Enhanced TNFα and oxidative stress in patients with heart failure: effect of TNFα on platelet O2 - production

2003 ◽  
Vol 90 (08) ◽  
pp. 317-325 ◽  
Author(s):  
Luciano Biase ◽  
Pasquale Pignatelli ◽  
Luisa Lenti ◽  
Giuliano Tocci ◽  
Fabiana Piccioni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nadph Oxidase ◽  
Nyha Class ◽  
Experimental Studies ◽  
Specific Inhibitor ◽  
Class Iii ◽  
Nyha Classification ◽  
Patients With Heart Failure ◽  
O2 Production

SummaryExperimental studies have suggested that TNFα, a pro-inflammatory cytokine, may contribute to the deterioration of cardiovascular function through various mechanisms, including the generation of reactive oxygen species. It has not yet been demonstrated whether TNFα has prooxidant activity in patients with heart failure, and what the mechanism eventually resulting in this effect are.We analyzed 42 patients (38 men and 4 women, aged 26 to 74 years) with heart failure, secondary to idiopathic dilated car-diomyopathy (n=21), coronary artery disease (n=15), and valve disease (n=6), and 20 controls (18 men and 2 women, aged 49 to 67 years). Ten patients were in class I,9 in class II,15 in class III and 8 in class IV according to NYHA Classification. Blood samples were obtained from each patient to evaluate basal and collagen-induced platelet O2 - production, and plasma TNFα. In vivo results showed increased platelet O2 - production and plasma TNFα levels in NYHA class III-IV compared with that in controls or in NYHA I-II (p<0,001); platelet O2 - production correlated significantly (R=0,6; p<0,01) with TNFα plasma levels. In vitro studies showed TNFα dose-dependently (5-40 pg/ml) induced platelet O2 - production, and that this effect was significantly inhibited by its specific inhibitor, WP9QY (1 μM); aspirin (100 μM), AACOCF3, a specific PLA2 inhibitor (14 μM), and DPI, an inhibitor of NADPH oxidase, significantly inhibited TNFα-mediated platelet O2 - production.This study suggests that in patients with heart failure, enhanced platelet O2 - production is mediated by TNFα via activation of arachidonic acid and NADPH oxidase pathways.

Abstract 4606: Appetite Ratings on Single-item Visual Analog Scale Identify Patients with Heart Failure at Risk for Malnutrition

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Terry A Lennie ◽  
Seongkum Heo ◽  
Susan J Pressler ◽  
Sandra B Dunbar ◽  
Misook L Chung ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Visual Analog Scale ◽  
Protein Intake ◽  
Nyha Class ◽  
Heart Association ◽  
Data Systems ◽  
Class Iii ◽  
Analog Scale ◽  
Patients With Heart Failure

Background : Patients with heart failure (HF) are at risk for malnutrition due to multiple factors. A simple, clinically feasible tool to identify risk for malnutrition is needed. Visual analog scales have been used in studies on appetite but it is unknown whether an appetite scale can be used to identify patients with HF at risk for malnutrition. Purpose : To determine whether differences in kcal and protein intake could be identified in patients with HF grouped by their appetite rating. Method : A total of 137 patients (63% male, 60 ± 12 years, 56% NYHA class III/IV, ejection fraction (39 ± 14%) were recruited from outpatient HF clinics in the Midwest and South. Patients provided detailed 4-day food diaries that were reviewed by a registered dietitian to verify serving sizes and preparation methods and to obtain missing information. Patients were also asked to rate their appetite over the 4 days of diet recording on a 10 mm visual analog with anchors of “no appetite” and “extremely good appetite” Diaries were analyzed by Nutrition Data Systems software. Three series of between-group comparisons of kcal and protein (total and referenced to kg body weight) were made by t-tests using 4 mm (below midpoint), 5 mm (mid-point), and 6 mm (above mid-point) cut-points. Results : Significant differences in kcal and protein intake were identified between groups using the 6 mm cut point. A total of 36% of the patients had low appetite ratings (<6mm). Patients with low appetite ratings consumed 20% fewer total kcals (1555 vs. 1936 kcal, p = .001) and 23% fewer kcal/kg (18 vs. 22 kcal, p = .005) than those with high ratings. The low appetite group also consumed 24% less protein than the high appetite group (62 g vs. 82 g, p = .001). The .71 g/kg protein intake of the low appetite group was below the recommended .8 g/kg protein intake for adults. In contrast, the .91 g/kg protein intake of the high appetite group was above the recommended level. Conclusion : Patients with lower appetite ratings had kcal and protein intakes below recommended levels while those with high appetite ratings had adequate intake. These results provide evidence that rating appetite on a visual analog scale may be a simple tool that could be used clinically to identify patients with HF at risk for malnutrition. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).

Stability and feasibility of measurement of lung-to-finger circulation time by simple breath holdings in heart failure patients

2021 ◽  
Author(s):  
Tomoyuki Tobushi ◽  
Kasai Takatoshi ◽  
Masayuki Hirose ◽  
Kazuhiro Sakai ◽  
Manabu Akamatsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Intraclass Correlation ◽  
Circulation Time ◽  
Infrared Light ◽  
Breath Hold ◽  
Laser Sensor ◽  
Class Iii ◽  
Heart Failure Patients ◽  
Nyha Classification

Abstract Lung to finger circulation time (LFCT) has been used to estimate cardiac function. We developed a new LFCT measurement device using a laser sensor at fingertip. We measured LFCT by measuring time from re-breathing after 20 seconds of breath hold to the nadir of the difference of transmitted red light and infrared light, which corresponds to percutaneous oxygen saturation. Fifty patients with heart failure were enrolled. The intrasubject stability of the measurement was assessed by the intraclass correlation coefficient (ICC). The ICC calculated from 44 cases was 0.85 (95% confidence interval:0.77-0.91), which means to have “Excellent reliability.” By measuring twice, at least one clear LFCT value was obtained in 89.1% of patients and the overall measurability was 95.7%. We conducted all LFCT measurements safely. High ICCs were obtained even after dividing patients according to age, cardiac index (CI), and New York Heart Association (NYHA) classification; 0.85 and 0.84 (≥ 75 or < 75 years group, respectively), 0.81 and 0.84 (N=28, ≥ or < 2.2 L/min/M2), 0.82 and 0.94 (NYHA Class I-II or Class III). These results show that our new method to measure LFCT is highly stable and feasible for any type of heart failure patients.

Abstract 310: Variability in Patient-Reported Health Status by NYHA Classification: Implications for Clinical Trials

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Andy T Tran ◽  
Paul S Chan ◽  
Phillip G Jones ◽  
John Spertus
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Health Status ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Class I ◽  
Nyha Classification ◽  
Patient Reported ◽  
Patients With Heart Failure ◽  
Reported Health

Background: A foundation of current clinical trials is to categorize the severity of heart failure (HF) by New York Heart Association (NYHA) classification to ensure that enrolled patients have similar disease severity. Because the NYHA represents a clinician’s assessment of patients’ health status, it may vary from patients’ perspectives and can lead to more or less symptomatic patients being enrolled in clinical trials. We sought to directly compare the ranges of patient-reported health status, as assessed by the well-validated and reliable Kansas City Cardiomyopathy Questionnaire (KCCQ), with NYHA class in recent clinical studies. Methods: We used data from 2 contemporary HF clinical trials, HF-ACTION in patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and TOPCAT in patients with Heart Failure with Preserved Ejection Fraction (HFpEF), and 1 prospective cohort study, the KCCQ Interpretability study (KCCQINT) in patients with HFrEF, where both NYHA and the KCCQ were contemporaneously collected. The distributions of KCCQ Overall Summary (KCCQ-os) scores by NYHA and the variation in assigned NYHA classes among patients with KCCQ scores ≥80 (congruent with NYHA Class I) were then described. Results: A total of 6,072 patients (mean age 64±12 years, 41% female) were included across the 3 studies. Figure 1 shows marked overlap in KCCQ scores across NYHA classes. In KCCQINT, 148 (27%) out of 545 patients reported a KCCQ-os score ≥80, of whom 39 (26%), 81 (55%) and 28 (19%) were coded as NYHA Class I, II and III. None were classified as NYHA Class IV. In HF-ACTION, 677 (32%) of 2129 patients reported a KCCQ-os score ≥80, of whom 548 (81%), 128 (19%) and 1 (<1%) were coded as NYHA Class II, III and IV, respectively. In TOPCAT, 484 (14%) out of 3398 patients reported a KCCQ-os score ≥80, of whom 410 (85%) and 74 (15%) were considered NYHA Class I-II and III-IV, respectively. Conclusions: Although the NYHA is used to identify similarly ill patients for enrollment in clinical trials, there is marked variability within and across studies in patients’ self-reported health status. Future trials should consider patient-reported outcome measures as the basis for defining patient eligibility to enroll a more homogenous cohort of disease severity.

Pd Treatment for Severe Congestive Heart Failure

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 231-235 ◽  
Author(s):  
Bernd G. Stegmayr ◽  
Ravi Banga ◽  
Lennart Lundberg ◽  
Ann Marie Wikdahl ◽  
Marianne Plum-Wirell
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Nyha Class ◽  
Fatal Outcome ◽  
Severe Congestive Heart Failure ◽  
Class Iii ◽  
Refractory Heart Failure ◽  
Nyha Classification ◽  
Heart Size ◽  
Angiotension Converting Enzyme

Our objective was to evaluate if peritoneal dialysis (PD) could improve survival of patients with progressive severe congestive heart failure resistant to drug therapy. The patients were selected by the cardiologist in cooperation with a nephrologist, including patients not responding to conventional medication with an expected fatal outcome within the next months. The study included 16 consecutive patients with a chronic progressive severe refractory heart failure (sHF) of NYHA class III (n = 6) or IV (n = 10) who did not respond to diuretics and angiotension converting enzyme (ACE) inhibitors. They had a mean age of 60 years (±14, range 30 -75, median 62 years). Nine of the patients had sHF as the only reason for initiating PD (all NYHA IV), while 7 also needed dialysis due to uremia. Five of 7 had been on hemodialysis but switched to PD due to a progressive congestive sHF. ln 2 patients, PD was decided already at start of dialysis therapy due to the severity of their heart failure. The reason for sHF was: valvular dysfunction (n = 5) with defect prosthesis (n = 3); in the course of a myocardial infarction (n = 4); and cardiomyopathy (n = 4). Tenckhoff catheters were inserted under local anesthesia and ultrafiltration was started and maintained until discharge. The survival time and change in heart size by x ray was used for analyses. All patients improved their stage of congestive heart failure by NYHA classification already during the first month. Six patients died during the follow-up period due to cardiac reasons (sudden death, relapse of sHF) after a mean of 10.7 months (±3.7, range 1 24 months). Ten were alive after a median observation period of 10 months (±12.5, range 1–36 months). Heart size was reduced in 15 of the patients. Three of the patients with sHF but without uremia could stop the PD. The results showed that ultrafiltration by PD was easy to perform despite low initial blood pressure. The sHF was reduced and life span was prolonged with improved quality of life.

scholarly journals One-Year Survival and Renal Function Recovery of Acute Kidney Injury Patients with Chronic Heart Failure

2014 ◽  
Vol 5 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Wen Zhang ◽  
Dan Wen ◽  
Yan-Fang Zou ◽  
Ping-Yan Shen ◽  
Yao-Wen Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Clinical Characteristics ◽  
Nyha Class ◽  
Kidney Injury ◽  
Class Iii ◽  
Kidney Dysfunction ◽  
Nyha Classification

Objective: To describe and analyze the clinical characteristics of acute kidney injury (AKI) patients with preexisting chronic heart failure (CHF) and to identify the prognostic factors of the 1-year outcome. Methods: A total of 120 patients with preexisting CHF who developed AKI between January 2005 and December 2010 were enrolled. CHF was diagnosed according to the European Society of Cardiology guidelines, and AKI was diagnosed using the RIFLE criteria. Clinical characteristics were recorded, and nonrecovery from kidney dysfunction as well as mortality were analyzed. Results: The median age of the patients was 70 years, and 58.33% were male. 60% of the patients had an advanced AKI stage (‘failure') and 90% were classified as NYHA class III/IV. The 1-year mortality rate was 35%. 25.83% of the patients progressed to end-stage renal disease after 1 year. Hypertension, anemia, coronary atherosclerotic heart disease and chronic kidney disease were common comorbidities. Multiple organ dysfunction syndrome (MODS; OR, 35.950; 95% CI, 4.972-259.952), arrhythmia (OR, 13.461; 95% CI, 2.379-76.161), anemia (OR, 6.176; 95% CI, 1.172-32.544) and RIFLE category (OR, 5.353; 95% CI, 1.436-19.952) were identified as risk factors of 1-year mortality. For 1-year nonrecovery from kidney dysfunction, MODS (OR, 8.884; 95% CI, 2.535-31.135) and acute heart failure (OR, 3.281; 95% CI, 1.026-10.491) were independent risk factors. Conclusion: AKI patients with preexisting CHF were mainly elderly patients who had an advanced AKI stage and NYHA classification. Their 1-year mortality and nonrecovery from kidney dysfunction rates were high. Identifying risk factors may help to improve their outcome.

Venous Thromboembolism Prophylaxis Practices in Acutely Ill Medical Patients with Heart Failure (NYHA Class III or IV): Findings from IMPROVE.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1869-1869
Author(s):  
Ricardo Pavanello ◽  
James B. Froehlich ◽  
Victor Tapson ◽  
Jean-Francois Bergmann ◽  
Mashio Nakamura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Venous Thromboembolism ◽  
Nyha Class ◽  
Medical Patients ◽  
Class Iii ◽  
Vte Prophylaxis ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
The Usa ◽  
Pharmacologic Prophylaxis

Abstract Background Acutely ill medical patients with heart failure have an increased risk for venous thromboembolism (VTE) and expert consensus guidelines recommend that they should receive VTE prophylaxis. However, little data is available on physician’s practices for providing prophylaxis to these patients. Our aim was to characterize VTE prophylaxis practices in acutely ill hospitalized medical patients with heart failure (NYHA class III or IV) enrolled in the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). Methods Patient recruitment began in July 2002. Patients aged ≥ 18 years and hospitalized for ≥ 3 days with an acute medical illness are enrolled consecutively. Exclusion criteria are: therapeutic antithrombotic agents or thrombolytics at admission, major surgery or trauma during 3 months prior to admission, and VTE treatment within 24 hours of admission. Results Of 6946 patients enrolled up to 31 March 2005 in 49 hospitals in 12 countries, 784 (11%) were heart failure patients. Compared with patients without heart failure, patients with heart failure were more likely to be in an ICU/CCU (13% vs 8%), immobile ≥ 4days (50% vs 30%), over 60 years old (85% vs 61%), perceived to be obese (20% vs 13%), or have respiratory failure (27% vs 17%; p<0.0001 for all). In total, only 51% of heart failure patients received pharmacologic prophylaxis and 61% received any type of prophylaxis. Pharmacologic prophylaxis type varied by region with low-molecular-weight heparin (LMWH) used less often, and unfractionated heparin (UFH) used more often in the USA compared with other participating countries (see Table). Aspirin and warfarin were used as VTE prophylaxis in 6% and 3% of heart failure patients, respectively. Intermittent pneumatic compression (IPC) was used more often in the USA than in other countries (24% vs 0.2%). Conclusions Although acutely ill medical patients with heart failure are at risk of VTE and should receive prophylaxis, only 61% of these patients in IMPROVE actually received any type of prophylaxis. This reflects poor physician-awareness of the benefits of prophylaxis in this patient group and suggests that significant opportunity exists to improve physician practices. Table. VTE prophylaxis in acutely ill medical patients with heart failure VTE prophylaxis (% patients) USA Other participating countries LMWH 15 46 UFH 27 13 Aspirin 8 4 Warfarin 5 1 Any pharmacologic prophylaxis 43 56 IPC 24 0.2 Elastic stockings 6 7

scholarly journals The Effects of Sacubitril/Valsartan on Clinical, Biochemical and Echocardiographic Parameters in Patients with Heart Failure with Reduced Ejection Fraction: The “Hemodynamic Recovery”

2019 ◽  
Vol 8 (12) ◽  
pp. 2165 ◽  
Author(s):  
Giuseppe Romano ◽  
Giuseppe Vitale ◽  
Laura Ajello ◽  
Valentina Agnese ◽  
Diego Bellavia ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Heart Association ◽  
Class Iii ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Echocardiographic Parameters ◽  
The Impact

Background: Sacubitril/valsartan has been shown to be superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF). However, knowledge of the impact on cardiac performance remains limited. We sought to evaluate the effects of sacubitril/valsartan on clinical, biochemical and echocardiographic parameters in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Sacubitril/valsartan was administered to 205 HFrEF patients. Results: Among 230 patients (mean age 59 ± 10 years, 46% with ischemic heart disease) 205 (89%) completed the study. After a follow-up of 10.49 (2.93 ± 18.44) months, the percentage of patients in New York Heart Association (NYHA) class III changed from 40% to 17% (p < 0.001). Median N–Type natriuretic peptide (Nt-proBNP) decreased from 1865 ± 2318 to 1514 ± 2205 pg/mL, (p = 0.01). Furosemide dose reduced from 131.3 ± 154.5 to 120 ± 142.5 (p = 0.047). Ejection fraction (from 27± 5.9% to 30 ± 7.7% (p < 0.001) and E/A ratio (from 1.67 ± 1.21 to 1.42 ± 1.12 (p = 0.002)) improved. Moderate to severe mitral regurgitation (from 30.1% to 17.4%; p = 0.002) and tricuspid velocity decreased from 2.8 ± 0.55 m/s to 2.64 ± 0.59 m/s (p < 0.014). Conclusions: Sacubitril/valsartan induce “hemodynamic recovery” and, consistently with reduction in Nt-proBNP concentrations, improve NYHA class despite diuretic dose reduction.

Abstract 827: High Serum Level of Neopterin Is a Risk Factor of Patients with Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Toshiki Sasaki ◽  
Yasuchika Takeishi ◽  
Tetsuro Shishido ◽  
Tetsu Watanabe ◽  
Joji Nltobe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Nyha Class ◽  
Enzyme Linked Immunosorbent Assay ◽  
Class Iii ◽  
Cardiac Events ◽  
Roc Curve Analysis ◽  
Serum Neopterin ◽  
Neopterin Concentration ◽  
Patients With Heart Failure

Neopterin is produced by activated monocytes/macrophages, and serum neopterin concentrations reflect the level of oxidative stress. We assessed the hypothesis that serum neopterin is a risk factor for heart failure and predicts adverse clinical outcomes in patients with heart failure. Serum neopterin concentration was measured in 198 patients with heart failure and 62 control subjects by a competitive enzyme-linked immunosorbent assay. Patients were prospectively followed during a median follow-up period of 745 days with end points of cardiac death or re-hospitalization due to progressive heart failure. Serum concentration of neopterin was significantly higher in New York Heart Association (NYHA) Class III/IV patients than in NYHA class I/II patients (P < .001). From the receiver operating characteristic (ROC) curve analysis, the cut-off value of serum neopterin level was determined as 10 nmol/L. Kaplan-Meier analysis clearly demonstrated that the high neopterin group had a significantly higher incidence of cardiac events than occurred in the low neopterin group (P < .0001). Patients were divided into 4 groups based on the serum neopterin levels, the highest 4th quartile was associated with the highest risk of cardiac events (11.1-fold compared with 1st quartile). In the multivariate Cox analysis, serum neopterin concentration was an independent risk factor for cardiac events (hazard ratio 1.70, 95% confidence interval 1.16–2.50, P = 0.0068). Serum neopterin concentration is an independent prognostic factor for heart failure, and may be useful for risk stratification of patients with heart failure.

scholarly journals The Effects of Sacubitril/Valsartan on Clinical, Bioumoral and Echocardiographic Parameters in Patients with Heart Failure with Reduced Ejection Fraction: The “Hemodynamic Reverse Remodeling”

2019 ◽  
Author(s):  
Giuseppe Romano ◽  
Giuseppe Vitale ◽  
Laura Ajello ◽  
Valentina Agnese ◽  
Diego Bellavia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Cardiac Performance ◽  
Reverse Remodeling ◽  
Severe Mitral Regurgitation ◽  
Class Iii ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Echocardiographic Parameters

Background: Sacubitril/valsartan has been shown to be superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF). However the effect on cardiac performance remains unknown. We sought to evaluate the effects of sacubitril/valsartan on clinical, bioumoral and echocardiographic parameters in patients with HFrEF. Methods: Sacubitril/valsartan was administered to 205 HFrEF patients. Results: Among 230 patients (mean age 59 &plusmn; 10 years, 46% with ischemic heart disease) 205 (89%) completed the study. After a follow&ndash;up of 10.49 (2.93&plusmn;18.44) months, the percentage of patients in NYHA class III changed from 40% to 17% (p&lt;0.001). Median N&ndash;Type natriuretic peptide (Nt-proBNP) decreased from 1865 &plusmn; 2318 to 1514 &plusmn; 2205 pg/mL, (p=0.01). Furosemide dose reduced from 131.3 &plusmn; 154.5 to 120 &plusmn; 142.5 (p=0.047). Ejection fraction (from 27&plusmn; 5.9% to 30 &plusmn; 7.7% (p&lt;0.001) and E/A ratio (from 1.67 &plusmn; 1.21 to 1.42 &plusmn; 1.12 (p=0.002)) improved. Moderate to severe mitral regurgitation (from 30.1% to 17.4%; p=0.002) and tricuspid velocity decreased from 2.8 &plusmn; 0.55 m/sec to 2.64 &plusmn; 0.59 m/sec (p&lt;0.014). CONCLUSIONS: Sacubitril/valsartan induce &ldquo;hemodynamic reverse remodeling&rdquo; and in association with Nt-proBNP concentrations lowering improve NYHA class despite a diuretic dose reduction.

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