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)

Chronic atrial fibrillation affects over 2.2 million people and is associated with complications including heart failure, stroke, and exercise intolerance. Since drug therapy and cardioversion have been only partially successful in restoring sinus rhythm, surgical procedures were developed for medically refractory atrial fibrillation (1). We report a case of successful left atrial radiofrequency ablation for chronic atrial fibrillation in a patient who had a large secundum atrial septal defect.
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PMID:Radiofrequency maze ablation for atrial fibrillation in a patient undergoing atrial septal defect repair. 1465 Sep 1

165 patients with clinically-manifested chronic heart failure (CHF) and preserved (ejection fraction--EF > 40%) left ventricular (LV) systolic function have been investigated. 135 of them have ischaemic heart disease (IHD) and high blood pressure, 8 patients are without IHD and 22 patients with normal blood pressure. 62 patients have chronic atrial fibrillation. Survival value in patients with CHF and preserved LV systolic function was compared to survival value of those with CHF and impaired ejection fraction (EF < 40%). Patients with preserved LV systolic function have been found to be with better survival value than those with impaired ejection fraction (68 and 33% accordingly).
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PMID:[Clinical and instrumental predictors of survival in patients with chronic heart failure and intact systolic left ventricle function]. 1472 30

A 61-year-old man with congestive heart failure was referred to our hospital and diagnosed as atrial septal defect (ASD) [Qp/Qs = 1.6] with chronic atrial fibrillation. Occurrence of atrial fibrillation was supposed to be the cause of heart failure rather than L-R shunt of ASD. The patient was successfully operated on with the use of routine cardiopulmonary bypass. Radiofrequency modified maze procedure was done, and then small ASD (1 cm of diameter) was closed with patch. Postoperative transthoracic Doppler echocardiography confirmed clear A wave for transmitral and transtricuspid flow. The patient recovered uneventfully and was discharged in stable sinus rhythm and has been drug free since then.
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PMID:[Radiofrequency modified maze operation for chronic atrial fibrillation with ASD; report of a case]. 1497 9

Cardiac resynchronization therapy (CRT) or biventricular pacing is a novel adjunctive therapy for patients with advanced heart failure (HF). Many patients with severe HF have a left bundle branch block or an intraventricular conduction delay, with up to 25% of patients with a QRS > 120 ms, resulting in significant left ventricular (LV) dyssynchrony and a high mortality rate. The efficacy of CRT is based on the reduction in the conduction delay between the two ventricles and optimization of the ejection fraction, decrement in mitral regurgitation, LV remodeling, thus resulting in symptom improvement. Cardiac resynchronization therapy can be achieved both transvenously using a coronary sinus branch, or epicardially. Clinical trials have demonstrated a significant improvement in the NYHA class and the exercise capacity as well as a marked reduction in the hospitalization rate. More recently, the COMPANION trial showed a 43% reduction in a composite endpoint of all-cause mortality and hospitalization in the group receiving a CRT device in combination with an implantable cardiac defibrillator (ICD). Thus, management of patients with reduced LV function, wide QRS, and symptomatic refractory HF, despite optimal drug therapy, should include CRT as an option. The adjunct of an ICD combined with CRT should be considered if the LV ejection fraction (ischemic cardiomyopathy) is <30%. There are still significant unanswered questions regarding the nonresponder population and the role of tissue Doppler imaging techniques, the impact of CRT on total mortality and CRT in dilated cardiomyopathy or chronic atrial fibrillation. The use CRT postoperatively or at time of cardiac surgery, as well as new epicardial approaches using a thoracoscopic approach or robotically assisted surgery in patients not suitable for coronary vein leads are challenging topics to address in the years to come.
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PMID:Cardiac resynchronization therapy: device-based medicine for heart failure. 1515 61

From January 1986 to January 1987, 116 Mitroflow pericardial valves were implanted in 98 patients at our center. Ages ranged from 10 to 83 years (mean, 64.9 years). Forty-three patients (44%) were in New York Heart Association Functional Class III or IV at the time of surgery. Twelve patients (12%) had undergone prior cardiac surgery. Ten hospital deaths (10%) (70% Confidence Limits, 7% to 14%) occurred. Incremental risk factors for hospital death included female gender (p = 0.08), higher functional class preoperatively (p = 0.04), and longer cardiopulmonary bypass time (p = 0.05). All 88 hospital survivors (100%) were followed for 6 to 13 months (mean, 9 months) after repair. Two late deaths (2.3%) occurred: 1 at 1.5 months from subacute cardiac failure, and another at 5 months from non-valve-related sepsis. Actuarial survival at 15 months was 87% +/- 5.5%. No late reoperations were performed. One patient who exhibited mild mitral incompetence 4 months postoperatively is being followed closely. Two patients (2.3%) who were not on anticoagulant therapy developed thromboembolic events in association with chronic atrial fibrillation. No patient has had hemolysis or infective endocarditis. All patients are now in Functional Class I or II. Our early-phase assessment of this valve reveals a low risk of valve-related events. Its low-profile frame and wide, flexible sewing ring make this prosthesis technically satisfactory for implantation. Continuing close follow-up will determine intermediate-and late-phase hazards.
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PMID:Early-phase events with the mitroflow pericardial valve. 1522 43

A 79-year-old man presented with dilated cardiomyopathy and chronic atrial fibrillation. A DDD pacemaker was implanted due to sick sinus syndrome. His left ventricular ejection fraction was 23%. He was repeatedly admitted with congestive heart failure. Although cardiac resynchronization therapy was attempted, insertion of a pacing lead into the coronary sinus failed. Right ventricular bifocal pacing was done. The QRS width was shortened to 155 msec during bifocal pacing and 157 msec during right ventricular outflow pacing from 221 msec during right ventricular apical pacing. Heart failure was improved from New York Heart Association class III to II. Regional wall motion was assessed by strain of the myocardium. Bifocal pacing increased stroke volume due to improvement of longitudinal dyssynchrony of the septal and lateral walls. Bifocal pacing is effective for patients with severe congestive heart failure in whom biventricular pacing therapy has failed. Strain Doppler imaging is useful for the assessment of regional wall motion during cardiac pacing.
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PMID:[Assessment of regional wall motion using strain Doppler imaging during right ventricular bifocal pacing in a patient with severe congestive heart failure: a case report]. 1537 39

Cardiac resynchronization therapy (CRT) is a new therapeutic option for patients who have drug-refractory end-stage heart failure. Much information has been obtained from patients who have sinus rhythm, but the use of CRT in patients who have chronic atrial fibrillation (AF) has not been studied extensively. Accordingly, we evaluated the clinical response and long-term survival rate of CRT in patients who had heart failure and chronic AF, and the results were compared with those in patients who had sinus rhythm and who underwent CRT. Sixty patients who had end-stage heart failure (30 had sinus rhythm and 30 had chronic AF), New York Heart Association classes III to IV, left ventricular ejection fraction <35%, QRS interval >120 ms, and a left bundle branch block received a biventricular pacemaker. New York Heart Association class, Minnesota Quality of Life score, and 6-minute walking distance were evaluated at baseline and after 6 months of CRT. Long-term follow-up was </=2 years. New York Heart Association class, Minnesota Quality of Life score, and 6-minute walking distance improved significantly in the 2 groups after 6 months of CRT. The number of nonresponders was greater among patients who had AF. Nevertheless, the long-term survival rate was comparable between patients who had sinus rhythm and those who had AF. Patients who had AF demonstrated comparable benefit from CRT as those who had sinus rhythm.
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PMID:Comparison of response to cardiac resynchronization therapy in patients with sinus rhythm versus chronic atrial fibrillation. 1558 5

Changes in myosin heavy chain (MHC) isoform expression and protein composition occur during cardiac disease and it has been suggested that even a minor shift in MHC composition may exert a considerable effect on myocardial energetics and performance. Here an overview is provided of the cellular basis of the energy utilisation in cardiac tissue and novel data are presented concerning the economy of myocardial contraction in diseased atrial and ventricular human myocardium. ATP utilisation and force development were measured at various Ca(2+) concentrations during isometric contraction in chemically skinned atrial trabeculae from patients in sinus rhythm (SR) or with chronic atrial fibrillation (AF) and in ventricular muscle strips from non-failing donor or end-stage failing hearts. Contractile protein composition was analysed by one-dimensional gel electrophoresis. Atrial fibrillation was accompanied by a significant shift from the fast alpha-MHC isoform to the slow beta-MHC isoform, whereas both donor and failing ventricular tissue contained almost exclusively the beta-MHC isoform. Simultaneous measurements of force and ATP utilisation indicated that economy of contraction is preserved in atrial fibrillation and in end-stage human heart failure.
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PMID:Myosin heavy chain composition and the economy of contraction in healthy and diseased human myocardium. 1608 76

Despite progress in the management of heart failure (HF) using pharmacotherapy, the mortality and morbidity associated with this condition remain unacceptably high. Cardiac resynchronization therapy (CRT), a left-sided pacing therapy for drug-refractory and highly symptomatic HF patients with ventricular conduction delay, has been shown to improve left ventricular (LV) systolic function, myocardial oxygen consumption, and New York Heart Association functional class and to inhibit or reverse LV chamber dilation and remodeling. Atrial fibrillation is common in patients with HF and is associated with significant worsening of HF and myocardial function. Only recently have trials been designed to specifically study CRT in patients with HF and chronic atrial fibrillation. These studies have shown that CRT with biventricular or univentricular LV pacing in patients with atrial fibrillation corrects mechanical dyssynchrony and results in significant and sustained improvement in functional capacity, LV ejection fraction, quality of life, and QRS duration.
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PMID:Expanding cardiac resynchronization for systolic heart failure to patients with mechanical dyssynchrony and atrial fibrillation. 1619 87

We studied 944 hospitalized heart failure patients 65 years and older to examine the impact of incident atrial fibrillation on mortality. Patients were categorized into four groups based on past medical history and admission electrocardiogram: (1) no (neither past nor current), (2) incident (newly diagnosed), (3) past and (4) chronic (past and current) atrial fibrillation. The primary outcome was 4-year all-cause mortality. Bivariate and multivariable Cox proportion hazards analyses were used to determine risk of all-cause mortality. In the multivariable model, we adjusted for various demographic and clinical covariates. Compared with patients who never had atrial fibrillation, those with incident atrial fibrillation had a 57% higher risk of death (unadjusted hazard ratio, 1.57; 95% confidence interval, 1.22-2.03). After adjustment for other covariates the association remained unchanged (adjusted hazard ratio, 1.41; 95% confidence interval, 1.08-1.83). Past or chronic atrial fibrillation was not associated with increased risk of death.
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PMID:Incident atrial fibrillation and mortality in older adults with heart failure. 1632 63


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