A Case of Cardiac Amyloidosis With Dilated Left Ventricular Chamber and Improvement of Electrocardiogram After Standard Heart Failure Treatment

Dendritic cells (DCs) are the most potent antigen-presenting cells and play a central role in initiating the primary immune response. Although increasing evidence supports immune-mediated inflammation plays an important role in the pathophysiology of heart failure, little is known regarding the source and mechanism that trigger immune responses. The present study examined whether circulating DCs have any role in the pathophysiology in heart failure in humans. Methods and Results: With multi-color flow-cytometry we determined the numbers of circulating myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) in decompensated heart failure patients with NYHA class III or IV on admission (n=27) and the age-matched control subjects (n=21). DC activation markers such as CD40 and CCR7 were also measured. On admission, circulating mDC and pDC counts were significantly lower in decompensated heart failure patients compared to control subjects (12417 ± 2849 versus 5394 ± 3547 and 3321 ± 1491 versus 1800 ± 1474/ml, respectively, p<0.01). Circulating DCs were activated in the decompensated heart failure patients compared to control subjects (CD40; 1.6 ± 1.8 versus 8.5 ± 9.2, CCR7; 3.5 ± 4.1 versus 13.5 ± 10.0, respectively, p<0.05). Heart failure treatment significantly restored the reduction and the activation of circulating DCs (p<0.05). The increases of circulating DCs numbers after treatment were correlated with the decreases in B-type natriuretic peptide (BNP) and troponin-T (r=0.64, p<0.01 and r=0.46, respectively, p<0.05) and with the increase in left ventricular ejection fraction (LVEF) (r=0.73, p<0.01). Furthermore, we found that patients with smaller circulating DCs numbers (less than 10000/ml) after heart failure treatment had poor prognosis compaired with those who had greater DCs numbers (more than 10000/ml) during the 6-month follow-up (p<0.01). Thus, we found that changes of circulating DCs numbers were well correlated with cardiac injury and function, and that poor recovery of the circulating DCs number after treatment predicted recurrence of decompensated heart failure. Conclusion : These findings suggest that circulating DCs may play an important role in pathophysiology in heart failure in humans.

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Clinical significance of ischemia-like electrocardiographic finding during heart failure treatment on left ventricular recovery in patients with non-ischemic dilated cardiomyopathy

Journal of Cardiology ◽

10.1016/j.jjcc.2021.01.017 ◽

2021 ◽

Author(s):

Kenji Maemura ◽

Yuki Ikeda ◽

Takumi Oki ◽

Mayu Yazaki ◽

Teppei Fujita ◽

...

Keyword(s):

Heart Failure ◽

Dilated Cardiomyopathy ◽

Clinical Significance ◽

Left Ventricular ◽

Heart Failure Treatment ◽

Failure Treatment ◽

Left Ventricular Recovery ◽

Non Ischemic Dilated Cardiomyopathy

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Comparison of Angiotensin-Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) for Heart Failure Treatment in Congenital Heart Diseases with Left-to-Right Shunt

The Indonesian Biomedical Journal ◽

10.18585/inabj.v12i1.997 ◽

2020 ◽

Vol 12 (1) ◽

pp. 62-8

Author(s):

Alit Utamayasa ◽

Mahrus Ahmad Rahman ◽

Teddy Ontoseno ◽

Budiono Budiono

Keyword(s):

Heart Failure ◽

Congenital Heart ◽

Heart Diseases ◽

Left Ventricular ◽

Congenital Heart Diseases ◽

Converting Enzyme ◽

Angiotensin Receptor ◽

Heart Failure Treatment ◽

Failure Treatment ◽

Pediatric Heart Failure

BACKGROUND: The angiotensin-converting enzyme inhibitors (ACEIs) have become the forefront of heart failure treatment for more than a decade. Currently, angiotensin receptor blockers (ARBs) are thought to have similar effectiveness. This study aimed to compare the impact of captopril, one of ACEI, and valsartan, one of ARB, on clinical presentation and echocardiographic, electrocardiographic, and chest x-ray improvement in patients with left-to-right shunt congenitalheart diseases.METHODS: This study used a double-blind randomized controlled trial of captopril and valsatran to children with left-to-right shunt congenital heart diseases who suffer from heart failure in the Dr. Soetomo General Hospital, Surabaya, Indonesia. Pediatric heart failure scores, echocardiography, electrocardiography (ECG), and chest photographs were examined at the beginning of the study and after 30 days of treatment.RESULTS: A decrease in pediatric heart failure scores were showed after the administration of ACEI (7.06±2.04 vs. 4.75±2.43; p<0.0001; 95% CI: −2.98 - 1.65); ARB (6.81±2.25 vs. 3.94±1.98; p<0.0001; 95% CI: −3.76 to 1.98). The echocardiography examination, an increase in left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), % fractional shortening (FS), and left ventricular (LV) dimension occurred after the administration of ACEI and ARB. The values also didn’t significantly differrent between the two groups. The ECG evaluation showed a decrease in heart rate frequency after the administration of ACEI (117.75±14.67 vs. 109.63±17.59; p=0.039; 95% CI: −15.78 to −0.46) and ARB (117.10±21.86 vs.108.6±20.66; p=0.006; 95% CI: −14.17 to −2.83).CONCLUSION: ARB showed better outcome in clinical condition, echocardiography, ECG, and chest radiographs.KEYWORDS: captopril, valsartan, heart failure, congenital heart disease, left to right shunt

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Heart failure on peritoneal dialysis: Where do we stand?

Portuguese Journal of Nephrology & Hypertension ◽

10.32932/pjnh.2021.10.144 ◽

2021 ◽

Vol 35 (3) ◽

Author(s):

Marina Reis ◽

◽

Catarina Almeida ◽

Ana Gomes ◽

João Fernandes ◽

...

Keyword(s):

Heart Failure ◽

Peritoneal Dialysis ◽

Ejection Fraction ◽

Left Ventricular ◽

New Drugs ◽

Preserved Ejection Fraction ◽

Dialysis Patients ◽

Heart Failure Treatment ◽

Failure Treatment ◽

Uremic Cardiomyopathy

Cardiovascular disease continues to be the most frequent cause of death in peritoneal dialysis patients and an important obstacle for the improvement of technique survival. Heart failure diagnosis and management is particularly challenging among dialysis patients, and this condi‑ tion remains underdiagnosed and undertreated in this population. The most common phenotype of heart failure among peritoneal dialysis patients is heart failure with preserved ejection fraction, diastolic disfunction and left ventricular hypertrophy. Unfortunately, unlike what happens with heart failure with reduced ejection fraction, there is lack of evidence to support a specific drug regimen to treat heart failure with preserved ejection fraction. Several conditions associated with end stage kidney disease, such as anemia, hyperphosphatemia, secondary hyperparathyroidism, inflammation, and insulin resistance seem to be involved in the pathogenesis of heart failure with preserved ejection fraction and for this reason, the term uremic cardiomyopathy has been proposed. There is a lack of evidence regarding the optimal heart failure treatment for peritoneal dialysis patients and more studies are needed to assess the efficacy and safety of the new drugs available for heart failure treatment. This review explores the spectrum of heart failure on peritoneal dialysis, its pathogenesis, risk factors and possible therapeutic and preventive measures.

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