Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Permanent residents at high altitude may develop excessive polycythaemia (H-Hb) and pulmonary hypertension, which often leads to cardiac failure. Inhibitors of calcium channels have been shown to reverse pulmonary hypertension in respiratory diseases and in primary pulmonary hypertension, but their efficiency has not been evaluated in high-altitude-induced pulmonary hypertension. Systolic pulmonary arterial pressure (Ppa) was studied by Doppler echocardiography, at rest and after sublingual nifedipine, in 31 asymptomatic residents at 3,600 m. Individuals were separated into two groups according to resting Ppa: a group with low Ppa (< or =4.7 kPa, n=17) and a group with high Ppa (>4.7 kPa, n=14). Individuals were also split into two groups according to haemoglobin (Hb) concentration: a normocythaemic (L-Hb) group ([Hb] < or =180 g.L(-1), n=17) and a H-Hb group ([Hb] >180 g.L.(-1), n=14). No significant difference in Ppa was observed between the L-Hb and H-Hb groups. There was no correlation between [Hb] and Ppa. Nifedipine induced a decrease of >20% in Ppa in two-thirds of the subjects. This response was correlated with higher levels of basal Ppa (p<0.001) and was inversely correlated with age in the L-Hb group (p<0.05). Pulmonary vasoreactivity to nifedipine was independent of the degree of H-Hb. Pulmonary hypertension secondary to chronic altitude hypoxia may be reversible, despite a possible remodelling of the pulmonary arterioles.
 ...
PMID:Pulmonary hypertension in high-altitude chronic hypoxia: response to nifedipine. 986 18

Secondary pulmonary hypertension is a marker of advanced heart failure (HF) that confers a poor prognosis. Consecutive patients from 2004 through 2005 who underwent echocardiographic assessments of systolic pulmonary arterial pressure (SPAP) before the implantation of cardiac resynchronization therapy defibrillators were included. Patients were divided into tertiles according to baseline SPAP. Patients in the lowest (group I, 20 to 29 mm Hg) and highest (group III, 45 to 88 mm Hg) tertiles were compared for the end points or death or transplantation and for HF hospital admission. Two hundred seventy patients were evaluated, of whom 95% were Caucasians and 91% men. The mean age was 66.5 +/- 11.6 years, the mean QRS duration was 155 +/- 30 ms, the mean left ventricular ejection fraction was 22.6 +/- 9.7%, and the mean New York Heart Association functional class was 3.0 +/- 0.4. In a multivariate model, death or transplantation was significantly more likely in group III (hazard ratio 2.62, 95% confidence interval 1.1 to 6.4, p = 0.036), as was HF admission (hazard ratio 6.35, 95% confidence interval 2.6 to 15.8, p <0.001). In patients with follow-up echocardiographic assessments, a reduction in SPAP was a significant predictor of freedom from the combined end point (hazard ratio 0.29, 95% confidence interval 0.12 to 0.76, p = 0.011). In conclusion, elevated baseline SPAP in patients who underwent cardiac resynchronization therapy is an independent predictor of all-cause mortality or transplantation and HF admission. A decrease in SPAP on follow-up echocardiography is an independent positive prognostic marker.
 ...
PMID:Usefulness of pulmonary artery pressure by echocardiography to predict outcome in patients receiving cardiac resynchronization therapy heart failure. 1817 13

Pulmonary hypertension secondary to left ventricular systolic dysfunction is often a poor prognostic marker in chronic heart failure. In this article, we review evidence supporting modern strategies addressing pulmonary hypertension in patients with left ventricular systolic dysfunction, including right-sided heart catheterization with vasoreactivity testing and subsequent parenteral, oral, and inhaled therapy. We delineate a diagnostic approach to secondary pulmonary hypertension and outline evidence-based therapeutic strategies for management in acute and chronic heart failure.
 ...
PMID:Pulmonary hypertension secondary to left ventricular systolic dysfunction: contemporary diagnosis and management. 1903 18