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

Elevation of cytosolic sodium is thought to be correlated with an increase in force of contraction due to an activation of sodium-calcium exchange. We investigated the inotropic response mediated by the new sodium-channel activator BDF 9148 (0.01-100 mumol/l) on failing human myocardium. Force of contraction was studied using electrically driven human papillary muscle strips from moderately (NYHA II-III, mitral valve replacement) and terminally (NYHA IV, heart transplantation) failing hearts. We also investigated the effects in auricular trabeculae from non-failing hearts (aortocoronary bypass operation). Results were compared with inotropic responses to DPI 201-106 (DPI, 0.1-3 mumol/l), Ca2+ (1.8-15 mmol/l) and isoprenaline (0.001-1 mumol/l). Carbachol (100 mumol/l) and adenosine (1000 mumol/l) were examined in the presence of BDF 9148 and isoprenaline. Both sodium-channel activators, BDF 9148 and DPI 201-106, increased force of contraction in a dose-dependent manner in papillary muscle strips as well as in auricular trabeculae. BDF 9148 and DPI 201-106 were more effective (max. PIE NYHA II-III 1.6 +/- 0.2 mN, NYHA IV 5.9 +/- 0.7 mN, P less than 0.05) and more potent (EC50 (in mumol/l): NYHA IV 0.35, 0.19-0.66; NYHA II-III 1.85, 1.37-2.41) in terminally failing as compared to moderately failing left ventricular myocardium. Moreover, the positive inotropic effects of BDF 9148 were greater than those of DPI 201-106 in NYHA IV (max. PIE 2.7 +/- 0.3 mN, P less than 0.05). In NYHA IV, BDF 9148 was as effective as CA2+ (max. PIE 5.1 +/- 0.4 mN). In the same hearts, the positive inotropic effects of isoprenaline were reduced in NYHA IV (max. PIE 2.1 +/- 0.3 mN) compared to NYHA II-III (max. PIE 3.4 +/- 0.4 mN, P less than 0.05). Adenosine as well as carbachol did not affect the positive inotropic response of BDF 9148 or DPI 201-106 but reduced the effectiveness of isoprenaline (P less than 0.05). In myocardial membranes, BDF 9148 was 1000-fold less effective in competition experiments with 3H-ouabain than ouabain. We conclude that (1) sodium-channel activators may produce a significant cAMP-independent positive inotropic effect in left ventricular myocardium from failing human hearts; (2) the inotropic effect of sodium-channel activators were more potent and more effective in NYHA IV as compared to NYHA II-III. The degree of myocardial failure does not reduce the effectiveness of the sodium-channel activator BDF 9148.
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PMID:Evidence for a sustained effectiveness of sodium-channel activators in failing human myocardium. 165 40

The results of surgical treatment of 180 patients were studied according to the character of infectious endocarditis (primary--PIE and secondary--SIE), the functional class (FC) in the preoperative period, and the patients' immune status. The survival of patients with PIE (with hospital mortality taken into account) was somewhat higher than that of patients with SIE. Survival in the late-term periods was significantly higher in patients with PIE. There were no fatal outcomes among patients with PIE of FC III, mortality among patients with SIE was 7.7%; mortality in FC IV was, respectively, 10 and 21.6%; the mortality rate among patients with PIE and SIE of FC V was 43.5 and 57.5%, respectively. The late-term results were good in 85.5 and satisfactory in 14.5% of patients. Twenty-one (16%) patients died. Cardiac failure and recurrent sepsis were the main causes of fatal outcomes. The preoperative immunological parameters (the concentration of ceruloplasmin, blood serum IgG and IgM, the activity of lymphocyte mitochondrial enzymes and the neutrophil test) reflect the activity of infectious endocarditis and have an effect on the development of postoperative complications and on the mortality.
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PMID:[Analysis of results of surgical treatment of patients with infectious endocarditis]. 204 91

This column is the eighth in a series reporting on the efforts of the Centers for Medicare & Medicaid Services ([CMS], formerly known as the Health Care Financing Administration), to improve care for Medicare beneficiaries with heart failure. Previous columns have focused on the hospital-based National Heart Failure project. An outpatient practice-based project, the Heart Failure Practice Improvement Effort (HF PIE), was described in the fourth and sixth columns. This column reports experience from the HF PIE project at the practice level in three states.
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PMID:Improving heart failure care: CMS' initiative. Improving heart failure care in outpatient practices. 1192 82

Ca2+ sensitizers like EMD 57033 (EMD) and CGP 48506 (CGP) may be advantageous for the treatment of human heart failure, as they increase force of contraction without increasing the intracellular Ca2+ transients or energy consumption. However, whether or not Ca2+ sensitizers differ in their mode of action in human myocardium is not fully understood. The present study investigates the influence of EMD and CGP on force of contraction (FOC) and the intracellular Ca2+ transient (fura-2 ratio method) in left ventricular papillary muscle strips from left ventricular failing human myocardium (DCM, n = 28) as well as in right atrial trabeculae (RA, n = 21) obtained from patients undergoing cardiac bypass surgery. In isolated trabeculae of DCM, FOC was more efficacious and potently increased after application of EMD (EC50 EMD: 4.7 +/- 1.0 mumol/l, max. PIE EMD: + 12.0 +/- 2.0 mN/mm2) than CGP (EC50: 16.9 +/- 7.6 mumol/l, max. PIE: +6.4 +/- 2.8 mN/mm2). Similar results were obtained in RA. Application of carbachol (100 mumol/l) had no effect on the positive inotropic effect of EMD or CGP. Both Ca2+ sensitizers significantly increased time to half peak relaxation as well as diastolic tension in DCM. EMD (10 mumol/l) and CGP (30 mumol/l) did not affect the Ca2+ transients in RA. The Ca2+ sensitizers EMD and CGP increase cAMP and Ca2+ independently from the force of contraction in the human myocardium. However, their therapeutic use in human heart failure may be limited as they impair relaxation.
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PMID:Effects of the Ca2+ sensitizers EMD 57033 and CGP 48506 on myocardial contractility and Ca2+ transients in human ventricular and atrial myocardium. 1206 3

Purchasers of health care, patients, physicians, and other health care professionals are increasingly seeking to evaluate quality of health care. Scattered reports have suggested that there is currently marked variation in evaluation and treatment of heart failure and substantial gaps between guideline recommendations and care delivered to heart failure patients. Heart failure is the most common discharge diagnosis for Medicare beneficiaries and yet, until recently, relatively little national information was available to describe the quality of care and to identify opportunities to improve practice. To address the need to evaluate care of patients with heart failure and support national, state, and local efforts to improve care and outcomes, the Health Care Financing Administration has initiated three programs that stretch across much of the continuum of care: the National Heart Failure Quality Improvement Project, focusing on inpatient care; the Heart Failure Practice Improvement Effort (HF PIE), a pilot outpatient effort in 11 states; and the 2001 requirement for Medicare+Choice Organizations to initiate quality improvement efforts for their heart failure patients. This paper is the first in a series that will provide information about these programs. We hope that this series will stimulate discussion on how clinicians can join these national efforts to improve the care and outcomes of patients with heart failure. (c)2000 by CHF, Inc.
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PMID:Medicare initiatives to improve heart failure care: an introduction. 1218 90

Nonbacterial thrombotic (noninfectious, pseudoinfectious--PIE) endocarditis is characterized by precipitation of thrombus, not containing bacteria, on the valve cusps. Mitral and aortal valves are affected most frequently. Vegetations, as a rule, do not exceed 6-7 mm and have a high inclination to embolism. Hypercoagulation plays a leading role in PIE pathogenesis. The most frequent acquired causes of sterile vegetation forming are malignant tumors and rheumatic diseases (especially systemic lupus erythematosus--SLE and antiphospholipid syndrome--APS). Valve pathology is most frequent lesion of heart in APS patients. It is supposed, that antibodies to phospholipids (aPL) have a special importance in valve lesion pathogenesis at APS, besides, changes in valve apparatus at SLE are associated exactly with aPL. Main problems of PIE patients are recurrent thromboembolism, development of valve dysfunction with clinical signs of heart failure (4-6% cases), difficulties in differential diagnostics: PIE is hard to diagnose if basic disease is accompanied by fever (diffuse diseases of connective tissue etc.). Transesophageal echocardiography is a leading method in PIE diagnostics. The main therapeutic option in PIE treatment is anticoagulant therapy: nonfractional or subcutaneous heparin in presence of systemic or pulmonary embolism, in patients with disseminated malignant tumors--complete doses of nonfractional heparin.
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PMID:[Pseudoinfectious endocarditis]. 1872 Jul 5