scholarly journals Emerging Novel Therapies for Heart Failure

2015 ◽  
Vol 9s2 ◽  
pp. CMC.S29735 ◽  
Author(s):  
Anthony M. Szema ◽  
Sophia Dang ◽  
Jonathan C. Li
Keyword(s):  
Heart Failure ◽  
Energy Production ◽  
Heart Function ◽  
Human Subjects ◽  
Unmet Need ◽  
Novel Therapies ◽  
Current Standard ◽  
Mortality And Morbidity ◽  
Novel Treatments ◽  
Coronary Dilation

Heart function fails when the organ is unable to pump blood at a rate proportional to the body's need for oxygen or when this function leads to elevated cardiac chamber filling pressures (cardiogenic pulmonary edema). Despite our sophisticated knowledge of heart failure, even so-called ejection fraction-preserved heart failure has high rates of mortality and morbidity. So, novel therapies are sorely needed. This review discusses current standard therapies for heart failure and launches an exploration into emerging novel treatments on the heels of recently-approved sacubitril and ivbradine. For example, Vasoactive Intestinal Peptide (VIP) is protective of the heart, so in the absence of VIP, VIP knockout mice have dysregulation in key heart failure genes: 1) Force Generation and Propagation; 2) Energy Production and Regulation; 3) Ca+2 Cycling; 4) Transcriptional Regulators. VIP administration leads to coronary dilation in human subjects. In heart failure patients, VIP levels are elevated as a plausible endogenous protective effect. With the development of elastin polymers to stabilize VIP and prevent its degradation, VIP may therefore have a chance to satisfy the unmet need as a potential treatment for acute heart failure.

scholarly journals Transcatheter therapies for secondary mitral regurgitation in advanced heart failure: what are we aiming for?

2021 ◽  
Author(s):  
Andrea Scotti ◽  
Andrea Munafò ◽  
Alberto Margonato ◽  
Cosmo Godino
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Heart Transplantation ◽  
Symptomatic Relief ◽  
Clinical Status ◽  
Unmet Need ◽  
Advanced Heart Failure ◽  
Mortality And Morbidity ◽  
Clinical Consequences ◽  
Secondary Mitral Regurgitation

AbstractA severe secondary mitral regurgitation (SMR) can be found in a significant portion of patients affected by advanced heart failure (AHF). Conventional therapies (optimal medical therapy, devices, surgery) present restricted clinical efficacy in this stage of the left ventricle disease which is burdened by high mortality and morbidity rates. Although the treatment of choice is represented by heart transplantation (HTx), there is an unmet need related to the limited supply of donor hearts (as opposed to the growing prevalence of AHF) and the low eligibility of highly symptomatic patients. In case of concomitant severe SMR, transcatheter mitral valve therapies (repair and replacement) may play a crucial role in this setting. While a direct prognostic improvement after correction of SMR has yet to be proved, AHF patients can benefit from the following: hemodynamic stabilization, symptomatic relief, normalization of pulmonary arterial pressures, and reduction in hospitalizations for acute heart failure. Obtaining these results may lead to the clinical consequences of reaching the HTx in good enough clinical status (bridge to heart transplantation), becoming eligible for the HTx (bridge to HTx candidacy), and being delisted for clinical improvement (bridge to recovery). Therefore, achieving traditional secondary endpoints in patients with AHF and SMR can translate into significant clinical implications.

scholarly journals Application of the Canadian Cardiovascular Society's heart failure guidelines in a heart function clinic

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Brynn Victoria Margaret Aucoin ◽  
Robert S. Stevenson
Keyword(s):  
Heart Failure ◽  
Practice Guidelines ◽  
Heart Function ◽  
Guideline Recommendation ◽  
Evidence Based ◽  
Clinical Practices ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Failure Data

Keywords: Heart Failure, Guideline Adherence, Evidence Based-PracticePurpose: Heart failure is a significant diagnosis that poses serious mortality and morbidity risks. Many studies have assessed the efficacy of evidence-based guidelines in improving patient outcomes in the management of heart failure; however, there is limited data on how these guidelines are applied in clinical practice.Methods: A retrospective, cross-sectional approach was used to examine a physician’s adherence to the Canadian Cardiovascular Society’s (CCS) most recent practice guidelines on managing heart failure. Data was collected from electronic hospital health records and patient charts of patients enrolled in a heart function clinic. Qualitative and quantitative analyses were done to compare current clinical practices related to investigations, treatment, and follow-up to the guidelines.Results: A total of 37 patients met inclusion criteria for this study (n=37). The majority of patients were males, 81%, with an average age of 71 years, 10 medications with 5.5 comorbidities. Recommendations regarding wait times, frequency of follow-up, and blood work were met 97%, 78%, and 64% of participants, respectively with most patients being reassessed more frequently than the guideline recommendation. Medical therapy recommendations were met in over 70% of participants. All participants had EF assessments as frequently or more frequently than guideline requirements.Conclusion: Overall, the Heart Function Clinic practices assessed in this study align well with the current guidelines recommended by the CCS. Although this study is by no means comprehensive, it provides an initial glimpse into how practice guidelines may be applied in clinical practice and identifies areas where further work needs to be done.

scholarly journals Staphylococcus aureus Keratitis: Incidence, Pathophysiology, Risk Factors and Novel Strategies for Treatment

2021 ◽  
Vol 10 (4) ◽  
pp. 758
Author(s):  
Jason W. Lee ◽  
Tobi Somerville ◽  
Stephen B. Kaye ◽  
Vito Romano
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Clinical Characteristics ◽  
Surgical Intervention ◽  
Current Evidence ◽  
Bacterial Keratitis ◽  
Novel Therapies ◽  
Causative Pathogen ◽  
Novel Treatments

Bacterial keratitis is a devastating condition that can rapidly progress to serious complications if not treated promptly. Certain causative microorganisms such as Staphylococcus aureus and Pseudomonas aeruginosa are notorious for their resistance to antibiotics. Resistant bacterial keratitis results in poorer outcomes such as scarring and the need for surgical intervention. Thorough understanding of the causative pathogen and its virulence factors is vital for the discovery of novel treatments to avoid further antibiotic resistance. While much has been previously reported on P. aeruginosa, S. aureus has been less extensively studied. This review aims to give a brief overview of S. aureus epidemiology, pathophysiology and clinical characteristics as well as summarise the current evidence for potential novel therapies.

scholarly journals Right ventricular function and its coupling with the pulmonary circulation in acute heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Barki ◽  
M Losito ◽  
M.M Caracciolo ◽  
F Bandera ◽  
M Rovida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Acute Phase ◽  
Pulmonary Circulation ◽  
Heart Function ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Response To Treatment ◽  
The Right ◽  
B Lines

Abstract Background The right ventricle (RV) is extremely sensitive to hemodynamic changes and increased impedance. In acute heart failure (AHF), the development of pulmonary venous congestion and the increase of left ventricular (LV) filling pressures favors pulmonary vascular adverse remodeling and ultimately RV dysfunction, leading to the onset of symptoms and to a further decay of cardiac dynamics. Purpose The aim of the study was to evaluate RV morphology and functional dynamics at admission and discharge in patients hospitalized for AHF, analyzing the role and the response to treatment of the RV and its coupling with pulmonary circulation (PC). Methods Eighty-one AHF patients (mean age 75.75±10.6 years, 59% males) were prospectively enrolled within 24–48 hours from admission to the emergency department (ED). In either the acute phase and at pre-discharge all patients underwent M-Mode, 2-Dimensional and Doppler transthoracic echocardiography (TTE), as well as lung ultrasonography (LUS), to detect an increase of extravascular lung water (EVLW) and development of pleural effusion. Laboratory tests were performed in the acute phase and at pre-discharge including the evaluation of NT-proBNP. Results At baseline we observed a high prevalence of RV dysfunction as documented by a reduced RV systolic longitudinal function [mean tricuspid annular plane systolic excursion (TAPSE) at admission of 16.47±3.86 mm with 50% of the patients exhibiting a TAPSE<16mm], a decreased DTI-derived tricuspid lateral annular systolic velocity (50% of the subjects showed a tricuspid s' wave<10 cm/s) and a reduced RV fractional area change (mean FAC at admission of 36.4±14.6%). Furthermore, an increased pulmonary arterial systolic pressure (PASP) and a severe impairment in terms of RV coupling to PC was detected at initial evaluation (mean PASP at admission: 38.8±10.8 mmHg; average TAPSE/PASP at admission: 0.45±0.17 mm/mmHg). At pre-discharge a significant increment of TAPSE (16.47±3.86 mm vs. 17.45±3.88; p=0.05) and a reduction of PASP (38.8±10.8 mmHg vs. 30.5±9.6mmHg, p<0.001) was observed. Furthermore, in the whole population we assisted to a significant improvement in terms of RV function and its coupling with PC as demonstrated by the significant increase of TAPSE/PASP ratio (TAPSE/PASP: 0.45±0.17 mm/mmHg vs 0.62±0.20 mm/mmHg; p<0.001). Patients significantly reduced from admission to discharge the number of B-lines and NT-proBNP (B-lines: 22.2±17.1 vs. 6.5±5 p<0.001; NT-proBNP: 8738±948 ng/l vs 4227±659 ng/l p<0.001) (Figure 1). Nonetheless, no significant changes of left atrial and left ventricular dimensions and function were noted. Conclusions In AHF, development of congestion and EVLW significantly impact on the right heart function. Decongestion therapy is effective for restoring acute reversal of RV dysfunction, but the question remains on how to impact on the biological properties of the RV. Funding Acknowledgement Type of funding source: None

scholarly journals Cardiac Amyloidosis Therapy: A Systematic Review

2021 ◽  
Vol 11 (1) ◽  
pp. 10-17
Author(s):  
Franco Iodice ◽  
Marco Di Mauro ◽  
Marco Giuseppe Migliaccio ◽  
Angela Iannuzzi ◽  
Roberta Pacileo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Cardiac Amyloidosis ◽  
Restrictive Cardiomyopathy ◽  
Novel Therapies ◽  
Preserved Ejection Fraction ◽  
Cardiac Damage ◽  
Transthyretin Amyloidosis ◽  
To Come ◽  
Almost All

Heart involvement in Cardiac Amyloidosis (CA) results in a worsening of the prognosis in almost all patients with both light-chain (AL) and transthyretin amyloidosis (ATTR). The mainstream CA is a restrictive cardiomyopathy with hypertrophic phenotype at cardiac imaging that clinically leads to heart failure with preserved ejection fraction (HFpEF). An early diagnosis is essential to reduce cardiac damage and to improve the prognosis. Many therapies are available, but most of them have late benefits to cardiac function; for this reason, novel therapies are going to come soon.

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