Development of Small-molecule SERCA2a Stimulators: A Novel Class of Ino-lusitropic Agents.

The issues of epidemiology, pathophysiology and basic principles of treatment of chronic heart failure in patients with type 2 diabetes mellitus are considered. Attention is paid to both means of glycemic correction and treatment of chronic heart failure directly, taking into account the effectiveness, cardiovascular safety of drugs, as well as their impact on the course and prognosis of chronic heart failure. The results of randomized clinical trials to study the effectiveness of various groups of drugs for the treatment of chronic heart failure in patients with type 2 diabetes mellitus are presented. It is indicated that the overall goal of the treatment of type 2 diabetes mellitus is to achieve and maintain glycemic control, as well as to reduce the risk of long-term complications, in particular chronic heart failure. The goal of chronic heart failure treatment is to improve the clinical condition and quality of life of patients, to reduce the frequency of hospitalizations and mortality. The appointment of some groups of hypoglycemic drugs has a neutral or negative effect on the course and prognosis of chronic heart failure, so their use is limited or not recommended in the treatment of patients with type 2 diabetes mellitus and chronic heart failure. The emphasis is on those classes of drugs that have demonstrated significant advantages in influencing the morbidity and mortality associated with chronic heart failure and type 2 diabetes mellitus in comparison with other drugs, namely, inhibitors of the sodium-dependent glucose cotransporter type 2 and angiotensin receptor inhibitors II and neprilisin (sacubitril / valsartan). Experts call such classes of drugs as sodium-dependent glucose cotransporter type 2, angiotensin receptor inhibitors II and neprilisin, mineralocorticoid receptor antagonists and beta-blockers as the "Fantastic Four", given the significant positive effect of their combined use on the course and prognosis of chronic heart failure. Modern approaches to the treatment of chronic heart failure in patients with type 2 diabetes mellitus are based on the updated guidelines of the European Society of Cardiology for the diagnosis and treatment of acute and chronic heart failure, as well as on the recommendations of the American Diabetes Association for the classification, prevention and treatment of heart failure in patients with diabetes. Conclusion. The most important achievements in recent years, which have significantly improved the treatment outcomes of patients with chronic heart failure and type 2 diabetes mellitus, include: the development of new classes of drugs; conducting large-scale randomized clinical trials that demonstrated the benefits of certain groups of drugs in terms of their impact on the development, course and prognosis of chronic heart failure in type 2 diabetes mellitus, and updated comprehensive and balanced therapy for these patients

Un-Break My Heart

Metabolic assessment of exercise in chronic heart failure patients treated with short-term vasodilators.

Commonality Between Depression and Heart Failure

Background Chronic heart failure is the main critical illness and cause of death in the later stages of cardiovascular disease, and it is one of the two major challenges in the field of cardiovascular research. The clinical application of traditional Chinese medicine in the prevention and treatment of chronic heart failure has been relatively common in China, and the “Expert Consensus on the Diagnosis and Treatment of Chronic Heart Failure with Integrated Traditional Chinese and Western Medicine” has been published in China. Combining the literature in this field, the authors found that Zhigancao Decoction has been used in the treatment of chronic heart failure with more clinical research reports and higher frequency (this article refers to it as a high-frequency prescription for short). However, Zhigancao Decoction was not included in the recommended prescriptions in the “Expert Consensus on the Diagnosis and Treatment of Chronic Heart Failure with Integrated Traditional Chinese and Western Medicine,” and there was no relevant systematic review and meta-analysis. For this reason, this article has carried out two parts of work, including systematically organizing the literature in this research field and carrying out systematic review and meta-analysis. This can provide stronger evidence support for Zhigancao Decoction combined with conventional Western medicine in the treatment of chronic heart failure and provide a new option for the improvement and update of the “Expert Consensus on the Diagnosis and Treatment of Chronic Heart Failure with Integrated Traditional Chinese and Western Medicine.” Methods This article used the bibliometric method to investigate the research articles on the treatment of chronic heart failure with integrated traditional Chinese and Western medicine and analyzed the high-frequency prescriptions which are used and reported frequently. In addition, we also used manual and computer-aided search methods, the search scope includes CNKI, WANFANG, VIP, SinoMed, Web of Science, PubMed, and Cochrane Library, and the search content is the clinical randomized control of Zhigancao Decoction combined with conventional Western medicine in the treatment of chronic heart failure trials (RCTs). The search period is from the establishment of the database to January 29, 2021. The literature was managed and screened by EndNote software; the quality of the included literature was evaluated according to the modified Jadad scale, and the risk bias was assessed using the Cochrane tool; the results of the included studies were analyzed using the Review Manager 5.3 software; the sources of heterogeneity between the studies were analyzed using Stata16.0 software for sensitivity analysis. Results According to the bibliometric analysis, the maximum number of research reports is 553, which are arranged in descending order of 21 prescriptions, including Zhenwu Decoction, Zhigancao, and powder of five drugs containing poria. The second most frequently used prescription is Zhigancao Decoction combined with conventional Western medicine in the treatment of chronic heart failure, but its systematic review and meta-analysis still need further research. A total of 17 clinical randomized controlled trials of Zhigancao Decoction combined with conventional Western medicine in the treatment of chronic heart failure were included in the search, with a total of 1752 subjects. Meta-analysis results show that Zhigancao combined with conventional Western medicine is more effective than conventional Western medicine in the treatment of chronic heart failure. The advantages are the following 5 outcome indicators: total clinical effective rate, left ventricular ejection fraction, left ventricular end-diastolic diameter, B-type natriuretic peptide, and 6-minute walk test. Conclusions There are many prescriptions combined with Western medicine to treat chronic heart failure, among which Zhigancao Decoction is the second most frequently used prescription. There are many original studies on Zhigancao Decoction combined with conventional Western medicine in the treatment of chronic heart failure. The quality of the evaluation research shows that the overall standard is scientific, and a few experimental designs are slightly irregular. Meta-analysis shows that Zhigancao Decoction combined with conventional Western medicine has better therapeutic effects and safety than conventional Western medicine. This shows the characteristics and advantages of integrated Chinese and Western medicine in the treatment of cardiovascular diseases and is worth recommending.

Background:Coronary heart disease (CHD) is an important cause of chronic heart failure, and chronic heart failure is also a serious complication in the end stage of coronary heart disease. At present, there is no specific treatment plan. Shenfu injection has advantages in the treatment of heart failure in patients with coronary heart disease, but there is a lack of standard clinical study to verify this. Therefore, the purpose of this randomized controlled trial is to evaluate the efficacy and safety of Shenfu injection combined with furosemide in the treatment of chronic heart failure in patients with coronary heart disease.Methods:This is a prospective randomized controlled trial to study the efficacy and safety of Shenfu injection combined with furosemide in the treatment of coronary heart disease and chronic heart failure. This study will be approved by the clinical research ethics committee of our hospital. The patients will be randomly divided into two groups according to 1:1:(a) Shenfu injection combined with furosemide group and (b) simple furosemide group. Standard treatment for 7 days followed up for 30 days at the same time, pay attention to its efficacy and safety indicators. The total effective rate of cardiac function improvement, left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-pro BNP), 6-minute walk test (6-MWTD), and adverse reactions will be observed. Data will be analyzed using the statistical software package SPSS version 25.0 (Chicago, IL).Discussion:This study will evaluate the efficacy and safety of Shenfu injection combined with furosemide in the treatment of coronary heart disease with chronic heart failure. The results of this experiment will provide a clinical basis for Shenfu injection combined with furosemide in the treatment of coronary heart disease and chronic heart failure.OSF Registration number:doi: 10.17605/OSF.IO/27FPM

The development of new methods for the prevention and treatment of chronic heart failure and its control is an urgent medical and social problem. In this regard, using of new biological markers of the disease may be useful for early diagnosis of the disease, predict a clinical course, monitor the effects of pharmacotherapy (personalized medicine) and play an important role in stratifying the patient's risk. In 2013, according to the recommendation of the American Heart Association, a galectin-3 was introduced into the pool of such biomarkers for prevention and treatment of chronic heart failure. Objective: to improve prediction of the course and effectiveness of the therapy for hypertension and chronic heart failure as the hypertension complication in men 40-60 years old by applying the level of galectin-3 as a biomarker. There were observed the men 40-60 years old with hypertension and chronic heart failure for the concentration of galectin-3. Also, there were observed subjects without cardiovascular pathology (n=79), the men with hypertonic disease with myocardial hypertension (n=62) and the men with chronic heart failure II-III functional class of NYHA (n=50) for the indicators of central and systemic hemodynamics. The level of galectin-3 was determined by immunoassay analysis on the equipment "Stat Fact 300". Structural and functional parameters of myocardium were assessed by an ultrasound method using the equipment "RADMIR ULTIMARA". Data statistical analysis was performed on a personal computer using standard statistical package "Statistica 10.0". All data is presented in the form of average (M) and standard deviation (± σ). It has been established that the concentration of galectin-3 significantly decreases against the background of treatment. The level of galectin-3 in the patients with the II stage of hypertonic disease with good treatment effect was close to normal values compared to those with moderate treatment effect. In terms of patients with hypertension III stage, the level of galectin-3 also decreased, indicating the possibility of therapy monitoring using this biomarker. The mathematical model of the galectin-3 influencing factors also has been determined in patients with hypertension. The boundary level of the galectin-3 has been calculated, it is counted 46.51 pg/ml. It might be assumed a moderate effect of the treatment of hypertensive patients and chronic heart failure in males.

chronic heart failure (CHF) is a complex and prevalent disease affecting 2% of adults in developed countries. This number increases to 6–10% in adults over the age of 65 ([3][1], [8][2]), and on diagnosis, half of all CHF patients die within 4 years ([11][3]). In addition to the significant

Background:Coronary heart disease is a serious cardiovascular disease. There is coronary atherosclerosis, resulting in lumen stenosis, blockage, and then the symptoms of insufficient blood supply and hypoxia in the myocardium. Chronic heart failure is a kind of syndrome with abnormal ventricular filling and ejection function, which is the final stage of the development of coronary heart disease. At present, the treatment plan of Western medicine can significantly reduce the hospitalization rate, but it is still not satisfactory for the prognosis and mortality of patients. Shenfu injection has advantages in the treatment of heart failure in patients with coronary heart disease, but there is a lack of standard clinical studies to verify it, so the purpose of this randomized controlled study is to evaluate the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease.Methods:This is a prospective randomized controlled trial to study the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease. The patients will be randomly divided into a treatment group and the control group according to 1:1, in which the treatment group is treated with Shenfu injection combined with sodium nitroprusside, and the control group is treated with sodium nitroprusside alone. Both groups will be treated with standard treatment for 7 days and followed up for 30 days to pay attention to their efficacy and safety indexes. The observation indexes include TCM syndrome score, N-terminal pro-brain natriuretic peptide, left ventricular ejection fraction, brain natriuretic peptide, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, stroke volume, adverse reactions and so on. We will use SPSS 25.0 software for data analysis.Discussion:This study will evaluate the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease. The results of this experiment will provide a clinical basis for Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in coronary heart disease.Trial registration:DOI 10.17605/OSF.IO/4KNG3

Cardiac resynchronization therapy (CRT): Clinical trials, guidelines, and target populations

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

More than 4000 patients have been evaluated in randomized controlled trials of cardiac resynchronization therapy (CRT). These studies have demonstrated that CRT with or without an implantable cardioverter-defibrillator (ICD) consistently improves quality of life, functional status, exercise capacity, and cardiac structure and function and reduces morbidity and mortality in heart failure patients with ventricular dyssynchrony. The magnitude of benefit seen with CRT is comparable to or exceeds that seen with evidence-based drug therapies for heart failure but occurs in patients who are already receiving such medications. Thus, CRT has been added to the list of evidence-based therapies that make heart failure patients feel better and live longer (the Table). Consequently, a strong ethical mandate exists for the use of CRT in heart failure. This mandate is reflected in our current practice guidelines for the management of chronic heart failure, which state that all eligible patients should receive CRT unless contraindicated.1,2 End of debate! CRT should be a routine part of any evidence-based treatment regimen for heart failure. View this table: Major Benefits of Evidence-Based Heart Failure Therapies Of course, things are never quite so simple, so let us take a look at the evidence supporting this clinical mandate for CRT and address patient selection, some of the limitations of CRT, and some of the unanswered questions about the use of CRT in heart failure. None of this discussion will lessen the role of CRT in the treatment of heart failure; rather, it will guide the selection of appropriate patients and speculate on the future application of CRT to an even broader group of heart failure patients. Response by Greenberg and Mehra p 2698 Approximately one third of patients with systolic heart failure exhibit ventricular dyssynchrony, defined as a QRS duration >120 ms on the surface ECG.3,4 Ventricular dyssynchrony produces suboptimal ventricular …

Temporal trends in the outcomes of acute heart failure: between consolatory evidences and real progress.

Chronic heart failure is one of the most common cardiovascular diseases in clinical practice, with high morbidity and poor prognosis. However, the cure rate of modern medicine has limitations, so exploring the prevention and treatment of heart failure with traditional Chinese medicine has become a contemporary hotspot. Since ancient times, Chinese medicine has had the treatment concept of "seeking the root of the disease", which has guiding significance for the treatment of heart failure. Many studies have found that the level of BNP is related to the TCM syndrome of heart failure. This article attempts to explore the possible micro-connection between the theory of seeking the basics of treatment and BNP in the treatment of chronic heart failure from the perspective of microscopic syndrome differentiation of traditional Chinese medicine. Distinctive advantages in the treatment of chronic heart failure.

Heart failure is a tremendous health problem with significant morbidity and mortality. The treatment of heart failure should be applied appropriately to improve the successful management of patients. This study aims to evaluate the adherence to European Society of Cardiology (ESC) guidelines for the treatment of chronic heart failure and to determine factors associated with guideline adherence. This study is an observational study comprising 97 patients with chronic heart failure with reduced ejection fraction. The guideline adherence was assessed the by the use of guideline adherence indicator (GAI), which consider GAI-3 or GAI-5, by calculating the proportion of recommended drugs was prescribed divided by a number of drugs indicated according to the ESC guidelines, in the absence of contraindications. The results showed the use of each indicated drugs were angiotensin- converting enzyme inhibitors or angiotensin receptor blockers (78.4%), beta-blockers (61.9%), mineralocorticoid receptor antagonists (61.9%), diuretics (89.7%), and digitalis (26.8%). Furthermore, the predominant categories of GAI-3 and GAI-5 were moderate. This study demonstrates that the adherence to ESC guidelines for the treatment of chronic heart failure still needs to be improved compared to recent studies. Also, age, etiology of heart failure and comorbidity were associated factors that influence the implementation of ESC guidelines.