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)

We conducted a study of the influence of the vasoactive peptides atrial natriuretic peptide (ANP) and neuropeptide Y (NPY) on survival of patients on hemodialysis and their association and relative importance with cardiac and clinical variables. Thirty-three hemodialysis patients were characterized by age, sex, diagnosis, blood pressure, serum (S)-albumin, serum (S)-urea, hemoglobin, dialysis dose, weight gain, duration of dialysis, cardiac hypertrophy, volume, failure, and ischemia and plasma levels of ANP and NPY. The outcomes were analyzed for early deaths (< 1 year) and for all deaths. The association of the variables to early deaths and all deaths, respectively, was studied in Cox proportional hazard analyses. The variables were also studied in three hierarchical steps: clinical variables only, clinical and cardiac variables, and all variables. For all deaths, the independent variables were plasma NPY (pmol/L) (hazard ratio [HR] = 1.035, p = 0.004), heart volume (ml/m2) (HR = 1.009, p = 0.001), and S-albumin (g/L) (HR = 0.750, p = 0.034). For early deaths, the independent variables were predialysis ANP (pmol/L) (HR = 1.008, p = 0.034) and NPY (pmol/L) (HR = 1.031, p = 0.026). In the hierarchical study, excluding the vasoactive peptides, heart volume, heart failure and S-albumin were independently associated with all deaths, and mean arterial blood pressure was associated with early death. When also excluding the cardiac parameters, S-albumin was associated with all deaths and mean arterial blood pressure with early death. In conclusion, plasma levels of the vasoactive peptides ANP and NPY are the most important group in a hierarchy of variables that predict imminent death in hemodialysis patients, and NPY is associated with late death. ANP and NPY apparently sum up the detrimental influence of many factors in hemodialysis patients.
 ...
PMID:Neuropeptide-Y and atrial natriuretic peptide as prognostic markers in patients on hemodialysis. 1255 11

Long-term prognosis in dialysis is poor compared to that in healthy control persons. A worsening of the prognosis is noted especially for patients who at initiation of dialysis have congestive heart failure, ischemic heart disease, or left ventricular dysfunction or hypertrophy. This is the main reason that cardiovascular causes are the most common for morbidity in these patients. The weight obtained when normal urine output is present is the dry weight. With reduced ability to excrete the volume by the kidneys in end-stage renal disease (ESRD), the body will retain water and the patient will gain weight. This extra weight is due to volume overload. While volume overload may induce a rise in blood pressure, if the heart is in acceptable condition, a fast removal of fluid by ultrafiltration (UF) during dialysis may instead cause hypotension. Ultrafiltration failure in peritoneal dialysis (PD) patients may lead to successive water retention and overhydration with subsequent cardiac failure, while volume overload may occur over a few days in hemodialysis (HD) patients. Anemia or even too-high hematocrit may impair cardiac function further and worsen conditions caused by wrong dry weight. Thus, during long-term and sustained volume overload, left ventricular (LV) hypertrophy will occur in an eccentric manner. A sustained overload then may lead to cell death and LV dilatation and, eventually, systolic dysfunction. Once a severe left ventricular dilatation has developed, the blood pressure may decrease during volume overload. A worsened prognosis is seen if malnutrition and low albumin levels are present. Volume overload necessitates ultrafiltration to achieve dry weight. Thereby, volume contraction contributes to exaggerated stimulation of or response to activation of the RAS and alpha-adrenergic sympathetic systems. If ultrafiltration goes beyond these compensatory mechanisms, hypotension will occur and increase the risk for hypoperfusion of vital organs. Such episodes may cause cardiac morbidity, aspiration pneumonia, vascular access closure, or neurological complications (seizures, cerebral infarction), besides a more rapid lowering of residual renal function. Preventive measures are, first, finding the right dry weight; second, minimizing interdialytic weight gain; third, optimizing the target for hemoglobin (110-120 g/l); fourth, lowering dialysate calcium (1.25 mmol/l); and fifth, eventually using higher dialysate potassium if long dialyses are performed.
 ...
PMID:Ultrafiltration and dry weight-what are the cardiovascular effects? 1266 7

Eplerenone is a highly selective aldosterone blocker, which is under development for the treatment of hypertension and heart failure. To assess its usefulness in older patients with systolic hypertension and widened pulse pressure, we compared the effects of eplerenone with amlodipine, on clinic blood pressure (BP) and pulse pressure and in a subset of the patients, ambulatory BP, vascular compliance, and urinary albumin excretion. The study involved 269 patients > or =50 years of age who were randomly assigned to either eplerenone (50 to 200 mg daily) or amlodipine (2.5 to 10 mg daily) in a double-blind titration to effect design. After 24 weeks of therapy, reductions in clinic systolic BP were similar for both treatments (eplerenone, -20.5+/-1.1 mm Hg; amlodipine, -20.1+/-1.1 mm Hg). Reductions in clinic diastolic BP were modestly larger on amlodipine (-6.9+/-0.7 mm Hg) compared with eplerenone (-4.5+/-0.7 mm Hg) (P=0.014). Pulse pressure was also reduced similarly from baseline by the 2 treatment groups (eplerenone, -15.9 mm Hg versus amlodipine, -13.4 mm Hg, P=0.07). Changes from baseline in pulse wave velocity after 24 weeks of therapy were statistically similar for eplerenone and amlodipine. In patients with microalbuminuria at baseline (>30 mg albumin/g creatinine), eplerenone reduced the urinary albumin/creatinine ratio by 52% compared with a reduction of 10% by amlodipine (P=0.04). Thus, eplerenone was as effective as amlodipine in lowering systolic BP and pulse pressure as well as pulse wave velocity in older patients with widened pulse pressure hypertension. Furthermore, eplerenone reduced microalbuminuria to a greater extent than amlodipine in this older patient group.
 ...
PMID:Effects of the selective aldosterone blocker eplerenone versus the calcium antagonist amlodipine in systolic hypertension. 1475 24

Since publication of the Spanish Society of Cardiology Clinical Practice Guidelines on High Blood Pressure in January 2000, a new body of scientific evidence has been obtained that needs to be taken into account in clinical practice. A complete clinical evaluation by assessment of the global cardiovascular risk score should be done in patients with hypertension. In this connection, ECG findings and urine albumin excretion are of particular value. Up to now, the results of most important clinical trials indicate that the aim should be to normalize blood pressure, with stricter control in patients at higher risk (diabetes, target organ damage or left ventricular hypertrophy). Antihypertensive therapy should be selected on an individual basis, taking in account that patients with certain associated pathologies will benefit more from particular groups of drugs. Those with diabetes or left ventricular hypertrophy seem to benefit from pharmacological block of the renin-angiotensin system, and patients with heart failure from combined therapy with ACE inhibitors plus beta-blockers.
 ...
PMID:[2003 update of the Guidelines of the Spanish Society of Cardiology on High Blood Pressure]. 1273 87

Microalbuminuria (defined as an albumin-creatinine ratio of 10-25 mg/mmol on the first-morning urine sample, or an albumin excretion rate of 20-200 microg/min on a timed collection) is present in 20-30% of all patients with type 2 diabetes, and is especially common in those with hypertension, endothelial dysfunction and other features of insulin resistance. Although microalbuminuria is predictive of worsening microvascular disease in the kidney (5-10% per year progress to overt diabetic nephropathy), an increased albumin excretion rate (AER) reflects a generalized abnormality of vascular function and is associated with 2-4-fold increases in cardiovascular and all-cause mortality. The extent to which microalbuminuria is a risk factor independent of other variables in type 2 diabetes, e.g. blood pressure and smoking, has been highlighted by recent cohort studies, e.g. the Heart Outcome Prevention Evaluation study and the Wisconsin Epidemiological Study of Diabetic Retinopathy. In the former study, for example, microalbuminuria at baseline increased the adjusted relative risks (RR) of a major cardiovascular event (RR 1.83), all-cause death (RR 2.09) and hospitalization for heart failure (RR 3.23) in both diabetic and non-diabetic subjects. These studies also highlighted that AER is a continuous risk factor, and that levels of AER below the arbitrary threshold for defining microalbuminuria are associated with relatively increased cardiovascular risk. Similarly, microalbuminuria affects 10-15% of middle-aged non-diabetics and is associated with coronary, peripheral and cerebral vascular complications. Detection of microalbuminuria, especially in type 2 diabetes, signifies the need to intensify blood pressure control as part of a multiple risk factor intervention strategy in a high-risk group. As hypertensive patients with type 2 diabetes are frequently treated by more than one antihypertensive agent, ACE inhibitors and low-dose diuretics are preferably recommended in order to provide sufficient blood pressure control and target organ protection.
 ...
PMID:Microalbuminuria: a common, independent cardiovascular risk factor, especially but not exclusively in type 2 diabetes. 1276 61

Malnutrition, muscle wasting and cachexia are often present in chronic heart failure (CHF). However, malnutrition in CHF patients is not always as severe as muscle wasting. Data in the literature show that 24% of CHF patients have malnutrition (albumin < 3.5 mg/dl) but 68% have muscle atrophy. This apparent discrepancy can be explained by considering the metabolic role of the striate muscle. In fact, the striate muscle maintains the body metabolic performance by continuous exchanges of fuels (amino acids) with the liver. This happens in case of malnutrition or starvation. In such situations, glucose is produced by gluconeogenesis when amino acids are metabolized in the liver. Malnutrition, muscle wasting and the frequent progression through cachexia can be reduced by specific therapy such as cytokine and/or catabolic hormone antagonists. This is because cytokines and catabolic hormones, with consequent insulin resistance, cause muscle wasting. An alternative and/or complementary therapy may be exogenous amino acid supplementation. In fact, amino acids: a) are rapidly absorbed regardless of pancreatic activity, b) reduce insulin resistance, c) induce the hepatic synthesis of anabolic molecules such as growth hormone and insulin-like growth factor, and d) modulate the catabolic hormonal-mediated effects on adipocytes. Research on the best suitable qualitative and quantitative amino acid composition for an alternative and/or complementary therapy is still being studied in different research centers.
 ...
PMID:Malnutrition, muscle wasting and cachexia in chronic heart failure: the nutritional approach. 1278 75

Systolic and diastolic left ventricular dysfunction is common and important predictor of risk of death in end-stage renal failure. Systolic dysfunction is defined echocardiographically by a shortening fraction < 25% or an ejection fraction < 40%. Systolic dysfunction has a poor prognosis, strongly associated with myocardial ischemia and left ventricular hypertrophy (LVH). Diastolic dysfunction combines relaxation problems with compliance abnormalities and usually is associated with LVH. It is not clinically possible to distinguish systolic from diastolic LV dysfunction. This underlines the importance of echocardiographic diagnosis. In the present study we have analysed echocardiographically the left ventricular systolic and diastolic function and some possible risk factors contributing to its dysfunction development in patients with chronic renal failure (crf) treated by hemodialysis (HD). From a cohort of 85 patients with crf we selected for analysis 59 clinically stable patients. Echocardiography (ECHO), ECG, body mass index (BMI), serum creatinine, urea, total protein, albumin, hemoglobin, hematocrit, electrolytes, endothelin (ET-1) and parathyroid hormone (PTH) concentrations were evaluated in all patients after HD session. In all HD patients systolic and diastolic LV dysfunction was observed as well as LVH: concentric LVH was detected by ECHO in 46 patients and in 13 patients excentric LVH was observed. Mean serum concentrations of urea, creatinine, endothelin (ET-1), PTH and phosphate were increased while serum concentration of hemoglobin, total protein, albumin, sodium, potassium, calcium were in the normal range. Positive correlation was found between PTH serum concentration and LVM r = 0.704 (p < 0.001), between PTH serum concentration and IVS r = 0.267 (p < 0.04), between PTH serum concentration and PW r = -0.238 (p < 0.04), between ET-1 and RWT r = 0.447 (p < 0.04) and negative correlation between BMI and LVMI r = -0.451 (p < 0.05). Our observations suggests that uremic cardiomyopathy is heterogenous (systolic and diastolic dysfunction) and multifactoral. The correlations between serum PTH concentration and LVH and between BMI and LVH confirmed that both hyperparathyroidism and malnutrition are important factors influencing the development of LVH which plays an important role in the systolic and diastolic cardiac failure in HD patients.
 ...
PMID:[Left ventricular systolic and diastolic dysfunction in patients with chronic renal failure treated with hemodialysis]. 1293 88

To clarify the indications and usefulness of Percutaneous endoscopic gastrostomy (PEG) in patients with Silicosis and some co-morbidities, we analyzed eight cases of silicosis, who suffered from dysphagia and had received a PEG for tube feeding during the period from 1998 to 2002. The characteristics, and clinical course, of each case were statistically analyzed before and during PEG usage. All cases were bed-ridden males, with a mean age of 80 years. The profusion rate (PR) grade of silicosis was for five cases in category 2, and for three cases in category 4. Most of the co-morbidities were dementia (five cases), and chronic heart failure (four cases). There were no significant improvements in the measured nutrition criteria (albumin, lymphocytes) nor in respiratory function (arterial O2) between before and during PEG usage. Tube feeding through the PEG was not performed in three cases because of repeated aspiration pneumonia. The mean duration of PEG usage was 9 months, ranging from 5 to 20 months. Five cases died of the co-morbidities. Furthermore, there was significant deterioration in the bacteriological data (p = 0.001), suggesting a worsening of the swallowing disturbances during PEG usage, or the emergence of more resistant organisms as a result of empirical antibiotic therapy. The present results suggest that the indications of PEG in cases of severe chronic obstructive pulmonary disease (COPD) such as silicosis, associated with other morbidities, and with dysphagia, are somewhat limited. The patient's general condition should be an important factor in deciding whether or not this technique should be used.
 ...
PMID:Evaluation of percutaneous endoscopic gastrostomy in elderly patients with silicosis and co-morbidities. 1476 69

Clinically unrecognized intravascular volume overload may contribute to worsening symptoms and disease progression in patients with chronic heart failure (CHF). The present study was undertaken to prospectively compare measured blood volume status (determined by radiolabeled albumin technique) with clinical and hemodynamic characteristics and patient outcomes in 43 nonedematous ambulatory patients with CHF. Blood volume analysis demonstrated that 2 subjects (5%) were hypovolemic (mean deviation from normal values -20 +/- 6%), 13 subjects (30%) were normovolemic (mean deviation from normal values -1 +/- 1%), and 28 subjects (65%) were hypervolemic (mean deviation from normal values +30 +/- 3%). Physical findings of congestion were infrequent and not associated with blood volume status. Increased blood volume was associated with increased pulmonary capillary wedge pressure (p = 0.01) and greatly increased risk of death or urgent cardiac transplantation during a median follow-up of 719 days (1-year event rate 39% vs 0%, p <0.01 by log-rank test). Systolic blood pressure was significantly lower in hypervolemic patients than in those with normovolemia or hypovolemia (107 +/- 2 vs 119 +/- 2 mm Hg, p = 0.008), and hypotension was independently associated with increased risk of hypervolemia in multivariate analysis (odds ratio 2.64 for a 10-mm Hg decrease in systolic blood pressure, 95% confidence interval 1.13 to 6.19, p = 0.025). These findings demonstrate that clinically unrecognized hypervolemia is frequently present in nonedematous patients with CHF and is associated with increased cardiac filling pressures and worse patient outcomes.
 ...
PMID:Relation of unrecognized hypervolemia in chronic heart failure to clinical status, hemodynamics, and patient outcomes. 1513 99

Diabetic nephropathy has become the single most important cause of end-stage renal disease in the USA, Europe and Japan. The earliest marker of incipient diabetic nephropathy is the transition of normoalbuminuria to microalbuminuria at an albumin excretion rate of 20 microg/min. Human studies in patients both with and without diabetic kidney diseases have shown that the severity of baseline proteinuria is an important predictor of the rate of loss of renal function. Moreover, the reduction in protein excretion rate when patients with nephropathies are being treated with antihypertensive agents predicts the efficacy of subsequent renoprotection. Experimental and clinical observations provide the rationale for targeting the renin-angiotensin system as a renoprotective approach in diabetic and nondiabetic proteinuric nephropathies. Losartan (Cozaar, Merck Sharpe and Dohme) is a potent, orally active and highly specific angiotensin-type 1 receptor blocker. In addition to its antihypertensive efficacy, losartan decreases the left ventricular mass index in patients with hypertension, left ventricular end-diastolic and end-systolic volume in subjects with heart failure and prevents cardiovascular morbidity and death, predominantly stroke, independent of blood pressure reduction. Short-term studies in Type 1 diabetic patients with overt nephropathy have demonstrated that losartan and angiotensin-converting enzyme inhibitors have similar beneficial effects on albumin excretion rate, blood pressure and renal hemodynamics. Losartan also lowered albumin excretion rate in microalbuminuric patients with Type 2 diabetes mellitus. Moreover, the large multicenter Reduction of End points in Noninsulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL) trial has shown that blockade of angiotensin-type 1 receptor with losartan is superior to conventional antihypertensive therapy in slowing the progression of overt Type 2 diabetic nephropathy. Together, data from clinical trials demonstrate the beneficial effect of angiotensin-type 1 receptor blockers, including losartan, in the primary and secondary prevention of renal disease progression in diabetic patients. Nevertheless, it can be expected that the positive results achieved so far with this class of drugs may be further implemented by including angiotensin-type 1 receptor antagonists as a part of the multidrug approach that may hold more promise for the future of renoprotection in diabetic patients with chronic nephropathy.
 ...
PMID:Losartan in diabetic nephropathy. 1522 8


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>