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

In epidemiological surveys and in large-scale therapeutic trials, the prognosis of patients with ischemic heart failure is worse than in patients with a non-ischemic etiology. Even heart transplant candidates may respond better to intensified therapy if they have non-ischemic heart failure. The term 'non-ischemic heart failure' includes various subgroups such as hypertensive heart disease, myocarditis, alcoholic cardiomyopathy and cardiac dysfunction due to rapid atrial fibrillation. Some of these causes are reversible. The therapeutic effect of essential drugs such as angiotensin-converting enzyme inhibitors, beta-blockers and diuretics does not, in general, significantly differ between ischemic and non-ischemic heart failure. However, in some trials, response to certain drugs (digoxin, tumor necrosis factor-alpha, inhibition with pentoxifylline, growth hormone and amiodarone) was found to be better in non-ischemic patients. Patients with ischemic heart failure and non-contracting ischemic viable myocardium may, on the other hand, considerably improve following revascularization. In view of prognostic and possible therapeutic differences, the etiology of heart failure should be determined routinely in all patients.
Heart Fail Monit 2001
PMID:Ischemic versus non-ischemic heart failure: should the etiology be determined? 1263 96

Augmented peripheral and central chemoreceptor sensitivity has recently been demonstrated in both experimental and clinical settings of chronic heart failure (CHF). As a result of the effects of chemoreflexes on the respiratory, circulatory and neurohormonal systems, changes in their activity may account for several pathophysiological features of CHF--predominantly augmented ventilation, abnormal cyclic respiratory pattern and sympathetic overactivity. Although the precise underlying mechanisms are not known, a heightened chemoreflex drive may constitute an ominous sign in CHF. Patients with abnormally elevated chemosensitivity demonstrate an augmented ventilatory response to exercise, a severely impaired autonomic regulation and suppression of baroreceptor function, and a higher prevalence of ventricular arrhythmias. All these factors may unfavorably influence the prognosis of CHF. In fact, we have recently confirmed in a group of patients with advanced CHF that high peripheral chemosensitivity is an independent predictor of death. New therapies are needed in CHF to improve prognosis and quality of life. Drugs, such as opiates, and oxygen administration have been shown to suppress chemosensitivity, which may further favorably influence exercise tolerance and modify periodic breathing in CHF patients. Treatment strategies targeted at peripheral and central chemoreceptors may be a promising option for further evaluation.
Heart Fail Monit 2001
PMID:Chemosensitivity in chronic heart failure. 1263 97

Persistence of cardiotropic viruses (enterovirus, adenovirus) and anticardiac autoimmunity constitute the predominant etiopathogenic pathways of dilated cardiomyopathy (DCM). The diagnosis of inflammatory cardiomyopathy (InfCM) imposes sensitivity and specificity requirements, which are not fulfilled by the histological Dallas Criteria. The immunohistological quantification and characterization of immunocompetent infiltrates and cell adhesion molecule (CAM) expression has endorsed a new entity of secondary cardiomyopathies acknowledged by the World Health Organization (WHO), InfCM, in approximately 50% of DCM patients. In the absence of viral persistence, InfCM patients benefit from immunosuppressive treatment. Enteroviral and adenoviral genomes have been detected in a significant proportion of DCM patients. Enteroviral persistence is associated with an adverse prognosis. The induction of the coxsackie-adenovirus receptor (CAR) exclusively in 63% of DCM patients, but not in other cardiomyopathies, might constitute a key molecular determinant for cardiotropic viral infections in DCM. In InfCM patients with enterovirus or adenoviral persistence, interferon-beta administration leads to viral elimination and cessation of the intramyocardial inflammation, paralleled by a significant improvement of left ventricular systolic function and heart failure symptoms. The biopsy-guided etiopathogenic differentiation of DCM has endorsed specific treatment strategies: immunosuppressive regimens are favorable in autoimmune InfCM, whereas patients with viral persistence benefit from antiviral immunomodulation.
Heart Fail Monit 2003
PMID:Current insights into the pathogenesis, diagnosis and therapy of inflammatory cardiomyopathy. 1270 33

Heart failure is one of the leading causes of hospitalization worldwide. Mitral regurgitation (MR) is a known complication of end-stage cardiomyopathy and is associated with a poor prognosis. Historically, these patients were managed medically and frequently with mitral valve replacement, both of which have unfavorable long-term outcomes. Over a 10-year period, we studied 167 patients with cardiomyopathy and severe MR who underwent mitral valve repair. These patients with 4+ MR, a mean left ventricular ejection fraction (LVEF) of 14+/-6 and New York Heart Association (NYHA) class III or IV congestive heart failure (CHF) were prospectively studied. All patients underwent mitral valve repair with an undersized annuloplasty ring. There was one intra-operative death and eight 30-day mortalities. Intra-operative echocardiography revealed no MR in most patients and trivial to mild MR in seven patients. There were 26 late deaths; two of these patients had progression of CHF and underwent transplantation. The 1-, 2-, and 5-year actuarial survival rates were 82%, 71%, and 52%, respectively. NYHA class was improved for all patients from a pre-operative mean of 3.2+/-0.2 to 1.8+/-0.4 postoperatively. At 24-month follow-up, all patients demonstrated improvement in LVEF, cardiac output, and end-diastolic volume, with a reduction in sphericity index and regurgitant volume. Mitral valve repair utilizing an undersized annuloplasty ring is safe and effectively corrects MR in cardiomyopathic patients. All of the observed changes contribute to reverse remodeling and restoration of the normal LV geometric relationship. Mitral valve repair offers a new strategy for patients with MR and end-stage cardiomyopathy.
Heart Fail Monit 2003
PMID:Mitral valve repair as an alternative treatment for heart failure patients. 1280 79

Heart failure (HF) is a major health problem, causing significant morbidity and mortality. Its complex pathophysiology has not yet been fully elucidated. There is growing evidence that oxidative stress is implicated in the cardiac dysfunction leading to HF. In addition, several components of neurohormonal activation, such as catecholamines, angiotensin, aldosterone, tumor necrosis factor-a, endothelin, and cytokines, have been demonstrated to enhance oxidative stress. On the other hand, various pathophysiological parameters of HF, such as cardiomyocyte apoptosis, ventricular remodeling, mechanoelectric uncoupling, and endothelial dysfunction have been shown to be induced by oxidative stress. Despite substantial experimental evidence, the correlation of oxidative stress with the clinical parameters of HF is unclear. The potential association between oxidative stress and HF has led to the study of antioxidant interventions that may attenuate the oxidative damage. Promising results have been obtained mainly from studies using water-soluble antioxidants (such as vitamin C) and factors that inhibit free radical formation (such as allopurinol). The amelioration of oxidative stress in conjunction with pathophysiological abnormalities has been clearly shown in humans, but studies with clinical end-points are scarce. Furthermore, carvedilol and several other cardiovascular drugs, besides their favorable effects on neurohormonal activation in HF, may have additional intrinsic antioxidant properties. Even though the experimental evidence is promising, many more human clinical trials are needed in order to clarify the exact role of oxidative stress in HF and the potential benefits of antioxidant intervention.
Med Sci Monit 2003 Jun
PMID:The possible role of oxidative stress in heart failure and the potential of antioxidant intervention. 1282 62

In 60 patients with stable functional class II exertional angina with hyperkinetic type of circulation, baseline hemodynamics was studied following a 2-week treatment. A negatively chrono- and inotrophic effect was observed with taking anaprilin in a dose of 160 mg per day and a dose of 80 mg per day combined with 2 ml of 5 per cent solution of thiamine-chloride in injections. No effect was elicited with an 80 mg/d anaprilin without thiamine. The use of anaprilin and thiamine combined in treatment of IHD patients permits to reduce doses of beta-adrenoblockers as large doses of it may result in heart failure.
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PMID:[Combined use of anaprilin and thiamine in the treatment of ischemic heart disease]. 1461 3

Recent research has demonstrated that ambulatory BP is a superior means to predict cardiovascular outcomes in treated patients with hypertension. Ambulatory blood pressure monitoring has been utilized to evaluate the efficacy of all anti-hypertensive drugs including the angiotensin II receptor blockers (ARBs). This paper reviews the relationship of clinic and ambulatory blood pressures to cardiovascular outcomes and the benefits of ARBs to maximize improvement in clinical end-points in patients with hypertension. Clinical trial evidence has demonstrated that ARBs are a preferred class in patients with electrocardiographic evidence of left ventricular hypertrophy, in patients with type 2 diabetes, patients with chronic kidney disease, and in individuals with heart failure who have clinically relevant intolerability to angiotensin converting enzyme inhibitors. In addition, there is increasing evidence from clinical trials that many of the ARBs provide adequate 24 h blood pressure control alone or in combination with other anti-hypertensive agents. We conclude that the combination of event reduction from large-scale clinical trials, adequate 24 h BP reduction, and improved tolerability compared to most other classes of anti-hypertensive agents, make the ARBs a suitable initial treatment for patients with hypertension.
Blood Press Monit 2003 Oct
PMID:Evaluation of the 24 h effects of the angiotensin II receptor blockers: means to improve cardiovascular outcomes? 1462 72

Statins, also known as 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, consistently reduce cardiovascular risk. It has recently emerged that cholesterol reduction is not their only mode of action, with current research largely focused on the pleiotropic effects of statins. These include the improvement of endothelial dysfunction, their anti-inflammatory properties, and the mobilization of bone marrow-derived endothelial progenitor cells. All these effects are potentially beneficial in chronic heart failure (CHF), although prospective trials are needed to confirm this. However, cholesterol reduction by statins per se may prove detrimental in patients with CHF, as cholesterol seems to be able to inactivate endotoxin as a stimulus for proinflammatory cytokine production. It is therefore tempting to speculate that low doses of statins still confer pleiotropic effects without lowering plasma cholesterol levels.
Heart Fail Monit 2004
PMID:Statins: a treatment option for chronic heart failure? 1577 4

Systemic thromboembolism is well recognized in patients with left ventricular (LV) impairment. We report a case of cardiac failure presenting with systemic coagulopathy and an unusual pattern of thrombotic manifestations as a consequence of LV impairment.
Heart Fail Monit 2004
PMID:Multisite thrombosis: a late presentation of myocardial infarction. 1577 5

Transforming growth factor beta-1 is involved in local signaling for a variety of human diseases including renal diseases, cardiac hypertrophy and fibrosis in heart failure, hepatic fibrosis, and pulmonary fibrosis. Elevated levels of circulating transforming growth factor beta-1 result in organ fibrosis in animal models. In humans smoking, hypertension, diabetes and obesity appear to result in elevated circulating levels. This paper outlines a hypothesis that elevated circulating levels of transforming growth factor beta-1 are part of the molecular link between several entities that have epidemiologic ties including hypertension, diabetes, smoking and obesity on one hand and diseases resulting in organ fibrosis on the other including renal disease and cardiac fibrosis and hypertrophy in heart failure. Additionally, it is suggested that elevated levels are not simply a marker of a similar mechanism of disease production but that elevated levels of circulating transforming growth factor beta-1 lead to disease production and to the synergy of risk factors seen in production of human fibrotic diseases.
Med Sci Monit 2005 Jul
PMID:Circulating transforming growth factor beta-1: a partial molecular explanation for associations between hypertension, diabetes, obesity, smoking and human disease involving fibrosis. 1612 68


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