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)

Time and frequency domain parameters of heart rate variability (HRV) were determined in patients with severe endstage heart failure awaiting cardiac transplantation (HTX). These parameters were then correlated with mortality to investigate the performance of HRV in discriminating between groups with high and low risk of death. The standard deviation of five consecutive RR intervals (SDANN) was found to be the parameter with the greatest sensitivity (90%) and specificity (91%). Patients with SDANN values of < 55 msec had a twenty-fold increased risk of death (90% confidence limits: 4-118, P < 0.001). The results furthermore suggest that measurements of HRV are superior to other prognostic markers such as left ventricular ejection fraction, pulmonary artery wedge pressure, cardiac index, and serum sodium levels. We conclude that HRV is a powerful, noninvasive tool to assess the risk of death in candidates for HTX. HRV measurements can therefore be used as a supplement to other markers of risk to determine the optimal therapeutic strategy in patients with severe congestive heart failure.
 ...
PMID:Prognostic value of heart rate variability in patients awaiting cardiac transplantation. 127 28

Two patients suffering from dilated Cardiomyopathy (CMP) had to undergo orthotopic heart transplantation (HTX). In both cases, the postoperative period was without any complications. The immunosuppression consisted of Cyclosporin-A and Azathioprine including a one week prophylactic treatment with Antithymocyte Globuline (ATG). Four months postoperatively, they developed clinical signs of heart failure. The endomyocardial biopsies showed rejection at stage I according to Billingham's grading plus a fine interstitial fibrosis. Therefore, the Cyclosporin treatment was suspended and replaced by conventional immunosuppression consisting of Prednisolone and Azathioprine. Acute heart failure was managed by catecholamines in combination with aggressive diuretic therapy. After three weeks, both patients recovered. 12 weeks later, one died because of an acute rejection episode. The other is in good condition, with conventional immunosuppression at the present time. A vascular process caused by Cyclosporin-A as the pathogenic mechanism is considered. The absence of rejection signs in the biopsies as well as the remarkable improvement of heart failure after withdrawal of Cyclosporin-A support this possibility.
 ...
PMID:Cyclosporin-A induced heart failure after orthotopic heart transplantation. 244 Jan 40

Advanced coronary artery disease (CAD) and ischemic cardiomyopathy with elevated pulmonary artery pressures are criteria of a severe illness. In selected cases surgical revascularization has proved beneficial in terms of survival, reduction of morbidity and lowering the frequency of angina pectoris [6] in numerous studies over the past 25 years. But most of the earlier publications concentrated on patients with angina pectoris (AP) as a dominant symptom. Patients without AP but with predominant signs of congestive heart failure were largely excluded. This has changed recently [1-3,7,8,10,12,16,18] with the advent of the concept of hibernating myocardium. This term is defined as the presence of persistent myocardial and left ventricular dysfunction at rest due to reduced regional coronary blood flow that can be partially or completely restored to normal by myocardial revascularization [5,19]. Salvage of viable myocardium by successful revascularization improves left ventricular dysfunction. Diagnosis of hibernating myocardium is crucial because it does not leave the patient with chronic heart failure a candidate only for cardiac transplantation. Instead, these patients' left ventricular dysfunction is potentially reversible following revascularization by coronary bypass surgery. Furthermore we face a critical shortage of donor organs and extending waiting lists for possible transplant candidates. Following the start of the heart transplantation (HTX) program at our institution more than 690 operations were performed until September 1995. We screened more than 1600 patients for their eligibility as cardiac transplant recipients or for other forms of treatment. In this group of patients it has always been our policy to revascularize rather than transplant whenever possible.
 ...
PMID:Ischemic cardiomyopathy--revascularization vs. transplantation. 927 Nov 73

To examine important points surrounding the indications for heart transplantation (HTX) to care after HTX, we reviewed 22 patients with refractory heart failure aged less than 60 years who had been observed for the past 6 years. Sixteen patients had dilated cardiomyopathy; 1, dilated hypertrophic cardiomyopathy; 3, restrictive cardiomyopathy; and 2, ischemic cardiomyopathy; there were 15 males and 7 females, and 6 of the 22 patients were children. The 22 patients were divided into two groups according to their response to tailored medical therapy. Group 1 (n = 6) consisted of those whose cardiac function improved to New York Heart Association (NYHA) status 2 from NYHA status 3 or 4. Group 2 (n = 16) still exhibited refractory heart failure. Seven of these 16 patients went on to have successful HTX. Survival in groups 1 and 2 combined was significantly lower than actuarial survival post-HTX cited in the registry of the International Society for Heart and Lung Transplantation, and group 2 had an even lower survival than the total groups 1 and 2 survival. Survival in children was much lower than that in adults. Seven of the 16 patients in group 2 showed a genetic link, but there was no genetic link in group 1 patients. One patient in group 2 had a panel reactive antibody (PRA) value of 46% and died while awaiting HTX. Post-HTX care in terms of immunosuppressant therapy, was modified for each patient. It is particularly necessary to consider the time a patient will wait on the list for candidates for HTX who are children, have a genetic link, or are positive for PRA. A genetic approach is helpful to determine indications for HTX. Sensitive monitoring of post-HTX immunosuppression is needed.
 ...
PMID:Points to note from indications for heart transplantation to post-heart transplant care: from the care of patients with refractory heart failure and overseas heart transplantation. 947 40

Invasive methods as coronary angiography and intravascular ultrasound (IVUS) are still the routine tools for diagnosis of cardiac allograft vasculopathy (CAV). Nevertheless, invasive tests are expensive and not free of risk. Dobutamine stress echocardiography (DSE) emerged as a useful noninvasive tool for assessment of cardiac allograft vasculopathy (CAV). In our study, echocardiographic wall motion abnormalities (WMA) at rest had a sensitivity of 57% (specificity 88%) to detect CAV defined by IVUS and angiography, which was significantly (p < 0.0001) improved to 72% (specificity 88%) by stress testing. Additional M-mode analysis of systolic wall thickening improved the sensitivity of the resting echocardiogram to 72% (specificity 85%), the combined M-mode and 2D-analysis during stress had a sensitivity of 85% (p < 0.0001; specificity 82%). DSE was also useful to predict prognosis: 1.9% of patients with normal, but 27.3% of patients with abnormal 2D-DSE developed cardiac events (heart failure, infarction, death, re-HTX, PTCA) between annual studies (p < 0.0002). No change in serial DSE studies was associated with a low event rate (4%), compared to serial DSE deterioration (29%, p < 0.0014). Based on our experience, we postpone invasive studies for 12-24 months, if DSE is normal or remains unchanged in serial studies. Angiography is used in patients with abnormal or deteriorating DSE. In conclusion, noninvasive DSE provides useful diagnostic and prognostic information. It appears safe to use DSE as a first step of CAV monitoring.
 ...
PMID:Stress echocardiography for assessment of cardiac allograft vasculopathy. 1115 93

Specific blockade by antibodies (Abs) utilized in induction therapy may cause activation-induced cell death (AICD) in lymphocytes of transplant recipients, preactivated via CD95 and tumour necrosis factor-alpha receptor type 1 (TNFR1), and reduce allograft rejection frequency. Amongst 618 heart transplant (HTX) patients receiving antithymocytes globulin (ATG) therapy, 14 recipients with IVUS-verified freedom of transplant vasculopathy were studied. The control group contained 14 patients awaiting transplantation, classified by the New York Hearth Association heart failure as class IV. From 618 HTX patients 89% were free of rejection grade ISHLT > or =2-3 within 3-month post transplantation and 86% after one year. The death inducing receptors (DIR) such as CD95, CD95L and soluble TNFR1 were significantly increased in HTX recipients versus controls, as demonstrated by FACS, immunoblotting or ELISA (P < 0.001). The presence of increased DIR and in vivo apoptosis in HTX recipients, indicated by annexin-V binding, was further confirmed by the presence of high concentration of histones in the sera of patients. ATG, anti-IL-2R and OKT-3 Abs inhibited cell proliferation in a dose-dependent manner. The induction of apoptosis and/or necrosis was demonstrated in cells cultured with these Abs by annexin-V and 7-aminoactinomycin staining, respectively. Our findings demonstrate that T cells from HTX recipients express high level of CD95, CD95L and soluble TNFR1, and undergo apoptosis and AICD. These cells recognizing donor alloantigens may be selectively eliminated in vivo, and should be responsible for the observed immunological unresponsiveness, indicated by low rejection rates in our patient cohort treated by conventional triple therapy.
 ...
PMID:Activation-induced T cell death, and aberrant T cell activation via TNFR1 and CD95-CD95 ligand pathway in stable cardiac transplant recipients. 1198 6

We conducted a three-week randomized trial comparing the improvement of functional capacity by exercise training in chronic heart failure by the steady-state (EF 27.3%, n = 20) and the interval modus (EF 29.3%, n = 20) with a control group (EF = 26.6%, n = 10). Minimal EF was 10%, the lowest maximal oxygen consumption was 9.3 ml/kg/min and the lowest cardiac output was 1.9 l/min; 9 patients had been evaluated for HTX. VO2 at the anaerobic threshold and at maximal exercise increased in the continuous exercise group by 1.4 or 1.6 ml/kg/min, respectively, corresponding to an increase of 13.7% (p < 0.05) and 9.3% (p < 0.05). In the interval training group the increase was 1.3 and 1.5 ml/kg/min corresponding to 14% (p < 0.05) and 8.1% (p < 0.05). Continuous short-term exercise had no impact to central hemodynamics as pulmonary artery pressure (PA), capillary wedge pressure (pc), cardiac index (CI) or stroke volume index (SVI), whereas after interval training a significant increase at maximal exercise could be seen in CI (p < 0.05) and SVI (p < 0.01) with a concomitant drop in systemic peripheral resistance (p < 0.05) compared to the steady-state modus. Interval training was further characterized by a higher short-term but lower mean work load with a significantly smaller increase in lactate. Quality of life was improved according to the SF-36 questionnaire in both training groups but the psychologic sum factor was three times as high, increasing to 24.2% in the steady-state exercise group. It can be concluded that clinically stable patients with heart failure and even those already having been evaluated for cardiac transplantation profit from short-term physical training. Both training modalities seem equally suited to improve functional capacity. However interval training leads to more pronounced improvement in hemodynamics compared to the steady-state exercise, whereas the later had a greater impact on psychological well-being and quality of life. Patients with heart failure and severe peripheral deconditioning tolerate higher workloads with more peripheral stress by an interval training modus. Long-term training modalities need to be established to further improve and stabilize functional status.
 ...
PMID:[Physical training as interval or continuous training in chronic heart failure for improving functional capacity, hemodynamics and quality of life--a controlled study]. 1206 5

Chronic cardiac hepatopathy is a common entity in patients evaluated for heart transplantation (HTX). Hepatic injury is caused by severe heart failure resulting from prolonged recurrent congestion and/or impaired arterial perfusion. No data are available on the reversibility of cardiac hepatopathy in patients undergoing HTX. Data of 56 consecutive adult patients undergoing HTX during 2000-02 at the University Hospital of Innsbruck were analysed retrospectively. The following parameters were evaluated at the time of listing and 3, 6 and 12 months after HTX. Plasma levels of gamma-glutamyl transferase (gamma-GT), alkaline phosphatase (AP), bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and total plasma protein. When listed for HTX, only 12% of all patients analysed had physiological values throughout the seven laboratory parameters assessed. Elevated levels of gamma-GT, AP, bilirubin, AST, ALT, LDH and total plasma protein were detected in 66.6%, 29%, 50%, 16.7%, 10%, 40% and 18% of all patients respectively. Accordingly, median plasma levels of gamma-GT, bilirubin and LDH were elevated, whereas the mean plasma level of AP was at the upper normal range. In contrast, median plasma level of AST and mean plasma levels of ALT and total plasma protein were within the normal range: gamma-GT (median, 109.0; range, 634.0 U/l; n = 36), AP (mean, 120.2 +/- 78.9 U/l; n = 29), bilirubin (median, 1.3; range, 16.1 mg/dl; n = 32), LDH (median, 226.0; range, 2355.0 U/l; n = 33), AST (median, 29.0; range, 145.0 U/l; n = 36), ALT (mean, 28.3 +/- 20.8 U/l; n = 36) and total plasma protein (mean, 7.2 +/- 1.1 g/dl; n = 25). Within 3 months after HTX, elevated parameters except LDH significantly ameliorated: gamma-GT (median, 59.0; range, 1160.0 U/l; P = 0.011), AP (92.2 +/- 75.2 U/l; P = 0.016), bilirubin (median, 0.9; range, 8.1 mg/dl; P = 0.004), LDH slightly increased (median, 281.0; range, 543.0 U/l; P = 0.039), but there was a delayed improvement of this parameter after 6 and 12 months post-HTX. End-stage heart failure is characterized by a cholestatic liver enzyme profile with elevated plasma levels of gamma-GT and bilirubin. These parameters significantly improve within 3 months after HTX. Therefore, chronic cardiac hepatopathy seems to be a benign, potentially reversible disease.
 ...
PMID:Cardiac hepatopathy before and after heart transplantation. 1591 Feb 96

Mortality among heart transplant (HTX) candidates remains high. This review of the literature shows that psychosocial characteristics like depression, social isolation and coping strategies contribute to morbidity and mortality in heart failure (HF) patients, and may also be relevant to the prognosis of HTX candidates. Based on the research to date, physical activity favourably affects subjective and objective parameters not only in HF patients, but also in HTX candidates. Depression is prevalent among HTX candidates, especially in ischaemic patients, and seems to be related to earlier transplantation. Findings on the effects of depression on pretransplant mortality are conflicting. Not much is known concerning social isolation, coping, nutrition, or weight loss in this patient group. Identification of modifiable psychosocial and behavioural variables related to clinical status in this patient group is clearly needed and will aid the development of behavioural interventions to supplement medical therapies.
 ...
PMID:Psychosocial and behavioural factors in heart transplant candidates--an overview. 1754 24

Strategy and results of the Innsbruck Mechanical Circulatory Support Program are presented, and the impact of such programs on pediatric heart transplantation (HTX) in Europe is discussed. Venoarterial extracorporeal membrane oxygenation (vaECMO) and ventricular assist devices (VADs) were used in 21 pediatric patients (median age 3.3 years, 2 days to 17 years) for acute heart failure (AHF) following a bridge or bridge-to-bridge strategy. Twelve patients were treated with vaECMO: eight were weaned after 2-10 days, two died, and two were switched to a VAD. Of the last, one was weaned 47 days later and the other underwent HTX 168 days later. In nine patients, VAD was implanted without preceding vaECMO. One such patient died (cerebral hemorrhage) after 236 days; of the remaining eight patients three were weaned and five underwent HTX. Waiting time for HTX (high-urgency status) varied from 4 to 372 days. Fifteen patients were discharged (follow up: 2-74 months); 14 are doing very well (New York Heart Association (NYHA) Functional Classification Class I, neurologically normal), whereas one suffers from severe neurologic damage, presumably from resuscitation before vaECMO. Data from Eurotransplant on pediatric HTX in 2004, 2005, and 2006 (33, 49, and 34 transplanted hearts, respectively; recipients <16 years of age) are discussed. Mechanical circulatory support (MCS) substantially improves survival with AHF in pediatric patients. Medium-term support (up to 400 days in our patients) is possible and outcome of survivors is excellent. Wide spread use of MCS might slightly aggravate the lack of donor organs, which could result in longer support times.
 ...
PMID:The pediatric mechanical circulatory support program in Innsbruck, Austria, and the impact of such programs on lack of donor hearts in Europe. 1804 50


1 2 3 Next >>