Symptoms Of Severe Congestive Heart Failure Research Articles

Severe heart failure (NYHA Class IV) is associated with increased left ventricular mass index and short mitral deceleration time in severe aortic valve stenosis.

In aortic valve stenosis (AS), congestive heart failure (CHF) is a well-established symptom that indicates the need for surgical aortic valve replacement (SAVR). However, it is difficult to judge whether CHF symptoms such as dyspnea are caused by severe AS or other conditions, especially in elderly persons with restricted mobility or other organ complications. It is important to identify objective and noninvasive parameters associated with severe CHF symptoms in severe AS. One hundred ninety-eight patients with severe AS without left ventricular (LV) dysfunction were retrospectively studied. CHF symptoms were classified by New York Heart Association (NYHA) functional class. Echo parameters were compared between NYHA I-III and NYHA IV. Patients with NYHA IV (n=40; 20%) were older (86±6 vs 82±8years; P=.001) and had a larger LV mass index (LVMI) (157±43 vs 114±34g/m2 , P<.001), a higher transmitral flow velocity ratio (E/A) (1.31±0.62 vs 0.93±0.42; P=.001), a shorter deceleration time (DT) (202±72 vs 286±98ms; P<.001), and a higher systolic pulmonary arterial pressure (SPAP) (44±13 vs 35±13mmHg; P<.001) than patients with NYHA I-III. On multivariable analysis, LVMI and DT were independently associated with NYHA IV. Receiver operating characteristic curve analysis identified LVMI≥142g/m2 and DT≤194ms as the cutoff values associated with NYHA IV in patients with severe AS. Left ventricular mass index and DT were independently associated with severe heart failure (NYHA IV). These echo parameters could be helpful to judge whether CHF symptoms are caused by severe AS.

Role of brain serotonin dysfunction in the pathophysiology of congestive heart failure

Inherited or non-inherited dilated cardiomyopathy (DCM) patients develop varied disease phenotypes leading to death after developing congestive heart failure (HF) or sudden death with mild or no overt HF symptoms, suggesting that environmental and/or genetic factors may modify the disease phenotype of DCM. In this study, we sought to explore unknown genetic factors affecting the disease phenotype of monogenic inherited human DCM. Knock-in mice bearing a sarcomeric protein mutation that causes DCM were created on different genetic backgrounds; BALB/c and C57Bl/6. DCM mice on the BALB/c background showed cardiac enlargement and systolic dysfunction and developed congestive HF before died. In contrast, DCM mice on the C57Bl/6 background developed no overt HF symptoms and died suddenly, although they showed considerable cardiac enlargement and systolic dysfunction. BALB/c mice have brain serotonin dysfunction due to a single nucleotide polymorphism (SNP) in tryptophan hydroxylase 2 (TPH2). Brain serotonin dysfunction plays a critical role in depression and anxiety and BALB/c mice exhibit depression- and anxiety-related behaviors. Since depression is common and associated with poor prognosis in HF patients, we examined therapeutic effects of anti-depression drug paroxetine and anti-anxiety drug buspirone that could improve the brain serotonin function in mice. Both drugs reduced cardiac enlargement and improved systolic dysfunction and symptoms of severe congestive HF in DCM mice on the BALB/c background. These results strongly suggest that genetic backgrounds involving brain serotonin dysfunction, such as TPH2 gene SNP, may play an important role in the development of congestive HF in DCM.

Detection of early systolic dysfunction with strain rate imaging in a patient with light chain cardiomyopathy

Congestive heart failure (CHF) in cardiac amyloidosis has been attributed to the development of diastolic dysfunction, because severe CHF symptoms have been observed despite a normal or only mildly reduced LV ejection fraction (EF). An early impairment of longitudinal systolic function has been described by means of tissue Doppler-derived myocardial deformation imaging ('strain rate imaging', SRI). Our patient presented with signs of CHF and significantly increased brain-natriuretic peptide (BNP) levels. Conventional measures of systolic contractile function were within the normal range and mitral inflow Doppler showed only moderate diastolic dysfunction. Histopathological examination by endomyocardial biopsy revealed interstitial deposition of amyloid fibers. Quantitative assessment of myocardial velocities (TDI) and deformation properties (Strain) from the apical view demonstrated a significant impairement of systolic longitudinal myocardial function. In patients with isolated diastolic dysfunction detected by conventional Doppler echocardiography, the quantitative assessment of myocardial strain and strain rate can be helpful in the early detection of systolic dysfunction.

Thiamine blood levels and high doses of diuretics in patients with moderate to severe congestive heart failure symptoms

Background: The no pharmacological management of congestive heart failure (CHF) has been understudied. Thiamine deficiency causes high-output CHF and restoration of its body stores is associated with complete reversal. Therefore we assessed thiamine blood levels (pmol/ml) and its association with the use of high-doses of furosemide. Methods: In a cohort of 22 patients (pts) with moderate to severe CHF (NYHA III/IV) using the erythrocyte transketolase activity thiamine levels were determined. The pts were then divided according to daily furosemide doses (group I<120 mg and group II≥120 mg).

The effects of spironolactone on thiamine blood levels in patients with congestive heart failure on chronic high doses of loop-diuretics

Background: The nonpharmacological management of congestive heart failure (CHF) has been understudied. The importance of micronutrients such as vitamin B1 (thiamine) has long been known since its deficiency is associated with the development of high-output CHF. In the present study, we studied the relationship between adding to ACE inhibition further aldosterone suppression with spironolactone and thiamine blood levels (pmol/ml). Methods: A total of 22 patients (pts) with moderate to severe CHF symptoms (NYHA II/IV) were divided in two groups according to the use of spironolactone [group I-spironolactone 25 mg/qd (n 11) and group II no spironolactone (n 11)]. Thiamine blood levels were determined using the erythrocyte transketolase activity. The groups were compared regarding food intake, furosemide doses, demographics and thiamine blood levels (mean SD) using a student’s t test. Chi-square and Kruskal-Wallis tests were used to assess variables associated with thiamine levels. Results: Group I and II were similar regarding food intake, daily furosemide doses (110.9 30.2 and 105.5 26.9 mg, respectively; p 0.05), demographics (etiology of CHF, age, hypertension, diabetes, smoking, alcohol abuse, dyslipidemia and adjuvant drug CHF treatment). Patients in group I showed significantly higher thiamine blood levels when compared to patients in group II (277.2 89.8 and 154.7 35.7 pmol/ml, respectively) (p 0.001). None of the dependent variables cited above were associated with thiamine blood levels. Conclusion: In a cohort of ambulatory CHF patients (NYHAII/IV) on high doses of loop diuretics the use of spironolactone is associated with higher thiamine blood levels. The significance of this finding remains to be established by future studies with prospective design and larger sample sizes. Safety and Efficacy of Intermittent, Short-Term, Outpatient Nesiritide Infusions for the Treatment of Decompensated Heart Failure Ghaith M. Mulki, Carol Pisano, Gallagher Colleen, Cianci Pamela, Muhyaldeen Dia, Marc A. Silver1—Department of Medicine and the Heart Failure Institute, Advocate Christ Medical Center, Oak Lawn, IL

Left ventricular and biventricular pacing in congestive heart failure.

Dual-chamber pacing improved hemodynamics acutely in a subset of patients with left ventricular (LV) dysfunction but conveyed no long-term symptomatic benefit in most. More recently, LV pacing and biventricular (multisite) pacing have been used to improve systolic contractility by altering the electrical and mechanical ventricular activation sequence in patients with severe congestive heart failure (CHF) and intraventricular conduction delay or left bundle branch block (LBBB). Intraventricular conduction delay and LBBB cause dyssynchronous right ventricular and LV contraction and worsen LV dysfunction in cardiomyopathies. Both LV and biventricular cardiac pacing are thought to improve cardiac function in this situation by effecting a more coordinated and efficient ventricular contraction. Short-term hemodynamic studies have shown improvement in LV systolic function, which seems more pronounced with monoventricular LV pacing than with biventricular pacing. Recent clinical studies in limited numbers of patients suggest long-term clinical benefit of biventricular pacing in patients with severe CHF symptoms. Continuing and future studies will demonstrate whether and in which patients LV and biventricular pacing are permanently effective and equivalent and which pacing site within the LV produces the most beneficial hemodynamic results.

Congestive heart failure symptoms in patients with preserved left ventricular systolic function: Analysis of the CASS registry

The clinical characteristics and long-term survival of 284 patients from the Coronary Artery Surgery Study (CASS) registry data base who had moderate to severe congestive heart failure symptoms and a left ventricular ejection fraction ≥0.45 were studied. A control group consisting of registry patients with an ejection fraction ≥0.45 who did not have heart failure was used for comparison. Patients who had heart failure were older and more likely to be female and to have a higher incidence of hypertension, diabetes and chronic lung disease than registry patients who did not have heart failure. As a group, patients with heart failure had more severe angina and were more likely to have had a prior myocardial infarction than were registry patients without heart failure.At 6 year follow-up, 82% of patients in the heart failure group survived compared with 91% of patients in the control group (p < 0.0001). Multivariate analysis using the Cox proportional hazards model identified the following independent predictors of mortality: regional ventricular systolic dysfunction, number of diseased coronary arteries, advanced age, hypertension, lung disease, diabetes, increased left ventricular end-diastolic pressure and heart failure symptoms. Among patients with heart failure, the 6-year survival rate of those who had three-vessel coronary artery disease was 68% compared with 92% for the group without coronary artery disease. However, the 6-year survival rate for patients with heart failure who underwent surgical revascularization of diseased coronary arteries was not significantly improved compared with that of patients treated medically.It appears from these data that the presence of moderate to severe heart failure symptoms in patients with an ejection fraction ≥0.45 is a clinical marker for a distinct patient group characterized by increased age, more severe clinical coronary artery disease, hypertension and an increased incidence of additional medical illnesses that have independent value in predicting long-term survival. As a result of the high incidence of concurrent illnesses, this patient group has a significantly reduced 6-year survival rate compared with a CASS registry patient group that did not have heart failure, and the additional presence of coronary artery disease dramatically reduces their survival. However, surgical treatment of coronary artery disease is not associated with improved survival over a 6-year follow-up period in this CASS registry subgroup.