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

The literature concerning nuclear cardiology and cardiac MRI has been particularly rich in the fields of diagnosis, prognosis and therapeutic evaluation of coronary artery disease and cardiac failure. Almost 18 million 'conventional' myocardial scintigraphies (SPECT-single photon emission tomography, or TEM: tomography by monophotonic emission in French) are routinely performed worldwide each year. Nuclear cardiology represents the 3rd scientific domain of application for scintigraphy, after oncology and neurology. The advent of new conventional gamma cameras and PET (positron emission tomography) combined with CT will allow considerable improvement in the quality of investigation in obese or tri-truncal patients and women. We will limit ourselves to original clinical studies, based on scintigraphical techniques or magnetic resonance imaging, applied to the classic cardiological themes: myocardial infarction and ischaemia, cardiomyopathy and cardiac failure. We will also consider the new directions in nuclear cardiology regarding a new tracer and some innovative technology: rubidium-82 and TEP-CT.
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PMID:[The best of nuclear cardiology and MRI in 2005]. 1647 61

Large numbers of people have anterior myocardial infarctions, many in mid-life, with progressive left ventricular dilatation and heart failure with diminished life expectancy. Myocardial revascularization alone helps ischemia, but does little in cases of large ventricular volume, which is the major determinant of post infarction mortality. Ventricular restoration results in immediate improvement in size and function and when added to revascularization, has markedly improved survival and freedom from congestive heart failure. When coronary bypass is being considered after anterior infarction or in patients with reduced ventricular function, MRI to determine function and viability is recommended. Then a valid, informed judgment can be made about patch reconstruction of the left ventricle.
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PMID:Left ventricular remodeling or restoration for congestive heart failure. 1651 4

Stem cells offer a promising approach to the treatment of myocardial infarction and prevention of heart failure. We have used iron labeling of bone marrow stromal cells (BMSCs) to noninvasively track cell location in the infarcted rat heart over 16 weeks using cine-magnetic resonance imaging (cine-MRI) and to isolate the BMSCs from the grafted hearts using the magnetic properties of the donor cells. BMSCs were isolated from rat bone marrow, characterized by flow cytometry, transduced with lentiviral vectors expressing green fluorescent protein (GFP), and labeled with iron particles. BMSCs were injected into the infarct periphery immediately following coronary artery ligation, and rat hearts were imaged at 1, 4, 10, and 16 weeks postinfarction. Signal voids caused by the iron particles in the BMSCs were detected in all rats at all time points. In mildly infarcted hearts, the volume of the signal void decreased over the 16 weeks, whereas the signal void volume did not decrease significantly in severely infarcted hearts. High-resolution three-dimensional magnetic resonance (MR) microscopy identified hypointense regions at the same position as in vivo. Donor cells containing iron particles and expressing GFP were identified in MR-targeted heart sections after magnetic cell separation from digested hearts. In conclusion, MRI can be used to track cells labeled with iron particles in damaged tissue for at least 16 weeks after injection and to guide tissue sectioning by accurately identifying regions of cell engraftment. The magnetic properties of the iron-labeled donor cells can be used for their isolation from host tissue to enable further characterization.
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PMID:Iron particles for noninvasive monitoring of bone marrow stromal cell engraftment into, and isolation of viable engrafted donor cells from, the heart. 1662 84

We propose a novel framework to predict pacing sites in the left ventricle (LV) of a heart and its result can be used to assist pacemaker implantation and programming in cardiac resynchronization therapy (CRT), a widely adopted therapy for heart failure patients. In a traditional CRT device deployment, pacing sites are selected without quantitative prediction. That runs the risk of suboptimal benefits. In this work, the spherical harmonic (SPHARM) description is employed to model the ventricular surfaces and a novel SPHARM-based surface correspondence approach is proposed to capture the ventricular wall motion. A hierarchical agglomerative clustering technique is applied to the time series of regional wall thickness to identify candidate pacing sites. Using clinical MRI data in our experiments, we demonstrate that the proposed framework can not only effectively identify suitable pacing sites, but also distinguish patients from normal subjects perfectly to help medical diagnosis and prognosis.
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PMID:A prediction framework for cardiac resynchronization therapy via 4D cardiac motion analysis. 1668 8

Animal studies have shown some success in the use of stem cells of diverse origins to treat heart failure and ventricular dysfunction secondary to ischemic injury. The clinical use of these cells is, therefore, promising. In order to develop effective cell therapies, the location, distribution and long-term viability of these cells must be evaluated in a noninvasive manner. MRI of cells labeled with magnetically visible contrast agents after either direct injection or local or intravenous infusion has the potential to fulfill this goal. In this Review, techniques for labeling and imaging a variety of cells will be discussed. Particular attention will be given to the advantages and limitations of various contrast agents and passive and facilitated cell-labeling methods, as well as to imaging techniques that produce negative and positive contrast, and the effect on image quantification of compartmentalization of contrast agents within the cell.
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PMID:Technology insight: in vivo cell tracking by use of MRI. 1699 Aug 41

Reactive oxygen species, in particular superoxide, have been closely linked to the underlying pathophysiology of ischemic cardiomyopathy: superoxide not only mediates mechanoenergetic uncoupling of the myocyte but also adversely impacts on myocardial perfusion by depleting endothelial-derived nitric oxide bioavailability. Xanthine oxidase generates superoxide upon oxidation of hypoxanthine and xanthine and has been detected in cardiac myocytes and coronary endothelial cells of patients with ischemic heart disease. Here we investigated the effects of oxypurinol, a xanthine oxidase inhibitor, on myocardial contractility in patients with ischemic cardiomyopathy. Twenty patients (19 males, 66+/-8 years) with stable coronary disease, severely suppressed systolic function (left ventricular ejection fraction 22+/-2%), and nonelevated uric acid plasma levels received a single intravenous dose of oxypurinol (400 mg). Cardiac MRI studies, performed before and 5.2+/-0.9 h after oxypurinol administration, revealed a reduction in end-systolic volumes (-9.7+/-4.2%; p=0.03) and an increase in left ventricular ejection fraction (+17.5+/-5.2%; p=0.003), whereas 6 patients (6 males, 63+/-3.8 years, ejection fraction 26+/-5%) who received vehicle only did not show significant changes in any of the parameters studied. Oxypurinol improves left ventricular function in patients with ischemic cardiomyopathy. These results underscore the significance of reactive oxygen species as important pathophysiological mediators in ischemic heart failure and point toward xanthine oxidase as an important source of reactive species that serve to modulate the myocardial redox state in this disease.
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PMID:Inhibition of xanthine oxidase improves myocardial contractility in patients with ischemic cardiomyopathy. 1701 75

Translating research into clinical practice has been a challenge throughout medical history. From the present review, it should be clear that this is particularly the case for heart failure. As a consequence, public awareness of this disease has been disillusionedly low, despite its prognosis being worse than that of most cancers and many other chronic diseases. We explore how over the past 150 years since Ludwig and Marey concepts about the evaluation of cardiac performance in patients with heart failure have emerged. From this historical-physiologic perspective, we have seen how 3 increasingly reductionist approaches or schools of thought have evolved in parallel, that is, an input-output approach, a hemodynamic pump approach, and a muscular pump approach. Each one of these has provided complementary insights into the pathophysiology of heart failure and has resulted in measurements or derived indices, some of which still being in use in present-day cardiology. From the third, most reductionist muscular pump approach, we have learned that myocardial and ventricular relaxation properties as well as temporal and spatial nonuniformities have been largely overlooked in the 2 other, input-output and hemodynamic pump, approaches. A key message from the present review is that relaxation and nonuniformities can be fully understood only from within the time-space continuum of cardiac pumping. As cyclicity and rhythm are, in some way, the most basic aspects of cardiac function, considerations of time should dominate over any measurement of cardiac performance as a muscular pump. Any measurement that is blind for the arrow of cardiac time should therefore be interpreted with caution. We have seen how the escape from the time domain-as with the calculation of LV ejection fraction-fascinating though as it may be, has undoubtedly served to hinder a rational scientific debate on the recent, so-called systolic-diastolic heart failure controversy. Lacking appreciation of early relaxation abnormalities and inappropriate degrees of nonuniformities has, indeed, led to some unfortunate misunderstandings about the pathophysiologic time progression of heart failure, in particular, heart failure with compensated hemodynamic pump function (ie, with normal or preserved LV ejection fraction). We have seen that with the introduction of newer powerful diagnostic techniques, as, for example, TDI and MRI, to evaluate ventricular "muscular pump" function, this debate can now be held in a more serene physiologic context. These aspects will be elaborated further in subsequent chapter papers of this symposium. With ongoing stem and other cell-based therapies and future reductionistic insights into cardiac cellular performance, we foresee the emergence of a fourth simple-parallel school of thought viewing the heart as a network of communicating different cell types, that is, cardiomyocytes, endothelial cells, fibroblasts, neurons. In this postgenomic age with the introduction of the rapidly evolving discipline of in vivo molecular imaging techniques, we anticipate that novel measurements of cardiac performance in patients with heart failure will soon become available and complement biopsy and other already available cardiac cellular biomarkers (cardiac troponin I; creatine kinase-MB; myoglobin; BNP). Through the use of these novel biomarkers as a fourth diagnostic track in the evaluation of cardiac performance in patients with heart failure, we will soon be able to increasingly understand the behavior of the heart as a complex biologic system-in other words, how these "low-level" biologic functions and signal transduction pathways at a cellular level contribute to the above "high-level" or system-level approach of cardiac performance at the muscular, the hemodynamic, and the input-output pump system levels and, hopefully, how they could contribute to an early diagnosis of chronic heart failure, in patients.
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PMID:Cardiac dysfunction in heart failure: the cardiologist's love affair with time. 1708 77

During the period 1984-2005, eight patients aged 25-57 years were treated for cardiac sarcoidosis. Diagnosis was obtained in three patients by endomyocardial biopsy, in three at heart transplantation (HTx) and in two at autopsy. Two patients had heart block, five ventricular arrhythmias and six dilated cardiomyopathy with congestive heart failure. Five patients died, one by sudden death, two of heart failure and two after HTx. Diagnosing cardiac sarcoidosis remains difficult, although MRI and PET scan have renewed the awareness of the disease.
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PMID:[Cardiac sarcoidosis--a difficult diagnosis. A report of 8 consecutive patients with arrhythmias and cardiomyopathy]. 1711 43

Left ventricular hypertrophy (LVH), used in this review to denote abnormally increased left ventricular (LV) mass, is an important cardiac trait because of its association with numerous adverse cardiovascular outcomes including myocardial infarction and heart failure. LV mass is typically assessed by noninvasive cardiac imaging (echocardiography or MRI); electrocardiography is an insensitive measure. There are two predominant types of hypertrophy: concentric, where LV wall thickness is increased relative to cavity dimensions, and eccentric, where LV wall thickness is not increased relative to cavity dimensions. Several large studies indicate that the prevalence of concentric LVH is higher in African-Americans versus whites. Although there are data to suggest that concentric LVH results in systolic heart failure in animal models, such data are lacking in humans. How concentric LVH affects the prevalence of systolic and diastolic heart failure in African-Americans needs further study. Given the large burden of LVH among African-Americans, such data are needed to estimate the expected burden and type of heart failure which will occur in the future in this population.
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PMID:Increased prevalence of concentric left ventricular hypertrophy in African-Americans: will an epidemic of heart failure follow? 1713 Oct 73

Heart failure constitutes a major health problem in USA and Europe. Angiotensin converting enzyme inhibitors and _ blockers were shown to reduce morbidity and mortality in patients with CHF. Yet, their effectiveness is limited. A significant number of patients with heart failure manifest myocardial conduction abnormalities. Conduction abnormalities, especially in the form of left bundle branch block (LBBB) may be associated with abnormal mechanical function. Several studies demonstrated that these patients may gain benefit from biventricular (BiV) pacing in terms of improvement in exercise tolerance, heart failure morbidity and even decreased mortality. BiV pacing was also associated with improvement in ejection fraction, reduction in the extent of mitral regurgitation and a decrease in cardiac size (reverse remodeling). However, a significant number of patients do not gain benefit from biventricular pacing despite having conduction abnormalities. The underlying reason is that the electrical activity may not closely reflect mechanical activity. Several imaging modalities and techniques have been proposed to improve the selection of patients who may benefit from biventricular pacemakers. Of those, echo-Doppler, and especially, Tissue Doppler Imaging has been demonstrated as important tools for evaluating patients for cardiac resynchronization therapy (CRT) and following their response. The advantages of echo include accessibility, portability, its cost and a high temporal resolution. Yet, it is limited by its acoustic windows and scanning angles. MRI is a useful tool for evaluating patients for CRT by providing 3-D image of myocardial function. However, it is limited for follow-up after implantation due to its cost and a potential damage to the patients or pacemakers. Dyssnchrony imaging is a rapidly evolving field. New imaging techniques such as speckle tracking are promising and close update is needed to keep track of the developments and the changes in this exciting field.
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PMID:Imaging of myocardial dyssynchrony in congestive heart failure. 1713 Oct 75


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