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PubMed2000

[Diagnosis and treatment of heart failure in primary health care. Low correlation between Pro-ANF and heart failure].

Three eastern Swedish primary care clinics serving a predominantly rural clientele monitored for 13 months all patients under 80 years of age with a diagnosis based on clinical signs alone of heart failure (n = 56) or suspected incipient heart failure (n = 62). Echocardiography was performed on all patients. For 64% of the former group, the putative diagnosis matched echocardiography findings. Results showed a purely diastolic disorder in one-fifth of all 118 patients, and a hemodynamically significant, hitherto unknown heart defect in about as many. Pro-ANF assays correlated poorly with manifest heart failure. Pharmacological treatments were registered, and at 6-month follow-up, 82% of patients with systolic failure were receiving ACE-inhibition.

Aged↗
PubMed2001

[Serum copper levels in patients with chronic heart failure associated with systolic left ventricular dysfunction and its relation to the severity of cardiac failure].

UNLABELLED: The authors examined the serum copper concentrations in a group of 40 patients with chronic heart failure and significant systolic left ventricular dysfunction with an ejection fraction of less than 35%. In 21 patients the examination was made on admission to hospital on account of deterioration of cardiac insufficiency (group A), in 19 patients with stable chronic cardiac failure the examination was made at the out-patient department (group B). Assessment of serum copper concentrations was made by the method of absorption spectrophotometry under standard conditions. Assessment of the ejection fraction of the left ventricle and dimensions of the cardiac compartments was made by two-dimensional echocardiography. The heart rate was assessed from the electrocardiogram at rest. RESULTS: The authors found statistically significantly higher copper concentrations in patients of group A (19.78 +/- 1.67 mumol/l) as compared with group B (14.80 +/- 1.54 mumol/l, p < 0.001). The correlation between copper concentrations, the left ventricular ejection fraction, dimensions of the cardiac compartments and heart rate are not significant. CONCLUSION: Serum copper concentrations in patients with chronic heart failure and significant systolic left ventricular dysfunction are related to the severity of the disease and are higher in patients admitted on account of cardiac insufficiency than in patients with stable cardiac failure.

Aged↗
PubMed2003

Treatment of heart failure--role of biventricular pacing for heart failure not responding well to drug therapy.

OBJECTIVE: Patients with heart failure may have conduction abnormalities in up to 30%, further aggravating cardiac output. Drugs worsen these abnormalities and resynchronisation therapy with biventricular pacing improves cardiac function by effecting a more coordinated and efficient ventricular contraction. We report here the technique of biventricular pacing and its results. METHODOLOGY: Patients with NYHA Class III to IV heart failure, widened QRS (> or = 130 ms) complex on the ECG and impaired LVEF < or = 40% were enrolled. RESULTS: Biventricular pacing was performed in 29 patients (26 males, three females) from August 1999 to December 2001. The mean age of the patients was 59.6 +/- 12.8 years and 62% had underlying ischemic heart disease. All were in NYHA class III or more. Twenty-three had LBBB, four RBBB and two had widened paced QRS complex. The QRS duration was 161 +/- 21 ms and LVEF was 22 +/- 8%. All the left ventricular leads were implanted successfully. The procedure time was 167.0 +/- 79.6 mins and the fluoroscopy time was 43.8 +/- 41.4 mins. There were no significant complications. The NYHA class improved from a mean of 3.1 to 2.0 and exercise time from 252 +/- 95 seconds to 392 +/- 152 seconds at six months post implant (p=0.049). On follow-up (one month to 28 months), 25 (86%) patients had improvement in heart failure symptoms and 26 (90%) of the patients remained alive. CONCLUSION: Biventricular pacing can be safely performed and results in improvement in symptoms and exercise tolerance in heart failure patients with ventricular dyssynchrony not responding to drug therapy.

Cardiac Pacing, Artificial↗
PubMed2004

[Clinical characteristics, treatment and short-term morbidity and mortality of patients with heart failure followed in heart failure clinics. Results of the BADAPIC Registry].

INTRODUCTION AND OBJECTIVES: Despite recent improvements in therapy, heart failure is still associated with high mortality and hospitalization rates. New management strategies such as heart failure clinics could help to improve this situation. PATIENTS AND METHOD: We analyzed the clinical features, treatment, morbidity and mortality of 3909 patients with heart failure followed at 62 heart failure clinics in Spain in the last 3 years (BADAPIC Registry). Mean follow-up time was 13 +/- 4 months. RESULTS: Mean age was 66 +/- 12 years (40% of the patients were older than 70 years), and 67% were male. Etiology was ischemic heart disease in 41% of the cases, systemic hypertension in 19%, idiopathic dilated cardiomyopathy in 17%, valvular disease in 17% and other in the remaining 6%. Left ventricular ejection fraction was < 45% in 68% of the patients. After inclusion in the BADAPIC Registry, 86% of the patients received diuretics, 37% received digoxin, 87% were given angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, 32% received spironolactone, 59% received beta blockers and 28% were given nitrates. Actuarial survival at 24 months was 87%, admission-free survival was 80% and event-free survival was 76%. Survival was similar in men and women, higher in patients younger than 70 years (P<.05), and slightly higher in those with left ventricular ejection fraction > 45% (P=.08). CONCLUSIONS: The treatment received by patients included in the BADAPIC Registry closely approached the recommended standards. Their short-term survival rate was very high.

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PubMed2005

[A case of postoperative recurrent lung cancer with chronic renal failure and respiratory failure successfully treated with gefitinib].

We administered gefitinib to a patient after considering his request to be treated with the drug. Fortunately, he responded favorably to the treatment and did not show signs of serious adverse effects or deterioration of renal functions. The patient was a 69-year-old male who visited an outpatient clinic because of chronic renal failure and was diagnosed with primary lung cancer. He then underwent an operation for lung cancer, but because it had progressed to stage IV the lesion was not completely resected. The patient was unable to receive effective chemotherapy due to the prior chronic renal failure. During best support care, the patient suffered from respiratory failure due to the tumor growth, and his quality of life (QOL) deteriorated. The patient was administered 250 mg of gefitinib orally, which was effective in reducing the tumor, improving his QOL, and prolonging his survival time. With the lack of literature on administering gefitinib to patients with chronic renal failure and evidence supporting the effectiveness of this treatment, the physician in charge should obtain the patient's informed consent before initiating treatment using this anticancer drug.

Adenocarcinoma↗
PubMed1988

Renal failure in diabetics in the UK: deficient provision of care in 1985. Joint Working Party on Diabetic Renal Failure of the British Diabetic Association, the Renal Association, and the Research Unit of the Royal College of Physicians.

Two surveys of diabetic renal failure were conducted in 1985. The first survey was designed to identify all diabetic patients having advanced renal failure (serum creatinine greater than 500 mumol/l and/or blood urea greater than 25 mmol/l in six selected health regions of the UK. The study identified 181 such patients indicating that approximately 10 people in every million of the population were affected. It is calculated that there were about 580 patients having diabetic renal failure in the whole of the UK. The majority of the patients (78%) were considered by their physicians to be suitable for renal support treatment. Those who were excluded were considered unsuitable chiefly on account of old age or cardiac problems. In the second survey all 66 renal units in the UK reported the number of diabetic patients starting renal support treatment in 1985. There were 273 patients, suggesting that there may be a shortfall when compared with the number of diabetics likely to need treatment. The Working Party recommends that diabetics who develop renal failure should always be considered for treatment by dialysis or transplantation, and that appropriate resources should be made available for them.

Adult↗
PubMed1995

Plasma exchange in patients with acute renal failure in the course of multiorgan failure.

Multiorgan failure (MOF) due to intoxication, trauma or sepsis in the progressive late stages always include acute renal failure (ARF). The prognosis of these patients is poor despite adequate dialysis. This study included 27 consecutive patients (20 men and 7 women, age range 15-77 years) with a rapid progress of MOF including ARF, who were treated by plasma exchange as an attempt to reverse the progress of MOF. Twenty-three of the patients suffered from a septic shock. Oliguria or anuria was present in all, dialysis was performed in 16 of them, and mechanical respiratory aid in 17. Plasma exchange was performed 1-10 times and almost exclusively by centrifuge technique, using albumin and/or liquid stored plasma (in a few cases fresh frozen plasma) as colloidal replacement fluid. Twenty-two patients survived (81%) and 5 patients died. The reasons of death were cerebral haemorrhagia, brain abscess, myocardial sudden death, relapsing sepsis from multiple hepatic abscesses and a not drained psoas abscess. All survivors could leave hospital recovered from renal failure with few other sequelae. The plasma exchange technique is easy to perform despite low blood pressures by using a vein to vein access. Plasma exchange, therefore, may be tried to reverse late stages of multiorgan failure.

Acute Kidney Injury↗
PubMed1995

[Pathophysiology and treatment of congestive heart failure--recently advanced strategy for heart failure].

The principle functions of the heart are to accept blood from the systemic and the pulmonary circulatory system, pump and deliver it to the whole body tissues and lungs. The term "heart failure" is used to describe the pathophysiological state in which an abnormality of cardiac function is responsible for failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues, or to do so only from an elevated filling pressure. Thus, for a long period, heart failure has been thought of as a mechanical disorder of the heart and vessels, and its treatment has been based on improving impaired cardiac function and hemodynamic disorder. Recently multi-center, randomized placebo-controlled survival trials revealed that pure inotropic agents such as phosphodiesterase inhibitors succeeded in mechanical improvement, yet not only failed to prolong the patient's life, but also increased mortality. A number of neurohumoral mechanisms, which are activated in heart failure, were thought to be compensatory ones. However, survival trials demonstrated that two types of drug interfering with the renin-angiotensin system and the sympathetic nervous system reduced mortality. Those drugs are angiotensin-converting enzyme (ACE) inhibitors and beta blockers. ACE inhibitors reduce the direct effects of angiotensin II on myocardial cells, which may lead to cell necrosis, imbalanced remodeling through fibrosis, and attenuate the progressive ventricular dilatation. Local tissue renin-angiotensin system may be potentially important in regulating the angiotensin II production in both heart and vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1995

[Does nocturnal hypoxia relate to acute exacerbation of chronic respiratory failure with right heart failure in late sequelae of pulmonary tuberculosis?].

Thirty-eight patients with late sequelae of pulmonary tuberculosis (TB seq.) were studied to clarify whether or not nocturnal oxyhemoglobin desaturation (NOD) could relate to acute exacerbation of chronic respiratory failure (AE). All patients had been untreated with home oxygen therapy, because they were not severely hypoxic. We performed sleep studies, pulmonary function tests and arterial blood gas analysis and investigated past history about AE in each patient. Twelve patients had experienced AE with right heart failure and they were classified as CHF (congestive heart failure) group. The rest was classified as Non-CHF group. These two groups were compared as for each variables examined. There was no difference between the two groups in age, body weight, %VC, FEV1.0%, and awake PaO2. Awake PaCO2 was significantly higher in CHF group. Although no difference was observed in baseline SaO2, the degree of NOD was significantly greater in CHF group when evaluated by lowest SaO2 during sleep and 85% desaturation time (total time spent with SaO2 less than 85%). Moreover, 21 of Non-CHF and 6 of CHF were studied for cardiac parameters using right side cardiac catherization. While the differences of mean pulmonary arterial pressure and cardiac output between the two groups were not significant, pulmonary arteriolar resistance was higher in CHF group. We concluded that NOD in TB seq. had a major role in AE with right heart failure. We speculated that AE might be caused, at least partly, by pulmonary vasopressor response to recurrent NOD.

Acute Disease↗
PubMedDate not supplied

[Effect of reperfusion therapy on the prognosis of acute myocardial infarction complicated by left heart failure: prediction based on the acute course of left ventricular heart failure].

This study evaluated the correlation between the acute course and prognosis of patients with acute myocardial infarction complicated by heart failure. Heart failure was defined as a mean pulmonary capillary wedge pressure equal to or greater than 20 mmHg with radiographic evidence of pulmonary congestion during hospitalization in the coronary care unit. A total of 77 heart failure patients underwent primary percutaneous transluminal coronary angioplasty or thrombolysis. Twelve patients who died within the first 3 days (group I) had a higher incidence of unsuccessful reperfusion (50 vs 19%, p < 0.05) and cardiogenic shock (64 vs 4%, p < 0.01), compared with the 65 patients who survived at least the initial 4 days (group II). These 65 patients were classified into three subgroups according to the course of heart failure: early regression type (group IIA, n = 38); prolonged type (group IIB, n = 18); delayed-onset type (group IIC, n = 9). Patients in group IIB had a higher incidence of multivessel disease than group IIA. Patients in group IIC had a higher incidence of unsuccessful reperfusion. Cardiac index in group IIB was lower than in group IIA (2.50 +/- 0.70 vs 1.91 +/- 0.39 l/min/m2). Changes in left ventricular ejection fraction were 4.1 +/- 9.2% in group IIA, -6.6 +/- 16.8% in group IIB, and 0.9 +/- 7.3% in group IIC. The hospital mortality rate was 0% in group IIA, 11% in group IIB, and 33% in group IIC, the reinfarction rate was 0, 17 and 22%, and sustained arterial patency was demonstrated in 81, 62 and 43%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

Congestive heart failure with normal left ventricular systolic function. Clinical approaches to the diagnosis and treatment of diastolic heart failure.

The syndrome of congestive heart failure with preserved left ventricular systolic function is common in clinical practice. The signs and symptoms of the disorder are similar to those of congestive heart failure with left ventricular systolic dysfunction, underscoring a need for routine evaluation of left and right ventricular systolic function in patients with congestive heart failure. The syndrome may be related to anatomic abnormalities that increase the resistance to ventricular filling, or to physiologic abnormalities of myocardial relaxation or compliance. Advancing age, often in association with hypertension, coronary artery disease, tachycardia, and atrial fibrillation, is commonly associated with the disorder. Randomized controlled clinical trials are needed to evaluate the efficacy of various therapeutic agents in reducing the risks associated with diastolic heart failure.

Algorithms↗
PubMed1998

[National and international guidelines ignore significant cause of heart failure. Diastolic dysfunction is often the cause of heart failure in the elderly and in women].

Comparison of patients treated for chronic heart failure at a large hospital with patients included in major treatment studies published during the past ten years yielded important information. The former series was characterised by greater proportions of the elderly and of women than were the series recruited to the often cited ACE (angiotensin-converting enzyme) inhibitor studies. Although only patients with systolic dysfunction were recruited to the latter studies, a substantial body of evidence suggests the prevalence of severe heart failure among patients with normal systolic function to increase with increasing age. Thus, as many as 50 per cent of all elderly patients with chronic heart failure may have normal systolic function. In most cases, the heart failure is probably due to diastolic dysfunction, a condition that still lacks both a simple diagnostic procedure and a well-documented treatment.

Aged↗
PubMedDate not supplied

[Sustained low-efficiency dialysis (SLED) in patients with prevalent systolic heart failure refractory to medical treatment and with chronic renal failure].

Systolic heart failure refractory to conventional medical therapy is the principal cause of the high hospitalization rates and of high mortality risks. When this condition is associated with chronic renal failure it is necessary to treat the body liquid composition alterations, and the alterations in the hemodynamic state without creating low flow conditions, trying to achieve an electrolytic and an acid-base balance to reduce the plasmatic volume and permit refilling between the interstitium and plasm. Sustained low-efficiency dialysis (SLED) is a dialysis technique allowing the maintenance of hemodynamic stability through a reduced ultrafiltration rate, it allows an adequate clearance of small solutes, and with sustained treatment it maximizes the dialysis dose and determines a clinical improvement through the removal of the hydric overload. Our experience suggests that SLED is a substitutive treatment for acute dialysis in patients with systolic heart failure refractory to conventional medical treatment.

Aged↗
PubMed1998

Epidemic of pediatric deaths from acute renal failure caused by diethylene glycol poisoning. Acute Renal Failure Investigation Team.

CONTEXT: Contaminated pharmaceutical products can result in substantial morbidity and mortality and should be included in the differential diagnosis of deaths of unknown origin. OBJECTIVE: To investigate an outbreak of deaths among children from acute renal failure in Haiti to determine the etiology and institute control measures. DESIGN: Case-control study, cohort study, and laboratory toxicologic evaluation. SETTING: Pediatric population of Haiti. PARTICIPANTS: Cases were defined as Haitian residents younger than 18 years with idiopathic anuria or severe oliguria for 24 hours or longer. Febrile hospitalized children without renal failure were enrolled as control subjects. MAIN OUTCOME MEASURE: The odds of exposure to suspected etiologic agents among cases and controls. RESULTS: We identified 109 cases of acute renal failure among children. The clinical syndrome included renal failure, hepatitis, pancreatitis, central nervous system impairment, coma, and death. Of 87 patients with follow-up information who remained in Haiti for treatment, 85 (98%) died; 3 (27%) of 11 patients transported to the United States for intensive care unit management died before hospital discharge. A locally manufactured acetaminophen syrup was highly associated with disease (odds ratio, 52.7; 95% confidence interval, 15.2-197.2). Diethylene glycol (DEG) was found in patients' bottles in a median concentration of 14.4%. The median estimated toxic dose of DEG was 1.34 mL/kg (range, 0.22-4.42 mL/kg). Glycerin, a raw material imported to Haiti and used in the acetaminophen formulation, was contaminated with 24% DEG. CONCLUSIONS: An epidemic of severe systemic toxicity and deaths from DEG-contaminated acetaminophen syrup occurred in Haiti. Good manufacturing practice regulations should be used by all pharmaceutical manufacturers to prevent such tragedies.

Acetaminophen↗
PubMed2002

Severe cardiac failure in newborns with VGAM. Prognosis significance of hemodynamic parameters in neonates presenting with severe heart failure owing to vein of Galen arteriovenous malformation.

OBJECTIVE: Neonatal vein of Galen malformation complicated by severe cardiac failure is a rare disease. The purpose was to assess the outcome of this life-threatening malformation and identify hemodynamic prognostic factors. DESIGN: Retrospective study. PATIENTS: Twenty-four newborns with cardiac failure requiring mechanical ventilation were consecutively admitted from 1986 to 2000. INTERVENTIONS: Cardiovascular evaluation including echocardiogram was performed in all cases. Eighteen transarterial shunt occlusions with glue were applied by the same team of three physicians. MEASUREMENTS AND RESULTS: Twelve babies survived and underwent one endovascular session at least (median age 20 days) with a mean 63 months follow-up. Embolization was not performed in 6 of the 12 nonsurvivors because of severe brain damage or profound hypotension Cardiogenic shock occurred in all nonsurvivors, but also in one long-term survivor (p<0.0001). Echocardiogram showed signs of right ventricular failure, most often in the dead babies (p=0.005). The pulmonary systemic arterial pressure ratio was significantly higher in the nonsurvivor group (p=0.031), and it decreased significantly after the first embolization only in patients who survived (p=0.01). Patent ductus arteriosus and a diastolic aortic reversed-flow were present in all nonsurvivors in contrast to 30% of the long-term survivors (p=0.003 ). There was no difference in the left ventricular contractility and mean cardiac output between the two groups. CONCLUSIONS: The outcome of vein of Galen malformation complicated by severe cardiac failure requiring mechanical ventilation remains poor. Neonatal embolization seems to be beneficial only in babies without suprasystemic pulmonary hypertension.

Arteriovenous Malformations↗
PubMed2002

Haemodynamic responses during head-up tilt and tilt reversal in two groups with chronic autonomic failure: pure autonomic failure and multiple system atrophy.

Continuous haemodynamic responses to head-up tilt (HUT) and its reversal were studied in 21 subjects with sympathetic denervation due to primary chronic autonomic failure; 10 had pure autonomic failure (PAF; peripheral failure) and 11 had multiple system atrophy (MSA; central failure); 8 healthy subjects (controls) also were studied. Supine systolic, diastolic and mean arterial pressure (MAP) and total peripheral resistance (TPR) were highest in PAF. The MAP response to HUT and tilt reversal were different between groups. After HUT, MAP increased in controls (12+/-4 mmHg), but decreased in PAF and MSA (41+/-4 & 19+/-4 mmHg respectively); the fall in PAF was greater than in MSA. With tilt reversal, MAP returned promptly, but not entirely to pretilt levels in controls, with small (insignificant) overshoots in MSA and PAF. The TPR response to HUT and tilt reversal was different between groups. After HUT, TPR increased in controls (0.31+/-0.04 PRU), decreased in PAF (0.23+/-0.1 PRU) and was unchanged in MSA. With tilt reversal, TPR remained elevated (15 %) above baseline in the controls and rose in PAF (13 %) with no change in MSA. There were no differences in supine heart rate (HR), stroke volume (SV) or cardiac output (CO) between the three groups; HR, SV or CO responses to HUT or tilt reversal also did not differ between the groups. Thus, after HUT, MAP decreased, with greater hypotension induced in PAF than MSA. Since CO did not differ between groups, the decrease in TPR appears to account for the greater fall in BP in PAF than in MSA. The elevated TPR at rest pre-tilt and after tilt reversal probably contributed to supine hypertension in PAF. These haemodynamic observations may aid therapeutic strategies to reduce orthostatic hypotension and prevent supine hypertension.

Aged↗
PubMed1989

A controlled clinical study of amalgam restorations: survival, failures, and causes of failure.

The survival and modes of failure of amalgam restorations were investigated retrospectively. 2660 Class I or II lesions were restored and evaluated yearly or half-yearly for failures during the 30- to 84-month follow-up. Restorations with unacceptable margins were not counted as failures if no traces of secondary caries could be seen. 8% of the restorations were lost because of patient drop-out. Of the remaining restorations, 1% was replaced due to primary caries. Of the remaining number (2431), 9% failed because of all other reasons. The leading mode of failure was bulk fracture (4.6%), followed by tooth fracture (1.9%), and marginal ridge fracture (1.3%). For all other reasons, 0.8% of the restorations failed. Only two restorations were replaced because of secondary caries. The alloy selection in both conventional and high-copper categories significantly influenced the survival of the restorations for reasons directly related to the restoration.

Dental Amalgam↗
PubMed2006

The prognostic value of big endothelin-1 in more than 2,300 patients with heart failure enrolled in the Valsartan Heart Failure Trial (Val-HeFT).

BACKGROUND: Endothelin is elevated in heart failure and contributes to neurohormonal activation, hemodynamic deterioration, and cardiovascular remodeling. Here, we examined its prognostic value in a large population of patients with chronic heart failure. METHODS AND RESULTS: Big endothelin-1 (Big ET-1) and 4 other neurohormones were measured at study entry in 2359 patients enrolled in the Valsartan Heart Failure Trial (Val-HeFT) and their concentrations related to outcome over a median follow-up of 23 months. Baseline concentration of Big ET-1 (median 0.80 pmol/L) was proportional to severity of disease (New York Heart Association class, left ventricular structure and function). High circulating concentrations of brain natriuretic peptide (BNP), creatinine and bilirubin, advanced New York Heart Association class, elevated body mass index, and the presence of atrial fibrillation were independently associated to higher concentrations of Big ET-1. Big ET-1 (ranking second just behind BNP among neurohormonal factors) was an independent predictor of outcome defined as all-cause mortality (hazard ratio 1.49, 95% CI 1.20-1.84, P = .0003) or the combined endpoint of mortality and morbidity (hazard ratio 1.43, 95% CI 1.20-1.69, P < .0001) and provided incremental prognostic value compared with BNP. CONCLUSIONS: In a large population of patients with symptomatic heart failure, the circulating concentration of Big ET-1, a precursor of the paracrine and bioactive peptide ET-1, was an independent marker of mortality and morbidity. In this setting, BNP remained the strongest neurohormonal prognostic factor.

Aged↗