scholarly journals Valvular Heart Disease in Heart Failure

2017 ◽  
Vol 10 ◽  
Author(s):  
Giuseppe Rosano
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Severe Aortic Stenosis ◽  
Clinical Status ◽  
Heart Team ◽  
Hybrid Procedures ◽  
Increased Risk ◽  
Co Morbidity ◽  
Patients With Heart Failure

Structural valvular heart disease may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure may also develop in patients treated with valve surgery. Patients with heart failure with valvular heart disease are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous) all patients should receive appropriate medical and device therapy taking into account that vasodilators must be used with caution in patients with severe aortic stenosis. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of valvular heart disease. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk– benefit ratio of different treatment strategies and should be made by a multidisciplinary ‘heart team’ with a particular expertise in valvular heart disease. The heart team should include heart failure cardiologists, cardiac surgeons/structural valve interventionists, imaging specialists, anaesthetists, geriatricians and intensive care specialists. This article will review recent developments and distill practical guidance in the management of this important heart failure co-morbidity.

The impact of nesiritide in patients with heart failure and significant valvular heart disease

2004 ◽  
Vol 10 (4) ◽  
pp. S116
Author(s):  
Ambika Bhaskaran ◽  
Robert M. Siegel ◽  
Jennifer Vermillion ◽  
Barbara Barker ◽  
Therese Sargent ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Patients With Heart Failure ◽  
The Impact

Co-morbidity (HFrEF and HFpEF): renal dysfunction

ESC CardioMed ◽  
2018 ◽  
pp. 1812-1816
Author(s):  
Kevin Damman
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Renal Dysfunction ◽  
Venous Pressure ◽  
Renal Perfusion ◽  
Reduced Ejection Fraction ◽  
Unselected Patient ◽  
Increased Risk ◽  
Co Morbidity ◽  
Patients With Heart Failure

Renal dysfunction is one of the most prevalent co-morbidities in patients with heart failure, present in 40–60% in unselected patient populations. The kidney is at the centre of the pathophysiology of heart failure as it is responsible for the maladaptive excessive salt and water retention, and is also the main target for therapy for most heart failure treatments. Although systemic processes that are activated in heart failure contribute to the pathophysiology of renal dysfunction (probably more in heart failure with preserved versus reduced ejection fraction), the most important causes are a reduction in renal perfusion and an increase in renal venous pressure. As patients with combined heart and renal dysfunction have a strongly increased risk of worse clinical outcomes, these patients should be intensively monitored and treated according to heart failure guidelines.

scholarly journals Pergolide Associated Cardiac Valvulopathy Based on Ontario Administrative Data

2008 ◽  
Vol 35 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Cindy Zadikoff ◽  
Minh Duong-Hua ◽  
Kathy Sykora ◽  
Connie Marras ◽  
Anthony Lang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Hospital Admissions ◽  
Population Based ◽  
Hazard Ratio ◽  
Exposure Effect ◽  
Increased Risk ◽  
Secondary Objective

Introduction:Pergolide is an ergot derived dopamine agonist that is widely used for the treatment of Parkinson’s disease. Studies have found an association between pergolide and valvular heart abnormalities although there is still much to be learned about the clinical significance of the valvular changes, who is at risk, and whether there is duration of exposure effect.Objective:To assess the long term risk of hospital admissions for valvular heart disease (VHD) or congestive heart failure (CHF, a clinically overt outcome of VHD) in new users of pergolide compared to new users of levodopa. The secondary objective was to assess whether there are any characteristics that can predict who is at higher risk of developing this outcome.Design:Retrospective, population-based cohort study.Setting:Ontario, Canada.Subjects:Ontario residents aged 66 and older, newly started on treatment with either pergolide or levodopa.Outcomes:Admission to hospital with the most responsible diagnosis of congestive heart failure or valvular heart disease.Results:The risk for admission for valvular heart disease or congestive heart failure were higher in those with 1-4 years exposure to pergolide compared with no exposure to pergolide (VHD: hazard ratio 2.4, p = 0.04; CHF: hazard ratio 1.6, p =0.02). No such pattern was found with exposure to levodopa.Conclusion:Our study demonstrates that treatment with pergolide is associated with a higher risk of hospital admission for valvular heart disease or congestive heart failure and that this risk is greater in those with 1-4 years exposure than in those with less exposure. We did not find an increased risk beyond four years.

Assessing left ventricular systolic function: from ejection fraction to strain analysis

2020 ◽  
Author(s):  
Brian P Halliday ◽  
Roxy Senior ◽  
Dudley J Pennell
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Valvular Heart Disease ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Abstract The measurement of left ventricular ejection fraction (LVEF) is a ubiquitous component of imaging studies used to evaluate patients with cardiac conditions and acts as an arbiter for many management decisions. This follows early trials investigating heart failure therapies which used a binary LVEF cut-off to select patients with the worst prognosis, who may gain the most benefit. Forty years on, the cardiac disease landscape has changed. Left ventricular ejection fraction is now a poor indicator of prognosis for many heart failure patients; specifically, for the half of patients with heart failure and truly preserved ejection fraction (HF-PEF). It is also recognized that LVEF may remain normal amongst patients with valvular heart disease who have significant myocardial dysfunction. This emphasizes the importance of the interaction between LVEF and left ventricular geometry. Guidelines based on LVEF may therefore miss a proportion of patients who would benefit from early intervention to prevent further myocardial decompensation and future adverse outcomes. The assessment of myocardial strain, or intrinsic deformation, holds promise to improve these issues. The measurement of global longitudinal strain (GLS) has consistently been shown to improve the risk stratification of patients with heart failure and identify patients with valvular heart disease who have myocardial decompensation despite preserved LVEF and an increased risk of adverse outcomes. To complete the integration of GLS into routine clinical practice, further studies are required to confirm that such approaches improve therapy selection and accordingly, the outcome for patients.

scholarly journals Use of a homecare electronic health record to find associations between patient characteristics and re-hospitalizations in patients with heart failure using telehealth

2013 ◽  
Vol 19 (2) ◽  
pp. 107-112 ◽  
Author(s):  
Kavita Radhakrishnan ◽  
Cynthia S Jacelon ◽  
Carol Bigelow ◽  
Joan Roche ◽  
Jenna Marquard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Patient Characteristics ◽  
Health Records ◽  
Discharge Data ◽  
Increased Risk ◽  
Co Morbidity ◽  
Patients With Heart Failure ◽  
Medicare Patients ◽  
Electronic Health ◽  
And Gender

Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of the start of telemonitoring. In adjusted analyses, the patients’ number of medications and type of cardiac medications were significantly ( P < 0.05) associated with an increased risk of re-hospitalization. After stratifying the sample by illness severity, age and gender, other significant ( P < 0.05) predictors associated with an increased risk of all-cause and cardiac re-hospitalization were psychiatric co-morbidity, pulmonary and obesity co-morbidities within gender, beta blocker prescription in females and primary HF diagnosis in the oldest age stratum. The study's findings may assist homecare agencies seeking to allocate resources without compromising patient care.

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