Congestive Heart Failure

Publisher: Heart Failure Society of America, Blackwell Publishing

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  • Other titles
    Congestive heart failure (Greenwich, Conn.: Online), CHF
  • ISSN
    1527-5299
  • OCLC
    85449786
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

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Blackwell Publishing

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Publications in this journal

  • Congestive Heart Failure 08/2013;
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    ABSTRACT: Primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counterpulsation (IABP) are established treatment modalities in acute myocardial infarction complicated by cardiogenic shock. We hypothesized that the insertion of the IABP before primary PCI might result in better survival of patients with cardiogenic shock compared with postponing the insertion until after primary PCI. We, therefore, retrospectively studied 48 patients who had undergone primary PCI with IABP because of cardiogenic shock complicating acute myocardial infarction (26 patients received the IABP before and 22 patients after primary PCI). No significant differences were present in the baseline clinical characteristics between the 2 groups. The mean number of diseased vessels was greater in the group of patients treated with the IABP before primary PCI (2.8±0.5 vs 2.3±0.7, P=.012), but the difference in the number of treated vessels was not significant. The peak creatine kinase and creatine kinase-MB levels were lower in patients treated with the IABP before primary PCI (median, 1077; interquartile range, 438–2067 vs median, 3299; interquartile range, 695–6834; P=.047 and median, 95; interquartile range, 34–196 vs median, 192; interquartile range, 82–467; P=.048, respectively). In-hospital mortality and the overall incidence of major adverse cardiac and cerebrovascular events were significantly lower in the group of patients receiving the IABP before primary PCI (19% vs 59% and 23% vs 77%, P=.007 and P=.0004, respectively). Multivariate analysis identified renal failure (odds ratio, 15.2; 95% confidence interval, 3.13–73.66) and insertion of the IABP after PCI (odds ratio, 5.2; 95% confidence interval, 1.09–24.76) as the only independent predictors of in-hospital mortality. In conclusion, the results of the present study suggest that patients with cardiogenic shock complicating acute myocardial infarction who undergo primary PCI assisted by IABP have a more favorable in-hospital outcome and lower in-hospital mortality than patients who receive IABP after PCI. Abdel-Wahab M, Saad M, Kynast J, et al. Comparison of hospital mortality with intra-aortic balloon counterpulsation insertion before versus after primary percutaneous coronary intervention for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol. 2010;105:967–971.
    Congestive Heart Failure 09/2010; 16(5).
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    ABSTRACT: Objectives. We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). Background. Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel is associated with absolute mortality reduction in AMI patients. Methods. All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan–Meier method and Cox regression analyses. Results. We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n=5050) and a mean follow-up of 1.50 years (SD=1.2), 709 (28.1%) and 812 (32.2%) deaths occurred in patients receiving and not receiving clopidogrel treatment, respectively (P=.002). The corresponding numbers for patients without HF (n=6092), with a mean follow-up of 2.05 years (SD=1.3), were 285 (9.4%) and 294 (9.7%), respectively (P=.83). Patients with HF receiving clopidogrel demonstrated reduced mortality (hazard ratio, 0.86; 95% confidence interval, 0.78–0.95) compared with patients with HF not receiving clopidogrel. No difference was observed among patients without HF (hazard ratio, 0.98; 95% confidence interval, 0.83–1.16). Conclusions. Clopidogrel was associated with reduced mortality in patients with HF who do not undergo PCI after their first-time AMI, whereas this association was not apparent in patients without HF. Further studies of the benefit of clopidogrel in patients with HF and AMI are warranted.—Bonde L, Sorensen R, Fosbol EL, et al. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study. J Am Coll Cardiol. 2010;55:1300–1307.
    Congestive Heart Failure 01/2010; 16(5).
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    ABSTRACT: To assess the sensitivity and specificity of a new computer-enhanced resting electrocardiographic analysis device for the detection of coronary stenosis, 189 patients (aged 61.3+/-12.9 years, 57 women) scheduled for coronary angiography from 4 Asian centers were included in an observational study. Angiographic results were independently classified for hemodynamically relevant stenosis by 2 angiographers. The device calculated a severity score from 0 to 20. The score was significantly higher for patients with coronary stenosis (5.4+/-1.8 vs 1.7+/-2.1). The study device (cutoff 4.0) identified 73 of 77 patients with stenosis (sensitivity 94.8%, specificity 86.6%). Adjusted positive and negative predictive values were 78.4% and 97.1%, respectively (receiver operating characteristic area under the curve, 0.914 [95% confidence interval, 0.868-0.961]). Subgroup analysis showed no significant influence of sex, age, previous revascularization procedures, or participating center. The new computer-enhanced, resting electrocardiographic analysis device appears to identify patients with relevant coronary stenosis with high sensitivity and specificity.
    Congestive Heart Failure 10/2008; 14(5):251-60.
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    ABSTRACT: Although adherence to evidence-based therapy has been shown to improve clinical outcomes post-myocardial infarction (MI) and in patients with heart failure, adherence remains suboptimal. One method that has demonstrated success in improving adherence is the reduction in the frequency of drug administration (eg, switching from a twice-daily to a once-daily regimen). A once-daily controlled-release (CR) formulation of carvedilol--a beta-blocker used in the treatment of post-MI left ventricular dysfunction (LVD), heart failure, and hypertension--has recently received US approval. This review provides a switching protocol for transitioning stable patients from twice-daily carvedilol to once-daily carvedilol CR. Based on the findings from a head-to-head comparison study of carvedilol and metoprolol tartrate suggesting that carvedilol is associated with superior reductions in mortality and morbidity, physicians may consider switching patients with heart failure receiving beta-blockers who have not shown benefits in this setting. Algorithms are provided for switching patients with heart failure or post-MI LVD from another beta-blocker to carvedilol CR.
    Congestive Heart Failure 09/2008; 14(5):272-80.
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    ABSTRACT: Objectives. The objective of this study was to assess the usefulness of each type of strain for left ventricular (LV) dyssynchrony assessment and its predictive value for a positive response after cardiac resynchronization therapy (CRT). Furthermore, changes in extent of LV dyssynchrony for each type of strain were evaluated during follow-up. Background. Different echocardiographic techniques have been proposed for assessment of LV dyssynchrony. The novel 2-dimensional (2D) speckle tracking strain analysis technique can provide information on radial strain (RS), circumferential strain (CS), and longitudinal strain (LS). Methods. In 161 patients, 2D echocardiography was performed at baseline and after 6 months of CRT. Extent of LV dyssynchrony was calculated for each type of strain. Response to CRT was defined as a decrease in LV end-systolic volume >/=15% at follow-up. Results. At follow-up, 88 patients (55%) were classified as responders. Differences in baseline LV dyssynchrony between responders and nonresponders were noted only for RS (251+/-138 ms vs 94+/-65 ms; P<.001), whereas no differences were noted for CS and LS. A cutoff value of radial dyssynchrony >/=130 ms was able to predict response to CRT with a sensitivity of 83% and a specificity of 80%. In addition, a significant decrease in extent of LV dyssynchrony measured with RS (from 251+/-138 ms to 98+/-92 ms; P<.001) was demonstrated only in responders. Conclusions. Speckle tracking RS analysis constitutes the best method to identify potential responders to CRT. Reduction in LV dyssynchrony after CRT was noted only in responders.-Delgado V, Ypenburg C, van Bommel RJ, et al. Assessment of left ventricular dyssynchrony by speckle tracking strain imaging comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy. J Am Coll Cardiol. 2008;51;1944-1952.
    Congestive Heart Failure 09/2008; 14(5):287.
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    ABSTRACT: Congestive heart failure is a widespread cardiac disease in western countries. At present, the main measure for monitoring the level of pulmonary edema in telemedicine systems is weight, which is not a reliable indicator. The authors propose a novel bioimpedance telemedical system to monitor these patients. The system measures the resistivity of each lung using optimization methods and transmits the measurements via a modem to a call center. Preliminary results show that the measured resistivity values among healthy young patients are consistent and reproducible within 48 hours. The mean resistivity values in patients with pulmonary congestion were lower than those of the healthy patients: 887 [Omega*cm]+/-117 vs 1244 [Omega*cm]+/-87 (P<.01). The system is noninvasive, safe, and portable. It retrieves unique information correlated with the amount of fluid in the lungs and transmits the data to a medical call center in order to improve the diagnostics and treatment of congestive heart failure.
    Congestive Heart Failure 08/2008; 14(5):239-44.
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    ABSTRACT: This study used data from the National Hospital Discharge Survey to examine secular trends and regional variation in hospitalization rates for congestive heart failure. The hospitalization rate for congestive heart failure rose significantly between 1995 and 2004 for adults aged 35 to 64 years. This trend was particularly marked in the West region (from 10.3 per 10,000 population in 1995 to 17.0 per 10,000 population in 2004; P<.001) and the South region (from 21.9 per 10,000 population in 1995 to 27.6 per 10,000 population in 2004; P<.001). The regional variations for congestive heart failure hospitalization among adults aged 35 to 64 years were associated with primary care physicians per 10,000 population, regional income level, and the proportion of Medicare payment.
    Congestive Heart Failure 08/2008; 14(5):266-71.
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    ABSTRACT: As with any other diagnostic method, the cost-effectiveness of B-type natriuretic peptide (BNP) testing depends on the indication of its use and the specific clinical setting. The use of BNP levels, in conjunction with other clinical information, provides information that seems to be particularly helpful in the diagnosis, prognosis, and management of heart failure (HF) as well as screening for left ventricular systolic dysfunction. In the screening for asymptomatic left ventricular systolic dysfunction, BNP testing seems to be cost-effective (<$50,000 per quality-adjusted life-years gained) when used in a population with a prevalence of at least 1%. BNP testing, in fact, results in cost savings in the diagnosis of HF. Although the data are less robust, BNP seems cost-effective in the risk stratification of hospitalized HF patients when compared with echocardiography. Because BNP guidance seems to reduce the number of rehospitalizations in recently hospitalized patients with chronic HF, the use of BNP is also most likely cost-effective in this indication. For the remaining and, in part, evolving indications, further studies are needed to assess cost-effectiveness.
    Congestive Heart Failure 07/2008; 14(4 Suppl 1):35-7.
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    ABSTRACT: Although there is overwhelming evidence that natriuretic peptides might be helpful in the diagnosis and management of congestive heart failure patients, the relationship among brain natriuretic peptides (BNP), renal function, and the severity of heart failure is less clear. It is obvious that the metabolism and elimination of BNP and N-terminal prohormone brain natriuretic peptide (NT-proBNP) are different with BNP clearance less dependent upon renal function. This paper reviews current data about the diagnostic and predictive role of natriuretic peptides to detect cardiac events in patients with chronic kidney disease. Although BNP and Nt-proBNP can be used to diagnose acute heart failure and may help predict risk and future cardiac events in patients with chronic kidney disease (CKD), a strategy that incorporates their use in daily clinical practice is still lacking.
    Congestive Heart Failure 07/2008; 14(4 Suppl 1):38-42.
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    ABSTRACT: B-type natriuretic peptide levels are quantitative markers of cardiac stress and heart failure that summarize the extent of systolic and diastolic left ventricular dysfunction, valvular dysfunction, and right ventricular dysfunction. Initial observational pilot studies have addressed 7 potential indications in the intensive care unit: identification of cardiac dysfunction, diagnosis of hypoxic respiratory failure, risk stratification in severe sepsis and septic shock, evaluation of patients with shock, estimation of invasive measurements, weaning from mechanical ventilation, as well as perioperative and postoperative risk prediction. Although additional studies are required to better define the clinical utility of B-type natriuretic peptide values in the intensive care unit, current data suggest that the diagnosis of hypoxic respiratory failure and timing of extubation seem to be the most promising indications.
    Congestive Heart Failure 07/2008; 14(4 Suppl 1):43-5.
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    ABSTRACT: Asymptomatic left ventricular dysfunction (ASLVD), a known precursor phase of heart failure, fulfills the essential criteria that should be met before screening for a disease. It is common and associated with reduced longevity and quality of life. Left untreated, it progresses to heart failure, which incurs a mortality greater than most cancers as well as significant morbidity rates. In addition, we now have several population-based studies that demonstrate that both B-type natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NTproBNP) can accurately exclude left ventricular systolic dysfunction. More recent work shows that this can be done cost-effectively. There is also a wealth of evidence from randomized controlled trials indicating that the treatment of ASLVD can reduce both morbidity and mortality and slow progression to the heart failure state. The main stumbling block to implementation of screening, in addition to the perceived cost, may well be the lack of a randomized study showing that screening the population for ASLVD really does alter the natural history of the condition, something that other screening strategies have so far failed to do.
    Congestive Heart Failure 07/2008; 14(4 Suppl 1):5-8.
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    Congestive Heart Failure 07/2008; 14(4 Suppl 1):4.