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

THE DEVELOPMENT OF CELL THERAPY: The stakes in the management of heart failure have become such that new therapeutic strategies have to be developed. Among the cell, molecular and genetic approaches aimed at reinforcing the deficient heart muscle by restoring its functional potential, cell therapy is the favored option in clinical application perspectives. IN THE FIELD OF ISCHEMIC HEART FAILURE: All the experimental data have shown that implantation of contractile cells in the post-infarction areas led to improved cardiac function. INTERESTING PRELIMINARY RESULTS: For ethical and immuno-biological reasons, the successful transplantation of autologous skeletal myoblasts has led our team to conduct a phase I clinical trial. Although the results of this study are preliminary with regard to cardiac function, they suggest the validity of the cell transplantation concept and allow one to hope that this new treatment method will have its place among the therapeutic arms of heart failure.
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PMID:[Myocardial implantation of muscle cells]. 1242 86

Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure. THE STUDIES LINKING DIABETES MELLITUS (DM) WITH HEART FAILURE (HF) : The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy. TREATMENT OF HEART FAILURE IN DIABETIC PATIENTS : The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients.
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PMID:Influence of diabetes mellitus on heart failure risk and outcome. 1255 46

IN THE CONTEXT OF AGEING: The Doppler echocardiography is a non-invasive technique that permits assessment of the "physiological" ageing of the cardiac and vascular structures, notably including a concentric remodelling of the left ventricle associated with relaxation abnormalities, dilatation of the left atrium, valvular reorganisation and a modification in the large vessels. IN A PATHOLOGICAL CONTEXT: The Doppler echocardiography also detects the various cardiovascular affections related to ageing: valvulopathies, notably calcified aortic stenosis and mitral failure due to mitral anulus calcification or prolapsus of the valve; primary hypertrophic cardiomyopathy or secondary to arterial hypertension or an amyloidosis, and possibly leading to heart failure with spared systolic function, frequent in elderly patients; ischemic cardiopathies that have benefited, as in younger patient, from new echographical stress testing techniques, which safely study the variability in myocardial ischemia. Transoesophageal echography can also be performed in elderly patients, but the indications of this more invasive and less well-tolerated examination must be assessed case by case. It is very useful when an intra-parietal aortic hematoma is suspected or during aortic dissection or infectious endocarditis.
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PMID:[Echocardiography in elderly patients]. 1510 87

MODALITIES FOR THE DIAGNOSIS OF VENOUS THROMBOEMBOLISM: Currently rely on the confrontation of the initial clinical data and the results of D-dimer measurements, a venous Doppler, although reliable, is not a first-line exploration. REGARDING TREATMENT: Indications for thrombolysis are currently limited to massive pulmonary oedema with shock. Alteplase added to heparin improves the progression of severe embolism; it spares the patients from heavy interventions of resuscitation but the mortality remains the same. Concerning anticoagulant treatments, prolonged antivitamin K at classical doses is more effective than low doses and for limited duration if phlebitis is an idiopathic one. FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION: Treatment of these heart failures, formerly know as 'diastolic' is similar to that of the acute phase of systolic heart failure. However, care should be taken with vasodilatators. CONCERNING HEART FAILURE IN GENERAL: The brain natriuretic peptide (BNP) represents a remarkable progress for the aetiological diagnosis of dyspnoea (inferior to 80 pg/ml in the case of pulmonary origin, superior to 300 pg/ml in the case of cardiac origin or severe pulmonary embolism). Regarding treatment, for acute heart failure, it is still the association of nitrates and diuretics, with oxygen therapy and eventually inotropics. Beta-blockers, which have revolutionized the treatment of chronic heart failure, must be maintained whenever possible in the case of the onset of acute pulmonary oedema. Multisite pacing is increasingly used in refractory chronic heart failure. Implantable defibrillation has become common practice. Non-invasive ventilation (Bi or C-PAP) is interesting in acute cardiogenic pulmonary oedema. THE PREVENTIVE ROLE OF N ACETYL-CYSTEINE: N acetyl cysteine reduces the incidence of nephropathies induced by the radio contrast products in patients with chronic kidney failure. Combined with hydratation, it must be proposed the day before and on the day of the procedure in any patient with diabetes or kidney failure.
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PMID:[Diagnostic and therapeutic progress. Venous thromboembolism, cardiac insufficiency and radio contrast agents]. 1522 98

INCREASING PREVALENCE OF HOSPITALISATIONS AND MORTALITY: Heart failure represents a major public health problem. Indeed, the ageing of the population and the frequency of cardiovascular risk factors explain the considerable increase in the prevalence of heart failure over the past few years. SYSTOLIC FUNCTION IS USUALLY PRESERVED: The physiopathological features of cardiovascular ageing have resulted in the high prevalence of heart failure with preserved systolic function. Hence, in patients aged over 75 presenting with heart failure, around 50% exhibit preserved ejection fraction. THE NEED FOR GERONTOLOGICAL ASSESSMENT: The prognosis of heart failure remains severe, notably in elderly, fragile patients often exhibiting several diseases. Within this context, a gerontological assessment is crucial in order to screen for concomitant diseases, the degree of the patients' dependence and the presence of "fragility". This work-up must assess the cognitive function, autonomy, somatic status, living conditions and the medico-social management of these patients.
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PMID:[Heart failure, a disease of the elderly]. 1552 60

The Heart Failure Survival Score (HFSS) and peak exercise oxygen consumption (VO2) predict survival in ambulatory patients with heart failure and are used for selection for cardiac transplantation. However, the populations tested have predominately been men. To investigate if peak VO2 and the HFSS predict prognosis in women, we derived HFSS and measured peak VO2 in 274 women referred for cardiac transplantation and in 278 men matched by referral year. Seven HFSS parameters were obtained, including presence of coronary artery disease, left ventricular ejection fraction, heart rate, mean arterial blood pressure, peak VO2, presence of intraventricular conduction defects, and serum sodium. Subjects were divided into high-, medium-, and low-risk strata for HFSS and VO2 based on previous cutpoints. Survival curves were derived using Kaplan-Meier analysis and compared by log-rank analysis. Follow-up averaged 929 days. For women, 1-year event-free survival in the low- (>14), medium- (10.1 to 14), and high-risk (<10 ml/kg/min) VO2 strata was 93%, 84%, and 80%, respectively. For the HFSS, 1-year event-free survival in the low- (>or=8.10), medium- (7.20 to 8.09), and high-risk (<or=7.19) strata was 90%, 87%, and 67%, respectively. Survival curves for VO2 (p <0.01) and HFSS (p <0.001) demonstrated significant differences. In both genders, the low-risk groups for HFSS and VO2 can safely have transplantation deferred. Women had better survival than men for a given peak VO2. The HFSS was consistent between genders. In conclusion, peak VO2 and the HFSS are excellent parameters to predict survival in women with congestive heart failure. THE HFSS is more consistent than the peak VO2 between the genders.
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PMID:Comparison of peak exercise oxygen consumption and the Heart Failure Survival Score for predicting prognosis in women versus men. 1726 6

Based on the changes in the field of heart transplantation and the treatment and prognosis of patients with heart failure, these updated guidelines were composed by a committee under the supervision of both the Netherlands Society of Cardiology and the Netherlands Association for Cardiothoracic surgery (NVVC and NVT).THE INDICATION FOR HEART TRANSPLANTATION IS DEFINED AS: 'End-stage heart disease not remediable by more conservative measures'.CONTRAINDICATIONS ARE: irreversible pulmonary hypertension/elevated pulmonary vascular resistance; active systemic infection; active malignancy or history of malignancy with probability of recurrence; inability to comply with complex medical regimen; severe peripheral or cerebrovascular disease and irreversible dysfunction of another organ, including diseases that may limit prognosis after heart transplantation.Considering the difficulties in defining end-stage heart failure, estimating prognosis in the individual patient and the continuing evolution of available therapies, the present criteria are broadly defined. The final acceptance is done by the transplant team which has extensive knowledge of the treatment of patients with advanced heart failure on the one hand and thorough experience with heart transplantation and mechanical circulatory support on the other hand. (Neth Heart J 2008;16:79-87.).
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PMID:Guidelines for heart transplantation. 1834 30

WHEN A PATIENT WITH CONGESTIVE HEART FAILURE IS NOT RESPONDING OR DETERIORATING WITH TREATMENT, THE FOLLOWING QUESTIONS MUST BE ASKED: 1. Are the symptoms due to heart failure or an associated condition? 2. Has maximum therapy been administered? 3. What is the cause of the heart failure and is there a condition which is amenable to specific therapy? 4. Are there associated conditions which may be responsible for the poor response to treatment? 5. Is the patient a candidate for vasodilator therapy? In spite of all efforts there are some patients who will remain with intractable heart failure, but many with so called refractory failure can be improved when the above points are carefully considered.
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PMID:Refractory heart failure. 2128 14

BACKGROUND: Left ventricular remodeling after myocardial infarction (MI) results in ventricular dilation, fibroplasia, and decline in cardiac function. There is significant morbidity and mortality associated with this process, often leading to heart failure despite medical management. New therapies aimed at altering ventricular remodeling after MI are needed, and cytotherapy utilizing progenitor cells is a current area of investigation. THE PROBLEM: Many variables need to be considered to maximize the therapeutic benefit of cytotherapy, including the cell type, the method of delivery, the timing, and patient selection. Investigation into progenitor cell biology will continue to identify novel treatment strategies that then must be tested clinically to demonstrate safety, feasibility, and ultimately therapeutic benefit. BASIC/CLINICAL SCIENCE ADVANCES: Although progenitor cells have the potential to affect ventricular remodeling through multiple mechanisms, their major effect is likely due to actions of secreted factors. Hepatocyte growth factor, stromal-derived growth factor-1 alpha, and stem cell factor affect the mobilization of progenitor cells, which makes it possible to develop treatment strategies based on recruitment of endogenous progenitor cells. CLINICAL CARE RELEVANCE: There have been a number of randomized controlled trials demonstrating modest improvements in cardiac function using progenitor cell therapies after MI. In addition, clinical trials have used granulocyte-colony-stimulating factor as a treatment aimed at increasing progenitor cell mobilization. CONCLUSION: Progenitor cell therapy after MI has been shown to be safe and feasible with some improvements in cardiac function and clinical outcomes. Further investigation is needed to better understand the biology of progenitor cells and the effects of progenitor cell-based therapies.
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PMID:Progenitor Cells for the Treatment of Acute Myocardial Infarction. 2202 3

ACCORDING TO THE EJECTION FRACTION, PATIENTS WITH HEART FAILURE MAY BE DIVIDED INTO TWO DIFFERENT GROUPS: heart failure with preserved or reduced ejection fraction. In recent years, accumulating studies showed that increased mortality and morbidity rates of these two groups are nearly equal. More importantly, despite decline in mortality after treatment in regard to current guideline in patients with heart failure with reduced ejection fraction, there are still no trials resulting in improved outcome in patients with heart failure with preserved ejection fraction so far. Thus, novel pathophysiological mechanisms are under development, and other new viewpoints, such as multiple comorbidities resulting in increased non-cardiac deaths in patients with heart failure and preserved ejection fraction, were presented recently. In this review, we will focus on the tested as well as the promising therapeutic options that are currently studied in patients with heart failure with preserved ejection fraction, along with a brief discussion of pathophysiological mechanisms and diagnostic options that are helpful to increase our understanding of novel therapeutic strategies.
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PMID:Current treatment of heart failure with preserved ejection fraction: should we add life to the remaining years or add years to the remaining life? 2425 Oct 65


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