20 research outputs found
Calcium channel blockers in heart failure
AbstractThe rationale for the use of calcium enamel bleckers in patients with chronic heart failure lies in their vasodilator action, antiischemic effect, ability to lessen left ventricular diastole dysfunction and data showing their effect in preventing progression of myocardiai dysfunction in animals with cardiomyopathy. Despite initial studies reporting improvement of the hemodynamic profile with nifedipine, further evaluation showed variable results, with hemodynamic worsening seen in up to 29% of patients. Longer-term controued studies evaluating Symptoms and clinical status demonstrated worsening chronic heart failure in ~25% of patients within 8 weeks of nifedipine therapy. Although diltiazem has a lesser myo cardial depresseset effect and its short-term use was associated with less frequent hemodynamic and clinical worsening, long-tern exposure te the drug in a large group of paients with chronic heart failure due to left ventricular systolic dysfunction after myocardial infarction resulted in an increased incidence of cardiac events, with worsening heart failure and death. The use of verapamil in a simiar patient cohort showed the loss of its demostrated protective effect in patients with clinical evidence of heart failure.In an attempt to improve the safety of calcium channel blockers, the following approaches were suggested 1) use of second-generation drugs with less myocardial depressant effect; 2) concomitant use of angiotensin-converting enzyme inhibitors to prevent reported neurohormonal activation; and 3) development of drugs with favorable neurohormonal effects. These approaches led to mixed results. The use of some second-generation calcium channel blockers such as nisoldipine, felodipine and nicardipine resulted in no change or worsening of clinical status, which did not seem to be prevented by concomitant use of angiotensin-converting enzyme inhibitors. A recent study using amlodipine demonstrated improvement of both the clinical and neurohormonal profiles. Two large ongoing studies are evaluating the effects of felodipine and amlodipine on morbidity and mortality of patients with chronic heart failure and are likely to provide further information regarding the role of calcium blockers in the treatment of this condition
TCT-274 A Randomized Prospective Study of Same Day Discharge after Coronary Artery Stenting and Facilitated Femoral Hemostasis with a Closure Device
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Percutaneous Retrieval of an Embolized Transcatheter Mitral Valve Repair Clip Causing ST-Segment Elevation Myocardial Infarction
Mitral valve repair clip detachment and embolization is a rare phenomenon, with few reported cases. We describe a case of subacute transcatheter mitral valve repair clip embolization presenting as an inferior ST-segment elevation myocardial infarction, with subsequent successful percutaneous device retrieval. (Level of Difficulty: Intermediate.)
CRT-162 Impella® and Tandem Heart® for Circulatory Support in Refractory Cardiogenic Shock
CRT-100.95 Drug Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Interventions. Evidence From a Meta-analysis of Randomized Controlled Trials
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Comparison of the Tolvaptan Versus Furosemide-Based Diuretic Regimes in Patients Hospitalized for Heart Failure with Hyponatremia (AQUA-AHF)
Hyponatremia is associated with worse longitudinal outcomes, and recently, poorer diuretic response in patients hospitalized for heart failure (HF). Whether tolvaptan monotherapy is a viable alternative to intravenous loop diuretics for decongestive therapy has not been tested. This study prospectively compared the efficacy and safety of a tolvaptan-based versus furosemide-based diuretic regimen on short-term outcomes in hyponatremic acute HF patients.
Prospective, randomized, open-label, parallel-group, pilot study comparing a tolvaptan-based versus conventional continuous infusion furosemide-based regimen. Thirty-three subjects requiring hospitalization for acute HF with evidence of volume overload, and a serum sodium < 135 mEq/L within 48h of presentation were randomized to tolvaptan 30mg PO once daily or furosemide 5mg/h IV for the initial 24h, after which treatments could be escalated if required. Primary efficacy and safety endpoints were mean urine output and mean change in GFR at 24h post randomization. Additional endpoints included net fluid balance, changes in laboratory markers (electrolytes, cystatin C, NT-proBNP, plasma renin), weight, and dyspnea up to 96h post-randomization.
Tolvaptan subjects were less often male (61 vs 93%) and had lower LVEF (24 vs 33%). Age, home diuretic dose, baseline serum sodium and vitals were not different. Four subjects in each group required study drug dose escalation (median daily dose throughout was tolvaptan 30mg and furosemide 120mg). Urine output and net fluid balance was not significantly different between tolvaptan or furosemide groups at 24h or any subsequent time point up to 96h. GFR tended to increase with tolvaptan, whereas it decreased with furosemide. Cystatin C improved at 24h with tolvaptan and the % change was significant compared to furosemide (-6.4±11.8 vs 4.1±17.2 % change, p=0.036). No significant between group differences were seen at 24h or study drug discontinuation/96h for NT-proBNP or PRA. As expected, serum sodium and potassium increased with tolvaptan compared to furosemide. Proportion with self-reported dyspnea that was moderately or markedly better at 24h was not different between groups (44% tolvaptan vs 27% furosemide, p=0.469). No major adverse events occurred.
Diuresis with tolvaptan was similarly effective compared to intravenous furosemide for acute HF. Tolvaptan was associated with signals for improved renal and electrolyte safety, however the clinical significance needs to be tested in a larger study