Heart failure: Diagnosis and healthcare burden

Clinical Cardiology, National Heart & Lung Institute, Imperial College, London.
Clinical medicine (London, England) (Impact Factor: 1.49). 01/2004; 4(1):13-8. DOI: 10.7861/clinmedicine.4-1-13
Source: PubMed

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    • "Cardiovascular diseases represent an enormous medical and social burden [1,2] and the pathophysiology of most of these diseases, such as myocardial infarction or heart failure, involves death of cardiac myocytes leading to a loss of functional tissue. Cell based therapies are commonly believed to be the next generation of therapies for replacing such lost tissue [3-5]. "
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    ABSTRACT: Bone marrow derived mesenchymal stem cells (MSCs) are promising candidates for cell based therapies in myocardial infarction. However, the exact underlying cellular mechanisms are still not fully understood. Our aim was to explore the possible role of direct cell-to-cell interaction between ischemic H9c2 cardiomyoblasts and normal MSCs. Using an in vitro ischemia model of 150 minutes of oxygen glucose deprivation we investigated cell viability and cell interactions with confocal microscopy and flow cytometry. Our model revealed that adding normal MSCs to the ischemic cell population significantly decreased the ratio of dead H9c2 cells (H9c2 only: 0.85 +/- 0.086 vs. H9c2+MSCs: 0.16 +/- 0.035). This effect was dependent on direct cell-to-cell contact since co-cultivation with MSCs cultured in cell inserts did not exert the same beneficial effect (ratio of dead H9c2 cells: 0.90 +/- 0.055). Confocal microscopy revealed that cardiomyoblasts and MSCs frequently formed 200-500 nm wide intercellular connections and cell fusion rarely occurred between these cells. Based on these results we hypothesize that mesenchymal stem cells may reduce the number of dead cardiomyoblasts after ischemic damage via direct cell-to-cell interactions and intercellular tubular connections may play an important role in these processes.
    Full-text · Article · Apr 2010 · BMC Cell Biology
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    • "almost 5 million people are affected, and 30% to 40% of all patients die within one year after diagnosis [1], [2]. The CHF is associated with major abnormalities of autonomic cardiovascular control, and this group of patients often develop breathing anomalies such as various forms of oscillatory breathing patterns characterized by rises and falls in ventilation. "
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    ABSTRACT: A correntropy-based technique is proposed for the characterization and classification of respiratory flow signals in chronic heart failure (CHF) patients with periodic or nonperiodic breathing (PB or nPB, respectively) and healthy subjects. The correntropy is a recently introduced, generalized correlation measure whose properties lend themselves to the definition of a correntropy-based spectral density (CSD). Using this technique, both respiratory and modulation frequencies can be reliably detected at their original positions in the spectrum without prior demodulation of the flow signal. Single-parameter classification of respiratory patterns is investigated for three different parameters extracted from the respiratory and modulation frequency bands of the CSD, and one parameter defined by the correntropy mean. The results show that the ratio between the powers in the modulation and respiratory frequency bands provides the best result when classifying CHF patients with either PB or nPB, yielding an accuracy of 88.9%. The correntropy mean offers excellent performance when classifying CHF patients versus healthy subjects, yielding an accuracy of 95.2% and discriminating nPB patients from healthy subjects with an accuracy of 94.4%.
    Full-text · Article · Mar 2010 · IEEE transactions on bio-medical engineering
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    • "Our data support the belief that CHF diagnosis is complex, and clinical suspicion needs to be supported by further investigation. [14] It is noteworthy that the majority of heart failure patients were identified as needing some palliative care input irrespective of ECHO data. This supports recent prospective clinical data demonstrating that patients with CHF and normal ejection fraction (i.e. "
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    ABSTRACT: Clinical guidance recommends early CHF palliative care intervention, but the magnitude of need is unknown and evidence-based referral criteria absent.This study aimed to: 1) Measure point prevalence of inpatients appropriate for palliative care. 2) Identify patient characteristics associated with palliative care appropriateness. 3) Propose evidence-based clinical referral criteria. Census: all adult medical inpatient files in a UK tertiary teaching hospital were reviewed, identifying patients with CHF as a reason for current admission, using NYHA stage 3/4 classification, cross referenced with existing ECHO data. Each CHF patient was classified according to appropriateness for palliative care against a definition of unresolved pain and/or symptoms and/or psychosocial problems 7 days post admission. Three hundred and sixty-five patient files were reviewed, and 28 clinically identified as having CHF. Of these, 11 had confirmed unpreserved ejection fraction,16 of the 28 patients were appropriate for palliative care. Of the total inpatient population reviewed, 10 (2.7%) had both confirmed ejection fraction </=45%, and were appropriate for palliative care. Of the 17 clinically-identified CHF patients with no recorded evidence of ejection fraction </=45%, 5 (29.4%) were still appropriate for palliative care. A total of 4.4% of the reviewed inpatient population had a clinical diagnosis of CHF and were appropriate for palliative care. CHF patients with ejection fraction >45% also require palliative care. Our conservative criteria suggest a point prevalence of 2.7% of patients having both ejection fraction </=45% and palliative care needs, although this may be a conservative estimate due to the file review methodology to identify unresolved palliative care problems. It is important to note that the point prevalence of patients with clinical diagnosis and palliative care needs was 4.4% of the population. We present evidence-based referral criteria from the larger multi methods study.
    Full-text · Article · Jul 2009 · BMC Palliative Care
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