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Biomedical subjects

Hector O Ventura

Publications and source records attributed to Hector O Ventura.

At least 19 recordsLinked to original sources
PubMed2006

Left ventricular geometry and mortality in patients >70 years of age with normal ejection fraction.

Numerous studies have indicated that left ventricular (LV) hypertrophy predicts morbidity and mortality, including studies in older patients. The prognostic impact of other LV geometric patterns, including concentric remodeling (CR), compared with LV hypertrophy has not been studied in a large cohort of older patients. Echocardiographic and clinical data were studied in 9,771 consecutive patients aged >70 years with ejection fractions > or =50% who were followed for 3.1 years to determine the impact of LV geometric patterns. CR was the most prevalent pattern (43%), and 16% met criteria for LV hypertrophy. Although patients with CR had significantly lower LV mass indexes than patients with normal structure as well as those with LV hypertrophy, their mortality was 35% higher than that of normal subjects (15.5% vs 11.5%, p <0.0001) and 13% higher than that of patients with eccentric LV hypertrophy (15.5% vs 13.7%, p <0.001) with similar mortality to those with concentric LV hypertrophy (15.5% vs 15.9%). In conclusion, abnormal LV geometry is extremely common in patients aged >70 years with normal systolic function, being present in 59% of this population, with CR (43%) by far the most common LV geometric pattern. Patients aged >70 years with CR have significantly increased mortality compared with similarly aged patients with either normal structure or eccentric LV hypertrophy, with similar increased mortality to those with concentric LV hypertrophy.

Aged↗
PubMed2006

Comparison of cardiac and peripheral arterial stiffening and ventriculovascular uncoupling in patients with uncomplicated hypertension versus patients with hypertension after heart transplantation.

Despite normal ejection fractions, patients who undergo heart transplantation (HT) have low peak aerobic capacity and reduced arterial compliance, suggesting "ventriculovascular uncoupling." To what extent this is related to post-transplantation hypertension versus the unique characteristics of the donor-recipient relation remains poorly understood. Echocardiograms were retrospectively reviewed from 126 normal subjects, 309 patients with uncomplicated hypertension (UH), and 58 consecutive patients with HT >1 year after the procedure who were stable without evidence of rejection. Left ventricular (LV) end-systolic elastance (Ees), a measure of LV systolic performance; effective arterial elastance (Ea), a measure of vascular stiffness; and Ea/Ees, a parameter describing ventriculovascular coupling, were obtained. Compared with normal subjects, tandem increases in Ea (+24% and +85%, all p values <0.0001) and Ees (+23% and +33%, all p values <0.0001) were observed in patients with UH and HT, respectively, with patients with HT having significantly higher values than those with UH (both p values <0.05). Although the Ea/Ees ratio remained similar between normal subjects and patients with UH, patients with HT exhibited increases in the Ea/Ees ratio (all p values <0.01) and reduced stroke volume indexes (-20% and -22%, respectively, all p values <0.05). These changes were associated with a doubling of LV concentric remodeling in patients with HT compared with those with UH (67% vs 34%, p <0.0001). In conclusion, HT is associated with increases in Ees, Ea, and the Ea/Ees ratio, suggesting ventriculovascular uncoupling and maximal LV stroke work. These aberrations, which determine cardiovascular performance in the setting of HT, are not simply explained by vascular age or post-transplantation hypertension but may adversely affect functional capacity.

Blood Pressure↗
PubMed2006

Fish oils produce anti-inflammatory effects and improve body weight in severe heart failure.

BACKGROUND: Fish oils have been shown to reduce production of tumor necrosis factor-alpha (TNF-alpha) in healthy subjects. We sought to evaluate the effects of fish oils on pro-inflammatory cytokines and body weight in patients with advanced heart failure. METHODS: Fourteen patients (New York Heart Association [NYHA] Class III to IV heart failure) were randomized in a double-blinded trial to active therapy with 8 g of n-3 fatty acids (Group A, n = 7) or placebo (Group B, n = 7) for 18 weeks. TNF-alpha and interleukin-1 (IL-1) production were measured by radioimmunoassay after endotoxin stimulation of peripheral blood mononuclear cells. RESULTS: Placebo-treated patients had a 44% increase in TNF-alpha (from 1.28 to 1.84 pg/ml; p = 0.07) but no significant change in IL-1 (from 0.68 to 0.78 pg/ml) production. n-3 fatty acids resulted in a 59% reduction in TNF-alpha (from 1.64 to 0.68 pg/ml; p = 0.02) and 39% decrease in IL-1 (from 1.98 to 1.21 pg/ml; p = 0.09) production. There was an inverse correlation between change in TNF-alpha production and change in percent body fat (r = -0.6; p = 0.02). CONCLUSIONS: Fish oils decrease TNF-alpha production in heart failure and improve body weight. Fish oil therapy may represent a novel therapeutic approach in late-stage heart failure characterized by cardiac cachexia.

Adipose Tissue↗
PubMed2006

Left ventricular geometry and survival in patients with normal left ventricular ejection fraction.

In hypertensive populations, left ventricular (LV) geometry, which is characterized by hypertrophy, predicts cardiovascular outcome. The left ventricle can also alter its shape by concentric remodeling (CR) in the absence of LV hypertrophy, a feature that is detected by echocardiography. This study assessed the prevalence and prognostic significance of various forms of LV geometry and changes in LV geometry over time in patients with normal LV systolic function. Retrospective analysis of a large clinical population (n = 35,602) that was referred for echocardiography was done, with all-cause mortality as the primary outcome. Abnormal LV geometry was identified in 46% of patients, with CR present in 35% (n = 12,362) and LV hypertrophy in 11% (n = 3,958). Patients with abnormal LV geometry were older and more obese compared with subjects with normal LV geometry. There was a strong relation between abnormal LV geometry and mortality, and patients with CR and LV hypertrophy exhibited considerably higher relative risk for all-cause mortality compared with subjects with normal LV geometry (relative risk [RR] 1.99, 95% confidence interval [CI] 1.88 to 2.18, p <0.0001; RR 2.13, 95% CI 1.89 to 2.40, p <0.0001, respectively). Subjects with CR who reverted to a normal geometric pattern had improved survival (RR 0.64, 95% CI 0.42 to 0.97, p = 0.03) compared with those who progressed to LV hypertrophy (RR 1.54, 95% CI 1.01 to 2.47, p = 0.05). In conclusion, CR, a form of cardiac adaptation, is frequently noted in patients with normal LV ejection fractions and confers a risk of death similar to that of LV hypertrophy. Normalization of CR is associated with better survival, whereas transition to LV hypertrophy increases mortality.

Aged↗
PubMed2006

Ancient Egyptian medicine and the concept of heart failure.

BACKGROUND: The cardiac glosses of the Ebers papyrus comprise the concepts and notions of the Egyptian physicians about the heart and its diseases. We sought to analyze some of the cardiac glosses of the Ebers papyrus, focusing on those which may describe early concepts of the syndrome of heart failure. METHODS AND RESULTS: Review of Joachim's German translation and both Bryan's and Ghalioungui's English translations of the Ebers papyrus. One clinical scenario describes patients with "weakness of the heart" or "cardiac dysfunction:" "His heart is bored," "The heart weakens," "This means that the heart does not speak or that the vessels of the heart are dumb. Its information under your hands normally appears because of the air with which they are filled is missing...." Debility that has arisen in the heart." The other clinical scenario supplies information about patients with heart failure and "fluid retention" or "congestion": "His heart is flooded. This is the liquid of the mouth. His body parts are all together weak"..."His heart is over flooded...." CONCLUSION: Whether or not Egyptian medicine and the contents of the papyri paved the way for future knowledge, the clinical scenarios included in the Ebers papyrus may represent one of the earliest documented observations of the syndrome of heart failure.

Cardiac Output, Low↗
PubMed2006

Osborn waves in sepsis.

A patient with severe sepsis, who presented with moderate hypothermia and the classical electrocardiographic findings that have been described in patients with accidental hypothermia is presented. Rewarming was associated with proportional improvement of the initial electrocardiographic abnormalities. A brief discussion is included about the electrophysiologic mechanisms of Osborn waves, the differential diagnosis of this electrocardiographic finding as well as other findings described in patients with hypothermia.

Aged↗
PubMed2006

Understanding the basics of cardiopulmonary exercise testing.

Cardiopulmonary exercise testing adds important additional information to that provided by the standard exercise test. In particular, cardiopulmonary exercise testing provides precise determination of aerobic capacity, the causes of dyspnea with exertion, and prognosis in patients with systolic heart failure. This review provides basic, practical information about cardiopulmonary exercise testing for the clinician.

Disability Evaluation↗
PubMed2005

Relation between left ventricular geometry and transmural dispersion of repolarization.

Studies have shown an association between left ventricular (LV) geometry and complex ventricular ectopic activity. Increased transmural dispersion of repolarization (TDR), which correlates to the interval from the peak to the end of the T wave (Tpe) on the surface electrocardiogram, is linked to ventricular tachyarrhythmias. The relation between LV geometry and TDR is unknown. The mean Tpe interval, measured from leads V(1) to V(3) of the surface electrocardiogram, was assessed in 300 patients (50% men) who had normal LV systolic function and QRS duration and were categorized into 3 equal groups, which were matched by age and gender, according to echocardiographically determined LV geometry (normal structure, concentric remodeling, and LV hypertrophy). The Tpe interval was corrected for the QT interval using Tpe/QTc and was compared among the 3 groups. Compared with those who had normal LV structure, the Tpe interval was significantly prolonged in those who had LV hypertrophy and significantly shortened in those who had concentric remodeling (p = <0.0001 for the 2 comparisons). Correcting for the QT interval using Tpe/QTc yielded similar results. Thus, TDR was increased in patients who had LV hypertrophy but decreased in concentric remodeling compared with those who had normal cardiac structure. Although LV hypertrophy represents a maladaptive geometric process that results in an unfavorable electrical substrate, concentric remodeling may represent a structural adaptation that has a more favorable electrical milieu.

Arrhythmias, Cardiac↗
PubMed2005

Statin use and risks of death or fatal rejection in the Heart Transplant Lipid Registry.

Although small, randomized trials have shown that statin use is associated with decreased risks of mortality and severe rejection, no study has examined statin therapy as used in actual practice in large numbers of heart transplant recipients. We analyzed data from the Heart Transplant Lipid Registry (n = 12 centers). Patients were included if they underwent transplantation between 1995 and 1999, survived >/=30 days after transplantation, and had >/=30 days of Registry follow-up. Multivariable Cox regression models, with propensity scoring performed to adjust for nonrandom allocation of statin therapy, were performed to determine the association of statin therapy with death and fatal rejection. The study included 1,186 patients, with a mean follow-up of 580 +/- 469 days; 937 patients (79%) received statin therapy. Overall, 71 patients (6%) died and 40 (3.4%) had fatal rejection. The statin group had a lower frequency of death (4% vs 13.7%, p <0.0001) and fatal rejection (2.4% vs 7.2%, p = 0.0001). Using multivariable Cox regression, with propensity scoring included to adjust for likelihood of receiving statin therapy, statin use was the only factor associated with lower risk of death (hazard ratio 0.29, 95% confidence interval 0.13 to 0.67) and fatal rejection (hazard ratio 0.27, 95% confidence interval 0.09 to 0.78). This study represents the largest population of heart transplant recipients analyzed for the relation between statin therapy and clinical outcomes in actual practice. Statin therapy was significantly associated with lower risk of death and fatal rejection, benefits that were independent of lipid values.

Chi-Square Distribution↗
PubMed2005

Hypertension as a hemodynamic disease: the role of impedance cardiography in diagnostic, prognostic, and therapeutic decision making.

Hypertension is the most common cardiovascular disease, affecting approximately 60 million Americans. Despite the importance of this condition, only the minority of patients are appropriately identified and treated to reach recommended blood pressure (BP) goals. Although historically defined as an elevation of BP alone, hypertension is characterized by abnormalities of cardiac output, systemic vascular resistance, and arterial compliance. These hemodynamic aspects of hypertension have implications for diagnosis, risk stratification, and treatment. Impedance cardiography (ICG) has emerged as a unique and highly accurate noninvasive tool that is used to assess hemodynamic parameters. Measurement of the various hemodynamic components using ICG in those with hypertension allows more complete characterization of the condition, a greater ability to identify those at highest risk, and allows more effectively targeted drug management. This article reviews the importance of hemodynamic factors in hypertension and the evolving role of ICG technology in the assessment and management of this important cardiovascular condition.

Cardiography, Impedance↗
PubMed2005

Bloodletting as a cure for dropsy: heart failure down the ages.

BACKGROUND: Dropsy was a term used to describe generalized swelling and was synonymous with heart failure. Its treatment options were scanty and were aimed to cause "emptying of the system" or to relieve fluid retention. These remedies were rudimentary, erratic in action, and associated with inconvenient side effects. METHODS AND RESULTS: Bloodletting, either by venesection or by leeches, was a popular way to alleviate symptoms from dropsy. Although bloodletting, purgatives, cauterization, and Southey tubes were drastic, their use demonstrated that physicians were not powerless to help people with severe heart failure. Several centuries of intensive investigations in different areas of heart failure ended with the development of new therapeutic strategies that made bloodletting obsolete. CONCLUSION: In an era when adequate treatment of heart failure has become a reality, it is appropriate to acknowledge those who paved the way to such great progress.

Bloodletting↗
PubMed2005

Relationship among epicardial coronary disease, tissue myocardial perfusion, and survival in heart transplantation.

BACKGROUND: Cardiac allograft vasculopathy continues to represent the major limitation to long-term cardiac allograft survival. Routine angiography and intravascular ultrasound fall short in their ability to detect microcirculatory aberrations. Thrombolysis in myocardial infarction (TIMI) myocardial perfusion grades (TMPG) have been used as a measure of microvascular circulation in patients treated for acute myocardial infarction. We studied the correlation of epicardial coronary anatomy with microvascular flow as determined by TMPG and correlated it with patient outcome. METHODS: We enrolled 66 consecutive cardiac transplant recipients (49 men; mean age 52 +/- 13 years; range 15-70 years) undergoing surveillance coronary angiogram during a 9-month period. All angiograms were interpreted for epicardial coronary anatomy by an independent investigator. Another investigator, blinded for clinical data and angiogram interpretation, interpreted TMPGs. TMPG 0 was defined as no apparent tissue-level perfusion; TMPG 1 indicated presence of myocardial blush but no clearance from the microvasculature; TMPG 2 blush cleared slowly; and TMPG 3 indicated that blush began to clear during washout (blush is minimally persistent after 3 cardiac cycles of washout). Cardiac deaths served as the primary outcome variable. RESULTS: Fifty-eight of 66 patients had an abnormal TMPG. Mean TMPG in all these patients was 4.2 +/- 3 (normal is 9). Forty-four patients (Group A) with no angiographic coronary narrowing had TMPG 4.81 +/- 3.1, and 22 patients (Group B) with epicardial coronary narrowing 40% of lumen diameter had TMPG 3.0 +/- 2.5 (p = 0.007). There was no difference in TMPG related to the coronary territory involved. At a mean follow-up of 30 +/- 2.5 months, 6 (13.6%) of 44 patients in Group A had died, and 7 (31.8%) of 22 in Group B had died (p < 0.03). CONCLUSIONS: Microcirculatory aberrations as assessed by tissue TMPG is abnormal across all coronary territories in cardiac transplant recipients and associated with poor survival, suggesting a generalized microvascular involvement even in the presence of a normal angiogram. Patients with focal epicardial coronary narrowing have significantly greater decline in tissue perfusion, independent of the coronary territory involved, and exhibit poor survival compared with patients without epicardial coronary disease.

Adolescent↗
PubMed2005

Early recognition and treatment of hypertensive heart disease.

PURPOSE OF REVIEW: Hypertension leads to left ventricular hypertrophy, diastolic dysfunction, and eventually clinical heart failure (hypertensive heart disease). There is an important need for physicians to recognize this entity, understand its pathophysiology, and become fluent in treatment options available. This review of recent basic science and clinical data serves to accomplish this task. RECENT FINDINGS: In the past year, a number of exciting concepts have come to the forefront. First, data on the use of brain natriuretic peptide as a screening biomarker has shown promise in patients with symptoms of heart failure. For the earliest detection of structural changes, serum propeptide of procollagen type I, a marker of the deposition of type I collagen in the cardiac interstitium provides a noninvasive way to quantify myocardial fibrosis. Treatment options in the past few years have focused heavily on the anti-fibrotic effects of inhibitors of the renin-angiotensin-aldosterone system, perhaps supplanting beta blockers as first-line agents to regress left ventricular hypertrophy. The concept of aldosterone escape is discussed, highlighting the importance of aldosterone inhibitors in these patients. Lastly, we provide a comprehensive review of all antihypertensive classes and their effects on hypertensive heart disease. SUMMARY: The incidence of hypertensive heart disease is increasing. Earlier detection may be possible with newly studied serum biomarkers. All anti-hypertensive treatments have shown improvement in regressing left ventricular hypertrophy, but inhibitors of the renin-angiotensin-aldosterone system possess the most potent anti-fibrotic effects. It is increasingly important for clinicians to identify and manage hypertensive heart disease to prevent increased morbidity and mortality.

Adrenergic beta-Antagonists↗
PubMed2004

Efficacy and safety of sildenafil in the evaluation of pulmonary hypertension in severe heart failure.

This study sought to evaluate the utility of sildenafil in assessing pulmonary artery reactivity in left-sided cardiac failure and secondary pulmonary hypertension (PH). Fourteen consecutive patients with heart failure were studied, with oral doses of either sildenafil 25 mg (n = 8) or 50 mg (n = 6) every 8 hours for </=3 doses, and invasive serial hemodynamic measurements were performed. Thirteen patients (93%) demonstrated >20% decreases in pulmonary artery pressures. There was also a 20% reduction of the pulmonary vascular resistance/systemic vascular resistance ratio, indicating relative pulmonary artery selectivity. Compared with sildenafil 25 mg, sildenafil 50 mg demonstrated greater reductions of pulmonary pressures. Oral sildenafil is safe and effective for the evaluation of PH reactivity in heart failure.

Administration, Oral↗