Search

Study objectivesSleep-disordered breathing (SDB) is common in patients with congestive heart failure and has important implications regarding symptoms and prognosis. However, the burden of SDB on those with heart failure has not been well characterized in developing countries, including Mozambique in sub-Saharan Africa. Diagnosing SDB in individuals with congestive heart failure is important because treatment of SDB may improve outcomes.MethodsBetween September 2014 and April 2017, patients hospitalized in a specialized cardiology unit in Maputo, Mozambique with decompensated congestive heart failure were recruited using convenience sampling. We determined the prevalence of SDB and associated risk factors.ResultsA total of 165 patients were recruited, of which 145 had evaluable sleep study data. The overall prevalence of SDB in patients with decompensated congestive heart failure was 72%, and of these 46% had Cheyne-Stokes respirations. Male sex, higher body mass index, and lower left ventricular ejection fraction were all associated with a higher likelihood of SDB and more severe SDB. Cheyne-Stokes respirations were associated with male sex, lower ejection fraction, and larger left atrial size.ConclusionsWe conclude that in sub-Saharan Africa SDB is common in decompensated congestive heart failure and strongly predicted by demographic and echocardiographic parameters. This study highlights the need for the development of diagnostic tools and management strategies for patients with severe heart failure in resource-limited settings.CitationLo S, Mbanze I, Orr JE, et al. The prevalence of sleep-disordered breathing and associated risk factors in patients with decompensated congestive heart failure in Mozambique. J Clin Sleep Med. 2023;19(6):1103-1110.

Background: Pediatric acute heart failure is now being increasingly recognized as an important source of healthcare resource utilization. B-type natriuretic peptide (BNP) continues to be the dominant biomarker in pediatric heart failure. This study aimed to prove the role of BNP in diagnosis and prognosis of congestive heart failure in children. Method: This case-control study was performed in Zagazig University Hospitals and include 60 infants and children who were divided into 2 groups: group 1 consisted of 30 children diagnosed by congestive heart failure, and group 2 consisted of 30 age and sex-matched apparently healthy children. Serum BNP levels were measured for both groups with assessment of the cardiac function, CBC, CRP and serum creatine level. Results: BNP is significantly higher among CHF patients compared to controls. BNP is found to be higher in patients with severe heart failure compared to moderate and mild HF patients with significant correlation. BNP is found to be higher among congestive heart disease patients with sensitivity of 93.3% and specificity of 76%. BNP is a significant independent diagnostic parameter for CHF. BNP is found to be non-significant prognostic factor for children with CHF. Conclusions: BNP continues to be the dominant biomarker in pediatric heart failure. BNP is a significant diagnostic marker in diagnosis of heart failure, while it found to be non-significant prognostic factor in CHF. [ABSTRACT FROM AUTHOR]

Background: CKD's relationship to incident heart failure is uncertain. In 10,190 male patients, we examined CKD with incident nonfatal heart failure and cardiovascular (CVD) mortality (mean age, 65years). Kidney function was measured by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation in clinically relevant categories of <60 and 0 ml/min/1.73 m2 (referent); and <45, 45 to 60, 60 to 90, and 90+. (referent). In multivariable models, males with eGFR<60ml/min/1.73 m2 had a 2-fold incidence of heart failure (95% CI, 1.62-2.56, p<0.0001) compared to reference group. Compared to the reference group, the hazard ratio [HR] for heart failure in eGFR categories of 60-90, 45-60, and <45ml/min/1.73m2 was 1.25 (0.99-1.61), 2.58 (1.95-3.50), and 1.55 (0.95-2.81). in the subgroup of non-diabetics and normotensive people at baseline (n=7545), males with eGFR<60 ml/min/1.73 m2 had 2.2-fold risk of heart failure (95% CI 1.69-2.91). Compared to reference group, those with eGFR 45-60 and <45 ml/min/1.73 m2 had >2.5-fold increased risk of heart failure or CVD mortality. Conclusion: Even without diabetes or hypertension, men with moderate CKD had a greater risk of heart failure and CVD death/heart failure. [ABSTRACT FROM AUTHOR]

Abstract Aims Determine the feasibility of implementing a heart failure (HF) management strategy that (i) uses a device‐based, remote, dynamic, multimetric risk stratification model to predict the risk of HF events and (ii) uses a standardized, centrally administered, ambulatory medication intervention protocol to reproducibly and safely decrease elevated risk scores. Methods and results Prospective, non‐randomized, single‐arm, multicenter feasibility study (Intervene‐HF) was conducted in HF patients implanted with a cardiac resynchronization therapy with implantable cardio defibrillator (CRT‐D) with TriageHF risk score feature. Certified HF nurses (CHFN) in the Medtronic Care Management Services Program implemented an ambulatory medication intervention strategy by following a standardized guided action pathway triggered by risk‐based alert. When CHFN received notification of increased risk score (HF care alert), they implemented a 3 day course of diuretic up‐titration (PRN) previously prescribed by a physician. Safety was monitored daily. Recovery after PRN was defined as ≥70% recovery of impedance toward baseline levels. Sixty‐six patients followed for 8.2 ± 3.9 months had 49 HF care alerts. Twenty‐three of 49 alerts did not receive PRN due to protocol‐mandated criteria. Twenty‐six of 49 alerts received PRN, 22 were completed, and 19 led to impedance recovery. Four interventions were stopped for safety without leading to an adverse event (AE). One of 26 PRNs was followed by a HF event. Eighty‐five per cent (22/26) of PRNs were completed without an AE; 69% (18/26) met the recovery criteria. Conclusions The Intervene‐HF study supports the feasibility of testing, in a large randomized clinical trial, an ambulatory medication intervention strategy that is physician‐directed, CHFN‐implemented, and based on individualized device risk stratification.

Abstract Aims This study aimed to examine the clinical utility of a multisensor, remote, ambulatory diagnostic risk score, TriageHF™, in a real‐world, unselected, large patient sample to predict heart failure events (HFEs) and all‐cause mortality. Methods and results TriageHF risk score was calculated in patients in the Optum® database who had Medtronic implantable cardiac defibrillator device from 2007 to 2016. Patients were categorized into three risk groups based on probability for having an HFE within 6 months (low risk

Aims: Determine the feasibility of implementing a heart failure (HF) management strategy that (i) uses a device‐based, remote, dynamic, multimetric risk stratification model to predict the risk of HF events and (ii) uses a standardized, centrally administered, ambulatory medication intervention protocol to reproducibly and safely decrease elevated risk scores. Methods and results: Prospective, non‐randomized, single‐arm, multicenter feasibility study (Intervene‐HF) was conducted in HF patients implanted with a cardiac resynchronization therapy with implantable cardio defibrillator (CRT‐D) with TriageHF risk score feature. Certified HF nurses (CHFN) in the Medtronic Care Management Services Program implemented an ambulatory medication intervention strategy by following a standardized guided action pathway triggered by risk‐based alert. When CHFN received notification of increased risk score (HF care alert), they implemented a 3 day course of diuretic up‐titration (PRN) previously prescribed by a physician. Safety was monitored daily. Recovery after PRN was defined as ≥70% recovery of impedance toward baseline levels. Sixty‐six patients followed for 8.2 ± 3.9 months had 49 HF care alerts. Twenty‐three of 49 alerts did not receive PRN due to protocol‐mandated criteria. Twenty‐six of 49 alerts received PRN, 22 were completed, and 19 led to impedance recovery. Four interventions were stopped for safety without leading to an adverse event (AE). One of 26 PRNs was followed by a HF event. Eighty‐five per cent (22/26) of PRNs were completed without an AE; 69% (18/26) met the recovery criteria. Conclusions: The Intervene‐HF study supports the feasibility of testing, in a large randomized clinical trial, an ambulatory medication intervention strategy that is physician‐directed, CHFN‐implemented, and based on individualized device risk stratification. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to examine the clinical utility of a multisensor, remote, ambulatory diagnostic risk score, TriageHF™, in a real‐world, unselected, large patient sample to predict heart failure events (HFEs) and all‐cause mortality. Methods and results: TriageHF risk score was calculated in patients in the Optum® database who had Medtronic implantable cardiac defibrillator device from 2007 to 2016. Patients were categorized into three risk groups based on probability for having an HFE within 6 months (low risk <5.4%, medium risk ≥5.4 < 20%, and high risk ≥20%). Data were analysed using three strategies: (i) scheduled monthly data download; (ii) alert‐triggered data download; and (iii) daily data download. Study population consisted of 22 901 patients followed for 1.8 ± 1.3 years. Using monthly downloads, HFE risk over 30 days incrementally increased across risk categories (odds ratio: 2.8, 95% confidence interval: 2.5–3.2 for HFE, P < 0.001, low vs. medium risk, and odds ratio: 9.2, 95% confidence interval: 8.1–10.3, P < 0.001, medium vs. high risk). Findings were similar using the other two analytic strategies. Using a receiver operating characteristic curve analysis, sensitivity for predicting HFE over 30 days using high‐risk score was 47% (alert triggered) and 51% (daily download) vs. 0.5 per patient year unexplained detection rate. TriageHF risk score also predicted all‐cause mortality risk over 4 years. All‐cause mortality risk was 14% in low risk, 20% in medium risk, and 38% in high risk. Conclusions: TriageHF risk score provides a multisensor remote, ambulatory diagnostic method that predicts both HFEs and all‐cause mortality. [ABSTRACT FROM AUTHOR]

• Self-efficacy is associated with whether a patient performs heart failure self-care. • Depression is associated with self-care through self-efficacy. • Interventions targeting self-efficacy may benefit self-care performance. Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood. The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care. Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t -test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis. Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p <0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized. Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care. [ABSTRACT FROM AUTHOR]

Background: Acute heart failure (AHF) is a complex syndrome associated with high morbidity and mortality. This study aimed to derive a simple risk score with which to identify AHF patients at high risk for an all-cause death event during the first year after hospital discharge.Methods: Three hundred AHF patients from the Heart Failure registry were included in the analysis. Cox regression with a forward-conditional algorithm and bootstrapping procedure was used to build the prognostic score, while c-statistic was used to assess the prognostic performance of the score.Results: Seven variables were independently associated with an all-cause mortality event during the 1-year follow-up (FU): estimated glomerular filtration rate of 40-60; estimated glomerular filtration rate <40 mL/min/1.73 m2; uric acid >450 μmol/L; left-ventricular ejection fraction <45%; sodium <136 mmol/L; systolic blood pressure <115 mmHg; and a positive history of previous heart failure-related decompensation event(s). The score derived from significant variables enabled classification of patients into three risk categories: low (0-2 points), intermediate (3 points), and high (4-6 points). Observed all-cause mortality rates during the 1-year FU were 6.1%, 30.5%, and 80.9% across the three risk categories, respectively. The score demonstrated a high level of discrimination for an all-cause death event in the derivation cohort with the c-statistic value of 0.907 (95% CI, 0.867-0.939; p < 0.0001) and adequate calibration.Conclusions: The S2PLiT-UG score is a simple tool with potential for facilitating risk stratification and therapeutic decision-making during the first year after hospitalisation for an AHF event. Future external validation studies are required to confirm its prognostic performance. [ABSTRACT FROM AUTHOR]

Background: Activation of neurohormonal systems contributes to the progression of heart failure (HF). The mechanism(s) whereby these systems become activated is(are) not fully explained. We determined whether vagal cardiopulmonary baroreflex control of renal sympathetic nerve activity is abnormal in dogs with left ventricular (LV) dysfunction in the absence of clinical HF, and the relationship of abnormalities in baroreflexes to the development of the neurohumoral excitatory state.Methods: LV end-systolic and end-diastolic dimensions (echocardiography), arterial baroreflex sensitivity (slope of ΔRR/Δsystolic BP during phenylephrine or nitroglycerin bolus), and neurohumoral profiles (plasma norepinephrine, renin activity, and arginine vasopressin) were measured serially in conscious dogs (n=24) with progressive LV dysfunction due to rapid ventricular pacing. LV dimensions were used to define groups with mild, moderate, and marked LV dilatation (LVD; increase in LV end-diastolic volume <15%, 15-30%, and >30% of control, respectively). Changes in renal nerve activity (RNA) were recorded in response to increases in pulmonary capillary wedge pressure (PCWP) induced by volume infusion in anesthetized, sinoaortic-denervated dogs.Results: Cardiopulmonary baroreflex sensitivity (slope of %ΔRNA/ΔPCWP) for mild LVD (-17.8%/mmHg) was the same as controls (-17.7%/mmHg). However, the slopes of moderate (-5.8%/mmHg) and severe LVD (-1.9%/mmHg) were decreased significantly compared with controls (P < .05). Arterial baroreflex sensitivity was preserved at all stages of LVD. Plasma norepinephrine, renin activity, and arginine vasopressin remained unchanged after 4, 7, and 11 days of pacing.Conclusions: Vagal cardiopulmonary baroreflex control of renal sympathetic nerve activity is blunted early in the development of LVD. These abnormalities precede neurohumoral excitation and abnormal arterial baroreflexes and become apparent when LV end-diastolic volume starts to increase. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of Xiefei Lishui recipe on left ventricle remodeling in rats with heart failure. Methods Heart failure rat model was induced by intraperitoneal injections of doxorubicin. Rats were randomly divided into sham operation group (sham group), model group, traditional Chinese medicine group (TCM group), captopril group, and digoxin group. Distilled water, TCM [22g/(kg·d)], captopril [19mg/(kg·d)], and digoxin [32μg/(kg·d)] were administered by gastrogavage in rats in different groups for 35 days, respectively. Indices of ventricle remodeling and cardiac function, plasma levels of B-type natriuretic peptide (BNP), rennin (REN), angiotensin Ⅱ(AngⅡ) and aldosterone (ALD) were measured. Cardiomyocyte apoptosis index and collagen volume fraction (CVF) were analyzed. We also assayed myocardial mRNA expressions of MMP-2/9 and TIMP-1/2, and their tissue inhibiting factors TIMP-1 and TIMP-2. Results Compared with those in sham group, in model group cardiac function was significantly decreased, which could be significantly increased by TCM or captopril or digoxin, indices of cardiac remodeling were significantly increased, which could be significantly decreased by TCM or captopril (P<0.01 or P<0.05). Plasma levels of BNP, REN, AngⅡ and ALD, cardiomyocyte apoptosis index and CVF in model group were significantly increased, could be significantly decreased by TCM or captopril (P<0.01 or P<0.05). Myocardial mRNA expressions of MMP-2, MMP-9, TIMP-1 and TIMP-2 in model group were significantly upregulated compared with those in sham group, which could be significantly downregulated by TCM (P<0.01 or P<0.05). Conclusion Xiefei Lishui recipe can attenuate left ventricle remodeling and improve cardiac function in rats with heart failure, which may be related to downregulating myocardial mRNA expressions of MMP-2, MMP-9, TIMP-1 and TIMP-2 in the left ventricle as well as inhibiting cardiomyocyte apoptosis and myocardial fibrosis. [ABSTRACT FROM AUTHOR]

Congestive heart failure (CHF) remains a significant cause of death and disability in industrialized countries. Projections show that the prevalence of CHF will increase 46% from 2012 to 2030, resulting in over eight million adults with CHF in the United States. While substantial advances have been achieved in the treatment of CHF over the past two decades, CHF rivals cancer as a cause of mortality. Strategies focused on prevention of CHF should be emphasized to meaningfully impact the projected increase in CHF. Irrespective of the type of CHF, either systolic or diastolic, coronary artery disease has supplanted hypertension as the most prevalent cause for congestive heart failure, with a high rate of mortality and future hospitalizations. Since coronary artery disease plays a central role in the development of CHF, approaches to treat coronary artery disease and identification of patients at risk for recurrent myocardial infarction (RMI) are approaches to prevent development of CHF. Subjects who sustain recurrent MI represent a particularly high-risk group for development of CHF. Despite the evolution of therapy for MI from thrombolytic therapy to primary percutaneous coronary intervention (PCI), RMI occurs in ~ 10% of patients in the first year after first MI, and 3 years after their first MI. In this review I explore emerging approaches to prevent RMI including the rationale for recent trials of complete revascularization at the time of MI, newly emerging biomarkers that have additive predictive value for identifying patients with high risk of CHF and death when using existing biomarkers. Finally, the paradigm of hematopoietic stem cell mobilization in MI leading to monocyte expansion and acceleration of atherosclerosis is discussed as an emerging approach to identify patients at high risk of RMI, CHF, and death after MI.

FUNDAMENTO: A terapia de ressincronização cardíaca (TRC) é eficiente no tratamento de pacientes com insuficiência cardíaca (IC), disfunção ventricular grave e bloqueio intraventricular. O marcapasso convencional (MPC) em região apical de ventrículo direito provoca alterações da seqüência de ativação normal do coração semelhante às do BRE. Nesse sentido, pacientes com MPC e IC avançada poderiam ser candidatos a TRC, mas reduzidas casuísticas foram avaliadas e não há conclusões definitivas. OBJETIVO: Analisar o comportamento clínico-funcional da terapia de ressincronização cardíaca (TRC) nos portadores de marcapasso convencional. MÉTODOS: Pacientes com MPC, IC-CF(NYHA) III/IV refratária a terapêutica medicamentosa, fração de ejeção do ventrículo esquerdo (FEVE) BACKGROUND: Cardiac resynchronization therapy (CRT) is an efficient treatment for patients with heart failure (HF), severe ventricular dysfunction and intraventricular block. Conventional pacemakers (CPM) implanted in the right ventricular apical area cause alterations in the normal sequence of cardiac activation similar to those induced by LBBB (left bundle-branch block). Therefore, patients with CPM and advanced HF could be candidates to undergo CRT, but as only small numbers of patients have been evaluated so far, definitive conclusions are lacking. OBJECTIVE: To assess the clinical and functional outcome of cardiac resynchronization therapy (CRT) in patients with conventional pacemakers. METHODS: Patients with CPM, who were in NYHA HF functional class III/IV class refractory to drug therapy, and left ventricular ejection fraction (LVEF) )

OBJETIVO: Analisar o desempenho ventricular esquerdo após revascularização miocárdica associada à restauração da geometria ventricular pela "pacopexia", em pacientes portadores de miocardiopatia isquêmica com significativa disfunção ventricular, nos quais a restauração ventricular foi conseguida com técnica especial. MÉTODOS: Revascularização miocárdica associada à restauração da geometria ventricular através de técnica especial, sem utilização de próteses ou outros materiais sintéticos. RESULTADOS: Após o procedimento cirúrgico, foi observada melhora da classe funcional em 93,10% dos pacientes. Houve um aumento significante na comparação pré e pós operatórias da fração de ejeção do ventrículo esquerdo e diminuição do diâmetro sistólico do ventrículo esquerdo. Não houve alteração significante do diâmetro diastólico do ventrículo esquerdo e do volume sistólico. O tempo de seguimento após a operação variou de 1 mês a 3 anos e 4 meses. CONCLUSÃO: A técnica de restauração ventricular através da pacopexia mostrou-se eficaz no tratamento da grave disfunção ventricular de origem isquêmica, com impacto sobretudo na melhora da classe funcional dos pacientes estudados.OBJECTIVE: To analyze left ventricle performance after myocardial revascularization associated to ventricular geometrics restoration by "pacopexy" in schemic myocardiopathy patients with significant ventricular dysfunction in whom ventricular restoration was obtained through special technique. METHODS: Myocardial revascularization associated to ventricular geometrics restoration through special technique, with no use of prosthesis or other synthetic materials. RESULTS: Patients’ functional class was shown to have improved 93.10% after surgical procedure. Pre- and post-surgical comparison showed significant increase in left ventricle ejection fraction as well as decrease in left ventricle systolic diameter. No significant change was observed in left ventricle diastolic diameter or systolic volume. Post-surgical follow-up time length ranged from 1 month to 3 years and 4 months. CONCLUSION: Ventricular dysfunction restoration technique through pacopexy showed to be effective for the management of severe ventricular dysfunction from schemic causes. Major impact was observed in the functional class of patients under study.

OBJETIVO: Analisar a Avaliação Nutricional Subjetiva Global (ANSG) para o diagnóstico de desnutrição em pacientes cardiopatas. MÉTODOS: Em 106 pacientes hospitalizados (53 com insuficiência cardíaca), aplicou-se o questionário de ANSG com histórico nutricional (peso, dieta, sintomas gastrointestinais, capacidade funcional física e diagnóstico) e exame físico. Depois aferiram-se medidas antropométricas (peso, circunferência do braço, prega cutânea triciptal e circunferência muscular do braço). Para a avaliação objetiva dos pacientes com insuficiência cardíaca consideraram-se albumina sérica, contagem de linfócitos e antropometria. A curva ROC analisou sensibilidade, especificidade e acurácia da ANSG em relação à avaliação objetiva. RESULTADOS: A idade dos pacientes era de 57,7 ± 15,7 anos, e a maioria era de homens (67,9%). A curva ROC indicou o escore 16 como ponto de corte da ANSG com maior sensibilidade (62,2%) e especificidade (55,7%). A área sob a curva foi de 0,601 (IC 95%: 0,487 - 0,715). A prevalência de desnutrição foi de 51,9% pela ANSG e 42,5% pela avaliação antropométrica, com acurácia de 65,3% nos homens e 44,1% nas mulheres. Nos pacientes com insuficiência cardíaca, a prevalência de desnutrição foi de 60,4% pela ANSG e 32,1% pela avaliação objetiva, com acurácia de 67,6% nos homens e 31,3% nas mulheres. CONCLUSÃO: A ANSG identificou maior número de desnutridos do que a avaliação objetiva. O desempenho da ANSG na identificação de desnutrição foi maior nos homens. A ANSG detectou pacientes cardiopatas com risco nutricional.OBJECTIVE: To analyze the performance of Subjective Global Assessment of Nutritional Status (SGA) in diagnosing malnutrition in patients with heart disease. METHODS: One hundred and six hospitalized patients (53 with heart failure) completed an SGA questionnaire on their nutritional history (changes in body weight, dietary intake, gastrointestinal symptoms, functional capacity, and diagnosis) and underwent physical examination. Then, anthropometric measurements were obtained (body weight, mid-arm circumference, triceps skinfold thickness, and arm muscle circumference). Serum albumin, total lymphocyte count and anthropometric measurements were determined for the objective assessment of patients with congestive heart failure. An ROC curve was used to analyze sensitivity, specificity and accuracy of SGA compared to the objective assessment. RESULTS: Patients' age was 57.7 ± 15.7, and the majority was male (67.9%). The ROC curve showed score 16 as SGA cut-off point with the highest sensitivity (62.2%) and specificity (55.7%). The area under the curve was 0.601 (95% CI: 0.487 - 0.715). Anthropometric assessment showed malnutrition prevalence at 51.9% by SGA and 42.5% by, with accuracy of 65.3% in men and 44.1% in women. In patients with congestive heart failure, SGA assessed malnutrition prevalence was 60.4%, while objective assessment was 32.1% with accuracy of 67.6% in men and 31.3% in women. CONCLUSION: SGA detected a greater number of malnourished patients than the objective evaluation. Its performance in identifying malnutrition was better in men. It also detected cardiac patients at nutritional risk.

OBJETIVO: Analisar a importância da viabilidade do miocárdio e parâmetros clínicos na melhora da função ventricular, sintomas e prognóstico, como reversão do remodelamento. MÉTODO: Cento e quinze pacientes submetidos a revascularização do miocárdio com análise prévia da viabilidade do miocárdio com thallium-201. Fração de ejeção, volumes sistólicos e diastólicos do ventrículo esquerdo e classe funcional foram determinados, antes da cirurgia e a cada seis meses por 3 anos. RESULTADOS: Pacientes com > 4 segmentos viáveis demonstraram melhora da fração de ejeção de 34±6 para 44±4% (pOBJECTIVES: To evaluate the integration of both viability and clinical parameters on the improvement in systolic performance, symptoms and prognosis, with post-revascularization reverse remodeling. METHOD: One hundred and fifteen patients underwent thallium-201 imaging before myocardial revascularization. Left ventricular ejection fraction, left ventricular end-systolic volume index and left ventricular end-diastolic volume index were determined before and at each 6 months post-revascularization for 3 years. RESULTS: Patients with > 4 viable segments on thallium-201 imaging demonstrated an improvement in left ventricular ejection fraction from 34±6 to 44±4%, p

The aim of this study was to evaluate clinical and echocardiographic characteristics of patients with diabetic cardiomyopathy. The study included 72 patients, divided into two groups. The experimental group consisted of 32 diabetics, while 40 gender and age-matched healthy subjects were in the control group. In the experimental group there were 17 patients with insulin-dependent diabetes mellitus, and 15 patients with non-insulin-dependent diabetes mellitus. The average duration of diabetes mellitus was 9.53 years. All the patients underwent the following diagnostic procedures: standard laboratory tests, 12-lead ECG, chest X-ray, 24-h Holter ECG, and complete echocardiographic examination. More frequent appearance of ventricular rhythm disturbances (65,6% vs. 47,5%), increased heart rate (78.3 ± 8.2 vs. 72.1 ± 4.6 beats per minute), and alteration of diastolic (56.25% vs. 12.5%) and systolic function (43.8% vs. 0%) was registered in patients with diabetes, compared to the control group. Experimental group was divided, according to their left ventricular dimensions, into two subgroups: the subgroup with normal left ventricular dimensions, and the subgroup with the increased left ventricular dimensions. Patients with the increased left ventricular dimensions not only had significantly lower ejection fraction (37.4 ± 7.0 vs. 61.3 ± 4.2%), but also had significantly longer duration of diabetes (12.6 ± 5.8 vs. 8.01 ± 3.01 years), worse quality of glycoregulation (13.1 ± 2.5 vs. 10.4 ± 2.1%), and higher Shapiro’s microvascular complications index (2.7 ± 1.26 vs. 0.68 ± 0.56). High degree of correlation was also found between the duration of diabetes left ventricular ejection fraction (-0.86), and left ventricular mass (0.86). The similar level of correlation was shown with Shapiro’s index (-0.77 and 0.88), as well as with morning glycaemia (-0.57 and 0.41). According to the obtained results it could be concluded that the changing rate of diabetic cardiomyopathy was in direct correlation with the quality of diabetes control, the duration of diabetes, and the presence of complications in other organs.

OBJECTIVE: To discuss the protective mechanisms of atorvastatin treatment for isoproterenol (ISO)-induced chronic heart failure. MATERIALS AND METHODS: The rats were randomly divided into three groups: normal group (n = 15, age-matched normal adult rats), ISO group (n = 11, ISO induced heart failure) and atorvastatin group (n = 14, ISO induced lesion but received atorvastatin treatment). The cardiac function was evaluated by echocardiography and hemodynamics analysis. In addition, the Rac1 activity in the myocardium and the expression levels of Rac1, p47phox and p67phox were measured by RT-PCR and western blot. RESULTS: Rats in ISO group developed into heart failure with decreased cardiac function. The Rac1, p47phox and p67phox mRNA expressions and ROS release were increased in ISO group. Atorvastatin treatment improved cardiac function of rats with isoproterenol-induced chronic heart failure and decreased the Rac1, p47phox and p67phox mRNA expressions. Also, membrane protein expression of Rac1 and ROS release decreased significantly. CONCLUSIONS: Atorvastatin may improve cardiac function of rats with heart failure via inhibiting Rac1/P47phox/P67phox-mediated ROS release. [ABSTRACT FROM AUTHOR]

Objectives Concentrations of endothelin I (ET1) are elevated in CHF patients and, like other biomarkers that reflect hemodynamic status and cardiac pathophysiology, are prognostic. The Singulex assay (Sgx-ET1) measures the active form of ET1, with a short in vivo half-life and the Brahms assay measures C-terminal endothelin-1 (CT-ET1), a modified (degraded) product with longer half-life. We aimed to determine the prognostic importance of active and modified forms of endothelin 1 (Singulex and Brahms assays) in comparison with other commonly measured biomarkers of inflammation, hemodynamic status and cardiac physiology in CHF. Design and methods Plasma biomarkers (Sgx-ET1, CT-ET1, NTproBNP, IL-6, TNFα, cTnI, VEGF, hs-CRP, Galectin-3, ST2) were measured in 134 NYHA class II and III CHF patients with systolic dysfunction. Prognostic importance of biomarkers for hospitalization or death were calculated by both logistic regression and Kaplan–Meier survival analyses. Results CT-ET1 (OR = 5.2, 95% CI = 1.7–15.7) and Sgx-ET1 (OR = 2.9, CI = 1.1–7.7) were independent predictors of hospitalization and death and additively predicted events after adjusting for age, sex, and other significant biomarkers. Other biomarkers did not improve the model. Similarly, in Cox regression analysis, only CT-ET1 (HR 3.4, 95% CI = 1.4–8.4), VEGF (2.7, 95% CI = 1.3–5.4), and Sgx-ET1 (HR 2.6, 95% CI = 1.2–5.6) were independently prognostic. Conclusions Elevated concentrations of endothelin 1 predict mortality and hospitalizations in HF patients. Endothelin 1 was more prognostic than commonly obtained hemodynamic, inflammatory, and fibrotic biomarkers. Two different assays of endothelin 1 independently and synergistically were prognostic, suggesting either complementary information or extreme prognostic importance. [ABSTRACT FROM AUTHOR]

Los antagonistas de la angiotensina II, un nuevo grupo de medicamentos, bloquean de manera selectiva los receptores AT; esto ocasiona vasodilatación, aumento de la renina y de la angiotensina II, reducción de la resistencia periférica, de los niveles de aldosterona y de la presión arterial, sin modificar la frecuencia cardíaca. Todos ellos actúan de manera similar y comparten las mismas acciones farmacológicas, excepto por un ligero efecto uricosúrico del losartán, prototipo de estos compuestos. Son antihipertensivos tan eficaces como los demás medicamentos empleados para tratar la presión arterial elevada, con la ventaja de ser muy tolerados. Parecen regresar la hipertrofia ventricular izquierda y ser, al menos tan eficaces como los inhibidores de la ECA para el tratamiento de la insuficiencia cardíaca congestiva. El costo de estos fármacos es elevado. The angiotensin II antagonists, a new group of drugs, block in a selective way AT receptors, causing vasodilatation, increase of renin and of angiotensin II, reduction of peripheral resistance, of the aldosterone levels, and of blood pressure without modifying heart rate. All of them act in a similar way and share the same pharmacological actions, excepting a mild uricosuric effect of losarten, a prototype of these compounds. These antihypertensive drugs are as efficent as the rest of the drugs used to treat high blood pressure with the advantage that patients tolerate them better. They seem to regress left ventricular hypertrophy and to be at least as effective as ECA inhibitors for the treatment of congestive heart failure. The cost of these drugs is high.

Background Although it is known that trastuzumab causes cardiotoxicity, its extent and reversibility are still in question. Earlier studies have not evaluated consecutive patients with reproducible nuclear ventriculography. Objective We sought to evaluate the baseline characteristics which predispose patients to increased risk of trastuzumab cardiotoxicity and to determine the natural history of the cardiotoxicity. Methods and Results Left ventricular ejection fraction (LVEF) was measured in 76 women aged 36-73 years who had been treated with trastuzumab at the University of Maryland Greenebaum Cancer Center. LVEF was determined at baseline and then 3, 6, 9, and 12 months after treatment initiation. Cardiotoxicity was defined as ≥16% decrease in LVEF or ≥10% decrease in LVEF to <50%. There were no differences in comorbidities, earlier treatment, or demographics between patients with and without trastuzumab-induced cardiomyopathy except that African Americans were more likely to develop decreased LVEF (P < .05). Twenty-one patients (28%) met criteria for cardiotoxicity. Four of those patients were continued on trastuzumab and 17 patients had therapy withheld at some point. Only 1 patient developed symptomatic heart failure requiring inpatient hospitalization. LVEF improved in most patients regardless of whether or not trastuzumab was continued. Conclusions Decreased LVEF while undergoing trastuzumab therapy occurs frequently and is usually reversible. African Americans had a higher risk of developing decreased LVEF. These findings raise clinically important questions as to whether it is necessary to discontinue trastuzumab for asymptomatic decrease in LVEF and whether African Americans are more predisposed to a decrease in LVEF while receiving trastuzumab. Further studies carefully assessing LVEF should address these hypotheses. [ABSTRACT FROM AUTHOR]

Background: Possible beneficial effects of dietary omega-3 supplementation on patients with congestive heart failure (CHF) were investigated. Methods and results: 100 patients with CHF who had a tri-chamber pacemaker and automated defibrillator were initially recruited, and 70 agreed to participate.38 patients received 2 g/day of omega-3 and 32 received placebo capsules. BNP level, 6-min walk test and echocardiographic parameters were recorded at baseline and after 6 months of treatment. BNP levels decreased significantly after 6 months in the omega-3 group, from 1766.2 ± 1978.1 pg/mL to 1159.4 ± 1430.9 pg/dL (P < 0.005). Tei index and late diastolic velocity index were significantly improved in treated group. Mortality and hospitalization rates did not differ. Conclusion: The beneficial effects of omega-3 supplementation in patients with CHF were not as clear as hypothesized; however, omega-3 fatty acids can result in small changes in plasma BNP levels and modest improvements in echocardiographically assessed diastolic function (Clinical trial.gov registration: NCT01227837). [ABSTRACT FROM AUTHOR]

The article discusses a study on the relations of estimated glomerular filtration rate (eGFR) with the incidence of heart failure and analyzes the association of chronic kidney disease (CKD) with diabetes and hypertension. Healthy male physicians with no history of cardiovascular disease, cancer or liver disease were selected for the study. It suggests an association of moderate CKD with a higher incidence of heart failure, and a subgroup of normotensive and nondiabetic individuals with moderate CKD had similar and higher risk of heart failure.

To evaluate the effects of noncardiac disease on c-terminal brain natriuretic peptide (cBNP) concentrations in dogs. Prospective observational study. Urban university veterinary hospital. Thirty-eight apparently healthy dogs, 28 dogs with cardiac disease (14 CHF, 14 non-CHF), and 81 dogs with primary noncardiac diseases. none. Plasma was collected from each dog and analyzed for active (cBNP) B-type natriuretic peptide using an assay that is being investigated for commercial use (Biosite). Dogs with CHF had significantly higher plasma cBNP concentrations than dogs with subclinical cardiac disease, apparently healthy dogs, or dogs with primary noncardiac disease. However, 21% (28/133) of dogs without CHF (including healthy dogs, dogs with primary noncardiac disease, and dogs with subclinical cardiac disease) had cBNP concentrations above previously identified diagnostic thresholds for CHF, reiterating the importance of reestablishing new diagnostic cutoffs when considering comorbidities affecting B-type natriuretic peptide levels. A clinically relevant proportion of nondyspneic dogs with primary noncardiac diseases have increased cBNP concentrations that exceed previously identified diagnostic thresholds, potentially limiting the ability of this test to identify CHF when noncardiac comorbidities exist. Interpretation of increased cBNP concentrations in such cases must be appropriately interpreted with further diagnostic investigation. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess the rate of death and hospitalization for heart failure (HF) 1 and 3 years after a randomized trial of telephone intervention aimed to improve education and compliance in stable patients with HF ended. Background: The long-term effects of HF programs are not well known. Methods: In all, 1,518 patients with HF were randomized into the DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure). After completion of the trial, patients were followed up to 3 years to assess major outcomes. Compliance with diet, weight control, and treatment was evaluated. The effect of the intervention on mortality and HF hospitalizations was assessed using relative risk (RR), relative risk reduction, and Cox proportional hazards model for adjusting by potential confounders. Results: The rate of death or hospitalization for HF was lower in the intervention group (37.2% vs. 42.6%, RR: 0.81, 95% confidence interval [CI]: 0.69 to 0.96; p = 0.013) 1 and 3 years (55.7% vs. 57.5%, RR: 0.88, 95% CI: 0.77 to 1.00; p = 0.05) after the intervention ended. This benefit was mainly caused by a reduction in admission for HF (28.5% vs. 35.1% after 3 years, RR: 0.72, 95% CI: 0.60 to 0.87; p = 0.0004). Patients who showed improvement in 1 or more of 3 key compliance indicators (diet, weight control, and medication) had lower risks of events. Conclusions: The benefit observed during the intervention period persisted and was sustained 1 and 3 years after the intervention ended. This effect may be explained by the impact of the educational intervention on patients'' behavior and habits. [Copyright &y& Elsevier]

The article focuses on a study which described the national trends in all-cause readmissions rates after heart failure (HF) hospitalization among Medicare beneficiaries. The study found that national mean and risk-standardized all-cause readmission rates (RSRR) distributions among Medicare beneficiaries discharged after hospitalization. It concluded that there was no improvement in hospital readmission care among Medicare beneficiaries.

Chronic heart failure (CHF) is associated with frequent hospitalizations and high mortality. It affects more than 5 million individuals in the USA, and another 660,000 new cases are diagnosed each year; overall, heart failure (HF) now accounts for 7% of all deaths from cardiovascular disease. Hypertension (HTN) increases the risk of development of HF and it precedes it in 75% of cases. HF patients are nearly evenly divided between those with reduced left ventricular (LV) function or systolic dysfunction and those with preserved LV systolic function or diastolic dysfunction. The management of HTN in patients with CHF is challenging. Drugs such as β-blockers, angiotensin-converting enzyme inhibitiors, angiotensin receptor blockers, aldosterone receptor blockers, hydralazine and nitrates, which have shown mortality benefit in CHF and exert antihypertensive effects, should be used as first-line agents to control HTN in CHF. In addition, antihypertensive drugs such as α-receptor blockers that can increase mortality in HF should be avoided. The dihydropyridine group of calcium channel blockers are good antihypertensive medications with a neutral effect on mortality in patients with CHF. These may be used in CHF patients with refractory HTN. In patients with HF with reduced ejection fraction, HTN is treated differently in comparison to patients with HF with normal ejection fraction. This article reviews the treatment of essential HTN in patients at risk for developing HF, in the presence of HF and the latest developments in treatment that might benefit both HTN and HF management. [ABSTRACT FROM AUTHOR]

Aims: Many chronic heart failure (CHF) patients take β-blockers. When such patients are hospitalized for decompensation, it remains unclear how ongoing β-blocker treatment will affect outcomes of acute inotrope therapy. We aimed to assess outcomes of SURVIVE patients who were on β-blocker therapy before receiving a single intravenous infusion of levosimendan or dobutamine. [ABSTRACT FROM PUBLISHER]

Abstract: Background: The differential diagnosis of dyspnoea is difficult due to the low predictive value of clinical and laboratory parameters. The elevated levels of NT-proBNP in congestive heart failure may improve diagnostic accuracy. We have evaluated the effect of the introduction of an NT-proBNP assay on hospital length of stay (LOS) and mortality. Methods: There were 11,853 AMAU patient episodes in the 22 months study period (March 2005–Dec 2006). An NT-proBNP assay was requested in 657 (5.5%) of these. Comparison between categorical variables such as diagnosis, NT-proBNP testing, LOS, and in-hospital mortality was made using Chi-square tests. Literature review suggested that an NT-proBNP cut-off ≥5000 ng/L should predict acute in-patient mortality. Logistic regression analysis was used to examine the association between such an elevated NT-proBNP level and outcomes. Results: Of the 396 patients with NT-proBNP <5000 ng/L, 8.1% died compared with 22.5% of the 178 patients dying with values ≥5000 ng/L (p <0.0001). An NT-proBNP ≥5000 ng/L was predictive of both LOS ≥9 days (odds ratios (OR) 1.54 (95% CI 1.06, 2.24: p =0.02) and LOS ≥14 days (OR=1.87 (95% CI 1.29, 2.71: p =0.0009). NT-proBNP requests increased over time, from 2.6% to 8.2% of all patients; the result fell in the diagnostic range for CHF in 60% of requests. Conclusion: The introduction of an NT-proBNP was reflected in an appropriate but rapidly increasing pattern of requests from clinicians. High NT-proBNP levels predicted in-hospital mortality and longer LOS in an acute medical population. [Copyright &y& Elsevier]

Chronic heart failure (CHF) is an increasingly common condition in high-income countries that has a large and negative impact on life quality and expectancy, and is associated with high financial costs. In Canada, CHF has an especially large impact on rural settings because of the higher proportion of older adults (aged >65 years) in these settings, and because care and outcomes tend to be more adverse in rural parts of the country compared to urban settings. Much can be done to reduce these burdens in terms of pharmacological, behavioural and health service strategies. However, rural patients tend to have worse care and outcomes than urban patients. Realizing the benefits of these strategies in Canada's rural settings requires consideration of underlying reasons for poor care and outcomes. We propose the main reasons for adverse outcomes are related to the nature of CHF and the combined influence of demographics, health services and the rural context. Nurses remain under-used in CHF management in Canada and can play a vital and influential role in reducing the burden of CHF in rural settings. To increase and improve nurses' roles, we recommend that nurses should support the development and adaptation of disease management programs in rural settings and promote the centrality of nursing in these programs. Nurses in or working with rural settings should seek to support and use tele-health technologies effectively and provide better support to lay caregivers. It will also be vital to increase the nursing capacity regarding specialist roles for CHF management. [ABSTRACT FROM AUTHOR]

Background: There is a lack of published data about the nature of nursing interventions that are required to provide telephone management for patients with heart failure (HF). Purpose: The nature of patient issues, telephone nursing interventions, and associated workload at one HF clinic are described in this study. Methods: Workload was captured using a computerized workload measurement tool. An electronic telephone log categorizing nursing interventions as providing education, changing medication doses, ordering diagnostic tests and consulting with community health care providers, and the scope of practice required to complete the intervention was kept. Results: Nurses spent 24% of their working hours doing 1,914 telephone visits in one year. Medications were changed 583 times and diagnostic tests were ordered 207 times. Nurses initiated 65% of calls; others were received from patients, family members, and other health care providers. Conclusion: A combination of nurse practitioners and registered nurses with medical directives can address the issues that commonly arise through telephone management of HF patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: To estimate the impact on quality of life of evolving stages of heart failure in a community sample of Portuguese adults. Methods: Cross-sectional evaluation of 424 adults aged ≥45 years. Subjects were classified in stages defined by the American College of Cardiology: low risk, high risk for heart failure (stage A), asymptomatic cardiac dysfunction (stage B), symptomatic heart failure (stage C). Quality of life was assessed using 8 sub-domains of Short Form 36: physical functioning, role limitations-physical problems, bodily pain, general health perception, social functioning, vitality, role limitations-emotional problems and mental health. Results: Women scored significantly lower on all sub-domains. Quality of life decreased with age and increased with socioeconomic status. Adjusting for gender, age and education, physical sub-domains, general health perception, social functioning and role limitations-emotional problems decreased significantly with increasingly severe heart failure stages in women and men. No significant association was found with vitality and mental health. Conclusion: Significantly lower scores on quality of life sub-domains were found across increasing severity of heart failure stages, even in the early asymptomatic phases. The results contradict conceptual frameworks which suggest that the impact of heart failure on quality of life depends on symptoms. [Copyright &y& Elsevier]

Abstract: Background: Valid assessments of health-related Quality of Life (HRQL) are increasingly important in chronic, incurable conditions, such as chronic heart failure (CHF). Aims: To evaluate the psychometric properties of a Swedish version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in hospitalized patients with decompensated CHF. Method and results: The KCCQ and SF-36 were administered to patients (n =118) with CHF at baseline and then 1 (n =51) and 4 months (n =83) after admission. The Swedish version of the KCCQ appears to have acceptable convergent and discriminant validity for all suggested health domains. Cronbach''s alpha and test–retest reliability met for most of the scales the minimum of 0.70. Known-groups comparison indicated that the KCCQ discriminated between patients differing in the New York Heart Association (NYHA) classification (criterion validity). The KCCQ was also more responsive to changes in the NYHA classification as compared with the SF-36. However, KCCQ has some weakness in the response distributions for two questions and the convergent validity in one question. Conclusion: Overall, the KCCQ is a valid and reliable instrument in a Swedish CHF population. It yields reliable and valid scores and is quite responsive to clinical change. [Copyright &y& Elsevier]

Abstract: Background: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital admissions and the need for specialist care. Aim: To evaluate the feasibility of home care (HC) versus conventional care (CC) in relation to health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. Methods: Thirty-one patients seeking medical attention at hospital for worsening CHF were randomised to HC or CC. Following discharge within 48 hours from the hospital, patients in the HC group were followed-up in their homes by a specialist nurse. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Results: There was no significant difference in clinical events, adverse events or in HRQL. The total cost related to CHF was lower in the HC group after 12 months (p =0.05). Conclusion: Reduction in cost of care for selected patients with CHF eligible for hospital care might be achieved by early discharge from hospital followed by home visits. Due to the small number of patients, these results must be interpreted with caution. [Copyright &y& Elsevier]

The term “cardiorenal syndrome” has generally been reserved for declining renal function in the setting of advanced congestive heart failure. Considering the complex and bi-directional relationship between the heart and the kidneys, we postulate refining the definition to recognize the symbiotic nature of these organs. We divide the cardiorenal syndrome into five subtypes: type I, acute cardiorenal syndrome; type II, chronic cardiorenal syndrome; type III, acute renocardiac syndrome; type IV, chronic renocardiac syndrome; and type V, secondary cardiorenal syndrome. As early recognition of dysfunction in one organ may prove important in mitigating the spiral of co-dysfunction in both, the need for early and treatment-guiding biomarkers, along with their characteristics, are also discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To summarise the primary efficacy and safety results from the first international clinical trial with the VentrAssist™ left ventricular assist device and to provide an update on the VentrAssist™ Clinical Development Plan. Methods: The first prospective, single-arm, multicentre international clinical trial with the VentrAssist™ in bridge-to-transplant patients (CE Mark trial) was conducted in Australia, UK and Norway between 2004 and 2006. The primary outcome measure was survival until transplant or being transplant-eligible at postoperative day 154. The number and status of other clinical trials in the VentrAssist™ Clinical Development Plan are also described. Results: At the completion of the CE Mark trial, 25 of the 30 patients (83%) were transplanted or transplant-eligible. There were no unexpected safety issues and no reported uncontrolled stops of the VentrAssist™ pump. The Clinical Development Plan for the VentrAssist™ currently comprises seven clinical trials: two are completed, three are ongoing and two are ready for initiation. As of January 30th, 2007, a total of 87 patients have been implanted with the VentrAssist™ at 14 centres worldwide, yielding a total exposure time of more than 43 patient-years and a maximum implant duration of 2.7 years. Conclusions: The efficacy and safety data from a clinical trial of the VentrAssist™ were favourable and resulted in gaining European regulatory approval for this indication. Notably, the survival success rate for the VentrAssist™ was higher than that reported for other left ventricular assist devices. The overall number of implants with the VentrAssist™ has now surpassed that of any other third-generation centrifugal device. [Copyright &y& Elsevier]

Chronic heart failure is known to be an important risk factor for adverse perioperative outcome in patients undergoing non-cardiac surgery. A promising new form of electric therapy is currently being used in a phase III trial in patients with severe chronic heart failure (cardiac contractility modulation). Cardiac contractility modulation is a non-pharmacological approach to improve Ca2+ effect on cardiac myofilaments using electric currents. The caçdiac contractility modulation system used at present (OPTIMIZERTM III, Impulse Dynamics, Orangeburg, NY, USA) consists of a subcutaneously implanted pulse generator and three electrodes. As far as we know, cardiac contractility modulation therapy is a safe and feasible way of improving the systolic function of the heart in congestive heart failure patients. No pro-arrhythmic effects of this new therapy have been reported. The technique shows promise as an additive treatment for severe chronic heart failure. The perioperative and intraoperative management of patients should follow current cardiac pacemaker/implantable cardioyerter defibrillator guidelines. [ABSTRACT FROM AUTHOR]

This article investigates the influence of self-concept on adherence to prescribed health regimens in adults with heart failure. A Self-concept Mode Theory was used to examine the relationships between components of self-concept to recommended regimens. The study also examined the extent to which aspects of self-concept cognitive perception of health regiments might predict adherence to the regimens. Nurses should to identify methods that support feelings of challenge to self-concept.

Introduction: The problem of anemia in congestive heart failure and chronic kidney disease was thought to be insignificant for a long period of time. Recent investigations pointed out that the problem of anemia should be defined in the context of the cardio-renal anemia syndrome. A positive feedback mechanism indicates that cardio-renal anemia syndrome is due to an interaction between congestive heart failure, chronic renal failure and anemia. The aim of the study was to present the possible pathophysiological mechanisms of this syndrome, epidemiological characteristics and therapeutic results of the former investigations. Results: The results of the retrospective and prospective controlled trails have shown that management of anemia with subcutaneous administration of recombinant human erythropoietin together with intravenous iron infusion for at least 3-6 months lead to:relief of symptoms (improved NYHA functional class); increased left ventricular ejection fraction; reduced cardiovascular morbidity and mortality; reduced number of rehospitalizations; reduced requirements for usual therapeutic agents (especially diuretics); and improved renal function. Conclusion: In patients with heart and kidney disease anemia should be routinely identified and appropriately treated. Subcutaneous recombinant erythropoietin and intravenous iron may significantly improve overall survival and quality of life of these patients. [ABSTRACT FROM AUTHOR]

Introduction Anemia is more common and pronounced in patients with diabetic, than in patients with non-diabetic renal disease. While several factors contribute to its pathogenesis, the failure of the kidney to increase erythropoietin in response to falling hemoglobin appears to be the dominant factor. The most frequent complications of anemia in diabetic patients include decreased quality of life and work capacity and increased cardiovascular morbidity and mortality. Material and Methods This cross-sectional multicenter study included a total of 539 patients with type I (∼20%) and type II diabetes (∼80%) classified into five stages according to the glomerular filtration rate. Results Diabetic nephropathy appears in stage I, and progresses in all patients to the stage V (p=0.045). The presence of anemia progressively increased from stage I to stage V (from 60% to 100%, p=0.008). Only 62% of patients with anemia were treated (mainly with iron) and only 3.4% received erythropoietin treatment. Hypertension was present in 90% of patients in stage I and in 100% of patients in stage V nephropathy. The presence of heart failure increased from 0% (stage I) to 51% (stage IV, p=0.03). Around 62% of patients were referred to a nephrologist, and according to the logistic regression model, renal failure and presence of anemia were significant predictors of patients' referral to nephrologist. Conclusion In a primary care setting, anemia is a frequent finding, even in the very beginning of diabetic renal disease. Currently available guidelines for management of anemia are not followed; this may explain high percentage of patients with heart failure in pre-dialysis stage. Early referral to a nephrologist and regular follow-up by an endocrinologist and cardiologist are the best way for the prevention of diabetic complications and comorbidity. [ABSTRACT FROM AUTHOR]

Abstract: Background: Heart rate can affect cardiac function, but the importance of rates lower than 100 paced beats per minute is unknown. We therefore sought to evaluate the impact of different heart rates on ejection fraction, 6-minute walk, and peak oxygen consumption (VO2) in heart failure patients. Methods and Results: We studied 13 pacemaker-dependent New York Heart Association Class III patients with ejection fraction <40%, age 66 ± 13. Eligible patients included those pacing at least 75% of the time at a lower set rate of 60 ppm. This was a 3-period randomized blinded crossover study. Patients were assigned to pace at 60, 75, or 90 ppm (with rate responsivity to 20 ppm above the lower rate) for 2 months at each setting. At the end of each period, ejection fraction (by nuclear ventriculography) and exercise tolerance (by peak VO2 and 6-minute walk) were assessed. Ejection fraction, peak VO2, and 6-minute walk distance were significantly different among the 3 heart rates. All 3 were depressed at 90 ppm. A heart rate of 90 also led to more clinical deterioration and premature discontinuation from that period. Conclusions: Pacing at a heart rate of 90 led to lower ejection fraction, VO2, 6-minute walk distance and clinical evidence of worsening heart failure as compared with slower heart rates. [Copyright &y& Elsevier]