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At least 19 recordsLinked to original sources
PubMedDate not supplied

[From ischaemia to heart failure: heart rate--actor or stamper?].

The heart rate in sinus rhythm depends on If current-induced automaticity of sinus node cells. Such a current is activated by hyperpolarisation and is modulated by influences from sympathetic and para-sympathetic tones. There are established prognostic values for the baseline heart rate and its variability in coronary heart disease and heart failure. However, heart rate per se directly modulates myocardial oxygen consumption and cardiac contractility by interfering with the excitation-contraction coupling. The therapeutic implications of pharmacological modulation of the heart rate are important mainly for slowing the heart rate, as illustrated by the use of calcium antagonists in coronary heart disease and beta-blockers in both coronary heart disease and heart failure. The possibility of a direct action on sinusal automaticity by drugs such as ivabradine, an If channel blocker, reveals new therapeutic perspectives. Indeed, a benefit of combination therapy with these drugs and beta-blockers should be lower heart rate values than can be attained with maximally tolerated doses of beta-blockers.

Autonomic Nervous System↗
PubMed2001

Accurate noninvasive estimation of pulmonary vascular resistance by Doppler echocardiography in patients with chronic failure heart failure.

OBJECTIVES: This study was undertaken to explore further the relationship between Doppler-derived parameters of pulmonary flow and pulmonary vascular resistance (PVR) and to determine whether PVR could be accurately estimated noninvasively from Doppler flow velocity measurements in patients with chronic heart failure. BACKGROUND: The assessment of PVR is of great importance in the management of patients with heart failure. However, because of the inconclusive and conflicting data available, Doppler estimation of PVR is still considered unreliable. METHODS: Simultaneous Doppler echocardiographic examination and right heart catheterization were performed in 63 consecutive sinus rhythm heart failure patients with severe left ventricular systolic dysfunction. Hemodynamic PVR was calculated with the standard formula. The following Doppler variables on pulmonary flow and tricuspid regurgitation velocity curve were correlated with PVR: maximal systolic flow velocity, pre-ejection period (PEP), acceleration time (AcT), ejection time, total systolic time (TT), velocity time integral, and right atrium-ventricular gradient. RESULTS: At univariate analysis, all variables except maximal systolic flow velocity and velocity time integral showed a significant, although weak, correlation with PVR. The best correlation found was between AcT and PVR (r = -0.68). By regression analysis, only PEP, AcT and TT entered into the final equation, with a cumulative r = 0.87. When the function (PEP/AcT)/TT was correlated with PVR, the correlation coefficient further improved to 0.96. Of note, this function prospectively predicted PVR (r = 0.94) after effective unloading manipulations. CONCLUSIONS: The analysis of Doppler-derived pulmonary systolic flow is a reliable and accurate tool for estimating and monitoring PVR in patients with chronic heart failure due to left ventricular systolic dysfunction.

Blood Flow Velocity↗
PubMed1977

[Systemic lupus erythematosus and congestive heart failure. Heart histological and ultrastructural study (author's transl)].

Histological and ultrastructural studies were performed on myocardial biopsies and aortic and mitral valve leaflets obtained during an operation on a patient with Systemic Lupus Erythematosus (S.L.E.). Congestive heart failure and valvular dysfunction appeared five years after the diagnosis of S.L.E. was made. On histological study, aortic and mitral valve leaflets are uniformly thickened by fibrous tissue with a nodular appearance. No active endocarditis was associated with the fibrous scarring. Atrial myocardium and papillary muscle countain a fibrous net-work discret in the former, extensive in the latter. The scattered foci of fibrosis in the papillary muscle surround vessels without obliteration or parietal necrosis. Ultrastructurally their lumina appears narrowed by prominent endothelial cells with cytoplasmic aggregates of tubuloreticular structures (T.R.S.). These tubules are also present in some endocardial endothelial cells but are rare in the normal intrapapillary or atrial vessels that are not associated with a scar. Myocardial fibrous foci enclose atrophic and severely degenerated cardiac muscle cells; other cells situated at the periphery of the foci are normal in size or hypertrophic and moderately degenerated. The most altered muscle cells show an important loss of myofibrils, a proliferation of sarcoplasmic reticulum in myofibril free spaces, or necrosis with macrophagic resorption. Focal changes with loss of myofilaments, Z material streaming and concentric lamellar bodies are found in moderately degenerate cardiac muscle cells. The remaining papillary muscle cells and the atrial cells are all hypertrophied without degeneration. These changes suggest that focal myocardial fibrosis and associated cardiac muscle cell degeneration may be responsible for impaired cardiac performance in some patients with S.L.E. According to the constant topographic relation between the narrowed vessels whose endothelial cells contain T.R.S. and the surrounding fibrous foci, we believe that the myocardial fibrous patches may correspond to scarring of microinfarcts related to active S.L.E. vascularitis.

Aortic Valve↗
PubMed2004

[Spanish Registry of Heart Transplantation. 15th Official Report of the Working Group on Heart Failure, Heart Transplantation and Other Therapeutic Alternatives of the Spanish Society of Cardiology (1984-2003)].

This paper outlines the general characteristics and results obtained with heart transplantation in Spain after including the data for the year 2003. In 2003, 290 heart transplants were performed. Since 1984, a total of 4386 procedures have been performed. The average clinical profile of patients receiving a heart transplant in Spain is that of a man about 50 years old, blood group A, with nonrevascularizable coronary artery disease and functional status IV/IV (NYHA). The percentage of emergency heart transplantations was 29%, which is higher than in the previous year (26%) and the mean for the preceding 5 years (20%). The early mortality rate was 13%, which is similar to the mean for the preceding 5 years (13%). After combining the 2003 results with those of the previous years, the probability of survival at 1, 5 and 10 years was 76%, 66% and 54%, respectively. When survival rates for separate periods were considered, a significant improvement was seen in the last 5 years, with survival rates at of 81% at 1 year and 74% at 5 years. The most frequent causes of death were acute graft failure in the first month, infection and rejection in the first year, and a combination of vascular disease of the graft with sudden death in the long term. Comparative analysis of survival rates shows that our long-term results are slightly better than those published in the literature, with a gradual tendency for survival rate to improve in recent years.

Adolescent↗
PubMed2003

[Spanish Registry on Heart Transplantation. 14th official report of the working group on heart failure, heart transplantation and other therapeutic alternative of the Spanish Society of Cardiology (1984-2002)].

This report describes the general characteristics and outcomes of heart transplantation in Spain after data from 2002 were added to the registry. In 2002, 310 heart transplantations were performed. Since 1984, a total of 4,096 procedures have been performed. The average clinical profile of patients receiving a heart transplant in Spain is that of a man about 50 years old, blood group A, with nonrevascularizable coronary artery disease and functional status IV/IV (NYHA). The percentage of emergency heart transplantations was 26%, which is higher than the previous year (19%) and the mean for the preceding five years (22%). The early mortality rate was 10%, which is significantly lower than the mean for the preceding five years (14%). After combining the 2002 results with those of previous years, an increase in survival rate was seen. Thus, the probability of survival in the first, fifth and tenth years was 76%, 66%, and 54%, respectively. When survival rates for separate periods were considered, a clear improvement was seen from the first year (80%) to the fifth year (72%). The most frequent causes of death were acute graft failure in the first month, infection and rejection in the first year, and tumors and the combination of vascular disease of the graft with sudden death in the long term. Comparative analysis of survival rates shows that our long-term results are slightly better than those published worldwide, with a clear tendency for survival rate to improve as a consequence of the experience acquired in all stages of this cross-disciplinary procedure.

Heart Failure↗
PubMed1979

Postpartum cardiac failure--heart failure due to volume overload?

Ventricular function has been studied in 43 patients with the peripartum cardiac failure (PPCF) syndrome which occurs around Zaria. All patients had an echocardiogram on admission and 10 patients had right heart catheterization. Despite the gross edema, left ventricular function assessed by echocardiography and systolic time intervals was relatively good and the estimated cardiac output were high. At catheterization, although the pressures were high, the cardiac outputs were greater than normal in four out of six patients. No patient had a low cardiac output. These findings are not compatible with a severe heart muscle disorder, or cardiomyopathy. We suggest that the primary event in PPCF of Zaria is fluid retention which leads to a form of high output cardiac failure. The postpartum practices in this area (taking high sodium diets and lying on heated beds) almost certainly cause the fluid to accumulate initially, but the heart may be unable to meet the demands either because of preexisting heart muscle disease or, more likely, because of a rise of the peripheral resistance due to the volume expansion, overburdens such dilated hearts and leads to myocardial damage. Since there are similarities between this condition and PPCF in temperate climates, it is possible that there is a common mechanism which the traditional practices of this area have unveiled.

Adolescent↗
PubMed2005

[Spanish Heart Transplantation Registry. 16th official report of the Spanish Society of Cardiology Working Group on Heart Failure, Heart Transplantation, and Associated Therapies].

This paper describes the general situation regarding heart transplantation in Spain and the results obtained using the technique, incorporating data for the year 2004. In 2004, 294 heart transplants were carried out, which brings the total number of procedures performed since 1984 to 4680. Clinically, the typical heart transplant recipient in Spain is male, aged around 50 years, has blood group A, has non-revascularizable coronary artery disease, and is in NYHA functional class IV/IV. The percentage of emergency heart transplantations was 35%, which is higher than in the previous year (29%), and higher than the mean for the preceding 5 years (22%). The early mortality rate was 10%, which is lower that the mean for the preceding 5 years (13%). After combining the results for 2004 with those of previous years, the probability of survival at 1, 5 and 10 years was 80%, 70% and 60%, respectively. When the survival rates for different time periods were analyzed, a significant improvement could be seen in the last 5 years, with recent survival rates being 85% and 72% at 1 and 5 years, respectively. The most frequent cause of death in the first month was acute graft failure; in the first year, infection and rejection; and, over the long term, tumors and a combination of graft vasculopathy and sudden death. A comparative analysis of survival rates showed that long-term results in Spain are slightly better than those published in the world literature. Moreover, survival has tended to improve gradually in recent years.

Adolescent↗
PubMedDate not supplied

A study of the efficacy and safety of irbesartan in combination with conventional therapy, including ACE inhibitors, in heart failure. Irbesartan Heart Failure Group.

Because heart failure therapy with angiotensin-converting enzyme (ACE) inhibitors may not be optimal, owing to persistent levels of angiotensin II occurring through incomplete blockade and alternate pathways, the benefit of adding irbesartan, an angiotensin receptor antagonist, to conventional therapy, including ACE inhibitors, was examined. In this multicentre, randomised, double-blind, placebo-controlled study, 109 patients with heart failure (New York Heart Association functional class II and III) and left ventricular ejection fraction (LVEF) < or = 40% received stable doses of ACE inhibitors and diuretics before and throughout the study. Irbesartan was titrated as tolerated to 150 mg once daily in all patients. Exercise tolerance time (ETT), LVEF and clinical status were assessed at baseline and after 12 weeks. Compared with placebo, irbesartan in combination with conventional therapy, including ACE inhibitors, produced favourable trends in ETT and LVEF and was well tolerated in patients with mild to moderate heart failure.

Adult↗
PubMed2004

Implementation of guidelines for management of heart failure in heart failure clinic: effects beyond pharmacological treatment.

BACKGROUND: Patients with heart failure have scarce knowledge of their condition and frequently report poor quality of life. In spite of numerous studies showing improvement of survival and reduction in hospitalizations, several epidemiological studies showed that substantial proportion of patients are not receiving appropriate treatment. Intensive multidisciplinary approach can improve management of the patients with heart failure. AIM: To assess the efficacy of intensive patient management in heart failure clinic with respect to patient knowledge, pharmacological management, and quality of life. METHODS: From outpatients, visiting the heart failure clinic in period form March 2002 to March 2003, we prospectively enrolled patients with heart failure due to systolic dysfunction. Patient knowledge about their condition was assessed by a knowledge questionnaire. Data on their clinical characteristics, diagnostic and pharmacological management were analyzed. Quality of life was assessed with Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients rated their quality of life and heath on a seven-category descriptive scale from 1 (best) to 7 (worst). Data are shown as mean (S.D.). RESULTS: In this period we treated 50 patients (33 men), aged 67 (12) years. Patient knowledge about their condition improved after two visits to heart failure clinic (4.8 (1.5) vs. 7.3 (1.4), p<0.001). More patients were treated with beta blockers (40% vs. 84%, p<0.001) while there was a positive trend for treatment with angiotensin-converting enzyme inhibitors (94% vs. 98%) and spironolactone (54% vs. 70%). Equivalent mean daily dose of enalapril (11.0 (11.0) mg to 16.7 (8.7) mg, p<0.001) and carvedilol (13.0 (11.5) mg to 32.1 (18.2) mg, p<0.001) increased. Out-patient management was associated with improvement of MLHFQ score (47 (18) vs. 34 (16)), NYHA class (2.9 (0.4) vs. 2.5 (0.7)), quality of life score (5.3 (1.1) vs. 3.7 (1.0)), and health score (5.1 (1.1) vs. 3.7 (1.1)) (p<0.001 for all). CONCLUSIONS: Intensive management in heart failure clinic can be effective for translation of guidelines into clinical practice. It also improves patient's knowledge and quality of life as well as reduces the hospitalizations in heart failure patients.

Aged↗
PubMed2002

"Diastolic heart failure" or heart failure caused by subtle left ventricular systolic dysfunction?

OBJECTIVES: To determine whether patients with suspected heart failure but preserved systolic function, as determined by conventional echocardiographic measures (often said to have "diastolic heart failure), might have subtle left ventricular systolic dysfunction detectable by a new measure of left ventricular systolic function-left ventricular systolic atrioventricular plane displacement. DESIGN: Observational study. SETTING: Direct access echocardiography. PATIENTS: 147 patients with suspected heart failure referred by general practitioners. MEASUREMENTS: Echocardiographic assessment of conventional measures of left ventricular systolic function (fractional shortening, ejection fraction (by Simpson's biplane method) and "eyeball" assessment) and measurement of left ventricular systolic atrioventricular plane displacement. RESULTS: Between 21% and 33% of patients with "normal" left ventricular systolic function by conventional methods were found to have abnormal left ventricular systolic atrioventricular plane displacement. CONCLUSIONS: Approximately one quarter of patients with suspected heart failure but preserved systolic function by conventional methods have abnormal atrioventricular plane displacement. These patients with suspected heart failure but preserved systolic function by conventional echocardiographic measures may have heart failure caused by subtle systolic dysfunction rather than isolated "diastolic heart failure".

Aged↗