Current Heart Failure Reports (Curr Heart Fail Rep )

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: In patients with heart failure (HF), altered breathing patterns, including periodic breathing, Cheyne-Stokes breathing, and oscillatory ventilation, are seen in several situations. Since all forms of altered breathing cause similar detrimental effects on clinical outcomes, they may be considered collectively as an “altered breathing syndrome.” Altered breathing syndrome should be recognized as a comorbid condition of HF and as a potential therapeutic target. In this review, we discuss mechanisms and therapeutic options of altered breathing while sleeping, while awake at rest, and during exercise.
    Current Heart Failure Reports 01/2015;
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    ABSTRACT: Recent efforts have reduced the mortality from coronary artery disease (CAD), with the consequent increase in heart failure with reduced left ventricular function, referred to as ischaemic cardiomyopathy (ICM). As ischemic left ventricular (LV) dysfunction may be partially or completely reversible by revascularization in the presence of viable myocardium, the assessment of myocardial viability is central to the management of ICM. Decades of observational analyses have provided positive evidence for the role of revascularization in hibernating myocardium in improving survival. However, recently the Surgical Treatment for Ischaemic Heart Failure (STICH) trial has challenged this notion, highlighting the noninferiority of optimal medical therapy (OMT) over revascularization and OMT. In this review, we discuss noninvasive imaging modalities to assess myocardial viability and the impact of myocardial viability on revascularization. We critically appraise the STICH trial and suggest an algorithm for viability testing before revascularization in patients with ICM and significant LV dysfunction.
    Current Heart Failure Reports 12/2014;
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    ABSTRACT: Most cardiovascular implantable electronic devices (CIEDs) require a ventricular lead to be placed across the tricuspid valve. Tricuspid regurgitation (TR) is an understudied clinical complication of right ventricular lead implantation and its clinical significance is unknown. We review the incidence, predictors, and current management of TR as a complication of ventricular lead implantation. Emerging technologies, including leadless pacing devices and subcutaneous systems, offer the benefit of little or none tricuspid valve disruption.
    Current Heart Failure Reports 12/2014;
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    ABSTRACT: Persons with heart failure (HF) symptoms delay up to 7 days before seeking treatment. Delay can result in worse symptoms and potentially impact outcomes. The purpose of this review was to describe predictors and outcomes of delay in HF patients. Demographic factors, increased symptom number, social factors, greater HF knowledge, lower anxiety, and depression predicted increased delay. HF patients had difficulty recognizing and interpreting symptoms of HF. Results are conflicting related to symptom pattern, time of care seeking, and history of HF as predictors of delay. The only outcome predicted by delay was length of stay with those delaying longer reporting longer lengths of stay. Future research related to delay should include theoretical frameworks and larger, more ethnically diverse samples from multiple sites and link delay to outcomes. Valid and reliable instruments are needed to measure delay and related factors. HF education should include supportive others.
    Current Heart Failure Reports 12/2014;
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    ABSTRACT: The loss of contractile function is a hallmark of heart failure. Although increasing intracellular Ca2+ is a possible strategy for improving contraction, current inotropic agents that achieve this by raising intracellular cAMP levels, such as β-agonists and phosphodiesterase inhibitors, are generally deleterious when administered as long-term therapy due to arrhythmia and myocardial damage. Nitroxyl donors have been shown to improve cardiac function in normal and failing dogs, and in isolated cardiomyocytes they increase fractional shortening and Ca2+ transients, independently from cAMP/PKA or cGMP/PKG signaling. Instead, nitroxyl targets cysteines in the EC-coupling machinery and myofilament proteins, reversibly modifying them to enhance Ca2+ handling and myofilament Ca2+ sensitivity. Phase I–IIa trials with CXL-1020, a novel pure HNO donor, reported declines in left and right heart filling pressures and systemic vascular resistance, and increased cardiac output and stroke volume index. These findings support the concept of nitroxyl donors as attractive agents for the treatment of acute decompensated heart failure.
    Current Heart Failure Reports 09/2014; 11(3).
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    ABSTRACT: Heart failure (HF) is a major healthcare concern. Acute HF carries a high mortality and a high rehospitalisation rate. HF has a variety of detrimental effects on other organs. In recent years, the interactions between heart failure and the kidney have been the subject of significant investigations; this interaction, defined as “cardiorenal syndrome”, is relatively well characterized. We describe here another interaction between the heart and the liver, the “cardiohepatic syndrome”, in acute HF patients. Recent publications have shown that liver function test (LFT) abnormalities were associated with AHF severity. Clinical signs of systemic congestion were found to be associated with cholestasis, when signs of hypoperfusion were associated with liver cytolysis. Defining the LFT profile in AHF may play an important role in the future management of AHF patients.
    Current Heart Failure Reports 06/2014;
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    ABSTRACT: Growth differentiation factor 15 (GDF-15) is a stress-responsive cytokine expressed in the cardiovascular system. GDF-15 is emerging as a biomarker of cardiometabolic risk and disease burden. GDF-15 integrates information from cardiac and extracardiac disease pathways that are linked to the incidence, progression, and prognosis of heart failure (HF). Increased circulating levels of GDF-15 are associated with an increased risk of developing HF in apparently healthy individuals from the community. After an acute coronary syndrome, elevated levels of GDF-15 are indicative of an increased risk of developing adverse left ventricular remodeling and HF. In patients with established HF, the levels of GDF-15 and increases in GDF-15 over time are associated with adverse outcomes. The information provided by GDF-15 is independent of established risk factors and cardiac biomarkers, including BNP. More studies are needed to elucidate how the information provided by GDF-15 can be used for patient monitoring and formulating treatment decisions. Further understanding of the pathobiology of GDF-15 may lead to the discovery of new treatment targets in HF.
    Current Heart Failure Reports 09/2012; 9(4).
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    ABSTRACT: Anemia is a common comorbidity in heart failure (HF), and is associated with increased morbidity and mortality. However, it remains unclear whether anemia is merely a marker of poor prognosis or whether anemia itself confers risk. The pathogenesis of anemia in HF is multifactorial. Iron deficiency also confers risk in HF, either with or without associated anemia, and treatment of iron deficiency improves the functional status of patients with HF. An ongoing large clinical trial studying the use of darbepoetin–alfa in patients with anemia and systolic HF is expected to provide information that should improve our understanding of anemia in HF.
    Current Heart Failure Reports 09/2012; 9(4).
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    ABSTRACT: Limited donor availability for orthotopic cardiac transplantation has led surgeons to develop surgical alternatives to treat congestive heart failure as a result of ischemic cardiomyopathy. Coronary revascularization plays a clear role in patients with ischemic cardiomyopathy, substantial viable myocardium subtended by coronary stenoses, and presence of anginal symptoms. It is unclear whether patients with heart failure symptoms but no angina benefit from bypass surgery. Some of these patients present with left ventricular dilatation and akinetic/dyskinetic scars, and are therefore candidates for surgical ventricular restoration. Current evidence is lacking as to whether ventricular reconstruction should be performed along with coronary revascularization. Functional mitral regurgitation is often seen in patients with end-stage cardiomyopathy, and its presence portends decreased survival. Mitral valve repair has been shown to improve quality of life, functional class, and to contribute to left ventricle reverse remodeling; however, it has been insufficient in improving survival.
    Current Heart Failure Reports 12/2009; 5(4):204-210.
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    ABSTRACT: Echocardiography is the most important imaging tool for managing heart failure patients. With the advent of cardiac resynchronization therapy (CRT), its role has been broadened by data pertaining to patient selection, optimization of device settings, and outcome assessment. Beyond ejection fraction determination, echocardiographic methods that measure tissue velocity and strain may have the capability to determine degree of mechanical dyssynchrony and possibly predict likelihood of benefit with CRT. After implantation (as the ventricles are fully paced, adjusting the atrioventricular delay [atrioventricular optimization]), the timing of the right ventricular and left ventricular lead stimulation (ventricular-ventricular optimization) to achieve maximal cardiac filling or ejection may be clinically important. Atrioventricular and ventricular-ventricular optimization rely on echocardiography to determine optimal values. In long-term follow-up, serial measurement of left ventricular volume has significant correlation with mortality and is a reasonable measure of successful CRT; echocardiography is uniquely suited for this purpose.
    Current Heart Failure Reports 03/2009; 6(1).
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    ABSTRACT: More than half of patients with heart failure (HF) have a normal ejection fraction (EF). These patients are typically elderly, are predominantly female, and have a high incidence of multiple comorbid conditions associated with development of ventricular hypertrophy and/or interstitial fibrosis. Thus, the cause of HF has been attributed to diastolic dysfunction. However, the same comorbidities may also impact myocardial systolic, ventricular, vascular, renal, and extracardiovascular properties in ways that can also contribute to symptoms of HF by way of mechanisms not related to diastolic dysfunction. Accordingly, the descriptive term HF with normal EF has been suggested as an alternative to the mechanistic term diastolic HF. In this article, we review the current understanding of nondiastolic mechanisms that may contribute to the HF with normal EF syndrome to highlight potential pathways for research that may lead to new targets for therapy.
    Current Heart Failure Reports 02/2009; 6(1):57-64.
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    ABSTRACT: Atrial fibrillation (AF) and congestive heart failure (CHF) are common cardiac conditions that frequently coexist. There is a complex interplay between the two conditions, with each increasing the morbidity and mortality associated with the other. The management of AF in patients with CHF requires special care because of the increased risk of antiarrhythmic drug therapy in the group. This report reviews current treatment options and assesses the role of the newer therapies of biventricular pacing for CHF and radiofrequency ablation for AF. It also discusses results of the AF-CHF study, which were reported in November 2007.
    Current Heart Failure Reports 02/2008; 5(1):11-15.
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    ABSTRACT: Cardiac resynchronization therapy (CRT) improves clinical outcome and survival in advanced heart failure. However, some patients do not respond clinically or show improvement in left ventricular function. Our focus has turned to why such “nonresponders” exist. Follow-up of CRT has led to several explanations, varying by individual patient, and has shown the importance of device programming in CRT in heart failure. The failing heart displays delayed contraction in the ventricle, also referred to as mechanical dyssynchrony. Simply pacing both ventricles simultaneously might not be adequate to optimize systolic function. Individually tailoring the atrioventricular (AV) timing can improve left ventricular filling and cardiac output, and adjusting the interventricular (VV) pacing delay has also been shown to improve hemodynamics. Increasing evidence regarding AV and VV optimization is emerging. This article reviews the current data on optimization, including the physiology, numerous approaches, and current issues.
    Current Heart Failure Reports 02/2008; 5(1):38-43.
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    ABSTRACT: Heart transplantation remains the gold standard treatment for "end-stage" dilated cardiomyopathy. However, its epidemiologic impact on the heart failure problem continues to be small due to limited donor organ availability and contraindications. Therefore, several "conventional" surgical procedures have been developed to reverse the vicious cycle of ventricular remodeling that accompanies systolic heart failure and to improve symptoms and survival of the patients. This review discusses indications, results, and limitations of the most common surgical methods currently used to arrest or reverse cardiac remodeling.
    Current Heart Failure Reports 01/2008; 4(4):214-20.
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    ABSTRACT: Mild hyponatremia is common in patients hospitalized for worsening heart failure, and it is a major predictor of post-discharge mortality and morbidity irrespective of left ventricular ejection fraction. Recent data also suggest that standard therapy for heart failure does not improve or normalize serum sodium concentration during hospitalization. There are conclusive data that vasopressin antagonists improve or normalize serum sodium in this patient population. However, it is not known if this improvement or normalization in serum sodium is associated with an improvement in post-discharge outcomes. Future trials with vasopressin antagonists in patients hospitalized with worsening heart failure and hyponatremia are in order.
    Current Heart Failure Reports 01/2008; 4(4):207-13.
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    ABSTRACT: As part of the recommended modern post-myocardial infarction (MI) management, including reperfusion strategies, antiplatelet therapy, and beta-blockers, we may wonder whether the impact of early inhibition of the renin-angiotensin system (RAS) is as important as it was 20 years ago. This review demonstrates that significant clinical benefit can be derived from angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) even when added to other currently recommended treatment strategies in post-MI patients. Moreover, the effects of RAS inhibition extend far beyond the early post-MI neurohormonal activation and left ventricular remodeling phases. The favorable effects of RAS inhibition on important prognostic markers such as atrial fibrillation, renal function, and diabetes have recently been unraveled. Post-MI RAS inhibition also benefits all age groups, including elderly patients.
    Current Heart Failure Reports 01/2008; 4(4):190-7.
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    ABSTRACT: The possibility of modifying cardiac metabolism by switching the fuel used by the myocardium could become increasingly important. Inhibitors of free fatty acid (FFA) oxidation could have an important role in therapeutic strategy for patients with heart failure, and shifting the energy substrate preference away from FFA metabolism and toward glucose metabolism may be an effective adjunctive treatment. Additionally, abnormalities of glucose homeostasis in patients with heart failure contribute to the progression of the primary disease. If not adequately treated, these abnormalities can contribute to the occurrence of complications, including severe left ventricular dysfunction. Apart from meticulous metabolic control of frank diabetes, special attention should be paid to insulin resistance, a distinct clinical entity. The observed combined beneficial effects of FFA inhibitors on left ventricular function and glucose metabolism represent an additional advantage of these drugs, especially when abnormalities of myocardial and glucose metabolism coexist.
    Current Heart Failure Reports 01/2008; 4(4):236-242.
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    ABSTRACT: The presence of heart failure or left ventricular systolic dysfunction in the setting of acute myocardial infarction is associated with poor prognosis. Aldosterone is an important downstream mediator of the renin-angiotensin-aldosterone system that promotes myocardial collagen deposition, myocardial fibrosis, apoptosis, ventricular remodeling, and endothelial dysfunction. It may play an important role in the increased morbidity and mortality and the development and progression of heart failure after acute myocardial infarction. Extending the findings from the Randomized Aldactone Evaluation Study (RALES) in patients with chronic heart failure, the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) demonstrated that the selective aldosterone blocker eplerenone offered a significant survival benefit, attenuation of progression of heart failure, and prevention of sudden cardiac death when used in addition to optimal medical therapy. The current evidence-based guidelines now suggest that aldosterone blockade should be an integral component of heart failure therapy to improve outcomes in this high-risk population.
    Current Heart Failure Reports 01/2008; 4(4):183-9.
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    ABSTRACT: Obesity is associated with structural and functional changes in the heart. These changes may be precursors to more overt forms of cardiac dysfunction and heart failure. However, it is not known 1) whether cardiac hypertrophy in obese individuals results directly from increased adioposity or from the effects of comorbid conditions such as hypertension, diabetes, and sleep-disordered breathing and 2) whether functional changes (eg, mild reductions in systolic and diastolic function) in obese patients progress over time to the point where they cause heart failure, unless ischemic heart disease develops. Establishing a clear link between obesity and heart failure is complicated by the fact that obesity must be present for many decades before the risk of heart failure increases substantially. At present, there are no longitudinal studies of changes in cardiac size and function in humans with obesity. This article reviews data showing structural and functional changes in the heart in obesity and the evidence that these are or are not progressive over time. At present, we believe it is uncertain whether there is a true "cardiomyopathy of obesity."
    Current Heart Failure Reports 01/2008; 4(4):221-8.