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

In contrast to cyclic AMP-dependent positive inotropes, the calcium-sensitizer and partial phosphodiesterase (PDE) inhibitor pimobendan may induce beneficial effects in heart failure. However, its effect on relaxation, myocardial energetics and neurohormones are unknown. Twelve patients with heart failure, New York Heart Association (NYHA) classification II-III, due to ischemic cardiomyopathy, were studied for 1 h after they received 5 mg pimobendan intravenously (i.v.). Pimobendan progressively reduced systemic resistance and left ventricular end-diastolic pressure (LVEDP) (22 and 50%, respectively) and improved isovolumetric contractility and relaxation parameters by 30% (all p < 0.05 vs. control). LV end-diastolic and end-systolic volumes (LVEDV, LVESV) decreased significantly by 20 and 19%, respectively. Cardiac output (CO) increased by 17% due to a simultaneous increase in heart rate (HR) from 75 +/- 3 to 86 +/- 5 beats/min (mean +/- SEM, p < 0.05). Pimobendan did not change coronary hemodynamics, but myocardial O2 extraction and consumption were decreased significantly by 18 and 20%, respectively. Catecholamines, angiotensin II (AII), and aldosterone levels did not change significantly. In contrast, arterial and coronary venous renin increased significantly from 57 +/- 17 and 53 +/- 14.7 microM/h at control to 69 +/- 20 and 69 +/- 20 microM/h, respectively, 60 min after pimobendan administration. Simultaneously, cardiac renin uptake at baseline (0.449 +/- 0.185 mumol/min) changed to release (-0.071 +/- 0.145 mumol/min, p < 0.05). Serious side effects did not occur. Thus, pimobendan had progressive positive inotropic and lusitropic effects, diminished preload and afterload despite modest stimulation of plasma renin activity (PRA), and reduced systemic vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemodynamic, neurohumoral, and myocardial energetic effects of pimobendan, a novel calcium-sensitizing compound, in patients with mild to moderate heart failure. 753 50

A 67-year-old female patient underwent a left ventricular aneurysmectomy and mitral valve replacement for ischemic cardiomyopathy. The replacement was done through left ventricle rather than left atrium. She had heart failure of NYHA class IV despite aggressive medical therapy. Preoperative examination revealed a left ventricular aneurysm and mitral regurgitation of grade II with markedly reduced ventricular function (LVEF 17%). Mitral valve replacement through left ventricle preserving chorda of the mitral valve is a promising method to eliminate regurgitation and shorten the cardiac ischemic time.
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PMID:[A successful case of ischemic cardiomyopathy associated with left ventricular aneurysm and mitral regurgitation]. 756 43

Near infrared spectroscopy (NIRS) is a noninvasive technique of monitoring tissue oxygen saturation by detecting changes in tissue absorbance of two wavelengths (850 and 760 nm) reflecting the relative oxygenation of hemoglobin and myoglobin. Aim of the present study was to determine whether changes in skeletal muscle oxygen saturation during incremental exercise detected by NIRS can reflect an impared oxygen delivery and an early onset of anaerobic metabolism in patients with chronic heart failure (CHF). We studied 19 subjects (mean age 43 +/- 16 years). Seven patients had a history of CHF with a diagnosis of ischemic cardiomyopathy (Group A) and 12 were healthy sedentary (Group B). All patients had a history of dyspnea on exertion (NY-HA II), peripheral edema, pulmonary rales and cardiac gallop sounds over the last 6 months. They were in sinus rhythm and stable clinical condition in the last 3 months. They were well matched regarding age, sex and body surface area. All subjects performed an incremental work rate test in a ramp pattern on a upright cycle ergometer until volitional fatigue. Gas exchange was measured breath by breath with a metabolic chart. Muscle oxygenation was determined, transcutaneously, during the exercise test over the vastus lateralis muscle with NIRS. At peak exercise, work rate, VO2, anaerobic threshold (LAT), heart rate and systolic blood pressure were significantly lower in Group A compared to Group B (92 +/- 28 vs 232 +/- 17 watts; 14 +/- 2 vs 21 +/- 2 ml/kg/min; 868 +/- 225 vs 1317 +/- 354 ml/min; 149 +/- 7 vs 172 +/- 18 b/min; 145 +/- 18 vs 195 +/- 21 mm Hg, respectively; p < 0.0001 for all). In both groups, as work rate increased, tissue oxygenation initially either remained constant near resting levels or decreased. In both groups, muscle oxygenation decreased more steeply near the work rate where lactic acidosis (LAT) was detected. However, patients with CHF had an earlier acceleration in muscle deoxygenation compared to the other group, indicating a premature onset of anaerobic metabolism. Moreover, Group A had a flatter increase in both heart rate and systolic blood pressure and a steeper slope of oxygenation profile at all matched workloads compared to normals (Group A: -0.13 +/- 0.03 ml/min; Group B: -0.06 +/- 0.015 ml/min; p < 0.0001). The LAT correlated with the work rate at which the rate of tissue O2 desaturation accelerated (r = 0.94; p < 0.0001).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Near infrared spectroscopy and changes in skeletal muscle oxygenation during incremental exercise in chronic heart failure: a comparison with healthy subjects. 764 20

The three components of the Novacor left ventricular assist system, compact controller, battery, and back-up battery, have been miniaturized in the development of the wearable system. Therefore patients can be fully mobilized receiving mechanical circulatory support while awaiting heart transplantation. Between February 1992 and April 1994 a total of eight patients with decompensated heart failure (6 dilated cardiomyopathy, 1 acute myocarditis, 1 ischemic cardiomyopathy) were treated with the Novacor left ventricular assist systems. In the most recent four cases the wearable system (N100P) was used. Patients' ages ranged from 17 to 49 years. In five patients severe failure of the right side of the heart was present at the time of implantation. Hemodynamic stabilization was achieved in all patients during the 2 to 122 days (mean 30.8 +/- 42.5 days) of support. The following parameters were measured on average before and 24 hours after implantation of the left ventricular assist system: mean arterial pressure 70 +/- 11 versus 87 +/- 13 mm Hg (p < 0.05), cardiac index 1.71 +/- 0.42 versus 3.23 +/- 0.74 L/min/m2 (p < 0.05), pulmonary capillary wedge pressure 27.1 +/- 4.4 versus 9.9 +/- 5.2 mm Hg (p < 0.01), mean pulmonary pressure 41 +/- 9 versus 27 +/- 6 mm Hg (p < 0.05), and right ventricular ejection fraction 16.7% +/- 10.3% versus 22.0% +/- 11.6% (not significant). Patients who received the wearable system were capable of managing their own power supply during the bridging period and were able to walk to the hospital park and shopping area. One patient had a serious pulmonary infection, which was treated successfully, and two patients had a cerebrovascular accident, which resolved in one and resulted in a minor residual deficit in the other. All eight patients received a heart transplant. One patient died early after transplantation and seven patients are alive and well. In summary, the wearable Novacor left ventricular assist system provides major advantages regarding quality of life of patients during mechanical circulatory support. However, there is a remaining risk of thromboembolism despite anticoagulation therapy.
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PMID:Experience with the Novacor left ventricular assist system as a bridge to cardiac transplantation, including the new wearable system. 781 10

In patients with severe coronary disease and poor left ventricular function, coronary artery bypass grafting has a positive impact on long-term survival. In presence of angina or documented ischemia, it is beneficial in protecting functioning muscle against future infarction. In patients with heart failure and no angina, it is a rational option when large areas of akinetic but viable myocardium are identified preoperatively; under these circumstances, recovery of myocardial function is the goal of coronary revascularization. Obviously, reliable methods of assessing myocardial viability and contractile reserve are required for an accurate selection of patients. Advances in perioperative management, including myocardial preservation, have consistently reduced the operative risk in the most recent series, and more appropriate selection criteria have substantially contributed to the improved long-term survival. Variables associated with higher hospital mortality as well as factors influencing long-term outcome have been identified. The beneficial effect of coronary artery bypass grafting on the functional status of patients has been documented in several studies, and the improvement in left ventricular function has been objectively demonstrated. The concepts and the data presented in this review may help to define the present role of coronary artery bypass grafting in the treatment of ischemic cardiomyopathy.
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PMID:Coronary artery bypass grafting for left ventricular dysfunction. 781 24

Studies of electrocardiographic predictors of mortality in patients with chronic heart failure have reached varying conclusions. Differences in the characteristics of the patients studied may explain the conflicting results regarding both a prolonged QRS and an abnormal signal-averaged electrocardiogram (SAE). We therefore investigated the impact of the etiology of heart failure on the prognostic importance of a prolonged QRS and an abnormal SAE in 200 patients with heart failure. Patients were categorized according to etiology of heart failure and electrocardiographic parameters. The mortality of patients with a prolonged QRS was compared with mortality in those with both abnormal and normal SAEs. This was done for the entire group, and separately for those with ischemic and those with nonischemic cardiomyopathy. The mean follow-up was 18.8 months. Nonischemic patients with a prolonged QRS had significantly worse survival than other patients. However, nonischemic patients with an abnormal SAE did not have a worse prognosis than patients with a normal SAE. One-year survival of patients with a prolonged QRS was 71%, compared with 98% in patients with a normal and 87% in patients with an abnormal SAE (p < 0.05). In contrast, a prolonged QRS was not a predictor of poor prognosis in patients with ischemic cardiomyopathy (81% one year mortality). Patients with ischemic cardiomyopathy and an abnormal SAE tended to have a poorer survival than patients with a normal SAE (73% and 81% one year mortality, respectively). Thus, the etiology of heart failure affects the prognostic importance of both a prolonged QRS and an abnormal SAE.
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PMID:Prognostic value of the signal-averaged electrocardiogram and a prolonged QRS in ischemic and nonischemic cardiomyopathy. 786 89

A pretransplant diagnosis was compared with the diagnosis made after macroscopic and microscopic examination of the explanted hearts in 112 cardiac transplant recipients. A coronary angiogram was recorded in 87.5% and endomyocardial biopsy was performed in 12.5% of patients within 1 year of the transplant. Echocardiograms were obtained in all patients. Before transplantation, 57.1% of patients were classified as having ischemic cardiomyopathy and 33.9% were classified as having idiopathic dilated cardiomyopathy (IDC). At explantation, severe coronary artery disease was found in all patients with a pretransplant diagnosis of ischemic cardiomyopathy, in 9 patients with a pretransplant diagnosis of IDC (6 of them had a "normal" pretransplant angiograms), and in 3 of the 4 patients with presumptive alcoholic cardiomyopathy. Left ventricular hypertrophy, undetected on echocardiography, was found at autopsy in 11 patients with presumed IDC, and acute myocarditis was found in 3 patients with a pretransplant diagnosis of IDC. A correct pretransplant diagnosis can lead to different management (e.g., bypass surgery rather than transplant), and may also portend different pre- and post-transplant prognoses. The results of this study suggest that an "in-depth" search for a cause should be conducted in all patients with heart failure, regardless of their clinical presentation. Our study also emphasizes the limitations of coronary angiography and echocardiography in patients with IDC and the need for improving current diagnostic techniques in these patients.
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PMID:Discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy. 797 22

Intra-aortic balloon (IAB) counterpulsation has been utilized as an effective "bridge" to transplantation in patients with end-stage heart failure. To determine if patients with heart failure with nonischemic cardiomyopathy (NICM) derive the same benefit from IAB support as those with ischemic cardiomyopathy (ISCM), we evaluated 27 patients with NICM and 16 patients with ISCM who required IAB support while awaiting transplantation. Hemodynamic changes, effects on organ function (renal and hepatic), frequency of complications, and clinical outcomes were analyzed. Baseline demographics and hemodynamics were comparable in both groups (p = NS). Hemodynamics improved in both groups, immediately (15 to 30 min) following IAB insertion, with greater improvement (p < 0.05) in cardiac index and a trend toward greater reduction in filling pressures in the NICM group. Systemic vascular resistance fell to a similar degree in both groups. During continued IAB support (0.13 to 38 days in NICM, 1 to 54 days in ISCM), all hemodynamic changes persisted in both groups, with larger decrease (p < 0.05) in systemic vascular resistance and greater increase (p < 0.05) in cardiac index in the patients with NICM. The reduction in filling pressures, however, tended to be greater in patients with ISCM. Renal and hepatic function parameters improved to a similar extent in both groups. The frequency of complications and clinical outcome during IAB support were also similar in the two groups. These data confirm that IAB counterpulsation is a safe and effective "bridge" in patients with both NICM and ISCM with end-stage heart failure. The mechanism of sustained benefit in the two groups, however, may be different; afterload reduction appears to be more important in patients with NICM whereas reduction in filling pressures (increased coronary perfusion pressure) may be the main mechanism in patients with ISCM.
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PMID:Intra-aortic balloon counterpulsation as a 'bridge' to cardiac transplantation. Effects in nonischemic and ischemic cardiomyopathy. 798 84

Early studies of acute beta-blocking drug therapy, such as metoprolol and acebutolol, in patients with idiopathic dilated cardiomyopathy (IDC) and survivors of acute myocardial infarction were interpreted to have detrimental or, at best, neutral effects on cardiac and clinical hemodynamics. Subsequent trials of longer duration with metoprolol versus placebo in patients with IDC demonstrated an "exceptional response" to beta-blocker therapy in some individuals. Hemodynamics and patient demographic characteristics appear not to predict those patients who may or may not benefit. Controlled trials with newer beta-adrenoceptor modulating drugs--such as xamoterol, bucindolol, and carvedilol--have been equivocal in some situations. Xamoterol has been associated with progressive heart failure and increased sudden cardiac deaths, whereas bucindolol improved clinical heart failure symptoms and testing hemodynamic parameters, as did treatment with carvedilol, in patients with ischemic cardiomyopathy. The success of these agents in patients with congestive heart failure may be in their ability to modulate the excessive myocardial stimulation of the beta-adrenergic nervous system while benefitting the dynamics of the peripheral system.
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PMID:Controlled trials with beta blockers in heart failure: metoprolol as the prototype. 809 75

Modern therapeutic options in ischemic coronary disease such as thrombolysis, coronary angioplasty, new emerging strategies in treating heart failure and secondary prevention have resulted in decreasing cardiac mortality over the last ten years. In the era of interventional cardiology a new focus of clinical interest is the process of transition from loss of contractile function to definitive necrosis of severely ischemic myocardium. The decision for bypass surgery or angioplasty in patients with compromised contractile function should be based on evidence of viable myocardium with some or full potential for functional recovery; otherwise prognostic benefit may be questionable or dubious. The clinical substrate of non-contractile, but viable myocardial tissue may be present in patient presenting with both stable and unstable angina, in cases of acute or chronic myocardial infarction and in the setting of congestive heart failure resulting from ischemic cardiomyopathy. Various diagnostic methods are theoretically useful to assess residual myocardial viability both in hibernating myocardium (contractile down-regulation) and post-ischemic stunned (reperfused) myocardial tissue. Myocardial viability is confirmed both in presence of systolic wall motion or systolic wall thickening as evidenced from (contrast or radionuclide) left ventricular angiograms or echograms. Moreover, myocardial tissue perfusion by thallium-201 or other radioactive perfusion agents as documented by uptake of tracer is considered clear evidence of viability; however, lack of uptake of perfusion agents may not always exclude viable myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Myocardial vitality: clinical correlates and diagnostic concepts]. 815 Apr 10


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