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Acute Right Heart Failure

Gaspare Parrinello, Daniele Torres, Silvio Buscemi, Tiziana Di Chiara, Francesco Cuttitta, Mauro Cardillo, Francesca Romana Pluchinotta, Rosario Scaglione, Salvatore Paterna, Antonio Pinto
Left ventricular ejection fraction (EF) is helpful to differentiate heart failure (HF) phenotype in clinical practice. The aim of the study was to identify simple echocardiographic predictors of post-discharge all-cause mortality in hospitalized HF patients. Patients with acute HF (75 ± 9.8 years), classified in preserved (≥ 50%) and reduced (< 50%) EF (HFpEF and HFrEF, respectively), were enrolled. The mean follow-up period was of 25.4 months. Patients definitively analyzed were 135. At multivariate Cox model, right ventricular diameter (RVd), inferior vena cava diameter (IVCd) and blood urea nitrogen (BUN) resulted to be significantly associated with all-cause mortality in HFpEF (HR 2...
March 20, 2019: Internal and Emergency Medicine
Alexander Jobs, Amr Abdin, Suzanne de Waha-Thiele, Ingo Eitel, Holger Thiele, Cor de Wit, Reinhard Vonthein
AIM: Major clinical trials have shown that angiotensin-converting enzyme (ACE) inhibitors reduce mortality and morbidity in congestive heart failure (HF). Prior to these seminal findings hemodynamic effects of ACE inhibitors were examined in small studies. We aimed to review these studies systematically and meta-analyze the effects of ACE inhibitors on hemodynamics in HF. METHODS AND RESULTS: We identified studies investigating the acute hemodynamic effect of ACE inhibitors in naïve patients with congestive heart failure by searching PubMed and the Cochrane Central Register of Controlled Trials...
March 20, 2019: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Ji Hyun Lee, Jin Joo Park, Youngjin Cho, Il Young Oh, Byung Su Yoo, Jae Joong Kim, Kye Hun Kim, Seok Min Kang, Sang Hong Baek, Eun Seok Jeon, Myeong Chan Cho, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi
BACKGROUND AND OBJECTIVES: Conflicting data exist regarding the prognostic implication of ventricular conduction disturbance pattern in patients with heart failure (HF). This study investigated the prognostic impact of ventricular conduction pattern in hospitalized patients with acute HF. METHODS: Data from the Korean Acute Heart Failure registry were used. Patients were categorized into four groups: narrow QRS (<120 ms), right bundle branch block (RBBB), left bundle branch block (LBBB), and nonspecific intraventricular conduction delay (NICD)...
February 26, 2019: Korean Circulation Journal
Anja Lehner, Ingram Schulze-Neick, Marcus Fischer, Silvia Fernandez-Rodriguez, Sarah Ulrich, Nikolaus A Haas, André Jakob
PURPOSE OF THE REVIEW: Targeted pharmacotherapies did improve survival rates, exercise capacity, and quality of life (QoL) of PAH patients. However, these pharmacological interventions are expensive and not always accessible. In addition, not all patients do respond similarly to these medications and many will continue to deteriorate. This review aims to discuss the beneficial role of an artificial right-to-left shunt and highlights current interventional devices and outcomes. RECENT FINDINGS: Since patients with preexisting atrial shunts or patients with Eisenmenger's disease show better survival rates, improved exercise capacity, and QoL, PAH patients clinically do benefit from an atrial septostomy by reducing signs of right heart failure, improving left heart filling, cardiac output, and systemic oxygen transport despite hypoxia...
March 18, 2019: Current Cardiology Reports
Erin R Weeda, Zemin Su, David J Taber, John Bian, Thomas A Morinelli, Nicole A Pilch, Patrick D Mauldin, Derek A DuBay
Reducing acute care utilization is a means of improving long-term patient outcomes. We sought to assess high inpatient[IP] admission and standalone emergency department[ED] utilization within a 9-month period post-kidney transplantation, and to identify mutable factors to reduce utilization. In this ten-year retrospective study, 1,599 adult kidney transplant recipients were identified. A previous transplant, graft loss, or death within 3 months post-transplantation excluded 319 patients. Comprehensive resource utilization data were obtained from a statewide database...
March 12, 2019: Clinical Transplantation
Gaik Nersesian, Felix Hennig, Marcus Müller, Johanna Mulzer, Dmytro Tsyganenko, Christoph Starck, Tom Gromann, Volkmar Falk, Evgenij Potapov, Felix Schoenrath
Background: Temporary mechanical circulatory support (MCS) offers a valuable option for treatment of refractory heart failure. We present our experience with selected MCS devices in cardiogenic shock of different etiologies. Methods: We retrospectively studied patients who were treated in our institution between 01/2016 and 07/2018. Patients receiving only veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support were excluded. Left ventricular support patients received Impella; right ventricular support was conducted using Levitronix CentriMag...
January 2019: Annals of Cardiothoracic Surgery
Natalia Lewczuk, Alexander Zdebik, Joanna Bogusławska, Anna Turno-Kręcicka, Marta Misiuk-Hojło
Pulmonary hypertension (PH), if left untreated, may result in increasing cardiac back pressures and lead to right heart failure and death. An increase in venous pressure in pulmonary hypertension influences other organs. The ocular complications occur as a result of elevated venous pressure in the superior vena cava and in the ophthalmic veins that cause dilation of the ocular veins, resulting in congestion of the choroid and leading to complications such as ciliary detachment,1 central retinal vein occlusion, acute serous retinal detachment, macular edema, retinal neovascularization, choroidal effusions, chemosis, angle-closure glaucoma, transient myopia, and proptosis...
March 5, 2019: Survey of Ophthalmology
Takamitsu Nakamura, Manabu Uematsu, Juntaro Deyama, Yosuke Watanabe, Kazuto Nakamura, Tsuyoshi Kobayashi, Yukio Saito, Daisuke Fujioka, Ken-Ichi Kawabata, Jun-Ei Obata, Kiyotaka Kugiyama
BACKGROUND: The precise mechanisms underlying the high prevalence of pulmonary hypertension (PH) with increased pulmonary vascular resistance (PVR) in heart failure with preserved ejection fraction (HFpEF) remain largely unknown. Measurements of brachial-ankle pulse wave velocity (baPWV) have been shown to be useful for risk assessment in HF patients. Thus, this study sought to define the association of PVR with baPWV and clinical outcomes in HFpEF. METHODS AND RESULTS: Patients with HFpEF (n=198) had measurements of baPWV and PVR by right heart catheterization, and were prospectively followed-up for <96 months or until the occurrence of a composite of all-cause death, hospitalization with worsening HF, and non-fatal acute coronary syndrome...
February 27, 2019: Journal of Cardiac Failure
Hong-Li Xiao, Lian-Xing Zhao, Jun Yang, Nan Tong, Le An, Qi-Tong Liu, Miao-Rong Xie, Chun-Sheng Li
Acute pulmonary embolism (APE) with cardiac arrest (CA) is associated with a high mortality rate. Even upon return of the spontaneous circulation (ROSC), APE‑CA survivors are prone to myocardial cell apoptosis, a key cellular mechanism that induces heart failure. A recent study by our group discovered a post‑resuscitation imbalance in the serum angiotensin‑converting enzyme (ACE)2/ACE axis of the renin‑angiotensin system (RAS), as well as regressive cardiac function in a porcine model of APE‑CA. However, it has remained elusive how this imbalance in the ACE2/ACE axis affects myocardial cell apoptosis...
February 26, 2019: International Journal of Molecular Medicine
Shibu Mathew, Ardan M Saguner, Niklas Schenker, Lukas Kaiser, Pengpai Zhang, Yoshiga Yashuiro, Christine Lemes, Thomas Fink, Tilman Maurer, Francesco Santoro, Peter Wohlmuth, Bruno Reißmann, Christian H Heeger, Roland Tilz, Erik Wissner, Andreas Rillig, Andreas Metzner, Karl-Heinz Kuck, Feifan Ouyang
Background It has been suggested that endocardial and epicardial ablation of ventricular tachycardia ( VT ) improves outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia. We investigated our sequential approach for VT ablation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia in a single center. Methods and Results We included 47 patients (44±16 years) with definite (81%) or borderline (19%) arrhythmogenic right ventricular cardiomyopathy/dysplasia between 1998 and 2016...
March 5, 2019: Journal of the American Heart Association
Anna Bauer, Markus Khalil, Dorle Schmidt, Sabine Recla, Jürgen Bauer, Anoosh Esmaeili, Gemma Penford, Hakan Akintuerk, Dietmar Schranz
BACKGROUND: Left atrial congestion results from backward failure in dilated cardiomyopathy. We aimed to evaluate feasibility and efficacy of percutaneous atrioseptostomy to create a restrictive atrial septum defect in management of dilated cardiomyopathy.Methods and resultsFrom June 2009 to December 2016, 27 interventions comprised left atria decompressions in 22 dilated cardiomyopathy patients; 9 females; age: 24 days to 36.9 years; weight: 3-50 kg; NYHA-/Ross class IV (n=16). Mean left ventricular ejection fraction was 21...
February 26, 2019: Cardiology in the Young
Erik G Gunderson, Matthew P Lillyblad, Michelle Fine, Orly Vardeny, Theodore J Berei
Volume management in acute decompensated and chronic heart failure remains a significant challenge. While there has been progress in development of mortality reducing neurohormonal regimens in the reduced ejection fraction population, there has yet to be a clinical trial demonstrating anything more than symptomatic relief or biomarker reduction with pharmacotherapeutic, volume-based interventions made in the acutely decompensated individual or those with evolving outpatient congestion. As the number of patients with heart failure continues to grow, in addition to heart failure related hospitalizations, identifying therapies that have the potential to more safely and efficaciously aid in diuresis is paramount to decreasing inpatient length of stay and preventing unnecessary admissions...
February 25, 2019: Pharmacotherapy
Hariharan Regunath, Nathanial Moulton, Daniel Woolery, Mohammed Alnijoumi, Troy Whitacre, Jonathan Collins
Background: Tidal hyperinflation can still occur with mechanical ventilation using low tidal volume (LVT) (6 mL/kg predicted body weight (PBW)) in acute respiratory distress syndrome (ARDS), despite a well-demonstrated reduction in mortality. Methods: Retrospective chart review from August 2012 to October 2014. Inclusion : Age >18years, PaO2 /FiO2 <200 with bilateral pulmonary infiltrates, absent heart failure, and ultra-protective mechanical ventilation (UPMV) defined as tidal volume (VT) <6 mL/kg PBW...
February 2019: Journal of the Intensive Care Society
Maan Malahfji, Salman Arain
Reversed pulsus paradoxus was first described in 1973 as a rise in peak systolic pressure on inspiration in patients with idiopathic hypertrophic subaortic stenosis or isorhythmic ventricular rhythm and in patients with left ventricular systolic dysfunction on positive pressure ventilation. Positive pressure ventilation, for example, may impel blood from the pulmonary capillaries and venules into the left atrium. This may increase left ventricular preload and accelerate ventricular emptying, which in turn may cause the systolic arterial pressure to rise during inspiration...
October 2018: Methodist DeBakey Cardiovascular Journal
Yolanda C Bryce, Rocio Perez-Johnston, Errol B Bryce, Behrang Homayoon, Ernesto G Santos-Martin
Pulmonary embolus (PE) is the third most common cause of cardiovascular death with more than 600,000 cases occurring in the USA per year. About 45% of patients with acute PE will have acute right ventricular failure, and up to 3.8% of patients will develop chronic thromboembolic pulmonary hypertension (CTEPH) with progressive, severe, chronic heart failure. The right ventricle (RV) is constructed to accommodate a low-resistance afterload. Increases in afterload from acute massive and submassive PE and CTEPH may markedly compromise the RV function leading to hemodynamic collapse and death...
February 13, 2019: Insights Into Imaging
Hesham R Omar, Maya Guglin
BACKGROUND: Diuretic requirements in patients with acute decompensated heart failure (ADHF) and hyponatraemia versus normonatraemia on admission has not been previously explored. METHODS: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial dataset was utilised to examine the characteristics and diuretic requirements of patients with ADHF with hyponatraemia or normonatraemia on admission. RESULTS: Patients with ADHF and admission hyponatraemia (n = 103, average Na 130...
January 28, 2019: Heart, Lung & Circulation
Amalie Saab, Shiona Glass-Kaastra, Gordon Bryan Young
BACKGROUND: We reviewed numerous variables for ischemic stroke patients admitted to a rehabilitation unit to determine those that were statistically associated with discharge destination. METHODS: A retrospective chart review of patients with ischemic stroke discharged from the rehabilitation unit between January 1, 2005 and December 31, 2015. Variables were examined for their association with discharge destination (home versus long-term care (LTC)). Univariable relationships with discharge destination were assessed, and a multivariable logistic regression model was built...
February 11, 2019: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Li Wang, Jiamei Li, Ya Gao, Ruohan Li, Jingjing Zhang, Dan Su, Tao Wang, Guang Yang, Xiaochuang Wang
BACKGROUND: Previous studies have found a connection between left coronary artery dominance and worse prognoses in patient with acute coronary syndrome, which remains a predominant cause of morbidity and mortality globally. The aim of this study was to investigate whether coronary dominance is associated with the incidence of acute inferior myocardial infarction (MI). METHODS: Between January 2011 and November 2014, 265 patients with acute inferior MI and 530 age-matched and sex-matched controls were recruited for a case-control study in the Second Affiliated Hospital of Xi'an Jiaotong University in Xi'an, China...
February 4, 2019: BMC Cardiovascular Disorders
Thomas M D Sheard, Miriam E Hurley, John Colyer, Ed White, Ruth Norman, Eleftheria Pervolaraki, Kaarjel K Narayanasamy, Yufeng Hou, Hannah Kirton, Zhaokang Yang, Liam Hunter, Jung-Uk Shim, Alexander H Clowsley, Andrew J Smith, David Baddeley, Christian Soeller, Michael A Colman, Izzy Jayasinghe
Nanodomains are intracellular foci which transduce signals between major cellular compartments. One of the most ubiquitous signal transducers, the ryanodine receptor (RyR) calcium channel, is tightly clustered within these nanodomains. Super-resolution microscopy has previously been used to visualise RyR clusters near the cell surface. A majority of nanodomains located deeper within cells have remained unresolved due to limited imaging depths and axial resolution of these modalities. A series of enhancements made to expansion microscopy allowed individual RyRs to be resolved within planar nanodomains at the cell periphery and the curved nanodomains located deeper within the interiors of cardiomyocytes...
February 4, 2019: ACS Nano
Ahmet Öz, Tufan Çınar, Mert İlker Hayıroğlu, Şahin Avşar, Muhammed Keskin, Ahmet Lütfüllah Orhan
INTRODUCTION AND OBJECTIVES: Prior studies demonstrated that plasma osmolality may have a predictive value for in-hospital mortality in patients with heart failure and acute coronary syndrome. In addition, plasma glucose and blood urea nitrogen (BUN) levels, the components of plasma osmolality, have been shown to be an important contributor for in-hospital mortality in acute pulmonary embolism (APE) patients. Hence, the objective of the current study is to evaluate the effect of plasma osmolality upon admission with in-hospital mortality in patients with APE...
February 3, 2019: Clinical Respiratory Journal
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