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Pathophysiological mechanisms in chronic heart failure (data from[3]). RAAS: Renin-Angiotensin-Aldosterone System; SNS: Sympathetic nervous systems.
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![Figure 3 Heart failure medication therapy (data from[1,51]). HFrEF:...](profile/Ivana-Sopek/publication/353526557/figure/fig3/AS:1050631087325186@1627501379827/Heart-failure-medication-therapy-data-from1-51-HFrEF-Heart-failure-with-reduced_Q320.jpg)
Heart failure (HF) is a major public health problem with a prevalence of 1%-2% in developed countries. The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs. HF is classified according to left ventricular ejection fraction (LVEF) and falls into three groups: LVEF ≥ 50% - HF with pr...
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Context 1
... main pathophysiological mechanisms leading to HF are increased hemodynamic overload, ischemia, myocardial dysfunction and remodelling, excessive neurohumoral stimulation -chronic sympathetic nervous system overactivity as one of the key pathophysiological mechanisms (in the acute phase, this upregulated sympathetic activity is an essential compensatory response initiated in order to compensate for reduced contractility, and cardiac output but in the long-term, it contributes to cardiac dysfunction as it leads to cardiac hypertrophy and cell dysfunction), activation of the renin-angiotensin-aldosterone system (RAAS), excessive or inadequate proliferation of the extracellular matrix, accelerated apoptosis, and genetic mutations [3][4][5][6] (Figure 1). HF is associated with a variety of complications, such as frequent hospitalizations, fatal arrhythmias, and death in the advanced stage of the disease. ...
Context 2
... main pathophysiological mechanisms leading to HF are increased hemodynamic overload, ischemia, myocardial dysfunction and remodelling, excessive neurohumoral stimulation -chronic sympathetic nervous system overactivity as one of the key pathophysiological mechanisms (in the acute phase, this upregulated sympathetic activity is an essential compensatory response initiated in order to compensate for reduced contractility, and cardiac output but in the long-term, it contributes to cardiac dysfunction as it leads to cardiac hypertrophy and cell dysfunction), activation of the renin-angiotensin-aldosterone system (RAAS), excessive or inadequate proliferation of the extracellular matrix, accelerated apoptosis, and genetic mutations [3][4][5][6] (Figure 1). HF is associated with a variety of complications, such as frequent hospitalizations, fatal arrhythmias, and death in the advanced stage of the disease. ...
Context 3
... main pathophysiological mechanisms leading to HF are increased hemodynamic overload, ischemia, myocardial dysfunction and remodelling, excessive neurohumoral stimulation -chronic sympathetic nervous system overactivity as one of the key pathophysiological mechanisms (in the acute phase, this upregulated sympathetic activity is an essential compensatory response initiated in order to compensate for reduced contractility, and cardiac output but in the long-term, it contributes to cardiac dysfunction as it leads to cardiac hypertrophy and cell dysfunction), activation of the renin-angiotensin-aldosterone system (RAAS), excessive or inadequate proliferation of the extracellular matrix, accelerated apoptosis, and genetic mutations [3][4][5][6] (Figure 1). HF is associated with a variety of complications, such as frequent hospitalizations, fatal arrhythmias, and death in the advanced stage of the disease. ...
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Augmented central systolic blood pressure (cSBP), which is known to affect the cardiac afterload, is an independent risk factor for cardiovascular disease. While an inverse relationship is known to exist between the heart rate (HR) and the cSBP, it has not yet been clarified if the HR also modulates the association between the cSBP and the c...
Heart failure with preserved ejection fraction (HFpEF) represents ∼50% of all cases of congestive heart failure (CHF) with prevalence expected to increase with aging of the population. We performed an observational study of all patients admitted to 3 hospitals in the ExcelaHealth care system, Greensburg, PA, with a primary diagnosis of HFpEF heart...
Aims:
Guidelines support the role of B-type natriuretic peptide (BNP) and amino-terminal pro-BNP (NT-proBNP) for risk stratification of patients in programmes to prevent heart failure (HF). Although biologically formed in a 1:1 ratio, the ratio of NT-proBNP to BNP exhibits wide inter-individual variability. A report on an Asian population suggests...
Citations
... The benefits from VAD usage are, therefore, clear, and this technology supports the advancement of heart failure management. (Merkaš et al., 2021). This has led to a decline in HF-related hospital admissions globally today due to the massive success of VAD therapy. ...
The ventricular assist device has become a reliable and enduring therapy for patients with end-stage heart failure, with over 22,000 implantations to date. Initially designed as a bridge-to-transplant option but now it has become permanent cure for patients with acute heart failure. VAD has significant advancements in medical management and technology, particularly with the introduction of newer-generation devices, have greatly enhanced patient outcomes. This progress has led to an increasing use of ventricular assist devices as a destination therapy. Nonetheless, the substantial burden of adverse events remains a critical challenge in the current state of ventricular assist device therapy, despite this, its viable alternative of heart transplantation as it has solved the complications of donor heart and proved significant success among patient with acute heart failure.
... It is important to emphasize that SGLT2 inhibitor-associated ketoacidosis presents with euglycemia or only modestly elevated glucose blood concentrations, which causes delayed detection and treatment of ketoacidosis. Some of the risk factors for developing ketoacidosis in patients treated with SGLT2 inhibitors are prior diabetic ketoacidosis, hemoglobin A1C above 10%, recent hypoglycemia, low baseline serum bicarbonate levels, use of digoxin and medications for dementia [11] or concomitant therapy with pioglitazone [12]. Given that thiazolidinediones, including pioglitazone, can cause fluid retention, as such are contraindicated in patients with NYHA class III and IV heart failure, and are not recommended in patients with symptomatic heart failure [2]. ...
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an insulin-independent class of oral antihyperglycemic medication and from recently established therapy in chronic heart failure patients. A rare, but potentially life-threatening complication of SGLT2 inhibitor use is euglycemic diabetic ketoacidosis. We described a case of a middle-aged male patient with type 2 diabetes who developed metabolic ketoacidosis after a few days of empagliflozin administration. SGLT2 inhibitor related ketoacidosis presents with euglycemia or only modestly elevated glucose blood concentrations, which causes delayed detection and treatment of ketoacidosis. There are multiple possible risk factors and mechanism that might contribute to the pathogenesis of ketoacidosis. It is implied that SGLT2 inhibitor use and prescription by non-diabetologists (cardiologists, nephrologists, family physicians, etc.) will continue to grow in the future. It is important to inform the general cardiac public about this rare but serious side effect of SGLT2 inhibitors.
... This leads to a lot of weariness, shortness of breath and edema. Early detection of CHF, according to some experts, expands treatment options and lowers mortality rates [10]. ...
... Early detection of CHF, according to some researchers, extends alternative treatments and lowers fatality rates [10]. Many researchers used ECG signals to conduct diagnostic investigations for heart disorders, to reduce the number of heart diseaserelated deaths. ...
The electrocardiogram (ECG) is a vital diagnostic tool for identifying a variety of cardiac disorders, including cardiac arrhythmia (ARR), sinus rhythms and heart failure. However, rapid interpretation of ECG recordings is quite important in the diagnosis of heart-related diseases. Many patients can be saved using the systems developed for the rapid and accurate analysis of ECG signals. A novel ensemble method based on shifted one-dimensional local binary patterns (S-1D-LBP) and long short-term memory (LSTM) is presented for the prognosis of ARR, normal sinus rhythm (NSR) and congestive heart failure (CHF) in this study. The ECG signals were first subjected to the S-1D-LBP method. Depending on the R and L parameters of this method, nine different signals are generated. Each of the histograms of these signals is given to LSTM models with the same hyperparameters. ECG signals are classified according to the common decisions of LSTM models with nine different input signals. The suggested method was tested using ECG signals (ARR, NSR and CHF) from the MIT-BIH and BIDMC datasets. Considering the results obtained in the applications carried out with various scenarios, it was observed that a high (99.6%) success rate was attained by the proposed approach. The suggested S-1D-LBP + ELSTM (Ensemble LSTM) model is expected to be safe to employ in the classification of various signals.
... This study was approved by the Institutional Review Board (Zhongshan Hospital, Fudan University, Shanghai, China: Number B2020-056), and conducted in a 40-bed cardiac surgical intensive care unit (ICU). Patients were eligible to participate in the study if they met all of the following criteria 1 : clinical manifestations suggesting CHF {congestion on chest radiograph, rales on chest auscultation, clinically relevant oedema or an elevated filling pressure [either central venous pressure (CVP) ≥ 12 mmHg or pulmonary artery wedge pressure (PAWP) ≥ 15 mmHg], and an increased N terminal pro BNP [NT-proBNP > 900 pg/mL]}, 2,18,19 weaning failure (failed spontaneous breathing test) and relied on mechanical ventilation, 3 haemodynamic monitoring via a pulmonary artery catheter, 4 decision from the attending physician to use rh-BNP. Exclusion criteria were 1 : patients < 18 years old, 2 pregnant, 3 haemodynamic instability (norepinephrine or epinephrine ≥ 0.1 μg/kg/min), 4 unable to tolerate postural and positive end-expiratory pressure (PEEP) changes, 5 arrythmias, and 6 severe acute kidney injury [KDIGO stage 3 20 or underwent renal replacement therapy (RRT)]. ...
Aims:
Recombinant human brain natriuretic peptide (rh-BNP) is commonly used as a decongestive therapy. This study aimed to investigate the instant effects of rh-BNP on cardiac output and venous return function in post-cardiotomy patients with congestive heart failure (CHF).
Methods and results:
Twenty-four post-cardiotomy heart failure patients were enrolled and received a standard loading dose of rh-BNP. Haemodynamic monitoring was performed via a pulmonary artery catheter before and after the administration of rh-BNP. The cardiac output and venous return functions were estimated by depicting Frank-Starling and Guyton curves. After rh-BNP infusion, variables reflecting cardiac congestion and venous return function, such as pulmonary artery wedge pressure, mean systemic filling pressure (Pmsf) and venous return resistance index (VRRI), reduced from 15 ± 3 to 13 ± 3 mmHg, from 32 ± 7 to 28 ± 7 mmHg and from 6.7 ± 2.6 to 5.7 ± 1.8 mmHg min m2 /L, respectively. Meanwhile, cardiac index, stroke volume index, and the cardiac output function curve remained unchanged per se. The decline in Pmsf [-13% (-22% to -8%)] and VRRI [-12% (-25% to -5%)] was much greater than that in the systemic vascular resistance index [-7% (-14% to 0%)]. In the subgroup analysis of reduced ejection fraction (<40%) patients, the aforementioned changes were more significant.
Conclusions:
rh-BNP might ameliorate venous return rather than cardiac output function in post-cardiotomy CHF patients.
... Likewise, interesting observations have been reported for MR-pro ADM regarding catheter ablation, infectious endocarditis, and transcatheter aortic valve replacement [101][102][103][104]. Wallentin et al. performed a comparative analysis of the importance of biomarkers in chronic coronary heart disease and reported that NT-pro-BNP, troponin-T, and BNP demonstrate high importance, while AM remains less important [105]. Current guidelines recommend only BNP and/or NT-pro-BNP as markers for HF management [106]. AM is an inhibitor of tissue congestion; thus, AM and MR-pro ADM are attractive and superior biomarkers for tissue congestion, such as edema and pulmonary congestion [41,76]. ...
Adrenomedullin (AM) is a vasodilative peptide with various physiological functions, including the maintenance of vascular tone and endothelial barrier function. AM levels are markedly increased during severe inflammation, such as that associated with sepsis; thus, AM is expected to be a useful clinical marker and therapeutic agent for inflammation. However, as the increase in AM levels in cardiovascular diseases (CVDs) is relatively low compared to that in infectious diseases, the value of AM as a marker of CVDs seems to be less important. Limitations pertaining to the administrative route and short half-life of AM in the bloodstream (<30 min) restrict the therapeutic applications of AM for CVDs. In early human studies, various applications of AM for CVDs were attempted, including for heart failure, myocardial infarction, pulmonary hypertension, and peripheral artery disease; however, none achieved success. We have developed AM as a therapeutic agent for inflammatory bowel disease in which the vasodilatory effect of AM is minimized. A clinical trial evaluating this AM formulation for acute cerebral infarction is ongoing. We have also developed AM derivatives that exhibit a longer half-life and less vasodilative activity. These AM derivatives can be administered by subcutaneous injection at long-term intervals. Accordingly, these derivatives will reduce the inconvenience in use compared to that for native AM and expand the possible applications of AM for treating CVDs. In this review, we present the latest translational status of AM and its derivatives.
In accordance with the guidelines established by prominent European and global cardiology associations, comprehensive cardiac rehabilitation (CR) stands as an officially endorsed and highly recommended therapeutic approach (class I recommendations; level of evidence A) for a diverse spectrum of cardiac patients. Nevertheless, it is a cause for concern to observe that fewer than 50% of eligible patients are being effectively referred for CR, whether in an outpatient or inpatient setting. Concurrently, studies reveal that a substantial proportion of individuals with atherosclerotic cardiovascular disease maintain unhealthy lifestyles and exhibit suboptimal management of modifiable cardiovascular risk factors, including hypertension, lipid levels, and diabetes. Beyond the conventional patient profile encompassing those recovering from acute coronary syndrome with or without percutaneous coronary intervention, as well as patients who have undergone coronary or valvular surgery, contemporary CR now emphasizes specialized subgroups of patients. These include frail elderly patients, the female population with its unique considerations, individuals burdened by multiple cardiovascular comorbidities, those who have developed psychological consequences due to a cardiac illness and particularly those grappling with chronic heart failure. This editorial seeks to offer a state-of-the-art assessment of the significance and role of comprehensive CR within modern cardiology.
Background
Traditional Chinese eight brocade exercise (TCEBE) with same cycle and frequency and different durations has an effect on patients with chronic heart failure (CHF). However, relevant reports on the topic are lacking.
Objective
This study aims to explore the differences of rehabilitation effect by conducting TCEBE with the same cycle and frequency and different single exercise time for patients with CHF.
Methods
A total of 103 patients with CHF were randomly divided into long-time group (LTG), short-time group (STG) and control group (CG). The subjects in the three groups were given corresponding routine treatment. In addition, under the guidance of professional TCEBE coaches and nurses, TCEBE was conducted for 12 weeks (3 times/week) for LTG (60 min/time) and STG (30 min/time). Minnesota living with heart failure questionnaire (MLHFQ) was used, and 6-min walk (6MWK) and brain nautical peptide (BNP) were tested.
Results
1) At 12 weeks, the comparison between groups obtained the following results: For the LTG, MLHFQ was less than that of the CG (P < 0.01), 6MWT was greater than that of the CG (P < 0.05), and 6MWT was greater than that of the STG (P < 0.05); for the STG, MLHFQ was less than that of the CG (P < 0.05); no significant difference in BNP was found among the three groups; 2) At 12 weeks and 0 weeks, the comparison obtained the following results: For the LTG, MLHFQ decreased by 37.7 %, and 6MWT increased by 46.7 % (P < 0.01); for the STG, MLHFQ decreased by 31.7 %, and 6MWT increased by 31.5 % (P < 0.01); for the CG, MLHFQ decreased by 14.6 %, and 6MWT increased by 19.7 % (P < 0.05); no significant change in BNP was found in each group.
Conclusion
TCEBE of two kinds of duration improves the quality of life and 6MWT of patients with CHF but has no positive effect on BNP. Compared with 30-min/time, 60-min/time further improves 6MWT in patients with CHF but has no additional benefit on quality of life.
