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inotropics in heart failure

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https://www.readbyqxmd.com/read/27904524/integration-of-medical-therapy-and-mechanical-circulatory-support-in-the-management-of-acute-heart-failure
#1
Patrick Horn, Malte Kelm, Ralf Westenfeld
Acute heart failure is still characterized by poor prognosis with high mortality. Diagnosis is based on clinical symptoms and hemodynamic measurements. Early coronary revascularization in cardiogenic shock complicating myocardial infarction improves outcome. The further contemporary therapeutic options in the management of acute heart failure are limited to a merely symptomatic effect with relief of dyspnea, reduction of volume overload and improvement of hemodynamic parameters by vasodilators (in hypertension) or inotropic and vasopressor agents (in hypotension)...
December 1, 2016: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/27903339/-effect-of-goal-directed-haemodynamic-management-on-the-postoperative-outcome-in-elderly-patients-with-fragile-cardiac-function-undergoing-abdominal-surgery
#2
L S Zheng, E W Gu, X H Peng, L Zhang, Y Y Cao
Objective: To investigate the effect of goal-directed haemodynamic management based on stroke volume variation (SVV), cardiac index (CI) and mean arterial blood pressure (MAP) on the postoperative outcome in elderly patients with fragile cardiac function undergoing gastrointestinal surgery. Methods: Ninety patients with fragile cardiac function, aged 65-90 years old, ASAⅡ or Ⅲ, NYHA Ⅱor Ⅲ, scheduled for abdominal surgery were enrolled in this study.The patients were randomly assigned to two groups: Experience anesthesia group (group E, n=45) and goal-directed hemodynamic management group (G group, n=45)...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27895488/advances-in-the-management-of-heart-failure-the-role-of-ivabradine
#3
REVIEW
Ursula Müller-Werdan, Georg Stöckl, Karl Werdan
A high resting heart rate (≥70-75 b.p.m.) is a risk factor for patients with heart failure (HF) with reduced ejection fraction (EF), probably in the sense of accelerated atherosclerosis, with an increased morbidity and mortality. Beta-blockers not only reduce heart rate but also have negative inotropic and blood pressure-lowering effects, and therefore, in many patients, they cannot be given in the recommended dose. Ivabradine specifically inhibits the pacemaker current (funny current, If) of the sinoatrial node cells, resulting in therapeutic heart rate lowering without any negative inotropic and blood pressure-lowering effect...
2016: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/27882023/effects-of-bisoprolol-in-combination-with-trimetazidine-on-the-treatment-of-heart-failure-and-concomitant-chronic-obstructive-pulmonary-disease
#4
Yuanyuan Ke, Dingli Xu, Minxiong Li, Zenglong Wu, Yongpeng Huang
OBJECTIVE: To evaluate the effects of bisoprolol combined with trimetazidine on the treatment of heart failure patients having concomitant chronic obstructive pulmonary disease (COPD); in comparison with control group treated with standard therapy only. METHODS: A total of 120 heart failure patients having concomitant COPD were selected and randomly divided into a control group and a treatment group according to different treatment methods (n=60). The control group was given continuous low flow oxygen inhalation and inotropic agents, and their cardiac stress was also reduced...
September 2016: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/27876563/preoperative-optimization-of-the-heart-failure-patient-undergoing-cardiac-surgery
#5
REVIEW
Maxime Pichette, Mark Liszkowski, Anique Ducharme
Heart failure patients who undergo cardiac surgery are exposed to significant perioperative complications and high mortality. We herein review the literature concerning preoperative optimization of these patients. Salient findings are that end-organ dysfunction and medication should be optimized before surgery. Specifically: (1) reversible causes of anemia should be treated and a preoperative hemoglobin level of 100 g/L obtained; (2) renal function and volume status should be optimized; (3) liver function must be carefully evaluated; (4) nutritional status should be assessed and cachexia treated to achieve a preoperative albumin level of at least 30 g/L and a body mass index > 20; and (5) medication adjustments performed, such as withholding inhibitors of the renin-angiotensin-aldosterone system before surgery and continuing, but not starting, β-blockers...
August 6, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27875721/percutaneous-mitral-valve-repair-the-last-chance-for-symptoms-improvement-in-advanced-refractory-chronic-heart-failure
#6
Alessandra Berardini, Elena Biagini, Francesco Saia, Davide Stolfo, Mario Previtali, Francesco Grigioni, Bruno Pinamonti, Gabriele Crimi, Alessandro Salvi, Maurizio Ferrario, Antonio De Luca, Fabrizio Gazzoli, Maria Letizia Bacchi Reggiani, Claudia Raineri, Gianfranco Sinagra, Claudio Rapezzi
BACKGROUND: The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear. METHODS: Seventy-five consecutive patients with FMR grade≥3+ and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month...
November 12, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27872804/pulmonary-hypertension-secondary-to-pulmonary-veno-occlusive-disease-complicated-by-right-heart-failure-hypotension-and-acute-kidney-injury
#7
Nima Golzy, Stuti Fernandes, Justin Sharim, Rikin Tank, Henry D Tazelaar, Howard E Epstein, Victor Tapson, Antoine Hage
Pulmonary veno-occlusive disease (PVOD) is rare condition which can lead to severe pulmonary hypertension, right ventricular dysfunction, and cardiopulmonary failure. The diagnosis of PVOD can be challenging due to its nonspecific symptoms and its similarity to idiopathic pulmonary arterial hypertension and interstitial lung disease in terms of diagnostic findings. This case describes a 57 year old female patient who presented with a 5-month history of progressive dyspnea on exertion and nonproductive cough...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/27863728/fontan-patient-survival-after-pediatric-heart-transplantation-has-improved-in-the-current-era
#8
Kathleen E Simpson, Elizabeth Pruitt, James K Kirklin, David C Naftel, Rakesh K Singh, R Erik Edens, Aliessa P Barnes, Charles E Canter
BACKGROUND: Historically, patients with a prior Fontan procedure for complex congenital heart disease (CHD) have been considered at higher risk for death after heart transplant (HT) compared with other HT transplant candidates. With the overall trend of improved survival of pediatric HT recipients, it is unclear of Fontan patient post-HT survival has also improved in the current era. METHODS: Data from the Pediatric Heart Transplant Study database for Fontan patients who underwent HT was compared between the early era (1993 to 2006, n = 150) and late era (2007 to 2014, n = 252)...
November 15, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27843430/cirrhotic-cardiomyopathy-another-case-of-a-successful-approach-to-treatment-of-hepatorenal-syndrome
#9
Luis Otávio Mocarzel, Jessica Bicca, Luiza Jarske, Thamires Oliveira, Pedro Lanzieri, Ronaldo Gismondi, Mario Luiz Ribeiro
Hepatorenal syndrome (HRS) is defined as a failure of renal function, potentially reversible, in patients with liver cirrhosis and ascites. Recently, a component of cardiomyopathy associated with HRS was described, but the use of positive inotropic medicine as part of the treatment of the acute phase has not been extensively evaluated. We report a second case in our hospital of a patient with HRS type I without previous heart disease, with secondary hemodynamic decompensation due to liver disease, in which the abnormalities in systolic function by speckle-tracking echocardiography were observed and could be reversed by the use of inotropes...
September 2016: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/27837385/roads-maps-and-destinations-the-journey-of-left-ventricular-assist-device-implantation-in-ambulatory-patients-with-advanced-heart-failure
#10
REVIEW
Barry H Trachtenberg, Jerry D Estep
PURPOSE OF REVIEW: The benefit of left ventricular assist devices in patients dependent on inotropes or temporary mechanical support is clear. There is a large population of advanced heart failure patients who are ambulatory and not dependent on inotropes, but in whom mortality remains high. We review the limited evidence regarding the benefits and risks of LVADs in this population. RECENT FINDINGS: The REVIVE-IT trial, which aimed to study the use of LVADs in patients who are less sick and do not meet current FDA-indications, was suspended due to lack of equipoise in the setting of a spike in pump thromboses...
December 2016: Current Cardiology Reports
https://www.readbyqxmd.com/read/27836022/the-nhlbi-revive-it-study-understanding-its-discontinuation-in-the-context-of-current-left-ventricular-assist-device-therapy
#11
EDITORIAL
Francis D Pagani, Keith D Aaronson, Robert Kormos, Douglas L Mann, Cathie Spino, Neal Jeffries, Wendy C Taddei-Peters, Donna M Mancini, Dennis M McNamara, Kathleen L Grady, John Gorcsan, Ralph Petrucci, Allen S Anderson, Henry A Glick, Michael A Acker, J Eduardo Rame, Daniel J Goldstein, Salpy V Pamboukian, Marissa A Miller, J Timothy Baldwin
The National Institutes of Health National Heart, Lung, and Blood Institute convened a working group in March 2008 to discuss how therapies for heart failure (HF) might be best advanced using clinical trials involving left ventricular assist devices (LVAD). This group opined that the field was ready for a trial to assess the use of long-term ventricular assist device therapy in patients who are less ill than patients currently eligible for destination therapy, which resulted in the Randomized Evaluation of VAD InterVEntion before Inotropic Therapy (REVIVE-IT) pilot study...
November 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27834198/intermacs-interagency-registry-for-mechanically-assisted-circulatory-support-profiling-identifies-ambulatory-patients-at-high-risk-on-medical-therapy-after-hospitalizations-for-heart-failure
#12
Garrick C Stewart, Michelle M Kittleson, Parag C Patel, Jennifer A Cowger, Chetan B Patel, Maria M Mountis, Frances L Johnson, Maya E Guglin, J Eduardo Rame, Jeffrey J Teuteberg, Lynne W Stevenson
BACKGROUND: INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles provide important prognostic information for patients with advanced heart failure (HF) receiving mechanical support. The value of INTERMACS profiling has not been shown for patients followed on medical therapy for advanced HF at centers that also offer mechanical circulatory support. METHODS AND RESULTS: This prospective, observational study enrolled 166 patients with chronic New York Heart Association class III-IV HF, ejection fraction ≤30%, and ≥1 HF hospitalization in the previous year, excluding patients listed for transplant or receiving chronic intravenous inotropic therapy...
November 2016: Circulation. Heart Failure
https://www.readbyqxmd.com/read/27816725/blinatumomab-provoked-fatal-heart-failure
#13
REVIEW
Behrad Darvishi, Leila Farahmand, Neda Jalili, Keivan Majidzadeh-A
Mentioned in Blinatumomab (Blincyto®) clinical safety report, a 5 year old boy with acute lymphoblastic leukemia (ALL) receiving Blincyto® with the concentration of 30μg/m(2)/day on the fourth day of therapy developed both Cytokine Release Syndrome (CRS) and Tumor Lysis Syndrome (TLS). Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and Bilirubin peaks were 18, 7 and 8 folds more than upper normal limit (UNL) respectively. However, albumin was reduced to approximately half of the lower Normal limit (LNL)...
October 28, 2016: International Immunopharmacology
https://www.readbyqxmd.com/read/27816511/does-small-size-matter-with-continuous%C3%A2-flow-devices-analysis-of-the-intermacs-database-of-adults-with-bsa%C3%A2-%C3%A2-1-5-m-2
#14
Farhan Zafar, Chet R Villa, David L Morales, Elizabeth D Blume, David N Rosenthal, James K Kirklin, Angela Lorts
OBJECTIVES: This study investigated how small patient size affects clinical outcomes in patients implanted with a continuous flow left ventricular assist device (CFLVAD). BACKGROUND: The development of smaller CFLVADs has allowed ventricular assist device (VAD) use in anatomically smaller patients; however, limited outcome data exist regarding CFLVAD use in patients with a body surface area (BSA) ≤1.5 m(2). METHODS: All CFLVAD patients entered in the Interagency Registry for Mechanically Assisted Circulatory Support registry April 2008 to September 2013 and with BSA data were included...
October 27, 2016: JACC. Heart Failure
https://www.readbyqxmd.com/read/27813474/-cyclic-nucleotide-phosphodiesterases-role-in-the-heart-and-therapeutic-perspectives
#15
Ibrahim Bedioune, Pierre Bobin, Sarah Karam, Marta Lindner, Delphine Mika, Patrick Lechêne, Jérôme Leroy, Rodolphe Fischmeister, Grégoire Vandecasteele
Cyclic nucleotide phosphodiesterases (PDEs) degrade the second messengers cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP), thereby regulating multiple aspects of cardiac function. This highly diverse class of enzymes encoded by 21 genes encompasses 11 families that are not only responsible for the termination of cyclic nucleotide signalling, but are also involved in the generation of dynamic microdomains of cAMP and cGMP, controlling specific cell functions in response to various neurohormonal stimuli...
2016: Biologie Aujourd'hui
https://www.readbyqxmd.com/read/27798760/rad-deletion-phenocopies-tonic-sympathetic-stimulation-of-the-heart
#16
Bryana M Levitan, Janet R Manning, Catherine N Withers, Jeffrey D Smith, Robin M Shaw, Douglas A Andres, Vincent L Sorrell, Jonathan Satin
Sympathetic stimulation modulates L-type calcium channel (LTCC) gating to contribute to increased systolic heart function. Rad is a monomeric G-protein that interacts with LTCC. Genetic deletion of Rad (Rad(-/-)) renders LTCC in a sympathomimetic state. The study goal was to use a clinically inspired pharmacological stress echocardiography test, including analysis of global strain, to determine whether Rad(-/-) confers tonic positive inotropic heart function. Sarcomere dynamics and strain showed partial parallel isoproterenol (ISO) responsiveness for wild-type (WT) and for Rad(-/-)...
October 31, 2016: Journal of Cardiovascular Translational Research
https://www.readbyqxmd.com/read/27796576/cardiac-inotropy-lusitropy-and-ca-2-handling-with-major-metabolic-substrates-in-rat-heart
#17
Zai Hao Zhao, Jae Boum Youm, Yue Wang, Jeong Hoon Lee, Jae Hwi Sung, Joon-Chul Kim, Sun Hee Woo, Chae Hun Leem, Sung Joon Kim, Lan Cui, Yin Hua Zhang
Fatty acid (FA)-dependent oxidation is the predominant process for energy supply in normal heart. Impaired FA metabolism and metabolic insufficiency underlie the failing of the myocardium. So far, FA metabolism in normal cardiac physiology and heart failure remains undetermined. Here, we evaluate the mechanisms of FA and major metabolic substrates (termed NF) on the contraction, relaxation, and Ca(2+) handling in rat left ventricular (LV) myocytes. Our results showed that NF significantly increased myocyte contraction and facilitated relaxation...
November 2016: Pflügers Archiv: European Journal of Physiology
https://www.readbyqxmd.com/read/27778514/advanced-heart-failure-an-appraisal-of-the-potential-of-levosimendan-in-this-end-stage-scenario-and-some-related-ethical-considerations
#18
Sonja Fruhwald, Piero Pollesello, Friedrich Fruhwald
The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure...
December 2016: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/27774271/circulating-biomarker-responses-to-medical-management-vs-mechanical-circulatory-support-in-severe-inotrope-dependent-acute-heart-failure
#19
Anna J Meredith, Darlene L Y Dai, Virginia Chen, Zsuzsanna Hollander, Raymond Ng, Annemarie Kaan, Scott Tebbutt, Krishnan Ramanathan, Anson Cheung, Bruce M McManus
BACKGROUND: Severe inotrope-dependent acute heart failure (AHF) is associated with poor clinical outcomes. There are currently no well-defined blood biomarkers of response to treatment that can guide management or identify recovery in this patient population. In the present study, we characterized the levels of novel and emerging circulating biomarkers of heart failure in patients with AHF over the first 30 days of medical management or mechanical circulatory support (MCS). We hypothesized a shared a plasma proteomic treatment response would be identifiable in both patient groups, representing reversal of the AHF phenotype...
June 2016: ESC Heart Failure
https://www.readbyqxmd.com/read/27752636/cardiac-physiologic-regulation-of-sub-type-specific-adrenergic-receptors-in-transgenic-mice-overexpressing-%C3%AE-1-and-%C3%AE-2-adrenergic-receptors
#20
Ka Eul Kim, Hyun-Jin Tae, Petrashevskaya Natalia, Jae-Chul Lee, Ji Hyeon Ahn, Joon Ha Park, In Hye Kim, Taek Geun Ohk, Chan Woo Park, Jun Hwi Cho, Moo-Ho Won
OBJECTIVE: Combination of β1-adrenergic receptor (AR) blockade and β2-AR activation might be a potential novel therapy for treating heart failure. However, use of β-AR agonists and/or antagonists in the clinical setting is controversial because of the lack of information on cardiac inotropic or chronotropic regulation by AR signaling. METHODS: In this study, we performed hemodynamic evaluation by examining force frequency response (FFR), Frank-Starling relationship, and response to a non-selective β-AR agonist (isoproterenol) in hearts isolated from 6-month-old transgenic (TG) mice overexpressing β1- and β2-ARs (β1- and β2-AR TG mice, respectively)...
September 2016: Clinical and Experimental Emergency Medicine
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