Abstract 2942: High Mortality Rates are Associated with Withdrawal of Beta Blockers and Ace Inhibitors in Chemotherapy-Induced Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ashish Shukla ◽  
S Wamique Yusuf ◽  
Iyad Daher ◽  
Daniel Lenihan ◽  
Jb Durand
Keyword(s):  
Heart Failure ◽  
Cancer Patients ◽  
Ace Inhibitors ◽  
Matched Control ◽  
Beta Blockers ◽  
Left Ventricular ◽  
T Test ◽  
Rank Test ◽  
Lv Function ◽  
Kaplan Meier

Beta blockers (BB) and ACE inhibitors (ACE) are recommended for management of left ventricular (LV)dysfunction including patients with chemotherapy-induced cardiomyopathy (CCM). There is a scarcity of data for the long term requirement of these medications in cancer patients, and the effect of their withdrawal after improvement of LV function is unknown. We report a cohort study involving patients with CCM on BB and ACE who underwent withdrawal of these medications and their outcome. Methods: In a cohort of patients with CCM stabilized on BB (commonly carvedilol) and ACE, sixteen patients were identified that had therapy withdrawn and then presented with acute heart failure. Patients resumed BB and ACE therapy and outcomes of LV function and survival were evaluated. The change in LVEF by ECHO was compared using paired t-test, with a matched control population with t-test and survivability compared and calculated using Kaplan-Meier estimates and log rank test. Results: A total of 48 patients, case (n=16) and matched control (n=32), on maximal tolerated doses of ACE+BB, mean EF of 49.62% Upon withdrawal mean EF decreased to 30.62% (p<0.0001). Nine patients died within six months of discontinuation of therapy, three of sudden cardiac death. Reinstitution of carvedilol+ACE improved LVEF to a mean of 45% (p<0.0001). Discussion: This study demonstrates acute deterioration in cardiac function and survival upon withdrawal of BB and ACE in patients with CCM, and a mortality of 56.25% for case patients and 28.12% for control patients. These data indicate that BB and ACE are pivotal in cancer patients with CCM and necessitates their indefinite use.

scholarly journals Are there benefits of low doses of ACE inhibitors, MRAs, diuretics and statins in the treatment of heart failure?

2021 ◽  
Vol 14 (2) ◽  
pp. 226-231
Author(s):  
V. А. Lysenko
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Relative Risk ◽  
Ace Inhibitors ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Scientific Data ◽  
Rank Test ◽  
Coronary Syndrome

Treatment of chronic heart failure (CHF) is very controversial. The issue of optimal doses of beta-blockers, ACE inhibitors, aldosterone receptor antagonists, statins in patients with CHF has not been conclusively addressed. Achieving the maximum tolerated doses of drugs, though related to reduced mortality, but is accompanied by an increase in adverse drug reactions. The aim. To present and discuss our own clinical and scientific data concerning the role of beta-blockers and inhibitors of the renin-angiotensin aldosterone system, diuretics, statins in the treatment of CHF patients and optimization of dosage schemes. Material and methods. The study included 88 patients with CHF of ischemic origin, with sinus rhythm, stage II AB, NYHA FC II–IV, 58 – with reduced LV EF (HFrEF) and 30 – with preserved LV EF (HFpEF). The mean age of patients was 69.18 ± 9.97 years, men 52 % (n = 46). The median follow-up of the CHF patients was 396 days, the maximum number of follow-up days was 1302. During the observation period, 14 endpoints were registered, which accounted for 15.91 % of events: 7 deaths (8.0 %), 2 strokes (2.3 %), 2 cases of acute coronary syndrome (2.3 %), 3 progressive heart failure cases (3.4 %). Kaplan–Mayer curves were drawn to assess survival rate, and the significance of difference between groups was calculated by the criteria of Gehan–Wilcoxon, Cox–Mantel and log-rank test. Risk factors were determined, and prognostic uni- and multi-variant Cox proportional hazards regression models were used. The cut-off values of quantitative risk factors were obtained by ROC analysis. Results. The increase in the relative risk of adverse cardiovascular events in the CHF patients regardless of LV EF was associated with a daily carvedilol dose of more than 25 mg (HR = 1.05; 95 % CI 1.009–1.093; P = 0.0171); eplerenone – more than 12.5 mg (HR = 1.073; 95 % CI 1.005–1.144; P = 0.034), torasemide – more than 5 mg (HR = 1.13; 95 % CI 1.021–1.255; P = 0.019); rosuvastatin – more than 10 mg (HR = 1.107; 95 % CI 1.007–1.203; P = 0.035), and the trend in using atorvastatin at a dose of less than 10 mg (HR = 1.05; 95 % CI 0.951–1.165; P = 0.327). The use of ramipril in a daily dose of less than 2.5 mg was accompanied by a trend towards the 22 % reduced relative risk of adverse cardiovascular events (HR = 0.78; 95 % CI 0.384–1.580; P = 0.491). Conclusions. Positive treatment outcomes in the CHF patients, regardless of the phenotype, were associated with low daily doses of ramipril (<2.5 mg), eplerenone/spironolactone (<12.5 mg), torasemide (<5.0 mg), rosuvastatin (<10.0 mg), but with high doses of atorvastatin (>10.0 mg).

Cardiovascular Involvement in Thalassemia Major Patients: WEB-THAL® Data Analysis (A Web-Based Multicentric Database).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3824-3824
Author(s):  
Giorgio Derchi ◽  
Francesco Formisano ◽  
Martina Lamagna ◽  
Renzo Galanello ◽  
Patrizio Bina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ace Inhibitors ◽  
Beta Blockers ◽  
Large Population ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Web Based ◽  
Mean Values ◽  
Cardioactive Drug ◽  
History Of

Abstract Prevalence of Left Ventricular Dysfunction (LVD), and Congestive Heart Failure (CHF) have been widely described in Thalassemia Major (TM) patients (pts), according to age, therapy, severity and coexisting diseases. However, so far no data are available in a large population adequately transfused and chelated. To determine the LV involvement in treated TM patients, we studied 524 pts from 5 Thalassemia Centers in Italy (49% males, mean age 30 yrs, range 16 to 56 yrs). In all pts clinical and echocardiographic data were recorded in WEBTHAL® database, a large co-operative Italian project among Thalassemia Centres based on an Internet-shared software for thalassemia. Data were evaluated blind by two independent researchers. Patients were considered having LVD if at least one cardioactive drug and/or history of cardiopathy (heart failure and/or clinically relevant arrhythmias) was recorded in their file (102/524 patients, 19,5%). Tables I and II summarize the echocardiographic results and cardiological treatment. Table I TM population without LV involvement (n°422 pts) and on cardiological treatment (n° 102 pts) Mean * Statistically significant between groups Pretrasfusional Hb (g/dl) 9,4 Ferritin (μg/dl) mean of last 10yrs 2027,7 LV end diastolic diameter index (mm/m2) 31,8 FS (%) 35,0 EF (%) 60,6 Duration of transfusion period (yrs) 24,5 Pretransfusional Hb (g/dl) 9,5 Ferritin (μg/dl) mean of last 10yrs * 2389,6 LV end diastolic diameter index (mm/m2)* 32,9 FS %* 31,3 EF % 54,4 Duration of transfusion period (yrs)* 26,2 Table 2 Cardiovascular Drugs N° % At least one drug 102 19,5 ACE Inhibitors 81 15,5 Diuretics 39 7,4 Beta-blockers 24 4,6 Antiarrhythmics 16 3,1 Digoxin 8 1,5 The majority of patients (422 subjects, 80.5%) did not take any cardioactive drugs and were considered without LV involvement. Systolic Pulmonary pressure was elevated (PH) (&gt; 25 mmHg) in 10% of pts. ACE-inhibitors were the most used cardiovascular drug (15.5% of the pts), mainly males (n°56 pts, p&lt;0.001). Pts on cardiological treatment showed lower FS%, compared to pts without cardioactive treatment (p&lt; 0.001) and higher LV End Diastolic Diameter Index (32,9 vs 31,2, p&lt; 0.009). Pts with LV involvement had a significatively longer regular trasfusional period compared to patients of matched age and they higher mean ferritin values (Tab1). Female patients had a significantly lower prevalence of LV involvement. In this group EF% and FS% were higher than in males (p&lt; 0,001 and p&lt;0,04, respectively). According to these data, LV involvement is characterized by a large and hypokinetic LV and occurs in 19% of a regularly transfused and chelated TM population. The LV disfunction is likely related to a long exposure to iron load in the heart. The mean values of clinical and echocardiographical variables of TM population without LV involvement can be considered as reference values (Table I).

Right ventricular rather than left ventricular systolic dysfunction predicts outcome in patients undergoing transcatheter aortic valve implantation: insights from cardiac magnetic resonance imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Koschutnik ◽  
C Nitsche ◽  
C Dona ◽  
V Dannenberg ◽  
A.A Kammerlander ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Prognostic Information ◽  
Transcatheter Aortic Valve ◽  
Kaplan Meier ◽  
Lv Volumes ◽  
Valve Implantation ◽  
Rv Function

Abstract Background Right ventricular (RV) function is strongly associated with outcome in heart failure. Whether it also adds important prognostic information in patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. Methods We consecutively enrolled patients with severe aortic stenosis (AS) scheduled for TAVI and preprocedural cardiac magnetic resonance (CMR) imaging. Kaplan-Meier estimates and multivariate Cox regression analyses were used to identify factors associated with outcome. A composite of heart failure hospitalization and/or cardiovascular death was selected as primary study endpoint. Results 423 consecutive patients (80.7±7.3 years; 48% female) were prospectively included, 201 (48%) underwent CMR imaging. 55 (27%) patients presented with RV systolic dysfunction (RVSD) defined by RV ejection fraction (RVEF) &lt;45%. RVSD was associated with male sex (69 vs. 40%; p&lt;0.001), New York Heart Association (NYHA) functional status (NYHA ≥ III: 89 vs. 57%; p&lt;0.001), NT-proBNP serum levels (9365 vs. 2715 pg/mL; p&lt;0.001), and history of atrial fibrillation (AF: 51 vs. 30%; p=0.005). On CMR, RVSD was associated with left ventricular (LV) volumes (end-diastolic: 187 vs. 137 mL, end-systolic: 119 vs. 53 mL; p&lt;0.001) and EF (39 vs. 64%; p&lt;0.001). A total of 51 events (37 deaths, 14 hospitalizations for heart failure) occurred during follow-up (9.8±9 months). While LVSD (LVEF &lt;50%) was not significantly associated with outcome (HR 0.83, 95% CI: 0.33 – 2.11; p=0.694), RVSD showed a strong and independent association with event-free survival by multivariate Cox regression analysis (HR 2.47, 95% CI: 1.07–5.73; p=0.035), which was adjusted for all relevant CMR parameters (LV volumes and EF), cardiovascular risk factors (sex, NYHA, AF, diabetes mellitus type II, use of diuretics), and routine biomarkers (NT-proBNP, creatinine). Conclusions RVSD rather than LVSD, as determined on CMR, is an important predictor of outcome in patients undergoing TAVI. RV function might thus add useful prognostic information on top of established risk factors. Figure 1. Kaplan-Meier survival curves Funding Acknowledgement Type of funding source: None

scholarly journals Challenges in the diagnosis of peripartum cardiomyopathy: a case series

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Fabio Chirillo ◽  
Anna Baritussio ◽  
Umberto Cucchini ◽  
Ermanno Toniolli ◽  
Angela Polo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multimodality Imaging ◽  
Systolic Dysfunction ◽  
Case Series ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Lv Function ◽  
Prognostic Information ◽  
Clinical Scenarios ◽  
Anterolateral Wall

Abstract Background Peripartum cardiomyopathy (PPCM) is usually characterized by overt heart failure, but other clinical scenarios are possible, sometimes making the diagnosis challenging. Case summary We report a case series of four patients with PPCM. The first patient presented with acute heart failure due to left ventricular (LV) systolic dysfunction. Following medical treatment, LV function recovered completely at 1 month. The second patient had systemic and pulmonary thromboembolism, secondary to severe biventricular dysfunction with biventricular thrombi. The third patient presented with myocardial infarction with non-obstructed coronary arteries and evidence of an aneurysm of the mid-anterolateral LV wall. The fourth patient, diagnosed with PPCM 11 years earlier, presented with sustained ventricular tachycardia. A repeat cardiac magnetic resonance, compared to the previous one performed 11 years earlier, showed an enlarged LV aneurysm in the mid-LV anterolateral wall with worsened global LV function. Discussion Peripartum cardiomyopathy may have different clinical presentations. Attentive clinical evaluation and multimodality imaging can provide precise diagnostic and prognostic information.

scholarly journals Left ventricular systolic function decreases in lamin a/c cardiomyopathy wihout concomitant ventricular dilatation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
ES Eystein Skjolsvik ◽  
OL Oyvind Haugen Lie ◽  
MC Monica Chivulescu ◽  
MR Margareth Ribe ◽  
AIC Anna Isotta Castrini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
University Hospital ◽  
Lv Function ◽  
Lamin A ◽  
Age Related ◽  
End Stage Heart Failure ◽  
Lv Volumes ◽  
End Stage

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This work was supported by the Norwegian Research Council [203489/030] onbehalf Department of Cardiology, Research group for genetic cardiac diseases and sudden cardiac death, Oslo University Hospital, Rikshospitalet, Oslo, Norwa Background Lamin A/C disease is an inheritable cardiomyopathy characterized by conduction abnormalities, ventricular arrhythmias and end stage heart failure with complete age-related penetrance. Purpose To assess left ventricular structural and functional progression in patients with lamin A/C cardiomyopathy. Methods We included and followed consecutive lamin A/C genotype positive patients with clinical examination and echocardiography at every visit. We evaluated progression of left- ventricular size and function by mixed model statistics. Results We included 101 consecutive lamin A/C genotype positive patients (age 44 [29-54] years, 39% probands, 51%female) with 576 echocardiographic exams during 4.9 (IQR 2.5-8.1) years of follow-up. LV ejection fraction (LVEF) declined from 50 ± 12% to 47 ± 13%, p &lt; 0.001 (rate -0.5%/year). LV end diastolic volumes (LVEDV) remained stationary with no significant dilatation in the total population (136 ± 45ml to 138 ± 43ml, p = 0.60), (Figure). In the subgroup of patients &gt;58 years, we observed a decline in LV volumes 148, SE 9 ml to 140, SE 9 ml p &lt; 0.001 (rate -2.7 ml/year) towards end stage heart failure. Conclusions LVEF deteriorated, while LV size remained unchanged during 4.9 years of follow-up in patients with lamin A/C cardiomyopathy. In patients &lt;58 years, we observed a reduction in LV volumes. These findings represent loss of LV function without the necessary compensatory dilation to preserve stroke volume indicating high risk of decompensated end stage heart failure in lamin A/C. Abstract Figure.

scholarly journals Uric Acid, Oxidative Stress and Inflammation in Chronic Heart Failure with Reduced Ejection Fraction

2015 ◽  
Vol 23 (4) ◽  
pp. 397-406 ◽  
Author(s):  
Adriana Iliesiu ◽  
Alexandru Campeanu ◽  
Daciana Marta ◽  
Irina Parvu ◽  
Gabriela Gheorghe
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Uric Acid ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Xanthine Oxidase ◽  
Left Ventricular ◽  
Paraoxonase 1 ◽  
Lv Function ◽  
The Relationship

Abstract Background. Oxidative stress (OS) and inflammation are major mechanisms involved in the progression of chronic heart failure (CHF). Serum uric acid (sUA) is related to CHF severity and could represent a marker of xanthine-oxidase activation. The relationship between sUA, oxidative stress (OS) and inflammation markers was assessed in patients with moderate-severe CHF and reduced left ventricular (LV) ejection fraction (EF). Methods. In 57 patients with stable CHF, functional NYHA class III, with EF<40%, the LV function was assessed by N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) levels and echocardiographically through the EF and E/e’ ratio, a marker of LV filling pressures. The relationship between LV function, sUA, malondialdehyde (MDA), myeloperoxidase (MPO), paraoxonase 1 (PON-1) as OS markers and high sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) as markers of systemic inflammation was evaluated. Results. The mean sUA level was 7.9 ± 2.2 mg/dl, and 61% of the CHF patients had hyperuricemia. CHF patients with elevated LV filling pressures (E/e’ ≥ 13) had higher sUA (8.6 ± 2.3 vs. 7.3 ± 1.4, p=0.08) and NT-proBNP levels (643±430 vs. 2531±709, p=0.003) and lower EF (29.8 ± 3.9 % vs. 36.3 ± 4.4 %, p=0.001). There was a significant correlation between sUA and IL-6 (r = 0.56, p<0.001), MDA (r= 0.49, p= 0.001), MPO (r=0.34, p=0.001) and PON-1 levels (r= −0.39, p= 0.003). Conclusion. In CHF, hyperuricemia is associated with disease severity. High sUA levels in CHF with normal renal function may reflect increased xanthine-oxidase activity linked with chronic inflammatory response.

Abstract 3791: Improved Ventricular-Arterial Coupling After 4 Weeks of Exercise Training in Patients with Chronic Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Marcus Sandri ◽  
Stephan Gielen ◽  
Norman Mangner ◽  
Volker Adams ◽  
Sandra Erbs ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Exercise Training ◽  
Endothelial Function ◽  
Training Group ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Lv Function ◽  
Ventricular Ejection Fraction

Background: The concept of ventricular-arterial coupling implies that LV-function is determined by the three factors left ventricular diastolic, left ventricular systolic and arterial elastance. We have previously documented an improvement in endothelial function and systolic LV-function in patients with chronic heart failure (CHF) after 6 months of exercise training (ET). It remains, however, unclear, how shorter ET periods may affect endothelial, systolic and diastolic ventricular function as echocardiographic parameters related to ventricular arterial coupling in patients with CHF. METHODS: In this ongoing study we randomised 43 patients with stable CHF (age 60.3 ± 2.9 years, EF 27.4 ± 1.7%, VO 2 max 14.7 ± 4.3ml/kg*min) to a training or a control group (C). Patients in the training group exercised 4 times daily at 70% of the individual heart rate reserve for 4 weeks under supervision. At baseline and after 4 weeks the E/A ratio and septal/lateral E’/A’ velocities were determined by echocardiography with tissue Doppler. Exercise capacity was measured by ergospirometry and flow-mediated dilatation (FMD) was assessed by high-resolution radial ultrasound. RESULTS: After only 4 weeks of ET oxygen uptake at peak exercise increased from 14.9 ± 3.3 to 18.1 ± 4.7 ml/min/kg, (p<0.01 vs. C) in training subjects. Left ventricular ejection fraction improved from 26.8 ± 4.6 to 33.1 ± 5.5% (p<0.05 vs. C) in patients of the training group while it remained unchanged in the control group. E/A-ratio mended from 0.63 ± 0.12 to 0.81 ± 0.22 (p<0.01 vs. C) in training patients. Septal E’ velocities increased from 5.5 ± 0.5 to 7.8 ± 1.4 cm/s in training patients (p<0.05 vs. C). FMD of the radial artery improved from 8.2 ± 2.1 to 15.2 ± 3.8% (p<0.01 vs. C) as a result of ET. CONCLUSIONS: Only 4 weeks of endurance training are highly effective with significantly improved FMD accompanied by an emended systolic and diastolic LV-function. We hypothesise that the improvement in LV-EF in training patients may be caused by a corrected ventricular-arterial coupling: ventricular diastolic relaxation and effective endothelial function are ameliorated resulting in an augmentation of stroke volume.

Abstract P020: A Bioengineered Neonatal Cardiomyocyte Scaffold Promotes Cell Survival and Improves Left Ventricular Function in Rats with Heart Failure

2011 ◽  
Vol 109 (suppl_1) ◽  
Author(s):  
Jordan Lancaster ◽  
Elizabeth Juneman ◽  
Nicholle Johnson ◽  
Joseph Bahl ◽  
Steven Goldman
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cell Survival ◽  
Cell Tracking ◽  
Left Ventricular ◽  
Neonatal Rat ◽  
Lv Function ◽  
Coronary Artery Ligation ◽  
Neonatal Cardiomyocyte

Background: Cell-based regenerative therapies hold promise as a new treatment for heart failure. Tissue engineered scaffolds used for cell delivery enhance potential improvements in cardiac function by providing the structural and nutrient support for transplanted cell survival, integration, and re-population of injured tissues. Previously, our laboratory reported improvements in left ventricular (LV) function in rats with chronic heart failure (CHF) after placement of a neonatal cardiomyocyte (NCM) seeded 3-dimensional fibroblast construct (3DFC). In brief, 3 weeks after implantation of the NCM-3DFC, LV function improves by increasing (p<0.05) ejection fraction 26% and cardiac index 33%, while decreasing (p<0.05) LV end diastolic pressure 38%. The current report focuses on NCM survival and LV improvements out to 7 weeks post NCM-3DFC implantation. Methods and Results: Cardiomyocytes were isolated from neonatal rat hearts and seeded onto a 3DFC. We evaluated NCM-3DFC in vitro for cellular organization and the presence of functional gap junctions, which demonstrated extensive cell-to-cell connectivity. At 5 days in culture, the seeded patch contracted spontaneously in a rhythmic and directional fashion, beating at 43±3 beats/min with a mean displacement of 1.3±0.3 mm and contraction velocity of 0.8±0.2 mm/sec. The seeded patch could be electrically paced at near physiological rates (270±30 beats/min) while maintaining coordinated, directional contractions. For in vivo evaluation, rats underwent coronary artery ligation and allowed to recover for 3 weeks to establish CHF. NCM-3DFC were implanted 3 weeks after ligation and evaluated 3 and 7 weeks later (6 and 10 weeks after ligation respectively). Live cell tracking of implanted NCM using Q-Dots revealed ∼9% survival of transplanted cells 3 weeks after implantation. In addition, improvements in LV function continued at 7 weeks after implantation of the NCM-3DFC by increasing (p<0.05) ejection fraction 37%. Conclusion: A multicellular, electromechanically organized, cardiomyocyte scaffold, engineered in vitro can improve LV function when implanted directly on the hearts of rats with CHF; the transplanted cells survive and improve LV function chronically.

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