100 research outputs found
Effect of eprosartan-based therapy on systolic blood pressure and total cardiovascular risk in a large international population: preliminary report of the observational POWER study
No full textAssen Goudev,1 Jean-Pascal Berrou,2 Atul Pathak3 On behalf of the POWER Investigators1Department of Cardiology, Queen Giovanna University Hospital, Sofia, Bulgaria; 2Strategic Medical Affairs, CardioMetabolic Established Products, Abbott Products Operations AG, Allschwil, Switzerland; 3Faculte´ de Médecine et CHU Toulouse, Unité de Pharmacologie Cardiovasculaire et Autonome, Service de Pharmacologie et Cardiologie, INSERM U 1048, Université Paul Sabatier, Toulouse, FranceBackground: Estimation of total cardiovascular risk is useful for developing preventive strategies for individual patients. The POWER (Physicians' Observational Work on Patient Education According to their Vascular Risk) survey, a 6-month, open-label, multinational, post-marketing observational evaluation of eprosartan, an angiotensin II receptor blocker, was undertaken to assess the efficacy and safety of eprosartan-based therapy in the treatment of high arterial blood pressure in a large population recruited from 16 countries with varying degrees of baseline cardiovascular risk, and the effect of eprosartan-based therapy on total cardiovascular risk, as represented by the SCORE® (Systematic Coronary Risk Assessment) or Framingham risk equations.Methods: Participating physicians recruited > 29,000 hypertensive patients whom they considered to be candidates (according to specified criteria) for treatment with eprosartan 600 mg/day, with other drugs added at the discretion of the physician.Results: During treatment, systolic blood pressure decreased by 25.8 ± 14.4 mmHg to 134.6 ± 11.4 mmHg (P < 0.001), mean diastolic blood pressure fell by 12.6 ± 9.5 mmHg to 81.1 ± 7.6 mmHg, and pulse pressure fell by 13.2 ± 13.5 mmHg to 53.6 ± 11.4 mmHg (both P < 0.01). Calculated total cardiovascular risk declined in parallel with the reduction in blood pressure.Conclusion: The POWER study has demonstrated, in a large and nonselected population, the feasibility and practicability of reducing total cardiovascular risk through systematic management of high blood pressure.Keywords: hypertension, SCORE®, Framingham, eprosartan, cardiovascular ris
Early Detection and Prediction of Cardiotoxicity - Biomarker and Echocardiographic Evaluation
No full textNon
Sleep disorders in patients with acute and exacerbated chronic heart failure
No full textHeart failure is often accompanied by sleep disorders. Continuous Positive Airway Pressure (CPAP) therapy has proven in the treatment of obstructive sleep apnea, but the benefits associated with comorbid patients and patients with heart failure is still under research. On the other hand, central sleep apnea is also with high frequency in these patients and more difficult to treat. The aim of the current publication is to make a brief review of acute and exacerbated chronic heart failure in patients with sleep disorders – frequency, severity, and types to treat
Influence of atrial fibrillation on efficacy and safety of omecamtiv mecarbil in heart failure: the GALACTIC-HF trial
No full textAims:
In GALACTIC-HF, the cardiac myosin activator omecamtiv mecarbil compared with placebo reduced the risk of heart failure events or cardiovascular death in patients with heart failure with reduced ejection fraction. We explored the influence of atrial fibrillation or flutter (AFF) on the effectiveness of omecamtiv mecarbil.
Methods and results:
GALACTIC-HF enrolled patients with New York Heart Association (NYHA) Class II–IV heart failure, left ventricular ejection fraction ≤35%, and elevated natriuretic peptides. We assessed whether the presence or absence of AFF, a pre-specified subgroup, modified the treatment effect for the primary and secondary outcomes, and additionally explored effect modification in patients who were or were not receiving digoxin. Patients with AFF (n = 2245, 27%) were older, more likely to be randomized as an inpatient, less likely to have a history of ischaemic aetiology or myocardial infarction, had a worse NYHA class, worse quality of life, lower estimated glomerular filtration rate, and higher N-terminal pro-B-type natriuretic peptide. The treatment effect of omecamtiv mecarbil was modified by baseline AFF (interaction P = 0.012), with patients without AFF at baseline deriving greater benefit. The worsening of the treatment effect by baseline AFF was significantly more pronounced in digoxin users than in non-users (interaction P = 0.007); there was minimal evidence of effect modification in those patients not using digoxin (P = 0.47) or in digoxin users not in AFF.
Conclusion:
Patients in AFF at baseline were less likely to benefit from omecamtiv mecarbil than patients without AFF, although the attenuation of the treatment effect was disproportionally concentrated in patients with AFF who were also receiving digoxin.
Clinical Trial Registration: NCT02929329
Cardiac amyloidosis – an underestimated etiology for heart failure with preserved ejection fraction. A literary review
No full textСърдечната амилоидоза, доскоро приемана за рядко заболяване, е сериозна и прогресираща кардиомиопатия, отличаваща се с екстрацелуларно натрупване на неправилно нагънати протеини в камерния миокард. Диагностицирането на сърдечната амилоидоза в ранен етап е ключово за прогнозата на пациентите, предоставяйки именно тогава широк спектър от терапевтични възможности, свързани с подобряване на прогнозата и/или предотвратяване на потенциално необратима загуба на физическа функция и качеството на живот, като съвременните данни сочат, че по-голямата част от пациентите не получават навременна диагноза. Пациентите със сърдечна амилоидоза в ранен етап не показват редукция на левокамерната глобална систолна функция, но могат да развият симптоми на сърдечна недостатъчност със запазена фракция на изтласкване (HFpEF), като СА се счита за една от пренебрегваните етиологии на HFpEF при възрастни. Сърдечната амилоидоза е прогресивно заболяване с лоша прогноза, ако се остави без лечение. Средната продължителност на живот на нелекуваните пациенти с AL-сърдечна амилоидоза е по-малка от 6 месеца, а тази на пациентите с ATTR-CA е 2.5-3.5 години. Следователно ранната клинична идентификация е от съществено значение. Cardiac amyloidosis, once considered a rare disease, is a severe and progressive cardiomyopathy characterized by extracellular deposition of misfolded proteins in the ventricular myocardium. Early diagnosis of cardiac amyloidosis is essential for improving patient prognosis, as it allows for a broader range of therapeutic options that can enhance outcomes and/or prevent potentially irreversible loss of physical function and quality of life. Current data suggest that a majority of patients do not get a timely diagnosis. Patients with early-stage CA do not exhibit reduced global left ventricular systolic function but may develop symptoms of heart failure with preserved ejection fraction (HFpEF), with CA considered as one of the overlooked etiologies of HFpEF in the elderly. Cardiac amyloidosis is a progressive disease with a poor prognosis if left untreated. The average life expectancy of untreated patients with AL cardiac amyloidosis is less than 6 months, while that of patients with ATTR-CA is 2.5-3.5 years. Therefore, early clinical identifi cation is essential
NTProBNP AND HRV AND OUTCOME IN PATIENTS WITH HEART FAILURE WITH REDUCED VS. PRESERVED SYSTOLIC FUNCTION
No full textBackground: Heart failure /HF/ is usually associated with reduced systolic function. Elevated plasma concentrations of NTproBNP and heart rate variability /HRV/ are predictive of worse outcome in HF patients but there are few data about its predictive value in patients with HF and preserved systolic function.
Purpose and methods: The aim of this study was to determine the prognostic value of predischarge NT-proBNP and heart rate variability (HRV) in patients with reduced vs. preserved systolic function admitted for decompensated congestive HF. One hundred and twenty-seven patients were evaluated at the time of discharge by means of echocardiography, conventional laboratory tests, plasma for NTproBNP and Holter ECG for HRV. The primary endpoints of the study were defined as readmission for HF during the first 6 months after discharge, more than 2 hospitalizations for 1 year, or cardiac death.
Results: One hundred and twenty-one patients /95.3%/ were followed for mean of 387 ± 117 days. Fifty-four patients /44.6%/ had reduced systolic function. Despite of the significant differences in the clinical characteristics of the patients with HF with reduced vs preserved systolic function, prognosis in both groups was poor. Predischarge NTproBNP levels were predictive of worse outcome irrespectively of the systolic function. Kaplan-Meier survival curves showed that NTproBNP > 300 pg/ml was associated with significantly worse outcome in both groups and HRV<20 ms was predictive of event occurrence in the reduced systolic function group. HRV reflected the severity of the systolic dysfunction in the reduced systolic function group.
Conclusions: In hospitalized HF patients predischarge NTproBNP levels are associated with poor prognosis in HF patients irrespective of systolic function while HRV reflects the severity and poor prognosis only of heart failure with reduced systolic function
Torsion Mechanics as an Indicator of More Advanced Left Ventricular Systolic Dysfunction in Secondary Mitral Regurgitation in Patients with Dilated Cardiomyopathy: A 2D Speckle-Tracking Analysis
No full textLeft ventricular (LV) twist serves as a compensatory mechanism in systolic dysfunction and its degree of reduction may reflect a more advanced stage of disease. <b><i>Aim:</i></b> The aim was to investigate twist alterations depending on the degree of functional mitral regurgitation (MR) by speckle-tracking echocardiography. <b><i>Methods:</i></b> Sixty-three patients with symptomatic dilated cardiomyopathy (DCM) were included. Patients were divided according to MR vena contracta width (VCW): group 1 with VCW &#x3c;7 mm (mild/moderate MR) and group 2 with VCW ≥7 mm (severe MR). <b><i>Results:</i></b> There were no differences in LV geometry and function between groups. Group 2 showed lower endocardial basal rotation (BR) (–2.04° ± 1.83° vs. –3.23° ± 1.83°, <i>p</i> = 0.012); epicardial BR (–1.54° ± 1.18° vs. –2.31° ± 1.22°, <i>p</i> = 0.015); endocardial torsion (0.41°/cm ± 0.36°/cm vs. 0.63°/cm ± 0.44°/cm, <i>p</i> = 0.033) and mid-level circumferential strain (CSmid) (–6.12% ± 2.64% vs. –7.75% ± 2.90%, <i>p</i> = 0.028), when compared with group 1. Multivariable linear regression analysis identified endocardial BR, torsion and CSmid, as the best predictors of larger VCW. In the ROC curve analysis, endocardial BR and CSmid values greater than or equal to –3.63° and –9.35%, respectively, can differentiate patients with severe MR. <b><i>Conclusions:</i></b> In DCM patients, torsional profile was more altered in severe MR. Endocardial BR, endocardial torsion, and CSmid, can be used as indicators of advanced structural wall architecture damage.</jats:p
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