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

The speed of flow between aortic arch and abdominal aorta was determined from the corresponding minimal transit time (MTT) measured with 113m-In-DTPA and the Fucks-Knipping gamma camera. A total of 144 individuals was examined: 62 normal persons, 34 patients with cardiac insufficiency; 31 patients with hyperkinetic syndrome (effort syndrome and hyperthyroidism) and 17 patients with isolated aortic sclerosis without impairment of cardiac function. In all individual groups there was a highly significant correlation between speed of flow and heart rate. For a given heart rate speed of flow was diminished in cases of cardiac insufficiency and aortic sclerosis; it was accelerated in patients with hyperkinetic syndrome. By plotting the speed of flow through the aorta, normalized to an arbitary heart rate, against the corresponding MTT, also normalized to the same heart rate, the presence of aortic sclerosis could be differentially recognized in 14 of the 17 patients with this disease.
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PMID:[Isotope-angiographic measurement of aortic flow velocity for differential diagnosis of aortic sclerosis]. 114 52

M-mode and 'real-time' echocardiography was employed to study 100 elderly with systolic murmurs and cardiac disease. Technically adequate recordings were obtained in 89 patients. Independent assessment of the echocardiographs showed good reproducibility. Aortic sclerosis was the most prevalent lesion, but did not by itself impair left ventricular function. The echocardiographic diagnosis of mitral regurgitation was significantly related to heart failure and atrial fibrillation. A link between murmur and cardiac disease was postulated in 40% of cases.
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PMID:Echocardiographic diagnoses in elderly patients with systolic murmurs and cardiac disease. 373 54

A series of 45 adults with severe valvular aortic stenosis underwent echocardiographic examination before surgery. The echocardiographic indices of the severity of the stenosis were reviewed: In M mode: aortic valve opening was only clearly defined and quantifiable in 22 out of 45 cases. In these 22 cases, the separation of the valves was variable in 9 cases; the stenosis was underestimated in 2 cases both of which were unsuspected bicuspid valves; the stenosis were overestimated in 1 case leading to an erroneous diagnosis. In 2D: aortic valve opening was easier to detect than in M mode; it was quantifiable in 16 out of 21 patients (80 p. 100). The subcostal view was particularly valuable in patients with chronic pulmonary disease or with barrel-shaped chests. The 2D examination however, suffers from the same limitations as M mode: variability in the values of aortic valve opening in a third of cases and a general tendency to overestimate the severity of the stenosis. In two cases an erroneous diagnosis of severe stenosis was made in cases of simple aortic sclerosis either because of the inability to visualise a mobile 3rd left anterior cusp in the long axis view or because of artefact due to paravalvular calcification. The most reliable index of severity was the thickness of the left ventricular posterior wall: this measurement was never less than 13 mm, with a mean value of 15,8 +/- 1,8 mm in the 43 patients in whom it was measured. The measurement was also of prognostic significance; paradoxical thinning of the posterior wall and septum was a poor prognostic sign which was associated with cardiac failure and passive dilatation of the left ventricle sometimes shortly preceding sudden death. In the absence of cardiac failure, a posterior wall thickness of less than 13 mm excludes surgical aortic stenosis.
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PMID:[Echocardiography in the diagnosis of severe aortic valve stenosis in adults]. 640 7

Aortic valve disease is common in the elderly with recent data suggesting that aortic sclerosis and stenosis are the end-stage of an active disease process. Aortic atenosis may be diagnosed at symptom onset (angina, heart failure or syncope) but often the diagnosis is suspected in an asymptomatic patient with a systolic murmur. The diagnosis can be confirmed and disease severity evaluated reliably using Doppler echocardiography. Symptomatic severe aortic stenosis is treated with valve replacement, even in the elderly, due to the extremely poor prognosis without relief of outflow obstruction. Management is controversial when there is coexisting moderate aortic stenosis and left ventricular systolic dysfunction.
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PMID:Aortic stenosis. Clinical evaluation and optimal timing of surgery. 974 19

The true incidence of aortic stenosis among the general population is unknown but aortic sclerosis, its precursor, has been estimated to affect about 25% of people over age 65, while an estimated 3% of the population over age 75 have severe aortic stenosis. Severe aortic stenosis, when accompanied by symptoms of angina, syncope, or heart failure, is associated with high mortality rates. Two-dimensional and Doppler echocardiography are cornerstone tools for the evaluation and monitoring of aortic stenosis. Echocardiography helps identify the patient at risk of death and guide timing of aortic valve replacement. Other important diagnostic tools include cardiac catheterization, treadmill stress testing, and dobutamine stress echocardiography, although their use is limited to specific patient populations. Aortic valve replacement carries a significant operative risk of approximately 4.0%. However, risk of operative mortality varies according to comorbidities and disease presentation. There are many risk models that guide estimation of the risk of operative mortality. Understanding operative risk is important in patient care and the selection of patients for aortic valve replacement.
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PMID:Aortic stenosis: assessment of the patient at risk. 1804 56

Epidermal growth factor receptor (EGFR) signaling contributes to aortic valve development in mice. Because developmental phenotypes in Egfr-null mice are dependent on genetic background, the hypomorphic Egfr(wa2) allele was made congenic on C57BL/6J (B6) and 129S1/SvImJ (129) backgrounds and used to identify the underlying cellular cause of EGFR-related aortic valve abnormalities. Egfr(wa2/wa2) mice on both genetic backgrounds develop aortic valve hyperplasia. Many B6-Egfr(wa2/wa2) mice die before weaning, and those surviving to 3 mo of age or older develop severe left ventricular hypertrophy and heart failure. The cardiac phenotype was accompanied by significantly thicker aortic cusps and larger transvalvular gradients in B6-Egfr(wa2/wa2) mice compared with heterozygous controls and age-matched Egfr(wa2) homozygous mice on either 129 or B6129F1 backgrounds. Histological analysis revealed cellular changes in B6-Egfr(wa2/wa2) aortic valves underlying elevated pressure gradients and progression to heart failure, including increased cellular proliferation, ectopic cartilage formation, extensive calcification, and inflammatory infiltrate, mimicking changes seen in human calcific aortic stenosis. Despite having congenitally enlarged valves, 129 and B6129F1-Egfr(wa2/wa2) mice have normal lifespans, absence of left ventricular hypertrophy, and normal systolic function. These results show the requirement of EGFR activity for normal valvulogenesis and demonstrate that dominantly acting genetic modifiers curtail pathological changes in congenitally deformed valves. These studies provide a novel model of aortic sclerosis and stenosis and suggest that long-term inhibition of EGFR signaling for cancer therapy may have unexpected consequences on aortic valves in susceptible individuals.
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PMID:Reduced EGFR causes abnormal valvular differentiation leading to calcific aortic stenosis and left ventricular hypertrophy in C57BL/6J but not 129S1/SvImJ mice. 1944 46

CALCIFIC AROTIC STENOSIS AND ATHEROSCLEROSIS: Aortic stenosis is the most frequent valvular heart disease in western world and its incidence continues to rise. Aortic sclerosis is the first characteristic lesion of the cusps, which is today considered a process similar to atherosclerosis. The progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. Aortic stenosis is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. MEDICAL TREATMENT FOR AORTIC STENOSIS: The need for alternative to aortic valve surgery is highlighted by increasing longevity of the population and new therapeutic strategies to limit disease progression are needed to delay or potentially avoid, the need for valve surgery. Currently, there are no established disease modifying treatments in regard to the progression of aortic stenosis. The first results about influence of angiotensin-converting enzyme inhibitors and statins on aortic sclerosis and stenosis progression are promising. Statins are likely to reduce cardiovascular events rather than disease progression, but may be potentially a valuable preventive treatment in these patients. The prejudice against the use of angiotensin-converting enzyme inhibitors by patients with aortic stenosis is changing. The cautious use of angiotensin-converting enzyme inhibition by patients with concomitant hypertension, coronary artery disease, and heart failure seems appropriate. Definite evidence from large clinical trials is awaited.
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PMID:[Medical treatments in aortic stenosis: role of statins and angiotensin-converting enzyme inhibitors]. 2087 15