Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al, American College of Cardiology Foundation; American Heart Association. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation

Journal of the American College of Cardiology (Impact Factor: 16.5). 05/2009; 53(15):e1-e90. DOI: 10.1016/j.jacc.2008.11.013
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    • "Heart failure (HF) is the leading cause of death and hospitalization in industrialized countries, and covers an important part of the health care costs.1–3 In recent years, the introduction of new drugs and the use of devices has reduced mortality rates;4 however, the hospitalization rates continue to increase and the prognosis still remains unsatisfactory with high mortality and readmission rates.5–7 The growing acknowledge regarding metabolic abnormalities, hypercatabolic status, and cachexia in HF and their impact on outcomes have contributed to consider HF as a cardiac and whole body metabolic disease, which may be the final pathway of the hemodynamic abnormalities and the neurohormonal and inflammatory activation.8 "
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    ABSTRACT: Amino acids (AAs) availability is reduced in patients with heart failure (HF) leading to abnormalities in cardiac and skeletal muscle metabolism, and eventually to a reduction in functional capacity and quality of life. In this study, we investigate the effects of oral supplementation with essential and semi-essential AAs for three months in patients with stable chronic HF. The primary endpoints were the effects of AA's supplementation on exercise tolerance (evaluated by cardiopulmonary stress test and six minutes walking test (6MWT)), whether the secondary endpoints were change in quality of life (evaluated by Minnesota Living with Heart Failure Questionnaire-MLHFQ) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We enrolled 13 patients with chronic stable HF on optimal therapy, symptomatic in New York Heart Association (NYHA) class II/III, with an ejection fraction (EF) <45%. The mean age was 59 ± 14 years, and 11 (84.6%) patients were male. After three months, peak VO2 (baseline 14.8 ± 3.9 mL/minute/kg vs follow-up 16.8 ± 5.1 mL/minute/kg; P = 0.008) and VO2 at anaerobic threshold improved significantly (baseline 9.0 ± 3.8 mL/minute/kg vs follow-up 12.4 ± 3.9 mL/minute/kg; P = 0.002), as the 6MWT distance (baseline 439.1 ± 64.3 m vs follow-up 474.2 ± 89.0 m; P = 0.006). However, the quality of life did not change significantly (baseline 21 ± 14 vs follow-up 25 ± 13; P = 0.321). A non-significant trend in the reduction of NT-proBNP levels was observed (baseline 1502 ± 1900 ng/L vs follow-up 1040 ± 1345 ng/L; P = 0.052). AAs treatment resulted safe and was well tolerated by all patients. In our study, AAs supplementation in patients with chronic HF improved exercise tolerance but did not change quality of life.
    Clinical Medicine Insights: Cardiology 05/2014; 8:39-44. DOI:10.4137/CMC.S14016
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    • "A high blood pressure can result in coronary artery disease and changes in ventricular function and structure [2], and is a major risk factor for incident heart failure [3], with a 5-year survival rate of 35 % according to previous research [4]. Early diagnosis and treatment of heart failure are crucial for reducing heart failure related morbidity and mortality [5–7]. General practitioners (GPs) are most frequently involved in the diagnosis of heart failure [8]. "
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    ABSTRACT: The prevalence and diagnostic value of heart failure symptoms in elderly primary care patients with hypertension is unknown. To assess the prevalence, sensitivity, specificity, positive and negative predictive value of symptoms in association with an abnormal echocardiogram. Cross-sectional screening study in five general practices in the south-east of the Netherlands. Between June 2010 and January 2013, 591 primary care hypertension patients aged between 60 and 85 years were included, without known heart failure and not treated by a cardiologist. All patients underwent an echocardiogram and a structured interview including assessment of heart failure symptoms: shortness of breath, fatigue, oedema, cold extremities, and restless sleep. Restless sleep was reported by 25 %, cold extremities by 23 %, fatigue by 19 %, shortness of breath by 17 %, and oedema by 13 %. Oedema was the only symptom significantly associated with an abnormal echocardiogram (positive predictive value was 45 %, sensitivity 20 %, and specificity 90 %, OR 2.12; 95 % CI = 1.23-3.64), apart from higher age (OR 1.06; 95 % CI = 1.03-1.09), previous myocardial infarction (OR 3.00; 95 % CI = 1.28-7.03), and a systolic blood pressure of >160 mmHg (OR 1.62; 95 % CI = 1.08-2.41). Screening with echocardiography might be considered in patients with oedema.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 04/2014; 22(5). DOI:10.1007/s12471-014-0543-y · 1.84 Impact Factor
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    • "The American College of Cardiology/American Heart Association and European Society of Cardiology therefore supported the use of ARBs in patients with current or prior symptoms of heart failure resulting from systolic dysfunction, especially in those who are intolerant of ACE inhibitors.20,21 "
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    ABSTRACT: Hypertension is common in Asian populations and is a major cause of cardiovascular diseases. The prevalence of hypertension is increasing in many Asian countries. The overall prevalence of hypertension in India and the People's Republic of China has been estimated to be 20.6% in men and 22.6% in women. However, the rates of detection, treatment, and control of hypertension remain low in Asia. This reflects a low level of literacy and education, as well as a low level of access to medical care. To overcome these obstacles, strategies targeted at education, promotion, and optimization of medical care, are crucial to achieve target blood pressure control. Angiotensin receptor blockers are one of the first-line treatments for essential hypertension because they confer better cardiovascular outcomes. Losartan has been widely evaluated for the management of hypertension. Although some studies suggested that the blood pressure-lowering effect of losartan is perhaps lower than for other angiotensin receptor blockers, losartan has been demonstrated to be beneficial in terms of renal protection in patients with diabetes, heart failure resulting from either systolic or diastolic dysfunction, and diuretic-induced hyperuricemia. However, most of these data were obtained from Caucasian populations. The efficacy and safety of losartan in Asian populations may be different because of genetic and ethnic variations. Therefore, the efficacy and safety of losartan in Asian patients with hypertension warrant further study.
    Clinical Interventions in Aging 03/2014; 9:443-450. DOI:10.2147/CIA.S39780 · 2.08 Impact Factor
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