1,721,120 research outputs found
Heart failure: pathophysiology and clinical picture.
No full textDespite its high prevalence and significant rates of associated morbidity and mortality, the syndrome of decompensated heart failure (HF) remains poorly defined and vastly understudied. HF is due to several mechanisms including pump dysfunction disorder, neurohormonal activation disorder, and salt-water retention disorder. The first step of the syndrome includes cardiac damage and remodeling in terms of coronary disease systo diastolic dysfunction and myocardial metabolism alterations. Neurohormonal activation and hydrosaline retention occur during successive steps in response to cardiac injury for compensatory reasons. Both mechanisms provide inotropic support to the failing heart increasing stroke volume, and peripheral vasoconstriction to maintain mean arterial perfusion pressure. However, they are deleterious to cardiocirculatory homeostasis in the late stage. Further factors involve structural changes, such as loss of myofilaments, apoptosis and disorganization of the cytoskeleton, as well as disturbances in Ca homeostasis, alteration in receptor density, signal transduction, and collagen synthesis. Each disorder contributes at a different time to HF development and worsening. Clinical presentation depends on pulmonary congestion, organ perfusion, presence of coronary disease, fluid retention and systemic pressure. For these reasons, the picture of HF is widely varied
Kidney disease in heart failure: the importance of novel biomarkers for type 1 cardio-renal syndrome detection
No full textChronic kidney disease (CKD) in heart failure (HF) has been recognized as an independent risk factor for adverse outcome, although the most important clinical trials tend to exclude patients with moderate and severe renal insufficiency. Despite this common association, the precise pathophysiological connection and liaison between heart and kidney is partially understood. Moreover, is it not enough considering how much cardio-renal syndrome type 1 is attributable to previous CKD, and how much to new-onset acute kidney injury (AKI). Neither development of AKI, its progression and time nor duration is related to an adverse outcome. An AKI definition is not universally recognized, and many confounding terms have been used in literature: “worsening renal function”, “renal impairment”, “renal dysfunction”, etc., are all names that contribute to misunderstanding, and do not facilitate an universal classification. Therefore, AKI development should be the consequence of the basal clinical characteristics of patients, different primitive kidney disease and hemodynamic status. AKI could also be the mirror of several underlying associated diseases poorly controlled. Finally, it is not clear which is the optimal laboratory tool for identifying patients with an increased risk of AKI. In the current report, we review the different kidney diseases’ impact in HF, and we analyze the modalities for AKI recognition during HF focusing our attention about some new biomarkers with potential application in the current setting
Constrictive pericarditis in Erdheim-Chester disease: an integrated echocardiographic and magnetic resonance approach
No full textFrom gene mutations to biomechanical abnormalities and electrophysiological remodeling in hypertrophic cardiomyopathy: exploring the translational approach.
Full text linkAbnormal balance of inward and outward ion currents in HCM ventricular cardiomyocytes determines a reduced lusitropic response to beta-adrenergic stimulation, due to insufficient APD and Ca2+ transient shortening. In HCM patients, this translates into exercise-induced QTc prolongation, TQ shortening and impaired diastolic reserve, contributing to reduced exercise tolerance. MYBPC3-related HCM showed increased long-term prevalence of systolic dysfunction compared to MHY7, in spite of similar outcome. This trend was subtended by an age-related decline in contractile performance in vitro in MYBC3 but not in MHY7 samples. Such observations suggest different pathophysiology of clinical progression in the two subsets and may prove relevant for understanding of genotype-phenotype correlations in HC
Does the Measurement of Ejection Fraction Still Make Sense in the HFpEF Framework? What Recent Trials Suggest
No full textLeft ventricular ejection fraction (LVEF) is universally accepted as a cardiac systolic function index and it provides intuitive interpretation of cardiac performance. Over the last two decades, it has erroneously become the leading feature used by clinicians to characterize the left ventricular function in heart failure (HF). Notably, LVEF sets the basis for structural and functional HF phenotype classification in current guidelines. However, its diagnostic and prognostic role in patients with preserved or mildly reduced contractile function is less clear. This is related to several concerns due to intrinsic technical, methodological and hemodynamic limitations entailed in LVEF measurement that do not describe the chamber’s real contractile performance as expressed by pressure volume loop relationship. In patients with HF and preserved ejection fraction (HFpEF), it does not reflect the effective systolic function because it is prone to preload and afterload variability and it does not account for both longitudinal and torsional contraction. Moreover, a repetitive measurement could be assessed over time to better identify HF progression related to natural evolution of disease and to the treatment response. Current gaps may partially explain the causes of negative or neutral effects of traditional medical agents observed in HFpEF. Nevertheless, recent pooled analysis has evidenced the positive effects of new therapies across the LVEF range, suggesting a potential role irrespective of functional status. Additionally, a more detailed analysis of randomized trials suggests that patients with higher LVEF show a risk reduction strictly related to overall cardiovascular (CV) events; on the other hand, patients experiencing lower LVEF values have a decrease in HF-related events. The current paper reports the main limitations and shortcomings in LVEF assessment, with specific focus on patients affected by HFpEF, and it suggests alternative measurements better reflecting the real hemodynamic status. Future investigations may elucidate whether the development of non-invasive stroke volume and longitudinal function measurements could be extensively applied in clinical trials for better phenotyping and screening of HFpEF patients
Natriuretic peptides in heart failure: where we are, where we are going.
Full text linkTremendous advances have been made in understanding the pathophysiology and
treatment of congestive heart failure (CHF). However, diagnosis still remains
difficult, even with a comprehensive physical examination. Symptoms such as
dyspnea are non-specific and poorly sensitive indicators for early CHF that can
be largely undetected. The discovery of natriuretic peptides (BNP) as diagnostic
biomarkers has been one of the most critical advances for heart failure
diagnosis. Therefore, both B-type and N-terminal pro-B-type have potential role
in the diagnosis of heart failure, as well as in prognostic risk assessment. A
single determination of BNP at any time during the progression of chronic HF
provides a clinically useful tool for risk stratification. The hypothesis that
repeated measurements might carry prognostic information beyond a single measure
was confirmed in different settings. One of the main interests is given to the
values of repeated determinations for monitoring progression of disease, and for
the evaluation of the clinical effects of medical therapy. Nevertheless, despite
thousands of papers describing their potential utility, current guidelines have
not endorsed the highest level of recommendation for their use, in part, because
the application in clinical practice is often limited for the absence of well
codified cut off. Recently, European guidelines emphasized the role of
natriuretic peptides as potential laboratory markers. In the near future,
algorithm building will take into consideration clinical and echocardiographic
parameters as well as NP measurements, and this may lead to a correct diagnosis
and identification of patients at high risk. The purpose of this review is to
discuss the clinical approaches and future applications of natriuretic peptides
in heart failure and coronary diseas
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