scholarly journals The Role of Aldosterone Blockade in Patients with Hypertensive Heart and Cardiovascular Disease

2010 ◽  
Vol 2 ◽  
pp. CMT.S2232
Author(s):  
Bertram Pitt
Keyword(s):  
Heart Failure ◽  
Thiazide Diuretic ◽  
Severe Heart Failure ◽  
Hypertensive Heart Disease ◽  
Total Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
Aldosterone Blockade

Aldosterone blockade has been shown to be effective in reducing total mortality in patients with severe heart failure due to systolic left ventricular dysfunction and in patients with heart failure post myocardial infarction. Increasing evidence suggests that aldosterone blockade alone and or in conjunction with an angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) with or without a thiazide diuretic may also prevent target organ damage (TOD) in patients with hypertensive heart disease (HHD) independent of its effects on blood pressure. Aldosterone blockade may be of especial value in patients with resistant hypertension, visceral obesity, and sleep apnea. Aldosterone blockade prevents myocardial fibrosis and improves echocardiographic indices of diastolic function in patients with heart failure and a normal left ventricular ejection fraction (HFNEF). Its effects on cardiovascular mortality and hospitalization for heart failure in HFNEF are currently under investigation. Aldosterone blockade has also been shown to be beneficial in preventing experimental atherosclerosis and in limiting experimental stroke, although not as yet in man. Although aldosterone may cause serious hyperkalemia this is unlikely in patients with normal renal function. Nevertheless careful selection of patients and serial monitoring of serum potassium, especially in patients with chronic kidney disease, is essential if one is to obtain benefit from this strategy. The risk/benefit of aldosterone blockade alone and or in combination with an ACE-I or ARB with or without a thiazide diuretic in patients with HHD will however require further large scale prospective randomized study.

MANAGEMENT OF HEART FAILURE PATIENTS (UPDATE 2019) – PHARMACOLOGICAL THERAPY

2020 ◽  
Vol 1 (54) ◽  
pp. 30-32
Author(s):  
Przemysław Mitkowski ◽  
Maciej Grymuza
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Total Mortality ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Pharmacological Therapy ◽  
Left Ventricular Ejection ◽  
Premature Ventricular Contractions ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

The up-date of ESC Guidelines on the management of patients with heart failure was published last year. The beneficial effect of a new group of drugs (flozins, sacubitril/valsartan - ARNI) in patients with heart failure was pointed out. These drugs not only prevent the onset of heart failure but also reduce HF hospitalization rate and in patients with reduced left ventricular ejection fraction decrease risk of cardiovascular death and in case of empagliflozin, dapagliflozin or sacubitril/valsartan also total mortality. These latter medicines reduce also the likelihood of sudden cardiac death. ARNI reduce the number of appropriate ICD shocks, the incidence of non-sustained VT, premature ventricular contractions, and increase percentage of biventricular pacing in car­diac resynchronization recipients.

Abstract 17311: Ventricular Arrhythmias and Fibrosis in Patients With Heart Failure and Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Natasha Cuk ◽  
Jae H Cho ◽  
Donghee Han ◽  
Joseph E Ebinger ◽  
Eugenio Cingolani
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Mri ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
Ventricular Fibrosis

Introduction: Sudden death due to ventricular arrhythmias (VA) is one of the main causes of mortality in patients with heart failure and preserved ejection fraction (HFpEF). Ventricular fibrosis in HFpEF has been suspected as a substrate of VA, but the degree of fibrosis has not been well characterized. Hypothesis: HFpEF patients with increased degree of fibrosis will manifest more VA. Methods: Cedars-Sinai medical records were probed using Deep 6 artificial intelligence data extraction software to identify patients with HFpEF who underwent cardiac magnetic resonance imaging (MRI). MRI of identified patients were reviewed to measure extra-cellular volume (ECV) and degree of fibrosis. Ambulatory ECG monitoring (Ziopatch) of those patients were also reviewed to study the prevalence of arrhythmias. Results: A total of 12 HFpEF patients who underwent cardiac MRI were identified. Patients were elderly (mean age 70.3 ± 7.1), predominantly female (83%), and overweight (mean BMI 32 ± 9). Comorbidities included hypertension (83%), dyslipidemia (75%), and coronary artery disease (67%). Mean left ventricular ejection fraction by echocardiogram was 63 ± 8.7%. QTc as measured on ECG was not significantly prolonged (432 ± 15 ms). ECV was normal in those patients for whom it was available (24.2 ± 3.1, n = 9) with 3/12 patients (25%) demonstrating ventricular fibrosis by MRI (average burden of 9.6 ± 5.9%). Ziopatch was obtained in 8/12 patients (including all 3 patients with fibrosis) and non-sustained ventricular tachycardia (NSVT) was identified in 5/8 (62.5%). One patient with NSVT and without fibrosis on MRI also had a sustained VA recorded. In those patients who had Ziopatch monitoring, there was no association between presence of fibrosis and NSVT (X2 = 0.035, p = 0.85). Conclusions: Ventricular fibrosis was present in 25% of HFpEF patients in this study and NSVT was observed in 62.5% of those patients with HFpEF who had Ziopatch monitoring. The presence of fibrosis by Cardiac MRI was not associated with NSVT in this study; however, the size of the cohort precludes broadly generalizable conclusions about this association. Further investigation is required to better understand the relationship between ventricular fibrosis by MRI and VA in patients with HFpEF.

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