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

Poor survival in pulmonary hypertension is known to be associated with unfavorable hemodynamic variables, including elevated right atrial pressure, elevated mean pulmonary artery pressure, and low cardiac index. However, the effect of plasma volume on outcome has not been evaluated. Our goal was to study the spectrum of plasma volume distribution in patients with pulmonary hypertension and to determine whether plasma volume could provide any prognostic insight in these patients. Our pilot study comprised 11 patients (aged 46 +/- 16 years; 7 women) who were undergoing pulmonary artery catheterization before vasodilator therapy. In all 11 patients, plasma volume was measured, with use of < 25 microCi 131I-radioiodinated serum albumin. Patient follow-up averaged 19 months. There were 2 deaths. The 2 patients who died had the highest right atrial pressures in the group: > or = 17 mmHg. Those 2 patients also had 2 of the 3 highest plasma volumes at > or = 8.4%. None of the patients underwent lung transplantation. The propensity for elevated plasma volume and right atrial pressure in patients who died in this pilot study is consistent with the advanced right-sided heart failure that occurs in the terminal stages of pulmonary hypertension. Elevated plasma volume may be a useful prognosticator; further studies are needed to assess whether manipulation of plasma volume affects prognosis.
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PMID:Plasma volume and outcome in pulmonary hypertension. 1467 41

Individuals with type 2 diabetes and nephropathy represent a particularly high-risk group for both adverse cardiac as well as renal events. Using the Irbesartan in Diabetic Nephropathy Trial (IDNT) cohort, our objective was to determine baseline characteristics of individuals with type 2 diabetic nephropathy and hypertension predictive for cardiac events. IDNT identified 1715 individuals with type 2 diabetic nephropathy and hypertension having serum creatinine of 1.0 to 3.0 mg/dL and urinary albumin excretion rates > or = 900 mg/day. A cardiovascular (CV) composite was used consisting of CV death, nonfatal MI, hospitalization for heart failure, stroke, amputation, and coronary and peripheral revascularization. Using multivariable Cox regression analysis, 41 baseline characteristics determined a priori were analyzed for their potential relationship to risk of experiencing a CV event. Of the 1715 individuals, 518 (30.2%) had at least one of the CV composite end points. Older age, male gender, longer duration of diabetes, history of cardiovascular disease, history of CHF, high urinary albumin:creatinine ratio, and low serum albumin were strong predictors for CV events; of these, prior history of CVD (RR 2.00, 95% CI 1.63-2.45; P < 0.0001) and high urinary albumin:creatinine ratio (RR 1.29 per natural log unit, 95% CI 1.13-1.48; P = 0.0002) at baseline were highly predictive for cardiovascular events. In conclusion, among individuals with hypertension and diabetic nephropathy, both the degree of albuminuria and lower serum albumin levels provide additional prognostic information concerning cardiovascular risk, in addition to traditional coronary risk factors.
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PMID:Predictors of cardiovascular events in patients with type 2 diabetic nephropathy and hypertension: a case for albuminuria. 1548 18

Despite the crucial role of calcium in myocardial contractility, hypocalcemia has very rarely been reported as a reversible cause of heart failure. In this article, we describe a case of a 51-year-old woman with advanced stages of chronic renal failure after parathyroidectomy who exhibited congestive heart failure, severe hypocalcemia, hypomagnesemia and hypokalemia. Severe hypocalcemia resulted from discontinuation of taking calcium supplements after parathyroidectomy and from reduced 1.25(OH)2D3 synthesis by damaged kidneys. The patient presented with reduced left ventricular ejection fraction (EF) and ECG abnormalities (T wave alternans and increased QTc dispersion), both of which improved after correction of serum calcium levels. Her serum levels of total calcium corrected for serum albumin, but not serum levels of magnesium or potassium, positively and negatively correlated with EF and QTc dispersion, respectively. In the present case, both heart failure and the ECG abnormalities are directly associated with hypocalcemia.
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PMID:Reversible hypocalcemic heart failure with T wave alternans and increased QTc dispersion in a patient with chronic renal failure after parathyroidectomy. 1642 46

Although acute pericarditis is a common and usual benign disorder, sometimes evolution to constrictive pericarditis may occur. We present a case of constrictive pericarditis late after coronary bypass grafting, complicated by right sided heart failure. Edema formation was aggravated due to protein-losing enteropathy, resulting in hypoalbuminemia. Imaging of constrictive pericarditis was done by ultrasound as well as simultaneous pressure recording of the right and left ventricle. Imaging of intestinal protein loss was possible using intravenous Technetium-99m-labelled human serum albumin.
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PMID:Protein-losing enteropathy in association with constrictive pericarditis. 1650 21

The present study examined the usefulness of serum albumin concentration measured immediately after clinical stabilization for in-hospital risk stratification in 64 consecutive elderly, institutionalized patients with definite evidence of acute heart failure, of whom 17 died during their in-hospital stay. Serum albumin concentration was a powerful predictor of in-hospital death in this clinical setting (hazard ratio of 0.80 [0.71-0.89], p<0.001). A serum albumin concentration of <3 g/dl (median value) had a sensitivity of 94% and a specificity of 68% for the prediction of in-hospital mortality. Furthermore, this biomarker was able to provide incremental prognostic information over usual prognostic variables obtained at presentation such as age, systolic blood pressure and blood urea nitrogen.
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PMID:Usefulness of serum albumin concentration for in-hospital risk stratification in frail, elderly patients with acute heart failure. Insights from a prospective, monocenter study. 1802 37

Myocarditis, often initiated by viral infection, may progress to autoimmune inflammatory heart disease, dilated cardiomyopathy and heart failure. Although cardiac myosin is a dominant autoantigen in animal models of myocarditis and is released from the heart during viral myocarditis, the characterization, role and significance of anti-cardiac myosin autoantibodies is poorly defined. In our study, we define the human cardiac myosin epitopes in human myocarditis and cardiomyopathies and establish a mechanism to explain how anti-cardiac myosin autoantibodies may contribute to heart disease. We show that autoantibodies to cardiac myosin in sera from myocarditis and dilated cardiomyopathies in humans targeted primarily epitopes in the S2 hinge region of cardiac myosin. In addition, anti-cardiac myosin antibodies in sera or purified IgG from myocarditis and cardiomyopathy targeted the beta-adrenergic receptor and induced antibody-mediated cAMP-dependent protein kinase A (PKA) cell signaling activity in heart cells. Antibody-mediated PKA activity in sera was abrogated by absorption with anti-human IgG. Antibody-mediated cell signaling of PKA was blocked by antigen-specific inhibition by human cardiac myosin or the beta-adrenergic receptor but not the alpha adrenergic receptor or bovine serum albumin. Propranolol, a beta blocker and inhibitor of the beta-adrenergic receptor pathway also blocked the antibody-mediated signaling of the beta-adrenergic receptor and PKA. The data suggest that IgG antibody against human cardiac myosin reacts with the beta-adrenergic receptor and triggers PKA signaling in heart cells. In summary, we have identified a new class of crossreactive autoantibodies against human cardiac myosin and the beta-adrenergic receptor in the heart. In addition, we have defined disease specific peptide epitopes in the human cardiac myosin rod S2 region in human myocarditis and cardiomyopathy as well as a mechanistic role of autoantibody in the pathogenesis of disease.
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PMID:Consequences of unlocking the cardiac myosin molecule in human myocarditis and cardiomyopathies. 1878 70

We have been exploring the potential of 5-HT(2B) antagonists as a therapy for chronic heart failure. To assess the potential of this therapeutic approach, we sought compounds possessing the following attributes: (a) potent and selective antagonism of the 5-HT(2B) receptor, (b) low impact of serum proteins on potency, and (c) desirable pharmacokinetic properties. This Letter describes our investigation of a biphenyl benzimidazole class of compounds that resulted in 5-HT(2B) antagonists possessing the above attributes. Improving potency in a human serum albumin shift assay proved to be the most significant SAR discovery.
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PMID:A new class of 5-HT2B antagonists possesses favorable potency, selectivity, and rat pharmacokinetic properties. 1930 14

Electrolyte abnormalities are frequently observed in elderly long-term care (LTC) patients. Magnesium is a trace mineral, but is the second most abundant intracellular cation and the fourth most abundant cation in the body. This was a cross-sectional study to assess the prevalence of hypomagnesemia (HM) in non-selected elderly LTC patients. A total of 159 patients aged 65 years and older were included in the study. The attributes and variables related to the patients' hospital course were used to compare the two groups. We used univariate and multivariate analyses to correlate magnesium levels with demographic, clinical factors and laboratory data. HM was found in 36% of the patients, of whom 35% presented with moderate HM (0.8-0.9 microequiv./l) and 18% with severe HM (<or=0.7 microequiv./l). Patients with HM had a higher number of comorbid diseases per patient (p=0.038), low body mass index (BMI) (p=0.044) and more of them presented with laboratory markers of malnutrition, such as low total cholesterol (TC) and serum albumin (SA) levels. Coexistence with other electrolyte abnormalities was higher among patients with HM than without (p=0.006), predominantly hypocalcemia and hypokalemia (p=0.023 and 0.032, respectively). Using regression analysis, independent variables significantly associated with serum magnesium levels were serum albumin, calcium, potassium, urea levels, chronic renal failure (CRF), chronic heart failure (CHF), diabetes mellitus (DM) and diuretic drugs (R(2)=0.877). Both early (up to 30 days) and late rate of death were higher in patients with HM. The incidence of HM in LTC elderly patients is high and multifactorial. Understanding the causes of HM, correction of magnesium level, and definitive and effective treatment of the cause leading to HM is important to improve patient prognosis.
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PMID:Prevalence of hypomagnesemia (HM) in a geriatric long-term care (LTC) setting. 1966 41

The primary objective of this prospective dose-finding pilot study is to demonstrate the tolerability and safety of four dosages of 25% human albumin in patients with subarachnoid hemorrhage (SAH). For each dosage group, the study will enroll 20 patients who meet the eligibility criteria. The enrolled patients will undergo follow-up for 90 days post-treatment. The primary tolerability hypothesis is that intravenous 25% human albumin can be given without precipitating treatment related serious adverse events beyond expectations. The study will determine the maximum tolerated dosage of 25% human albumin therapy based on the rate of treatment related serious adverse events during treatment: severe or life-threatening heart failure. The secondary objectives are to obtain preliminary estimates of the albumin treatment effect using the incidence of neurological deterioration within 15 days after symptom onset. In addition, the incidence of rebleeding, hydrocephalus, seizures, delayed cerebral ischemia and the incidence of vasospasm (both symptomatic and by transcranial Doppler ultrasound criteria) within 15 days after symptom onset will be evaluated. Furthermore, the serum osmolality and serum albumin concentrations, serum magnesium concentration, blood pressure and heart rate within 15 days of symptom onset will also be observed. The Glasgow Outcome Scale, Barthel Index, modified Rankin Scale, NIH Stroke Scale, and Stroke Impact Scale will be performed 3 months after the onset of symptoms to assess residual neurological deficits.
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PMID:Treatment of subarachnoid hemorrhage with human albumin: ALISAH study. Rationale and design. 2053 87

A 23-year-old woman with heart failure developed pressure ulcer on her sacral area due to a long-term bed rest and impaired hemodynamics. The ulcer improved only slightly after 2 months with povidone-iodine sugar ointment because of severe nausea and anorexia. Then, the nutrition support team (NST) started intervention and estimated the patient's malnutrition from her body weight (30.1 kg), body mass index (BMI) (13.9), triceps skinfold thickness (TSF) (3.5 mm), arm circumference (AC) (17.2 cm) and serum albumin (2.6 g/dl). The NST administrated an enteral nutrition formula through a nasogastric tube and tried to provide meals according to the patient's taste. Although DESIGN score improved to 7 (DESIGN: d2e1s2i1g1n0 = 7) 2 months later, severe nausea prevented the patient from taking any food perorally. However, after nasogastric decannulation, her appetite improved and 1 month later her body weight increased to 32.8 kg, her BMI to 15.2, TSF to 7.5 mm, AC to 19.7 cm and serum albumin to 4.1 g/dl, and the wound completely healed.
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PMID:Successful Intervention for Pressure Ulcer by Nutrition Support Team: A Case Report. 2068 36


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