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1: Anesthesiology. 2008 Apr;108(4):559-67.
Comment in:
Anesthesiology. 2008 Apr;108(4):551-2.
Impact of heart failure on patients undergoing major noncardiac surgery.
Hammill BG, Curtis LH, Bennett-Guerrero E, O'Connor CM, Jollis JG, Schulman KA,
Hernandez AF.
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Durham, North
Carolina, USA.
BACKGROUND: Changes in the demographics and epidemiology of patients with
cardiovascular comorbidities who undergo major noncardiac surgery require an updated
assessment of which patients are at greater risk of mortality or readmission. The authors
evaluated short-term outcomes among patients with heart failure, coronary artery disease (CAD),
or neither who underwent major noncardiac surgery. METHODS: Patients were aged 65 and
older, had Medicare fee-for-service coverage, and underwent 1 of 13 major noncardiac
procedures from 2000 through 2004, excluding patients with end-stage renal disease and patients
who did not have at least 1 yr of Medicare fee-for-service eligibility before surgery. Main
outcome measures were operative mortality and 30-day all-cause readmission. RESULTS: Of
159,327 procedures, 18% were performed in patients with heart failure and 34% were performed
in patients with CAD. Adjusted hazard ratios of mortality and readmission for patients with heart
failure, compared with patients with neither heart failure nor CAD, were 1.63 (95% confidence
interval, 1.52-1.74) and 1.51 (95% confidence interval, 1.45-1.58), respectively. Adjusted hazard
ratios of mortality and readmission for patients with CAD, compared with patients with neither
heart failure nor CAD, were 1.08 (95% confidence interval, 1.01-1.16) and 1.16 (95%
confidence interval, 1.12-1.20), respectively. These effects were statistically significant. Patients
with heart failure were at significantly higher risk for both outcomes compared with patients with
CAD. CONCLUSIONS: Elderly patients with heart failure who undergo major surgical
procedures have substantially higher risks of operative mortality and hospital readmission than
other patients, including those with coronary disease, admitted for the same procedures.
Improvements in perioperative care are needed for the growing population of patients with heart
failure undergoing major noncardiac surgery.
Publication Types:
Comparative Study
PMID: 18362586 [PubMed - indexed for MEDLINE]
2: Anesthesiology. 2008 Apr;108(4):551-2.
Comment on:
Anesthesiology. 2008 Apr;108(4):559-67.
Implications of preoperative heart failure: the next frontier in perioperative
medicine?
Fleisher LA.
Publication Types:
Comment
Editorial
PMID: 18362582 [PubMed - indexed for MEDLINE]
3: Issues Emerg Health Technol. 2008 Jan;(111):1-4.
Implantable hemodynamic monitoring (the Chronicle IHM system): remote
telemonitoring for patients with heart failure.
Ho C.
(1) Remote monitoring for ambulatory heart failure patients uses an implantable device to record
hemodynamic data and transmit it to a central server for continuous assessment. (2) Preliminary
evidence from observational studies suggests a potential for reducing hospitalizations with the
use of right ventricle implantable hemodynamic monitoring (IHM). However, although a
multicentre, randomized controlled trial (COMPASS-HF) showed a reduction in hospitalizations
in the IHM group the results were not statistically significant and the US Food and Drug
Administration panel concluded the trial failed to meet its primary efficacy endpoint. (3) In the
COMPASS-HF study the most common device-related complication was lead dislodgement. (4)
Large randomized controlled trials are needed to demonstrate the clinical utility of IHM,
particularly in terms of its impact on reducing hospitalization and improving patient outcomes.
PMID: 18354860 [PubMed - indexed for MEDLINE]
4: Med Klin (Munich). 2008 Mar 15;103(3):135-42.
[Congenital heart disease in adulthood]
[Article in German]
Baumgartner H, Dabritz S.
EMAH-Zentrum/Kardiologie, Zentrum fur Erwachsene mit angeborenen und erworbenen
Herzfehler, Universitatsklinikum Munster, Albert-Schweitzer-Strasse 33, Munster.
[email protected]
While a few decades ago only a minority of patients, particularly of those with complex
congenital heart disease, could reach adulthood, progress of pediatric cardiology and cardiac
surgery allows now the survival of the majority. Thus, adult cardiology is faced with a new
challenging patient population. Since only a few congenital heart defects can be cured, regular
follow-up during adult life is of major importance. Residual as well as consequently developed
lesions must be recognized. Optimal timing of surgery or catheter intervention is necessary to
provide the best long-term outcome. Despite optimal treatment part of the patients will develop
long-term complications such as arrhythmias, pulmonary hypertension and, eventually, heart
failure. Acute complications such as arrhythmias, aortic dissection or rupture, endocarditis,
cerebral events due to embolism, bleeding or abscesses, and pulmonary embolism or bleeding
must be recognized early and treated appropriately. Management of noncardiac surgery,
pregnancy and delivery can be challenging. Another task is counseling regarding exercise and
sports, choice of profession, driving and insurance issues. Finally, psychosocial issues must be
taken into account for appropriate care of this special patient group.
Publication Types:
Comparative Study
English Abstract
Review
PMID: 18344063 [PubMed - indexed for MEDLINE]
5: MMW Fortschr Med. 2008 Jan 17;150(1-2):41.
[Special place of PETN among nitrates. No tolerance development, fewer
headaches]
[Article in German]
Munzel T.
Publication Types:
Interview
PMID: 18300643 [PubMed - indexed for MEDLINE]
6: Kardiol Pol. 2007 Dec;65(12):1503-5.
[The effect of cholinergic stimulation on autonomic balance and immune
response in patients with chronic heart failure]
[Article in Polish]
Biel B, Jankowska EA, Banasiak W, Ponikowski P.
Osrodek Chorob Serca, Klinika Kardiologii, ul. Weigla 5, 50-981 Wroclaw. [email protected]
Publication Types:
Review
PMID: 18181060 [PubMed - indexed for MEDLINE]
7: Kardiol Pol. 2007 Dec;65(12):1499-501; discussion 1502.
[Congestive heart failure and continuous murmur in patient after lumbar disc
surgery--a case report]
[Article in Polish]
Mazij M, Szafran B, Lenartowska L, Drelichowski S, Wlodarczak P, Sobkowicz B,
Lewczuk J.
Oddzial Kardiologiczny, Wojewodzki Szpital Specjalistyczny, Osrodek Badawczo-Rozwojowy,
ul. Kamienskiego 73a, 51-124 Wroclaw. [email protected]
We present a case of a 61-year-old female who was admitted to the hospital with symptoms of
congestive heart failure. Diagnosis of arteriovenous fistula was suggested by the
echocardiographic signs of high-output state and a continuous murmur heard especially close to
the surgical scar from an intervention on the L4-L5 disc that the patient had undergone eight
months before. Aortography confirmed arteriovenous fistula between the right common iliac
artery and inferior vena cava. After surgical closure of the fistula, normal cardiac function was
restored.
Publication Types:
Case Reports
English Abstract
PMID: 18181059 [PubMed - indexed for MEDLINE]
8: Kardiol Pol. 2007 Dec;65(12):1433-9; discussion 1440-1.
The role of tissue colour Doppler imaging in diagnosis of segmental
pulmonary embolism in congestive heart failure patients.
Gromadzinski L, Targonski R.
Oddzial Kardiologiczno-Internistyczny, Miejski Szpital Zespolony, ul. Niepodleglosci 44,
10-045 Olsztyn. [email protected]
BACKGROUND: Tissue Doppler imaging enables qualitative and quantitative assessment of
myocardial function of the left and right ventricles. AIM: To compare systolic longitudinal mitral
and tricuspid annular velocities in a congestive heart failure (CHF) patient group with clinical
suspicion of pulmonary embolism (PE). METHODS: Fifty-five consecutive CHF patients with a
history of abrupt onset of resting dyspnoea, elevated >35 mmHg right ventricular systolic
pressure (RVSP) and positive D-dimer test were included in the study. Patients underwent
standard echocardiography and tissue colour Doppler imaging with post-processing analysis
(Echopack 6.3, GE Vingmed) and spiral computed tomography (SCT) within 24 hours from
admission. Mitral and tricuspid annular longitudinal systolic and diastolic velocities were
measured at their lateral sites in a 4-chamber apical view. According to the results of the SCT
examination patients were classified into groups: PE positive (group 1 - 25 patients) and PE
negative (group 2 - 30 patients). RESULTS:Tricuspid annular lateral systolic velocity (SmRV)
was 6.5+/-2.6 cm/s in group 1 and 7.0+/-2.5 cm/s in group 2 (p=NS). Mitral annular lateral
systolic velocity (SmLV) was 6.4+/-3.0 cm/s and 4.3+/-2.0 cm/s in group 1 and group 2
respectively (p= 0.003). Patients diagnosed as PE cases showed statistically significant higher
mitral annular lateral systolic velocity. Using a cut-off value of >5.5 cm/s derived from receiver
operating characteristics curve analysis, patients were separated from those without PE with
sensitivity of 60% and specificity of 86.7%. The ratio of SmRV/SmLV was 1.1+/-0.4 and
1.73+/-0.87 in group 1 and group 2, respectively (p=0.001). Using a cut-off value ratio of
<or=1.2 derived from receiver operator characteristic curve analysis, patients were separated
from those without PE with a sensitivity of 76% and a specificity of 93.3%. CONCLUSION:
Mitral annular lateral systolic velocity above 5.5 cm/s and ratio of systolic lateral tricuspid
annular velocity to systolic lateral mitral annular velocity <or=1.2 are useful parameters of
pulmonary embolism in congestive heart failure patients.
Publication Types:
Comparative Study
PMID: 18181055 [PubMed - indexed for MEDLINE]
9: Kardiol Pol. 2007 Dec;65(12):1425-30; discussion 1431-2.
Quality of life in patients undergoing cardiac resynchronisation therapy.
Wojcicka M, Sterlinski M, Chwyczko T, Smolis-Bak E, Szwed H, Kowalik I.
II Klinika Choroby Wiencowej, Instytut Kardiologii, ul. Spartanska 1, 02-637 Warszawa.
[email protected]
BACKGROUND: Cardiac resynchronisation therapy (CRT) is often recommended for the
treatment of patients with severe heart failure and cardiac dyssynchrony. The procedure efficacy
should be evaluated not only by objective criteria and clinical end points, but also by patients'
subjective opinion of their everyday functioning. AIM: To assess the quality of life (QoL) in
patients treated with CRT. METHODS: The study comprised 26 CRT patients: 18 males and 8
females, aged 63.3+/-9.5 (34-75) years. The QoL was evaluated by NHP questionnaires twice:
before CRT implantation and 15+/-4 months (mean) after the procedure. RESULTS: There was a
significant improvement in the mean values of energy (2.9 vs. 2; p <0.01), physical mobility (4.3
vs. 3; p <0.05) and emotional reactions (5.2 vs. 3.7; p <0.05) following CRT. However, some
aspects of everyday functioning did not improve after CRT. They included looking after the
home (66.7 vs. 66.7%) and sex life (54.2 vs. 70.8%). An improvement was observed in home life
(33.3 vs. 20.8%) and social life (61.5 vs. 50%). CONCLUSIONS: Cardiac resynchronisation
therapy improves patients' QoL. The psycho-social condition of CRT patients needs further,
larger studies and should be taken into account by attending health professionals.
Publication Types:
Comparative Study
PMID: 18181054 [PubMed - indexed for MEDLINE]
10: Kardiol Pol. 2007 Dec;65(12):1417-22; discussion 1423-4.
Sudden cardiac death risk factors in patients with heart failure treated with
carvedilol.
Nessler J, Nessler B, Kitlinski M, Libionka A, Kubinyi A, Konduracka E, Piwowarska W.
Klinika Choroby Wiencowej, Instytut Kardiologii, Collegium Medicum UJ, Krakow.
[email protected]
BACKGROUND: Chronic heart failure (CHF) is associated with a high risk of sudden cardiac
death (SCD). Most frequently SCD occurs in patients with NYHA class II and III. AIM: To
evaluate the influence of prolonged carvedilol therapy on SCD risk in CHF patients.
METHODS: The study included 86 patients (81 men and 5 women) aged 56.8+/-9.19 (35-70)
years with CHF in NYHA class II and III receiving an ACE inhibitor and diuretics but not
beta-blockers. At baseline and after 12 months of carvedilol therapy the following risk factors for
SCD were analysed: in angiography - occluded infarct-related artery; in echocardiography - left
ventricular ejection fraction (LVEF) <30%, volume of the left ventricle (LVEDV) >140 ml; in
ECG at rest - sinus heart rate (HRs) >75/min, sustained atrial fibrillation, increased QTc; in
24-hour ECG recording - complex arrhythmia, blunted heart rate variability (SDNN <100 ms)
and abnormal turbulence parameters (TO and TS or one of them); in signal-averaged ECG - late
ventricular potentials and prolonged fQRS >114 ms. The analysis of SCD risk factors in basic
examination in patients who suddenly died was also performed. RESULTS: During one-year
carvedilol therapy heart transplantation was performed in 2 patients; 5 patients died. At 12
months the following risk factors for SCD were significantly changed: HRs >75/min (50 vs. 16
patients, p=0.006), LVEF <30% (37 vs. 14 patients, p=0.01), SDNN <100 ms (19 vs. 9 patients,
p=0.04). At 12 months the number of risk factors for SCD in each patient was significantly
reduced (p=0.001). In patients who suddenly died we found a greater amount of SCD risk factors
in basic examination (7 vs. 5) as compared to alive patients. CONCLUSIONS: Prolonged
beta-adrenergic blockade reduces risk of sudden cardiac death through significant LVEF
increase, reduction of HR at rest and improvement of HRV.
Publication Types:
Clinical Trial
PMID: 18181053 [PubMed - indexed for MEDLINE]
11: Diabetes Obes Metab. 2008 Jan;10(1):41-52.
Tissue angiotensin-converting enzyme inhibitors for the prevention of
cardiovascular disease in patients with diabetes mellitus without left
ventricular systolic dysfunction or clinical evidence of heart failure: a pooled
meta-analysis of randomized placebo-controlled clinical trials.
Saha SA, Molnar J, Arora RR.
Division of Cardiology, Chicago Medical School-North Chicago VA Medical Center, 3001
Green Bay Road, North Chicago, IL 60064, USA. [email protected]
AIM: The aim of this study was to determine the role of tissue angiotensin-converting enzyme
(ACE) inhibitors in the prevention of cardiovascular disease in patients with diabetes mellitus
without left ventricular systolic dysfunction or clinical evidence of heart failure in randomized
placebo-controlled clinical trials using pooled meta-analysis techniques. METHODS:
Randomized placebo-controlled clinical trials of at least 12 months duration in patients with
diabetes mellitus without left ventricular systolic dysfunction or heart failure who had
experienced a prior cardiovascular event or were at high cardiovascular risk were selected. A
total of 10 328 patients (43 517 patient-years) from four selected trials were used for
meta-analysis. Relative risk estimations were made using data pooled from the selected trials and
statistical significance was determined using the Chi-squared test (two-sided alpha error <0.05).
The number of patients needed to treat was also calculated. RESULTS: Tissue ACE inhibitors
significantly reduced the risk of cardiovascular mortality by 14.9% (p = 0.022), myocardial
infarction by 20.8% (p = 0.002) and the need for invasive coronary revascularization by 14% (p
= 0.015) when compared to placebo. The risk of all-cause mortality also tended to be lower
among patients randomized to tissue ACE inhibitors, whereas the risks of stroke and
hospitalization for heart failure were not significantly affected. Treating about 65 patients with
tissue ACE inhibitors for about 4.2 years would prevent one myocardial infarction, whereas
treating about 85 patients would prevent one cardiovascular death. CONCLUSION: Pooled
meta-analysis of randomized placebo-controlled trials suggests that tissue ACE inhibitors
modestly reduce the risk of myocardial infarction and cardiovascular death and tend to reduce
overall mortality in diabetic patients without left ventricular systolic dysfunction or heart failure.
Publication Types:
Meta-Analysis
PMID: 18095949 [PubMed - indexed for MEDLINE]
12: Med Sci Monit. 2007 Dec;13(12):BR255-8.
Evaluation of hawthorn extract on immunomodulatory biomarkers in a
pressure overload model of heart failure.
Bleske BE, Zineh I, Hwang HS, Welder GJ, Ghannam MM, Boluyt MO.
College of Pharmacy, University of Michigan, Ann Arbor, MI 48109-1065, USA.
BACKGROUND: Hawthorn extract (Crataegeus sp.) a botanical complementary and alternative
medicine is often used to treat heart failure. The mechanism(s) by which hawthorn extract may
treat heart failure is unknown but may include, theoretically, immunological effects. Therefore,
the purpose of this study is to determine the effect of hawthorn extract on the
immunomodulatory response in a pressure overload model of heart failure.
MATERIAL/METHODS: A total of 62 male Sprague-Dawley rats were randomized to either
aortic constriction + vehicle (AC; n=15), aortic constriction + hawthorn 1.3 mg/kg (HL, n=17),
aortic constriction + hawthorn 13 mg/kg (HM, n=15), or aortic constriction + hawthorn 130
mg/kg (HH, n=15). Six months after surgical procedure animals were sacrificed and plasma
samples obtained for the measurement of the following immunomodulatory markers: interleukin
(IL) IL-1ss, IL-2, IL-6, IL-10; and leptin. RESULTS: The mortality rate following 6 months of
aortic constriction was 40% in the AC group compared to 41%, 60%, and 53% for the HL, HM,
and HH groups respectively (P>0.05 compared to AC). Aortic constriction produced a similar
increase in the left ventricle/body weight ratio for all groups. Hawthorn extract had no effect on
the immunomodulatory markers measured in this study, although there appeared to be a trend
suggesting suppression of IL-2 plasma concentrations. CONCLUSIONS: In this animal model of
heart failure, hawthorn extract failed to significantly affect the immunomodulatory response
characterized after 6 months of pressure overload at a time when approximately 50% mortality
was exhibited. Mechanisms other than immunological may better define hawthorn's effect in
treating heart failure.
PMID: 18049426 [PubMed - indexed for MEDLINE]
13: Gene Ther. 2008 Feb;15(3):161-70. Epub 2007 Nov 22.
A lentiviral vector with a short troponin-I promoter for tracking
cardiomyocyte differentiation of human embryonic stem cells.
Gallo P, Grimaldi S, Latronico MV, Bonci D, Pagliuca A, Gallo P, Ausoni S, Peschle C,
Condorelli G.
Laboratory of Molecular Cardiology, San Raffaele Biomedical Science Park Foundation, Rome,
Italy.
Human embryonic stem cells (hESCs) may become important for cardiac repair due to their
potentially unlimited ability to generate cardiomyocytes (CMCs). Moreover, genetic
manipulation of hESC-derived CMCs would be a very promising technique for curing
myocardial disorders. At the present time, however, inducing the differentiation of hESCs into
CMCs is extremely difficult and, therefore, an easy and standardizable technique is needed to
evaluate differentiation strategies. Vectors driving cardiac-specific expression may represent an
important tool not only for monitoring new cardiac-differentiation strategies, but also for the
manipulation of cardiac differentiation of ESCs. To this aim, we generated cardiac-specific
lentiviral vectors (LVVs) in which expression is driven by a short fragment of the cardiac
troponin-I proximal promoter (TNNI3) with a human cardiac alpha-actin enhancer, and tested its
suitability in inducing tissue-specific gene expression and ability to track the CMC lineage
during differentiation of ESCs. We determined that (1) TNNI3-LVVs efficiently drive
cardiac-specific gene expression and mark the cardiomyogenic lineage in human and mouse ESC
differentiation systems (2) the cardiac alpha-actin enhancer confers a further increase in
gene-expression specificity of TNNI3-LVVs in hESCs. Although this technique may not be
useful in tracking small numbers of cells, data suggested that TNNI3-based LVVs are a powerful
tool for manipulating human ESCs and modifying hESC-derived CMCs.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 18033312 [PubMed - indexed for MEDLINE]