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inotropics in heart failure

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https://www.readbyqxmd.com/read/28817484/levosimendan-in-acute-and-advanced-heart-failure-an-appraisal-of-the-clinical-database-and-evaluation-of-its-therapeutic-applications
#1
J Altenberger, F Gustafsson, V-P Harjola, K Karason, D Kindgen-Milles, M Kivikko, G Malfatto, Z Papp, J Parissis, P Pollesello, G Pölzl, C Tschöpe
The use of inotropes for correcting haemodynamic dysfunction in patients with congestive heart failure has been described over many decades. However, negative or insufficient data have been collected regarding the effects of cardiac glycosides, catecholamines and phosphodiesterase inhibitors on quality of life and survival. More recently, the calcium sensitizer and potassium channel-opener levosimendan has been proposed as a safer inodilator than traditional agents in some heart failure settings, such as Advanced Heart Failure...
August 15, 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28794367/earlier-right-ventricular-pacing-in-cardiac-resynchronization-therapy-for-a-patient-with-right-axis-deviation
#2
Yusuke Hattori, Kohei Ishibashi, Takashi Noda, Hideo Okamura, Hideaki Kanzaki, Toshihisa Anzai, Satoshi Yasuda, Kengo Kusano
We describe the case of a 37-year-old woman who presented with complete right bundle branch block and right axis deviation. She was admitted to our hospital due to severe heart failure and was dependent on inotropic agents. Cardiac resynchronization therapy was initiated but did not improve her condition. After the optimization of the pacing timing, we performed earlier right ventricular pacing, which led to an improvement of her heart failure. Earlier right ventricular pacing should be considered in patients with complete right bundle branch block and right axis deviation when cardiac resynchronization therapy is not effective...
August 10, 2017: Internal Medicine
https://www.readbyqxmd.com/read/28782491/the-impact-of-cardiovascular-diseases-on-the-cardiovascular-regulation-during-exercise-in-humans-studies-on-the-metaboreflex-elicited-by-the-post-exercise-muscle-ischemia-method
#3
Antonio Crisafulli
Hemodynamics during dynamic exercise is finely regulated by some neural mechanisms. One of these mechanisms is the metabolic part of the exercise pressor reflex, i.e. the muscle metaboreflex. Hemodynamic response during the metaboreflex is characterised by the recruitment of the reserves in cardiac inotropism, pre-load, after-load and chronotropism. If one of these reserves is exhausted, then the cardiovascular response is achieved by recruiting one of the other reserves, thereby indicating a remarkable plasticity of the control of circulation...
August 4, 2017: Current Cardiology Reviews
https://www.readbyqxmd.com/read/28760938/vasorelaxation-to-the-nitroxyl-donor-isopropylamine-nonoate-in-resistance-arteries-does-not-require-perivascular-calcitonin-gene-related-peptide
#4
Alice M H Pinkney, Hamish A L Lemmey, Kim A Dora, Christopher J Garland
Nitroxyl (HNO) donors offer considerable therapeutic potential for the treatment of hypertension-related cardiovascular disorders, particularly heart failure, as they combine an inotropic action with peripheral vasodilation. Angeli's salt is the only HNO donor whose mechanism has been studied in depth, and recently, Angeli's salt vasodilation was suggested to be indirect and caused by calcitonin gene-related peptide (CGRP) released from perivascular nerves after HNO activates TRPA1 (transient receptor potential cation channel subfamily A member 1) channels...
July 31, 2017: Hypertension
https://www.readbyqxmd.com/read/28744974/obestatin-regulates-cardiovascular-function-and-promotes-cardioprotection-through-the-nitric-oxide-pathway
#5
Claudia Penna, Francesca Tullio, Saveria Femminò, Carmine Rocca, Tommaso Angelone, Maria C Cerra, Maria Pia Gallo, Iacopo Gesmundo, Alessandro Fanciulli, Maria Felice Brizzi, Pasquale Pagliaro, Giuseppe Alloatti, Riccarda Granata
Patients with ischaemic heart disease or chronic heart failure show altered levels of obestatin, suggesting a role for this peptide in human heart function. We have previously demonstrated that GH secretagogues and the ghrelin gene-derived peptides, including obestatin, exert cardiovascular effects by modulating cardiac inotropism and vascular tone, and reducing cell death and contractile dysfunction in hearts subjected to ischaemia/reperfusion (I/R), through the Akt/nitric oxide (NO) pathway. However, the mechanisms underlying the cardiac actions of obestatin remain largely unknown...
July 26, 2017: Journal of Cellular and Molecular Medicine
https://www.readbyqxmd.com/read/28689804/efficacy-and-safety-of-levosimendan-in-patients-with-acute-right-heart-failure-a-meta-analysis
#6
Jiayong Qiu, Lei Jia, Yingying Hao, Shenshen Huang, Yaqing Ma, Xiaofang Li, Min Wang, Yimin Mao
AIMS: Right heart failure (RHF), which is caused by a variety of heart and lung diseases, has a high morbidity and mortality rate. Levosimendan is a cardiac inotropic drug and vasodilator. The effect of levosimendan on RHF remains unclear. We sought to evaluate the efficacy and safety of levosimendan in patients with acute RHF. MATERIALS AND METHODS: We systematically searched PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov to identify studies reporting the efficacy and safety of levosimendan for the treatment of RHF...
September 1, 2017: Life Sciences
https://www.readbyqxmd.com/read/28677877/a-phase-2a-dose-escalation-study-of-the-safety-tolerability-pharmacokinetics-and-haemodynamic-effects-of-bms-986231-in-hospitalized-patients-with-heart-failure-with-reduced-ejection-fraction
#7
Cristina Tita, Edward M Gilbert, Adrian B Van Bakel, Jacek Grzybowski, Garrie J Haas, Mohammad Jarrah, Stephanie H Dunlap, Stephen S Gottlieb, Marc Klapholz, Parag C Patel, Roman Pfister, Tim Seidler, Keyur B Shah, Tomasz Zieliński, Robert P Venuti, Douglas Cowart, Shi Yin Foo, Alexander Vishnevsky, Veselin Mitrovic
AIMS: This study was designed to evaluate the safety, tolerability and haemodynamic effects of BMS-986231, a novel second-generation nitroxyl donor with potential inotropic, lusitropic and vasodilatory effects in patients hospitalized with decompensated heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: Forty-six patients hospitalized with decompensated HFrEF were enrolled into four sequential dose-escalation cohorts in this double-blind, randomized, placebo-controlled Phase 2a study...
July 5, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28665033/resveratrol-and-polydatin-as-modulators-of-ca-2-mobilization-in-the-cardiovascular-system
#8
REVIEW
Wenjuan Liu, Peiya Chen, Jianxin Deng, Jingzhang Lv, Jie Liu
In the cardiovascular system, Ca(2+) controls cardiac excitation-contraction coupling and vascular contraction and dilation. Disturbances in intracellular Ca(2+) homeostasis induce malfunctions of the cardiovascular system, including cardiac pump dysfunction, arrhythmia, remodeling, and apoptosis, as well as hypertension and impairment of vascular reactivity. Therefore, developing drugs and strategies manipulating Ca(2+) handling are highly valued in the treatment of cardiovascular disease. Resveratrol (Res) and polydatin (PD), a Res glucoside, have been well established to have beneficial effects on improving cardiovascular function...
June 30, 2017: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/28657248/dilated-cardiomyopathy-secondary-to-vitamin-d-deficiency-and-hypocalcaemia-in-the-irish-paediatric-population-a-case-report
#9
S Glackin, P Mayne, D Kenny, C J McMahon, D Cody
We identified three infants with dilated cardiomyopathy (DCM) secondary to severe vitamin D deficieny and hypocalcaemia. All infants were exclusively breast fed, from dark skinned ethnic backgrounds, born and living in Ireland. None of these pregnant mothers or infants received the recommended vitamin D supplementation. Each infant presented in heart failure and required inotropic support as well as calcium and vitamin D replacement. Cardiac function subsequently improved. This highlights the public health issue that many high risk pregnant mothers and infants are not receiving the recommended vitamin D supplementation...
March 10, 2017: Irish Medical Journal
https://www.readbyqxmd.com/read/28655414/heart-and-heart-liver-transplantation-in-patients-with-hemochromatosis
#10
Monique R Robinson, Sadeer G Al-Kindi, Guilherme H Oliveira
BACKGROUND: Hemochromatosis predisposes to dilated or restrictive cardiomyopathy which can progress to end-stage heart failure, requiring the use of advanced heart therapies including heart (HT) and heart liver (HLT) transplantation. Little is known about the characteristics and outcomes of these patients. METHODS AND RESULTS: We queried the United Network for Organ Sharing (UNOS) registry for all patients listed for HT or HLT for a diagnosis of 'hemochromatosis' between 1987 and 2014...
June 21, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28645834/left-ventricular-assist-device-therapy-for-destination-therapy-is-less-invasive-surgery-a-safe-alternative
#11
Sebastian V Rojas, Jasmin S Hanke, Murat Avsar, Philipp R Ahrens, Ove Deutschmann, Kirstin A Tümler, Aitor Uribarri, Sara Rojas-Hernández, Pedro L Sánchez, José M González-Santos, Axel Haverich, Jan D Schmitto
INTRODUCTION AND OBJECTIVES: The number of older patients with congestive heart failure has dramatically increased. Because of stagnating cardiac transplantation, there is a need for an alternative therapy, which would solve the problem of insufficient donor organ supply. Left ventricular assist devices (LVADs) have recently become more commonly used as destination therapy (DT). Assuming that older patients show a higher risk-profile for LVAD surgery, it is expected that the increasing use of less invasive surgery (LIS) LVAD implantation will improve postoperative outcomes...
June 20, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28633534/neuromuscular-electrical-stimulation-improves-exercise-tolerance-in-patients-with-advanced-heart-failure-on-continuous-intravenous-inotropic-support-use-randomized-controlled-trial
#12
Patrícia Forestieri, Douglas W Bolzan, Vinícius B Santos, Rita Simone Lopes Moreira, Dirceu Rodrigues de Almeida, Renata Trimer, Flávio de Souza Brito, Audrey Borghi-Silva, Antonio Carlos de Camargo Carvalho, Ross Arena, Walter J Gomes, Solange Guizilini
OBJECTIVE: To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support. DESIGN: A randomized controlled study. SUBJECTS: Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized. INTERVENTION: Patients were randomized into two groups: control group subject to the usual care ( n = 35); neuromuscular electrical stimulation group ( n = 35) received daily training sessions to both lower extremities for around two weeks...
June 1, 2017: Clinical Rehabilitation
https://www.readbyqxmd.com/read/28630772/severe-rhabdomyolysis-due-to-presumed-drug-interactions-between-atorvastatin-with-amlodipine-and-ticagrelor
#13
Iouri Banakh, Kavi Haji, Ross Kung, Sachin Gupta, Ravindranath Tiruvoipati
Atorvastatin and ticagrelor combination is a widely accepted therapy for secondary prevention of ischaemic heart disease. However, rhabdomyolysis is a well-known rare side effect of statins which should be considered when treatments are combined with cytochrome P450 3A4 enzyme inhibitors. We report a case of atorvastatin and ticagrelor associated severe rhabdomyolysis that progressed to multiorgan failure requiring renal replacement therapy, inotropes, intubation, and mechanical ventilation. Despite withdrawal of the precipitating cause and the supportive measures including renal replacement therapy, creatinine kinase increased due to ongoing rhabdomyolysis rapidly progressing to upper and lower limbs weakness...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28626160/effect-of-anemia-on-cardiovascular-hemodynamics-therapeutic-strategy-and-clinical-outcomes-in-patients-with-heart-failure-and-hemodynamic-congestion
#14
Muneyoshi Tanimura, Kaoru Dohi, Naoki Fujimoto, Keishi Moriwaki, Taku Omori, Yuichi Sato, Emiyo Sugiura, Naoto Kumagai, Shiro Nakamori, Tairo Kurita, Eitaro Fujii, Norikazu Yamada, Masaaki Ito
BACKGROUND: We investigated the effect of anemia on cardiovascular hemodynamics, therapeutic strategies and clinical outcomes in heart failure (HF) patients.Methods and Results:We divided 198 consecutive HF patients who underwent right heart catheterization before in-hospital HF treatment into 2 groups according to the presence or absence of hemodynamic congestion (HC: mean pulmonary capillary wedge pressure ≥15 mmHg and/or mean right atrial pressure ≥10 mmHg). The hemoglobin level correlated with the cardiac index (CI) and systemic vascular resistance index (SVRI) (r=-0...
June 17, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28611860/renal-function-and-outcomes-with-use-of-left-ventricular-assist-device-implantation-and-inotropes-in-end-stage-heart-failure-a-retrospective-single-center-study
#15
Sean Verma, Emmanuel Bassily, Shane Leighton, Rahul Mhaskar, Igor Sunjic, Angel Martin, Nancy Rihana, Tambi Jarmi, Claude Bassil
BACKGROUND: Left ventricular assist device (LVAD) and inotrope therapy serve as a bridge to transplant (BTT) or as destination therapy in patients who are not heart transplant candidates. End-stage heart failure patients often have impaired renal function, and renal outcomes after LVAD therapy versus inotrope therapy have not been evaluated. METHODS: In this study, 169 patients with continuous flow LVAD therapy and 20 patients with continuous intravenous inotrope therapy were analyzed...
July 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28602370/the-role-of-positive-inotropic-drugs-in-the-treatment-of-older-adults-with-heart-failure-and-reduced-ejection-fraction
#16
REVIEW
Daniel J Dooley, Phillip H Lam, Ali Ahmed, Wilbert S Aronow
Positive inotropic drugs have long been studied for their potential benefits in patients with heart failure and reduced ejection fraction (HFrEF). Although there has been an extensive amount of research about the clinical effects of these drugs in general, few studies examined their effect in older patients. Therefore, there is little or no evidence to guide the use of positive inotropes in older patients with HFrEF. However, recommendations from national heart failure guidelines may be generalized to older HFrEF patients on an individual basis, taking into consideration the basic geriatric principles of pharmacotherapy: start low and go slow...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28580728/late-graft-failure-in-heart-transplant-recipients-incidence-risk-factors-and-clinical-outcomes
#17
Ángela López-Sainz, Eduardo Barge-Caballero, Gonzalo Barge-Caballero, David Couto-Mallón, María J Paniagua-Martin, Leticia Seoane-Quiroga, Carmen Iglesias-Gil, José M Herrera-Noreña, José J Cuenca-Castillo, José M Vázquez-Rodríguez, María G Crespo-Leiro
AIM: To analyse the incidence, risk factors and clinical outcomes of late graft failure after heart transplantation. METHODS AND RESULTS: We conducted an observational, single-centre study based on 547 patients who underwent cardiac transplantation from 1991 to 2014 and who survived the in-hospital postoperative period. Late graft failure was defined as the first hospitalization due to this condition after discharge. Over a mean follow-up of 8.4 ± 6, 178 (32...
June 5, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28573241/mechanisms-underlying-action-of-xinmailong-injection-a-traditional-chinese-medicine-in-cardiac-function-improvement
#18
Zhengtao Li, Sujuan Li, Lin Hu, Fang Li, Alex Chun Cheung, Weizai Shao, Yuling Que, George Pek-Heng Leung, Cui Yang
BACKGROUND: As a bioactive composite extracted from American cockroach, Xinmailong injection (XML) is used for the treatment of congestive heart failure (CHF) in China. Clinical data has provided evidence that XML has positive inotropic properties. The objective of this study was to assess the mechanisms involved in the therapeutical effect of XML on CHF. MATERIALS AND METHODS: The effects of XML on the cardiac function in isolated rat heart were measured. A Ca(2+) imaging technology was used in rat cardiomyocytes (H9c2 cells) to reveal the role of XML on Ca(2+) channels...
2017: African Journal of Traditional, Complementary, and Alternative Medicines: AJTCAM
https://www.readbyqxmd.com/read/28571618/repetitive-use-of-levosimendan-in-advanced-heart-failure-need-for-stronger-evidence-in-a-field-in-dire-need-of-a-useful-therapy
#19
Gerhard Pölzl, Johann Altenberger, Loant Baholli, Paola Beltrán, Attila Borbély, Josep Comin-Colet, Juan F Delgado, Francesco Fedele, Antonella Fontana, Friedrich Fruhwald, Gregory Giamouzis, George Giannakoulas, Martín J Garcia-González, Finn Gustafsson, Kari Kaikkonen, Matti Kivikko, Jacek Kubica, Dirk von Lewinski, Ida Löfman, Gabriella Malfatto, Nicolás Manito, Martin Martínez-Sellés, Josep Masip, Bela Merkely, Fabrizio Morandi, Henning Mølgaard, Fabrizio Oliva, Emil Pantev, Zoltán Papp, Gian Piero Perna, Roman Pfister, Vito Piazza, Ramón Bover, Diego Rangel-Sousa, Alejandro Recio-Mayoral, Alexander Reinecke, Andreas Rieth, Toni Sarapohja, Gunter Schmidt, Mirko Seidel, Stefan Störk, Bojan Vrtovec, Gerhard Wikström, Patrik Yerly, Piero Pollesello
Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes (catecholamines and phosphodiesterase inhibitors), such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption...
September 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28553667/translation-of-cardiac-myosin-activation-with-2-deoxy-atp-to-treat-heart-failure-via-an-experimental-ribonucleotide-reductase-based-gene-therapy
#20
Kassandra S Thomson, Guy L Odom, Charles E Murry, Gregory G Mahairas, Farid Moussavi-Harami, Sam L Teichman, Xiaolan Chen, Stephen D Hauschka, Jeffrey S Chamberlain, Michael Regnier
Despite recent advances, chronic heart failure remains a significant and growing unmet medical need, reaching epidemic proportions carrying substantial morbidity, mortality, and costs. A safe and convenient therapeutic agent that produces sustained inotropic effects could ameliorate symptoms, and improve functional capacity and quality of life. We discovered small amounts of 2-deoxy-ATP (dATP) activate cardiac myosin leading to enhanced contractility in normal and failing heart muscle. Cardiac myosin activation triggers faster myosin crossbridge cycling with greater force generation during each contraction...
December 2016: JACC. Basic to Translational Science
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