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Pubblicazioni recenti - cardiac failure
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Comorbidities and their implications in patients with and without type 2 diabetes mellitus and heart failure with preserved ejection fraction. findings from the RICA Registry.
Int J Clin Pract2020 Aug;():e13661. doi: 10.1111/ijcp.13661.
Arévalo-Lorido J C, Carretero-Gómez J, Gómez Huelgas R, Llŕcer P, Manzano L, Quesada Simón M A, Roca Villanueva B, González Franco A, Cepeda J M, Montero-Pérez-Barquero M,
Abstract
AIM:
to determine if patients with heart failure and preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) have a higher comorbidity burden than those without T2DM, if other comorbidities are preferentially associated with T2DM, and if these conditions confer a worse patient prognosis.
METHODS AND RESULTS:
Cohort study based on the RICA Spanish Heart Failure Registry, a multicenter, prospective registry that enrolls patients admitted for decompensated HF and follows them for 1 year. We selected only patients with HFpEF, classified as having or not having T2DM, and performed an agglomerative hierarchical clustering based on variables such as the presence of arrhythmia, chronic obstructive pulmonary disease, dyslipidemia, liver disease, stroke, dementia, body mass index (BMI), hemoglobin levels, estimated glomerular filtration rate, and systolic blood pressure. 1,934 patients were analyzed: 907 had T2DM (mean age 78.4+/-7.6 years) and 1,027 did not (mean age 81.4+/- 7.6 years). The analysis resulted in 4 clusters in patients with T2DM, and 3 in the reminder. All clusters of patients with T2DM showed higher BMI, and more kidney disease and anemia than those without T2DM. Clusters of patients without T2DM had neither significantly better nor worse outcomes. However, among the T2DM patients, clusters 2, 3 and 4 all had significantly poorer outcomes, the worst being cluster 3 (HR 2.0, 95% CI 1.36-2.93, p=0.001).
CONCLUSIONS:
Grouping our patients with HFpEF and T2DM into clusters based on comorbidities revealed a greater disease burden and prognostic implications associated with the T2DM phenotype, compared to those without T2DM.
This article is protected by copyright. All rights reserved.
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Transcatheter mitral valve repair in patients with chronic liver disease: Insights from the national inpatient sample.
Catheter Cardiovasc Interv2020 Aug;():. doi: 10.1002/ccd.29173.
Khan Muhammad U, Khan Muhammad Z, Khan Safi U, Kaluski Edo,
Abstract
OBJECTIVE:
To evaluate contemporary national trends of morbidity, mortality, and healthcare utilization in patients with mitral regurgitation (MR) and co-existing chronic liver disease (CLD) undergoing transcatheter mitral valve repair (TMVR).
METHODS:
The National Inpatient Sample (NIS) was used to assess trends in patients undergoing TMVR between January 2012 and December 2017. Propensity match analysis was done to compare it to subjects without underlying CLD. Logistic regression analysis was used to identify predictors of in-hospital mortality.
RESULTS:
Of 15,270 patients undergoing TMVR, 569 (3.7%) had coexisting CLD. Patients with CLD had a higher proportion of males (61.3 vs 52.6%; p
CONCLUSION:
Patients with MR undergoing TMVR, with coexisting CLD bear substantially higher comorbidities, complication rates, and inpatient mortality compared with those without CLD. A favorable temporal trend of in-hospital mortality among these subjects is noteworthy.
© 2020 Wiley Periodicals LLC.
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Early clinical experience with AZD4831, a novel myeloperoxidase inhibitor, developed for patients with heart failure with preserved ejection fraction.
Clin Transl Sci2020 Aug;():. doi: 10.1111/cts.12859.
Nelander Karin, Lagerstrom-Fermer Maria, Amilon Carl, Michaëlsson Erik, Heijer Maria, Kjaer Magnus, Russell Muir, Han David, Lindstedt Eva-Lotte, Whatling Carl, Gan Li-Ming, Ericsson Hans,
Abstract
We evaluated safety, tolerability, pharmacokinetics and pharmacodynamics of AZD4831, a novel oral myeloperoxidase (MPO) inhibitor, in a randomized, single blind, placebo-controlled study, following once daily multiple ascending dosing to steady state in healthy subjects. Target engagement was measured as specific MPO activity in plasma following ex vivo zymosan stimulation of whole blood. Except for generalized maculopapular rash in 4 out of 13 subjects receiving the two highest doses, 15 mg and 45 mg AZD4831, no clinically relevant safety and tolerability findings were observed. AZD4831 was rapidly absorbed and plasma concentrations declined slowly with an elimination half-life of approximately 60 hours. A dose/concentration-effect relationship between MPO inhibition vs. AZD4831 exposure was established with >50 % MPO inhibition in plasma at concentrations in the low nanomolar range. Steady state levels were achieved within 10 days. Taken together the pharmacokinetic profile, the sustained dose/concentration dependent MPO inhibition, and available clinical data support further clinical development of AZD4831 in patients with heart failure with preserved ejection fraction (HFpEF).
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The epigenetics changes associated with anthracyclines induced cardiotoxicity.
Clin Transl Sci2020 Aug;():. doi: 10.1111/cts.12857.
Tantawy Marwa, Pamittan Frances G, Singh Sonal, Gong Yan,
Abstract
Advances in cancer treatment have significantly improved the survival of cancer patients, but unfortunately, many of these treatments also have long-term complications. Cancer treatmement related cardiotoxicities is becoming a significant clinical problem that a new discipline, Cardio-Oncology, was established to advance the cardiovascular care of growing cancer patient populations. Anthracyclines are a class of chemotherapeutic agents used to treat many cancers in adults and children. Their clinical use is limited by anthracycline-induced cardiotoxicity (AIC), which can lead to heart failure (HF). Early-onset cardiotoxicity appears within a year of treatment, while late-onset cardiotoxicity occurs more than one year and even up to decades after treatment completion. The pathophysiology of AIC was hypothesized to be caused by generation of reactive oxygen species (ROS) that lead to lipid peroxidation, defective mitochrondrial biogenesis, and DNA damage of the cardiomyocytes. The accumulation of anthracycline metabolites was also proposed to cause mitochondrial damage and the induction of cardiac cell apoptosis, which induces arrhythmias, contractile dysfunction, and cardiomyocyte death. This article will provide a general overview of cardiotoxicity focusing on the effect of anthracyclines and their epigenetic molecular mechanisms on cardiotoxicity.
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Cardiovascular risk after adjuvant trastuzumab in early breast cancer: an Italian population-based cohort study.
Oncologist2020 Aug;():. doi: 10.1634/theoncologist.2020-0216.
Franchi Matteo, Trama Annalisa, Merlo Ivan, Minicozzi Pamela, Tarantini Luigi, Garau Donatella, Kirchmayer Ursula, Di Martino Mirko, Romero Marilena, De Carlo Ilenia, Scondotto Salvatore, Apolone Giovanni, Corrao Giovanni, ,
Abstract
BACKGROUND:
Although trastuzumab (T) represents the standard of care for the adjuvant treatment of HER-2 positive early-stage breast cancer, contrasting results are available about the cardiac toxicity associated to its use. We conducted a multiregional population-based cohort investigation aimed to assess both the short- and long-term cardiovascular (CV) outcomes in women with early-breast cancer treated with T-based or standard adjuvant chemotherapy (CT).
PATIENTS AND METHODS:
We used healthcare utilization databases of six Italian regions, overall accounting for 42% of the Italian population. The study cohort was made by all women surgically treated for breast cancer who started a first-line adjuvant T-based or CT treatment. Patients treated with T were 1:2 matched to those treated with CT based on date of treatment start, age and presence of CV risk factors. Short- and long-term CV outcomes (heart failure and cardiomyopathy) were measured, respectively, after one year and at the end of follow-up.
RESULTS:
Among 28,599 women who met the inclusion criteria, 6,208 T users where matched to 12,416 CT users. After a mean follow-up of 5.88?years, short- and long-term cumulative CV risk were 0.8% and 2.6% in patients treated with T and 0.2% and 2.8% in those treated with CT, respectively. Adjusted hazard ratios were 4.6 (95% CI: 2.6 to 8.0) for short-term and 1.2 (0.9 to 1.6) for long-term CV risk.
DISCUSSION:
In our large real-world investigation, T-associated cardiotoxicity was limited to the treatment period. The addition of T to adjuvant CT did not result in long-term worsening of CV events.
IMPLICATION FOR PRACTICE:
Adjuvant trastuzumab-based chemotherapy represents the backbone therapy in HER2 positive early breast cancer patients. Although well tolerated, cardiovascular events can manifest during or after therapy due to treatment-related toxicities. In our wide multicentre and unselected cohort, long-term symptomatic cardiotoxicity was low and limited to the treatment period. The findings suggest that developing tools that would be adequately able to predict cardiac toxicity at an early stage remains an important area where additional research efforts are needed.
© AlphaMed Press 2020.
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Continuous venovenous hemodialysis may be effective in digoxin removal in digoxin toxicity: A case report.
Hemodial Int2020 Aug;():. doi: 10.1111/hdi.12867.
Gokalp Cenk, Dogan Aysun Fatma, Aygun Guray, Kurultak Ilhan, Ustundag Sedat,
Abstract
Digoxin is a cardiac glycoside that is used for the treatment of heart failure and atrial fibrillation. Besides its careful close follow-up, toxicity affects nearly 1% of congestive heart failure patients. Cessation of the drug, appropriate electrolyte and rhythm control and digoxin-Fab antibody are the mainstay for toxicity treatment in these patients. As known, hemodialysis and peritoneal dialysis are not effective by the means of digoxin removal. We present a 66-year-old patient who admitted to hospital with digoxin toxicity and severe acute kidney injury. The patient was treated with continuous venovenous hemodialysis because of her hypervolemia, hyperkalemia, cardiac instability, and the thought of probable decrease in digoxin levels concerning the continuous nature of solute clearance. Without the treatment using digoxin-specific Fab antibodies, the patient's digoxin level was decreased successfully with continuous venovenous hemodialysis. In conclusion, continuous venovenous hemodialysis may be a treatment option in digoxin toxicity especially those who suffer from severe renal dysfunction and cannot access digoxin antidote.
© 2020 International Society for Hemodialysis.
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Neutrophil/lymphocyte ratio predicts in-hospital complications in Takotsubo syndrome. Results from a prospective multi-center registry.
Clin Cardiol2020 Aug;():. doi: 10.1002/clc.23442.
Santoro Francesco, Guastafierro Francesca, Zimotti Tecla, Mallardi Adriana, Leopizzi Alessandra, Cannone Michele, Di Biase Matteo, Brunetti Natale Daniele,
Abstract
BACKGROUND:
Several hematological indices including subtypes of leukocytes populations have been associated with cardiovascular outcome. Takotsubo syndrome (TTS) is a form of acute heart failure syndrome featured by several in-hospital complications (IHCs).
HYPOTHESIS:
Hematological indices at admission may predict IHCs in TTS patients.
METHODS:
One hundred and sixty consecutive patients with TTS were enrolled in a multicenter prospective registry. Clinical data, admission hemogram, and IHCs were recorded.
RESULTS:
Incidence of IHCs was 37%, including pulmonary edema 9%, cardiogenic shock 9%, need of invasive ventilation 10%, death 8%, stroke 2.5%, and left ventricular thrombi 6%. Patients with IHCs were older, more frequently male, with physical stressor-induced TTS, lower left ventricular ejection fraction at admission. Neutrophil/lymphocyte ratio (NLr) (12?±?12 vs 7?±?8, P = .002) and white blood cells/mean platelet volume ratio (1.2?±?0.5 vs 1.0?±?0.5, P = .03) at admission were significantly higher in patients with IHCs. NLr values were predictor of IHCs (Odds ratios [OR] 1.07, 95% CI 1.03-1.11, P?
CONCLUSIONS:
NLr is an independent predictor of IHCs in patients admitted with TTS. Admission hemogram may represent a potential tool for prediction of IHCs in TTS.
© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
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Angiotensin-Converting Enzyme Inhibition: Beyond Blood Pressure Control-The Role of Zofenopril.
Adv Ther2020 Aug;():. doi: 10.1007/s12325-020-01455-2.
Borghi Claudio, Omboni Stefano,
Abstract
The extensive use of angiotensin-converting enzyme inhibitors (ACEIs) as antihypertensive agents and the huge amount of data collected in clinical trials and post-marketing studies has allowed the extending of the indication of ACEIs beyond blood pressure control. Current guidelines recommend ACEIs in symptomatic patients with heart failure with reduced ejection fraction to decrease the risk of heart failure hospitalization, and also in patients after acute myocardial infarction (AMI) with ST-elevation with or without post-AMI ventricular dysfunction. Analyzing the association between the choice of an ACEI after AMI with the risk of mortality and re-infarction, a class effect, rather than the superiority of some agents, has been described. The focus of this review is centered on the role of ACEIs in addition to and beyond blood pressure control. It summarizes clinical evidence on the use of these agents in cardiovascular diseases, with a specific interest in the experience with zofenopril, which presents a peculiar pharmacological profile that may contribute to additional clinical benefits in some identifiable populations of patients. Indeed, the presence of a sulfhydryl group in its structure confers on zofenopril high anti-oxidant and anti-ischemic properties involving the activation of the HS system, resulting in a cardioprotective effect. The efficacy and safety of zofenopril have been extensively evaluated and proved in the Survival of Myocardial Infarction Long-Term Evaluation (SMILE) program in numerous clinical settings. The pharmacological features and ancillary characteristics of zofenopril with potent cardioprotective effects seem to differentiate it from other ACEIs and to confer further benefits to patients.
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Blood Pressure, Congestion and Heart Failure with Preserved Ejection Fraction Among Patients with and Without Type 2 Diabetes Mellitus. A Cluster Analysis Approach from the Observational Registry DICUMAP.
High Blood Press Cardiovasc Prev2020 Aug;():. doi: 10.1007/s40292-020-00405-x.
Arévalo-Lorido José Carlos, Carretero-Gómez J, Aramburu-Bodas O, Grau-Amoros J, Torres-Cortada G, Camafort-Babkowski M,
Abstract
INTRODUCTION:
The association of patients with heart failure (HF) and preserved ejection fraction (HFpEF) and with type 2 diabetes mellitus (T2DM) is strong and related additionally to blood pressure (BP).
AIMS:
To analyze distinctive clinical profiles among patients with HFpEF both with and without T2DM.
METHODS:
The study was based on a Spanish National Registry (multicenter and prospective) of patients with HF (DICUMAP), that enrolled outpatients with HF who underwent an ambulatory BP monitoring (ABPM) and then were followed-up for 1 year. We categorized patients according to the presence/absence of T2DM then building different clusters based on K-medoids algorithm.
RESULTS:
103 patients were included. T2DM was present in 44.7%. The patients with T2DM were grouped into two clusters and those without T2DM into three. All patients with T2DM had kidney disease and anemia. Among them, cluster 2 had higher systolic blood pressure and pulse pressure (PP) with a bad outcome (p?=?0.03) regarding HF mortality and readmissions, influenced by eGFR (HR 0.93, 95% CI 0.97-0.87, p?=?0.04), and hemoglobin (HR 0.65, 95% CI 0.71-0.63, p?=?0.03). Among those without T2DM, cluster 3 had a pathological ABPM pattern with the highest PP, cluster 4 was slightly similar to cluster 2, and cluster 5 expressed a more benign pattern without differences on both, HF mortality and readmissions.
CONCLUSIONS:
Patients with HFpEF and T2DM expressed two different profiles depending on neurohormonal activation and arterial stiffness with prognostic implications. Patients without T2DM showed three profiles depending on ABPM pattern, kidney disease and PP without prognostic repercussion.
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Metformin Lowers Body Weight But Fails to Increase Insulin Sensitivity in Chronic Heart Failure Patients without Diabetes: a Randomized, Double-Blind, Placebo-Controlled Study.
Cardiovasc Drugs Ther2020 Aug;():. doi: 10.1007/s10557-020-07050-5.
Larsen Anders Hostrup, Wiggers Henrik, Dollerup Ole Lindgĺrd, Jespersen Nichlas Riise, Hansson Nils Henrik, Frřkićr Jřrgen, Brřsen Kim, Nřrrelund Helene, Břtker Hans Erik, Mřller Niels, Jessen Niels,
Abstract
PURPOSE:
The glucose-lowering drug metformin has recently been shown to reduce myocardial oxygen consumption and increase myocardial efficiency in chronic heart failure (HF) patients without diabetes. However, it remains to be established whether these beneficial myocardial effects are associated with metformin-induced alterations in whole-body insulin sensitivity and substrate metabolism.
METHODS:
Eighteen HF patients with reduced ejection fraction and without diabetes (median age, 65 (interquartile range 55-68); ejection fraction 39?±?6%; HbA1c 5.5 to 6.4%) were randomized to receive metformin (n?=?10) or placebo (n?=?8) for 3 months. We studied the effects of metformin on whole-body insulin sensitivity using a two-step hyperinsulinemic euglycemic clamp incorporating isotope-labeled tracers of glucose, palmitate, and urea. Substrate metabolism and skeletal muscle mitochondrial respiratory capacity were determined by indirect calorimetry and high-resolution respirometry, and body composition was assessed by bioelectrical impedance analysis. The primary outcome measure was change in insulin sensitivity.
RESULTS:
Compared with placebo, metformin treatment lowered mean glycated hemoglobin levels (absolute mean difference, -?0.2%; 95% CI -?0.3 to 0.0; p?=?0.03), reduced body weight (-?2.8 kg; 95% CI -?5.0 to -?0.6; p?=?0.02), and increased fasting glucagon levels (3.2 pmol L; 95% CI 0.4 to 6.0; p?=?0.03). No changes were observed in whole-body insulin sensitivity, endogenous glucose production, and peripheral glucose disposal or oxidation with metformin. Equally, resting energy expenditure, lipid and urea turnover, and skeletal muscle mitochondrial respiratory capacity remained unaltered.
CONCLUSION:
Increased myocardial efficiency during metformin treatment is not mediated through improvements in insulin action in HF patients without diabetes.
CLINICAL TRIAL REGISTRATION:
URL: https://clinicaltrials.gov . Unique identifier: NCT02810132. Date of registration: June 22, 2016.
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Sex-Related Differences in Dilated Cardiomyopathy with a Focus on Cardiac Dysfunction in Oncology.
Curr Cardiol Rep2020 Aug;22(10):102. doi: 10.1007/s11886-020-01377-z.
D'Amario Domenico, Camilli Massimiliano, Migliaro Stefano, Canonico Francesco, Galli Mattia, Arcudi Alessandra, Montone Rocco Antonio, Borovac Josip Andjelo, Crea Filippo, Savarese Gianluigi,
Abstract
PURPOSE OF REVIEW:
The aim of this report is to describe the main aspects of sex-related differences in non-ischemic dilated cardiomyopathies (DCM), focusing on chemotherapy-induced heart failure (HF) and investigating the possible therapeutic implications and clinical management applications in the era of personalized medicine.
RECENT FINDINGS:
In cardio-oncology, molecular and multimodality imaging studies confirm that sex differences do exist, affecting the therapeutic cardioprotective strategies and, therefore, the long-term outcomes. Interestingly, compelling evidences suggest that sex-specific characteristics in drug toxicity might predict differences in the therapeutic response, most likely due to the tangled interplay between cancer and HF, which probably share common underlying mechanisms. Cardiovascular diseases show many sex-related differences in prevalence, etiology, phenotype expression, and outcomes. Complex molecular mechanisms underlie this diverse pathological manifestations, from sex-determined differential gene expression to sex hormone interaction with their receptors in the heart. Non-ischemic DCM is an umbrella definition that incorporates several etiologies, including chemotherapy-induced cardiomyopathies. The role of sex as a risk factor for cardiotoxicity is poorly explored. However, understanding the various features of disease manifestation and outcomes is of paramount importance for a prompt and tailored evaluation.
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Cardiovascular Effects of Dipeptidyl Peptidase-4 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists: a Review for the General Cardiologist.
Curr Cardiol Rep2020 Aug;22(10):105. doi: 10.1007/s11886-020-01355-5.
Patel Kershaw V, Sarraju Ashish, Neeland Ian J, McGuire Darren K,
Abstract
PURPOSE OF REVIEW:
Results from cardiovascular (CV) outcome trials have revealed important insights into the CV safety and efficacy of glucose-lowering agents, including dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1RA).
RECENT FINDINGS:
Among patients with T2DM, DPP-4i have no significant effect on risk of major adverse CV events (MACE: CV death, myocardial infarction, or stroke) with mixed results regarding risk for heart failure (HF). While sitagliptin and linagliptin have neutral effects on HF risk, saxagliptin significantly increases the risk of HF. The CV safety of the GLP-1RA class of medications has been clearly demonstrated, and select agents, such as liraglutide, semaglutide, albiglutide, and dulaglutide, reduce the risk of MACE in patients with T2DM and established CV disease. CV outcome trials have demonstrated CV safety but not incremental efficacy for DPP-4i in most cases. Select GLP-1RA have proven efficacy for MACE and should be considered by cardiologists for CV risk mitigation in the care of patients with T2DM and established CV disease.
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Review of Transthyretin Silencers, Stabilizers, and Fibril Removal Agents in the Treatment of Transthyretin Cardiac Amyloid.
Curr Cardiol Rep2020 Aug;22(10):106. doi: 10.1007/s11886-020-01374-2.
Hough Augustus, Wearden Jessica, de Almeida Kristen, Kaiser Stephanie,
Abstract
PURPOSE OF REVIEW:
To provide a functional review for practicing clinicians on the current and emerging treatment considerations for transthyretin (TTR) cardiac amyloidosis (ATTR-CA).
RECENT FINDINGS:
Current treatment considerations are characterized as those silencing TTR translation, stabilizing TTR tetramers, and disrupting amyloid fibril deposition. Historically considered a rare disease state, ATTR-CA is increasingly recognized as an important mediator of heart failure morbidity and mortality. The emergence of widely available therapies for ATTR-CA has developed hope for patients where little was previously present. Thus, it is important that all cardiology clinicians have a functional understanding of the disease state and treatment options. This review will discuss agents within each of the above classes with expanded discussion on tafamidis given its favorable efficacy, safety, and availability. ATTR-CA diagnostic considerations are reviewed with regard to the identification of potential tafamidis candidates, and practical economic considerations are also reviewed.
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Association between right-sided cardiac function and ultrasound-based pulmonary congestion on acutely decompensated heart failure: findings from a pooled analysis of four cohort studies.
Clin Res Cardiol2020 Aug;():. doi: 10.1007/s00392-020-01724-8.
Kobayashi Masatake, Gargani Luna, Palazzuoli Alberto, Ambrosio Giuseppe, Bayés-Genis Antoni, Lupon Josep, Pellicori Pierpaolo, Pugliese Nicola Riccardo, Reddy Yogesh N V, Ruocco Gaetano, Duarte Kevin, Huttin Olivier, Rossignol Patrick, Coiro Stefano, Girerd Nicolas,
Abstract
BACKGROUND:
Right ventricular (RV) dysfunction and RV-pulmonary artery (PA) uncoupling are associated with the development of pulmonary congestion during exercise. However, there is limited information regarding the association between these right-sided cardiac parameters and pulmonary congestion in acutely decompensated heart failure (HF).
METHODS:
We performed an individual patient meta-analysis from four cohort studies of hospitalized patients with HF who had available lung ultrasound (B-lines) data on admission and/or at discharge. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), RV-PA coupling was defined as the ratio of TAPSE to PA systolic pressure (PASP).
RESULTS:
Admission and discharge cohort included 319 patients (75.8?±?10.1 years, 46% women) and 221 patients (77.9?±?9.0 years, 47% women), respectively. Overall, higher TAPSE was associated with higher ejection fraction, lower PASP, b-type natriuretic peptide and B-line counts. By multivariable analysis, worse RV function or RV-PA coupling was associated with higher B-line counts on admission and at discharge, and with a less reduction in B-line counts from admission to discharge. Higher B-line counts at discharge were associated with a higher risk of the composite of all-cause mortality and/or HF re-hospitalization [adjusted-HR 1.13 (1.09-1.16), p?
CONCLUSIONS:
In patients with acutely decompensated HF, impaired RV function and RV-PA coupling were associated with severe pulmonary congestion on admission, and less resolution of pulmonary congestion during hospital stay. Worse prognosis related to residual pulmonary congestion was enhanced in patients with RV dysfunction. TAPSE, tricuspid annular plane systolic excursion; PASP, pulmonary artery systolic pressure.
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The Cardiorenal Syndrome: Mechanistic Insights and Prognostication with Soluble Biomarkers.
Curr Cardiol Rep2020 Aug;22(10):114. doi: 10.1007/s11886-020-01360-8.
Seliger Stephen,
Abstract
PURPOSE OF REVIEW:
To characterize and interpret recent studies of biomarkers of cardiorenal syndrome.
RECENT FINDINGS:
Recent studies have questioned the mechanisms and significance of moderate worsening renal function (WRF) in patients with acute heart failure. In the setting of successful decongestion, WRF may not predict cardiorenal morbidity. Cardiac-specific biomarkers including cardiac troponins and natriuretic peptides are highly prognostic in acute and chronic HF patients with kidney impairment, and serial changes in these markers during hospitalization are also predictive of longer-term adverse outcomes. These markers also predict new HF in patients with established chronic kidney disease (CKD). The role of kidney tubular injury markers in acute HF remains controversial, with inconsistent associations with short- and long-term cardiorenal outcomes. Many cases of WRF in acute HF are not characterized by a clear pattern of renal tubular injury. Cardiac-specific and renal-specific biomarkers may provide mechanistic and prognostic information in cardiorenal syndromes.
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The clinical characteristics and outcomes of heart failure patient with chronic obstructive pulmonary disease from the Japanese community-based registry.
Heart Vessels2020 Aug;():. doi: 10.1007/s00380-020-01675-0.
Takabayashi Kensuke, Terasaki Yuka, Okuda Miyuki, Nakajima Osamu, Koito Hitoshi, Kitamura Tetsuhisa, Kitaguchi Shouji, Nohara Ryuji,
Abstract
Both heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common diseases, but few studies have assessed the relationship between COPD and outcomes in patients with acute HF, especially in relation to age or ejection fraction (EF). The Kitakawachi Clinical Background and Outcome of Heart Failure Registry was a prospective, multicenter, community-based cohort and enrolled a total of 1,102 patients with acute HF between 2015 and 2017 in this study. The primary endpoint was defined as a composite endpoint that included all-cause mortality and hospitalization for HF. We stratified patients into two groups: those aged???80 years (elderly) and?
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Probenecid Improves Cardiac Function in Subjects with a Fontan Circulation and Augments Cardiomyocyte Calcium Homeostasis.
Pediatr Cardiol2020 Aug;():. doi: 10.1007/s00246-020-02427-7.
Rubinstein Jack, Woo Jessica G, Garcia Anastacia M, Alsaied Tarek, Li Jia, Lunde Per Kristian, Moore Ryan A, Laasmaa Martin, Sammons Amanda, Mays Wayne A, Miyamoto Shelley D, Louch William E, Veldtman Gruschen R,
Abstract
Subjects with functionally univentricular circulation who have completed staged single ventricle palliation, with the final stage culminating in the Fontan procedure, are often living into adulthood. However, high morbidity and mortality remain prevalent in these patients, as diastolic and systolic dysfunction of the single systemic ventricle are linked to Fontan circulatory failure. We presently investigated the effects of probenecid in post-Fontan patients. Used for decades for the treatment of gout, probenecid has been shown in recent years to positively influence cardiac function via effects on the Transient Receptor Potential Vanilloid 2 (TRPV2) channel in cardiomyocytes. Indeed, we observed that probenecid improved cardiac function and exercise performance in patients with a functionally univentricular circulation. This was consistent with our findings from a retrospective cohort of patients with single ventricle physiology where TRPV2 expression was increased. Experiments in isolated cardiomyocytes associated these positive actions to augmentation of diastolic calcium homeostasis.
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Sex Hormones and Incident Heart Failure in Men and Post-Menopausal Women: The Atherosclerosis Risk in Communities Study.
J Clin Endocrinol Metab2020 Aug;():. doi: dgaa500.
Zhao Di, Guallar Eliseo, Ballantyne Christie M, Post Wendy S, Ouyang Pamela, Vaidya Dhananjay, Jia Xiaoming, Ying Wendy, Subramanya Vinita, Ndumele Chiadi E, Hoogeveen Ron C, Michos Erin D,
Abstract
CONTEXT:
Sex differences exist in heart failure (HF) phenotypes, but there is limited research on the role of sex hormones in HF and its subtypes.
OBJECTIVE:
To examine the associations of total testosterone, dehydroepiandrosterone sulfate (DHEA-S), and sex hormone binding globulin (SHBG) with incident HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF).
DESIGN:
Atherosclerosis Risk in Communities (ARIC) study (prospective cohort study). Median follow-up is 19.2 years.
SETTING:
General community.
PARTICIPANTS:
4,107 men and 4,839 post-menopausal women, with mean age of 63.2 (SD 5.7) and 62.8 (5.5) years, respectively.
EXPOSURE:
Plasma sex hormone levels were measured at Visit 4 (1996-1998).
MAIN OUTCOME MEASURES:
Incident HF events were identified through hospital discharge codes and death certificates.
RESULTS:
The HRs for HF associated with 1 SD decrease in log-transformed total testosterone, DHEA-S, and SHBG were 1.10 (95% CI 1.03, 1.17), 1.07 (1.00, 1.15), and 1.04 (0.96, 1.11) in men, and 1.05 (0.99, 1.13), 1.17 (1.09, 1.24), and 0.93 (0.85, 1.01) in women, respectively. The associations between sex hormones with subtypes of HF had similar patterns but were attenuated and became statistically insignificant.
CONCLUSION:
In this prospective cohort, lower levels of endogenous testosterone and DHEA-S in men, and DHEA-S in post-menopausal women, were associated with the development of HF. Similar directions of association in both sexes and both HF subtypes suggest that sex hormones play a role in the development of HF through common pathways regardless of sex.
© Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Enhancing myocardial repair with CardioClusters.
Nat Commun2020 Aug;11(1):3955. doi: 10.1038/s41467-020-17742-z.
Monsanto Megan M, Wang Bingyan J, Ehrenberg Zach R, Echeagaray Oscar, White Kevin S, Alvarez Roberto, Fisher Kristina, Sengphanith Sharon, Muliono Alvin, Gude Natalie A, Sussman Mark A,
Abstract
Cellular therapy to treat heart failure is an ongoing focus of intense research, but progress toward structural and functional recovery remains modest. Engineered augmentation of established cellular effectors overcomes impediments to enhance reparative activity. Such 'next generation' implementation includes delivery of combinatorial cell populations exerting synergistic effects. Concurrent isolation and expansion of three distinct cardiac-derived interstitial cell types from human heart tissue, previously reported by our group, prompted design of a 3D structure that maximizes cellular interaction, allows for defined cell ratios, controls size, enables injectability, and minimizes cell loss. Herein, mesenchymal stem cells (MSCs), endothelial progenitor cells (EPCs) and c-Kit cardiac interstitial cells (cCICs) when cultured together spontaneously form scaffold-free 3D microenvironments termed CardioClusters. scRNA-Seq profiling reveals CardioCluster expression of stem cell-relevant factors, adhesion/extracellular-matrix molecules, and cytokines, while maintaining a more native transcriptome similar to endogenous cardiac cells. CardioCluster intramyocardial delivery improves cell retention and capillary density with preservation of cardiomyocyte size and long-term cardiac function in a murine infarction model followed 20 weeks. CardioCluster utilization in this preclinical setting establish fundamental insights, laying the framework for optimization in cell-based therapeutics intended to mitigate cardiomyopathic damage.
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Xanthopsia Due to Digoxin Toxicity as a Cause of Traffic Accidents: A Case Report.
Am J Case Rep2020 Aug;21():e924025. doi: 10.12659/AJCR.924025.
Haruna Yusuke, Kawasaki Tatsuya, Kikkawa Yoko, Mizuno Rentaro, Matoba Satoaki,
Abstract
BACKGROUND Manifestations of digoxin toxicity vary, such as cardiac disturbances and gastrointestinal symptoms, and most are not specific to digoxin toxicity. We report a case of xanthopsia (yellow vision), a rare and relatively specific manifestation of digoxin toxicity, causing traffic accidents. CASE REPORT A 76-year-old man was admitted to our hospital for treatment of heart failure. He reported that his digoxin dose had been increased from 0.125 mg daily to 0.25 mg daily 3 weeks before admission. His serum digoxin level was 7.3 ng/mL (therapeutic range 0.8 to 2.0). Additional history-taking revealed that he had xanthopsia several days before admission and stopped riding a motorbike because of two traffic accidents. On ophthalmological examination, he had decreased responses on flash, cone, and 30-Hz flicker electroretinograms in both eyes without visual field impairment. Intravenous hydration was initiated and digoxin was withdrawn. Xanthopsia gradually improved along with the decline of serum digoxin levels and disappeared within a week. One month after admission, electroretinography findings were normal. CONCLUSIONS Our case highlights the importance of acknowledging color vision deficiencies due to digoxin toxicity even in the modern era. This condition may increase risk of adverse events because affected patients are less likely to recognize color vision deficiencies.
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