1,297 research outputs found
Vasopressin receptor blockade with tolvaptan in chronic heart failure: differential effects in normonatremic and hyponatremic patients
The Effect of Ventricular Assist Devices on Post-Transplant Mortality An Analysis of the United Network for Organ Sharing Thoracic Registry
ObjectivesThis study sought to determine the relationship between pre-transplant ventricular assist device (VAD) support and mortality after heart transplantation.BackgroundIncreasingly, VADs are being used to bridge patients to heart transplantation. The effect of these devices on post-transplant mortality is unclear.MethodsPatients 18 years or older who underwent first-time, single-organ heart transplantation in the U.S. between 1995 and 2004 were included in the analyses. This study compared 1,433 patients bridged with intracorporeal and 448 patients bridged with extracorporeal VADs with 9,455 United Network for Organ Sharing status 1 patients not bridged with a VAD with respect to post-transplant mortality. Because the proportional hazards assumption was not met, hazard ratios (HRs) for different time periods were estimated.ResultsIntracorporeal VADs were associated with an HR of 1.20 (95% confidence interval [CI]: 1.02 to 1.43; p = 0.03) for mortality in the first 6 months after transplant and an HR of 1.99 (95% CI: 1.44 to 2.75; p < 0.0001) beyond 5 years. Between 6 months and 5 years, the HRs were not significantly different from 1. Extracorporeal VADs were associated with an HR of 1.91 (95% CI: 1.53 to 2.37; p < 0.0001) for mortality in the first 6 months and an HR of 2.93 (95% CI: 1.19 to 7.25; p = 0.02) beyond 5 years. The HRs were not significantly different from 1 between 6 months and 5 years, except for an HR of 0.23 (95% CI: 0.06 to 0.91; p = 0.04) between 24 and 36 months.ConclusionsExtracorporeal VADs are associated with higher mortality within 6 months and again beyond 5 years after transplantation. Intracorporeal VADs are associated with a small increase in mortality in the first 6 months and a clinically significant increase in mortality beyond 5 years. These data do not provide evidence supporting VAD implantation in stable United Network for Organ Sharing status I patients awaiting heart transplantation
EARLY AND LATE EFFECTS OF ANGIOTENSIN RECEPTOR BLOCKADE ON KIDNEY FUNCTION IN PATIENTS WITH CHRONIC HEART FAILURE
Vasopressin V1 receptorâmediated aldosterone production as a result of selective V2 receptor antagonism: a potential explanation for the failure of tolvaptan to reduce cardiovascular outcomes in the EVEREST trial
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106076/1/ejhfhfr150.pd
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Newly diagnosed heart failure: change in quality of life, mood, and illness beliefs in the first 6 months after diagnosis
Objectives. This study sought to examine how patientsâ mood and quality of life (QoL) change during the early high-risk period after a diagnosis of heart failure (HF) and to identify factors that may influence change.
Design. A within-subjects, repeated-measures design was used. Assessments took place within 4 weeks of diagnosis and 6 months later.
Methods. One hundred and sixty six patients with HF completed assessments of their mood, QoL, and beliefs about HF and its treatment. Correlation analysis was conducted between the variables and analysis of variance and t-tests were used to assess differences in categorical variables. To examine which variables predicted mood and QoL, hierarchical multiple regressions were conducted.
Results. At follow-up, patientsâ beliefs indicated a realization of the chronicity of their HF, however their beliefs about the consequences of having HF did not change and their satisfaction with their treatment remained high. QoL and anxiety improved significantly over time but there was no significant change in depressed mood. As would be expected, improvement in symptoms was a key factor in improved mood and QoL. Other significant explanatory variables included age, comorbid chronic obstructive pulmonary disease, depressed mood, patientsâ beliefs about the consequences of their HF and their concerns about treatment.
Conclusions. This study suggests that addressing patientsâ mood and beliefs about their illness and its treatment may be additional ways of improving patient QoL in the early period after the diagnosis of HF
V2 Receptor Antagonist; Tolvaptan
Hyponatremia is the most common electrolyte disorder in hospitalized patients. Many studies documented that it was related to increased morbidity and mortality in patients with congestive heart failure, liver cirrhosis, and neurologic diseases. Although knowledge of hyponatremia has been cumulated, the optimal management of hyponatremia remains incompletely established in clinical practice because of the diversity of underlying disease states, and its multiple causes with differing pathophysiologic mechanisms. Since vasopressin receptor antagonists have unique aquaretic effect to selectively increase electrolytes-free water excretion, clinicians could apply a more effective method to treat hyponatremia. Tolvaptan has significant evidence that it improves serum sodium levels in patients with euvolemic or hypervolemic hyponatremia related with heart failure, cirrhosis or syndrome of inappropriate anti-diuretic hormone. Tolvaptan has acceptable safety and tolerability for long-term usage in chronic hyponatremia, and the beneficial effects on serum Na+ occurred in patients with both mild and marked hyponatremia
The Use of Titanium Mesh Cages in the Reconstruction of Anterior Column Defects in Active Spinal Infections: Can We Rest the Crest?
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