Anti-heart Failure Drugs Research Articles

Diagnosis and management of cancer therapy-related myocarditis in a young female: A case report and review of literature

BackgroundThe treatment of choice for Extra-osseous Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET), a rare neoplasm, is the VAC/IE regimen. This regimen includes Doxorubicin, Vincristine, Cyclophosphamide, Ifosfamide, and Etoposide, all of which have cardiotoxic effects. Myocarditis, a potentially threatening side effect following cancer therapy, can be accurately managed and diagnosed.Case PresentationIn the current study, we report the case of a 19-year-old female with a mass on the abdominal wall, diagnosed with ES/PNET. She was treated with the VAC/IE regimen. A month after the last session of chemotherapy, she experienced dyspnea. Upon evaluation, a high level of troponin and a low left ventricular ejection fraction (LVEF) were detected via transthoracic echocardiography. She was treated with anti-heart failure drugs, but the response was unsatisfactory. The possibility of Cancer therapy-related myocarditis was suspected, and cardiac magnetic resonance imaging (CMR) confirmed acute myocarditis. This patient exhibited a significant response to intravenous immunoglobulin (IVIG), with her LVEF improving from 30–35% to 50% within three months.ConclusionIn this case, based on negative tests and the absence of viral signs and symptoms, Cancer therapy-related myocarditis is highly suspected as the cause of myocarditis. This case underscores the importance of accurately utilizing CMR as a non-invasive method for diagnosing myocarditis. It effectively highlights the identification of reversible myocarditis with appropriate treatment and the notable response to IVIG, suggesting its potential as a favorable treatment for myocarditis in younger patients.

Efficacy and Safety of Kuoxin Formula in the Treatment of Dilated Cardiomyopathy-Related Heart Failure: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled, Multi-Center Clinical Trial.

Dilated cardiomyopathy (DCM) is a severe heterogeneous cardiomyopathy characterized by cardiac enlargement and declining heart function, often leading to refractory heart failure and life-threatening outcomes, particularly prevalent in China. The challenge lies in the scarcity of targeted therapies with substantial efficacy for DCM. Additionally, traditional anti-heart failure drugs are constrained due to hypotension propensity or limited symptom improvement. Kuoxin Formula (KXF), internally endorsed at Longhua Hospital, demonstrates clear biological evidence for enhancing cardiac function and myocardial remodeling. Previous clinical studies suggest its potential to enhance patients' quality of life. This trial aims to further evaluate KXF's safety and efficacy in managing DCM-related heart failure. This prospective, randomized, double-blind, placebo-controlled, multicenter trial aims to recruit 230 DCM patients from five centers. Participants will be randomly assigned to either KXF or placebo for 12 weeks, with careful monitoring of key indicators and adverse events. The primary outcome measures the proportion of patients with NT-proBNP reduction exceeding 30%. Secondary outcomes include New York Heart Association functional classification, Traditional Chinese Medicine syndrome scores, 6-minute walk test, Lee's heart failure score, and Minnesota Heart Failure Quality of Life Scale score. Ventricular remodeling will be assessed using cardiac ultrasound and ELISA. Safety metrics and adverse events will be meticulously recorded. This study will be the first multicentered research conducted in China that utilizes a randomized, double-blind, placebo-controlled design to investigate the use of TCM in the treatment of DCM. It seeks to develop new theoretical frameworks and provide solid clinical data to support the integration of TCM and modern medicine in treating heart failure in DCM patients. China Clinical Trial Registry, ChiCTR2300068937. Registered on March 1, 2023. https://www.chictr.org.cn/bin/project/edit?pid=190926.

Clinical Efficacy of Tapazole Integrated with Anti Heart Failure Drugs in the Remedy of Hyperthyroidism Merged with Heart Failure

Clinical Efficacy of Tapazole Integrated with Anti Heart Failure Drugs in the Remedy of Hyperthyroidism Merged with Heart Failure

Analysis of Application Effect of Conventional Drugs Combined with Aerobic Exercise in the Treatment of Patients with Heart Failure

To retrospectively analyze the efficacy of polypharmacy conventional drugs and aerobic exercise diagnosed in the treatment of chronic heart failure is the objective of the study. From January 2021 to June 2022, 106 patients with chronic heart failure were hospitalized in cardiovascular department of Zhejiang hospital. The control group was taken conventional anti-heart failure drug treatment. On the basis of the control group, the research group implemented 12 w of scientific aerobic exercise and monitored the patient’s exercise status and treatment effect on the mobile phone exercise applications. After receiving medication and 12 w of aerobic exercise training, left ventricular systolic dysfunction and left ventricular diastolic dysfunction in the study were lower than those in the control group and the left ventricular ejection fraction increased significantly compared to the study group and differences between the two groups was statistically significant (p<0.05). The red blood cell distribution width and the opposite association were seen in the subjects studied using New York heart association grade and left ventricular ejection fraction in cardiac function was determined. Manifestations of red blood cells were negatively associated with the maximal oxygen consumption in exercise capacity. Maximum power and time of exhaustion were negatively correlated. The two different groups have marked differences in the left ventricular ejection fraction and New York heart association classification, improvement of maximal oxygen consumption and time of exhaustion (p<0.05). Failure in the application of anti-heart failure drug therapy combined with moderate aerobic exercise application in long-term heart failure patients can effectively reduce the red blood cell distribution width and improve the patient’s health. Cardiac function and exercise capacity, and aerobic exercise can effectively reduce the degree of myocardial damage, improve exercise tolerance, and promote medical recovery of heart failure patients.

Inappropriate Activation of TLR4/NF-κB is a Cause of Heart Failure

Significance: Heart failure, a disease with extremely high incidence, is closely associated with inflammation and oxidative stress. The Toll-like receptor 4 (TLR4)/nuclear factor kappa-B (NF-κB) pathway plays an important role in the occurrence and development of heart failure. Recent advances: Previous studies have shown that TLR4/NF-κB causes heart failure by inducing oxidative stress and inflammation; damaging the endothelia; promoting fibrosis; and inducing myocardial hypertrophy, apoptosis, pyroptosis, and autophagy. Critical issues: Understanding the pathogenesis of heart failure is essential for the treatment of this disease. In this review, we outline the mechanisms underlying TLR4/NF-κB pathway-mediated heart failure and discuss drugs that alleviate heart failure by regulating the TLR4/NF-κB pathway. Future directions: During TLR4/NF-κB overactivation, interventions targeting specific receptor antagonists may effectively alleviate heart failure, thus providing a basis for the development of new anti-heart failure drugs.

Drug-nutrient cocrystallization-driven strategy towards self-assembly of milrinone and ferulic acid provides an exemplification in perfecting in vitro/vivo characteristics of anti-heart failure drugs

The in vitro/vivo properties of the anti-heart failure drug milrinone were optimized by cocrystallizing with a nutraceutical, ferulic acid.

Re-Norwood operation using femoral artery cannulation

Re-Norwood operation is technically difficult to perform and is a high risk procedure due to the underlying hypocardiac function. Herein, we describe our successful re-Norwood operation approach in a 6-month old infant with persistent severe cyanosis and aortic re-coarctation. Our procedure was performed using femoral artery cannulation to protect cerebrospinal and lower body perfusion. Safe reopening of the chest was achieved, despite strong adhesions due to prior surgeries. Our repair and anastomosis techniques are described in detail. Cardiac circulation and function improved post-surgery. The patient was maintained on anti-heart failure drug therapy after surgery while awaiting a Glenn procedure.

Effect of Danqi Buxin Decoction on Chronic Function Indexes and Life Quality in Patients with Chronic Heart Failure of Yang Deficiency Type.

Objective The purpose was to explore the clinical effect of Danqi Buxin decoction on chronic heart failure (CHF) with yang deficiency and its effect on cardiac function and life quality of patients. Methods 106 CHF patients with yang deficiency treated in Jinan Municipal Hospital of Traditional Chinese Medicine from February 2019 to February 2020 were selected as the research objects and divided into the treatment group and reference group according to the odd and even admission numbers, with 53 cases in each group. The reference group was treated with routine antiheart failure drugs, while the treatment group was additionally treated with Danqi Buxin decoction to compare the clinical effect and cardiac function changes between the two groups. Results The clinical effective rate in the treatment group was significantly higher than that in the reference group (P < 0.05). The TCM symptom scores at T1, T2, and T3 in the treatment group were significantly higher than those in the reference group (P < 0.05). After treatment, the LVEDV levels in both groups were significantly higher than those before treatment, while the BNP levels were significantly lower than those before treatment (P < 0.001). The LVEDV level in the treatment group after treatment was higher than that in the reference group, while the BNP level in the treatment group was significantly lower than that in the reference group (P < 0.001). The life quality scores in the treatment group after treatment were significantly higher than those in the reference group (P < 0.05). Conclusion Danqi Buxin decoction on the basis of conventional drugs can significantly improve the cardiac function and life quality of CHF patients with yang deficiency type. Its further research is helpful to establish a good treatment plan for CHF patients.

Covid-19 and development of heart failure: mystery and truth.

Coronavirus disease 2019 (Covid-19) is a novel worldwide pandemic caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During Covid-19 pandemic, socioeconomic deprivation, social isolation, and reduced physical activities may induce heart failure (HF), destabilization, and cause more complications. HF appears as a potential hazard due to SARS-CoV-2 infection, chiefly in elderly patients with underlying comorbidities. In reality, the expression of cardiac ACE2 is implicated as a target point for SARS-CoV-2-induced acute cardiac injury. In SARS-CoV-2 infection, like other febrile illnesses, high blood viscosity, exaggerated pro-inflammatory response, multisystem inflammatory syndrome, and endothelial dysfunction-induced coagulation disorders may increase risk of HF development. Hypoxic respiratory failure, as in pulmonary edema, severe acute lung injury (ALI), and acute respiratory distress syndrome (ARDS) may affect heart hemodynamic stability due to the development of pulmonary hypertension. Indeed, Covid-19-induced HF could be through the development of cytokine storm, characterized by high proliferation pro-inflammatory cytokines. In cytokine storm-mediated cardiac dysfunction, there is a positive correlation between levels of pro-inflammatory cytokine and myocarditis-induced acute cardiac injury biomarkers. Therefore, Covid-19-induced HF is more complex and related from a molecular background in releasing pro-inflammatory cytokines to the neuro-metabolic derangements that together affect cardiomyocyte functions and development of HF. Anti-heart failure medications, mainly digoxin and carvedilol, have potent anti-SARS-CoV-2 and anti-inflammatory properties that may mitigate Covid-19 severity and development of HF. In conclusion, SARS-CoV-2 infection may lead to the development of HF due to direct acute cardiac injury or through the development of cytokine storms, which depress cardiomyocyte function and cardiac contractility. Anti-heart failure drugs, mainly digoxin and carvedilol, may attenuate severity of HF by reducing the infectivity of SARS-CoV-2 and prevent the development of cytokine storms in severely affected Covid-19 patients.

Enalapril overcomes chemoresistance and potentiates antitumor efficacy of 5-FU in colorectal cancer by suppressing proliferation, angiogenesis, and NF-\u03baB/STAT3-regulated proteins

5-Fluorouracil (5-FU) is one of the most effective drugs for the treatment of colorectal cancer (CRC). However, there is an urgent need in reducing its systemic side effects and chemoresistance to make 5-FU-based chemotherapy more effective and less toxic in the treatment of CRC. Here, enalapril, a clinically widely used antihypertensive and anti-heart failure drug, has been verified as a chemosensitizer that extremely improves the sensitivity of CRC cells to 5-FU. Enalapril greatly augmented the cytotoxicity of 5-FU on the cell growth in both established and primary CRC cells. The combination of enalapril and 5-FU synergistically suppressed the cell migration and invasion in both 5-FU-sensitive and -resistant CRC cells in vitro, and inhibited angiogenesis, tumor growth, and metastasis of 5-FU-resistant CRC cells in vivo without increased systemic toxicity at concentrations that were ineffective as individual agents. Furthermore, combined treatment cooperatively inhibited NF-κB/STAT3 signaling pathway and subsequently reduced the expression levels of NF-κB/STAT3-regulated proteins (c-Myc, Cyclin D1, MMP-9, MMP-2, VEGF, Bcl-2, and XIAP) in vitro and in vivo. This study provides the first evidence that enalapril greatly sensitized CRC cells to 5-FU at clinically achievable concentrations without additional toxicity and the synergistic effect may be mainly by cooperatively suppressing proliferation, angiogenesis, and NF-κB/STAT3-regulated proteins.

Treatment of Dilated Cardiomyopathy with Qilan Qiangxin Capsule Combined with Sakubatra and Valsartan: A Case Report

A case of dilated cardiomyopathy was reported, including the course of onset and long-term application of Qilan Qiangxin Capsule combined with a new anti-heart failure drug, Sakubatril Valsartan, in order to improve the symptoms of heart failure, increase the LVEF (left ventricular ejection fraction), and reduce the plasma NT-proBNP (N-terminal B-type natriuretic peptide) level. The effect of improving ventricular remodeling is obvious, and the quality of life of patients is improved

SGLT2 Inhibitors Play a Salutary Role in Heart Failure via Modulation of the Mitochondrial Function

Three cardiovascular outcome trials of sodium glucose cotransporter 2 (SGLT2) inhibitors, including the EMPA-REG OUTCOME trial, CANVAS Program, and DECLARE TIMI 58 trial, revealed that SGLT2 inhibitors were superior to a matching placebo in reducing cardiovascular events, including mortality and hospitalization for heart failure, in patients with type 2 diabetes. However, the detailed mechanism underlying the beneficial effects that SGLT2 inhibitors exert on cardiovascular diseases remains to be elucidated. We herein review the latest findings of the salutary mechanisms of SGLT2 inhibitors in cardiomyocytes, especially focusing on their mitochondrial function-mediated beneficial effects. The administration of SGLT2 inhibitors leads to the elevation of plasma levels of ketone bodies, which are an efficient energy source in the failing heart, by promoting oxidation of the mitochondrial coenzyme Q couple and enhancing the free energy of cytosolic ATP hydrolysis. SGLT2 inhibitors also promote sodium metabolism-mediated cardioprotective effects. These compounds could reduce the intracellular sodium overload to improve mitochondrial energetics and oxidative defense in the heart through binding with NHE and/or SMIT1. Furthermore, SGLT2 inhibitors could modulate mitochondrial dynamics by regulating the fusion and fission of mitochondria. Together with ongoing large-scale clinical trials to evaluate the efficacy of SGLT2 inhibitors in patients with heart failure, intensive investigations regarding the mechanism through which SGLT2 inhibitors promote the restoration in cases of heart failure would lead to the establishment of these drugs as potent anti-heart failure drugs.

Adjusting Antithrombotic Therapy after Stent Implantation for Acute Myocardial Infarction in a Patient with Very Low Platelet

A 76-year-old woman presented with non-ST-elevation myocardial infarction. Platelet count was 10×109/L. Bone marrow cytology and platelet antibody testing 9 months earlier suggested refractory immune thrombocytopenia (unresponsive to glucocorticoid and γ-globulin). The patient stabilized after treatments that included clopidogrel, statin, nitrate, and conventional anti-heart failure drugs, but heart failure persisted. Nine days later, angiography revealed 90% occlusion in the left anterior descending artery, and the patient received a zotarolimus-eluting stent. Upon discharge from the hospital, the patient started to receive clopidogrel, statin, β-blocker, and spironolactone. The patient remained free from the symptoms and reported no signs of bleeding for the next 8 months until she was readmitted for pneumonia and heart failure. Platelet count at this time was 2×109/L. Clopidogrel was discontinued. Ginkgo leaf tablets (an herbal medication with reported activity against platelet aggregation) were initiated. Subsequent follow-up visits were unremarkable, until 16 months after percutaneous coronary intervention, when platelet count decreased to 1×109/L. Ginkgo leaf tablet was discontinued. In summary, the evidence supporting the efficacy of clopidogrel at shorter than the recommended 12 months is anecdotal, but the need to adjustment dual antiplatelet therapy in patients with very low platelet count is solid.

Prevention and Treatment of Cancer Therapeutics-related Cardiac Dysfunction

Cancer therapeutics-related cardiac dysfunction(CTRCD)is receiving more attention.Risk factors assessment before cancer therapy,cardiac function monitoring during and after cancer therapy,and early detection and treatment of myocardial injury are key to preventing clinical heart failure.The incidence and severity of cardiotoxicity can be reduced by measures such as reducing drug dose,adjusting administration route,and using low toxic drugs.Cardioprotective agents including anti-heart failure drugs and dexrazoxane are important for the prevention and treatment of CTRCD.Patients with advanced heart failure may also benefit from mechanical treatments including cardiac resynchronization therapy and mechanically-assisted ventricular devices.This article reviews the recent advances in the prevention and treatment of CTRCD.

AT1 receptor blocker azilsartan medoxomil normalizes plasma miR-146a and miR-342-3p in a murine heart failure model

Our study measured circulating microRNA (miRNA) levels in the plasma of calsequestrin (CSQ)-tg mouse, a severe heart failure model, and evaluated whether treatment with angiotensin II type 1 receptor blocker, azilsartan medoxomil (AZL-M) influenced their levels using miRNA array analysis. MiR-146a, miR-149, miR-150, and miR-342-3p were reproducibly reduced in the plasma of CSQ-tg mice. Among them, miR-146a and miR-342-3p were significantly restored by AZL-M, which were associated with improvement of survival rate and reduction of congestion. These results suggest that miRNA, especially miR-146a and miR-342-3p, could be used as potential biomarkers for evaluating the efficacy of anti-heart failure drugs.

Chylous Ascites as a Rare Manifestation of Congestive Cardiac Failure in a District Hospital

Chylous ascites is an uncommon type of ascites which may be associated with liver diseases, tuberculosis or malignancy. However, in a minority of cases, it is due to heart failure. This case report describes a 59 year old Malay gentleman who presented with multiple episodes of abdominal distension for the past six months associated with exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea and bilateral leg swelling. He denied having any fever, night sweats, anorexia or loss of weight. He did not exhibit any altered bowel habit or vomiting. Physical examination revealed a non tender, distended abdomen with an everted umbilicus. His legs were swollen bilaterally till the knees. Jugular venous pulsations were raised. Lungs revealed bibasal crepitations. Abdominal paracentesis showed milky turbid appearing peritoneal fluid. Laboratory studies revealed an exudative chylous ascites. Tuberculous workout, serum tumor markers and viral hepatitis screening were negative. His transthoracic echocardiogram revealed global hypokinesia with a left ventricular ejection fraction of 30%. Contrast Enhanced Computed Tomography scan of the thorax, abdomen and pelvis showed features consistent of liver cirrhosis with portal hypertension most probably attributable to the severe heart failure. There was no evidence to suggest malignancy. He was started on anti-heart failure drugs in which his ascites showed significant improvement within three months. Congestive cardiac failure should be considered as one of the causes for chylous ascites.

Analysis of chronic heart failure of coronary heart disease and ventricular arrhythmia

Objective To analyze the treatment and pathogenetic condition of chronic heart failure of coronary heart disease(CHD)and ventricular arrhythmia(VA). Methods 100 patients with chronic heart failure were collected to observe the treatment of chronic heart failureand pathogenetic condition of VA. Results 44 cases occured VA and 56 cases without VA in 100 patients.NT-proBNP(3 110.00±522.00)pg/mL of VA group was significantly higher than that(2 200.00±486.00)pg/mL of non-VA group(t= 8.996,P<0.05).LVEF(0.25±0.08)of VA group was lower than that of non-VA group(0.41±0.98)(t=11.625, P<0.05).The occurrence(100.00%)of premature ventricular contraction(PVC)of≥70mm group in left ventricular internal diameter(LVID)was higher than that of 60-69mm group(60.87%),50-59mm group(37.04%),40-49mm group (15.38%) with statistically significant(χ2= 5.853,12.532,27.375,all P< 0.05).The amount(44.20± 12.90)mg of useβreceptor blockers of amiodarone group was significantly lower than that of non-amiodarone group(44.20±12.90)mg(t= 5.284,P< 0.05). Conclusion NT-proBNP of CHEF of CHD and VA patients will improve and amiodarone can reduce the amount of use anti-heart failure drug. Key words: Coronary disease; Heart failure,congestive; Arrhy thmia

Severe Maternal Morbidity and Near Miss Mortality - A Case Report of an Adolescent with a Thyroid Storm

A thyroid storm is a major life threatening disorder and is more complicated when it happens in an unsupported pregnant teenager where possible maternal and perinatal morbidity and mortality are additional concerns on account of medical and social issues. This patient who defaulted treatment for Graves ’ disease for 18 months presented with cardiovascular, central nervous system, gastrointestinal, renal and obstetric complications as a medical emergency to the Labour Ward of the Jos University Teaching Hospital (JUTH). She was in cardiac failure, had anaemia and assessed to have a thyroid storm with intrauterine foetal death. She received intensive care from a multidisciplinary team with anti-thyroid and anti-heart failure drugs, oxygen, blood transfusion, antibiotics, supportive therapy, and subsequently went into labour and had forceps delivery of a macerated foetus and very proactive management that led to the aversion of a potential maternal mortality.

GW24-e3539 The research about the levels of serum N-terminal pro-brain natriuretic peptide, growth differentiation factor 15and troponin T in preoperative and postoperative cardiac resynchronisation therapy

ObjectivesTo study the feasibility to observe and evaluate the curative effect about the heart failure patients with Cardiac Resynchronisation Therapy (CRT), using the concentration changes of serum N-terminal brain natriuretic...

Recovery and recurrence of left ventricular systolic dysfunction in patients with idiopathic dilated cardiomyopathy

Some patients with nonischemic left ventricular (LV) systolic failure recover to have normal LV systolic function. However, few studies on the rates of recovery and recurrence have been reported, and no definitive indicators that can predict the recurrence of LV dysfunction in recovered idiopathic dilated cardiomyopathy (IDCMP) patients have been determined. It was hypothesized that patients who recovered from nonischemic LV dysfunction have a substantial risk for recurrent heart failure. Forty-two patients (32 men) with IDCMP (mean [+/- SD] age 56.9+/-8.7 years) who recovered from systolic heart failure (LV ejection fraction [LVEF] of 26.5+/-6.9% at initial presentation) to a near-normal state (LVEF of 40% or greater, and a 10% increase or greater in absolute value) were monitored for recurrence of LV systolic dysfunction. Patients with significant coronary artery disease were excluded. Patients were monitored for 41.0+/-26.3 months after recovery (LVEF 53.4+/-7.6%) from LV dysfunction. LV systolic dysfunction reappeared (LVEF 27.5+/-8.1%) during the follow-up period in eight of 42 patients (19.0%). No significant difference between the groups with or without recurrent heart failure was observed in the baseline clinical and echocardiographic characteristics. However, more patients in the recurred IDCMP group than those in the group that maintained the recovery state had discontinued antiheart failure medication (62.5% versus 5.9%, P<0.05). LV dysfunction recurs in some patients with reversible IDCMP. The recurrence was significantly correlated with the discontinuation of antiheart failure drugs. The results suggest that continuous medical therapy may be mandatory in patients who recover from LV systolic dysfunction.