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

Most patients presenting with heart failure have severe coronary artery disease. The identification of viable hibernating myocardium is of paramount clinical importance for a correct indication of revascularization. Contractile reserve may be identified when regional asynergy improves during low or moderate doses of dobutamine. Dipyridamole, given at infra-low dose, alone or preferably in association with a low dose of dobutamine, is another possible pharmacologic stress protocol. Dobutamine echocardiography has been found to be more specific than thallium scintigraphy for predicting functional recovery after revascularization. However, the absence of contractile reserve does not exclude the presence of myocardial viability: perfusion reserve may be too low because of a critical coronary artery stenosis, or profound ultrastructural changes of myocardial cells may be present, including significant loss of contractile material. Inotropic reserve can also be assessed by dobutamine stress echocardiography in patients with idiopathic cardiomyopathy. The evolution of hemodynamic variables can be measured during the stress test. Stress echocardiography, especially during exercise, could probably provide important information about heart failure associated with valvular heart disease.
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PMID:Role of stress echocardiography in heart failure. 966 40

A 31-year-old man was admitted to our hospital for further evaluation of heart failure symptoms. Crow-Fukase syndrome was diagnosed on the basis of findings of polyneuropathy, hepatomegaly, monoclonal hypergammaglobulinemia, and hypertrichosis. Dipyridamole-stress thallium-201 perfusion imaging, contrast left ventriculography, and coronary angiography revealed a markedly dilated and dysfunctioning left ventricle, extensive reversible ischemia with fixed defect, and multiple coronary lesions. Histopathology of myocardial biopsy specimens demonstrated ischemia-induced myocardial necrosis. These findings suggested that ischemic cardiomyopathy, probably due to inflammatory reactions of coronary arteries in Crow-Fukase syndrome, was responsible for the heart failure symptoms and left ventricular dysfunction in this patient.
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PMID:Crow-Fukase syndrome with ischemic cardiomyopathy. 1151 11

Coronary flow reserve (CFR) provides essential information about the coronary microvascular bed in the absence of narrowing of epicardial coronary arteries. Experimental and human data suggest chronic heart failure is associated with a reduction of CFR in the absence of coronary artery disease. Dipyridamole, papaverine, or adenosine administration intravenously or intracoronary achieve maximal vasodilation of coronary arteries in human studies, however, systemic administration of vasodilator (dipyridamole) resulted in conflicting effects on systemic blood pressure. Various mechanisms including the nitric oxide pathway, neurohumoral alterations, and microvascular spasm among others, may contribute to the decrease in CFR in nonischemic heart failure. Notably, there is no study which describes the correlation between subjective symptoms of heart failure and the severity of the decrease in CFR. Further investigation of this area may be beneficial in determining the appropriate level of exercise training for heart failure patients and understanding mechanisms of the progression of heart failure. (c)1999 by CHF, Inc.
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PMID:Coronary flow reserve of nonischemic heart failure. 1218 2

Dipyridamole increases adenosine levels and augments coronary collateralization in patients with coronary ischemia. This pilot study tested whether a 6-month course of sustained-release dipyridamole/aspirin improves coronary flow reserve and left ventricular systolic function in patients with ischemic cardiomyopathy. Six outpatients with coronary artery disease and left ventricular ejection fraction (LVEF) <40% were treated with sustained-release dipyridamole 200 mg/aspirin 25 mg twice daily for 6 months. Myocardial function and perfusion, including coronary sinus flow at rest and during intravenous dipyridamole-induced hyperemia, were measured using velocity-encoded cine magnetic resonance stress perfusion studies at baseline, 3 months, and 6 months. There was no change in heart failure or angina class at 6 months. LVEF increased by 39%+/-64% (31.0%+/-13.3% at baseline vs 38.3%+/-10.7% at 6 months; P=.01), hyperemic coronary sinus flow increased more than 2-fold (219.6+/-121.3 mL/min vs 509.4+/-349.3 mL/min; P=.01), and stress-induced relative myocardial perfusion increased by 35%+/-13% (9.4%+/-3.4% vs 13.9%+/-8.5%; P=.004). Sustained-release dipyridamole improved hyperemic myocardial blood flow and left ventricular systolic function in patients with ischemic cardiomyopathy.
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PMID:Effect of chronic sustained-release dipyridamole on myocardial blood flow and left ventricular function in patients with ischemic cardiomyopathy. 1754 6

Heart failure is a progressive syndrome. The rate of deterioration is highly variable and depends on several factors such as the nature and the causes of the overload, and the age of the patient. In general, following a long period of asymptomatic left ventricular (LU) dysfunction, the progression of the disease is rapid once symptoms ensue. Stress echocardiography may play a role both in the early and advanced stages of the disease. In the initial stages a reduced inotropic reserve can unmask initial damage. At advanced stages, stress echocardiography can identify a subgroup of patients at a better outcome despite a similar rest LV function. Protocols and stressors are the conventional ones also applied to patients with known or suspected coronary artery disease. Dipyridamole or dobutamine are able, with an excellent safety profile, to induce a contractile reserve, but the vasodilator stress has the advantage to assess coronary flow reserve, linking the information on function to perfusion. A wide spectrum of echocardiographic parameters is available to the clinical cardiologist assessing the risk of the individual patient. Rest and stress echocardiography are the ideal tool to be applied to this class of patients with dilated cardiomyopathy due to its low cost, widespread availability, lack of ionising radiation and repeatability.
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PMID:[Recent advances in the prognostic evaluation of non-ischemic dilated cardiomyopathy]. 1768 88

To study the structure of the risk factors and features of the course of a primary and recurrent myocardial infarction in elderly and old age we investigated 443 patients in the first 48 hours of the disease. Significant prevalence of risk factors was established in men with myocardial infarction in St. Petersburg. In most patients, especially with recurrent myocardial infarction, three or more risk factors were determined at the same time, which indicates a high coronary risk. The most frequently we observed the dislipoproteinemia, arterial hypertension, psycho-emotional stress, heart failure in anamnesis, link of disease to the season of year, the frequency of acute respiratory infections and colds, cardiac arrhythmia in anamnesis, smoking and alcohol abuse. Among the associated diseases, the cholelithic disease, urolithiasis and chronic bronchitis prevailed, especially with recurrent myocardial infarction. In the clinical pattern of disease in the first 24 hours, symptoms of heart failure prevailed. Anginal variant of a recurrent myocardial infarction occurs even less frequently, and symptoms of heart failure are more expressed, especially in prognostically unfavorable patients.
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PMID:[Risk factors and features of the course of primary and recurrent myocardial infarction in elderly and aged men]. 2103 83


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