Congestive heart failure (Greenwich, Conn.)最新文献

{"title":"Loop Diuretic Absorption","authors":"James Blake MD,&nbsp;Richard B. Devereux MD","doi":"10.1111/j.1527-5299.2000.80063.x","DOIUrl":"https://doi.org/10.1111/j.1527-5299.2000.80063.x","url":null,"abstract":"<p><i>Objectives. The present study was undertaken to determine if direct blockade of angiotensin II receptors by losartan potassium as compared to ACE inhibition might result in greater tolerability in patients with congestive heart failure in whom ACE inhibition resulted in hyperkalemia and azotemia.</i></p><p><i>Background. Blockade of angiotensin II receptors by losartan potassium may produce similar benefits in congestive heart failure as ACE inhibition. However, some observations suggest losartan potassium may have different effects on renal function than ACE inhibition.</i></p><p><i>Methods. Five consecutive patients with severe congestive heart failure were identified in whom treatment with ACE inhibition was complicated by hyperkalemia (K&gt;5.7) and azotemia. In three of these patients losartan potassium was substituted for ACE inhibition while losartan potassium was added to treatment with ACE inhibition in the remaining two. The mean of four serial values of potassium, blood urea nitrogen, and creatinine were compared before and after change in treatment using a two tailed t test.</i></p><p><i>Results. The addition or substitution of losartan potassium resulted in statistically insignificant reductions in blood urea nitrogen and creatinine and a significant reduction in potassium from 5.7±0.1 to 4.9±0.3, p&lt;0.03. Two patients who had required kayexalate were withdrawn. In all patients, hyperkalemia resolved and did not reoccur.</i></p><p><i>Conclusions. There appear to be fundamental differences between the effects of losartan potassium and ACE inhibitors on potassium excretion in congestive heart failure patients with mild to moderate renal insufficiency. Losartan potassium may also be associated with less azotemia in such patients. These differences may have important clinical implications, particularly in the subset of patients in whom ACE inhibition is poorly tolerated as a result of hyperkalemia and azotemia.</i></p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"6 4","pages":"198-201"},"PeriodicalIF":0.0,"publicationDate":"2013-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1527-5299.2000.80063.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71979233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CHF Reader Notification of Cessation","authors":"","doi":"10.1111/chf.12041","DOIUrl":"10.1111/chf.12041","url":null,"abstract":"","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"157"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31629071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preload Reserve Is Restored in Patients With Decompensated Chronic Heart Failure Who Respond to Treatment","authors":"Pierre Squara MD,&nbsp;Philippe Estagnasie MD,&nbsp;Olivier Belliard MD,&nbsp;Fabien Squara MD,&nbsp;Jean Claude Dib MD","doi":"10.1111/chf.12033","DOIUrl":"10.1111/chf.12033","url":null,"abstract":"<div>\u0000 <p>The authors designed this prospective study to show the relationship between preload reserve and treatment effectiveness of chronic heart failure (CHF). Fifty patients, aged 77±24 years, with decompensated CHF (B-type brain natriuretic peptide [BNP] &gt;1000 pg/mL) were included. Preload reserve was assessed by the changes in contraction indices during a passive leg raise (PLR). Contraction indices were assessed noninvasively using Bioreactance technology. After 4 days of optimized therapy, the same variables were reassessed and treatment-induced differences were calculated. Treatment effectiveness was assessed by the 4-day changes in BNP, body weight, and thoracic fluid content. The authors then compared treatment-induced changes in preload reserve with treatment effectiveness. Therapy was associated with an overall decrease in heart rate, blood pressure, and cardiac power index (CPi) and with an increase in all preload reserve indices. Treatment effectiveness correlated well with changes in preload reserve. The best correlation was found between treatment-induced changes in BNP and in PLR-induced changes of CPi (<i>R</i>=0.63, <i>P</i>&lt;.001). The PLR-induced changes in CPi increased from 21±48 to 51±48 in BNP responders and decreased from 34±34 to 5±19 mW/m² in BNP nonresponders (<i>P</i>&lt;.0001). Hence, effective treatment, as indexed by a decrease in BNP, restores the preload reserve in patients with decompensated CHF.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"207-213"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31269747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thiamine Supplementation for the Treatment of Heart Failure: A Review of the Literature","authors":"James J. DiNicolantonio PharmD,&nbsp;Asfandyar K. Niazi,&nbsp;Carl J. Lavie MD,&nbsp;James H. O'Keefe MD,&nbsp;Hector O. Ventura MD","doi":"10.1111/chf.12037","DOIUrl":"10.1111/chf.12037","url":null,"abstract":"<div>\u0000 <p>A systematic review of the literature was performed by searching Pubmed and EMBASE databases using the terms “thiamine,” “vitamin B1,” “heart failure,” “systolic dysfunction,” “ventricular dysfunction,” “cardiomyopathy,” “ventricular failure,” and “systolic failure.” Relevant trials and articles were evaluated pertaining to thiamine deficiency in patients with heart failure (HF) and references were searched for further inclusion of articles. A total of 20 articles were reviewed and summarized in detail. While more research is needed to fully elucidate the clinical thiamine deficiency in HF patients, recent evidence has indicated that supplementing with thiamine in HF patients has the potential to improve left ventricular ejection fraction. Thiamine deficiency appears to be not uncommon in patients with HF, and supplementation with thiamine has been shown to improve cardiac function, urine output, weight loss, and signs and symptoms of HF. Therefore, this simple therapy should be tested in large-scale randomized clinical trial to further determine the effects of thiamine in HF patients.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"214-222"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31269748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased Readmissions and Improved Quality of Care With the Use of an Inexpensive Checklist in Heart Failure","authors":"Abhijeet Basoor MD,&nbsp;Nitin C. Doshi MD,&nbsp;John F. Cotant MD,&nbsp;Tarek Saleh MD,&nbsp;Mina Todorov MD,&nbsp;Nishit Choksi MD,&nbsp;Kiritkumar C. Patel MD,&nbsp;Michele DeGregorio MD,&nbsp;Rajendra H. Mehta MD, MS,&nbsp;Abdul R. Halabi MD","doi":"10.1111/chf.12031","DOIUrl":"10.1111/chf.12031","url":null,"abstract":"<div>\u0000 <p>Providing effective discharge instructions, appropriate dose uptitration, education regarding heart failure (HF) monitoring, and strict follow-up have all been shown to decrease readmissions for HF but are all underutilized. The authors developed and evaluated the impact of a quality-improvement HF checklist as a tool to remind physicians to improve quality of care in HF patients. The checklist was used in randomly selected patients admitted with a primary diagnosis of acute decompensated HF. It included documentation regarding medications and dose uptitration, relevant counseling, and follow-up instructions at discharge. The checklist was used in 48 patients, and this checklist group was compared with 48 patients as a randomly selected control group. Higher proportions of patients were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in the checklist group compared with the control group (40 of 48 vs 23 of 48, <i>P</i>&lt;.001). Compared with the controls, the rate of dose uptitration for β-blockers and/or ACE inhibitors/ARBs was more common in the checklist group (4 of 48 vs 21 of 48, <i>P</i>&lt;.001). Both 30-day (19% to 6%) and 6-month (42% to 23%) readmissions were lower in the checklist group. The use of an HF checklist was associated with better quality of care and decreased readmission rates for patients admitted with HF.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"200-206"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31269745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Cystatin C as a Biomarker of Cardiac Diastolic Dysfunction in Patients With Cardiac Disease and Preserved Ejection Fraction","authors":"Kazumasa Nosaka MD,&nbsp;Kazufumi Nakamura MD, PhD,&nbsp;Kengo Kusano MD, PhD,&nbsp;Norihisa Toh MD, PhD,&nbsp;Takeshi Tada MD, PhD,&nbsp;Toru Miyoshi MD, PhD,&nbsp;Masayuki Doi MD, PhD,&nbsp;Kunihisa Kohno MD, PhD,&nbsp;Hiroshi Morita MD, PhD,&nbsp;Hiroshi Ito MD, PhD","doi":"10.1111/chf.12039","DOIUrl":"10.1111/chf.12039","url":null,"abstract":"<div>\u0000 <p>Diastolic dysfunction of the heart is correlated with cardiac mortality. Serum cystatin C (CysC) is an endogenous marker of kidney function. It is not clear whether serum CysC is associated with diastolic dysfunction in patients with varying cardiac conditions with concomitant diastolic abnormalities and preserved ejection fraction (EF). The authors measured serum CysC levels in patients with cardiac diseases and examined the relationships between serum CysC levels and diastolic function. Serum CysC was measured and echocardiography was performed in 124 consecutive patients with cardiac diseases. Transmitral flow (TMF) patterns surrogating diastolic function were categorized into two groups: a normal group and an abnormal group. Serum CysC and BNP showed a significant positive correlation. There were no significant differences in serum CysC among those cardiac diseases. Seventy-eight patients with cardiac disease and preserved EF (left ventricular EF ≥50%) and without renal dysfunction (estimated glomerular filtration rate ≥60 mL/minute/1.73 m²) were examined. Multivariate linear regression analysis demonstrated that left atrium diameter and abnormal TMF patterns were independent determinants of serum CysC. Furthermore, patients with elevated serum CysC levels had poor prognosis. Serum CysC is associated with diastolic dysfunction in patients with various cardiac diseases and preserved EF. Serum CysC might be a biomarker of cardiac diastolic dysfunction in patients with preserved EF.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"E35-E39"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31271877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing the Weight of Evidence on the Obesity Paradox and Heart Failure—Is There a Limit to the Madness?","authors":"Carl J. Lavie MD,&nbsp;Hector O. Ventura MD","doi":"10.1111/chf.12040","DOIUrl":"10.1111/chf.12040","url":null,"abstract":"<p>Since overweightness and obesity have adverse effects on cardiac structure and systolic and especially diastolic left ventricular (LV) function, as well as on cardiovascular (CV) diseases, including coronary heart disease (CHD) and hypertension (HTN), which are the leading causes of heart failure (HF), it really is no surprise that the prevalence of HF markedly increases with increasing severity of obesity.<span>2</span> In a study of 5881 Framingham Heart Study participants, Kenchaiah and colleagues<span>3</span> demonstrated that for every 1-kg/m² increase in body mass index (BMI), the risk of HF increases by 5% in men and 7% in women during a 14-year follow-up, with graded increases in the risk of HF across the entire spectrum of BMI. In addition, in a study by Alpert and colleagues<span>4</span> of 74 morbidly obese patients, nearly one third had clinical evidence of HF, and the prevalence of HF increased dramatically with the increasing duration of morbid obesity.</p><p>Despite this evidence, numerous large studies<span>5, 6</span> and meta-analyses<span>7</span> have demonstrated an obesity paradox in HF, ie, overweight and obese patients with HF have a better prognosis than do their leaner counterparts, with overall similar HF severity at baseline. More than a decade ago, we demonstrated this paradox with both BMI and percentage of body fat (BF); thus, in our study, for every 1% increase in BF there was a 13% reduction in major CV events.<span>8, 9</span></p><p>The mechanisms of the obesity paradox in HF remain unclear, and we have recently discussed the potential reasons for this puzzling paradox.<span>2</span> Certainly, very few studies of the obesity paradox in HF have addressed the potential role of nonpurposeful weight loss prior to study entry, and in almost every condition, including HF, nonpurposeful weight loss, especially with cachexia, is associated with a poor prognosis. Many overweight and obese patients may have developed HF secondary to HTN and CHD and as a result of the abnormalities in left ventricular diastolic and systolic function that often develops in these patients. Conversely, lean patients who develop HF do so from other mechanisms that may result in a more negative prognosis. Obese patients present with HF at younger ages, have a higher LV ejection fraction (EF) and higher blood pressure, thus allowing obese patients to tolerate more cardioprotective medications and at higher doses and to have a lower expression of brain natriuretic peptides. All these factors and others may lead to an earlier presentation with less severe disease, which could lead to a better prognosis in obese patients with HF compared with lean patients.</p><p>In the present and final issue of <i>Congestive Heart Failure</i>, Nagarajan and colleagues<span>10</span> from the Cleveland Clinic HF program confirmed the obesity paradox in 501 patients in an advanced HF clinic, but their data suggest that there may be a “limit to this ","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"158-159"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31629072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis of Morbid Obesity Patients With Advanced Heart Failure","authors":"Vijaiganesh Nagarajan MD MRCP,&nbsp;Clay A. Cauthen MD,&nbsp;Randall C. Starling MD MPH,&nbsp;Wai Hong Wilson Tang MD","doi":"10.1111/chf.12038","DOIUrl":"10.1111/chf.12038","url":null,"abstract":"<div>\u0000 <p>Obese patients have been noted to have better prognosis in many conditions including heart failure. We hypothesize that this favorable prognosis for obesity may not be seen in patients with morbid obesity and advanced heart failure. A total of 501 consecutive patients with advanced heart failure referred for heart transplant evaluation to the Cleveland Clinic were studied. Patients were categorized into 3 groups based on their body mass index score as nonobese (≤30 kg/m²), obese (30.1–40 kg/m²), and morbidly obese (≥40 kg/m²). There were fewer cardiovascular risk factors in the morbidly obese group. Unadjusted event-free survival rates were 48.4%, 57.4%, and 28.6% in the nonobese, obese, and morbidly obese groups, respectively (<i>P</i>=.02). In univariate analysis, both the nonobese group (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.09–1.91; <i>P</i>=.01) and the morbidly obese group (HR, 2.46; 95% CI, 1.40–4.30; <i>P</i>=.002) had significantly higher risk of all-cause mortality/transplantation compared with the obese group. This difference persisted in multivariate analysis after adjustment for confounding factors. Our study re-emphasizes the presence of an obesity paradox even in patients with very advanced heart failure. This favorable prognosis, however, may not be relevant in patients with morbidly obesity. Cardiovascular risk factors may not contribute to this phenomenon</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"160-164"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31269750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter Ablation of Atrial Flutter in Patients With Left Ventricular Assist Device Improves Symptoms of Right Heart Failure","authors":"Rashmi U. Hottigoudar MD,&nbsp;Allen G. Deam MD,&nbsp;Emma J. Birks MD, PhD,&nbsp;Kelly C. McCants MD,&nbsp;Mark S. Slaughter MD,&nbsp;Rakesh Gopinathannair MD, MA","doi":"10.1111/chf.12034","DOIUrl":"10.1111/chf.12034","url":null,"abstract":"<div>\u0000 <p>Persistent atrial flutter (AFL) in left ventricular assist device (LVAD) recipients can result in loss of AV synchrony, impaired ventricular filling and right heart failure (RHF). The authors report the largest series of HeartMate II (HMII) patients who developed AFL with decompensated RHF, which successfully resolved with AFL ablation. Eight patients with HMII LVAD (mean age, 57±12 years) had medically refractory AFL, with 7 developing de novo AFL after LVAD implant (onset range, 2 days–22 months post-implant). Three patients developed recurrent syncope, 2 had inappropriate implantable cardioverter-defibrillator shocks, and 6 had new or escalating need for inotropes. All had features of decompensated RHF. Seven patients underwent electrophysiology testing where mapping confirmed typical counterclockwise AFL (mean AFL cycle length, 252±49 ms) and radiofrequency ablation of cavotricuspid isthmus restored sinus rhythm in all patients. Complete resolution of symptoms and signs of RHF with improved quality of life were noted in all. No procedural complications were noted. During a mean follow-up of 9±5 months, all patients remained free of atrial flutter. Catheter ablation of AFL in LVAD patients is safe and highly effective, resulting in immediate and significant improvement in symptoms of RHF, and should be considered first-line therapy for AFL in these patients.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"165-171"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31629073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uremic Cardiomyopathy: An Underdiagnosed Disease","authors":"Eyad Alhaj MD, MPH,&nbsp;Nehad Alhaj MD,&nbsp;Ifad Rahman MD,&nbsp;Tariq O. Niazi MD,&nbsp;Robert Berkowitz MD, PhD,&nbsp;Marc Klapholz MD","doi":"10.1111/chf.12030","DOIUrl":"10.1111/chf.12030","url":null,"abstract":"<div>\u0000 <p>Uremic cardiomyopathy is responsible for high morbidity and mortality rates among patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD); however, the early implementation of hemodialysis may halt its progression. Nonconventional hemodialysis, such as frequent hemodialysis, appears to have an advantage over conventional hemodialysis. Kidney transplantation has been shown to reverse uremic cardiomyopathy and to confer a significant survival advantage over hemodialysis. Targeting future therapies at the underlying cellular mechanisms of uremic cardiomyopathy may finally start to reduce the burden of uremic cardiomyopathy in the CKD and ESRD population.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"E40-E45"},"PeriodicalIF":0.0,"publicationDate":"2013-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31382253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}