Article

Predictors of cardiac hepatopathy in patients with right heart failure.

Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Medical science monitor: international medical journal of experimental and clinical research (Impact Factor: 1.22). 10/2011; 17(10):CR537-41.
Source: PubMed

ABSTRACT Some patients with right heart failure develop cardiac hepatopathy (CH). The pathophysiology of CH is thought to be secondary to hepatic venous congestion and arterial ischemia. We sought to define the clinical and hemodynamic characteristics associated with CH.
A retrospective cross sectional analysis was performed in which subjects were identified from our institutional cardiology database if echocardiography showed either right ventricular (RV) hypokinesis or dilatation, and was performed within 30 days of right heart catheterization. A chart review was then performed to identify patient clinical characteristics and to determine if the patients had underlying liver disease. Subjects with non-cardiac causes for hepatopathy were excluded.
In 188 included subjects, etiology for right heart dysfunction included left heart failure (LHF), shunt, pulmonary hypertension, mitral- tricuspid- and pulmonic valvular disease. On multivariate analysis, higher RV diastolic pressure and etiology for RV dysfunction other than LHF were both associated with CH. Low cardiac output was associated with CH only amongst those without LHF.
CH is most often seen in subjects with elevated RV diastolic pressure suggesting a congestive cause in most cases. CH associated with low cardiac output in patients without LHF suggests that low flow may be contributing to the patophysiology in some cases.

0 Bookmarks
 · 
112 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pulmonary arterial hypertension (PAH) is a chronic progressive disease of the pulmonary vasculature characterized by elevated pulmonary arterial pressure and secondary right ventricular failure. PAH is considered a life-threatening condition unless treated. This article provides a comprehensive review of controlled and uncontrolled trials to define the risk-benefit for different therapeutic options of this clinical disorder. Relevant published articles were identified through searches of the National Center for Biotechnology PubMed database. All therapeutic measures for PAH were discussed. Six drugs have been approved in the United States for the treatment of PAH. Extensive medical advancement has been achieved in treatment of PAH. However, none of the approved therapies have shown ability to cure the disease. New research should be performed to develop promising new therapies.
    Medical science monitor: international medical journal of experimental and clinical research 04/2012; 18(4):RA31-9. · 1.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Neuroendocrine tumors (NET) encompass a heterogeneous group of tumors demonstrating varied clinical behavior. The field has recently witnessed several important developments stemming from improvements in histopathological classification schemes, advanced imaging techniques, and a deeper understanding of the molecular mechanisms underlying tumor progression (in both sporadic and hereditary cancers). Platinum-based chemotherapy remains the mainstay of therapy for high grade carcinomas. In contrast, the treatment of advanced well-differentiated NET depends on site of origin, underlying tumor biology, and whether or not the patient is symptomatic. Somatostatin analogs continue to play a key role in controlling hormone-mediated symptoms. In addition, octreotide has demonstrated anti-tumor activity in midgut carcinoids. Novel somatostatin analogs (for use alone or in the context of peptide receptor radiotherapy or imaging) are on the horizon. Agents targeting VEGF- and mTOR-pathway signaling have been approved for pancreatic neuroendocrine tumors. In addition, two RET inhibitors have been approved for medullary thyroid cancer, evidence for a fundamentally new treatment paradigm (based on the use of targeted agents). Despite the advances, there remains a serious unmet need for additional treatment options for refractory high-grade neuroendocrine carcinomas, paragangliomas/pheochromocytomas, adrenocortical carcinomas, and progressive carcinoid tumors. Furthermore, the role of liver-directed therapy in the context of available systemic approaches needs clarification. Steady progress is anticipated, however, given the unprecedented number of ongoing clinical trials related to NET (including studies focused on symptom control, genetics, imaging, and novel therapies).
    Seminars in Oncology 02/2013; 40(1):4-22. · 4.33 Impact Factor

Full-text (2 Sources)

View
3 Downloads
Available from
Jun 18, 2014