Ultrafiltration in Diuretic Resistant Congestive Heart Failure

Diuretic therapy has been the cornerstone of the medical treatment in patients with heart failure for the last fifty years. However, despite the fact that the majority of them are on diuretics, fluid balance remains a challenge for their physicians. Poor response, diuretic resistance, worsening of kidney function, electrolyte disturbances, and diuretic therapy associated morbidity and mortality have stimulated interest to develop effective and safe treatment strategies that improve decongestion and preserve kidney function. Ultrafiltration has been used to remove fluid from diuretic-refractory hypervolemic patients. Recently clinical studies have suggested that ultrafiltration may be highly effective for decongesting patients with either chronic or acutely decompensated heart failure... (excerpt

Patient Inclusion Criteria for Left Ventricular Assist Device

Mechanical cardiac circulatory support has been established as a benefactory treatment modality for patients with end stage heart failure. There is a variety of ventricular assist devices (VAD) that are available for implantation depending on patients’ clinical characteristics, type of heart failure and intention of treatment. Current indications of VAD placement are: a) bridge to transplant, for patients who are transplant candidates but who will not survive waiting until an organ is available, b) destination therapy, for patients who are not transplant candidates, c) bridge to recovery, for patients in whom the native heart function may possibly recover... (excerpt

Electrocardiographic and Electrophysiologic Characteristics of Ventricular Extrasystoles Arising from the Aortomitral Continuity

Left ventricular outflow tract arrhythmias originating from the aortomitral continuity, the left coronary cusp, the superior basal septum, and the epicardial left ventricular summit display common electrocardiographic and electrophysiological features, probably due to the close proximity of those locations. Catheter ablation of these arrhythmias can be challenging. The case of a 68-year-old male with frequent premature ventricular extrasystoles arising from the aortomitral continuity of the basal left ventricle is described. The electrocardiographic and electrophysiologic characteristics of this arrhythmia are discussed

How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association

Heart failure (HF) is rapidly growing, conferring considerable mortality, morbidity, and costs. Dedicated HF clinics improve patient outcomes, and the development of a national HF clinics network aims at addressing this need at national level. Such a network should respect the existing health care infrastructures, and according to the capacities of hosting facilities, it can be organized into three levels. Establishing the continuous communication and interaction among the components of the network is crucial, while supportive actions that can enhance its efficiency include involvement of multidisciplinary health care professionals, use of structured HF-specific documents, such as discharge notes, patient information leaflets, and patient booklets, and implementation of an HF-specific electronic health care record and database platform

Immunological disorders in chronic heart failure

Chronic heart failure (CHF) is characterized by hemodynamic disturbances, neurohormonal stimulation and activation of immune system, which maintains a low grade chronic inflammation via the production of proinflammatory cytokine, release of antibodies by B-lymphocytes and differentiation of subpopulations of T-lymphocytes.We saught to investigate the changes in WBC subpopulations in systolic CHF patients, understand their contribution to the blunted defense observed in advanced stages and identify their cellular immunological profile and potential presence of immunosenescence. We enrolled 86 patients with systolic CHF (66 males) with mean age 68.4±11,6 years. Nine patients (10.5%) were NYHA I or II, 33 (38.4%) NYHA III and 44 (51.1%) NYHA IV. The mean LVEF was 29,5±7,5%. Patients with advanced CHF NYHA IV exhibited significantly increased neutrophils and decreased lymphocytes. B-lymphocytes were significantly reduced and T-helpers increased, whereas the cytotoxic were reduced. T-helper cells showed intense differentiation and aging in NYHA IV patients. There was a statistically significant reduction of naive T-cells and increase in memory T-cells in these patients in comparison with those in NYHA III or I-II.Our study demonstrates the existence of significant immunosenescence in patients with advanced CHF, increased populations of highly differentiated and reduced populations of undifferentiated T-helper.Η χρόνια συστολική καρδιακή ανεπάρκεια (ΧΣΚΑ) χαρακτηρίζεται από αιμοδυναμικές διαταραχές, νευροορμονική διέγερση και ενεργοποίηση του ανοσολογικού συστήματος, που διατηρεί μια χαμηλής έντασης χρόνια φλεγμονή μέσω παραγωγής προφλεγμονωδών κυτοκινών, απελευθέρωσης αντισωμάτων από τα Β-λεμφοκύτταρα και διαφοροποίησης των υποπληθυσμών των Τ-λεμφοκυττάρων. Θελήσαμε να διερευνήσουμε την αλλαγές των υποπληθυσμών των λευκών αιμοσφαιρίων στη ΧΣΚΑ, τη συμβολή τους στην αμβλυμένη άμυνα στα προχωρημένα στάδια, το κυτταρικό ανοσολογικό προφίλ και την ύπαρξη ανοσογήρανσης. Συμπεριλάβαμε 86 ασθενείς με ΧΣΚΑ (66 άνδρες), μέσης ηλικίας 68,4±11,6 ετών, μέσο κλάσμα εξώθησης 29,5±7,5%, εννέα ασθενείς (10,5%) ΝΥΗΑ Ι-ΙΙ, 33 (38,4%) ΝΥΗΑ ΙΙΙ και 44 (51,1%) ΝΥΗΑ IV. Εξετάσαμε τους υποπληθυσμούς των λευκών αιμοσφαιρίων σε σχέση με τη λειτουργική κατάσταση ΝΥΗΑ. Οι ΝΥΗΑ IV ασθενείς παρουσίαζαν στατιστικά σημαντικά αυξημένα ουδετερόφιλα και μειωμένα λεμφοκύτταρα, Β-λεμφοκύτταρα σημαντικά μειωμένα και βοηθητικά Τ-λεμφοκύτταρα αυξημένα, ενώ τα κυτταροτοξικά Τ λεμφοκύτταρα ήταν μειωμένα. Τα βοηθητικά Τ-λεμφοκύτταρα εμφάνιζαν έντονη διαφοροποίηση και γήρανση σε ασθενείς με ΝΥΗΑ IV. Υπήρχε στατιστικά σημαντική μείωση των παρθένων Τ-κυττάρων και αύξηση των Τ-κυττάρων μνήμης στους ασθενείς με ΝΥΗΑ IV σε σχέση με εκείνους με ΝΥΗΑ ΙΙΙ, Ι-ΙΙ. Η μελέτη αποδεικνύει την παρουσία ανοσογήρανσης σε ασθενείς με ΧΣΚΑ ΝΥΗΑ IV με αυξημένους πληθυσμούς διαφοροποιημένων και μειωμένους πληθυσμούς αδιαφοροποίητων Τ-βοηθητικών λεμφοκυττάρων

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD

Cardiac contractility modulation in patients with heart failure - A review of the literature.

Experimental in vivo and in vitro studies showed that electric currents applied during the absolute refractory period can modulate cardiac contractility. In preclinical studies, cardiac contractility modulation (CCM) was found to improve calcium handling, reverse the foetal myocyte gene programming associated with heart failure (HF), and facilitate reverse remodeling. Randomized control trials and observational studies have provided evidence about the safety and efficacy of CCM in patients with HF. Clinically, CCM therapy is indicated to improve the 6-min hall walk, quality of life, and functional status of HF patients who remain symptomatic despite guideline-directed medical treatment without an indication for cardiac resynchronization therapy (CRT) and have a left ventricular ejection fraction (LVEF) ranging from 25 to 45%. Although there are promising results about the role of CCM in HF patients with preserved LVEF (HFpEF), further studies are needed to elucidate the role of CCM therapy in this population. Late gadolinium enhancement (LGE) assessment before CCM implantation has been proposed for guiding the lead placement. Furthermore, the optimal duration of CCM application needs further investigation. This review aims to present the existing evidence regarding the role of CCM therapy in HF patients and identify gaps and challenges that require further studies. [Abstract copyright: © 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Cardiac contractility modulation in patients with heart failure — A review of the literature

Experimental in vivo and in vitro studies showed that electric currents applied during the absolute refractory period can modulate cardiac contractility. In preclinical studies, cardiac contractility modulation (CCM) was found to improve calcium handling, reverse the foetal myocyte gene programming associated with heart failure (HF), and facilitate reverse remodeling. Randomized control trials and observational studies have provided evidence about the safety and efficacy of CCM in patients with HF. Clinically, CCM therapy is indicated to improve the 6-min hall walk, quality of life, and functional status of HF patients who remain symptomatic despite guideline-directed medical treatment without an indication for cardiac resynchronization therapy (CRT) and have a left ventricular ejection fraction (LVEF) ranging from 25 to 45%. Although there are promising results about the role of CCM in HF patients with preserved LVEF (HFpEF), further studies are needed to elucidate the role of CCM therapy in this population. Late gadolinium enhancement (LGE) assessment before CCM implantation has been proposed for guiding the lead placement. Furthermore, the optimal duration of CCM application needs further investigation. This review aims to present the existing evidence regarding the role of CCM therapy in HF patients and identify gaps and challenges that require further studies

The impact of vagotonic, adrenergic, and random type of paroxysmal atrial fibrillation on left atrial ablation outcomes

Background: Accumulating data have shown that the autonomic nervous system is strongly implicated in the genesis of atrial fibrillation (AF). The aim of this study was to assess the efficacy of a single ablation procedure in patients with vagotonic, adrenergic and random type of paroxysmal AF. Methods and results: The clinical records of consecutive patients with symptomatic, drug-refractory paroxysmal AF who underwent pulmonary vein antral isolation were analysed. The study population consisted of 104 patients (64 males, mean age 57.9 +/- 10.9 years) with paroxysmal AF. Based on AF triggers, patients were classified in those with vagotonic (31.7%), adrenergic (17.3%) and random AF (51%). Subjects with adrenergic and random AF tended to be older (p: 0.104) and displayed a higher incidence of hypertension (p: 0.088) compared with those with vagotonic AF. Following a mean follow-up period of 14.7 +/- 7.4 months, 74 patients were free from arrhythmia recurrence (71.2%). Late arrhythmia recurrence (N3 months from the index procedure) occurred in 33.3%, 16.7% and 30.2% of patients with vagotonic, adrenergic and random AF, respectively (p: 0.434). Cox regression analysis showed that early AF recurrence [hazard ratio (HR) 15.76; 95% confidence interval (CI) 5.45645.566, p<0.001], left atrial volume (HR 0.969; 95% CI 0.942-0.996, p: 0.025) and statin use (HR 6.828; 95% CI 2.078-22.437 p: 0.002) were independent predictors of late arrhythmia recurrence. Conclusions: In this study cohort, the type of paroxysmal AF was not associated with arrhythmia recurrence following left atrial ablation. (C) 2013 Elsevier Ireland Ltd. All rights reserved