization function via a transvenous approach failed. The patient was qualified for implantation of an epicardial left ventricle electrode. The surgery was combined with a planned exchange of ICD-CRT. Basing on a 6-month observation period an improvement heart performance and general state of health have been observed. No arrhythmic event has been noted in device memory. Performed procedures are picturing the evolution of in pacing techniques and automatic defibrillation in Poland over recent years.
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PMID:[From implantable cardioverter-defibrillator to cardiac resynchronization therapy with the use of epicardial left ventricular lead. The evolution of the treatment of post inflammatory heart failure--a case report]. 1708 44

Hunter's Syndrome (MPS II) is a class of hereditary disorder characterized by a deficiency of specific enzyme--iduronate sulphatase required to break down mucopolisacharides and occurs in Poland in one of 100-150 thousand male live births. MPS II may be lethal in the second decade of life as a result of infiltrativ cardiomiopathy leading to irreversible heart failure or upper airway obstruction caused by infiltration, granulation and deformation in trachea or larynx. We report a case of 14-year-old male with Hunter Syndrome who developed tracheal obstruction and was treated with Nd-Yag laser. We discuss the possibility of treatment and our results--improvement in patient's symptomatic and functional status.
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PMID:[The use of Nd-Yag laser in the treatment of tracheal tumor in 14 years old child with mukopolisacharydosis type II]. 1715 17

Lung cancer is the main cause of cancer deaths around the world. At 12% of all cancer incidents, lung cancer is the most frequent single cause of death, of both males and females. In 2002 among male population in Poland, lung cancer was the second, following heart failure, cause of death, ranging at 8% of deaths in general. It was third cause of death among females ranging at 2.3% in general. Considering cancer deaths in 2002 in Wielkopolska, lung cancer was most frequent cause of death among males (30%) and second frequent among females (10.4%). The last 25 years the number of deaths decreased among younger generation of males (first in the age group 20-44, later in the middle age group) and this phenomenon has dominated the general picture of cancer among males. However the increase of mortality rates in the older age group might be still observed. The constant increase of mortality has been observed among females, especially in the middle age group (45-64). It should be highlighted that the level of mortality has been equalled in both genders in the youngest age group (20-44), which means suddenly growing risk among young population of women in Wielkopolska.
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PMID:[Epidemiological situation concerning lung cancer in Wielkopolska in 1975-2002]. 1726 66

A significant progress in the treatment of heart failure occurred during the last 20 years. These advances were associated with the introduction and subsequent widespread use of angiotensin- -converting enzyme inhibitors and beta blockers, but also with progress in device therapy and cardiac surgery. Overall, prognosis in patients with severe heart failure is similar to outcomes reported in multicenter randomized clinical trials, such as CONSENSUS, CIBIS II, MERIT-HF, and COPERNICUS. In 2003-2007, a registry of patients with severe heart failure was established in Poland (POLKARD-HF) that included all patients initially considered candidates for heart transplantation (HTX). Mean duration of follow-up was 601 days (range 1-1462 days). One-year mortality (defined as death or super-urgent HTX) was 20% and differed from data presented by Stewart (2001). In addition, patient survival in the POLKARD-HF registry depending on the New York Heart Association (NYHA) class changed significantly in comparison to outcomes reported in the late 1980s. However, one-year mortality among NYHA class IV patients is still high and exceeds 50%. As reported in the POLKARD-HF registry, one- -year risk of death among patient who underwent elective HTX was about 20%, and 3-year risk was about 22%, significantly different from the risk of death among medically treated patients with heart failure. These results are similar to other European data and warrant reconsideration of appropriatness of HTX in elective patients (UNOS 2 status). Undoubtedly, NYHA class IV patients are candidates for HTX and should remain under specialist care in cardiac transplantation centers, and HTX should be performed in this group when indications for this procedure become urgent (UNOS 1 and 1a status). A specialized system of care for patients with severe heart failure should be created in Poland, particularly for patients referred for HTX. There is also an urgent need to introduce modern systems of mechanical cardiac support (left ventricular assist devices, LVAD) that would allow precise determination of indications and contraindications to HTX and create opportunities for long-term treatment.
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PMID:Cardiac transplantation is still the method of choice in the treatment of patients with severe heart failure. 1995 84


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