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Advanced heart failure

Srinivas Murali
No abstract text is available yet for this article.
July 2018: Critical Care Clinics
James H Tabibian, Daniel P Rhoades, Kimberly A Forde, Rhondalyn C McLean, Vinay Chandrasekhara
BACKGROUND & AIMS: Continuous-flow left ventricular assist devices (LVADs) for advanced heart failure have been associated with gastrointestinal bleeding (GIB). We examined the association between time of GIB after LVAD implantation and bleeding location (determined by endoscopy), etiology, and patient outcomes. METHODS: We performed a retrospective study of consecutive patients who underwent implantation of continuous-flow LVADs from 2008 through 2015. We analyzed data on anatomic location of GIB, etiology, length of hospital stay, transfusion requirement, time to endoscopy, and rate of readmission within 30 days...
June 12, 2018: Clinical Gastroenterology and Hepatology
Sarah Streeter Hutcheson, Victoria Phillips, Rachel Patzer, Andrew Smith, J David Vega, Alanna A Morris
BACKGROUND: Medicaid insurance in Georgia provides limited reimbursement for heart transplant (HT) and left ventricular assist devices (LVAD). We examined whether insurance type affects eligibility for and survival after receipt of HT or LVAD. METHODS AND RESULTS: We retrospectively identified patients evaluated for HT/LVAD from 2012 to 2016. We used multivariable logistic and Cox proportional hazards regression to examine the association of insurance type on treatment eligibility and one year survival...
June 15, 2018: Clinical Transplantation
Bruce G Lindsey, Sarah C Nuding, Lauren S Segers, Kendall F Morris
Advances in our understanding of brain mechanisms for the hypoxic ventilatory response, coordinated changes in blood pressure, and the long-term consequences of chronic intermittent hypoxia as in sleep apnea, such as hypertension and heart failure, are giving impetus to the search for therapies to "erase" dysfunctional memories distributed in the carotid bodies and central nervous system. We review current network models, open questions, sex differences, and implications for translational research...
July 1, 2018: Physiology
Kevin L Sack, Eric Aliotta, Daniel B Ennis, Jenny S Choy, Ghassan S Kassab, Julius M Guccione, Thomas Franz
Predictive computational modeling has revolutionized classical engineering disciplines and is in the process of transforming cardiovascular research. This is particularly relevant for investigating emergent therapies for heart failure, which remains a leading cause of death globally. The creation of subject-specific biventricular computational cardiac models has been a long-term endeavor within the biomedical engineering community. Using high resolution (0.3 × 0.3 × 0.8 mm) ex vivo data, we constructed a precise fully subject-specific biventricular finite-element model of healthy and failing swine hearts...
2018: Frontiers in Physiology
Ahmed M Selim, Lalit Wadhwani, Adam Burdorf, Eugenia Raichlin, Brian Lowes, Ronald Zolty
BACKGROUND: Pulmonary hypertension secondary to left heart disease (WHO Group 2) is a known risk factor in patients with heart failure. The favourable effect of left ventricular assist devices (LVAD) on pulmonary hypertension has been demonstrated before, although this effect has not been well-studied in advanced pulmonary arterial bed disease with a significant elevation in pulmonary vascular resistance. METHODS: We reviewed the records of 258 LVAD patients in our institution...
May 18, 2018: Heart, Lung & Circulation
Peter Magnusson, Fredrik Gadler, Stellan Mörner
Hypertrophic cardiomyopathy is the most common cardiogenetic disease affecting 1/500-1/1 000 individuals. Dyspnea is common but chest pain, dizziness or fainting may also cause considerable limitation for the patient. The diagnosis can be suspected from ECG. Echocardiography confirms hypertrophy of at least 15 mm, usually in the septum. If the obstruction of the outflow tract is severe, myectomy or alcohol ablation can relieve symptoms. Genetic evaluation of family members is advisable. To reduce symptoms, betablockers are used; verapamil or disopyramide are alternatives...
June 11, 2018: Läkartidningen
Ester Herrmann, Andreas Ecke, Eva Herrmann, Nina Eissing, Stephan Fichtlscherer, Andreas M Zeiher, Birgit Assmus
AIM: Patients with advanced systolic chronic heart failure frequently suffer from progressive functional mitral regurgitation. We report our initial experience in patients with an implanted pulmonary artery pressure (PAP) sensor, who developed severe mitral regurgitation, which was treated with the MitraClip system. We non-invasively compared changes in PAP values in patients after MitraClip with PAP changes in patients without MitraClip. METHODS AND RESULTS: Among 28 patients with New York Heart Association III heart failure with implanted PAP sensor for haemodynamic telemonitoring from a single centre, four patients (age 66 ± 6 years, left ventricular ejection fraction 21 ± 3%, and cardiac index 1...
June 12, 2018: ESC Heart Failure
Frederik Beckhoff, Brunilda Alushi, Christian Jung, Eliano Navarese, Marcus Franz, Daniel Kretzschmar, Bernhard Wernly, Michael Lichtenauer, Alexander Lauten
Severe tricuspid regurgitation (TR) is a complex condition of the right ventricle (RV) and tricuspid valve apparatus and is frequently associated with symptomatic heart failure and a significant morbidity and mortality. In these patients, left heart pathologies lead to chronic pressure overload of the RV, eventually causing progressive RV dilatation and functional TR. Therefore, TR cannot be considered as isolated heart valve disease pathology but has to be understood and treated as one component of a complex structural RV pathology and is frequently also a marker of an advanced stage of cardiac disease...
2018: Frontiers in Cardiovascular Medicine
Syed Yaseen Naqvi, Ibrahim G Salama, Ayhan Yoruk, Leway Chen
Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery...
May 2018: Cardiac Failure Review
Bradley S Fleenor, An Ouyang, T Dylan Olver, Jessica A Hiemstra, Melissa S Cobb, Gianmaria Minervini, Craig A Emter
Increased peripheral conduit artery stiffness has been shown in patients with heart failure (HF) with preserved ejection fraction. However, it is unknown whether this phenomenon extends to the coronary vasculature. HF with preserved ejection fraction may be driven, in part, by coronary inflammation, and inhibition of the enzyme DPP-4 (dipeptidyl-peptidase 4) reduces inflammation and oxidative stress. The purpose of this study was to determine the effect of saxagliptin-a DPP-4 inhibitor-on coronary stiffness in aortic-banded mini swine...
June 11, 2018: Hypertension
Kieran F Docherty, John J V McMurray
Despite significant advances in the last 30 years in reducing morbidity and mortality from heart failure with reduced ejection fraction (HFrEF) with pharmacological and device-based therapies, patients remain at a high risk of adverse cardiovascular outcomes. Sacubitril/valsartan, a first-in-class angiotensin receptor-neprilysin inhibitors (ARNI), has been shown to reduce the risk of cardiovascular death or heart failure hospitalisation and improve symptoms in patients with chronic, ambulatory, symptomatic HFrEF in a large, phase 3, multicentre, international, randomised controlled trial, PARADIGM-HF, when compared to the gold-standard angiotensin converting enzyme inhibitor, enalapril...
June 2, 2018: International Journal of Cardiology
Heide A Stirnadel-Farrant, Jiacong Luo, Lata Kler, Borut Cizman, Delyth Jones, Steven M Brunelli, Alexander R Cobitz
BACKGROUND: A combination of safety concerns and labeling changes impacted use of erythropoiesis-stimulating agents (ESAs) in renal anemia. Data regarding contemporary utilization in pre-dialysis chronic kidney disease (CKD) are lacking. METHODS: Electronic healthcare records and medical claims data of pre-dialysis CKD patients were aggregated from a large US managed care provider (2011-13). ESA use patterns, characteristics, and outcomes of ESA-treated/untreated patients were quantified...
June 11, 2018: BMC Nephrology
Mehmet Akif Topcuoglu, Liping Liu, Dong-Eog Kim, M Edip Gurol
Cardiac embolism continues to be a leading etiology of ischemic strokes worldwide. Although pathologies that result in cardioembolism have not changed over the past decade, there have been significant advances in the treatment and stroke prevention methods for these conditions. Atrial fibrillation remains the prototypical cause of cardioembolic strokes. The availability of new long-term monitoring devices for atrial fibrillation detection such as insertable cardiac monitors has allowed accurate detection of this leading cause of cardioembolism...
May 2018: Journal of Stroke
Tobias Gessler
Pulmonary arterial hypertension (PAH) is a rare, but severe and life-threatening disease characterized by vasoconstriction and remodeling of the pulmonary arterioles, leading to progressive increase in pulmonary vascular resistance and ultimately to right-heart failure. In the last two decades, significant progress in treatment of PAH has been made, with currently 12 drugs approved for targeted therapy. Among these, the stable prostacyclin analogues iloprost and treprostinil have been repurposed for inhalation...
June 7, 2018: Advanced Drug Delivery Reviews
Jennifer T Thibodeau, Mark H Drazner
Despite advances in biomarkers and technology, the clinical examination (i.e., a history and physical examination) remains central in the management of patients with heart failure. Specifically, the clinical examination allows noninvasive assessment of the patient's underlying hemodynamic state, based on whether the patient has elevated ventricular filling pressures and/or an inadequate cardiac index. Such assessments provide important prognostic information and help guide therapeutic decision-making. Herein, we critically assess the utility of the clinical examination for these purposes and provide practical tips we have gleaned from our practice in the field of advanced heart failure...
May 31, 2018: JACC. Heart Failure
Anna Frey, Roxane Sell, György A Homola, Carolin Malsch, Peter Kraft, Ignaz Gunreben, Caroline Morbach, Bálint Alkonyi, Eric Schmid, Isabella Colonna, Edith Hofer, Wolfgang Müllges, Georg Ertl, Peter Heuschmann, László Solymosi, Reinhold Schmidt, Stefan Störk, Guido Stoll
OBJECTIVES: This study sought to determine the spectrum of brain lesions seen in heart failure (HF) patients and the extent to which lesion type contributes to cognitive impairment. BACKGROUND: Cognitive deficits have been reported in patients with HF. METHODS: A total of 148 systolic and diastolic HF patients (mean age 64 ± 11 years; 16% female; mean left ventricular ejection fraction 43 ± 8%) were extensively evaluated within 2 days by cardiological, neurological, and neuropsychological testing and brain magnetic resonance imaging (MRI)...
May 31, 2018: JACC. Heart Failure
Emmanuel E Egom, Vincent Maher, Yassine El Hiani
Pulmonary hypertension (PH) due to left ventricular heart failure (LV-HF) is a disabling and life-threatening disease for which there is currently no single marketed pharmacological agent approved. Despite recent advances in the pathophysiological understanding, there is as yet no prospect of cure, and the majority of patients continue to progress to right ventricular failure and die. There is, therefore an urgent unmet need to identify novel pharmacological agents that will prevent or reverse the increase in pulmonary artery pressures while enhancing cardiac performance in PH due to LV-HF...
June 2, 2018: International Journal of Cardiology
Kristin Watson, Rachael Broscious, Sandeep Devabhakthuni, Zachary R Noel
PURPOSE OF REVIEW: Hypertensive emergency is defined as a systolic blood pressure > 180 mmHg or a diastolic blood pressure > 120 mmHg with evidence of new or progressive end-organ damage. The purpose of this paper is to review advances in the treatment of hypertensive emergencies within the last 5 years. RECENT FINDINGS: New literature and recommendations for managing hypertensive emergencies in the setting of pregnancy, stroke, and heart failure have been published...
June 8, 2018: Current Hypertension Reports
Yuji Okura, Sumika Ishigaki, Satoko Sakakibara, Chika Yumoto, Mitsue Hashitate, Chika Sekine, Tomomi Fujita, Tsugumi Takayama, Kazuyuki Ozaki, Nobuaki Sato, Tohru Minamino
Aortic stenosis (AS) is a life-threatening comorbidity of cancer patients. Aortic valve replacement (AVR) should be considered for some cancer patients, but neither the characteristics nor prognosis under conservative therapy is well known.We searched our echocardiography log (years 2005-2014) for cancer patients with AS, and 92 patients (54% female) were included in the study. To compare the survival curves, 470 control patients without AS were selected from our cancer registry.Mean age (± SD) was 77.6 ± 6...
June 6, 2018: International Heart Journal
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