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

This multicenter study evaluated the efficacy and tolerability of coenzyme Q10 in 1715 outpatients with chronic heart failure (New York Heart Association classes II and III), stabilized with standard therapy for 3 months. The patients were treated with coenzyme Q10 at a daily dose of 50 mg for 4 weeks, in addition to receiving conventional therapy. The efficacy of coenzyme Q10 was assessed by an open study that evaluated the improvement in clinical signs and symptoms of heart failure. After the baseline evaluation the subjects were seen on days 15 and 30. The intensity of signs and symptoms was assessed by a semiquantitative 4-point scale. Our results demonstrate that the administration of coenzyme Q10 in association with standard therapy improves dyspnea at rest, exertional dyspnea, palpitations, cyanosis, hepatomegaly, pulmonary rales, ankle edema, heart rate, and systolic and diastolic blood pressure in patients with stabilized heart failure. The rate of improvement and the low number of side effects in this large group of patients demonstrate that despite some methodological limitations in the study design and the short period of treatment (4 weeks) coenzyme Q10 given at a daily dose of 50 mg led to an improvement in the signs and symptoms of heart failure and in the quality of life.
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PMID:Italian multicenter study on the efficacy and safety of coenzyme Q10 as adjuvant therapy in heart failure. 824 96

Digitalis, diuretics, and vasodilators are considered standard therapy for patients with congestive heart failure, for which treatment is tailored according to the severity of the syndrome and the patient profile. Apart from the clinical seriousness, heart failure is always characterized by an energy depletion status, as indicated by low intramyocardial ATP and coenzyme Q10 levels. We investigated safety and clinical efficacy of coenzyme Q10 (CoQ10) adjunctive treatment in congestive heart failure, which had been diagnosed at least 6 months previously and treated with standard therapy. A total of 2500 patients in NYHA classes II and III were enrolled in this open noncomparative 3-month postmarketing drug surveillance study in 173 Italian centers. The daily dose of CoQ10 was 50-150 mg orally, with the majority of patients (78%) receiving 100 mg/day. Clinical and laboratory parameters were evaluated at the entry into the study and on day 90; the assessment of clinical signs and symptoms was made using from two- to seven-point scales. Preliminary results on 1113 patients (mean age 69.5 years) show a low incidence of side effects: 10 adverse reactions were reported in 8 (0.8%) patients, of which only 5 reactions were considered as correlated to the test treatment. After 3 months of test treatment the proportions of patients with improvement in clinical signs and symptoms were as follows: cyanosis 81%, edema 76.9%, pulmonary rales 78.4%, enlargement of the liver area 49.3%, jugular reflux 81.5%, dyspnea 54.2%, palpitations 75.7%, sweating 82.4%, arrhythmia 62%, insomnia 60.2%, vertigo 73%, and nocturia 50.7%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure (interim analysis). The CoQ10 Drug Surveillance Investigators. 824

Patients presenting in acute congestive heart failure demonstrate severe dyspnea, rales, hypoxia, and chest radiograph findings of acute pulmonary vascular congestion. Not all patients, however, have systolic left ventricular dysfunction. While initial stabilization of an acute episode in decompensated heart failure may follow a common pathway, understanding the nature of the dysfunction is important in selecting both short-term and long-term pharmacologic interventions required in the patient's management.
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PMID:Pharmacologic treatment of acute congestive heart failure resulting from left ventricular systolic or diastolic dysfunction. 839 34

Two new culprits have arisen in chronic heart failure (CHF). QT dispersion, which is the maximum QT interval minus the minimum QT interval in an ECG, may well predict sudden cardiac death. Aldosterone produces many harmful effects: magnesium loss, myocardial fibrosis, sympathetic activation, baroreflex dysfunction and ventricular arrhythmias. The RALES study is currently examining whether spironolactone improves mortality in CHF.
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PMID:Two new culprits in cardiovascular disease: QT dispersion and aldosterone. 852 84

Early identification of a high risk patient subgroup with infective endocarditis which develops a major complication (emboli, congestive heart failure, surgery for valve replacement, or death) during hospitalization would reduce morbidity, mortality and cost. Thus, for 74 patients with native valve infective endocarditis with documented vegetation by transthoracic two-dimensional echocardiogram, we reviewed 67 variables: history (15), physical examination (9), hematology/miscellaneous (7), chest X-ray (2), electrocardiogram (4), transthoracic two-dimensional echocardiograms (15) and hospital course (15). There were 48 men and 26 women, ages 45 +/- 19 years: 35 intravenous drug abusers and 39 non-users. There were 32 mitral, 21 tricuspid, 20 aortic, and 1 pulmonic valve vegetations; mean vegetation size was 1.4 +/- 0.9 cm2. Over the course of their hospitalization, 14 patients died (19%), 27 developed congestive heart failure (36%), 27 had systemic emboli (36%), and 22 required surgery (30%). The incidence of complications (death, heart failure or embolic events) did not differ between the drug abusers and non-users. Initial complaint of dyspnea on admission predicted the subsequent development of heart failure (P < 0.001), and a pre-admission embolus predicted a second in-hospital embolus (P < 0.001). Left atrial size, ventricular systolic or diastolic dimension did not effect prognosis. Importantly, a vegetation > 1.8 cm2 was 100% specific but only 30% sensitive for predicting the development of a complication. Vegetation mobility, shape, and number of cusps involved were not predictive. However, aortic valve vegetations had significantly more complications than those on the mitral valve (P < 0.03). By discriminant function analysis, 87% of major complications were predicted with the patient profile of having aortic valve vegetation, dyspnea on admission, prolonged preadmission fever, and no history of drug abuse; 75% of patients who developed heart failure were predicted by their having aortic valve vegetation, dyspnea, hypotension (systolic < 90 mm Hg), and no history of drug abuse; and 77% of patients requiring surgery were predicted by their having larger vegetation size, rales, and leftward shift of white blood cells. Thus, in native valve bacterial endocarditis with transthoracic echocardiographic documented vegetations, non-drug abusers with aortic vegetations, preadmission prolonged fevers, dyspnea, emboli and larger sized vegetations are at high risk for developing a major complication during their hospitalization.
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PMID:Early identification of patients with native valve infectious endocarditis at risk for major complications by initial clinical presentation and baseline echocardiography. 878 85

Ischemic heart disease is the most common cause of congestive heart failure, which often begins after acute myocardial infarction. To better delineate the clinical characteristics and outcomes of patients in whom congestive heart failure develops after acute myocardial infarction in the thrombolytic era, we prospectively evaluated patients enrolled in six of the TAMI trials. The study cohort comprised 1619 consecutive patients who had at least 1 mm of ST-segment elevation in two contiguous electrocardiographic leads within 6 hours of the onset of acute myocardial infarction and who received intravenous thrombolytic therapy. We prospectively collected clinical characteristics, baseline demographics, acute and 1-week angiographic variables, and in-hospital and 1-year outcome data. We performed stepwise multivariable regression analysis to determine the noninvasive and invasive predictors of the development of in-hospital congestive heart failure. Congestive heart failure developed in 301 patients in the hospital (19% of 1521 patients admitted were not in heart failure). These patients were likely to be older and female, have diabetes mellitus and previous myocardial infarction, and have an anterior wall myocardial infarction. On acute angiography, they had lower ejection fractions and a higher incidence of multivessel disease. Patency at 90 minutes was lower in the patients with congestive heart failure, and acute mitral regurgitation occurred in 1.6% versus 0.21% of patients without congestive heart failure. Patients with congestive heart failure had higher mortality, more in-hospital complications, and longer hospitalizations. At 1-year follow up, 21% of the patients in whom congestive heart failure developed had died versus 5% in the group without congestive heart failure. Predictors of new congestive heart failure included increased age, anterior wall myocardial infarction, lower pulse pressure and systolic blood pressure, diabetes mellitus, and the presence of rales on admission. The acute angiographic variables of reduced ejection fraction, increased number of diseased vessels, and attempted percutaneous intervention improved the concordance of the predictive model by 6%. Congestive heart failure remains a common clinical problem after acute myocardial infarction and is associated with a twofold increase in in-hospital morbidity and a fourfold increase in in-hospital and 1-year mortality. The development of congestive heart failure in the hospital can be predicted from noninvasive and invasive baseline characteristics. We present a simple table to predict congestive heart failure from baseline characteristics and invasive information.
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PMID:Clinical characteristics and long-term outcome of patients in whom congestive heart failure develops after thrombolytic therapy for acute myocardial infarction: development of a predictive model. 920 Mar 94

Renin, angiotensin II and aldosterone levels are elevated in congestive heart failure, especially when diuretics are introduced. This activation is clearly deleterious by elevating myocardial workload and is related to prognosis of heart failure. The link between hormonal activation and prognosis is causal, as hormonal inhibition by converting enzyme inhibitors improves heart failure prognosis. Angiotensin II and aldosterone appears to be toxic for the myocardium. The results of the trial conducted with angiotensin II antagonist losartan confirm data derived from converting-enzyme-inhibitors trials. The exact role of aldosterone is currently being evaluated in the RALES programme.
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PMID:[Renin-angiotensin-aldosterone system and heart failure: therapeutic aspects]. 977 28

RALES was a double-blind study which enrolled 1.663 patients with severe heart failure and a left ventricular ejection fraction of no more than 35 percent who were being treated with an angiotensin-converting-enzyme inhibitor, a loop diuretic and, in most cases, digoxin. A total of 822 patients were randomly assigned to receive 25 mg of spironolactone daily and 841 to receive placebo. The primary end point of the study was death from all causes. The trial was discontinued early after a mean follow-up of 24 months because an interim analysis determined that spironolactone was efficacious. There were indeed 386 deaths in the placebo group (46%) and 284 in the spironolactone group (35%) (relative risk of death: 0.70; 95% confidence interval, 0.60-0.82; p < 0.001). The reduction of mortality among patients in the spironolactone group was attributable to a lower risk of sudden cardiac death and of death from progressive heart failure. Patients treated by spironolactone had a lower hospitalization rate for worsening heart failure; they also had a significant improvement in the symptoms of heart failure as assessed by the New York Heart Association functional class. Serious hyperkalemia was minimal in both groups of patients. Gynecomastia or breast pain was reported in 10% of men who were treated with spironolactone as compared with 1% of men in the placebo group (p < 0.001).
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PMID:[Study of the month. The RALES study (randomized aldactone evaluation study]. 1058 74

Recent studies of atrial fibrillation, or rather "atrial fibrillations", have been based on focal atrial fibrillation which seems to be one of the commonest forms of paroxysmal atrial fibrillation. This observation led to the possibility of ablative therapy, usually near the pulmonary veins. Technological advances are awaited before a wider diffusion of this therapy becomes possible. In the field of defibrillation, the MUSTT study demonstrated the value of implantable defibrillators in the prevention of sudden death, in this trial in the case of asymptomatic high risk patients after myocardial infarction, with a decreased ejection fraction and non-sustained ventricular tachycardia. Two large scale randomised controlled trials (MERIT-HF and CIBIS II) have confirmed the value of betablockers in preventing sudden death, in patients with moderate or severe cardiac failure in association with classical treatment by diuretics, ACE inhibitors and digitalis. Similarly, for spironolactone, the RALES study showed a reduced incidence of sudden death in cardiac failure, as its physiopathological modes of action suggested. New techniques of three-dimensional mapping have confirmed their value. Finally, significant progress has been made in the field of genetics of cardiac arrhythmias, indicating that, in years to come, it will be possible to identify most of the genes responsible for conditions predisposing to arrhythmias.
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PMID:[The best of arrhythmias in 1999]. 1072 45

For more than 30 years after the discovery of aldosterone, scientists believed that its sole site of action was at epithelial tissues, most notably the kidney, where it mediated the transport of Na and K. It was soon recognized aldosterone contributed to several diseases by causing edema. Armed with this information, scientists set out more than 30 years ago to develop an antagonist of the mineralocorticoid receptor for the treatment of edematous states. From this effort, spironolactone (Aldactone was discovered. Spironolactone acts functionally as a competitive inhibitor of the mineralocorticoid (aldosterone) receptor, and although spironolactone is an effective mineralocorticoid receptor antagonist, it is not without limitations. These limitations include unwanted progestational and antiadrogenic side effects that limit its use in the chronic treatment of disease. In addition to its actions at the collecting tubule, aldosterone can participate in pathophysiology by actions at the heart, vasculature, and kidney, and it is likely that the most significant contributions to cardiovascular disease are due to actions at these sites rather than those related to Na and water retention. This is underscored by the recent clinical results from the RALES-004 Trial in which treatment with Aldactone demonstrated a significant benefit on mortality in patients with severe heart failure. The limited utility of spironolactone owing to the aforementioned steroid-related side effects has been especially frustrating, given the newly recognized role of aldosterone in cardiovascular disease. To obviate these limitations, eplerenone is currently being developed by Searle. Eplerenone is a competitive antagonist of the mineralocorticoid receptor that takes advantage of replacing the 17alpha-thoacetyl group of spironolactone with a carbomethoxy group, conferring excellent selectivity for the mineralocorticoid receptor over other steroid receptors. The pharmacological profile of eplerenone positions it to be an effective and selective mineralocorticoid receptor antagonist.
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PMID:Mineralocorticoid receptor antagonists: the evolution of utility and pharmacology. 1076 75


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