39 research outputs found
Vasemman kammion mekaaninen tukihoito : siltahoito tai vaihtoehto sydÀmensiirrolle
SydĂ€men vajaatoiminnan osuus ihmisten sairastuvuudessa ja kuolleisuudessa on edelleen merkittĂ€vĂ€ lÀÀke- ja muun hoidon kehityksestĂ€ huolimatta. SydĂ€mensiirto on paras loppuvaiheen vaikeaa sydĂ€men vajaatoimintaa sairastavan potilaan hoitomuoto, kun mikÀÀn muu hoito ei auta. SydĂ€mensiirtojen mÀÀrÀÀ rajoittaa kuitenkin pula siirrĂ€nnĂ€isistĂ€. Aikaisemmin verenkierron mekaanista tukihoitoa kĂ€ytettiin lyhytaikaisena siltahoitona vajaatoiminnan Âloppuvaiheesta sydĂ€mensiirtoon. Viime vuosina tapahtunut kehitys on moninkertaistunut verenkierron mekaanisen tukihoidon kĂ€ytön vaikeassa sydĂ€men vajaatoiminnassa siltahoitona tai vaihtoehtona sydĂ€mensiirrolle. Mekaanisesti sydĂ€men vasenta kammiota ja systeemiverenkiertoa tukevasta hoidosta saattaa tulla merkittĂ€vĂ€ vaihtoehto sydĂ€mensiirrolle, sillĂ€ tarkasti valikoiduilla potilailla kahden vuoden elinajan ennuste lĂ€hentelee sydĂ€mensiirtopotilaiden ennustetta.Peer reviewe
Assessment of Metabolic Phenotypes in Patients with Non-ischemic Dilated Cardiomyopathy Undergoing Cardiac Resynchronization Therapy
Studies of myocardial metabolism have reported that contractile performance at a given myocardial oxygen consumption (MVO2) can be lower when the heart is oxidizing fatty acids rather than glucose or lactate. The objective of this study is to assess the prognostic value of myocardial metabolic phenotypes in identifying non-responders among non-ischemic dilated cardiomyopathy (NIDCM) patients undergoing cardiac resynchronization therapy (CRT). Arterial and coronary sinus plasma concentrations of oxygen, glucose, lactate, pyruvate, free fatty acids (FFA), and 22 amino acids were obtained from 19 male and 2 female patients (mean age 56â±â16) with NIDCM undergoing CRT. Metabolite fluxes/MVO2 and extraction fractions were calculated. Flux balance analysis (FBA) was performed with MetaFluxNet 1.8 on a metabolic network of the cardiac mitochondria (189 reactions, 230 metabolites) reconstructed from mitochondrial proteomic data (615 proteins) from human heart tissue. Non-responders based on left ventricular ejection fraction (LVEF) demonstrated a greater mean FFA extraction fraction (35%â±â17%) than responders [18â±â10%, pâ=â0.0098, area under the estimated ROC curve (AUC) was 0.8238, S.E. 0.1115]. Calculated adenosine triphosphate (ATP)/MVO2 using FBA correlated with change in New York Heart Association (NYHA) class (rhoâ=â0.63, pâ=â0.0298; AUCâ=â0.8381, S.E. 0.1316). Non-responders based on both LVEF and NYHA demonstrated a greater mean FFA uptake/MVO2 (0.115â±â0.112) than responders (0.034â±â0.030, pâ=â0.0171; AUCâ=â0.8593, S.E. 0.0965). Myocardial FFA flux and calculated maximal ATP synthesis flux using FBA may be helpful as biomarkers in identifying non-responders among NIDCM patients undergoing CRT
Acute coronary syndromes and acute heart failure:a diagnostic dilemma and high-risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology
Acute coronary syndrome is a precipitant of acute heart failure in a substantial proportion of cases, and the presence of both conditions is associated with a higher risk of short-term mortality compared to acute coronary syndrome alone. The diagnosis of acute coronary syndrome in the setting of acute heart failure can be challenging. Patients may present with atypical or absent chest pain, electrocardiograms can be confounded by pre-existing abnormalities, and cardiac biomarkers are frequently elevated in patients with chronic or acute heart failure, independently of acute coronary syndrome. It is important to distinguish transient or limited myocardial injury from primary myocardial infarction due to vascular events in patients presenting with acute heart failure. This paper outlines various clinical scenarios to help differentiate between these conditions and aims to provide clinicians with tools to aid in the recognition of acute coronary syndrome as a cause of acute heart failure. Interpretation of electrocardiogram and biomarker findings, and imaging techniques that may be helpful in the diagnostic work-up are described. Guidelines recommend an immediate invasive strategy for patients with acute heart failure and acute coronary syndrome, regardless of electrocardiographic or biomarker findings. Pharmacological management of patients with acute coronary syndrome and acute heart failure should follow guidelines for each of these syndromes, with priority given to time-sensitive therapies for both. Studies conducted specifically in patients with the combination of acute coronary syndrome and acute heart failure are needed to better define the management of these patients
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC
2016 ESC on Acute and Chronic H
Highlights of the 2009 scientific sessions of the European Society of Cardiology
The annual congress of the European Society of Cardiology
(ESC) was held in Barcelona, Spain, August 29 to September
2, 2009. The total attendance was 31,323 participants
from 136 different countries. Excellent congress facilities
hosted 237 pre-arranged sessions in 30 meeting rooms
running in parallel, including several joint sessions in
collaboration with other societies (e.g., the American College
of Cardiology, the American Heart Association, and
the World Heart Federation). A total of 9,848 abstracts
from 96 different countries was submitted, and 4,085 (42%)
abstracts were selected for presentation